Public Health Department Masters Theses Collection

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Urban Air Pollution and Climate Stressors: Exploring Nitrogen Dioxide Patterns and Heat Wave Impacts in Holyoke, MA
(2025-02) Beltran Vargas, Nathalie
Climate change and air pollution are interconnected, with nitrogen dioxide (NO2) and heatwaves intensifying in urban environments, exacerbating public health risks and impacting urban agriculture. Therefore, we aimed to conduct a city-wide year-long measurement campaign to understand the spatiotemporal patterns and concentrations of NO2. Also, we aimed to assess the impact of heatwave exposure during early plant development on plant growth, phenology, flowering, fruit production, and the abundance of floral and non-floral visitors. We measured ambient NO₂ concentrations in Holyoke, MA, from August 2021 to 2022, using Ogawa passive samplers. We collected 260 weekly NO2 samples at 25 sites classified based on their land use characteristics. Sites included ‘fixed’ (yearlong, n = 5) and ‘rotating’ (weeklong, n = 20) locations. Results showed higher NO2 concentrations during winter (>150 µg/m³) compared to summer (<3.4 µg/m³), with commercial and highly dense sites experiencing the highest mean concentrations (17.09 µg/m³). Approximately 61% of rotating sites and 62% of weekly samples from fixed sites exceeded WHO air quality guidelines. A mixed-effects model revealed that weekly mean temperature, NDVI, and wind speed were the strongest predictors of NO₂. Additionally, we investigated the effects of heatwaves in urban environments using cherry tomato plants as a model system. Plants (n = 96) were exposed to heatwave (HW:37.7°C) and control (C: 28.8°C) conditions for 3 days during early development, then transplanted to pots and moved to 3 sites. We performed various surveys to assess plant growth, flowering, phenology, fruit production, and floral and non-floral visitors’ abundance. Heatwave exposure increased total flower counts yet did not influence initial growth rate or weekly plant height, but when the site with additional nutrient access was excluded, HW exposure significantly reduced plant height. HW-exposed plants produced more mature and immature fruits, attracted more non-floral visitors, and led to a delay in fruit ripening time. These findings highlight the dual challenges of air pollution and climate stressors in urban environments, emphasizing the need to understand their interactions to protect public health and support urban agriculture.
The Healthy Nordic Diet and Depression: A UMass Vitamin D Sub-Study
(2024-05) Scranton, Matthew R.
Major Depressive Disorder effects almost one fifth of adults in the United States and is the fourth leading cause of disability worldwide. Studies exploring the relationship between healthy diets and depression have shown that what we eat can help reduce our chances of experiencing depressive symptoms. Recent research has demonstrated the benefits of a Healthy Nordic Diet (HND) for many health conditions and many populations. Using food-frequency questionnaire data and the Inventory of Depression and Anxiety Symptoms (IDAS), this study explores the relationship between HND adherence and depressive symptoms in college-aged females enrolled in the UMass Vitamin D Study (2006 to 2014). After controlling for potential confounding in multivariable logistic and linear regression models, we did not find any statistically significant associations between depression and an HND. We believe that limitations due to misclassification prohibited the ability to reveal a true association. Future studies should look to strengthen measures of depression and HND in a larger, more diverse population.
Long Term Exposure to Fine Ambient Particulate Matter and Behavioral Problems in School-age Children in Accra, Ghana
(2024-05) Tejan-Jalloh, Umu-Kultumie
Accumulating evidence indicates early life exposure to air pollution exerts neurotoxic effects that may negatively impact children's behavioral health. Most previous studies on this topic were conducted in high-income countries, particularly in Europe. Limited studies have been done in low- and middle-income countries (LMICs), especially in sub-Saharan Africa where air pollution levels are among some of the highest. This study examined the relationship between long term ambient fine particulate matter (PM2.5) and behavioral problems in school children in Accra, Ghana. The study population comprised of 909 (60% girls) children aged 7-15 years from 90 elementary schools in the Greater Accra Metropolitan Area (GAMA), who participated in the Accra School Health and Environment Study (ASHES). Behavioral problems, including externalizing and internalizing behaviors, were assessed using the parent version of the Strengths and Difficulties Questionnaire (SDQ). Annual PM2.5 concentrations at schools and children's residences were estimated using a land-use regression model, and the average of both was used in the final analysis. We estimated covariate-adjusted associations between the average PM2.5 concentrations and behavioral problem scores using multivariable linear and logistics regression models. We also investigated potential effect modification by gender. PM2.5 concentration ranged 28.56 µg/m³ -39.46 µg/m³. After adjusting for confounders, there was a statistically significant positive association between PM2.5 and total SDQ score (beta per 10 µg/m³ increase = 2.7; 95% CI: 0.60, 4.7; p= 0.01) and internalizing behavior score (beta per 10 µg/m³ increase = 1.6; 95% CI: 0.50, 2.7; p= 0.004). Our results suggest no effect modification by gender. This study provides the first evidence of the effects of PM2.5 on children's behavioral problems in sub-Saharan Africa (SSA). Future ongoing studies will examine the longitudinal effect of PM2.5 on child behavioral health.
