Structural Drivers of Persistent Disparities in Tobacco Use and Secondhand Smoke Exposure

While the prevalence of tobacco use has declined substantially in recent decades, smoking remains the leading cause of preventable death in the United States. Moreover, patterns of tobacco use vary widely across socio-demographic groups. This dissertation explored structural drivers of persistent disparities in tobacco-related health outcomes, focusing on two examples in the U.S.: patterns of secondhand smoke (SHS) exposure among nonsmokers, and the high risk of smoking among sexual minority (SM) adults. In Chapter 2, I examined the relationship between smoke-free law coverage of workplaces and hospitality venues (restaurants and bars) and disparities in SHS exposure between 1999 and 2014. I found that smoke-free law coverage was associated with narrowing the differentials in SHS exposure between males and females, however, workplace smoke-free laws may have exacerbated SHS exposure disparities across quartiles of poverty income ratio, particularly for younger adults. In Chapter 3, I adopted attributable fraction and simulation modeling methods to quantify disparities in deaths attributable to SHS exposure between 2000 and 2016, and to project potential SHS exposure patterns through 2040. I found that Non-Hispanic Black adults have experienced a disproportionate burden of SHS-attributable mortality, compared to adults of other racial/ethnic backgrounds. In simulating the potential impacts of multiple intervention scenarios, I found that an intervention that weakened the association between smoking prevalence and SHS exposure resulted in more substantial declines in SHS exposure compared to an intervention that increased smoking cessation. Finally, in Chapter 4, I shifted focus to examine the high smoking prevalence among SM adults, including gay, lesbian, and bisexual individuals. I explored the relationship between smoking and exposure to state-level structural stigma, which encompasses societal norms and policies that constrain access to resources among stigmatized groups. Among SM adults, I found evidence of a curvilinear relationship between stigma and current smoking, where the probability of smoking was lowest at the lowest and highest levels of stigma. In sum, this dissertation examined patterns of tobacco-related health outcomes through a health equity lens. By combining empirical methods and simulation-based approaches, these studies provide insight into potential levers for reducing tobacco use and tobacco-related health disparities in the United States.PHDEpidemiological ScienceUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/162964/1/titusa_1.pd

Crossover: How Artists Build Careers Across Commercial, Nonprofit and Community Work

Explores how Los Angeles and San Francisco Bay area musicians, writers, and performing and visual artists move across sectors as part of their artistic and career development. Includes suggestions for developing opportunity and support for crossover

The human G93A-SOD1 mutation in a pre-symptomatic rat model of amyotrophic lateral sclerosis increases the vulnerability to a mild spinal cord compression

<p>Abstract</p> <p>Background</p> <p>Traumatic injuries can undermine neurological functions and act as risk factors for the development of irreversible and fatal neurodegenerative disorders like amyotrophic lateral sclerosis (ALS). In this study, we have investigated how a mutation of the superoxide dismutase 1 (SOD1) gene, linked to the development of ALS, modifies the acute response to a gentle mechanical compression of the spinal cord. In a 7-day post-injury time period, we have performed a comparative ontological analysis of the gene expression profiles of injured spinal cords obtained from pre-symptomatic rats over-expressing the G93A-SOD1 gene mutation and from wild type (WT) littermates.</p> <p>Results</p> <p>The steady post-injury functional recovery observed in WT rats was accompanied by the early activation at the epicenter of injury of several growth-promoting signals and by the down-regulation of intermediate neurofilaments and of genes involved in the regulation of ion currents at the 7 day post-injury time point. The poor functional recovery observed in G93A-SOD1 transgenic animals was accompanied by the induction of fewer pro-survival signals, by an early activation of inflammatory markers, of several pro-apoptotic genes involved in cytochrome-C release and by the persistent up-regulation of the heavy neurofilament subunits and of genes involved in membrane excitability. These molecular changes occurred along with a pronounced atrophy of spinal cord motor neurones in the G93A-SOD1 rats compared to WT littermates after compression injury.</p> <p>Conclusions</p> <p>In an experimental paradigm of mild mechanical trauma which causes no major tissue damage, the G93A-SOD1 gene mutation alters the balance between pro-apoptotic and pro-survival molecular signals in the spinal cord tissue from the pre-symptomatic rat, leading to a premature activation of molecular pathways implicated in the natural development of ALS.</p

A novel seed treatment-based multiplication approach for cassava planting material.

