Environmental and dietary exposures alter the levels of homocysteine in the human
body; however, little is known about the association of smoking status with homocysteine
levels. This study aimed to examine the association of smoking status with homocysteine
levels and to determine whether the association is modified by estradiol, a female
hormone, or cholesterol, a type of lipid.
Data were obtained from National Health and Nutrition Examination Survey 2003-2004
with analysis done in 2018 on 4,580 adults aged 20 years and older. A current smoker
defined as a person who smoked at least 100 cigarettes in his/her lifetime and at
least once in the last month; a former smoker is one who had smoked less than 100
cigarettes and had quit smoking at the time of the interview; a “never smoker” is
an adult who never smoked cigarettes in their lifetime or less than 100 cigarettes
in his/her lifetime.
After adjusting for age, sex, ethnicity, education, and income level, homocysteine
levels did differ by smoking status. The addition of estradiol as an interaction term
in adjusted models was associated with a 16.6% increase in homocysteine levels when
compared to models without the interaction term. Estradiol but not cholesterol did
moderate the association between smoking status and homocysteine levels.
The study concluded that homocysteine levels did differ across smoking status after
adjusting for confounders. Estradiol did moderate the relationship between homocysteine
and smoking status. This suggests that smoking may have long-term negative effects
on homocysteine levels with estradiol exacerbating this relationship particularly
in current smokers, hence, the importance of programs to prevent smoking initiation
and close monitoring of estradiol levels in current smokers who are also on hormone
replacements or who are obese.
College of Public Health Alumni Publish on Uninsurance
Dr. Ifeoma Ozodiegwu and Dr. Shaoqing Gong Doctor of Public Health alumni, Epidemiology
Faculty from Hunan University, West Virginia University and the East Tennessee State
University College of Business and Technology are co-authors.
Studies have shown racial differences in uninsurance rate among adults in the United
States. Few studies have focused on social-behavioral factors with uninsurance rate
among Asian Americans. This study aimed to estimate the weighted prevalence of uninsurance
among Asian Americans of Chinese, Filipinos, Japanese, Koreans, and Vietnamese ancestry,
and compare it with Whites, African Americans and Latinos. A second objective of the
study was to evaluate the associations of smoking, citizenship, and socioeconomic
status with uninsurance.
A total of 24,136 adults (aged 18–64) including 2,060 Asian Americans were selected
from the combined 2013–2014 California Health Interview Survey. Among Asians, compared
to Koreans, being Filipinos or Vietnamese was associated with lower odds of being
uninsured; meanwhile being male, non-citizen, lower education, and higher poverty
were significantly associated with increased odds of uninsurance. Elder age groups
and current smoking were significantly associated with increased odds of uninsurance
in bivariate analysis; however, such associations disappeared after adjusting for
There are differences in prevalence of uninsurance between Asians and Whites, and
among Asian subgroups. However, compared to previous estimates, there appears to be
a downtrend in uninsurance estimates for Koreans and Vietnamese. Being male, lower
education, higher poverty, non-citizen, and current smoking were positively significantly
associated with uninsurance. These findings can help design better interventions to
reduce racial and ethnic disparities in uninsurance, especially for Asian Americans.
To date, there is very limited research examining uninsurance among Asian Americans.
Therefore, it is important to identify the factors propelling the uninsurance rate
in this population, in order to effectively reduce the number of uninsured individuals.
ETSU researchers secure NIH grant to study childhood obesity risk factors
Dr. Liang Wang Associate Professor, Biostatistics and Epidemiology
Researchers at East Tennessee State University recently received a two-year, $148,000
grant through the National Institutes of Health (NIH) Small Grant Program (R03) to
study childhood obesity.
“Our proposed study will significantly extend the current knowledge about the risk
of and the pathways to childhood obesity,” said Dr. Liang Wang, principal investigator
and associate professor in the Department of Biostatistics and Epidemiology in ETSU’s
College of Public Health.
Wang and his fellow investigators (Dr. Arsham Alamian from the College of Public Health’s
Department of Biostatistics and Epidemiology and Dr. Diana Morelen from the Department
of Psychology in the College of Arts and Sciences) are examining the longitudinal
interplay of key family and individual risk factors on predicting the development
of obesity from childhood through adolescence.
“Findings from this study will help design innovative interventions that are directed
not only at children’s diet and exercise levels, but also at family contexts and child-rearing
practices,” Wang said. “Hence, our study will have important policy and clinical implications.”
In addition to this study, Wang has authored many papers on obesity and has honed
in on this public health challenge through the establishment of several non-profit
He is the founder and president of the International Chinese Nutrition Young Scholar
Network (ICNYSN), which consists of approximately 3,000 global scholars, practitioners,
students, and other professionals in nutrition sciences, obesity and health care fields.
The organization supports young scholars’ career development, interdisciplinary collaboration,
and improvement of public health in China and worldwide.