Re-Analysis of the DISC Study: Advanced Statistical Approaches to Understanding Dietary Interventions in Pediatric Cardiovascular Health
(2024-05) Saeedi, Anahita
The DISC study originally shed light on pediatric cardiovascular health's response to dietary interventions. Leveraging recent advances in statistical methods, we sought to enrich these insights by re-analyzing the data with more sophisticated techniques. Our study pursued three objectives: (1) re-assess the DISC data using linear and spline mixed-effects models, (2) investigate treatment effects within various participant subgroups, and (3) determine the impact of compliance on dietary outcomes, focusing on average percent calories from fats. We applied strong statistical tools to examine LDL-C levels and fat intake, considering adherence to treatment and subgroup differences. The intervention group exhibited a significant initial decrease in LDL-C with p-value (0.027) and sustained reductions in total and saturated fat intake over time with p-values.
The Association between the Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and the Risk of Male Breast Cancer
(2024-05) Aljizani, Firas
Background: Male breast cancer is a rare but serious condition with similarities to female breast cancer in hormone receptor status and histopathological features. Despite its rarity, male breast cancer often presents at a later stage and has a lower survival rate compared to female breast cancer. The potential chemo preventive role of non-steroidal anti-inflammatory drugs (NSAIDs) in female breast cancer raises the question of whether similar protective effects could be observed in male breast cancer. We explored the relationship between NSAID use and incidence of male breast cancer to shed light on whether NSAIDs could offer a similar protective effect in men as they do in women. Methods: This study included male participants from the NIH-AARP Diet and Health Study (N=187,827). NSAID use was assessed through self-reported questionnaires, with frequency categories for aspirin and non-aspirin NSAIDs. Incident breast cancer cases were ascertained from cancer registries and death certificates (N=228 over 15 years). Cox proportional hazard models were used to estimate relative risks and adjust for potential confounders including age, race, education, body mass index (BMI), physical activity, smoking status, and history of bone fracture, diabetes, and alcohol consumption. Results: The analysis revealed no significant association between NSAIDs use and the risk of male breast cancer in the overall population (HR=0.97, 95% CI 0.64-1.46). Similarly, stratification by family history of breast or prostate cancer and age groups did not show significant associations. The frequency of NSAID use, as well as aspirin and ibuprofen use specifically, also did not significantly impact the risk of male breast cancer. Discussion: Although our study did not find a significant association between NSAIDs use and male breast cancer risk, the observations indicated a slight inclination towards a reduced incidence of the disease with increased NSAID consumption. Notably, specific evaluations among participants with no familial history of breast or prostate cancer hinted at a possible reduced risk. Nonetheless, these findings were not statistically robust, underlining the need for additional research with greater statistical rigor to clarify if NSAIDs could play a role in the prevention of male breast cancer. This subtlety in our results, combined with the modest statistical power of the investigation, suggests caution in interpretation, emphasizing the necessity for further research to elucidate the potential chemo preventive effects of NSAIDs on male breast cancer.
Associations Between Birthweight and Preterm Birth and the Risk of Alzheimer's Disease in Women from the Women's Health Initiative
(2024-05) Nyhan, Emily A.
