Karl Francis Krupp

Interests

Teaching

My teaching interests include scientific writing, grant writing, research ethics, community-based participatory research, and global health.

Research

Since 2007, I have been involved in global health research focused on the social determinants of health in India and populations living in the US Mexico border region. My research interests include primary and secondary prevention of cervical cancer, population screening for chronic diseases, and slum health.

Courses

Scholarly Contributions

Journals/Publications

• Kiplagat, S., Ravi, K., Sheehan, D. M., Srinivas, V., Khan, A., Trepka, M. J., Bursac, Z., Stephens, D., Krupp, K., & Madhivanan, P. (2022). Sociodemographic patterns of preterm birth and low birth weight among pregnant women in rural Mysore district, India: A latent class analysis. Journal of biosocial science, 1-15.
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  Few studies have utilized person-centered approaches to examine co-occurrence of risk factors among pregnant women in low-and middle-income settings. The objective of this study was to utilize latent class analysis (LCA) to identify sociodemographic patterns and assess the association of these patterns on preterm birth (PTB) and/or low birth weight (LBW) in rural Mysore District, India. Secondary data analysis of a prospective cohort study among 1540 pregnant women was conducted. Latent class analysis was performed to identify distinct group memberships based on a chosen set of sociodemographic factors. Binary logistic regression was conducted to estimate the association between latent classes and preterm birth and low birth weight. LCA yielded four latent classes. Women belonging to Class 1 "low socioeconomic status (SES)/early marriage/multigravida/1 child or more", had higher odds of preterm birth (adjusted Odds Ratio (aOR): 95% Confidence Intervals (CI): 1.77, 95% CI: 1.05-2.97) compared to women in Class 4 "high SES/later marriage/primigravida/no children". Women in Class 2 "low SES/later marriage/primigravida/no children" had higher odds of low birth weight (aOR: 2.52, 95% CI: 1.51-4.22) compared to women in Class 4. Women less than 20 years old were twice as likely to have PTB compared to women aged 25 years and older (aOR: 2.00, 95% CI: 1.08-3.71). Hypertension (>140/>90 mm/Hg) was a significant determinant of PTB (aOR: 2.28, 95% CI: 1.02-5.07). Furthermore, women with a previous LBW infant had higher odds of delivering a subsequent LBW infant (aOR: 2.15, 95% CI: 1.40-3.29). Overall study findings highlighted that woman belonging to low socioeconomic status, and multigravida women had increased odds of preterm birth and low birth weight infants. Targeted government programs are crucial in reducing inequalities in preterm births and low birth weight infants in rural Mysore, India.
• Krupp, K., Adsul, P., Wilcox, M. L., Srinivas, V., Frank, E., Srinivas, A., & Madhivanan, P. (2022). Prevalence and correlates of metabolic syndrome among rural women in Mysore, India. Indian heart journal, 72(6), 582-588.
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  Metabolic Syndrome (MetS) is a strong predictor of Coronary Heart Disease (CHD). Studies in urban India have found about one-third of Indians suffer from MetS. Less is known about the prevalence of MetS in rural areas, where 70% of the population reside. This study examined the prevalence of Metabolic Syndrome in a population of rural women in India.
• Krupp, K., Pope, B., Srinivas, A., Ravi, K., Khan, A., Srinivas, V., Madhivanan, P., & Bastida, E. (2022). Parity and later life risk for coronary heart disease among slum-dwelling women in Mysore, India. Indian heart journal, 73(5), 622-628.
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  To examine the role of parity in coronary heart disease (CHD) among middle-aged Indian women living in government-designated slums in Mysore, India.
• Srinivas, V., Nishimura, H. M., Jayakrishna, P., Krupp, K., Madhivanan, P., & Madhunapantula, S. V. (2022). Evaluating the feasibility of utilizing Gynocular-triage-to-diagnose application with VIA (Visual inspection with Acetic acid) in community cervical cancer screening programs in rural Mysore, India. Indian journal of cancer, 58(3), 409-416.
