Socioecological Factors And Age Of Diagnosis For Autism Spectrum Disorder Among U.S. Children, Richline Wilson

Walden Dissertations and Doctoral Studies

As autism spectrum disorder (autism/ASD) diagnoses rise, understanding the influence of socioecological factors on the age of diagnosis among children in the United States is critical for timely intervention and improved quality of life. The purpose of this study was to examine how socioecological factors influence the age at which children are diagnosed with autism/ASD. The quantitative causal-comparative design, which was informed by Bronfenbrenner’s socioecological model, involved analysis of secondary data from the 2021 National Survey of Children’s Health (N=1416). Ordinal logistic regression analysis revealed that race and ethnicity moderated the relationship between socioeconomic status (caregiver educational and employment status …

Breast Cancer Survival Rates And Determinants In Ethiopia: A Systematic Review And Meta-Analysis Of Longitudinal Studies, Abenezer M. Tafese, Meseker T. Fentie, Beminate L. Seifu, Angwach A. Asnake, Bikiltu D. Dirbaba, Abdisa G. Jara, Elsabeth Tizazu Asare, Brandon George

College of Population Health Faculty Papers

BACKGROUND: Breast cancer is the most common cancer and the leading cause of cancer mortality among women in Ethiopia, accounting for 32% of new cancer cases and 17.6% of cancer deaths. Despite its growing burden, comprehensive data on survival rates and contributing factors remain limited. This systematic review and meta-analysis aimed to synthesize existing data on breast cancer survival in Ethiopia and identify key determinants influencing outcomes.

METHODS: A comprehensive systematic search was conducted in PubMed, Web of Science, Scopus, Embase, and CINAHL to identify studies on breast cancer survival in Ethiopia published between January 2014 and August 2024. Eligible …

Comparative Outcomes Of Coil Embolization And Surgical Clipping In Elderly Patients With Subarachnoid Hemorrhage: A Systematic Review And Meta-Analysis, Yohanna Idsabella Rossi, Gabriel Bolner, Jonathan Costa Dall'acqua, Fabiana Dolovitsch De Oliveira, Lucas V. Zacaria, Taís L. Denicol, Michel Frudit, Natália Vasconcellos De Oliveira Souza

Department of Neurology Faculty Papers

BACKGROUND AND OBJECTIVES: Elderly patients with subarachnoid hemorrhage (SAH) face a disproportionately high burden of morbidity and mortality. While endovascular coiling is often favored in this population, direct comparisons with surgical clipping are limited. We conducted a meta-analysis to compare outcomes of clipping versus coiling in SAH patients aged ≥ 60 years.

METHODS: A systematic search of PubMed, Embase, and Cochrane databases identified studies comparing the two treatments in this age group. The primary outcome was a composite of unfavorable outcomes (modified Rankin Scale [mRS] > 2 and mortality). Secondary outcomes included mortality, favorable outcome (mRS 0-2), rebleeding, and hospital length …

Adolescent Students’ Adaptability During The Covid-19 Pandemic Impacting Their Academic Preparedness In College: A Qualitative Exploration Of Resilience In Secondary School Disruptions, Nicole Tyanne Jameson

Dissertations

This study, conducted several years after the onset of the COVID-19 pandemic, takes a unique approach to investigating the long-term effects of the pandemic-induced disruptions on adolescents during secondary schooling and their academic preparedness in college. The study combined a descriptive qualitative analysis of academic routine data with quantifiable resilience scores, providing a comprehensive understanding of the challenges students faced, their adaptability and resilience, and the overall impact on their education journey into college. This comprehensive descriptive qualitative study utilizes triangulation of quantitative data and qualitative approaches to understand the subject matter thoroughly. The quantitative scores meticulously analyzed resiliency and …

Demographic Characteristics And Selected Personality Traits Of Women In Competitive Bodybuilding, Chloe A. Zeeuw