During the spring 2019 semester, Wang spent his sabbatical at Harvard T.H. Chan School
of Public Health Department of Nutrition working with Drs. Frank Hu and Qi Sun for
research projects with focus on obesity and nutrition epidemiology.
Wang is also the founder and president of the Institute of Health Education and Lifecourse
Promotion (iHELP) and serves as board director with the China Health Policy and Management
His research interests include obesity, nutrition epidemiology, and health education
and promotion. He has published almost 100 articles in a variety of scientific journals
and book chapters in the field. He received the North American Chinese Society for
Nutrition Outstanding Leadership and Service Award in 2016, Dean’s Special Recognition
Award for University (ETSU) Leadership from Faculty Senate in 2017, Dean’s Special
Recognition Award for Service on the Faculty Council at ETSU in 2017, and the ETSU
College of Public Health Foundation Service Award in 2018. He was nominated for ETSU
Distinguished Faculty Award for Service in 2019.
Dr. Ying Liu Participates in OHSU Orthodontics Study
Dr. Ying Liu Associate Professor, Biostatistics
Dr. Ying Liu, Assistant Professor in East Tennessee State University College of Public
Health’s Department of Biostatistics and Epidemiology, is part of a study funded by
the National Institutes of Health to research how mechanobehavior affects of outcomes
of orthopedic appliances in brachyfacial and dolichofacial children.
Dr. Laura Iwasaki, Chair of Oregon Health & Science University Orthodontics, is principal
investigator of the study. Co-investigators include Dr. Liu as well as Drs. Michelle
Kim, Hongzeng Liu, and Jeff Nickel of OHSU, and Dr. Luigi Gallo of the University
Each year, across the United States, treatment of malocclusions costs more than $9.5
billion, and represents the third largest category of dental procedures for people
under 20 years of age. Approximately one third of malocclusions involve treatment
of skeletal discrepancies due to mandibular retrognathism. The annual failure rates
of mandibular growth enhancement therapies results in direct costs of greater than
$700 million dollars. Furthermore, poor results may require the surgical management
of the malocclusion, which adds morbidity risk and considerably more financial costs.
The focus of the study is to identify how TMJ intracapsular mechanics, and day- and
night-time muscle activities differentially affects outcomes of orthopedic appliances
in diagnostic subgroups of growing children. The long-term goal of the research is
to identifying practical ways to improve outcomes and reduce the financial burdens
of unsuccessful therapies.
Dr. Alamian Named to ASPPH Diversity and Inclusion Advisory Committee
Dr. Arsham Alamian Associate Professor, Epidemiology
Dr. Arsham Alamian, associate professor in the Department of Biostatistics and Epidemiology
of East Tennessee State University’s College of Public Health, has been named a member
of the newly established Diversity and Inclusion Section and Diversity and Inclusion
Advisory Committee of the ASPPH. Members of the Diversity and Inclusion Section are
charged with advancing diversity and inclusiveness in curricula, policies and practices
within their schools and programs.
Dr. Alamian’s research focuses on the epidemiology of chronic disease, as well as
the epidemiology of multiple risk factors for cardiovascular diseases such as metabolic
syndrome. He is co-investigator on an R15 grant exploring the role of a novel adipokine
on liver-adipose tissue awarded by the National Institute of Diabetes and Digestive
and Kidney Diseases, an R03 grant exploring the role of family dynamics on childhood
obesity awarded by the National Institute of Child and Human Development, and an ETSU
interdisciplinary research development grant of a randomized controlled trial of screening
for subclinical atherosclerosis among asymptomatic individuals.
Alamian, who is also an elected, full member of the American College of Epidemiology,
received his doctoral degree in public health, with a specialization in epidemiology,
from the University of Montreal School of Public Health. He completed a fellowship
in public health through a Canadian Institutes of Health Research fellowship program
at McGill University, also in Montreal, and holds a master of science degree in pharmacy,
with a specialization in pharmacoepidemiology, from Laval University in Quebec City.
College of Public Health Alumnus Selected for CDC Fellowship
Dr. Daniel Owusu Alumnus, Epidemiology
Daniel Owusu, alumnus of East Tennessee State University College of Public Health’s
doctor of public health program, has been accepted to join the 2019 class of the Epidemic
Intelligence Service (EIS) of the Centers for Disease Control and Prevention (CDC).
CDC describes the EIS as a “2 year post-doctoral training program for health professionals
interested in practice of applied epidemiology”. EIS is a “long-standing, globally-recognized
fellowship program, renowned for its investigative and emergency response efforts.”
He will work with the Epidemiology and Prevention Branch in the Influenza Division
at the National Center for Immunization and Respiratory Diseases located in Atlanta.
“The EIS is one of the most prestigious fellowship available, and one of the most
important, for young professionals with expertise in Epidemiology. These are the
celebrated “Disease Detectives” who play such an important role in protecting the
country, and the world, from a wide variety of diseases and health conditions,” said.
