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HELPING CLINICIANS ADDRESS DIGITAL INFORMATION ABOUT CONTRACEPTION WITH ADOLESCENTS
Get PDFAdolescents frequently encounter contraceptive information online, though its quality varies, and many struggle to discern trustworthy sources given limited knowledge and prevalent misinformation. In the context of increasingly restrictive reproductive laws and threats to contraceptive access in the United States, supporting reproductive justice and informed decision-making about contraception is essential. Yet clinicians often lack strategies to address online information in clinical encounters, which exacerbates low rates of person-centered counseling for minors and contributes to dissatisfaction and use of non-preferred methods. This dissertation aimed to strengthen adolescent-centered contraceptive care by improving clinician communication. Aim 1 involved a qualitative content analysis of N=297 Reddit posts from adolescents/young adults (AYA) and caregivers. AYA (n=268) most often sought direct medical or behavioral advice (38%), contraceptive knowledge (15%), pregnancy scare guidance (11%), and communication or access advice (9%). They also shared sex/contraception education (13%) and opinions on contraceptive rights or behaviors (12%). Caregivers (n=29) most often sought method recommendations (38%), expressed moral concerns (35%), or sought knowledge (17%) and communication advice (10%). Across all posts (N=297), including 10% with randomly sampled comments, 15% contained misconceptions. Few posts expressed positive emotions (10%) or trust (10%), and many conveyed negative emotions (60%), mistrust (28%), and anti-hormonal sentiment (16%). Aim 2 analyzed interviews with 24 clinicians specializing in adolescent sexual and reproductive health. Clinicians identified ways to integrate online information into encounters, described strategies for digital and health literacy, and shared approaches for addressing disagreements with patient-identified information. They also emphasized the importance of using patient-centered language, including careful framing of the term “misinformation.” Aim 3 tested a training on incorporating discussion of online information about contraception into routine counseling, co-developed with N=20 advisors (teens, caregivers, clinicians). Pilot testing with N=35 clinicians demonstrated acceptability (mean=4.6, SD=0.5), appropriateness (4.7, 0.5), and feasibility (4.6, 0.5). Participants demonstrated immediate and sustained (4-month) improvements in knowledge, beliefs, self-efficacy, and self-reported counseling behaviors (p<0.05). This dissertation advances understanding of adolescent and caregiver contraceptive concerns and provides actionable strategies for clinical communication around online health information, addressing a critical social determinant of health in the digital age.Doctor of Philosoph
EVALUATING THE ROLE OF THE HUMAN RESPIRATORY MICROBIOME AND METABOLOME IN THE RESPONSE TO WOOD SMOKE EXPOSURE
Get PDFThe increasing global exposure to wildfire smoke, consistently linked to adverse respiratory outcomes, poses a significant and growing public health concern affecting both healthy and vulnerable populations. Therefore, understanding the mechanisms underlying the respiratory response to wildfire smoke is imperative for protecting respiratory health and developing novel therapeutic strategies against the adverse effects induced by smoke inhalation.In this study, we evaluated the microbiome and metabolome response of healthy individuals (n = 54) subjected to controlled exposure to wood smoke (500 µ/m3 for 2 hours). Induced sputum samples were collected at baseline and at two post-exposure time points (6 hours post-exposure (hpe) and 24 hpe). Microbiome analysis involved sequencing the bacterial 16S rRNA gene, while metabolomics analysis employed a non-targeted approach using a liquid chromatography-mass spectrometry (LC-MS/MS) workflow. Finally, microbiome and metabolome data were integrated with paired inflammatory cell and proteomic data following a multi-omics approach.Our findings revealed that short-term exposure to wood smoke causes respiratory dysbiosis and dynamic metabolic changes. Microbiome analysis revealed the enrichment of pathogenic bacteria (Haemophilus influenzae and Selenomonas) and a decrease in commensals (Neisseria cinerea and Porphyromonas catoniae). Furthermore, metabolomics analysis revealed a dynamic response to wood smoke, as well as the presence of bacteria-derived metabolites, including D-alanyl-alanine and various acyl-homoserine lactones. Metabolomics