Doctor of Philosophy, The Ohio State University, 2014, Veterinary Clinical Sciences

Cervical spondylomyelopathy (CSM) is the most common disease affecting the cervical vertebral column of large and giant breed dogs, with the osseous-associated form of the disease being the most prevalent in giant breed dogs. Among the giant breeds, Great Dane dogs are the most frequently affected. While there are several prospective studies evaluating the clinical, imaging, cerebrospinal fluid (CSF), and electrodiagnostic features of disc-associated CSM, no equivalent studies are available for the osseous-associated form of the disease. The pathologic changes underlying both forms of CSM are different and the results from studies investigating disc-associated CSM cannot be extrapolated to the osseous-associated form. The goal of this thesis was to perform a thorough and prospective investigation of the anatomic, diagnostic imaging, functional, and biochemical characterization of osseous-associated CSM in the Great Dane breed. In order to do this, 15 clinically normal (control) and 15 CSM-affected Great Danes (GDs) were enrolled and underwent physical and neurological examinations, radiography, computed tomography (CT) and magnetic resonance imaging (MRI) of the cervical vertebral column, transcranial magnetic motor evoked potential (TMMEPs), and cerebellomedullary cistern CSF collection. This thesis consists of seven experiments aimed at expanding the current knowledge available on the osseous-associated form of CSM in GDs. The goal of the first experiment was to compare the body conformation of the two groups of dogs (control vs. CSM-affected). Previously published literature had suggested that differences in body conformation were involved in the pathogenesis of CSM in GDs, but no objective study had investigated this theory. Six body measurements were obtained for each dog. Overall, no significant differences were identified between groups. The results of this study do not support the hypothesis that differences in body conformation play a role in the (open full item for complete abstract)

Committee: Ronaldo da Costa (Advisor); Sarah Moore (Committee Member); Matthew Allen (Committee Member); Tod Drost (Committee Member) Subjects: Veterinary Services

Master of Science, The Ohio State University, 2013, Industrial and Systems Engineering

Biomechanical modeling is one of the ways to assess the risk of pain and injury to an individual. Injuries and pain are becoming more common in the cervical spine. There are many cervical spine models available, but almost all of them were made to study impact loading (whiplash), which makes them unsuitable for studying activities of daily living. A personalized, dynamic, EMG-driven model is very important, because everybody activates their muscles differently, and that different activation will cause different loading patterns. The goal of this study was to create and evaluate a dynamic, EMG-driven cervical spine model that tracks motion and calculates spinal loads in the cardinal planes. The cervical spine model was created in MSC Adams™ and included vertebrae, intervertebral discs, ligaments, and muscles. The vertebrae (C1-C7) were harvested from a cadaver, and using a white light scanner, were turned into 3D models. The discs were modeled as bushing forces. The ligaments were modeled as single vector forces. Each ligament consisted of three vectors, which enables the model to calculate shear as well as force on the ligament. The muscles were modeled as straight line force vectors between the origin and insertion points. The loads on the discs were calculated using moment arms and force vectors from the ligaments and muscles, as well as velocity and acceleration of the vertebrae and skull. Three subjects were used to evaluate the model. Subjects completed sagittal flexion and lateral flexion trials. Electromyography data, optical data, and force plate data were collected. The internal load, calculated using the EMG and optical data, was compared to the external load, calculated with the force plate. The trials in the sagittal plane performed well (r2 = .70, AAE = 1.65 N), while some of the trials in the lateral plane worked well and some did not perform as well (r2 = .48, AAE = 1.74 N). There was significant co-activation in the muscle (open full item for complete abstract)

Committee: William Marras PhD (Advisor); Ehud Mendel MD (Committee Member) Subjects: Biomechanics; Biomedical Research; Occupational Safety

Doctor of Philosophy, Case Western Reserve University, 2021, Physiology and Biophysics