Dr. Randy Wykoff.
During his doctoral program in ETSU, Dr. Owusu undertook an internship with the World
Health Organization African Region office to work on tobacco and noncommunicable disease
control in order to experience public health practice in low-resource settings. He
completed his dissertation on tobacco smoking cessation in low-and-middle income countries.
Since graduating from ETSU, Dr. Owusu has been researching on how to communicate about
novel and alternative tobacco products, risk perception, and epidemiology of novel
and alternative tobacco product use as a Postdoctoral Research Associate at Georgia
State University. In addition, he is a key collaborator of the Tobacco Policy Research
Group (TPRG) in ETSU, and a member of the Sub-Sahara Tobacco Policy Research Group
(SATRG). He has authored or co-authored 27 peer-reviewed journal publications that
focused on tobacco, genetics, cancer and diabetes.
“It is an exciting moment for me to join the EIS class of 2019 and I look forward
to greater opportunities during and beyond the EIS fellowship. I see my acceptance
into the EIS class as a significant step that draws me closer to my dream of becoming
a leader in public health,” said Dr. Owusu. “It was this dream that influenced my
decision to pursue the DrPH degree program in the ETSU College of Public Health.”
Dr. Wykoff added “Since 2011, there have been 18 students with DrPH degrees admitted
into the EIS program. Even though there are over 75 DrPH programs in the country,
we are honored that four of these 18 EIS Officers are graduates of ETSU.”
“The great exposures during my doctoral training at ETSU, including a global public
health experience, and the invaluable supports from the faculty, staff, and alumni
of the college have immensely contributed to making this moment a reality,” concluded
Dr. Owusu. “I am forever grateful to all for your supports!”
ETSU Health Faculty and Students Study Hepatitis C in Rural Appalachia
Folawiyo Olanrewaju, Master of Public Health student, Biostatistics and Epidemiology
Folawiyo Olanrewaju, Master of Public Health student in East Tennessee State University’s
College of Public Health, has authored an article in the Healthcare Research and Public Safety Journal. The article, “Hepatitis C Virus Screening In Federally Qualified Health Centers in Rural Appalachia,” is a descriptive study designed to ascertain the Hepatitis C Virus (HCV) prevalence
and usefulness of screening in medical outreach settings compared to indigent healthcare
clinics in northeast Tennessee. Ms. Olanrewaju recently presented the research at
the Southern Regional Meeting of the Southern Society for Clinical Investigations
in New Orleans, Louisiana.
Drs. Patricia Vanhook and Stacey McKenzie of the ETSU College of Nursing, along with
College of Public Health students Falodun Ayotola, Anthony Peluso, Muhammed Jawla,
and Enaholo Omoike are co-authors.
The Hepatitis C Virus (HCV) is a common blood borne infection, with a higher age-adjusted
mortality rate than Hepatitis B Virus (HBV) or Human Immunodeficiency Virus (HIV).
Recent estimates show that more than 185 million people are infected with HCV worldwide.
The prevalence of HCV in the US is estimated at 2.7 to 3.9 cases per 100, 000 with
19 659 deaths in 2014. Without treatment, nearly 1.1 million people will die from
HCV by 2060. About 34 000 new cases of Hepatitis C Virus were reported in 41 states
in the US in 2015. The incidence of HCV in Tennessee was 13,023 per 100,000.
This descriptive study compares the observed outcome of routine HCV screening in medical
outreach settings and indigent healthcare clinics in Northeast Tennessee. Between
April 2017 and May 2018, routine, opt-out HCV testing was performed in 3 indigent
health care clinics and 3 medical outreach sites in the Tri-Cities region of Tennessee.
During screening, demographic information was collected and the de-identified data
A total of 120 persons were screened for HCV. Among these, 16 were HCV-antibody positive.
Of all patients screened, 67 (55.8%) were born between 1945 and 1965. 50% of HCV-antibody
positive patients were from this group. The frequency of males and females screened
were 46.7% and 53.3% respectively, with a higher proportion of males found to be positive
for HCV. Screening demonstrated HCV antibody prevalence of 13.33% among clients tested
in three indigent care clinics and three medical outreach events the in Tri-Cities
region. Most HCV-antibody positive persons were non-Hispanic whites (93.75%) in the
indigent care clinics.
The study identified a low prevalence of the Hepatitis C Virus in northeast Tennessee,
with a higher prevalence of Hepatitis C Virus among young adults, females, non-Hispanic
whites and indigent healthcare clinics. In this era of opioid epidemic contributing
significantly to the rates of HCV infection and the availability of direct-acting
antiviral agents that over a sustained virologic response rate of more 90%, the benefits
of targeted screening cannot be over emphasized.
