Archived Announcements

STUDENT NAME: Charles Marks

COMMITTEE CHAIRPERSON:
Dan Werb, Assistant Professor, Division of Infectious Diseases and Global Public Health, University of California San Diego

COMMITTEE MEMBERS:
Salvador Espinosa, Associate Professor, School of Public Affairs, San Diego State University
Natasha Martin, Association Professor, Division of Infectious Diseases and Global Public Health, University of California San Diego
Laramie Smith, Assistant Professor, Division of Infectious Diseases and Global Public Health, University of California San Diego
Jennifer Pearson, Assistant Professor, School of Community Health Sciences, University of Nevada, Reno
María Luisa Zúñiga, Professor, School of Social Work, San Diego State University

TITLE OF DISSERTATION: Addressing Cigarette-Related Health Inequities Through a Trauma-Informed Lens

DATE OF DEFENSE: June 23rd, 2021
TIME OF DEFENSE: 10:00 AM Pacific
LOCATION OF DEFENSE: Zoom

 

ABSTRACT

Background: Research has indicated that exposure to traumatic events is associated with cigarette use and with related outcomes such as pulmonary disease. Better characterizing the connection between trauma exposure and cigarette use and related outcomes remains a critical gap.

            Theoretical Framework: We developed the Trauma-Informed Theory of Individual Health Behavior (TTB) to guide the aims of this dissertation. TTB articulates three types of trauma: historical trauma, acute experiences of trauma, and trauma-replicating environments.

            Aims: Aim 1 (Historical Trauma): Identify how historical trauma has been conceptualized within the academic literature studying substance use and produce recommendations for incorporating the historical trauma concept into tobacco use research. Aim 2 (Trauma-Replicating Environments [i.e., poverty]): Examine the impact of income level on cigarette use transitions (initiation, cessation, reinstatement) and on cigarette use prevalence. Aim 3 (Acute Experiences of Trauma): Evaluate the mediating role of cigarette smoking on the relationship between trauma exposure during childhood and chronic obstructive pulmonary disorder (COPD) and chronic heart disease (CHD).

            Methods: Aim 1 employed a scoping review strategy to identify relevant literature. Aim 2 was undertaken through the development of statistical models and a novel mathematical model of income and cigarette use. Aim 3 employed a causal mediation approach, based on inverse probability weighting, to assess the mediating role of lifetime cigarette smoking on the relationship between childhood trauma exposure and COPD and CHD incidence.

            Results: Aim 1: We identified literature examining the relationship between historical trauma and substance use. We highlight that quantitative methods may be poorly suited to the study of this topic. Aim 2: We identified that lower income level is associated with increased risk of adopting cigarette use and a diminished likelihood of cessating use. Further, that income is attributable to a substantial amount of cigarette use prevalence, particularly among those who have never used cigarettes before. Aim 3: We identified that cigarette use mediates the relationship between childhood trauma exposure and COPD and CHD.

            Conclusions: We have explored how different trauma constructs may be applied to better understanding tobacco use disparities. The findings hold important implications for policy endeavors to reduce the harms of tobacco use and for future research directions.

STUDENT NAME: Nicole Pepper

COMMITTEE CHAIRPERSON: María Luisa Zúñiga, PhD – School of Social Work, San Diego State University

COMMITTEE MEMBERS: Heather Corliss, PhD – School of Public Health, San Diego State University Tommi Gaines, DrPh – Department of Medicine, University of California, San Diego Mark Reed, PhD – School of Public Health, San Diego State University Davey Smith, MD, MAS – Department of Medicine, University of California, San Diego

TITLE OF DISSERTATION: Use of Alkyl Nitrite Inhalants (Poppers) among People with and At-Risk for HIV

DATE OF DEFENSE: June 4, 2021

TIME OF DEFENSE: 11AM to 1PM

LOCATION OF DEFENSE: Zoom

ABSTRACT

Statement of Problem: Alkyl nitrites (poppers) are potent short-acting inhalants commonly used by men who have sex with men (MSM). Despite their association with HIV risk, what is empirically established is not well understood. The aim of this dissertation is to describe available literature on the recreational use of poppers in the U.S. in the context of HIV, identify research gaps, contribute to a better understanding of biological impacts of popper use on MSM with HIV, qualitatively describe contextual factors impacting HIV care among young MSM with HIV, and provide recommendations for clinical care and future research.

Methods: Chapter 1 – A scoping review on the recreational use of poppers as a risk factor for people living with and at-risk for HIV in the U.S. was conducted using the Social Ecological Model. Studies were included if they reported results on the recreational use of poppers, were related to HIV or HIV risk, were published 2001-2021, and were conducted in the U.S. Chapter 2 – In this secondary analysis, total HIV DNA from peripheral blood mononuclear cells was measured. Non-parametric rank analysis of covariance (ANCOVA) was conducted on the dependent variable (HIV DNA), with group (no substances versus poppers) as the independent variable and alcohol, tobacco, and cannabis use as covariates. Chapter 3 – In-depth, semistructured interviews with young MSM (18-30 years) living with HIV were conducted to explore individual, social and environmental contexts of popper use influencing HIV care outcomes.

Summary of Findings: Poppers are widely used by MSM, although use varies significantly in this heterogeneous group. Existing research overwhelmingly supports the relationship between poppers and HIV risk, however the impact of popper use on the HIV care continuum remains not well established. Concurrent use of poppers and other drugs is common. Among people who use poppers, perceived risk of use is low and education is needed and desired. Clinicians caring for MSM and people with HIV are well situated to assess and address popper use. Implications for clinical care, public health, policy, and future research are discussed.