analysis also uncovered a differential response based on baseline levels of 8-hydroxy-2’-deoxyguanosine, a marker of oxidative damage. Multi-omics integration revealed that at 24 hpe, airways undergo an overall anti-inflammatory or immune resolution response, driven by macrophages that are strongly correlated with proteins associated with an M2-like phenotype and commensal bacterial species (Neisseria oralis). This analysis also detected core and smoke-resilient bacteria-metabolite interactions, which could be characteristic of respiratory health.Together, these findings provide novel insights into the role of the respiratory microbiome in the host response to wood smoke. This study emphasizes the significance of considering the respiratory microbiome in inhalational toxicology studies, as well as the benefits of employing integrative approaches to gain a more comprehensive understanding of complex systems.Doctor of Philosoph
Masters of Our Own Domain: Oral Tradition Among African American Farmers, Fishermen, and Landowners
Get PDFABSTRACT Melody Hunter-Pillion: Masters of Our Own Domain: Oral Tradition Among African American Farmers, Fishermen, and Landowners(Under the direction of Blair L.M. Kelley and Elizabeth S. D. Engelhardt) African Americans gained intimate knowledge of coastal North Carolina environments as early as the pre-colonial period. Many generations of rural Black families, with expertise in the nation’s first industries of farming, fishing, and naval stores, stay rooted in a dynamic natural environment while also facing social, political, and economic challenges. Through the oppression of slavery, devastation of hurricanes, violence and discrimination of Jim Crow, and today’s sea level rise, African American men and women in eastern North Carolina have used oral tradition as a powerful tool to survive, adjust to change, and readjust repeatedly. Black farming and fishing cultures, as early pioneering developments in America, created local ecological knowledge. Black farmers and watermen are pragmatists who use practical solutions and oral tradition to survive and thrive in place. In the long struggle from slavery to freedom, Black people connected the idea of land to citizenship and liberty. The struggle for land and freedom, plus readjusting to each ecological and social challenge, produced valuable knowledge. The lives and stories of land-owning Black families in eastern North Carolina is where we need to look to understand American history. We can all learn from their deep well of knowledge, which has been historically undervalued and ignored. This dissertation examines the intergenerational narratives Black families use as tools to stay rooted in rural spaces. It explores the flexible and creative nature of Black culture and community survival through oral tradition in four North Carolina counties: Bladen, Brunswick, Carteret, and Craven. Stories help us to adapt, which allows culture to survive and move forward to create a stronger future. In the current period of global warming, we should consider whether sea level rise and climate change will outpace oral tradition as a culturally adaptive response. Black culture is once again pushed to readjust, and its past and future success may provide a model for society at large.Doctor of Philosoph
The Lay Belief of Love as Action and its Emotional and Behavioral Implications
Get PDFFor millennia, philosophers, theologians, academics, and laypersons have arguedthat love is action – that, regardless of feelings, love can exist through enactments withinthe physical world. It is unclear, however, the extent to which this belief exists within thecontemporary U.S., as well as whether manifestation of love beliefs matter within thecontext of loving relationships. We began our investigation by testing how love as actionbelief may shape reactions to positive and negative expectancy violations within romanticrelationships. Across two studies (N = 884), including an 11-day daily diary study, wedemonstrate that love as action belief exists on a spectrum. Our work also implies thatthose with a stronger love as action belief more readily communicate with their romanticpartner following expectancy violations. This body of work introduces a unique constructof love as action belief which has potential relevance for understanding a myriad ofinterpersonal dynamics.Master of Scienc
Injectable Hydrogels with Tissue-Adaptive Gelation and Mechanical Properties: Enhancing Softness and Stability