CPH Alumni and Faculty Publish on Tobacco Use in Middle School Students
Drs. Hadii Mamudu, Liang Wang, and Mary Ann Littleton are faculty co-authors. College
of Public Health alumni Crystal Robertson Besse and Candice Collins along with undergraduate
research assistant Holdon Guy and Nashville State Community College faculty member
Rafie Boghozian are additional co-authors.
Tobacco smoking remains the leading preventable cause of morbidity and mortality in
the United States. Over 36.5 million people in the U.S. continue to smoke and tobacco
use accounts for over 480,000 annual deaths and about $300 billion in economic costs.
Tobacco control has become complicated due to the invention and popularity of new
tobacco products, including hookah/waterpipe, little cigar and cigarillos (LCCs),
and electronic cigarettes (e-cigarettes). In particular, research reports show that
e-cigarettes have become the most commonly used tobacco product among youth.
Disparities in tobacco use exist across regions in the United States. The Central
Appalachian region carries very high rates of tobacco use prevalence but research
on tobacco use initiation is sparse. The objective of this study was to investigate
the intention to try tobacco and its associated factors among nonsmoking youth.
Data were obtained from 539 school-based tobacco surveys conducted in 11 middle schools
(6th–8th grades; aged 10–15 years) in Northeast Tennessee in 2015–2016. Nonsmoking
participants without firm commitment to abstain from trying tobacco in the next year
were considered to have an intention to try tobacco. The Full Information Maximum
Likelihood estimation (FIML) method in Mplus was employed to conduct a multivariable
logistic regression analysis to delineate correlates of intention to try tobacco.
Overall, 20.0% of participants intended to try tobacco. Among participants with the
intention to try tobacco, 53.7% owned tobacco-branded item(s), 86.1% believed that
tobacco users have more friends, and 88.9% lived with tobacco users. The researchers
suggest that individual, interpersonal, and community level factors influence intention
to try tobacco in this environment where tobacco pre-emption laws impede development
of local tobacco control policies and regulations.
A concerning proportion of the participants intend to try tobacco in the next year.
Tobacco promotions and interpersonal factors are significantly associated with the
intention to try tobacco. This study provides a baseline for monitoring intention
to use tobacco in this high-risk population, and the results suggest the need to implement
strong school-based anti-tobacco programs in the midst of tobacco preemption laws
that prevent local tobacco policies and regulations.
Dr. Liang Wang Creates Measure for Health Literacy Database
Dr. Liang Wang Associate Professor, Biostatistics and Epidemiology
A health literacy measure created by Dr. Liang Wang, Associate Professor for the East
Tennessee State University College of Public Health’s Department of Biostatistics
and Epidemiology, has been selected for an online health literacy database. The instrument
measure individuals' health literacy related to infectious disease.
The database, the Health Literacy Tool Shed, is a collaboration among CommunicateHealth,
Inc., Boston University, and RTI International with funding provided by the National
Institutes of Health’s National Library of Medicine.
Recent definitions of health literacy focus on specific skills needed to navigate
the health care system and on the importance of clear communication between health
care providers and their patients. Health care providers and patients both play important
roles in health literacy, but most measures focus on an individual’s health literacy
level. The site contains information about measures, including their psychometric
properties, based on a review of the peer-reviewed literature.
"The Infectious Disease Specific Health Literacy scale (IDSHL) has important public
health utility,” stated Dr. Wang. “In particular, the scale is relatively easy to
use and administer and can be completed in 20–30 minutes.”
Dr. Wang and his team created and tested the measure “Infectious Disease-Specific Health Literacy Scale – IDSHL” in 2016. To create the measure, Dr. Wang’s team focused on three core principles
to guide conceptualization of the IDSHL instrument: cognition, decision-making and
self-efficacy to prevent or treat infectious diseases. They used these core principles
to facilitate four focus groups among individuals living in Beijing (average education
level: middle school) in order to gain a comprehensive understanding of the domains
which should be included in the instrument.
A conceptual model consisting of six domains was formed: five inter-related domains
assessed one's skills to prevent/treat infectious diseases and the remaining domain
assessed cognitive ability.
“This instrument can be used by healthcare professionals to screen patients who may
be at risk for misinterpreting key health information,” continued Dr. Wang. “It can
also be used as a population-level IDSHL assessment tool in public health promotion
and prevention activities and research."
College of Public Health Faculty and Alumna Publish on Obesity
Drs. Kesheng Wang and Arsham Alamian, faculty in the Departments of Biostatistics
and Epidemiology, and Dr. Ying Li, faculty in the Department of Environmental Health,
Asian immigrants first came to the United States in significant numbers more than
a century and a half ago, mainly as low-skilled male laborers who mined, farmed and
built the railroads. In 2014, among a total 42.4 million immigrants in the U.S., Asian
Americans accounted for 42.4%. The health of an immigrant population is a function
of influences derived from the sending country, the receiving country, and the migration
and resettlement experience itself. The existence of a healthy immigrant effect, i.e.,
that immigrants are on average healthier than the native born, is a widely cited phenomenon
across a multitude of literatures including epidemiology and the social sciences.