In mammals, the carotid body (CB) chemosensitive glomus (type I) cells are the primary sensors of oxygen (O2) and secondary sensors of carbon dioxide (CO2) in the blood. Glomus cells also receive projections from sympathetic postganglionic fibers, whose cell bodies reside in the superior cervical ganglion (SCG) and receive sympathetic preganglionic input from fibers in the cervical sympathetic chain (CSC). Hypoxia (HX, low blood O2) and/or hypercapnia (HC, high blood CO2), activate CB glomus cells, which signals the brainstem respiratory pattern generator via chemoafferent fibers of the carotid sinus nerve (CSN). Hypoxia also activates small intensely fluorescent (SIF) cells in the SCG, which projects to the brainstem. In addition to CB chemoreceptors, mammals possess central chemoreceptors, including the retrotrapezoid nucleus (RTN), which are stimulated by increases in protons (H+) - via carbonic anhydrous catalyzed reaction of CO2 and water. Our data shows that: (1) HX (10% O2, 90% N2), HC (5% CO2, 21% O2, 74% N2) or the physiologically-relevant hypoxic-hypercapnic (HH) (5% CO2, 10% O2, 85% N2) gas challenges elicited robust ventilatory responses in juvenile postnatal (P) 25 Sprague Dawley SHAM rats, (2) ventilatory responses elicited by HX alone and HC alone were generally additive in SHAM rats, (3) ventilatory responses to HX, HC and HH were markedly attenuated in bilateral CSN transected (CSNX) rats compared to SHAM, and (4) ventilatory responses elicited by HX alone and HC alone were generally not additive in CSNX rats. Additionally, our data shows that adult male C57BL6 mice with bilateral CSC transection (CSCX) display numerous altered responses to a HX (10% O2, 90% N2) challenge that also occurred in male C57BL6 mice with SCG removal (SCGX), however SCGX mice also displayed changes during HX challenge that CSCX mice did not, including diminished total increases in minute ventilation. Therefore, our data proposes that CB chemoafferent input is essential fo (open full item for complete abstract)

Committee: Stephen J Lewis (Advisor); William Schilling (Committee Chair); Sudha Chakrapani (Committee Member); Derek Damron (Committee Member); Thomas Dick (Committee Member); David Friel (Committee Member) Subjects: Physiology

Doctor of Philosophy, The Ohio State University, 2020, Biomedical Engineering

Motor vehicle crashes (MVC) are the leading cause of cervical spine (c-spine) injuries in children below 18 years of age. However, there have been reports of increasing injury trends around five year of age. In automotive safety, this age typically corresponds with a transition of child restraint systems: from a harnessed device to a booster seat which use the adult seatbelt. Anthropomorphic test devices (ATDs) and finite element modeling are commonly used to predict the biomechanical responses of pediatric occupants during MVC. However, a lack of experimental pediatric c-spine data results in the use of scaling techniques of adult male biomechanical responses to assess pediatric injury risks. These scaling techniques seldom represent the vast changes the c-spine undergoes from childhood to adulthood. Pediatric ATDs lack the ability to represent the nuances of growth and development of the pediatric c-spine and often result in poor biofidelity, or the ability to accurately predict and reproduce biomechanical responses of children. There is a need to understand the biomechanical response of the pediatric c-spine in a way that accounts for anatomical and developmental differences between children and adult males. Therefore, the objective of this study is to quantify the cervical spine range of motion, strength and stiffness of children 5–7 years old. A custom testing device was developed and validated to quantify pediatric c-spine strength and stiffness in the sagittal and coronal planes while range of motion (ROM) was quantified for all major planes of motion. Isometric strength was measured at a neutral neck position, 0° of axial deviation, and at mid-range of motion, 30° of axial deviation in each plane. During testing muscle activation was assessed and maximum voluntary isometric contractions (MVIC) were quantified for each participant. Dynamic concentric strength and stiffness values were quantified at a dynamic rate of 30°/s. Children had equal ROM in all pl (open full item for complete abstract)

Committee: John Bolte IV (Advisor); Laura Boucher (Committee Member); Yun Seok Kang (Committee Member); Alan Litsky (Committee Member) Subjects: Biomechanics; Biomedical Engineering