Alzheimer’s Disease is known as the most common type of dementia, currently affecting 5.8 million Americans. Dementia is an increasingly prevalent brain disease known for the loss of cognitive functioning and behavioral abilities that results in the inability to complete basic life tasks. The Developmental Origins of Adult Disease (DOAD) hypothesis states that exposures in utero and in early life can increase the risk of developing chronic disease decades later. The study aimed to investigate the potential associations between birthweight, preterm birth status, and the risk of Alzheimer’s disease in women from the Women’s Health Initiative (WHI). The WHI is a large prospective cohort study, made up of women from various demographic backgrounds. At baseline, women self-reported their birthweight and preterm birth category.
Sexual Orientation Differences in Experiences of Discrimination and Markers of Cardiometabolic Health Among Women
(2024-05) Hunt, Rebecca
Queer populations (including those who identify as lesbian, gay, or bisexual) experience more negative health outcomes than straight populations. This study aims to assess sexual orientation differences in experiences of discrimination and association with markers of cardiometabolic health. Data from the Pioneer Valley Stress Study pilot (2023-2024) were used (N=161 survey participants and N=38 participants who completed study visits). Discrimination was measured using the Everyday Discrimination Scale (including discrimination frequency, situation, and chronicity) and Daily Heterosexist Experiences Questionnaire (including occurrence and distress) while cardiometabolic indicators included cholesterol, waist circumference, waist-hip ratio, BMI, percent body fat, blood pressure, fasting blood glucose, triglycerides, BMI, and resting heart rate. Linear regression models were fit to assess the association between discrimination and cardiometabolic health. Significant differences in EDS situation and frequency scores between queer and heterosexual using clinically significant cut-points of cardiometabolic health markers study participants emerged. Overall, we did not find statistically significant differences in the association between discrimination and cardiometabolic health with the exception of fasting blood glucose. In crude models, higher EDS frequency and situation scores were associated with higher levels of fasting blood glucose (b=0.542, P=0.036, and b=2.06, P=0.003 respectively) among queer participants only. In adjusted models, this association persisted for EDS situation scores (b=2.279, P=0.003). Follow-up is needed to understand how discrimination may be associated with long-term cardiometabolic health.
The Associations Between Neighborhood Poverty and Crime and Adverse Birth Outcomes in Hispanic Women
(2024-05) Griffin, Brittany N.
Approximately one in nine babies born in the United States is premature and has low birthweight (LBW) with the second highest rates among Puerto Rican women (14.5%) (2). Disparities exist by socioeconomic status as well as by race and ethnicity. However, established risk factors only account for a portion of the disparities in adverse outcomes. Other factors that have not been studied as frequently include environmental, contextual, and neighborhood-level factors. These are of particular interest because of their potentially modifiable nature. We evaluated the association between neighborhood poverty, overall neighborhood crime, and violent neighborhood crime and adverse birth outcomes using data from Proyecto Buena Salud, a prospective cohort study of 1,610 Hispanic women conducted from 2006-10. Participant addresses were mapped and census block-level crime information from 2006-2010 using AGS CrimeRisk data to model the association between neighborhood crime and preterm birth, LBW, and small-for-gestational age (SGA) adjusting for individual demographic, medical, and socioeconomic variables. We found no association between neighborhood poverty and preterm birth or LBW. There was a positive association between neighborhood poverty and SGA (OR 2.0, 95% CI 1.114-3.585) when comparing women who lived in the highest quartile of neighborhood poverty to women who lived in the lowest quartile for neighborhood poverty when adjusted for age of the mother, pre-pregnancy BMI, and stress in the second and third trimesters. There was no association between overall neighborhood crime and adverse birth outcomes. There was no association between violent neighborhood crime and preterm birth or LBW. Violent neighborhood crime was positively associated with a 1.5 times higher odds SGA (95% CI: 1.03-2.2) when adjusted for smoking before pregnancy, smoking during early pregnancy, education levels, parity, age of the mother, pre-pregnancy BMI, and gestational weight gain. Women who lived in the highest quartile of violent neighborhood crime had 2.1 times higher odds of SGA (95% CI: 1.2-3.4, p-trend of 0.0037) compared to women who lived in the lowest quartile of violent neighborhood crime when adjusted for smoking before pregnancy, education levels, age of the mother, and pre-pregnancy BMI.
Factors Associated with Mental Health Screening among Church-affiliated African American Populations
(2024-05) Dankwah, David A.
