Digital Commons Network^™

Support Beyond Services: Examining The Role Of Neighbor Relationships, Housing Staff, And Place In Mental Health Recovery, Kenna Estell Dickard

Dissertations and Theses

This dissertation explores the role of non-clinical support for individuals with serious mental illness (SMI). Through three interconnected manuscripts, this dissertation highlights the importance of housing staff support, places in the community, and neighbor relationships in fostering recovery for individuals with SMI. The first manuscript analyzes how housing staff support influences residents' well-being through an ecological lens. This study found that staff support is associated with reduced loneliness, higher residential satisfaction, and increased sense of community. This study also considers the role of self-determination as a moderator, demonstrating the importance of resident agency in maximizing well-being outcomes. The second manuscript …

Assessing Older Adult Behavioral Health Diagnoses In Oregon By Geographical Area, Physical Disability Status, And Age., N F. Parsons, Allyson Stodola, Ellis Hews, Nirmala Dhar, Sheryl Elliott, Sarah Dys, Walter D. Dawson

Institute on Aging Publications

This repeated cross-sectional study aims to assess potential differences among behavioral health (BH) diagnoses for older adults. Differences in services across urban versus rural/remote areas may contribute to deeply entrenched barriers to improved BH for this population.

The Effect Of Birthweight And Gestational Age On Cognitive Function In Midlife: The Bogalusa Heart Study, Eunsun Gill, David J Libon, Soo Jung Kang, Ileana De Anda-Duran, Lydia A Bazzano, Wei Chen, Camilo Fernandez-Alonso, Emily W Harville

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Although the relationships between birthweight, gestational age (GA), and cognitive function (CF) before midlife have been demonstrated, the relationships after midlife and potential racial disparities remain inconclusive. This study examined the association between birthweight, GA, and midlife CF stratified by race.

METHOD: 1,032 subjects from the Bogalusa Heart Study (67% Whites, 33% Blacks, mean age 48.1 ± 5.3 years) were studied. Cognition was assessed with tests measuring verbal episodic memory, working memory, attention, graphomotor information processing speed, and global CF. Each test was standardized by sex and age, then averaged. The global CF was computed by averaging all cognitive …

The Ecology Of Gender-Based Violence For Syrian Refugee Women In Tripoli And Akkar, Dima Masoud

Dissertations and Theses

Lebanon is a country that suffers from multiple economic, political, and health crises. Additionally, the mass displacement of Syrian refugees to Lebanon after the war in Syria over a decade ago has left Syrian refugees vulnerable, including the vulnerability of Syrian refugee women to gender-based violence (GBV). While these conditions have affected all of Lebanon, this dissertation focuses on the regions of Tripoli and Akkar in northern Lebanon. Tripoli and Akkar are regions that border Syria, which means that an influx of Syrian refugees, mostly unregistered, comes in. While other regions in Lebanon also border Syria, Tripoli and Akkar are …

How Far-Right Populism Harms Ethnic Minorities’ Health: The Case Of The United States, Dina Rosenberg

Working Papers Series

Public health is a political issue, and the health of ethnic minorities is a key component of it. We argue that far-right populism, whether grassroots or elitist, harms the health of immigrants and minorities. Anti-minority attitudes and policies—such as health chauvinism promoted by far-right populists—along with hate rhetoric and ensuing personal and institutional discrimination create a climate of hostility that negatively affects health outcomes in underprivileged communities. We hypothesize that immigrants and ethnic minorities living in such a climate are more likely to experience health problems and underutilize healthcare. To test this, we leverage the significant variation between U.S. states …

The Gender Effects Of Covid: Evidence From Equity Analysts, Frank Weikai Li, Baolian Wang

Research Collection Lee Kong Chian School Of Business

We use COVID-19 and sell-side analysts as an experiment to study the effects of gender on labor productivity. We find that the forecast accuracy of female analysts declined more than that of male analysts, especially when schools were closed and among analysts who were more likely to have young children, were inexperienced, were busier, or lived in southern states of the US. Relative to male analysts, females also reduced their forecast timeliness and resorted to more heuristic forecasts but did not reduce coverage or updating frequency. Relative to pre pandemic, female analysts’ careers were more negatively affected than male analysts’. …