Master of Science, University of Toledo, 2010, Bioengineering

Fusion has been the historic gold standard for the treatment of the degenerated disc in the spine. Fusion surgeries constrain the motion at the implanted level there by transferring additional load to the adjacent levels. Many clinical studies have shown that adjacent segment degeneration was observed in patients over time. In order to overcome the drawbacks of the fusion procedures, the artificial discs are being explored to treat disc degeneration related problems. Artificial discs are designed to preserve motion at the index level and lessen effects on the adjacent segments. More recently, the need to preserve the sagittal balance following disc replacement has been stressed. Existing devices provide motion, but may not actively preserve or correct sagittal balance. A new disc design was compared with the existing disc designs, analyzing the effects of design parameters on Cervical Disc Arthroplasty Performance and Sagittal Balance, using a finite element model (FEM). An experimentally validated ligamentous intact C3-C7 FEM was modified to simulate four disc designs: Synergy 0 degree (S0), Synergy 6 degree (S6), a ball and socket (BS) and a ball and trough (BT) at C5-C6 level. S0 has parallel metal endplates whereas S6 has 6 degrees built-in lordosis between the endplates. S0 and S6 both have a polymer core. BS has an inferior polymeric ball and a superior metal socket. BT has a metal ball on superior endplate with an elongated inferior metal trough. Appropriate material properties, contacts and boundary conditions were defined for all the models. A compressive follower load of 73.5N and incremental moments up to 1.5 Nm were applied to define the neutral posture and to simulate physiologic motions respectively. The follower load resulted in less than 1 degree of extension for intact, S0 and S6, extension around 3 degrees for BS and flexion over 1 degrees for BT. Flexion-extension Center Of Rotation (COR) was closer to intact for all the discs except for BT, wher (open full item for complete abstract)

Committee: Vijay Goel PhD (Advisor); Charles Armstrong PhD (Committee Member); Ashok Biyani MD (Committee Member) Subjects: Biomedical Research; Engineering; Health Care; Mechanical Engineering; Mechanics; Surgery

Master of Science, The Ohio State University, 2010, Veterinary Clinical Sciences

The incidence of cervical lesions in the dog ranges from 13.9-25.4%. Clinical signs associated with cervical intervertebral disc disease include severe neck pain, low head carriage, thoracic limb lameness/paresis, proprioceptive ataxia, and varying degrees of tetraparesis. Although the diagnosis and treatment of many disorders of the cervical spine have been described in the literature, few studies have aimed at understanding the pathogenesis of these diseases. The aims of this study were (1) to describe the micromorphometry of the cervical intervertebral discs in the dog and identify differences between chondrodystrophic and nonchondrodystrophic dogs, and (2) to determine the kinematic motion patterns of the cranial and caudal cervical spine in large breed dogs. All 5 cervical discs from 6 chondrodystrophic and 6 nonchondrodystrophic dogs were harvested for the micromorphometry study. The specimens were decalcified and two hematoxylin and eosin slides prepared from each disc. Slides were scanned using an Aperio Scanner and the scans analyzed. The nucleus of chondrodystrophic dogs was small, rounded and more dorsally-located compared to those of nonchondrodystrophic dogs. The mean width of the dorsal annular fibers was smaller in chondrodystrophic dogs. Cells were elongated in the outer regions of the disc and rounded in the inner regions. Cell grouping occurred more frequently in the inner regions than the outer regions. Eight spines were harvested from Foxhound dogs for the kinematic study. The spines were determined to be free of any spinal pathology using radiography, CT and MRI. Spines were stripped of all musculature, leaving ligaments and joint capsules intact, and sectioned into cranial (C2-C4) and caudal (C5-C7) segments. Specimens were loaded into a custom jig and LED markers attached to the vertebral bodies. Spines were tested using pure moment loading in flexion/extension, left/right lateral bending and left/right axial rotation and motion tracked using (open full item for complete abstract)

Committee: Ronaldo C. da Costa (Advisor); Matthew J. Allen (Committee Member); Alan S. Litsky (Advisor) Subjects: Veterinary Services

Master of Arts in Psychology, Cleveland State University, 2013, College of Sciences and Health Professions

The most common cause of cervical cancer in women is the Human Papillomavirus (HPV) (Cokkinides, Bandi, Siegel, Warn, & Thun, 2007). Survivors of sexual assault are at a high risk for contracting HPV and other sexually transmitted infections (Lee, Westrup, Ruzek, Keller, & Weitlauf, 2007), therefore placing them at higher risk of developing cervical cancer. Unfortunately, these women are less likely than non-survivors to have cervical cancer screenings (Bazargan, Bazargan, Farooq, & Baker, 2004). Previous research has suggested that post-traumatic stress disorder (PTSD) and locus of control (LOC) may have some influence on screening participation in sexual assault survivors. This study investigates the relationship between sexual trauma, PTSD, LOC, and cervical cancer screenings. More specifically, we aim to examine if PTSD and LOC have mediation effects on the relationship between sexual trauma and cervical cancer screenings.