Cassava (Manihot esculenta Crantz) is an important food security crop in many parts of the developing world. The crop?s high yield potential and multitude of uses?both for nutrition and processing?render cassava a promising driver for the development of rural value chains. It is traditionally propagated from stem cuttings of up to 30 cm in length, giving a multiplication rate as low as 1:10. Propagating cassava traditionally is very inefficient, which leads to challenges in the production and distribution of quality planting material and improved cultivars, greatly limiting the impact of investments in crop breeding. The work described in the present study aimed to develop a seed treatment approach to facilitate the use of shorter seed pieces, increasing the multiplication rate of cassava and thus making the crop?s seed systems more efficient. After several tests, formulation was identified, consisting of thiamethoxam 21 g ha-1, mefenoxam 1.0 g ha-1, fludioxonil 1.3 g ha-1, thiabendazole 7.5 g ha-1 and Latex 2% as a binder. Plant growing from seed pieces treated with this formulation displayed increased crop establishment and early crop vigor, leading to an improved productivity throughout a full growing cycle. This allowed to reduce the cassava seed piece size to 8 cm with no negative effects on germination and crop establishment, leading to yields comparable to those from untreated 16 cm pieces. This, in turn, will allow to increase the multiplication ratio of cassava by a factor of up to 3. Notably, this was possible under regular field conditions and independently of any specialised treatment facilities. Compared with existing seed production protocols, the increased multiplication rates allowed for efficiency gains of between 1 to 1.9 years compared to conventional five-year cycles. We believe that the technology described here holds considerable promise for developing more reliable and remunerative delivery channels for quality cassava planting material and improved genetics

A Vacancy Model of Pore Annihilation During Hot Isostatic Pressing of Single Crystals of Nickel-Base Superalloys

An improved diffusion model of pore annihilation during hot isostatic pressing of single crystals of nickel-base superalloys is proposed. The model considers dissolution of pores by emission of vacancies and their diffusion sink to low-angle boundaries. The calculation, which takes into account pore size distribution,predicts the kinetics of pore annihilation similar to experimental one

Isoniazid preventive therapy-related adverse events among Malawian adults on antiretroviral therapy: A cohort study.

Adverse events may be a cause of observed poor completion of isoniazid preventive therapy (IPT) among people living with HIV in high tuberculosis burden areas. Data on IPT-related adverse events (AE) from sub-Saharan Africa are scarce. We report IPT-related AEs, associated clinical characteristics, and IPT discontinuations in adults who were stable on antiretroviral therapy (ART) when they initiated IPT. Cohort study nested within a randomized, controlled, clinical trial of cotrimoxazole and chloroquine prophylaxis in Malawians aged ≥ 18 years and virologically suppressed on ART. Eight hundred sixty-nine patients were followed for a median of 6 months after IPT initiation. IPT relatedness of AEs was determined retrospectively with the World Health Organization case-causality tool. Frailty survival regression modeling identified factors associated with time to first probably IPT-related AE. The overall IPT-related AE incidence rate was 1.1/person year of observation. IPT relatedness was mostly uncertain and few AEs were severe. Most common were liver and hematological toxicities. Higher age increased risk of a probably IPT-related AE (aHR = 1.02; 95% CI 1.00-1.06; P = .06) and higher weight reduced this risk (aHR = 0.98; 95% CI 0.96-1.00; P = .03). Of 869 patients, 114 (13%) discontinued IPT and 94/114 (82%) discontinuations occurred at the time of a possibly or probably IPT-related AE. We observed a high incidence of mostly mild IPT-related AEs among individuals who were stable on ART. More than 1 in 8 persons discontinued IPT. These findings inform strategies to improve implementation of IPT in adults on ART, including close monitoring of groups at higher risk of IPT-related AEs

Collaborative capacity development to complement stroke rehabilitation in Africa

This scholarly book focuses on stroke in Africa. Stroke is a leading cause of disability among adults of all ages, contributing significantly to health care costs related to long term implications, particularly if rehabilitation is sub-optimal. Given the burden of stroke in Africa, there is a need for a book that focuses on functioning African stroke survivors and the implications for rehabilitation within the African context. In addition, there is a need to progress with contextualised, person-centred, evidence-based guidance for the rehabilitation of people with stroke in Africa, thereby enabling them to lead socially and economically meaningful lives. The research incorporated in the book used a range of primary and secondary methodological approaches (scoping reviews, systematic reviews, meta-analyses, descriptive studies, surveys, health economics, and clinical practice guideline methodology) to shed new insights into African-centred issues and strategies to optimise function post-stroke