To date, however, there is very limited research examining the influence of immigrant
generation on obesity among Asian Americans.
The aim of this research was to analyze the association of immigration generation
and obesity among Asian Americans in California. The research team analyzed data from
a large population-based sample that is representative of Asian ethnic groups: Chinese,
Filipino, Vietnamese, Korean, and Japanese. In contrast, most national surveys on
health sample a small number of Asian Americans. Further, they pooled weighted data
from the latest cycle of California population, i.e., 2013–2014. The results of this
study can help to refine the diverse risk profile for obesity among Asian Americans
while also contributing to the overall understanding of the impact of migration on
chronic health conditions.
Overall, 23.3% of the Asian population was obese, and 40.0% was overweight. The percentage
of 1st, 2nd, and 3rd generation were 72.7%, 22.6%, and 4.6%, respectively. Overall,
1st generation of Asians had lower odds of being obese compared to Whites. Multiple
logistic regression analyses showed that overall, 2nd generation and 3rd generation
Asians had higher odds of being obese compared to 1st generation Asians. Among Chinese,
compared to the 1st generation, the 3rd generation had increased likelihood of being
Compared to Whites, Hispanics, and Blacks, Asian immigrants are less likely to be
obese. Among Asians, 2nd and 3rd generations were more likely to be obese than 1st
generation. The obesity rate seems to increase the longer Asian immigrants remain
in the United States. The results of this study can help to better understand the
diverse risk profile for obesity among Asian Americans while also contributing to
the overall understanding of the impact of migration on chronic health conditions.
ETSU Study Examines Cardiovascular Risk Factors of Hispanic Children
Dr. Basil Alhassan Alumnus, Epidemiology
A recent study by researchers at East Tennessee State University sheds new light
on the relationship between maternal physical activity and the cardiovascular health
of Hispanic children.
Dr. Basil Alhassan, an alumnus of ETSU’s Doctor of Public Health in Epidemiology program,
has published an article in PeerJ that discusses the relationship between maternal
physical activity and body mass index (BMI) and blood pressure, physical activity
and BMI in Hispanic preadolescents.
Drs. Ying Liu, Deborah Slawson, Jonathan Peterson and Arsham Alamian, faculty in the
ETSU College of Public Health, are co-authors. Additional co-authors include ETSU
faculty members Dr. Jo-Ann Marrs of the College of Nursing and Dr. William A. Clark
of the College of Clinical and Rehabilitative Health Sciences.
“Studies have shown physical inactivity, elevated blood pressure, and being overweight
or obese track from childhood to adulthood and increase the risk of cardiovascular
diseases, such as heart disease and stroke,” Alamian said. “We’ve also seen a correlation
between maternal obesity and physical inactivity and obesity and inactivity in older
“However, our study is the first to explore this relationship in Hispanic preadolescents.”
The researchers, led by Alamian, chair of the APPalachian Obesity and METabolic Diseases
(APPOMET) Working Group at ETSU, used data collected from 118 Hispanic children enrolled
in a metabolic syndrome study in Johnson City.
The investigators determined that about four out of every 10 preadolescents were overweight
or obese and about three out of 10 had elevated blood pressure.
This study also found that preadolescents of obese mothers were 6.47 times more likely
than preadolescents of mothers with normal BMI to engage in less than three days of
at least 60 minutes of vigorous physical activity per week.
Compared to preadolescents whose mothers engaged in moderate physical activity, children
whose mothers did not engage in moderate physical activity were 2.92 times more likely
to engage in less than three days of physical activity per week and were 2.5 times
more likely to have elevated blood pressure.
The prevalence of elevated blood pressure among Hispanic preadolescent subjects, especially
in 2- to-5- year-olds (45.7 percent) was higher than estimates from national studies.
“The findings suggest the need for public health interventions that would encourage
mothers to increase physical activity and improve weight control as a means for reducing
obesity and hypertension in Hispanic preadolescents,” the authors concluded.
Dr. Megan Quinn Leads Summer Student Project in Belize
Dr. Megan Quinn Associate Professor, Epidemiology
Dr. Megan Quinn is no stranger to leading students in real-world epidemiological training
experiences outside the United States. In the past, she has taken groups to Nicaragua
for summer projects; however, ongoing political unrest in Nicaragua called for a change
in locale for this summer's experiential training. Instead, the group traveled to
Punta Gorda, Belize, to partner with Hillside Healthcare International (HHCI). HHCI
is a faith inspired, non-profit organization dedicated to providing health care and
disease prevention to the people of Southern Belize. In addition, the group offers
"cuturally-rich educational rotations for medical, nurse practitioner, physician assistant,
pharmacy, physical therapy, and public health students that challenges them to better
understand their role in international health care."