Committee: Lisa Doane PhD (Committee Chair); Michael Horvath PhD (Committee Member); Boaz Kahana PhD (Committee Member) Subjects: Psychology

PHD, Kent State University, 2024, College of Arts and Sciences / School of Biomedical Sciences

Opioid addiction and opioid use disorder (OUD) is one of the major problems that we are facing not only in the US but all around the world. An estimated 3 million US citizens and 16 million people worldwide suffer from OUD by 2022. This number is expected to keep rising in the coming years. One of the leading causes of death related to OUD is opioid-induced respiratory depression (OIRD), in which overdose is accompanied by into respiratory arrest; the individual can die if not treated promptly. Currently, the only approved treatment modality for OIRD is a drug known as naloxone which is administered by emergency personnel to an individual who has overdosed on opioids and is suffering from OIRD. Naloxone as a drug also has its own issues like a short half-life; this precipitates withdrawal and blocks the analgesic effects of opioids. One of the major problems associated with naloxone is the potential need for repeated administration of higher doses to counter the effects of fentanyl and its analogs at the epicenter of this epidemic. This has made it necessary for development of new more efficient drugs with lesser side effects to counter this epidemic. Neuronal signaling from the superior cervical ganglion (SCG) is shown to modulate respiratory dynamics at least in part. The aim of this study was to deduce the effect of a novel thiol ester D-Cysteine ethyl ester (D-CYSee) on fentanyl-mediated effects on intrinsic Ca2+ activity in the SCG and to determine how it compares to naloxone. We used real-time Ca2+ imaging to deduce changes in intrinsic Ca2+ activity in response to voltage-gated Na+ and Ca2+ channel blockersand naloxone in presence and absence of fentanyl, and D-CYSee in presence and absence of fentanyl in cells isolated from the SCG. Key outcomes from our studies show that 1) cells receiving drug-free control treatment showed consistent activity and extracellular Ca2+ was key for the activity; 2) the activity was driven primarily by L-type calcium channels a (open full item for complete abstract)

Committee: Derek Damron Dr. (Advisor); Colleen Novak Dr. (Advisor); Lee Gilman Dr. (Committee Member); Gary Koski Dr. (Committee Member); Jennifer McDonough Dr. (Committee Member); Stephen Lewis Dr. (Committee Member) Subjects: Biology; Biomedical Research; Cellular Biology; Neurosciences

Master of Science (MS), Wright State University, 2024, Pharmacology and Toxicology

Cisplatin is an effective chemotherapeutic agent that is used to treat lung, breast, esophageal, ovarian, and pancreatic cancers. Despite being effective in treating a wide variety of cancer types, its cytotoxicity to off-target healthy tissues restricts its therapeutic application. The platinum atom of cisplatin interacts with DNA and results in the formation of inter-and intra-strand crosslinks, which are often referred to as DNA adducts. These adducts are mutagenic and potentially lethal to cells. The sole pathway for cells to excise intra-strand cisplatin-DNA adducts from the genome is through nucleotide excision repair. The fate of unrepaired DNA adducts is not understood fully. However, using a combination of differential centrifugation and DNA immunoblotting, we have detected cisplatin adduct-containing damaged DNA associated with small extracellular vesicles (SEVs) that are released into the cell culture medium. Moreover, the inhibition of caspase signaling blocks this release. Our observation that this response holds with multiple different cancer cell lines (U2OS, HeLa, HEK293, A375) suggests that it is a general phenomenon of cancer cell response to cisplatin. Because SEVs are involved in intercellular communication and can transmit their contents throughout the body, this work has important implications for the systemic effects of DNA damage-based anti-cancer therapies. Moreover, the detection of cisplatin adduct-containing DNA could be useful as a marker of cancer cell killing or side effects

Committee: Michael G. Kemp Ph.D. (Advisor); Yong-jie Xu M.D., Ph.D. (Committee Member); Ravi P. Sahu Ph.D. (Committee Member) Subjects: Genetics; Pharmacology; Toxicology

Doctor of Philosophy (PhD), Ohio University, 2023, Communication Studies (Communication)

This study extends knowledge on social support in promoting cervical cancer prevention in Nigeria. I drew on qualitative interviewing to understand and explain how supportive communication in interpersonal networks (relational networks and provider-patient interactions) and groups can influence women's decision to screen for cervical cancer in North-central Nigeria. The investigation focused on women's knowledge and experiences with cervical cancer and pap screening to identify supportive attributes that facilitated the uptake of pap screening in the female target population. A purposeful sample of 63 adult females participated in this study. An iterative approach was used to inductively synthesize and interpret data. Results characterize support provided by healthcare providers and lay persons (women, friends, family, and groups) as they provided relevant resources and modeled behaviors to convince women to utilize pap screening services. Insights from this study can serve as building blocks for constructing interpersonal and group communication interventions, and improving screening practices to increase the uptake of pap screening in North-Central Nigeria.