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  Cervical cancer is the third most common cancer among women in India. The aim of the study is to determine the feasibility of using the Gynocular-triage-to-diagnose (Gynocular T2D/GT2D) in conjunction with visual inspection with acetic acid (VIA) in community-based cervical cancer screening programs in rural Mysore, India.
• Weaver, L. J., Krupp, K., & Madhivanan, P. (2022). Conceptual and methodological challenges in idioms of distress research: Common questions and a step-by-step guide. Transcultural psychiatry, 13634615211042235.
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  Research premised on the construct of idioms of distress has proliferated in the last 40 years. The aim of this work is to foreground the experiential and socially adaptive functions of cultural expressions of distress around the world. Researchers who work in this field often begin from very different starting points in terms of their prior knowledge of the research context, their interest in theoretical or applied implications of their work, and the target areas of distress that they study. While this multiplicity of approaches ensures that the literature captures diverse manifestations of suffering, it also creates confusion for those who are new to the field and who may not know where to begin. This article seeks to resolve some of that confusion by identifying common conceptual challenges across the idioms of distress literature, and then providing a detailed step-by-step methodological example of an idioms of distress study in India that could be adapted for similar work in other contexts.
• Zohourian, T., Hakim, N., Dorcius, P. M., Shaheen, R., Rao, I. R., Carter, R., Krupp, K., & Madhivanan, P. (2022). Attitudes, beliefs, and norms about sex and sexuality among young Indian male adults: A qualitative study. Indian journal of sexually transmitted diseases and AIDS, 41(1), 35-38.
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  Little is known about the risky sexual behaviors, attitudes, beliefs, and sources of information regarding sexual health among young adult Indian males. Currently, students in Indian secondary schools do not receive a structured comprehensive sexual health education. This qualitative study explored the sources of information, knowledge, and attitudes around sexual behaviors among young men in Mysore, India.
• Degarege, A., Krupp, K., Tamargo, J., Martinez, S. S., Campa, A., & Baum, M. (2021). Polysubstance use and adherence to antiretroviral treatment in the Miami Adult Studies on HIV (MASH) cohort. AIDS care, 1-8.
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  Evidence for a relationship between polysubstance use, depression, and adherence to antiretroviral therapy (ART) is limited. The objectives of this study were to examine the associations of depression, illicit drug, and alcohol use with adherence to ART. People living with HIV (PLHIV) from the Miami Adult Studies on HIV cohort were asked about the number of doses of their ART medication missed to assess ART adherence. Harmful alcohol drinking was evaluated using the Alcohol Use Disorders Identification Test and illicit substance use assessed with self-report and urine screen. The Center for Epidemiologic Studies Depression Scale was used to assess depression symptoms. Of 391 PLHIV, 16.6% missed at least one dose (range:1-4) in the past four days. Cocaine/crack, opiate use, and depression were significantly independently associated with a greater mean number of doses missed. The mean number of doses missed was significantly greater among participants who used alcohol in combination with cocaine/crack, marijuana, and tobacco compared to non-users. In conclusion, polysubstance use increased the risk for poor ART adherence among PLHIV. The use of cocaine/crack or opiates individually and depressive symptoms also promote poor ART adherence. An integrated approach targeting substance disorders and depression may help achieve better ART adherence.
• Krupp, K., Madhivanan, P., Killgore, W. D., Ruiz, J. M., Carvajal, S., Coull, B. M., & Grandner, M. A. (2021). Neurological Manifestations in COVID-19: An Unrecognized Crisis in Our Elderly?. Advances in geriatric medicine and research, 3(3).
