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The Relationship Between Substance Use, Suicidality, and Access to Care Among Women Veterans: A Secondary Analysis of the Substance Abuse and Mental Health Services Administration National Survey on Drug Use and Health
No full textWomen military Veterans represent a growing population with unique healthcare needs. Women Veterans are at risk for adverse mental health outcomes, including the development of substance use disorders, and are also at risk for suicidal ideation, plans, and attempts. Further, women Veterans may face gender-specific barriers to mental health care. Utilizing data from the 2015-2019 and 2021 Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey on Drug Use and Health, this dissertation examines rates of substance use, specifically opioid, cannabis, and stimulants, and explores the relationship between substance use, suicidality, and access to substance use and mental health treatment among women Veterans.
The first paper within this dissertation describes rates of opioid, cannabis, and stimulant use and use disorders among women Veterans, while drawing comparisons between women non-Veterans and men Veterans.
The second paper within this dissertation examines the association between suicidality, including suicidal ideation, attempts, or plans, and substance use. This paper also examines whether the relationship between suicidality and substance use is moderated by access to substance use treatment.
The third paper within this dissertation explores barriers to accessing substance use disorder treatment among women Veterans and explores how these barriers might differ compared to women non-Veterans and men Veterans.
The key findings of this dissertation include that women Veterans are more likely to use cannabis than both women non-Veterans and men Veterans, but less likely to develop a cannabis use disorder. Women Veterans were also more likely to be prescribed opioids and to use non-prescribed prescription opioids but were not at increased risk for the development of an opioid use disorder. Non-prescribed prescription opioid use increased the odds of suicidal ideation among women Veterans, while lifetime cannabis use increased the odds of suicide plans among women Veterans. Women Veterans were more likely to report stigma-related barriers to accessing mental health treatment compared to both women non-Veterans and men Veterans. These dissertation findings contribute to what is known about substance use, suicidality, and access to care among women Veterans, and will help to inform the development of future interventions geared towards improving care for women Veterans
An HA-based targeting system for improved lung cancer treatment
No full textNon-small cell lung cancer (NSCLC) is the leading cause of cancer-related deaths worldwide. Platinum-based chemotherapy, such as cisplatin (CDDP), is a front-line treatment. However, the efficacy of platinum-related therapy is limited by the rapid development of drug resistance. Autophagy has been recognized as a critical factor in chemoresistance to CDDP. To overcome this, we introduced chloroquine (CQ) into the treatment, which is an effective autophagy inhibitor that can sensitize cancer cells to radiation and other anticancer drugs. To effectively co-deliver these two drugs, we developed a 5-aminosalicylic acid (5-ASA) derivatized nanocarrier based on hyaluronic acid (HA-ASA), which can actively target various types of cancer by targeting the overexpressed cell surface glycoprotein CD44.
We introduced 5-aminosalicylic acid (5-ASA) to the polymer (HA-ASA) as the hydrophobic core to form micelles. This novel nanocarrier can self-assemble in aqueous solution to form particles of ~100nm in size. Both CDDP and CQ can be loaded effectively into the HA-ASA micelles through various carrier/drug interactions with a final size of ~140 nm.
We showed that CDDP can induce autophagy in 3LL, FVBW17, and A549 cell lines and that the CDDP-CQ combination has a synergistic effect in vitro, with a combination index of smaller than 1. Meanwhile, we found that both CDDP and CQ can induce the expression of COX2, which can promote tumor progression, metastasis, and immunotherapy resistance. 5-ASA is an inhibitor of cyclooxygenase (COX), which can counteract the activity of the induced COX2
She Will Thrive: Single Mothers Nonprofit Program Development
No full textParenting, especially as a single mother, presents challenges beyond financial strain and relational tensions. It has implications regarding health, familial well-being, and socioeconomic status. With an increasing number of single-parent households led by mothers, the need for targeted intervention is becoming rampant. This paper explores the realities of single motherhood, focusing on health disparities and economic struggles. Drawing on qualitative data from When She Thrives (WST), a nonprofit organization dedicated to supporting single mothers. This study aims to develop a program tailored to address their specific needs. Through qualitative analysis of survey responses and recorded discussions, key themes surrounding judgment, time constraints, and poverty emerged as pressing issues for mothers. Based on insights from the literature review and recommendations, a pilot program called Strong Moms will be created. Strong Moms aims to mitigate factors such as stress and loneliness that lead to persistent disparities regarding health and income. This program has the potential to address systemic barriers impacting the public health sector by providing opportunities to decrease social isolation, supplying pathways for healthier quality of life , and empowering single mothers
An Assessment of the Impact of Secondary School Demographics on Athletic Training Services in Pennsylvania