Committee: Christina Beck Dr. (Advisor) Subjects: Communication; Health

Master of Science, The Ohio State University, 2021, Dentistry

Abstract: Osteoporosis is a systematic skeletal disease that reduces bone mineral density (BMD) leading to a high risk of bone fracture with aging. While dual energy x-ray absorptiometry (DEXA) has been widely used to diagnose the osteoporosis, its 2D image limits its reliability to measure BMD. Otherwise, conventional medical computed tomography (CT) provides more comprehensive 3D images to improve the BMD based diagnosis. However, its high radiation dose limits access of patients. The objective of this study was to examine whether 3D dental cone beam CT (CBCT) can assess age-dependent changes of volumetric BMD and morphology with less radiation dose than the medical CT. Methods: After IRB approval, total of 138 clinical CBCT images were retrospectively obtained from 73 female and 65 male patients (20 to 69 years of age). The 3D images of cervical vertebral bodies (C2 and C3) were digitally isolated by removing lateral and posterior processes at 10 voxels from either side of the vertebral end plate. Non-bone voxels outside of the C2 and C3 were removed using a segmentation algorithm. A gray level, which is proportional to BMD, was obtained for each bone voxel and averaged to compute the mean gray value. Morphology including volume, heights, widths and concavities was also measured. Two-way ANOVA was performed with p<0.05.   Results: The C2 and C3 BMD of women over age 60 were significantly lower than those younger age 50 (p<0.010), while they were not significantly different between the age groups of men (p>0.061). The morphology of C2 and C3 were not significantly different between age groups of women (p>0.084). Conclusion: The reduced BMD of older women likely results from postmenopausal demineralization of bone. The current findings suggest that CBCT can detect age-dependent changes of cervical BMD providing baseline information to develop an alternative tool to diagnose osteoporosis.

Committee: Do-Gyoon Kim (Advisor); Toru Deguchi (Committee Member); Damian Lee (Committee Member); Fengyuan Zheng (Committee Member) Subjects: Dentistry; Medical Imaging

Doctor of Philosophy, The Ohio State University, 2020, Communication

Introduction: Surrogate information seeking (SIA), or the act of seeking information on behalf of another, is a common health behavior. However, the phenomena remains under studied. The first study tests key propositions of the Lay Information Mediary Behavior (LIMB) model in order to understand surrogates' motivations for SIA, engagement in active and passive SIA behaviors, and willingness to share information with care recipients. The second study tests an extended Cognitive Mediation Model (CMM) to further understand the cognitive mechanisms linking surrogates' seeking and sharing behaviors. Study 1: Semi-structured interviews were conducted with caregivers of breast, endometrial, and ovarian cancer patients (n = 19). Thematic analysis of these interviews suggested that caregivers engaged in active and passive SIA for intrinsic and extrinsic reasons. Caregivers predominantly sought information to close their own knowledge gaps, but they still shared new or novel information with their care recipient. Study 2: A cross-sectional survey was administered to the caregivers of breast cancer patients diagnosed within the last two years (n = 130). Partial support was found for the proposed model. Distal variables including surveillance gratifications, information requests, and caregivers' perception of patient information gathering capacity were associated with active and passive SIA behaviors. SIA behaviors, in turn, were associated with attention and elaboration. Perceived knowledge and elaboration were associated with sharing information with care recipients, but cognitive processing did not play a role in caregivers' perceptions of knowledge. Conclusion: Taken together, the studies in this dissertation suggest that while information surrogates are occasionally extrinsically motivated, most SIA is intrinsically-motivated. Caregivers engage in active and passive SIA, and share with their care recipients. Additional motivations, such as surveillance gratifications and p (open full item for complete abstract)

Committee: Shelly Hovick Ph.D. (Advisor); Cho Hyunyi Ph.D. (Committee Member); Jesse Fox Ph.D. (Committee Member) Subjects: Communication

Doctor of Philosophy, Case Western Reserve University, 2020, Biomedical Engineering