Prevalence And Associated Factors Of Mental And Substance Use Problems Among Adults In Kenya: A Community-Based Cross-Sectional Study, Patrick Nzivo Mwangala, Anita Kerubo, Millicent Makandi, Rachel Odhiambo, Amina Abubakar

Institute for Human Development, East Africa

Data on the burden and determinants of mental and substance use problems among women in urban and rural informal settlements in Kenya is sparse, thus limiting preventive and treatment efforts in these areas. To bridge the gap, we (a) determined the prevalence of depressive, anxiety and post-traumatic stress disorder (PTSD) symptoms and alcohol and drug use problems among women compared to their spouses and (b) examined the correlates of these outcomes. Data collection for this cross-sectional survey was conducted in 2022 in Mombasa, Kwale and Nairobi counties in Kenya. A total of 1528 adults (1048 women) took part. The 9-Item …

How Do Health Insurer Practices Affect Health Equity For Gay And Bisexual Men And Transmasculine Individuals? A Qualitative And Health Policy Assessment, Alexa D'Angelo

Dissertations and Theses

In the U.S. there continue to be stark disparities in health that affect LGBTQ+ communities. These disparities include those related to mental health, sexually transmitted infections, along with chronic illnesses and some cancers. Higher health needs across diagnostic categories mean that LGBTQ+ individuals require access to the healthcare system both to prevent conditions disproportionately affecting the community, and to treat conditions as they arise. In the U.S., access to healthcare often requires either reliable insurance coverage or another payer to cover costs associated with care. Thus, health insurance status and coverage of care, along with coverage regulations and health policies …

The Rose That Grew From Concrete: Exploring The Romantic Experiences Of Black Men With Histories Of Childhood Sexual Abuse, Tatyana Nichelle Smith

Dissertations

Contemporary research typically characterizes Black heterosexual relationships by dismal marriage and divorce rates, largely ignoring the reality of how Black men develop attachments with their romantic partners and therefore continuing to perpetuate deficit perspectives of Black men (e.g., the cause of conflictual romantic relationships and “broken” Black families). What may be less understood about these relationships is the influence of childhood trauma, such as childhood sexual abuse, and Black men’s experiences of gender role conflict. Research shows that Black men’s experiences of childhood sexual abuse and socialization about masculinity have important implications for how they come to view themselves and …

Down Syndrome In Africa: Challenges, Opportunities, And Future Directions, Eimear Mcglinchey, Salina Tewolde, Amanda He, Juan Fortea, Lingani Mbakile-Mahlanza, Ayda Tefera, Emmanuel Epenge, Jason Hassenstab, Rachel Maina, Zul Merali

Brain and Mind Institute

INTRODUCTION: As life expectancy improves for people with Down syndrome (DS) in Africa, the risk of developing DS-associated Alzheimer’s disease (DSAD) will rise. There is a pressing need to plan for this emerging challenge, particularly in the context of existing health and social disparities.

METHODS: This work emerged from a pan-African collaboration, including discussions at the Brain Ageing and Dementia in Low- and Middle-Income Countries conference held in Nairobi in 2024, where stakeholders identified regional priorities for DS and dementia care.

RESULTS: Limited epidemiological, cognitive, biomarker data, delayed diagnoses, and gaps in specialized services may impact access …

Ecological Grief Among Farmers And Pastoralists In Ethiopia And Kenya, Syed Shabab Wahid, Christine Musyimi, Benjamin Oestericher, Linda Khakali, Lauren Carruth, Emily Mendenhall, Edna Bosire

Brain and Mind Institute

Climate change is a major cause of mental distress worldwide. In many ways, climate change has become a chronic disaster, while in other ways each acute event can accumulate and present challenges within and between communities. A growing body of evidence indicates that a changing climate can precipitate a cluster of negative affective states scholars call “ecological grief.” Ecological grief reflects psychological responses to climate changes and destruction of nature, species, culturally significant or sacred spaces. Until now, ecological grief has been conceptualized as a psychological response connected primarily to the destruction of the natural environment, and has not fully …