While in Belize, students participated in a number of outreach and epidemiological
projects among the local population. These included implementing tuberculosis education,
creating a diabetes management patient tracking tool and data entry guide, quality
improvement projects for the public health depratment, working with mobile clinics,
and administering an HIV survey.
Dr. Quinn is an Associate Professor in the Department of Biostatistics and Epidemiology
in the College of Public Health where she also serves as the Coordinator for Global
Health Initiatives. She manages a number of roles within her department. She also
teaches several graduate-level classes, including Infectious Disease Epidemiology.
In addition, she is a member of the Center for Excellence in Inflammation, Infectious
Disease, and Immunity.
Dr. Maisonet Nogueras Funded to Study Endocrine Disrupting Chemicals
Dr. Mildred Maisonet Nogueras Assistant Professor, Epidemiology
Dr. Mildred Maisonet Nogueras, Assistant Professor in the Department of Biostatistics
and Epidemiology in the East Tennessee State University College of Public Health,
has received an R03 grant from the National Institute of Environmental Health Sciences
of the National Institutes of Health to study prenatal exposure to endocrine disrupting
chemicals and anti-müllerian hormone concentrations in female adolescent study participants.
The reproductive lifespan of the woman is largely determined by factors that regulate
the number of follicles laid down during fetal development and their subsequent degeneration
rate during adult life. Of concern is a possible role of endocrine disrupting chemicals
in dysregulating the number of follicles or in promoting depletion of the follicle
pool. Endocrine disrupting chemicals have been detected in human ovarian follicular
fluid. In addition, concentrations of certain types of these chemicals detected in
cord blood and amniotic fluid from pregnant women suggest human fetal exposure and
the possibility of follicular alterations beginning at an early developmental stage.
To date, the literature assessing potential human effects of exposure to environmental
endocrine disrupting chemicals on markers of ovarian reserve, such as anti-müllerian
hormone, is sparse. The goal of the project is to contribute to current knowledge
by conducting secondary analysis of data collected in female adolescents participating
in the Avon Longitudinal Study of Parents and Children to assess the association of
prenatal exposure to perfluoroalkyl sulfonate and organochlorine pesticides with anti-müllerian
Dr. Maisonet Nogueras and her team will also assess temporal changes in hormone concentrations
in relation to these exposures. The Avon Longitudinal Study of Parents and Children
is a population-based, birth cohort with a long follow-up period and extensive data
collection including the assessment of clinical measures in a large subset of participants.
Results of the proposed study will address the rather sparse, existing evidence and
support the development of new hypothesis.
Ifeoma Ozodiegwu to Present at National Session
Ifeoma Ozodiegwu will present her research poster, titled “Socioeconomic status and
overweight in low-income countries: A case study of the modifying role of education
on the association between household wealth and overweight in Mozambique,” during
the meeting’s Student Poster Session scheduled to take place later this year. The
session is sponsored by the Delta Omega Honorary Society in Public Health through
the Academic Public Health Caucus. Delta Omega hosts a national student poster session
honoring exceptional student research. Each year the selected students are given the
opportunity to present faculty nominated research at the APHA annual meeting. Participants
are awarded a cash prize and certificate.
Ozodiegwu is one of just 29 students selected to present her scholarship and research
at the APHA meeting in San Diego.
An international student from Nigeria, Ozodiegwu just completed her third year in
the doctor of public health program where she is concentrating in epidemiology in
the Department of Biostatistics and Epidemiology. She holds a master of public health
degree from ETSU and a bachelor’s degree in applied biochemistry from Enugu State
University of Science and Technology in Nigeria.
Earlier this year, Ozodiegwu was awarded the inaugural Sherrod Library Graduate Student
Scholarship for Excellence in Research at ETSU. She received the award for her paper
addressing the relationship between maternal obesity and neonatal mortality in sub-Saharan
Spring 2018 Student Awards
The Department of Biostatistics and Epidemiology honored its students at two award
ceremonies during April 2018. The first was the Annual ETSU College of Public Student
Award Ceremony on April 6, 2018 and the second was the ETSU School of Graduate Studies
Awards Ceremony on April 18, 2018.
Outstanding DrPH Epidemiology Student Chair's Award for Scholarship Ruby Yadav
University Libraries - Sherrod Library Graduate Student Scholarship for Excellence
in Research Ifeoma D. Ozodiegwu
Student Affairs Housing and Residence Life Housing GA of the Year Youssoufou Ouedraogo
Women on Wednesdays' talk: 'Environmental Contamination and Human Health'
Dr. Mildred Maisonet Nogueras Assistant Professor, Epidemiology
Human exposure to environmental contaminants is common. While studies demonstrate
that some people may be at higher risk of exposure than others, everyone is exposed
to some degree. East Tennessee State University epidemiologist Dr. Mildred Maisonet
will discuss this critical issue in a free public lecture on Wednesday, Jan. 31.