Multi-modality imaging is on the forefront of precision medicine, especially in the field of oncology, where radiological data enables accurate staging, prognostication, and precise anatomical localization for radiation therapy planning. In cervical cancer for example, 18F-labelled 2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) allows precise quantification of the local disease extent and distant metastatic burden. Moreover, magnetic resonance (MR) images empower a careful cancerous tissue targeting with radiation therapy by yielding a superior soft tissue contrast. As for computed tomography (CT), it supports FDG-PET attenuation correction and radiation planning by providing electron density information. However, such comprehensive and extensive investigations are generally expensive, inconvenient for the patient, and labor-intensive for the medical professionals especially for the radiation oncologist who needs to perform manual contouring of the targeted tumor and the adjacent normal tissues to be avoided or organs at risk (OARs). Nonetheless, the accuracy of such approach is affected by the inherent multi-image registration errors, and a workflow based on a single imaging session is highly desired. In this dissertation, we designed a novel approach for FDG-PET/MR based cervical cancer staging and radiation planning, by tailoring the state of art deep learning algorithms in order to accelerate and automate the workflow. First, we took advantage of image to image translation capacity with deep learning to perform cross-modality image synthesis by generating synthetic CT (sCT) from MR images, thus precluding the need for CT acquisition. To address time-expenses and patients discomfort without jeopardizing the treatment effectiveness, we carefully built our sCT generation models on two MR sequences only. Finally, we developed a novel approach for automatic contouring that leverage general anatomical topography knowledge with the deep learning s (open full item for complete abstract)

Committee: Raymond Muzic Jr, Ph.D. (Advisor); David Wilson Ph.D. (Committee Chair); Robert Brown Ph.D. (Committee Member); Xin Yu Sc.D. (Committee Member); Bryan Traughber M.D. (Committee Member) Subjects: Artificial Intelligence; Biomedical Engineering; Medical Imaging

Doctor of Philosophy, The Ohio State University, 2020, Public Health

Compared to the rest of the United States (U.S), Appalachia experiences significant health and economic disparities. Appalachian women are at increased risk for many chronic diseases, including cervical cancer. Prior research has suggested that the prevalence of risk factors for cervical cancer, including high-risk human papillomavirus (HPV) infection, is high among Appalachian women. Prior research also suggests that Appalachian women mostly perceive themselves to be at average risk of cervical cancer. One goal of this research was to compare an objective measure of cervical cancer risk to a woman's perceived risk of cervical cancer to determine misperceptions of risk. The main interest in misperception is to determine if there is an association of socioeconomic status (SES) at an individual as well as county-level with cervical cancer risk misperceptions. Considering that there is no published research investigating cervical cancer risk misperceptions, this dissertation will present novel findings in the domain of cervical cancer risk misperception research. Additionally, it is of interest to determine if cervical cancer risk misperception mediates the relationship between an individual's socioeconomic status and their adherence to cervical cancer screening guidelines. Lastly, this research will examine the association between individual and county-level SES with the outcomes of high-risk HPV infection and current abnormal Pap smear. Data for these studies were drawn from the Community Awareness Resources and Education (CARE) 1 project 3 study, a case-control study designed to determine variables associated with cervical cancer abnormalities among Ohio Appalachian women. HPV status was determined by biological specimen, and information regarding risk factors for cervical cancer were obtained from study surveys to construct an index for cervical cancer risk. Participants were categorized as low, average, or high risk for cervical cancer and this objective classi (open full item for complete abstract)

Committee: Electra Paskett (Advisor); Tasleem Padamsee (Committee Member); Michael Pennell (Committee Member); Paul Reiter (Committee Member) Subjects: Epidemiology; Public Health

MA, Kent State University, 2017, College of Arts and Sciences / Department of Sociology and Criminology

Previous research finds that breast cancer is less stigmatized than cervical cancer based on the different factors contributing to each disease. Utilizing data from the 2013 National Health Interview Survey, a nationally representative survey on broad health topics, I examine (1) whether a stigmatized cancer diagnosis results in greater psychological distress; and, (2) the extent to which the relationship between a cancer diagnosis and psychological distress is moderated by perceptions of neighborhood social cohesion. I hypothesized not only that women with cervical cancer experience greater distress, but also that they perceive themselves as more socially isolated compared to their counterparts suffering from breast cancer. Controlling for sociodemographic and neighborhood characteristics, I employ OLS regression to test my hypotheses. Findings show that women with cervical cancer do, indeed, experience more psychological distress than women with breast cancer. Moreover, for women with cervical cancer, perceptions of neighborhood social cohesion act as a buffer, thus narrowing the mental health gap between women with cervical and breast cancer. These findings add to the growing literature involving the stress process and neighborhood characteristics on psychological distress. They also have the potential to inform practitioners and policy makers about the benefits of focusing interventions at the neighborhood level in order to alleviate mental health disparities among subgroups that may be more vulnerable to psychological distress.