Background: Long-standing barriers prevent African Americans from utilizing mental health services. Churches have been culturally responsive locations in African American communities for delivering effective health interventions and services. This study examines factors associated with mental health screening among church-affiliated African-American populations. Methods: This cross-sectional study used baseline data from the Healthy Actions to Impact Mind and Soul, an intervention designed to increase mental health screening for church-affiliated African-American adults in Kansas City, MO. Self-administered surveys collected data on mental health screening, violence and healthcare discrimination experiences, mental health-related attitudes, mental health status, religious coping, and socio-demographics. Analytic methods included descriptive statistics and logistic regression analyses. Results: Study participants (N=180; mean age=52) were mostly women (81%); 58% reported they or a family member had ever experienced violence (gunshot, abuse, etc.), 18% had experienced discrimination in a healthcare setting in the last 12 months, and 74% perceived that mental health was serious in their community. A total of 38% had been screened for mental health, and 44% reported they would “definitely” get mental health screening if it were offered at their church. After adjusting for socio-demographics, perceived stress, and anxiety, individuals who had experienced violence had increased odds of past mental health screening (Adjusted Odds Ratio [aOR]=3.36; 95% CI: 1.61-6.99; p=0.001) as did people who believed that mental health problems was “very serious” in their community (aOR=2.87; 95% CI: 1.21- 6.81; p=0.02). Individuals who had experienced healthcare discrimination had increased odds of “definitely” being willing to get mental health screening at their church (aOR=2.52; 95% CI: 1.02 - 6.25; p=0.044) as did people who believed that mental health was “very serious” in their community (aOR=2.81; 95% CI: 1.21- 6.53; p=0.016). Religious coping was not associated with past mental health screening or willingness to be screened at church. Conclusion: The possibility of a perpetrator attending the same church as a victim may explain why experience with violence is not positively associated with willingness to be screened at church. Mental health screening at African-American churches has the potential to increase mental health screening among populations that are exposed to violence and healthcare discrimination.
Age at Type 2 Diabetes Diagnosis, Depression, and Risk of Cardiovascular Disease: Findings from the Women's Health Initiative
(2024-05) Biney, Godness Kye
Cardiovascular diseases (CVD) are a leading cause of morbidity and mortality globally and in the United States (US). Type 2 Diabetes (T2D), which affects over 37 million Americans, and depression, impacting more than 21 million US adults, have been identified as significant risk factors for CVD. Epidemiological evidence suggests a bidirectional relationship between T2D and depression. However, their compounded risk on CVD is largely understudied, with no study to date assessing the interaction between T2D or age at T2D diagnosis and depression and their impact on CVD risk. This study aimed to investigate how age at T2D diagnosis and potential interactions with depression can impact the relationship between T2D and cardiovascular events among participants in the Women’s Health Initiative (WHI) cohort. WHI is a large, multi-racial cohort of postmenopausal women in the US. At baseline and follow-up, participants self-reported their depression status (Yes/No), T2D status (Yes/No), and the age group they were diagnosed with T2D. Based on this information, we categorized age at onset into early (30-49) versus late (>=50). We also categorized our T2D duration into five years intervals. Incident CVD events (i.e., any CVD event, CHD, CHF, MI, and stroke) were all adjudicated outcomes and binary in nature (Yes/No). Cox proportional hazard regression models were used to estimate the unadjusted and adjusted hazard ratios (HR) and their 95% confidence intervals (95% CI) for the association between Age at T2D and incident CVD, considering depression as an effect modifier. After adjusting for numerous crucial covariates, we found that individuals with early onset T2D (30-49) who also have depression are at a heightened risk for CHF compared to their counterparts with depression and late (>=50) onset T2D. We also found that individuals with a longer duration of T2D who also had depression were at a progressively increasing risk of any CVDs with every five-year increase in the duration of T2D. These results support the bidirectional relationship between T2D and depression and their compounded risk on CVD. Our study emphasizes the need for a comprehensive, multidisciplinary approach to care.