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  As of December 2020, there were more than 900,000 COVID-19 hospitalizations in the US with about 414,000 among individuals aged 65 years and older. Recent evidence suggests a growing number of older patients continue to suffer serious neurological comorbidities including polyneuropathy, cerebrovascular disease, central nervous system infection, cognitive deficits, and fatigue following discharge. Studies suggest that complaints manifest late in disease and persist beyond resolution of acute COVID-19 symptoms. Recent research reports that neurocognitive symptoms are correlated with severe disease, older age, male gender, and comorbidities including hypertension, renal failure, and neoplastic disease. The underlying causes are unclear, but current hypotheses include hypoxic-ischemic brain injury, immunopathological mechanisms, and neurotropism of SARS-CoV-2 infection. There is a pressing need for more research into the underlying mechanisms of post-COVID-19 neurological sequela, particularly in the elderly, a population already burdened with neurocognitive disorders.
• Lohr, A. M., Doubleday, K., Ingram, M., Wilkinson-Lee, A. M., Coulter, K., Krupp, K., Espinoza, C., Redondo-Martinez, F., David, C., & Carvajal, S. C. (2021). A Community Health Worker-Led Community-Clinical Linkage Model to Address Emotional Well-Being Outcomes Among Latino/a People on the US-Mexico Border. Preventing chronic disease, 18, E76.
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  Compared with their non-Hispanic White counterparts, Latino/a people have limited access to health resources that might improve their emotional well-being. Interventions that prioritize the Latino/a population, address social determinants of health, and decrease health disparities are needed. The objective of this study was to describe a community-clinical linkage intervention led by community health workers (CHWs) in 3 Latino/a populations along the US-Mexico border.
• Lutrick, K., Rivers, P., Yoo, Y. M., Grant, L., Hollister, J., Jovel, K., Khan, S., Lowe, A., Baccam, Z., Hanson, H., Olsho, L. E., Fowlkes, A., Caban-Martinez, A. J., Porter, C., Yoon, S., Meece, J., Gaglani, M., Burns, J., Mayo Lamberte, J., , Nakayima Miiro, F., et al. (2021). Interim Estimate of Vaccine Effectiveness of BNT162b2 (Pfizer-BioNTech) Vaccine in Preventing SARS-CoV-2 Infection Among Adolescents Aged 12-17 Years - Arizona, July-December 2021. MMWR. Morbidity and mortality weekly report, 70(5152), 1761-1765.
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  The BNT162b2 (Pfizer-BioNTech) mRNA COVID-19 vaccine has demonstrated high efficacy in preventing infection with SARS-CoV-2 (the virus that causes COVID-19) in randomized placebo-controlled Phase III trials in persons aged 12-17 years (referred to as adolescents in this report) (1); however, data on real-word vaccine effectiveness (VE) among adolescents are limited (1-3). As of December 2021, the Pfizer-BioNTech vaccine is approved by the Food and Drug Administration (FDA) for adolescents aged 16-17 years and under FDA emergency use authorization for those aged 12-15 years. In a prospective cohort in Arizona, 243 adolescents aged 12-17 years were tested for SARS-CoV-2 by reverse transcription-polymerase chain reaction (RT-PCR) each week, irrespective of symptoms, and upon onset of COVID-19-like illness during July 25-December 4, 2021; the SARS-CoV-2 B.1.617.2 (Delta) variant was the predominant strain during this study period. During the study, 190 adolescents contributed fully vaccinated person-time (≥14 days after receiving 2 doses of Pfizer-BioNTech vaccine), 30 contributed partially vaccinated person-time (receipt of 1 dose or receipt of 2 doses but with the second dose completed
• Madhivanan, P., Krupp, K., Coudray, M., Colbert, B., Ruiz-Perez, D., Cui, H., Bokulich, N., Narasimhan, G., Mathee, K., Cook, R. L., Schwebke, J., & Roe, D. (2021). Longitudinal assessment of nonavalent vaccine HPV types in a sample of sexually active African American women from ten U.S. Cities. Vaccine, 39(34), 4810-4816.