“Environmental Contamination and Human Health: Does It Matter?” is the fifth talk
in the 2017-18 “Women on Wednesdays” lecture series sponsored by ETSU’s Women’s Studies
Program. It will begin at noon in the presentation room of the Multicultural Center,
located on the second level of the D.P. Culp University Center, and a light lunch
will be provided.
Maisonet, an assistant professor in ETSU’s College of Public Health, will discuss
the current research on environmental contamination and human health. She will highlight
how and why some people are more vulnerable than others to environmental health risks
and provide useful strategies for minimizing those risks.
Prior to joining ETSU in 2014, Maisonet completed her doctoral degree in epidemiology
at the Johns Hopkins Bloomberg School of Public Health. In addition to her work at
ETSU and Johns Hopkins, she has worked at the Centers for Disease Control and Prevention,
the Rollins School of Public Health in Atlanta and the University of Oulu Faculty
of Medicine in Finland. Her research specialties include fetal origin of disease
and children’s environmental health.
The “Women on Wednesdays” series is designed to raise awareness about the research,
scholarship and community engagement that women at ETSU are doing; to provide a venue
where women on campus and in the community can discuss and support each other’s work;
and to give students an opportunity to meet faculty who could become mentors for their
For more information, call Dr. Phyllis Thompson, director of ETSU Women’s Studies,
at 423-439-4125. For disability accommodations, call the ETSU Office of Disability
Services at 423-439-8346.
Dr. Wang’s research team collected data for The Childhood Obesity Study in 2015 from
Beijing, Shanghai, Nanjing, and Xi’an. This study analyzed data from 1626 students
aged 7-16 and their parents. Results showed that, overall, 11.1% of the children were
obese, 19.7% had central obesity (as defined by waist-to-height ratio (WHtR) ≥ 0.48),
and 9.0% had hypertension. Over three months, 51.9% of children consumed Western fast
food while 43.6% of children consumed Chinese fast food.
Analyses showed that children whose mother had elementary school level of education
or below were more likely to consume western fast food. Authors also found that, when
running two models adjusting for Western then Chinese fast food consumption, maternal
body mass index was positively associated with child obesity, central obesity, and
Other authors on the article include Yaling Zhao and Youfa Wang from Xi’an Jiaotong
University Health Science Center, Hong Xue from Virginia Commonwealth University,
and Huijun Wang, Chinese Center for Disease Control and Prevention.
This study was funded in part by the National Institute of Health.
BMC Public Healthis an open access, peer-reviewed journal that considers articles on the epidemiology
of disease and the understanding of all aspects of public health. The journal has
a special focus on the social determinants of health, the environmental, behavioral,
and occupational correlates of health and disease, and the impact of health policies,
practices and interventions on the community.
College of Public Health Faculty, Students, and Alumna Publish in International Journal
of Public Health
Gabrielle Caldara, Heather Owens, Ifeoma Ozodiegwu, and Elaine Loudermilk, graduate
students in the Department of Biostatistics and Epidemiology, along with Dr. Jill
Stinson of the Department of Psychology and College of Public Health alumna Kathleen
Collins, are co-authors. Project Hope United Kingdom’s Thoughtful Path Program in
Munsieville, South Africa was integral to the success of the project.
Adverse childhood experiences research based in the United States demonstrates that
traumatic stress in childhood can cause negative physical and mental health outcomes.
Many developing countries lack extensive research and comprehensive data on exposure
to childhood trauma. The World Health Organization ACE international questionnaire
(ACEIQ) highlights multiple types of abuse, neglect, and violence while broadening
the definition of traumatic stress to include more globally relevant concerns.
The goal of the research project was to modify the questionnaire to use culturally
appropriate questions and terminology for Munsieville, an undeveloped township in
South Africa. Without adapting the questionnaire to use culturally appropriate questions
and terminology, respondents may not have been able to provide appropriate responses.
After meeting to focus groups to modify the survey, it was given to local stakeholders
for review and approval. The pilot study demonstrated that the modified questionnaire
provides a comprehensive, and culturally appropriate, measure of childhood trauma,
leading to increased community participation during a survey conducted in early 2017.
College of Public Health Faculty Research Diabetes among Veterans
Dr. Ying Liu Assistant Professor, Epidemiology
Dr. Ying Liu, Assistant Professor in the Department of Biostatistics and Epidemiology
in the East Tennessee State University College of Public Health, has published a research
brief for the Centers for Disease Control and Prevention regarding diabetes among
the United States veteran population. The brief, “Prevalence of and Trends in Diabetes Among Veterans, United States, 2005–2014,” examined data from five cycles of the US National Health and Nutrition Examination
Drs. Kesheng Wang, Shimin Zheng, and Liang Wang from the Department of Biostatistics
and Epidemiology along with Dr. Ying Li of the Department of Environmental Health
in the College of Public Health are co-authors. Sonica Sayam of University of Maryland
and Xiaonan Shao of Carnegie Mellon University are additional co-authors.