Get PDFUltra-soft injectable hydrogels are paramount in biomedical applications such as tissue fillers, drug depots, and tissue regeneration scaffolds. Synthetic approaches relying on linear polymers are confronted by the necessity for significant dilution of polymer solutions to reduce chain entanglements. Bottlebrush polymers offer an alternative approach due to suppressed chain overlap and entanglements, which facilitates lower solution viscosities and increased gel softness. Leveraging the bottlebrush architecture in linear-bottlebrush-linear (LBL) block copolymer systems, where L is a thermosensitive linear poly(N-isopropylacrylamide) block, and B is a hydrophilic polyethylene glycol brush block, injectable hydrogels were designed to mimic tissues as soft as the extracellular matrix at high polymer concentrations. Compared to an analogous system with shorter brush side chains, increasing the side chain length enables a decrease in modulus by up to two orders of magnitude within 1–100 Pa at 20 wt% polymer concentrations, near to the physiological water content of ~70%. This system further exhibits thermal hysteresis, enabling stability with inherent body temperature fluctuations. The observed features are ascribed to kinetically hindered network formation by bulky macromolecules
Prevalence, Characteristics, and Genetic Architecture of Avoidant/Restrictive Food Intake Phenotypes
Get PDFThis cohort study investigates the prevalence of avoidant/restrictive food intake (ARFI) in the general pediatric population, developmental characteristics of affected children, and the genetic underpinnings of ARFI symptoms.Key PointsQuestionWhat is the prevalence of avoidant/restrictive food intake (ARFI) in the general pediatric population, developmental characteristics of affected children, and the genetic underpinnings of ARFI symptoms?FindingsIn this cohort study of 35 751 children, those with ARFI exhibited more developmental difficulties compared with children with no ARFI. Two independent genome-wide significant loci and an association with ADCY3 were identified, and small to moderate genetic correlations were observed between ARFI and mental health, cognitive, anthropometric, food-associated, and gastrointestinal phenotypes.MeaningThis study suggests that the prevalence of ARFI was considerable and affected children had an associated elevated risk for developmental difficulties.ImportanceA narrow range of food consumption and/or restricted eating is a core feature of avoidant/restrictive food intake (ARFI) disorder. However, there is limited knowledge of developmental characteristics of children with ARFI and its etiological influences, which constrains research, prevention, and intervention efforts.ObjectiveTo estimate the prevalence of ARFI phenotypes in a population-based sample, examine developmental characteristics across childhood, and investigate the genetic architecture of ARFI using genome-wide association analyses.Design, Setting, and ParticipantsThis preregistered study used data from children born from 1999 to 2009 in the population-based Norwegian Mother, Father, and Child Cohort Study (MoBa), with mother-reported data on ARFI symptoms at 3 and 8 years and linkage with diagnostic data from population health registries. Data were analyzed from March 2024 to May 2025.ExposuresMultiple items were used to identify children with broad ARFI. These children were subclassified into 3 groups based on symptom persistence: ARFI–broad transient (only at age 3 years), emergent (only at age 8 years), and persistent (ages 3 and 8 years). Children in these groups with 1 or more indicators of clinical significance (eg, nutritional deficiency) were further classified into ARFI-clinical subgroups.Main Outcomes and MeasuresARFI groups were compared across developmental characteristics from 6 months to 14 years. Genome-wide methods were used to examine single-nucleotide variant (SNV) heritability (SNV-h2), conduct genetic association analyses, and quantify genetic correlations with other phenotypes.ResultsOf 35 751 children with available ARFI assessments at 3 and 8 years (18 236 male [51%]), the prevalence of ARFI–broad persistent, transient, and emergent was 2129 (6.0%), 6338 (17.7%), and 3001 (8.4%), respectively. The prevalence of ARFI-clinical persistent, transient, and emergent was 624 (1.8%), 1157 (3.2%), and 484 (1.4%), respectively (2265 [6.3%] overall). Children with ARFI–broad persistent exhibited more developmental difficulties compared with children with no ARFI. SNV-h2 ranged from 8% to 16%. Two independent genome-wide significant loci were identified. For ARFI-clinical, a significant association was identified with ADCY3 (z = 5.42; P = 3.03 × 10−8). Small to moderate genetic correlations were observed for ARFI-broad, ARFI-clinical and mental health, cognitive/educational, anthropometric, food-associated, and gastrointestinal disorder phenotypes.Conclusions and RelevanceThis cohort study found that the prevalence of ARFI in the general pediatric population was substantial, and affected children had an associated elevated risk of developmental difficulties across multiple domains. Findings suggest a need for broad support interventions and advance understanding of the genetic underpinnings of ARFI