Tobacco, Alcohol, And Poverty In Lao Pdr Based On National Survey Analysis, Robert M. Semakula

Loma Linda University Electronic Theses, Dissertations & Projects

Tobacco and alcohol use are among the most prevalent and harmful addictive behaviors globally, including in the Lao People’s Democratic Republic (Lao PDR). In Southeast Asia and the Western Pacific, substance use patterns are shaped by cultural, social, economic, policyrelated, and environmental factors. This study aimed to: (1) explore associations between different patterns of alcohol and tobacco use among men and women in Lao PDR, and (2) investigate the effect of poverty on the relationship between alcohol and tobacco use. We conducted a secondary analysis of the 2013 Lao National Adult Tobacco Survey (N = 9,706), a nationally representative sample …

A Comprehensive Literature Review Of Gender Differences In Perception And Response To Stress, Zoe M. Shankland

University Honors Theses

It is well established that psychological stress, whether acute, chronic, or recurring, creates an imbalance in the body’s ability to regulate itself, leading to the potential for long-term disease. This paper looks at the possibility that women (anyone who identifies as a woman) experience more general mental stress than men (anyone who identifies as a man) due to women experiencing unique stressors under a patriarchal society. Men and women live different lives in modern society due to differing societal expectations and biological processes for women (menstruation, pregnancy, menopause). These extra feelings of stress may be tied to traditional gender roles …

Linking Symptom Inventories Using Semantic Textual Similarity, Eamonn Kennedy, Shashank Vadlamani, Hannah M Lindsey, Kelly S Peterson, Kristen Dams O'Connor, Ronak Agarwal, Houshang H Amiri, Raeda K Andersen, Talin Babikian, David A Baron, Erin D Bigler, Karen Caeyenberghs, Lisa Delano-Wood, Seth G Disner, Ekaterina Dobryakova, Blessen C Eapen, Rachel M Edelstein, Carrie Esopenko, Helen M Genova, Elbert Geuze, Naomi J Goodrich-Hunsaker, Jordan Grafman, Asta K Håberg, Cooper B Hodges, Kristen R Hoskinson, Elizabeth S Hovenden, Andrei Irimia, Neda Jahanshad, Ruchira M Jha, Finian Keleher, Kimbra Kenney, Inga K Koerte, Spencer W Liebel, Abigail Livny, Marianne Løvstad, Sarah L Martindale, Jeffrey E Max, Andrew R Mayer, Timothy B Meier, Deleene S Menefee, Abdalla Z Mohamed, Stefania Mondello, Martin M Monti, Rajendra A Morey, Virginia Newcombe, Mary R Newsome, Alexander Olsen, Nicholas J Pastorek, Mary Jo Pugh, Adeel Razi, Jacob E Resch, Jared A Rowland, Kelly Russell, Nicholas P Ryan, Randall S Scheibel, Adam T Schmidt, Gershon Spitz, Jaclyn A Stephens, Assaf Tal, Leah D Talbert, Maria Carmela Tartaglia, Brian A Taylor, Sophia I Thomopoulos, Maya Troyanskaya, Eve M Valera, Harm Jan Van Der Horn, John D Van Horn, Ragini Verma, Benjamin S C Wade, Willian C Walker, Ashley L Ware, J Kent Werner, Keith Owen Yeates, Ross D Zafonte, Michael M Zeineh, Brandon Zielinski, Paul M Thompson, Frank G Hillary, David F Tate, Elisabeth A Wilde, Emily L Dennis

Faculty, Staff and Students Publications

An extensive library of symptom inventories has been developed over time to measure clinical symptoms of traumatic brain injury (TBI), but this variety has led to several long-standing issues. Most notably, results drawn from different settings and studies are not comparable. This creates a fundamental problem in TBI diagnostics and outcome prediction, namely that it is not possible to equate results drawn from distinct tools and symptom inventories. Here, we present an approach using semantic textual similarity (STS) to link symptoms and scores across previously incongruous symptom inventories by ranking item text similarities according to their conceptual likeness. We tested …