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  Chronic infection with high-risk human papillomavirus is a necessary cause for cervical carcinogenesis. This study examined prevalence of nonavalent vaccine preventable HPV types over four months among sexually active women in the United States.
• Madhivanan, P., Krupp, K., Waechter, R., & Shidhaye, R. (2021). Yoga for Healthy Aging: Science or Hype?. Advances in geriatric medicine and research, 3(3).
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  Yoga, one of the world's oldest health systems is receiving new attention for claims that it can contribute to healthy aging. Until recently, scientific evidence for its efficacy has relied heavily on small and poorly-designed research, but this is changing. Multiple, well-designed studies provide data showing that yoga practice has positive effects on cellular aging, mobility, balance, mental health, and prevention of cognitive decline-all areas of concern for older adults. Since the cost of implementing yoga-based community and home-based interventions is low-policymakers are also eyeing yoga practice as a cost-effective way to reduce medical costs and improve outcomes among a growing aging population. This commentary reviews the evidence for both physical and mental health benefits from yoga, as well as concerns about injuries that have been associated with certain types of yoga practice. It reveals a surprising range of yoga programs and difficulty levels that provide opportunities for almost anyone to participate and gain health benefits with practice.
• Madhivanan, P., Nishimura, H., Ravi, K., Pope, B., Coudray, M., Arun, A., Krupp, K., Jayakrishna, P., & Srinivas, V. (2021). Acceptability and Concordance of Self- Versus Clinician- Sampling for HPV Testing among Rural South Indian Women. Asian Pacific journal of cancer prevention : APJCP, 22(3), 971-976.
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  Despite being largely preventable, HPV-related cervical cancers continues to be the second highest cause of cancer deaths among Indian women. HPV testing using self-sampled samples may offer an opportunity to expand cervical cancer screening in India where there is currently a shortage of providers and facilities for cervical cancer screening. The study examines acceptability and concordance of self vs. clinician collected samples for HPV-relted cervical cancer screening among rural South Indian women.
• Ruiz-Perez, D., Coudray, M. S., Colbert, B., Krupp, K., Kumari, H., Stebliankin, V., Mathee, K., Cook, R. L., Schwebke, J., Narasimhan, G., & Madhivanan, P. (2021). Effect of metronidazole on vaginal microbiota associated with asymptomatic bacterial vaginosis. Access microbiology, 3(5), 000226.
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  Vaginal dysbiosis-induced by an overgrowth of anaerobic bacteria is referred to as bacterial vaginosis (BV). The dysbiosis is associated with an increased risk for acquisition of sexually transmitted infections. Women with symptomatic BV are treated with oral metronidazole (MET), but its effectiveness remains to be elucidated. This study used whole-genome sequencing (WGS) to determine the changes in the microbiota among women treated with MET. WGS was conducted on DNA obtained from 20 vaginal swabs collected at four time points over 12 months from five randomly selected African American (AA) women. The baseline visit included all women who were diagnosed with asymptomatic BV and were untreated. All subjects were tested subsequently once every 2 months and received a course of MET for each BV episode during the 12 months. The BV status was classified according to Nugent scores (NSs) of vaginal smears. The microbial and resistome profiles were analysed along with the sociodemographic metadata. Despite treatment, none of the five participants reverted to normal vaginal flora - two were consistently positive for BV, and the rest experienced episodic cases of BV. WGS analyses showed spp. as the most abundant organism. After treatment with MET, there was an observed decline of and species. One participant had a healthy vaginal microbiota based on NS at one follow-up time point. Resistance genes including and were detected. Though limited in subjects, this study shows specific microbiota changes with treatment, presence of many resistant genes in their microbiota, and recurrence and persistence of BV despite MET treatment. Thus, MET may not be an effective treatment option for asymptomatic BV, and whole metagenome sequence would better inform the choice of antibiotics.