Diabetes was the seventh leading cause of death in the United States in 2013. Approximately
30.3 million Americans had diabetes, including an estimated 7.2 million who had the
disease but had not received a diagnosis. The disease is more prevalent among US veterans,
who make up 9% of the civilian US population, than among the general population and
affects nearly 25% of US Department of Veterans Affairs patients.
NHANES obtained representative samples from 50 states and the District of Columbia.
Veteran status was self-identified through participant household interviews. The number
of veterans interviewed ranged from 472 to 685 for each cycle from 2005 through 2012.
The researchers found the prevalence of diabetes in veterans in 2013–2014 was 20.5%
and the prevalence of undiagnosed diabetes was 3.4%. Diabetes was most prevalent
among veterans aged 65 years or older (27%), among male veterans (22%), among veterans
with less than 12 years of education (33.5%) and among veterans with an annual income
below the federal poverty line (23.8%). The team concluded that effective prevention
and intervention approaches are needed to lower diabetes prevalence among US veterans
and ultimately improve their health status.
Dr. Arsham Alamian Re-Elected to the APHA Governing Council
Dr. Arsham Alamian Associate Professor, Epidemiology
Dr. Arsham Alamian has been re-elected to the Governing Council. The Governing Council
is the representative legislative body of the American Public Health Association (APHA).
It consists of voting and nonvoting members who represent different constituencies
Voting members include: at least two elected representatives of each Section (Dr.
Alamian will represent the Epidemiology Section) and an additional number of representatives
from the unaffiliated membership; one representative designated by each (state or
regional) Affiliated Association; the officers of the Association; the chair of the
Intersectional Council, the chair of the Council of Affiliates, and chair of the Student
Assembly; the elected members of the Executive Board; and three elected representatives
and the immediate past chair of the Student Assembly.
The primary roles of the Governing Council as set forth in the Bylaws are to:
Establish policies for the Association and for the guidance of the Executive Board
and the officers; amend the Bylaws of the Association and to adopt rules for the conduct
of its own business.
Receive and act upon reports or recommendations from any organization constituent,
the Science Board, the Action Board, the Education Board, the Standing Committees
and the Executive Board.
Elect the Executive Board, the officers of the Association, and honorary members.
Establish Sections of the Association; combine or discontinue Sections; prescribe
the composition of the Section Councils; maintain coordination among the Sections;
and formulate general rules governing their policies; and recognize Affiliates Associations.
Detection of Risk Factors and Trends of Oral Health among U.S.
Dr. Ying Liu Assistant Professor, Epidemiology
Dr. Ying Liu, Assistant Professor, Department of Biostatistics and Epidemiology was
a recent recipient of a grant titled, Detection of Risk Factors and Trends of Oral Health among U.S., from the East Tennessee State University, Research Development Committee. The funds
will allow Dr. Liu to secure the NHANES database and support data analysis.
While oral health disparities continue to serve as a major health-related threat for
a large number of individuals in the U.S., the available evidence would strongly suggest
that problems faced by U.S. veterans in this area are currently among the most severe.
The objective in this study is to identify those U.S. veterans at greatest risk for
oral health issues. The study will utilize data from the National Health and Nutrition
Examination Survey (NHANES). To address the critical needs for oral health in U.S.
veterans, the planned specific aims are as follows. Specific Aim #1: Determine temporal
changes in the oral health status of U.S. veterans. Specific Aim #2: Identify key
risk factors that predict oral health problems in U.S. veterans.
At the completion of this research, Dr. Liu’s expectation is to have identified key
risk factors that predict oral health status and temporal changes of oral health status
in U.S. veterans. These results can ultimately be expected to have a significant positive
impact on development of cost-effective interventions to improve the oral health among
U.S. veterans. The successful completion of this project will also provide better
targeting of available resources and monitoring of veterans’ oral health status, and
aid in developing policies to improve the oral health of U.S. veterans, a too often
Drs. Abraham Alhassan and Arsham Alamian Featured in Illuminated: Cardiovascular Health Risks in Hispanic Children
Dr. Abraham Alhassan DrPH Alumnus, Epidemiology
Dr. Arsham Alamian Associate Professor, Biostatistics and Epidemiology
Abraham Alhassan, Doctor of Public Health graduate with a concentration in Epidemiology,
and Dr. Arsham Alamian, Assistant Professor in the Department of Biostatistics and
Epidemiology, have studied the prevalence of cardiovascular risk factors in the investigation
of metabolic syndrome among Hispanic children in Johnson City, TN. For his dissertation,
Abraham focused on three topics that influence health outcomes: diet, sociodemographic
factors and biomarkers to examine their association with cardiovascular diseases among
Hispanic children. Abraham graduated Spring 2017 and is pursuing a career in public