Structure Vs Agency: The Intersectionality Of Race, Mental Health, And Homelessness, Jayley Martin

University Honors Theses

This project investigates the intersectionality between race, mental health, and homelessness, emphasizing the dynamic interplay between structural factors and individual characteristics. Through an integrative literature review, the research addresses the question of how race, mental health, and homelessness are interconnected. The findings suggest a distinct relationship between untreated mental illness and an increased risk of homelessness, particularly among marginalized racial groups. In addition, some mental illnesses, such as anxiety and depression, have a higher incidence among those who face conflict due to racial discrimination. Structural components such as systemic racism in social services and healthcare practices significantly impact access to …

Nursing Education Research In Sub-Saharan Africa: A Systematic Review And Bibliometric Analysis, Beth Waweru, Peter Gatiti, Serah Wachira

School of Nursing & Midwifery, East Africa

Nursing education is pivotal for ensuring competent healthcare professionals, and its improvement is essential for enhancing the quality of health care systems globally. This study focuses on nursing education research in Sub-Saharan Africa (SSA) over the last decade, employing both bibliometric analysis and systematic review methodologies. The bibliometric analysis reveals an evolving landscape of nursing education research in SSA, offering insights into trends, key countries, journals, and predominant research themes. Notably, the study identifies a scarcity of literature using bibliometric approaches in nursing research, addressing this gap by providing a comprehensive overview of the field.The systematic review, guided by the …

The Relationship Between Lifetime Trauma Exposure And Psychosis In A Multi-Country Case-Control Study In Africa, Anne Stevenson, Supriya Misra, Engida Girma, Dickens Akena, Melkam Alemayehu, Amantia Ametaj, Bizu Gelaye, Stella Gichuru, Symon Kariuki, Lukoye Atwoli

Internal Medicine, East Africa

Background: Exposure to traumatic events is a known risk factor for psychosis. Additionally, psychosis may be a risk factor for exposure to traumatic events. There are little data on the relationship between traumatic events and psychosis in sub-Saharan Africa, particularly in large, cross-country samples using the same instrument.

Methods: In a case-control study, 21,606 adults were recruited with psychosis (cases) and 21,329 adults without any history of psychosis (controls) in Ethiopia, Kenya, South Africa, and Uganda from 2018 to 2023 (n = 42,935). Lifetime trauma exposure was assessed using the Life Events Checklist-5. Regression models included the: i) prevalence of …

Europe–Africa Collaboration: Working Together To Strengthen Health Research, Implementation, And Equitable Systems, Lara Pandya, Irene Norstedt, Martin Seychell, Emer Cooke, Isabel De La Mata Barranco, Niklas Blomberg, Marleen Temmerman, Michael Makanga

Centre of Excellence in Women and Child Health

In September 2024, key representatives from European Union (EU) directorates and agencies convened to enhance collaboration with Africa in strengthening health research, innovation, and implementation. The meeting focused on bolstering joint efforts to improve health outcomes and support wellbeing across all ages in Africa. Despite progress in addressing infectious diseases, the continent faces a dual burden with the rise of non-communicable diseases and emerging threats such as antimicrobial resistance, climate change, falsified medicines, and pandemic risks. These challenges are exacerbated by fragile health systems, rapid population growth, urbanisation, and limited access to affordable medical interventions.

To address these issues, the …

Navigating Early Career As An Oncologist: Thriving In Diverse Paths., Gita Suneja, Marjorie C Green, Janaki Parameswaran, Joseph Mccollom Do

PCI Publications and Projects

Early-career oncologists navigate a complex landscape of professional development, clinical responsibilities, and research endeavors. This manuscript explores key challenges and strategies for success in the early years of an oncology career, focusing on the first job after fellowship, career transitions, and practical tips for intentionality. Effective mentorship is pivotal, providing guidance in clinical decision making, research pursuits, and professional networking. Career development strategies include securing funding, building collaborative networks, and identifying opportunities for leadership. Additionally, balancing clinical duties with research and personal well-being requires time management and institutional support. This article emphasizes the importance of fostering inclusive mentorship, advocating for …