Policy Alternatives to Increase Access to Early Childhood Education and Care in Massachusetts
(2013-02) Lemay, Meghan
Access to early childhood education not only leads to improved social, academic, and health outcomes for children, but can also carry the same benefits into adulthood. Early education and care programs can work against some of the negative effects of social factors such as socioeconomic status, discrimination, social support, and work demands which have been linked to physical and mental health outcomes. Early education programs could intervene not only in the life of a child, but also impact parents, families, and populations. This thesis will review the research showing early childhood education leads to better social and health outcomes and that there is a lack of adequate access to early childhood education for low-income families in Massachusetts. This thesis presents three state-level policy options for making early childhood education more accessible to low-income families in Massachusetts: lengthen the certification period of child care vouchers; reduce the administrative burden on families including eliminating the need for double documentation; dissolve the child care subsidy waiting list by making child care services an entitlement for families at or below 50% State Median Income. These policy options are evaluated based on the criteria of political feasibility, equity and fairness, administrative ease, effectiveness, and cost. Based on this policy analysis, a recommendation is made for Massachusetts to lengthen the certification period of child care vouchers, as well as reduce the administrative burden on families including eliminating the need for double documentation.
The Impact of Gestational Diabetes on Maternal and Cord Blood Lipids Among Prenatal Care Patients in Western Ma
(2012-09) Raj, Preethi
Gestational diabetes mellitus (GDM), a pregnancy-induced metabolic disorder that affects 2-10% of pregnancies poses future risk for diabetes mellitus (DM) and cardiovascular disease in mother and child. However, few prospective studies have examined the effect of GDM on altered maternal and cord blood lipids, specifically HDL, LDL, triglycerides, and total cholesterol, both during and after pregnancy. We have evaluated the association between GDM and lipid metabolism in pregnant mothers and their infants using data from a prospective cohort study conducted at Baystate Medical Center’s Wesson Women and Infant’s Unit. GDM was assessed prenatally by 3-hr GTT blood samples and was confirmed by obstetrician review. Lipids were assessed via fasting and non-fasting blood samples obtained during 3-hr GTTs performed at 24-28 weeks of gestation and 6-8 weeks post-partum. Data for covariates were collected via an interview form administered at the time of recruitment. We used multivariable linear regression to evaluate the association between GDM status and maternal lipids during and after pregnancy as well as cord lipids. These study results inform future research on GDM as a risk factor for future metabolic disorders in mother and child.
Urinary Melatonin Levels and Risk of Postmenopausal Breast Cancer in the Women's Health Initiative Observational Study
(2012-05) Doherty, Ashley
Prior studies have observed a link between night shift work and increased risk of breast cancer. Melatonin, a hormone related to circadian rhythm, has been proposed to lower breast cancer risk by inhibiting cell proliferation. The disruption of peak melatonin that occurs during night shift work could explain the increase in risk observed. Several studies have assessed whether higher melatonin levels are associated with decreased breast cancer risk, but results have been conflicting. We examined the relationship between urinary melatonin levels and breast cancer risk in a nested case-control study conducted within the Women’s Health Initiative Observational Study. First morning urine samples collected at baseline were assayed for melatonin levels in 258 women diagnosed with invasive breast cancer and 515 matched controls from three enrollment sites. Using conditional logistic regression to adjust for matching factors and established risk factors, results indicate no association between urinary melatonin levels and breast cancer risk. The mean creatinine adjusted melatonin levels for cases and controls were 16.30 ng/mg and 16.05 ng/mg, respectively. Compared to the lowest quartile of creatinine adjusted melatonin, the odds of breast cancer did not vary by quartile of creatinine adjusted melatonin, adjusted for known breast cancer risk factors: second quartile 0.84 (95% CI 0.52-1.38), third quartile 1.05 (95% CI 0.65-1.72) and fourth quartile 1.09 (95% CI 0.66-1.81). This study does not suggest that melatonin is protective against breast cancer and suggests that reasons other than melatonin suppression may explain the increased risk of breast cancer seen in night shift workers.
