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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Item Novel Immunotherapy Agents in Oncology: Generalizability of Trial Results and Drivers of Clinical Utilization(2021) Mishkin, Grace; Franzini, Luisa; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Cancer is the second most common cause of death in the United States after heart disease. Novel immunotherapy agents such as nivolumab and pembrolizumab have become an essential, albeit extremely expensive, component of oncology care since their first approvals in melanoma in 2014 and lung cancer in 2015. However, little is known about differences between immunotherapy clinical trial participants and the real-world patient population, or about the drivers of provider utilization of these agents. The first objective of this dissertation used the SEER-Medicare linked database with claims data from 2014-2016 to conduct two aims analyzing potential disparities between Medicare beneficiaries on active treatment for melanoma and lung cancer and Medicare clinical trial participants. Aim one compared the characteristics of Medicare patients on active cancer treatment to Medicare patients on active cancer treatment clinical trials. Aim two compared Medicare patients receiving the novel immunotherapy agents nivolumab or pembrolizumab to Medicare patients participating in trials of these two immunotherapy agents. Because of the demographic differences in the melanoma and lung cancer patient populations, these aims were analyzed separately in melanoma and lung cancer. As hypothesized, patients in clinical trials were significantly younger and had fewer comorbid conditions than patients undergoing active cancer treatment not in clinical trials. Underrepresentation of non-White and female patients in clinical trials was hypothesized, but these results were less consistent. The second objective used Medicare Open Payments data from 2016 and Medicare provider utilization data from 2017 to analyze 1) if industry payments promoting nivolumab or pembrolizumab were positively associated with whether a provider was a high utilizer of the agent, and 2) among these high utilizers, if industry payments were positively associated with greater utilization amounts. The hypothesized results, that industry payments were associated with greater likelihood of high utilization and more utilization among high utilizers, were seen in some of the analyses but not consistently throughout the study. Through unique analyses of recent datasets, this dissertation advances our understanding of potential disparities in clinical trial representativeness and the generally positive relationship between promotional payments and provider utilization of immunotherapy agents in the Medicare cancer patient population.Item SUPPLEMENT USE AMONG A PRE-COLONOSCOPY POPULATION(2018) O'Connor, Shanelle; King-Marshall, Evelyn C; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In the United States, Colorectal Cancer (CRC) is the third leading cause of cancer-related deaths in both males and females. In 2017, it was estimated that 50,260 people would die from colon cancer alone (American Cancer Society, 2017). There are several behavioral factors that are known to reduce the risk of CRC. Studies have shown that less smoking, reduced heavy alcohol use, engaging in regular physical activity and healthy eating habits are associated with a lower risk of developing colorectal cancer (Lynes et al, 2016). In recent studies, researchers found an inverse relationship between Calcium and Vitamin D use and colorectal cancer through various mechanisms (Chan & Giovannucci, 2010). However, the role of other supplements, including multi-vitamins, vitamin C, and vitamin B6, remains uncertain; there have only been a few studies conducted with these other supplements and their role in colon cancer risk reduction. According to Consumer Survey on Dietary Supplements, 68% of U.S. adults report that they use a dietary supplement and over 50% are regular users. NHANES survey shows that women, older adults, and whites use supplements more than their counterparts (Picciano, 2005). A survey was administered to patients prior to their colonoscopy appointment to investigate perceived and actual understanding of the procedure, health literacy, and general health. Participants were selected from eligible patients (18 years or older; could read/write English; cognitively able to fill out survey) scheduled for a colonoscopy at either a university hospital-based center or a university-affiliated outpatient endoscopy center situated in Alachua County, Florida from September 2011 through October 2013 (Curbow et al, 2015). The goal of this proposed Master’s thesis capstone is to conduct a secondary analysis of data collected from patients in this study to determine associations regarding supplement use with various variables such as demographic factors, perceived health literacy, informed about CRC, concern about CRC, reason for colonoscopy and general health. These associations will help us to better understand how these variables impact supplement use among this population.Item STAYING HEALTHY AFTER CANCER: THE HIDDEN INFLUENCE OF SOCIAL NETWORKS(2017) Guida, Jennifer Lyn; Liu, Hongjie; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: Few rigorous empirical studies have used social network models to investigate changes to the relationships most important to cancer survivors and their effects on health. The objective of this dissertation was to longitudinally examine the associations between egocentric social network change over time and physical, physiological, and mental health among cancer survivors and older adults without a history of cancer. Method: The National Social Life Health and Aging Project (NSHAP) (2004-2011) is a nationally representative cohort of older adults aged 57 and older. Physical functioning was measured with the Activities of Daily Living Scale and inflammation was measured by C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and vascular endothelial growth factor (VEGF). Depressive symptoms were measured with the 11-item version of the Centers for Epidemiologic Studies Depression (CES-D) Scale. Multiple logistic and linear regression and structural equation modeling were used to assess the relationships of interest. Results: Older cancer survivors and older adults without cancer experienced similar social network changes over time. In the overall NSHAP sample, adding new network members was protective of functional decline [odds ratio (OR): 0.64, 95% confidence interval (CI): 0.41-0.99] and experiencing a change in the frequency of contact was positively associated with functional decline (OR: 1.92, 95% CI: 1.15- 3.20). CRP levels were significantly 26% lower among cancer survivors who added two network members compared to those who added no network members. Experiencing a change in the frequency of contact was associated with a 19% higher level of TNF-α. Social support was directly associated with depressive symptoms and did not vary by cancer status. No mediation effects between social support, inflammation, and depressive symptoms were observed in path models and latent variable models. Conclusion: Together these results suggest that when new relationships form or when stable relationships remain strong over time, their effects on health are positive. Alternatively, negative health effects may emerge when relationships become weaker over time. This study provides significant and timely information to develop effective interventions to improve quality of life for cancer survivors and older adults.Item RACIAL/ETHNIC VARIABILITY IN THE EFFECT OF RADIATION ON SECOND PRIMARY THYROID CANCER IN CHILDREN: ANALYSIS USING SURVEILLANCE EPIDEMIOLOGY AND END RESULTS DATA(2015) McClarin, Lavisha J.; Carter-Pokras, Olivia; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Increases in pediatric thyroid cancer incidence could be partly due to previous clinical intervention. This retrospective cohort study used 1973-2012 data from the Surveillance Epidemiology and End Results program to assess the association between previous radiation therapy exposure in development of second primary thyroid cancer (SPTC) among 0-19-year-old children. Statistical analysis included the calculation of summary statistics and univariable and multivariable logistic regression analysis. Relative to no previous radiation therapy exposure, cases exposed to radiation had 2.46 times the odds of developing SPTC (95% CI: 1.39-4.34). After adjustment for sex and age at diagnosis, Hispanic children who received radiation therapy for a first primary malignancy had 3.51 times the odds of developing SPTC compared to Hispanic children who had not received radiation therapy, [AOR=3.51, 99% CI: 0.69-17.70, p=0.04]. These findings support the development of age-specific guidelines for the use of radiation based interventions among children with and without cancer.