Master's Theses

This study investigated demographic characteristics and measures of personality (dimensions of performance perfectionism and five-factor model characteristics) in women in competitive bodybuilding between 18-25 years old. A total of 24 women completed an online survey which included a demographic questionnaire, the Five Factor Model Rating Form (FFMRF), and the Performance Perfectionism Scale for Sport (PPSS) inventories. Descriptive results for the FFMRF were Openness (18.17±3.12), Conscientiousness (25.58±3.33), Extraversion (19.96±3.46), Agreeableness (19.88±4.58), and Neuroticism (15.67±4.94), and for the PPS-S were Self-oriented performance perfectionism (20.96±3.53), Socially prescribed performance perfectionism (13.96±4.26), and Other-oriented performance perfectionism (10.54±4.23). Pearson’s correlation coefficients and Shapiro-Wilk tests revealed that …

Caregiver Perceptions, Knowledge, And Likelihood To Intervene With Suicidal Youth, Amber L. Willwerth

All-Inclusive List of Electronic Theses and Dissertations

This study utilized an online survey to target primary caregivers of a child aged 5-18. The survey highlighted factors regarding caregiver involvement in suicide prevention efforts, such as their knowledge, comfort and confidence intervening with a youth experiencing suicidality, and barriers to doing so. It was found that caregivers who had experienced suicide prevention training reported higher levels of comfort and confidence intervening with their own child and another child than those who had not, as well as lower levels of worry. Higher levels of education were also found to predict lower levels of worry, suggesting that further training and …

Mental Health Service Utilization Among Arab/Middle Eastern In The Us: Structural Disparities, Digital Access, And Stigma-Related Barriers., Fatima M. Aldarweesh

Electronic Theses and Dissertations

Arab Middle Eastern (AME) United States (US) college-attending students are more susceptible to disproportionate mental health problems and underutilization of mental healthcare services due to cultural, structural, and psychosocial barriers. The study examines mental health service utilization and mental health outcomes among AME, particularly focusing on the impact of structural, cultural, and psychosocial determinants grounded in Andersen and Aday’s Health Services research model and Corrigan’s stigma framework. The three interconnected aims use secondary nationally representative data from the Healthy Minds Study (HMS) 2019-2024. The study was analyzed using logistic regression and generalized structural equation modeling across three aims to identify …

Engaging In Movement At Work: Exploring Engagement And Physical Activity., Spencer A. Cavan

Electronic Theses and Dissertations

High levels of employee engagement provide organizations competitive advantages such as increased customer satisfaction, profits, and employee productivity. Despite potential benefits, the number of engaged employees is declining and organizations need to find innovative ways to enhance engagement. Emerging evidence suggests workplace physical activity may generate organizational benefits extending beyond health improvement. Therefore, the purpose of this study was to investigate perceptions of engagement among employees participating in a physical activity intervention at work. A qualitative design, guided by phenomenology, examined perceptions of workplace physical activity and perceived levels of engagement, as well as constraints related to involvement among university …

Rethinking Health Systems Responsiveness In Low–And Middle-Income Countries, Meesha Iqbal

Dissertations and Theses (Open Access)

Health systems responsiveness (HSR) refers to a health system’s ability to meet legitimate non-health expectations of the population. Traditionally, HSR has been conceptualized across eight domains: respect for dignity, autonomy, confidentiality, prompt attention to health needs, availability of basic amenities, choice of provider, access to social support networks, and clarity of communication. However, as the expectations of populations in high-income countries (HICs) and low- and middle-income countries (L&MICs) differ significantly due to diverse social and cultural contexts, the conceptualization of HSR also varies. We conducted a systematic review of literature to adapt and contextualize the HSR framework for L&MICs based …

Application Of Machine Learning In Early Childhood Development Research: A Scoping Review, Faith Benson, Daisy Chelangat, Willie Brink, Patrick Mwangala, Akbar Waljee, Cheryl Moyer, Amina Abubakar

Institute for Human Development, East Africa

Background: Early childhood development (ECD) lays the foundation for lifelong health, academic success and social well-being, yet over 250 million children in low- and middle-income countries are at risk of not reaching their developmental potential. Traditional measures fail to fully capture the risks associated with a child’s development outcomes. Artificial intelligence techniques, particularly machine learning (ML), offer an innovative approach by analysing complex datasets to detect subtle developmental patterns.