The Relationship Between Seroreactivity to Trypanosoma Cruzi and Electrocardiographic Abnormalities in Two Endemic Areas For Chagas Disease in Guatemala
(2011-09) Gramajo-rodriguez, Rodrigo Antonio
Chagas disease caused by the protozoan Trypanosoma cruzi is the leading cause of heart disease in Latin America. After an acute phase that typically includes few symptoms, a chronic cardiac phase occurs for many infected individuals. The progression to chronic heart disease is not fully understood in Guatemala. The objective of this study was to determine the association between T. cruzi infection and progression to Chagas heart disease in Guatemala and determine if the relation is modified according to vector predominance. Using a community-based cross-sectional approach, 813 individuals from two areas of Guatemala were included in the study: 478 (58.8%) from Jalapa and 335 (41.2%) from Chiquimula. Data including serologic evaluation, electrocardiography (ECGs) and demographics were collected to compare the degree of detectable cardiac abnormalities in infected and uninfected individuals. Overall, T. cruzi seroprevalence was 28.8%, 247 (30.4%) presented an abnormal electrocardiography and 79 (9.7%) were diagnosed as Chagas heart disease. Seroreactivity was statistically (p-value<0.05) associated with abnormal ECG, Chagas heart disease, community, age, occupation, time living in the area, knowledge of the vector, ventricular condition defects and ST-T waves changes. The age and sex-adjusted association between a positive seroreactive and abnormal ECG was higher in Jalapa OR=2.0 (CI95% 1.2, 3.1) than in Chiquimula OR=1.2 (CI95% 0.9, 1.8). These results show the high Chagas-cardiac burden in this population and support the idea that the vector predominance plays an importance role in the association and that this should be taken into account in the design of intervention for vector control.
Coffee, Tea Consumption and Endometrial Cancer Risk: Women's Health Initiative Observational Study
(2011-09) Giri, Ayush
Approximately 40,000 women in the U.S. are diagnosed with endometrial cancer annually. Biological data suggest coffee or tea consumption may lower endometrial cancer risk through estrogenic and insulin-mediated pathways. Epidemiologic data are inconsistent, with two of three prospective cohort studies showing an inverse association with coffee consumption and two prospective cohort studies finding no association with tea consumption. We used publicly available data from the Women's Health Initiative Observational Study to evaluate the association between coffee, tea and endometrial cancer risk. We identified 48,912 eligible post-menopausal women with a mean follow-up time of 7.5 years. During this period there were 452 incident endometrial cancer cases. We used Cox-proportional hazard models to evaluate the effects of coffee and tea consumption on endometrial cancer risk, while adjusting for potential confounders including age, body mass index and hormone therapy use. Overall, we did not find an association between coffee consumption and endometrial cancer risk. Compared to women who did not drink coffee on a daily basis (none or < 1 cup/day), the multivariable adjusted hazard ratios for women who drank 2-3 cups/day was 0.95 [95% confidence interval (CI) 0.74,1.22] for total coffee, 0.91 (95% CI 0.68,1.23) for regular coffee, and 0.94 (0.62,1.42) for decaf coffee. Compared to obese women who did not drink coffee on a daily basis (none or < 1 cup/day), the multivariable adjusted hazard ratios (HR) for obese women who drank ≥ 2cups/day as reported at baseline were: 0.79 (95% CI 0.53,1.17] for total coffee, 0.62 (95% CI 0.39,1.00) for regular coffee, and 0.78 (95% CI 0.40,1.50) for decaf coffee. Furthermore, obese women who consistently reported drinking ≥2 cups of regular coffee/day had an even further reduced risk [HR 0.40 (95% CI 0.18,0.91)]. In comparison to women who did not drink tea on a daily basis, obese women who drank 1 cup and ≥ 2cups of tea/day had multivariable adjusted hazard ratios of 0.45 (95% CI 0.22,0.92) and 0.99 (95% CI 0.60,1.62), respectively. The results from our study suggest that regular coffee consumption may be protective against endometrial cancer among obese postmenopausal women, with inconclusive results for tea. Our study adds to the biological understanding and to the small body of prevalent epidemiologic literature on coffee consumption and endometrial cancer risk.
