School of Public Health

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The collections in this community comprise faculty research works, as well as graduate theses and dissertations.

Note: Prior to July 1, 2007, the School of Public Health was named the College of Health & Human Performance.

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Author: search.filters.author.Demarco, Maria Teresa

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    APPLIED EPIDEMIOLOGICAL STUDIES OF HIGH RISK HUMAN PAPILLOMAVIRUS INFECTIONS AND RISK OF CERVICAL PRECANCER
    (2017) Demarco, Maria Teresa; Carter-Pokras, Olivia; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Persistent infection with human papillomavirus (HPV) is a leading cause of cancer among women worldwide. Health care providers face a growing number of competing cervical cancer screening approaches and tests. HPV testing is very sensitive but a secondary test is needed to identify infections with sufficient risk of cervical precancer/cancer. This dissertation aims to address three questions in the management of HPV infections: (1) to compare the first HPV screening test seeking FDA approval that identifies many individual HPV types (BD Onclarity™) to two FDA approved assays (Roche cobas™ and Qiagen HC2™); (2) to clarify how HPV type influences cumulative risk of clearance, progression or persistence of HPV infections; and (3) to assess whether established etiologic co-factors for cervical precancer, given HPV infection, represent clinically useful, actionable factors that clinicians “need to know” when considering how to manage the HPV infected woman. All manuscripts in this dissertation used data from the HPV Persistence and Progression Cohort, conducted by Kaiser Permanente Northern California and the National Cancer Institute. The study population is a group of 33,295 women, ages 30 or older, who are HPV positive at baseline and have results for cytology. Contingency table methods, Kappa statistics and McNemar’s test were used to assess agreement between HPV DNA tests (manuscript 1). Competing risk proportional hazards models were used to estimate eight-year cumulative risks of HPV clearance, progression to precancer, or persistence (manuscript 2). Absolute risks from Logistic-Cox models were used to study whether co-factors acted as clinically relevant risk stratifiers (manuscript 3). Results from this dissertation suggest that: (1) Onclarity agreement was good to excellent compared with cobas and HC2, and clinical accuracy was high for detection of precancer; (2) cumulative risk of clearance varied little by HPV type, cumulative risk of progression was substantially higher for HPV16, and long-term persistence was uncommon; and (3) the most important predictors of progression from HPV infection to precancer were HPV type and cytologic result. By clarifying these aspects of methods, and management of HPV-positive women, it is hoped that this dissertation will contribute to the improvement of cervical cancer screening incorporating HPV testing.
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    FACTORS ASSOCIATED WITH COMPLETION OF THE HUMAN PAPILLOMAVIRUS VACCINE SERIES AMONG HISPANIC AND NON-HISPANIC WHITE ADOLESCENT GIRLS IN THE UNITED STATES
    (2011) Demarco, Maria Teresa; Carter-Pokras, Olivia; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Despite recommendations of three Human Papillomavirus (HPV) vaccine shots for all adolescent girls, only 29.1% of non-Hispanic Whites and 23.4% of Hispanics achieve completion. This study describes factors associated with completion of the HPV vaccine series among Hispanic and non-Hispanic White 13-17 year old girls who initiated the series. A secondary data analysis was performed of the cross-sectional 2009 National Immunization Survey-Teen survey. Despite similar initiation rates (one in five), Hispanic girls who had initiated the series (59.9%) were less likely to complete the series than non-Hispanic Whites (76.4%). After accounting for poverty status and home ownership, Hispanics were less likely to complete the HPV vaccine series. Factors associated with HPV vaccine series initiation were age at interview and age at HPV vaccine series initiation for Hispanics; and continuous health insurance since age of 11, mother's marital status, and number of children in the household for non-Hispanic Whites.