Committee: Manacy Pai Ph.D. (Advisor); Richard Adams Ph.D. (Committee Co-Chair); Kristen Marcussen Ph.D. (Committee Member) Subjects: Sociology

MS, University of Cincinnati, 2016, Education, Criminal Justice, and Human Services: Health Education

Human Papillomavirus (HPV) is the most common Sexually Transmitted Infected (STI) in the US with more than 90% and 80% of all sexually active men and women, respectively, becoming infected with HPV at some point in their lives. HPV is associated with cancer of the cervix, vulva, vagina, penis, or anus and genital warts, and cancer in the throat, including the base of the tongue and tonsils (CDC, 2016). Due to the morbidity and mortality of HPV-related diseases, recommendations by the Advisory Council on Immunization Practices (ACIP) are to routinely vaccinate boys and girls at age 11 or 12 against HPV (Markowitz, et al, 2014). Unfortunately, vaccine rates in adolescents receiving the first of three doses is an estimated 60% in females and 41.7% in males. The vaccine rates in adolescents receiving all three doses is an estimated 39.7% in females and 21.6% in males (Reagan-Steiner et al., 2015). The purpose of this study was to examine: 1) characterize school nurses' a) knowledge of HPV and the vaccine, b) self-efficacy to provide HPV vaccine information, c) intention to recommend the HPV vaccine and d) professional practice of providing HPV vaccine education and information, and 2) determine associations between school nurses' age, the number of years in school environment, geographical location and serving specific grade levels with the following variables: a) knowledge of HPV and the vaccine, b) self-efficacy to provide HPV vaccine information, c) intention to recommend the HPV vaccine and d) professional practice of providing HPV vaccine education and information. Results from this study suggest school nurses reported limited HPV and vaccine knowledge, moderate levels of self-efficacy, low intentions to regularly encourage parents to get their child vaccinated against HPV and lack engagement of professional practice in providing parents and students with HPV vaccine education and information. Despite empirical evidence of the HPV vaccine's efficacy and safety, (open full item for complete abstract)

Committee: Amy Bernard Ph.D. (Committee Chair); Brittany Rosen Ph.D. (Committee Chair) Subjects: Health Education

Doctor of Philosophy, University of Toledo, 2016, Health Education

Introduction: In 2016, it is estimated that approximately 12,500 American women will be diagnosed with cervical cancer and about 4,100 women will die from the disease (American Cancer Society, 2015). A recent study showed that there has been a 5.5% decrease in Pap test screening over the period of 2008-2013 (84.5% to 80.7%) (Sabatino, White, Thompson, & Klabunde, 2015). This is a troublesome statistic, since the Healthy People 2020 target of 93% has yet to be met (Healthy People 2020, 2014a). This urgent public health issue needs to be addressed. Although some studies have looked at predictors of Pap test screening (Eaker, Adami, & Sparen, 2001; Gu, 2010; Kahn, Goodman, Slap, Huang, & Emans, 2001) there is a gap in health behavior research examining the psychosocial factors that predict American women's failure to meet Pap test screening national recommendations (Chan, Yang, Gu, Wang, & Tao, 2015). This dissertation consisted of two studies: 1) Racial/Ethnic Disparities, Body Weight, and Other Psychosocial Antecedents that Predict Women's Failure to Meet Pap Test Screening National Recommendations and 2) Using the Modified Integrated Behavioral Model to Validate a Path Model of Women's Failure to Meet Pap Test Screening National Recommendations. The aim of both studies was to identify psychosocial variables explaining and predicting adult women's failure to meet Pap test screening national recommendations. Methods: The first study was a secondary data analysis of the 2014 National Cancer Institute's nationally representative HINTS 4 Cycle 4 data. The second study was an original, cross-sectional web survey using a modified Integrated Behavioral Model (IBM) to explain and predict failure to meet Pap test screening national recommendations. The outcome variable for both studies was failure to meet Pap test screening national recommendations. For the first study, the explanatory variables were identified based off the psychosocial and demographic correlates (open full item for complete abstract)