Awareness, Knowledge, And Motivations About Lifespan, Healthspan, And Healthy Longevity Medicine In The General Population: The Healthy Longevity (Helo) Conceptual Framework, Belinda Wang, Anna Szucs, Elena Sandalova, E. J. Horberg, Paul A. O'Keefe, Louis Island, Hans J. Meij, Sonny Rosenthal, Andrea B. Maier

Research Collection College of Integrative Studies

The global population is ageing and the gap between lifespan (total years lived) and healthspan (years lived free of diseases) is increasing. Healthy Longevity Medicine (HLM) is an approach to optimise health and healthspan, and it has substantial public health implications. Despite those implications, the understanding of public perspectives on this field is lacking. The HEalthy LOngevity (HELO) framework was developed through a literature review guided by expert discussions across disciplines to include evidence-based concepts of health-related decision-making, ageing, and HLM. The framework organises concepts into three components. The first two components, awareness and knowledge, explore public perception and understanding …

Born Too Soon: Every Story Counts: Lessons In Ethical, Inclusive Storytelling From Born Too Soon, Mary V. Kinney, Amy Reid, Mercy Juma, Anna Gruending, Olufunke Bolaji, Doris Mollel, Denise Suguitani, Silke Mader, Karen Walker, Marleen Temmerman, Joy Lawn

Centre of Excellence in Women and Child Health

Storytelling is increasingly recognized as a powerful tool in public health communication, particularly for addressing complex and stigmatized health issues. In the context of pregnancy and childbirth, personal narratives have proven effective in shaping perceptions, empowering women, complementing health education, and driving policy and legal reforms. Preterm birth remains a significant global challenge, and lived experiences of affected families offer critical insights that illuminate systemic gaps and advocate for the rights of babies, mothers, families, and healthcare workers. The Born Too Soon 2023 campaign placed people—especially women, families, communities, and healthcare workers—at the core of its advocacy efforts. This commentary …

The Impact Of Nicu Death On Bereaved Mothers, Jennie Terranova

University Honors Theses

Infant loss in the United States occurs 5.6 per 1,000 live births. This paper examines risk factors that contribute to neonatal death. Prematurity is a risk factor for NICU admission. A portion of premature babies receiving care in the NICU will die. The stressful nature of the NICU has been studied widely in journals. The impact of NICU death on hospital staff and bereaved parents has been studied less. Mortality studies suggest that bereaved mothers are at a high risk of dying within the first 5 years after their child has died. Despite the frequency of maternal death post-child loss, …

A Multi-Site Study Of Clinician Perspectives In The Lifecycle Of An Algorithmic Risk Prediction Tool, Rita Dexter, Kristin Kostick-Quenet, Jennifer Blumenthal-Barby

Center for Medical Ethics and Health Policy Staff Publications

Recent advancements in the performative capacities of artificial intelligence (AI), machine learning (ML), and algorithmic-based tools open up numerous applications in modern medicine. There are, however, few studies that track the whole lifecycle of a digital healthcare tool as it evolves from conception, to design, and deployment in real world settings-especially with a focus on the social dynamics amongst the end-users of the tool: clinicians. In this paper, we present data from a multi-site, 5-year study focused on the development and deployment of an algorithmic risk calculator (HeartMate 3 Risk Score) into a validated and efficacy tested clinical decision support …

Are Education, Socioeconomic Status, And Household Size Dependent Variables Influencing The Developmental Origins Of Inflammatory Bowel Disease?, Richard Kellermayer

Faculty, Staff and Students Publications

No abstract provided.