The Impacts of Substance Use and Depression on HIV Pre-Exposure Prophylaxis Use and Adherence Among Sexual and Gender Minority Adolescents and Young Adults in the Keeping it LITE Cohort
Get PDFSubstance use and depression are prevalent in sexual and gender minorities (SGM), but evidence about their impacts on HIV pre-exposure prophylaxis (PrEP) use is mixed. We assessed these impacts in a US-based cohort of 3,330 young SGM who tested negative for HIV and completed baseline and semiannual assessments on substance use (cocaine, methamphetamine, or heroin), depression, and PrEP use and adherence. We estimated prevalence differences (PDs) to compare baseline and 12-month PrEP use and adherence between participants with and without substance use and depression, separately and jointly. At baseline, 8% of participants reported substance use and depression, 7% reported substance use only, 38% reported depression only, and 47% reported neither. PrEP use was reported by 22%, with 78% reporting prior-day adherence. Compared to participants without depression or substance use, participants with substance use alone were more likely to report PrEP use at baseline (PD = 18.9; 95% CI: 7.6, 30.2) and 12 months (PD = 15.9, 95% CI: 5.1, 26.7), without adherence differences. Depression alone was associated with lower baseline PrEP use (PD=-3.6, 95% CI: -6.7, -0.4) and adherence (PD=-10.0, 95% CI: -18.4, -1.6), but associations attenuated over 12 months. Those with both substance use and depression (vs. neither) reported higher baseline PrEP use (PD = 6.5, 95% CI: -0.6, 13.5) and lower adherence (PD=-12.9, 95% CI: -26.2, 0.5), with associations weakening over 12 months. Substance use and depression had opposing relationships with PrEP use and adherence. In addition to its mental health benefits, depression treatment may improve PrEP uptake and adherence in young SGM
Charting the Impact of Maternal Antibodies and Repeat Exposures on Sapovirus Immunity in Early Childhood From a Nicaraguan Birth Cohort
Get PDFBACKGROUND: Sapovirus is an important cause of acute gastroenteritis in childhood. While vaccines against sapovirus may reduce gastroenteritis burden, a major challenge to their development is a lack of information about natural immunity. METHODS: We measured sapovirus-specific IgG in serum collected, between 2017 and 2020, of mothers soon after delivery and at 6 time points in Nicaraguan children until 3 years of age (n=112 dyads) using virus-like particles representing three sapovirus genotypes (GI.1, GI.2, GV.1). RESULTS: Sixteen (14.3%) of the 112 children experienced at least one sapovirus gastroenteritis episode, of which GI.1 was the most common genotype. Seroconversion to GI.1 and GI.2 was most common between 5 and 12 months of age, while seroconversion to GV.1 peaked at 18 to 24 months of age. All children who experienced sapovirus GI.1 gastroenteritis seroconverted and developed genotype-specific IgG. The impact of sapovirus exposure on population immunity was determined using antigenic cartography: newborns share their mothers' broadly binding IgG responses, which declined at 5 months of age and then increased as infants experienced natural sapovirus infections. CONCLUSION: By tracking humoral immunity to sapovirus over the first 3 years of life, this study provides important insights for the design and timing of future pediatric sapovirus vaccines
Better health and less stress: an elicitation survey on quitting little cigars and cigarillos by young adults