No full textResearch to date has investigated the nationwide presence of athletic trainers in secondary schools for the past 30 years. These individual studies only encompass certain components of athletic training services and/or aspects of secondary schools. PURPOSE: To examine the characteristics of athletic training services as well as the demographics of secondary schools such as school type, school size, and geographic location in Pennsylvania. METHODS: Data was collected from a sample of 737 Pennsylvania secondary schools with various school types, school sizes, geographic settings, and athletic training services. This data was collected from public domain websites of the Pennsylvania Interscholastic Athletic Association (PIAA) and the individual Pennsylvania secondary schools. Specifically, this study gave insight as to how the characteristics of the secondary schools (school type, school size, geographic setting) influence the athletic training services (athletic trainer (yes/no), number of athletic trainers (0-3 or more), athletic trainer employment provider) offered. Descriptive statistics were calculated for all variables. Fisher-Freeman-Halton Exact and Pearson Chi-Square tests were conducted to assess the relationship between the school type, school size, and geographic location and the availability of athletic training services. RESULTS: There were statistically significant (p < 0.001) relationships between the school type and school size and the athletic training services (yes/no and 0-3 or more). The rates of athletic training employment for public schools and the differing school sizes reflected previous research. The rates of athletic training employment for private schools and the ranging geographic locations varied from previous reports. Specifics regarding the number of athletic trainers employed and the athletic trainer employment providers were limited due to the lack and consistency of research. CONCLUSION: Further efforts need to be made to ensure accessibility and accurate athletic training information is available by athletic training employment providers and the athletic trainer’s site of employment. Further research needs to continue assessing state-specific secondary school demographics and the athletic training services provided
International assessment of Lynch syndrome screening practices
No full textLynch syndrome (LS) is an inherited cancer syndrome that increases risk of developing certain cancers, most commonly colorectal and endometrial. It is important to distinguish between LS and sporadic cancers because it can help inform the risk of additional cancers as well as identify relatives who may also be at risk of developing LS-associated cancers. In the US, there has been considerable effort by organizations including the Lynch Syndrome Screening Network (LSSN) to promote universal tumor screening as part of routine diagnosis of colon and endometrial cancers to identify more cases of LS. However, it is unclear what LS screening practices currently exist internationally.
In order to characterize global LS screening practices with regards to screening of colorectal cancer tumors, this study implemented a survey to capture screening procedures and methods, cascade testing, and efficacy measures. The online survey was distributed to individuals at member organizations of LSSN, members of the International Society for Gastrointestinal Hereditary Tumors (InSiGHT), and the Collaborative Group of the Americas on Inherited Gastrointestinal Cancer (CGA-IGC). Additionally, two interview guides were developed depending on whether survey respondents’ organizations had a routine LS screening program or not. This was done by creating open-ended questions based on survey questions. This will support future work in elucidating how barriers and facilitators, such as insurance and social factors, may inform LS screening practices.
There were 27 survey respondents from seven countries: Canada, US, Denmark, Ireland, Netherlands, UK, and Japan. Some key findings from the survey showed that no institutions offer only direct-to-germline testing, 92.6% of responding institutions perform universal tumor screening, 81.5% of institutions use a patient-mediated method of informing relatives about cascade testing, and 48.1% of institutions systematically track LS detection rates. The public health significance of this project is that it identifies ways in which resources developed by LSSN could be leveraged to facilitate implementation of LS screening programs (especially universal tumor screening) world-wide and provide guidance on how population-specific improvements could be made to current screening programs. Ultimately, this will help to increase LS diagnoses and reduce the burden that LS can have in families globally
Assessment of Colorectal Cancer Screening and Surveillance Methods: A Literature Review and Pilot Data Analysis
No full textMonitoring for colorectal cancer (CRC) comes in the form of screening and surveillance. Screening for CRC presents an opportunity to detect early-stage CRC or prevent onset entirely, leading to better outcomes. However, engagement with screening varies widely across different populations. The literature review describes barriers and facilitators of screening experienced by both eligible individuals and providers of CRC screening. Using the Ovid MEDLINE database, a thorough search process resulted in 13 studies being included for review. Surveillance of CRC is a critical component of care after treatment with curative intent for CRC. It provides the opportunity to monitor for CRC recurrence or new onset of cancer. A data analysis of a separate observational study evaluated the effectiveness of a current CRC surveillance method. Results from both components of this essay emphasize that use of current screening and surveillance methods are not optimal, leading to a greater public health burden due to increased CRC incidence and mortality that otherwise could have been prevented. Consistent barriers and facilitators to screening identified in the literature review include an individual’s age, psychological factors such as attitude towards screening or potential diagnosis, knowledge of CRC and CRC screening, and insurance status. The literature review in particular highlighted the public health significance of promoting a holistic, evidence-based approach to identify factors impacting screening rates to inform new methods and interventions that can increase the population screening rate from the current level of compliance in the United States of only 58.7%
Clinical Trial Knowledge Among Adults with Inherited Retinal Dystrophy (IRD)
No full textBackground: Treatments for inherited retinal dystrophy (IRD) are quickly becoming a reality due to tremendous advances in ocular gene therapy research. Patient misconceptions about clinical trials can act as a barrier to study participation enrollment.
Purpose: This study aims to identify potential clinical trial knowledge gaps among adults with IRD as well as patient preferences for receiving new information. The hope is that this information can be used to develop patient educational intervention and promote timely, informed decision-making.