Piloting Trauma-Informed Workshops To Enhance Life Skills In Housing Transitions: Action Research, Negar Ghaderi

Critical and Creative Thinking Capstones Collection

This action research pilot project explores how trauma-informed, life skills workshops grounded in critical and creative thinking methods can support Housing First (HF) residents transitioning from homelessness to permanent housing. The study is based on the understanding that addressing homelessness requires more than housing provision—it demands attention to the cognitive and emotional impacts of trauma through co-created, resident-centered interventions. Using iterative cycles of planning, acting, observing, and reflecting, the project engages a small, fluctuating group of 4–5 participants from a diverse community of 60 HF residents. The pilot program includes six workshops, one focus group discussion, and individual interviews over …

Navigating Crisis: A Qualitative Exploration Of Parents' Journeys With Suicidal Adolescents In Australian Emergency Departments, Demee Rheinberger, Lauren Mcgillivray, Fiona Shand, Sally Ann Pollard, Susanne Oliver Armstrong, Julia Lessing, Katherine Boydell

The Qualitative Report

Rates of emergency department (ED) presentations for suicide crisis (thoughts, feelings, plans and behaviours) in adolescents are increasing. Parents play a key role in supporting adolescents during and after the ED presentation, however little is known about parental experiences in the ED. Interviews with 20 parents from across Australia were undertaken to help understand this experience. A reflexive thematic analysis was conducted, resulting in three themes which explore the impact of the suicide crisis and ED presentation on the parents’ sense of identity. First, parents’ identity was threatened as they were faced with the juxtaposition between the role of protector …

Field Journal: The Excluded Middle, Carrie E. Kouts

Masters Theses

What does it look like to engage with organisms and landscapes at the periphery of anthropocentric value structures? How does one break the internalized myth that the “built” environment is excluded from the natural world? When does a hyper-mobile and hyper-commodified society confront the exponential crisis of animal death? Within this series of journal entries, field notes, collection observations, weird prose, and sensory musings, one will find questions on the nature of being human and the complex narratives of care we encounter in a world shared with more-than-humans. Each handwritten vignette and photograph from daily life weaves a non-linear and …

Opioid Use Disorder Within The Emergency Department: Not All Skin Infections Are Equal, Jennifer E. Pletcher

Graduate Doctoral Dissertations

The emergency department (ED) is where two health crises commonly converge, the opioid crisis and cellulitic infections while simultaneously being the front door to the healthcare system at large. The aim of this dissertation is to fill the gap in knowledge about specific skin and soft tissue injury and severe infection (SSTI) with comorbidity of opioid use disorder (OUD) (OUD SSTI) population and demonstrate inequities as compared to the SSTI and severe infection without OUD comorbidity (non-OUD SSTI) through the lens of the Conceptual Model of Nursology for Enhancing Equity and Quality: Population Health and Health Policy. The Nationwide Emergency …

Influences And Implications Of Medical Mistrust On Healthcare Behaviors In A Low Health Outcomes County In The State Of New Jersey, Dale Johnson, Adeena Javed, Nathaniel J Byrnes, Anne C Jones, Kristin N Bertsch

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Medical mistrust is an ongoing concern in the United States, with patient confidence in both individual practitioners and institutions decreasing sharply in recent years. Atlantic County, New Jersey has some of the worst health outcomes in the state and is below the national average. This study sought to investigate medical mistrust by recruiting participants to complete a survey and/or health screening at 12 food pantry distribution events throughout Atlantic County (N = 124). The mean score for the Medical Mistrust Index was 19.06 (SD = 5.6) for participants who reported receiving the annual influenza vaccine and 16.05 (SD = 4.7) …

Initial Crisis Leadership During Covid-19 Higher Education: A Systematic Review, Joseph Crawford, Kerryn Butler-Henderson, Karima Lalani, Jürgen Rudolph, Sabu K.M.

Faculty, Staff and Student Publications

The effect of the novel coronavirus pandemic (COVID-19) on the higher education sector is profound. The scholarly research on COVID-19 effects in higher education have largely focused on presenting intra-period facts, often with poor contextualisation to the broader evidence base. This manuscript draws on the first comprehensive systematic literature reviw database comprising 138 publications, the COVID-19 in Higher Education Database, to provide a first glance at six months of COVID-19 crisis leadership responses in the higher education sector. This systematic review aims to consolidate learning and teaching literature between 1 January 2020 and 30 June 2020 to share timely educational …