Objective: To map the existing literature on the use of ML in ECD research, including its geographical distribution, to identify research gaps and inform future directions. The review focuses on …

Social Cohesion, Trust, And Utilisation Of Maternal Health Services Among Refugee And Host Community Women In Bangladesh And Kenya, Haeun Lee, Ryan Rego, Neyat Fiseha, Ashok Barman, Nimo Sharif, Peninah Wachira, Joe Kolars, Akbar Waljee, Rubhana Raqib, Amina Abubakar

Institute for Human Development, East Africa

The global refugee crisis places significant pressure on host communities, particularly in low- and middle-income countries. Social cohesion and trust between refugee and host communities are critical for maternal health service utilisation. This study explores the relationship between host–refugee trust, social cohesion, and maternal health service use in Bangladesh and Kenya, focusing on facility-based delivery, antenatal care visits, and postnatal care attendance. To do so, a cross-sectional survey was administered among 649 refugee/displaced women and 371 host community women in the two locations. The results show high trust levels in both groups, while social cohesion is greater among refugee/displaced women. …

Adolescent E-Cigarette Expectancies: Measure Development And Preliminary Validity Of The Electronic Nicotine Vaping Outcomes Measure For Youth, Paul T. Harrell, Kelli J. England, Tracey E. Barnett, Vani N. Simmons, Richard W. Handel, Amy C. Paulson

Department of Pediatrics Faculty Publications

BACKGROUND: Electronic nicotine delivery systems (“e-cigarettes”) are the nicotine product most commonly used by adolescents. Research, treatment, and policy could benefit from measures of adolescent e-cigarette beliefs about outcomes of use (ie, expectancies). In the current study, we developed and tested an adolescent electronic nicotine vaping expectancy measure.

METHODS: A focus group with adolescents evaluated potential e-cigarette expectancy items. A panel of national experts assisted in revision of these items. Finally, items were administered to a sample of adolescents 14-17 years old (N = 267, Mean age 15.6, SD = 1.1, 50.9% Female, 50.2% Non-Hispanic White, 22.5% Non-Hispanic Black, 14.2% …

Adolescent Online Leisure, Media Literacy, Online Victimization, And Multifaceted Well-Being During Covid-19: The Role Of Parental Support, Yunqi Wang

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

The rapid advancement of the internet and digital technology has provided opportunities for adolescents to conduct leisure activities online on a daily basis. However, research on adolescent technology use and mental health often highlights negative effects without carefully examining the specific mechanisms, which overlooks the complexity of effects of online behaviors on adolescent well-being and the importance of developing adolescents’ media literacy skills. Moreover, despite the crucial role of family dynamics in adolescent development, research on how parental support and involvement might affect adolescent technology use and well-being is still limited. The current study retrieved data from Programme for International …

Resilience Of Interdependent Transportation And Healthcare Systems: A Simulation-Driven Framework Incorporating Social Equity And Facility Optimization, S. Yasaman Ahmadi

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

The overarching goal of this dissertation is to develop an integrated, simulation-driven framework to assess and enhance the resilience of interdependent transportation and healthcare systems before, during, and after natural hazards. By examining how spatial disruptions, social vulnerability, operational constraints, and infrastructure interdependencies affect access to and functionality of hospitals, this research offers a multifaceted evaluation of system performance under stress. This dissertation examines the impact of natural hazards, particularly floods, on the interdependent transportation and healthcare systems. The proposed approach combines and advances GIS-based network analysis, graph-theoretical modeling, and discrete-event simulation to evaluate system performance under different scenarios. The …

Intergenerational Family Dynamics Among Caregivers And Children’S Social-Emotional Development In China, Weiman Xu

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

The early years of a child’s life are pivotal for social-emotional development. While extensive research has explored the role of family settings in fostering children's social-emotional development (Bornstein, 2005), the impact of grandparental involvement, particularly the caregiving dynamics between generations, remains less well understood. This study aims to fill this gap by examining two critical aspects of intergenerational dynamics among caregivers (i.e. parent-grandparent coparenting and parent-grandparent relationship quality) and their associations with children’s social-emotional development (i.e. social skills and problem behaviors). Two specific aims were delineated: 1) examine the unique contribution of parent-grandparent coparenting, especially the power and authority domain …

The Impact Of Culture And Language On Internal Communication And Patient Care In Small To Medium-Sized Black Immigrant-Owned Healthcare Practices In Texas., Chisom Nwosu