Committee: Jiunn-Jye Sheu PhD (Committee Chair); Timothy R Jordan PhD (Committee Member); Shipra Singh PhD (Committee Member); Andrew Geers PhD (Committee Member) Subjects: Health Education; Public Health; Public Health Education

Bachelor of Science (BS), Ohio University, 2016, Translational Health

Prior to this research, a pilot study was conducted in the rural Appalachian region to assess the relationships among the rate of cervical cancer and cervical cancer mortality, HPV status, food insecurity, produce intake, produce intake behavior, and risky sexual behavior (Hewage, 2014). Similar to the pilot study, this thesis assessed the impact of food security status, produce intake/behaviors, and risky sexual behaviors on HPV status, as well as the relationships among these variables in women of Appalachian Ohio attending a free clinic for gynecological care.

Committee: Cheryl Howe PhD (Advisor); Darlene Berryman PhD (Advisor) Subjects: Nutrition

Doctor of Philosophy, The Ohio State University, 2016, Public Health

Introduction: Malawi has the highest age-adjusted incidence of cervical cancer in the world and a case-fatality rate of over 60%. Virtually all cases of cervical cancer are caused by the human papillomavirus (HPV). Most women will have an HPV infection during their lifetime but the majority will clear the infection without any symptoms or lasting impact. Several risk factors are associated with increased risk of progression from initial HPV infection to cervical cancer. Our study examined a potential risk factor for HPV infection and evaluated self-collection of samples for HPV testing. Specifically, we examined intravaginal practices (IVP) as a risk factor for HPV infection and abnormal cervical lesions among rural Malawian women. Second, we examined the validity and feasibility of self-collected sampling for HPV testing in a clinic setting. Last, we assessed the acceptability and identified correlates of acceptability for self-collection of samples for HPV testing in a community setting. Methods: We used data from the baseline wave of a cohort study on sexual and reproductive health and a cross-sectional, clinic-based study examining sexual and reproductive tract infections. In our first aim, we used generalized linear models with a binomial distribution and log link and fisher's exact test to examine the associations between the type of intravaginal practices (IVP) (cleansing with soap and water, cleansing with cotton, cloth, or tissue, and inserting other substances) and frequency of IVP and HPV in 193 women presenting for care at a rural clinic in Lilongwe District, Malawi. Using this same population, we examined the feasibility, validity, and acceptability of self-collected sampling for HPV testing. In order to make these assessments we calculated a kappa statistic, sensitivity and specificity of self-collected samples compared to clinician-collected samples. Last, we used data from the baseline wave of a representative community-based cohort study among wome (open full item for complete abstract)

Committee: Alison Norris MD PhD (Advisor); Abigail Norris Turner PhD (Committee Member); Annie-Laurie McRee PhD (Committee Member); Abigail Shoben PhD (Committee Member) Subjects: Epidemiology; Public Health

Master of Arts in Psychology, Cleveland State University, 2015, College of Sciences and Health Professions

Despite the fact that cervical cancer screening techniques have made this disease nearly 100% preventable, 4,100 women are expected to die as a result of cervical cancer in the United States this year (American Cancer Society, 2015). This dismal estimation is due to the many barriers that stand in the way of women participating in screening. Two barriers commonly studied separately are knowledge and anxiety. This study uniquely hypothesized that anxiety would negatively moderate the otherwise positive relationship between knowledge and attendance. An additional hypothesis was that viewing the test as a preventative health measure would be positively associated with screening attendance. Surveys containing demographic questions and measures of knowledge and anxiety were given to women at a reproductive clinic, a university campus, and via social media websites. A logistic regression indicated that knowledge and anxiety do predict screening attendance. However, the interaction between knowledge and anxiety was not significant. Additionally, a significant difference regarding view of the purpose of the Pap test was found between attenders and non-attenders via a chi-square. These findings indicate that knowledge and anxiety are independent barriers to screening attendance and will therefore likely require separate interventions in order to be eliminated. Additionally, the way a women views the purpose of the Pap test was uncovered as a new barrier to screening. This indicates the importance of framing Pap tests as preventative health measures in order to encourage screening attendance.

Committee: Lisa Doane PhD (Advisor); Michael Horvath PhD (Committee Member); Michael Wisniewski PhD (Committee Member) Subjects: Clinical Psychology