LUNG CANCER IN NEPAL: THE ROLE OF TRADITIONAL TOBACCO PRODUCTS AND COMBUSTION RELATED HOUSEHOLD AIR POLLUTION

The burden of chronic diseases such as cancer is increasing in low and middle income countries around the globe. Nepal, one of the world’s poorest countries, is no exception to this trend, with lung cancer as the leading causes of cancer deaths. Despite this, limited data is available on the environmental and behavioral risk factors that contribute to the lung cancer etiology in Nepal. The objectives of this dissertation are to: 1) investigate the ethnic differences in consumption of local tobacco products and their role in lung cancer risk in Nepal; 2) evaluate urinary metabolite of 1,3-butadiene as a biomarker of exposure to combustion related household air pollution (CRHAP); 3) investigate the association between CRHAP exposure and lung cancer risk using urinary metabolite of 1,3-butadiene as a biomarker of exposure; 4) investigate the association between CRHAP exposure and lung cancer risk using questionnaire based measure of exposure. Lung cancer cases (n=606) and frequency matched controls (N=606) were recruited from B.P. Koirala Memorial Cancer Hospital. We obtained biological samples and information on lifestyles including cooking habits and type of fuels used. We used liquid chromatograph tandem mass spectrometer (LC-MS/MS) to quantify urinary metabolites of 1,3-butadiene in urine samples. We employed a combination of logistic and linear regression models to detect any exposure-disease associations while controlling for known confounding variables. Overall, we found that ethnic groups in Nepal use different tobacco products that have different differing cancer potency -we observed the highest odds ratios for the traditional tobacco products. The biomarker analysis showed strong evidence that monohydroxybutyl mercapturic acid is associated with biomass fuel use among participants. However, we did not find significant association between urinary MHMBA and lung cancer risk. When we used questionnaire based measure of exposure to household air pollution, we observed significant, dose-response associations between CRHAP exposure and lung cancer risk, particularly among never-smokers. Our results show that important role of local tobacco products in lung cancer risk in Nepal. Furthermore, we demonstrate that CRHAP exposure is a risk factor for lung cancer risk, independent of tobacco smoking.

SEEKING CULTURAL FAIRNESS IN A MEASURE OF RELATIONAL REASONING

Relational reasoning, or the ability to identify meaningful patterns within any stream of information, is a fundamental cognitive ability associated with academic success across a variety of domains of learning and levels of schooling. However, the measurement of this construct has been historically problematic. For example, while the construct is typically described as multidimensional—including the identification of multiple types of higher-order patterns—it is most often measured in terms of a single type of pattern: analogy. For that reason, the Test of Relational Reasoning (TORR) was conceived and developed to include three other types of patterns that appear to be meaningful in the educational context: anomaly, antinomy, and antithesis. Moreover, as a way to focus on fluid relational reasoning ability, the TORR was developed to include, except for the directions, entirely visuo-spatial stimuli, which were designed to be as novel as possible for the participant. By focusing on fluid intellectual processing, the TORR was also developed to be fairly administered to undergraduate students—regardless of the particular gender, language, and ethnic groups they belong to. However, although some psychometric investigations of the TORR have been conducted, its actual fairness across those demographic groups has yet to be empirically demonstrated. Therefore, a systematic investigation of differential-item-functioning (DIF) across demographic groups on TORR items was conducted. A large (N = 1,379) sample, representative of the University of Maryland on key demographic variables, was collected, and the resulting data was analyzed using a multi-group, multidimensional item-response theory model comparison procedure. Using this procedure, no significant DIF was found on any of the TORR items across any of the demographic groups of interest. This null finding is interpreted as evidence of the cultural-fairness of the TORR, and potential test-development choices that may have contributed to that cultural-fairness are discussed. For example, the choice to make the TORR an untimed measure, to use novel stimuli, and to avoid stereotype threat in test administration, may have contributed to its cultural-fairness. Future steps for psychometric research on the TORR, and substantive research utilizing the TORR, are also presented and discussed.

An Investigation of Child and Adolescent Dental Sealant Predictors, NHANES 2011-2012

Objective: To examine sociodemographic and dental factors for associations with dental sealant placement in children and adolescents aged 6-18 years old. Methods: Secondary data analysis of 2011-2012 NHANES data was conducted. Multiple logistic regression models were used to assess relationships between predictor variables and sealant presence. Results: More than a third (37.1%) of children and adolescents have at least one sealant present; 67.9% of children compared with 40.4% of adolescents. Racial/ethnic differences exist, with Non-Hispanic black youth having the lowest odds of having sealants. Sealant placement odds vary by presence of dental home; the magnitude of the odds varies by age group. Those with untreated decay have lower odds of having sealants than those who do not have untreated decay (child OR: 2.6, 95% CI: 1.83-3.72; adolescent OR: 3.9, 95% CI: 2.59-6.07). Conclusion: Disparities exist in odds of sealant prevalence across racial/ethnic groups, income levels, and dental disease and visit characteristics. Further research is necessary to understand the reasons for these differences and to inform future interventions.

Maternal Age and Infant Mortality for White, Black, and Mexican Mothers in the United States

Funding for Open Access provided by the UMD Libraries Open Access Publishing Fund.