Dissertations

This qualitative phenomenological study explored how cultural competency in small to medium-sized Black immigrant-owned healthcare practices in Texas affects internal communication and patient care. Through semi-structured interviews with nine clinical and administrative leaders in Dallas and Houston, five themes emerged: culturally competent leadership, intentional communication structures, language and interpretation practices, patient-centered cultural sensitivity, and the use of technology for adaptation. Findings suggest that culturally aware leadership and inclusive communication strategies foster team cohesion and improve patient trust and care. Participants reported adapting workflows to meet religious, language, and communication needs through human and technological tools. The study underscores embedding cultural …

The Relationship Between Total Serum Cholesterol And Hypertensive Outcomes Among Women 50-60 Years Old: Findings From The Framingham Heart Study, Sierra Smith

Capstone Experience: Master of Public Health

Objective: To assess whether total serum cholesterol (TSC) among middle-aged women is associated with subsequent hypertension while accounting for potential confounders.

Methods: A sample of 853 adults who identify as women, aged 50-60, from the Framingham Heart Study 1948-1972 cohort was selected for this study. Participants' TSC was measured at baseline, and they were followed for 24 years for cardiovascular disease outcomes or death. The outcome of interest in this study was hypertension. A multivariable logistic regression was used to analyze the relationship between TSC and hypertension while controlling for age, glucose, systolic, and diastolic blood pressure.

Results: Compared to …

Analysis Of The Clinical, Socioeconomic, And Sociodemographic Characteristics Of Virally Unsuppressed Children Aged 2-14 Living With Hiv/Aids In The Region Of Abidjan 2 – Côte D’Ivoire (Region Supported By Usaid), Maman Fathim Kamagate

Capstone Experience: Master of Public Health

Background: Viral suppression among children living with HIV (CLHIV) remains suboptimal in Côte d’Ivoire. This study assessed clinical, socioeconomic, and demographic characteristics associated with viral non-suppression among CLHIV aged 2–14 years in Abidjan 2 to inform targeted interventions under the U.S. Agency for International Development (USAID)-supported Reaching Impact, Saturation, and Epidemic Control (RISE) project.

Methods: A retrospective analysis was conducted using routine program data from 1,203 CLHIV across 73 health facilities. Descriptive, bivariate, and multivariate analyses were performed to examine associations with viral load suppression status. Findings guided the development of a multi-level implementation plan using Kotter’s Change Management Framework, …

Readiness Of Universitas Indonesia To Be An Inclusive Campus For People With Disabilities, Dumilah Ayuningtyas, Tri Auri Putri Ayuningtyas, Anita Pebrina Lubis, Anindya Naila Sabahat, Ratih Oktarina, Afaf Jauhar

Masyarakat: Jurnal Sosiologi

Ensuring equal education rights remains a challenge in Indonesia, despite constitutional mandates and the global commitment to “no one left behind.” The Disability Participation Rate remains low; in 2023, only 21.03% of individuals aged 19–23 were included. This reflects, among other factors, the limited preparedness of educational institutions. This study evaluates Universitas Indonesia’s readiness to develop inclusive education for persons with physical, sensory, mental, and intellectual disabilities. Using the capability approach, it assesses whether institutional resources can be translated into capability-enhancing conditions for students with disabilities. The study draws on literature review, targeted document searches, SWOT analysis, IFE-EFE matrices, and …

Medical Surveillance In Custodial Jsas: Preventing Bloodborne Pathogen Exposure, Kiara Gadea

Electronic Theses, Projects, and Dissertations

Custodians play an important role in maintaining our surroundings safe and sanitary. However, in doing so, they are their exposure to health hazards that put them at risk, yet these exposures are often overlooked. One major risk they face is contact with bloodborne pathogens, which put custodial staff at risk for infections such as hepatitis B. While Job Safety Analyses (JSA’s) outline various protective measures, many fail to incorporate medical surveillance as part of their risk management program. Overlooking this important detail leaves custodians vulnerable to health risks that can be prevented.

Adding a medical surveillance section to custodial JSA’s, …

Bilingual Budget-Friendly Hispanic Cookbook And Resource Guide For Food Pantries In San Bernardino County, Anasofia Garay Guzman

Electronic Theses, Projects, and Dissertations

San Bernardino County is faced with a significant issue of food insecurity with its residents relying on food pantries to meet their food and nutritional needs. However, the food items offered at food pantries are often limited in quantities and the variety is inconsistent, which makes it a challenge for families wanting to prepare healthier budget friendly meals while maintaining its cultural relevance. This project consists of two main key components: a bilingual, culturally relevant budget-friendly Hispanic cookbook and a comprehensive resource guide about ways and ingredient substitutions adaptable to the recipe based on what is available.