Methods: The Clinical Trial HEalth Knowledge and Beliefs Scale (CHEKS) was distributed via email to members of the My Retina Tracker registry, an international research database of individuals and families affected by IRD. The study team developed an additional 4 items to assess clinical trial knowledge that is particularly relevant to ocular gene therapies (CHEKS+). In addition to the CHEKS tool, the survey included demographic questions, sources of clinical trial information, and preference for receiving educational material.
Results: For 202 survey responses, the mean CHEKS+ score was 94.5 ±13.6 (out of a possible total 116). Participants who reported that they had a good understanding of clinical trials scored higher (101.4 +11.3) than those who did not self-perceive strong understanding (90.3 +13.2) (p < 0.001). CHEKS items that addressed the patient experience during a clinical trial, such as the option to withdrawal from the study, performed worse (mean score of 3.1 out of 4) than items that addressed patient considerations prior to trial consent (mean score of 3.4) (p < 0.001). Participants most often obtained clinical trial information from registries (indicated by 55.9% of participants) and ophthalmology providers (28.2%). Of the participants who preferred to receive written information on clinical trials (89.1%), 85.4% preferred online over hardcopy distribution. Most participants preferred to receive clinical trial information on a recurring basis (84.8%).
Conclusions: There are common clinical trial misconceptions among adults with IRD. The findings from this study support public health efforts to develop educational interventions that enable equitable access to research opportunities for patients with IRD
PROMINENT: AN INTERPRETABLE DEEP LEARNING METHOD TO PREDICT PHENOTYPES USING DNA METHYLATION
No full textDNA methylation (DNAm) is an epigenetic mark that regulates genome function and is important for normal development in mammals. To understand the complex interplay between genetics, DNA methylation, and phenotype, computational approaches have emerged to uncover DNAm marker-phenotype associations, often employing regression techniques, such as Methylation Risk Scores (MRS) or methylation profile scores (MPS). Recently, a deep neural network (DNN) method, MethylNet was proposed to predict traits based on DNAm array data based on variational auto encoder. However, understanding the association between DNAm data and phenotypes in the DNN architecture remains challenging since MethylNet does not directly incorporate the relationship between methylation and genes. Also, its high demand for computation time necessitates meticulous tuning of important model parameters to achieve optimal performance, making it difficult to optimize data training. To overcome these challenges, we introduce Pathway Information-based Methylation Neural Network (PROMINENT). PROMINENT incorporates gene-level DNA marker information and gene pathway priors to enhance prediction accuracy and interpretability. In a comprehensive comparison using asthma, idiopathic pulmonary fibrosis (IPF), and first-episode psychosis (FEP) data, PROMINENT shows promise in predicting phenotypes using DNA methylation data with reasonable computational time
Regulation of Acvrl1 and its Implications in Hereditary Hemorrhagic Telangiectasia
No full textHereditary hemorrhagic telangiectasia (HHT) is a genetic disorder inherited in an autosomal dominant pattern that affects at least 1 in 5000 people worldwide. It is characterized by the presence of arteriovenous malformations (AVMs), abnormal connections between arteries and veins lacking capillary beds, which pose life-threatening risks including stroke and heart failure. HHT is caused primarily by heterozygous loss-of-function mutations in ENG (endoglin), which causes HHT1, or ACVRL1 (ALK1), which causes HHT2. ENG and ALK1 act in a common pathway: ENG is an accessory receptor that facilitates bone morphogenetic protein (BMP) binding to ALK1, a signaling receptor. Despite an understanding of the affected signaling pathway, there are currently no targeted therapeutics for HHT. We suggest that one potential therapeutic approach is to enhance the expression of ACVRL1 to slow development and/or progression of AVMs, particularly in HHT1 patients, in whom ACVRL1 is intact. To investigate the regulation of acvrl1 gene expression, I am interrogating the activity of putative cis regulatory elements in zebrafish. ACVRL1 is expressed predominantly in endothelial cells, specifically arterial endothelial cells, and its expression depends on blood flow. Using a stable zebrafish line, I have determined that deletion of a small segment (667 bp) of intron 1 implicated in flow responsiveness is not necessary for basal or flow induced acvrl1 expression. Additionally, using CRISPR/Cas9, I have generated two new lines in which putative enhancers, identified by single cell ATAC-seq as being enriched (more open) in 5 day-post fertilization zebrafish embryonic arterial endothelial cells, are deleted. Thus far, I have established parental (P0) lines with large deletions in the 5’ intergenic region (2 lines each targeting 2 putative enhancers) and intron 1 (1 line targeting 2.7 kb of this intron). Further work is required to identify founders for each line and determine the necessity of these cis elements in basal and flow induced acvrl1 expression in their offspring. Identifying these elements will offer valuable insights into strategies for enhancing ACVRL1 expression to counteract endoglin loss in HHT1 patients. This research holds public health significance because it may lead to development of targeted gene therapies for HHT patients