Beverage Consumption and Body Composition Among College-aged Women
(2011-01-01) Sloan, Matthew
In the U.S., over 67 million adults are obese and 300,000 annual deaths are related to obesity. Among college-aged women, over 60% report daily consumption of caloric beverages. Prior studies indicate positive associations between these beverages and obesity, but conflicting results for diet drinks. Studies were limited, however, by obesity measures that failed to accurately assess abdominal adiposity or percent body fat, and few studies included college-aged women. We examined this relationship among participants aged 18-30 in the University of Massachusetts Vitamin D Status Study (n=237). We assessed average diet in the past two months using a modified version of the Harvard Food Frequency Questionnaire and calculated percent body fat by dual-energy X-ray absorptiomtery. Confounding factors were assessed using a lifestyle questionnaire. Multiple logistic regression was used to adjust for important risk factors. We found no association between intake of sugar-sweetened beverages or juice and obesity after controlling for confounding factors. However, high consumption of diet drinks (i.e., >2 servings per week) was associated with an increased risk of overweight (BMI>25) (OR=2.88, 95% CI 1.34, 6.21), high waist circumference (>80 cm) (OR=3.14, 95% CI 1.56, 6.35) and high percent body fat (>33%) (OR=2.86, 95% CI 1.42, 5.77) as compared to light consumption (i.e, <1 serving per>month). These associations were not attenuated by controlling for total caloric intake. Findings should be evaluated in additional longitudinal studies to determine whether diet drinks contribute to adiposity or if the association is due to higher diet drink consumption by overweight women.
Selective Serotonin Reuptake Inhibitors and Bone Mineral Density in a Population of U. S. Premenopausal Women
(2011-01-01) Peterson, Lori J
Selective Serotonin Reuptake Inhibitors and Bone mineral Density in a Population of U.S. Premenopausal Women May 2011 M.S., UNIVERSITY of Massachusetts Amherst Directed by: Professor Elizabeth R. Bertone-Johnson Low bone mineral density (BMD) in post-menopausal women is a risk factor for bone fractures and osteoporosis development. Prior studies in post-menopausal women have shown the use of antidepressant medications, specifically selective serotonin reuptake inhibitors (SSRIs) to be inversely related to BMD. However, the association has not been studied in pre-menopausal women. Current SSRI use is widespread with 8% of U.S. women age 18-44 reporting use. We evaluated the association between SSRIs and BMD and bone mineral content (BMC) cross-sectionally using data from the University of Massachusetts Vitamin D Status Study. SSRI use, diet, and lifestyle factors were assessed by questionnaire. BMD and BMC were measured using dual-energy x-ray absorptiometry (DEXA). The study included 256 women aged 18-30 (mean=21.6 years, SD=4.3 years). In this population, SSRI use was 5%, BMD values ranged from 0.97-1.38 g/cm2 (mean 1.16, SD 0.08), and BMC values ranged from 1833g to 3682g (mean 2541.5, SD=349.2). After adjustment for age, body mass index, and physical activity, mean BMD in the 13 users of SSRIs was 1.15g/cm2 (SD=0.06) compared to 1.16g/cm2 (SD=0.77) in the 243 non-users (p =0.66). After the same adjustments, mean BMC in the 13 users was 2467.1g (SD=285.0) compared to 2547.6g (SD=352.6) in the 243 non-users (p=0.94). Our findings do not support an inverse association between SSRI use and BMD or BMC. However, given the prevalence of SSRI use in young women and the potential for adverse effects on bone health, further study of this association is warranted.
Vitamin D Levels and Risk of Dyslipidemia among Us Children with Diabetes and Obesity
(2011-01-01) Hagan, Elsina E.
Dyslipidemia is increasing among U.S. children, and the prevalence is highest among children with diabetes and obesity. Recently, vitamin D deficiency has been suggested as a possible dietary risk factor for dyslipidemia. Despite the high prevalence of vitamin D deficiency amongst children, virtually no studies have evaluated the association between vitamin D and dyslipidemia among children. We evaluated the vitamin D and dyslipidemia relationship among 240 children and adolescents aged 2 through 21 years who were outpatients of a pediatric endocrinology unit at a large tertiary care facility in Western Massachusetts from April 2008 to April 2010. Eligible children were those with either obesity and/or type 1 or 2 diabetes mellitus. A total of 17.4% of children had severe (<15.0 ng/ml) vitamin D deficiency, 19.2% had moderate (15.0-19.9 ng/ml) deficiency, 36.3% were insufficient (20.0-29.9 ng/ml), and 27.1% had normal (≥30.0 ng/ml) levels. A total of 28.8% of children had high total cholesterol (TC ≥180 mg/dL), 19.6% had high triglycerides (TG; <10years: ≥110 mg/dL, ≥10years: ≥130 mg/dL), 21.3% had low high density lipoprotein (HDL <40 mg/dL), and 6.7% had high low density lipoprotein (LDL ≥130 mg/dL). Moderate vitamin D deficiency was associated with increased risk of high TC (adjusted odds ratio [OR adj] = 2.9, 95% confidence interval (CI): 1.0, 8.8) compared to children with normal vitamin D levels. Severe vitamin D deficiency was associated with an increased risk of low HDL (OR adj = 3.5, 95% CI: 1.0-12.3) and high TG (OR adj = 11.7, 95% CI: 1.9, 70.3) compared to children with normal vitamin D levels. Children with moderate vitamin D deficiency had approximately 3-fold increased risk of high TC compared to children with normal vitamin D levels. In comparison to children with normal vitamin D levels, severe vitamin D deficiency was associated with a strong and significant increased risk of low HDL and high TG; with a significant dose-response relationship. Additionally, in linear regression analyses, we found that an increase in vitamin D deficiency was associated with a significant mean increase in all four measures of dyslipidemia. Vitamin D adequacy may reduce the risk of dyslipidemia in children.