The cookbook included …

Exploring Factors Influencing Care And Outcome Among Stroke Patients In Tennessee, Omodele Agbejimi

Electronic Theses and Dissertations

Introduction: Stroke is the fifth leading cause of death in Tennessee. Socioeconomic variables influence the delivery of stroke treatment and its outcomes. Despite advances in acute stroke care, the burden of stroke keeps increasing. This study aimed to explore literature on factors contributing to stroke care and outcomes in the U.S., assess the determinants of stroke patients’ outcomes, and examine the geographical disparities in stroke hospitalization and stroke death rate and their association with stroke care accessibility in Tennessee.

Methods: A scoping review was conducted using socio-ecological models to explore literature on factors contributing to stroke care and outcomes. A …

Evaluation Of The Psychometric Properties Of The Social Communication Questionnaire In Rural Kenya, Patricia Kipkemoi, Jeanne Savage, Joseph Gona, Kenneth Rimba, Martha Kombe, Paul Mwangi, Collins Kipkoech, Danielle Posthuma, Charles Newton, Amina Abubakar

Institute for Human Development, East Africa

Children can be reliably diagnosed with autism as early as 3 years of age, and early interventions are initiated. There is often a significant gap between the age of onset of symptoms (2–3 years) and diagnosis (8–10 years) in Africa. We conducted a study to validate the Social Communication Questionnaire (SCQ) as a screening instrument in a rural setting in Kenya. The study was conducted along the Kenyan Coast. Study participants included 172 children with a neurodevelopmental disorder (NDD) diagnosis (84 of which were autism) and 112 controls. Internal consistency was evaluated through the use of Cronbach’s alpha, confirmatory factor …

Linking Chronic Kidney Disease To Incident Heart Failure And Adverse Cardiac Remodeling Through The Plasma Proteome: The Aric Study, Leo F Buckley, Pranav Dorbala, Victoria Lamberson, Brian L Claggett, Yue Ren, Morgan E Grams, Josef Coresh, Kunihiro Matsushita, Ryan T Demmer, Ruth F Dubin, Rajat Deo, Peter Ganz, Christie M Ballantyne, Ron C Hoogeveen, Bing Yu, Amil M Shah

Faculty, Staff and Student Publications

Background: Investigation of circulating plasma proteins may reveal insights into molecular pathways that contribute to the development of heart failure (HF) among people with chronic kidney disease.

Objectives: The authors aimed to identify circulating kidney function-related plasma proteins that are associated with the risk of incident HF.

Methods: The authors studied participants of the ongoing longitudinal ARIC (Atherosclerosis Risk In Communities) study. Relative plasma concentrations of 4,697 unique proteins were measured with the use of an aptamer assay (Somalogic). Each protein was tested for associations with estimated glomerular filtration rate (eGFR), log-transformed urine albumin-to-creatinine ratio (UACR), and incident HF by …

Evaluating Covid-19, Influenza, And Rsv Vaccine Effectiveness, Iromi N. Jayawardena

All Dissertations

Respiratory infectious diseases, including COVID-19, influenza, and RSV, pose significant public health challenges, especially during the respiratory virus season. Vaccination remains the primary intervention to mitigate morbidity and mortality associated with these diseases. Vaccine effectiveness (VE) can vary between seasons and populations, necessitating continuous evaluation. This study aims to evaluate the effectiveness of the 2024-2025 COVID-19 mRNA vaccine, 2024-2025 seasonal influenza vaccine, and single-dose RSV vaccine over two seasons.

Utilizing electronic health records (EHRs) from the Prisma Health healthcare system, this dissertation emulated target trials to assess the vaccine effectiveness of each vaccine. Risk set propensity matching was used to …

Chance Or Strategy? Assessing The Unanticipated Policy Window For Active Transportation During The Covid-19 Pandemic: A Systematic Review, Katja Siefken, Michael Pratt, Juliana Mejía-Grueso, Adrian Bauman, Deborah Salvo, Catherine B Woods, Wanda Wendel-Vos, Justin Richards, J Jaime Miranda, Pedro C Hallal, Andrea Ramírez Varela

Faculty, Staff and Student Publications

Physical activity (PA) policy is essential for promoting population-level PA by coordinating efforts across various sectors. Global crises like the COVID-19 pandemic can open policy windows, enabling rapid implementation of innovative policies. This study examined how policy windows shaped active transportation (AT) policies during the pandemic, resulting in infrastructural changes.