• Srinivas, V., Herbst De Cortina, S., Nishimura, H., Krupp, K., Jayakrishna, P., Ravi, K., Khan, A., Madhunapantula, S. V., & Madhivanan, P. (2021). Community-based Mobile Cervical Cancer Screening Program in Rural India: Successes and Challenges for Implementation. Asian Pacific journal of cancer prevention : APJCP, 22(5), 1393-1400.
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  The aim of this study is to demonstrate the feasibility; mention the challenges encountered and highlight the success of implementing a community-based mobile cervical cancer-screening program in rural India.
• Valencia, D. Y., Habila, M., McClelland, D. J., Degarege, A., Madhivanan, P., & Krupp, K. (2021). Infection-associated biofilms and statins: protocol for systematic review. BMJ open, 11(5), e046290.
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  Owing to their propensity for being associated with infections, biofilms have become a focus in infectious disease research. There is evidence suggesting that statins, which are commonly used for prevention of cardiovascular disease, may prevent biofilm-associated infections, but this association has not been well-understood.
• Weaver, L. J., Krupp, K., & Madhivanan, P. (2021). The Hair in the Garland: Hair Loss and Social Stress Among Women in South India. Culture, medicine and psychiatry.
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  Generations of scholars have debated hair's significance as a symbol of womanhood, fertility, and spiritual morality in South India. For contemporary Indian women, hair is a site of concern, often expressed as an everyday preoccupation with hair loss or "hair fall," as it is known in the subcontinent. This exploratory study investigated hair fall among Kannada-speaking Hindu women in the South Indian city of Mysuru, Karnataka. It used a series of focus group discussions to explore how women talk about the causes and consequences of hair fall, and how women cope with hair-related distress. Participants articulated clear, shared ideas about why hair falls and how it can be managed. They connected hair fall to broader stressors in their lives both directly and symbolically. Hair fall, therefore, appears to function idiomatically in this context, both as an idiom of distress in its own right, and as a symptom of other idioms and forms of distress. Additional research is needed to establish the importance of hair fall relative to other distress constructs, and to more directly assess its potential value in research and intervention.
• Chandrashekarappa, S. M., Krishna, M., Krupp, K., Jaykrishna, P., Urs, C. V., Goswami, S. P., Ravi, K., Khan, A., Arun, A., Dawes, P., Newall, J., & Madhivanan, P. (2020). Size at birth and cognitive function among rural adolescents: a life course epidemiology study protocol of the Kisalaya cohort in Mysuru, South India. BMJ paediatrics open, 4(1), e000789.
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  It is proven that adverse intrauterine environment results in 'early life programming,' alterations in metabolism and physiological development of the fetus, often termed as 'Developmental Origins of Health and Disease' (DOHaD) resulting in a smaller size at birth, greater non-communicable diseases (NCD) risk factors during childhood and adolescence, and cardiometabolic disorders in adulthood. Nevertheless, very few studies have examined the relationship between DOHaD programming and cognition. This study aims to examine if impaired prenatal growth indicated by birth weight is associated with cognition among adolescents in the Kisalaya cohort, a rural birth cohort in South India, thus providing newer insights into DOHaD programming for adolescent mental health in a low-income and middle-income country setting.
• Degarege, A., Krupp, K., Srinivas, V., Ibrahimou, B., & Madhivanan, P. (2020). Structural equation modeling to detect correlates of childhood vaccination: A moderated mediation analysis. PloS one, 15(10), e0240749.
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  This study used a health belief theory derived framework and structural equation model to examine moderators, mediators, and direct and indirect predictors of childhood vaccination.
• Gonzalez, M., Montejo, K. A., Krupp, K., Srinivas, V., DeHoog, E., Madhivanan, P., & Ramella-Roman, J. C. (2020). Design and implementation of a portable colposcope Mueller matrix polarimeter. Journal of biomedical optics, 25(11).
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  Mueller matrix polarimetry can provide useful information about the function and structure of the extracellular matrix. A portable and low-cost system could facilitate the clinical assessment of cervical anomalies in low-resource settings.