Get PDFIntroduction Little cigars and cigarillos (LCCs) pose health risks similar to cigarettes yet remain popular among US young adults (YAs), particularly Black or African American YAs. While previous studies have explored beliefs surrounding LCC prevention and use, no research has yet focused on LCC cessation beliefs. Aims and methods This study examined the beliefs of 134 YAs who currently or formerly used LCC aged 18–29, recruited via Qualtrics panels. Participants responded to open-ended questions eliciting behavioral, normative, and control beliefs regarding quitting LCCs. Responses were coded using iterative thematic analysis to identify emergent themes. Results Key behavioral beliefs about quitting LCCs included positive long-term physical and mental health benefits. Parents and friends were frequently cited as normative supporters of quitting. Facilitators to quitting included finding alternative activities and the appeal of saving money, while addiction and mood regulation were prominent barriers. Black participants especially mentioned mood effects, such as stress, as a perceived disadvantage of quitting, whereas non-Black participants more often reported no disadvantages to quitting. Conclusions This elicitation study identified beliefs that can begin to inform the development of media campaigns focused increasing LCC cessation among YAs to promote health equity. Further research will examine the relationship between identified LCC beliefs and quitting intentions. This study provides insights into the beliefs and motivations about quitting among YAs who use LCCs, especially Black YAs. The identification of salient behavioral, normative, and control beliefs offers a foundation for developing public health messages that emphasize both the health risks of continued use and the psychological benefits of quitting. Future testing can examine the promise of addressing addiction and mood regulation, incorporating the role of parental support, and messages about evidence-based cessation methods in promoting quitting LCC use
Little Cigar and Cigarillo Graphic Health Warnings and Quitting Behaviors
Get PDFImportance: Although little cigars and cigarillos (LCCs) are common combustible tobacco products, the effects of LCC warning labels on behavioral outcomes remain untested. Objective: To evaluate the effects of LCC graphic health warnings (GHWs) on promoting LCC quitting intentions and behaviors. Design, Setting, and Participants: This randomized clinical trial included 1029 adult LCC users from a Qualtrics online panel who were randomized to (1) LCC GHWs (n = 339), (2) existing US Food and Drug Administration (FDA) text-only warnings (n = 346), or (3) no stimulus control (n = 344). Participants accessed messages via email from May 1 to August 31, 2023, and completed surveys each day, with repeated exposure to LCC packages based on study condition. Interventions: Participants were exposed to 6 new LCC GHWs or FDA text-only cigar warnings 18 times over 3 weeks. The control group received no visual stimuli. Main Outcomes and Measures: The primary outcome was postintervention quit intentions, measured by a score ranging from 1 (low quit intention) to 4 (high quit intention). Secondary outcomes were the proportion having forgone or butted out (ie, extinguished an LCC that they had already lit) LCCs in the past week and the proportion having attempted to quit or reduced LCC use in the past week. Data were analyzed on an intent-to-treat basis using mixed-model analysis of variance and were adjusted for baseline behaviors. Results: Among the 1029 participants, the mean (SD) age was 43.9 (11.3) years, 578 (56.2%) were men, and 767 (74.5%) were users of both types of LCCs. Retention to trial end was high across all arms (LCC GHWs, 307 of 339 [90.6%]; FDA text-only warnings, 316 of 346 [91.3%]; and control group, 308 of 344 [89.5%]). Participants in the LCC GHW group reported significantly higher postintervention (and change from preintervention to postintervention) quit intentions (mean score, 2.9 [95% CI, 2.8-3.0]) compared with FDA text-only participants (mean, 2.5 [95% CI, 2.4-2.6]) and control (mean, 2.6 [95% CI, 2.4-2.7]) (P < .001). The mean proportion of participants reporting quit attempts after the intervention was significantly higher for participants in the LCC GHW group compared with participants in the text-only group (0.4 [95% CI, 0.4-0.5] vs 0.3 [95% CI, 0.2-0.3]). Participants in the LCC GHW group were more likely than those in the text-only group to forgo or butt out LCCs (adjusted estimate [SE]: forgoing little cigars, 0.12 [0.03]; forgoing cigarillos, 0.13 [0.03]; butting out little cigars, 0.07 [0.04]; butting out cigarillos, 0.07 [0.03]). No significant difference occurred in the change (from pre to post) in quit attempts between the LCC GHW and control groups. Conclusions and Relevance: This randomized clinical trial found that LCC GHWs were effective in increasing quit intentions and reducing LCC use behaviors. Current FDA warnings appear insufficient. Findings support enhanced GHWs on LCC packages to address significant public health gaps, aligned with global tobacco control strategies. Trial Registration: ClinicalTrials.gov Identifier: NCT05849051