Perineal Talc Use and Risk of Endometrial Cancer in Postmenopausal Women
(2011-01-01) Crawford, Lori B
Endometrial cancer is the most common female reproductive cancer in the United States. Most known risk factors for endometrial cancer are either genetic or related to exposure to estrogens; less is known about risk due to environmental exposures. While several studies have examined the relationship between perineal powder use and ovarian cancer risk, only one study has addressed the relationship with endometrial cancer risk. The Women's Health Initiative Observational Study, a prospective cohort study of 93,676 United States postmenopausal women from 1993-2005, measured perineal powder use at baseline via self-report. Cases of endometrial cancer were self-reported and confirmed by both local and central physician adjudicators. Cox proportional hazards regression was used to examine the association between perineal powder use and endometrial cancer, adjusting for known risk factors. Of the 48,912 women in our analysis, 25,181 (52%) reported ever use of perineal powders. There were 452 incident cases of endometrial cancer diagnosed during 366,872 person-years of follow-up. Ever use of perineal powder was not significantly associated with increased risk of endometrial cancer (hazard ratio 1.05, 95% confidence interval 0.87-1.27). However, use of any perineal powder for 20 or more years was associated with a 30% increase in risk (hazard ratio 1.30, 95% CI 1.01-1.67) compared to never users. Use of powder on both a diaphragm and the perineal area was associated with a 39% increase in risk (hazard ratio 1.39, 95% CI 1.00-1.93). Cessation of perineal powder use, particularly on a diaphragm, may help reduce risk of endometrial cancer.
Education, Occupation, and Migration as Predictors of Multiple Sexual Partnerships Among People Tested for Hiv in Luderitz, Namibia
(2011-05) Blank, Sima
Multiple sexual partnerships are associated with greater risk of HIV, sexually transmitted infections (STIs) and intimate partner violence. Namibia has an HIV prevalence of 18% and surveys have shown that up to 40% of men in parts of the country have multiple sexual partners; however, no studies have evaluated characteristics associated with this behavior. We evaluated the relationship between education, occupation, and migration and multiple sexual partnerships among people tested for HIV in Lüderitz, Namibia. Data are taken from a cross-sectional study of 570 men and women conducted in a Voluntary Counseling and Testing Center from September-November 2009. Multinomial logistic regressions adjusted for relevant confounders suggest that employment other than manual labor is associated with a three-fold increase in the odds of having 4-6 partners over the lifetime (OR=3.44 95%CI: 1.29-9.15) and a non-significant two-fold increase in the risk of having 7 or more partners over the lifetime (OR=1.93 95%CI: 0.57-6.57). Stratification by gender shows that among women, employment other than manual labor is associated with almost a five-fold increase in the odds of having 4 or more sexual partners over the lifetime (OR=4.58 95%CI: 1.48-14.23). Women with an education of grade 12 or higher also have increased odds of having 4 or more sexual partners over the lifetime (OR=3.78 95%CI: 1.26-11.36). Results show no significant associations with migration, or among men for any exposure variables. Although further studies are warranted, results suggest that programs for HIV and STI intervention and family planning among women should be aimed at workplaces.

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