Methods: A systematic review using PubMed, Scopus, ProQuest-Coronavirus Research Database, Web of Science, WHO COVID-19 Research Database, PsycInfo, and SPORTDiscus conducted to characterize AT policy during the pandemic (2020-2023). Descriptive analyses were conducted in Stata. PROSPERO registration number: CRD42025644930.

Results: The search retrieved 3879 articles; 1162 were duplicates, leaving 2716 …

Evaluation Of The Zanesville-Muskingum County Ohio’S Mosquito And Tick Disease Vector Control Program, Samantha Wantz

Capstone Experience: Master of Public Health

This project aimed to evaluate the Zanesville – Muskingum County Health Department’s (ZMCHD) Vector Control Program based on performance measures, program indicators, and customer satisfaction. A secondary goal of the project is to evaluate and revise the existing policies and procedures of the program in regards specifically to the safety of the intern. Based on information from the Ohio Department of Health infectious disease dashboard, in the last 10 years (2014-2024) Muskingum County has reported 12 total cases of La Crosse virus, one case of West Nile Virus, and one case of Malaria (Ohio Department of Health, 2024a). ZMCHD has …

Supporting Autistic Students' Mental Wellness: A Community Readiness Model Approach, Cady Walker

Capstone Experience: Master of Public Health

Autism spectrum disorder or difference (ASD) is a lifelong neurodevelopmental disability, usually identified during childhood. However, many adults miss the opportunity for diagnosis during childhood due to previous misunderstandings about autism presentation, camouflaging behaviors, and misdiagnoses. While current diagnostic tools for assessing autism in children are more robust, similar measures are lacking for adults who were not diagnosed in childhood. This gap poses risks for poor mental health outcomes among adults who missed a timely ASD diagnosis, which can be especially challenging for autistic college students. Although some higher education institutions offer support programs for autistic students, most do not, …

Contextualization Of Harmonized Cognitive Assessment Protocol (Hcap) In An Aging Population In Rural Low-Resource Settings In Africa: Experiences And Strategies Adopted To Optimize Effective Adaption Of Cognitive Tests In Kenya, Roselyter Riang’A, Eunice Muthoni, Niranjani Nagarajan, Felix Agoi, Patrick Mwangala, Alden Gross, Jean Ikanga, Kenneth Langa, Edward Miguel, Anthony Ngugi

Population Health, East Africa

Cross-cultural adaptation of cognitive assessments is crucial for detecting Alzheimer's disease (AD) and related dementias (ADRD) in aging populations. This study documents the adaptation of the Harmonized Cognitive Assessment Protocol (HCAP) for a pilot study on the Longitudinal Study of Health and Aging in Kenya (LOSHAK) in rural Kilifi County, Kenya, highlighting challenges and strategies for optimizing outcomes. As part of the LOSHAK feasibility phase, cognitive tests including: the Swahili Mental State Examination, 10-word recall, animal naming, story recall, clock drawing, and making change, were administered to 202 participants (≥45 years) from the Kaloleni/Rabai Health and Demographic Surveillance System (KRHDSS). …

Improving Health Outcome Through Mobile Clinics, Spatial Access, And Overdose Management: A Data-Driven Study Of People Who Inject Drugs, Individuals With Opioid Use Disorder, And College Students, Abass A. Babatunde

All Dissertations

ABSTRACT

Background

The opioid crisis remains a critical public health challenge in the United States. Mobile Health Clinics (MHCs) have emerged as a promising solution to bridge healthcare access gaps for these vulnerable populations, particularly for PWID and individuals with OUD in underserved and rural communities. Despite their potential, geographic disparities in MHC access and knowledge gaps in opioid overdose management and related diseases, including Hepatitis C Virus (HCV), remain significant barriers to care. This dissertation addresses three key dimensions of healthcare delivery for PWID, OUD populations, and college students: (1) barriers to MHC utilization for HCV screening and treatment …