• Kiplagat, S., Coudray, M. S., Ravi, K., Jayakrishna, P., Krupp, K., Arun, A., & Madhivanan, P. (2020). Evaluating a Conditional Cash Transfer Scheme in a Maternal Health Care Utilization Program Among Rural Pregnant Women in Mysore District, India. Women's health reports (New Rochelle, N.Y.), 1(1), 159-166.
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  According to the World Bank report in 2015, the maternal death rate in India was 174 per 100,000, which is among the highest in the world. The Indian Government launched the (JSY) conditional cash transfer program in 2005 to curb the adverse birth outcomes by promoting institutional delivery and providing antenatal care (ANC) services for pregnant women. This study evaluates the factors associated with JSY conditional cash transfer program in rural Mysore, India. Between 2011 and 2014, a prospective cohort study was conducted to examine the feasibility and acceptability of integrated ANC and HIV testing using mobile clinics in rural Mysore. Pregnant women in the provided an informed consent and answered an interviewer-administered questionnaire in local language, . All women underwent routine ANC services and were followed-up immediately after delivery, and 6 months and 12 months after delivery. Binary logistic regression was performed to identify factors associated with JSY benefits. The mean age of the 1,806 mothers was 21.2 ± 2.2 years and 58.9% of the mothers had primary education. Nearly half (51.6%) of the women reported having received JSY benefits. Factors associated with receiving JSY benefits included pregnant woman's partner not having any formal education (adjusted odds ratio [AOR]: 1.35; 95% confidence interval [CI]: 1.01-1.80), having income ≤4,000 Indian Rupees (AOR: 1.47; 95% CI: 1.04-2.09), rare visits (once in 3 months visit) with Accredited Social Health Activists (AOR: 3.55; 95% CI: 1.55-8.51), and delivery in a public institution (AOR: 1.23; 95% CI: 1.01-1.51). While JSY has been operational in India since 2005, there continue to remain major gaps in the receipt of JSY services in rural India. Future interventions should include targeted services and expansion of JSY scheme, specifically among rural pregnant women, who are most at need of these services.
• Krupp, K., Madhivanan, P., & Perez-Velez, C. M. (2020). Should qualitative RT-PCR be used to determine release from isolation of COVID-19 patients?. The Journal of infection, 81(3), 452-482.
• Shidhaye, R., Madhivanan, P., Shidhaye, P., & Krupp, K. (2020). An Integrated Approach to Improve Maternal Mental Health and Well-Being During the COVID-19 Crisis. Frontiers in psychiatry, 11, 598746.
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  The ongoing COVID-19 pandemic has led to disruption of normal life across the globe, severely affecting the already vulnerable populations such as the pregnant women. Maternal mental health and well-being is a public health priority and the evidence about the impact of COVID-19 on mental health status of pregnant women is gradually emerging. The findings of the recently published studies suggest that increased risk perception about contracting COVID-19, reduced social support, increase in domestic violence, disruption of antenatal care, and economic consequences of COVID-19 mitigation strategies can lead to adverse mental health outcomes in antenatal period. There is a significant increase in antenatal depression and anxiety since the onset of COVID-19 and social determinants of health (e.g., younger age, lower education, lower income) are associated with these poor outcomes. In this paper, we propose an integrated approach to improve the mental health and well-being of pregnant women. Physical activity and/or mind-body interventions like yoga can be practiced as self-care interventions by pregnant women. Despite social distancing being the current norm, efforts should be made to strengthen social support. Evidence-based interventions for perinatal depression should be integrated within the health system and stepped, collaborative care using non-specialist health workers as key human resource be utilized to improve access to mental health services. Use of digital platforms and smartphone enabled delivery of services has huge potential to further improve the access to care. Most importantly, the COVID-19 related policy guidelines should categorically include maternal mental health and well-being as a priority area.