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 …

Restricting Outdoor Advertising Of Unhealthy Food: Can Australia's Food Category-Based Classification System Be Applied Consistently?, Clare Whitton, Frith Klug, Alexia Bivoltsis, Georgina S.A. Trapp, Claire E. Pulker

Research outputs 2022 to 2026

Most outdoor food advertising (e.g. billboards and bus stops) features foods that are considered unhealthy. The most important technical challenge when designing policies to restrict unhealthy outdoor food advertising is defining 'unhealthy food'. To date, most restriction policies have used nutrient profiling models (i.e. foods are classified according to their nutritional composition) to determine which foods and beverages may be advertised. In Australia, state governments have endorsed a food category-based classification system, with no prescribed nutrient limits, which may create ambiguity when multiple users are identifying food advertisements to be restricted. This study aimed to assess the consistency of decisions …

Reentry For Formerly Incarcerated Individuals: A Focus On Workforce Reentry And Recidivism In Appalachia, Margaret E. Francisco

Electronic Theses and Dissertations

Formerly incarcerated individuals face challenges to successful reentry, a critical component of reducing recidivism and improving public health outcomes. These challenges are particularly acute in rural Appalachia, where structural disadvantages such as limited economic opportunities, healthcare access, and public transportation intersect with stigma and systemic barriers related to prior incarceration. This dissertation addresses these gaps through a mixed-methods examination of reentry and recidivism, grounded in public health frameworks and focused on the unique context of rural Appalachia.

This work includes three studies. First, a PRISMA-guided systematic review synthesized qualitative research on barriers and facilitators to employment following incarceration. Findings highlighted …

Predictors Of Healthcare Providers' Readiness For Health System Transformation In Saudi Arabia, Ahmed Ali Alasiri

Health Services Research Dissertations

The healthcare system in Saudi Arabia is undergoing significant health reform to warrant sustainable welfare provision. Privatization or public-private partnerships (PPPs) were introduced in 2021 and outlined the vision for the health system for 2023. The planned initiatives aim to be comprehensive and effectively reach individuals and society, including citizens, noncitizens, and visitors. This dissertation seeks to study and explore privatization, the role of healthcare providers, and their capacity to adapt to the transformation of the healthcare system. To achieve this ambitious goal, several interrelated projects have been undertaken. The first project was a systematic review aimed at studying the …

A Global Movement Takes Shape – Physical Activity, Health, And The New Era Of Responsibility: “Global Alliance For Promotion Of Physical Activity”, J. M. Steinacker, W. Van Mechelen, C. Joisten, S. Zanuso, C. A. Jaworski, Y. P. Pitsiladis

Research outputs 2022 to 2026

No abstract provided.

Nerve-To-Cancer Transfer Of Mitochondria During Cancer Metastasis, Gregory Hoover, Shila Gilbert, Olivia Curley, Clémence Obellianne, Mike T Lin, William Hixson, Terry W Pierce, Joel F Andrews, Mikhail F Alexeyev, Yi Ding, Ping Bu, Fariba Behbod, Daniel Medina, Jeffrey T Chang, Gustavo Ayala, Simon Grelet

Faculty, Staff and Students Publications

The nervous system has a pivotal role in cancer biology, and pathological investigations have linked intratumoural nerve density to metastasis1. However, the precise impact of cancer-associated neurons and the communication channels at the nerve–cancer interface remain poorly understood. Previous cancer denervation models in rodents and humans have highlighted robust cancer dependency on nerves, but the underlying mechanisms that drive nerve-mediated cancer aggressivity remain unknown2,3. Here we show that cancer-associated neurons enhance cancer metabolic plasticity by transferring mitochondria to cancer cells. Breast cancer denervation and nerve–cancer coculture models confirmed that neurons significantly improve tumour energetics. …

Measuring The Impact Of A Delay In Care On Pediatric Otolaryngologic Surgery Completion, Geethanjeli N Mahendran, Ching Siong Tey, Mary Frances Musso, Grace Shebha Anand, Jeffrey Larson, Mitesh Mehta, Lara Reichert, Kara Prickett, Nikhila Pinnapureddy Raol

Faculty, Staff and Students Publications

Objective: To determine if postponement of elective pediatric otorhinolaryngology surgeries results in a change in overall healthcare utilization and if there is any commensurate impact on disease progression.

Methods: We identified patients ≤18 years of age whose surgeries were postponed at the onset of the COVID-19 pandemic-related shutdown. We then tracked patients' rate of and patterns of rescheduling surgery. Surveys were also sent to caregivers to better characterize his/her decision regarding moving forward with his/her child's surgery during COVID-19.

Results: A total of 1915 pediatric patients had elective surgeries canceled, of which 992 (51.8%) were rescheduled within 4 months. No …

Stool-Based Molecular Tuberculosis Treatment Monitoring: A Faster Means For Detecting Persistent Mycobacteria Compared To Phenotypic Culture, Clement Gascua Adu Gyamfi, Abigail Seeger, Durbbin Mulengwa, Anca Vasiliu, Lucia Carratala-Castro, Bariki Mtafya, Nontobeko Maphalala, Shilzia Munguambe, Belen Saavedra, Tara Ness, Gugu Maphalala, Sozinho Acacio, Edson Mambuque, Joanna Ehrlich, Rojelio Mejia, Mangaliso Ziyane, H Lester Kirchner, Christoph Lange, Alexander Kay, Alberto L Garcia-Basteiro, Anna Mandalakas, Andrew R Dinardo

Faculty, Staff and Students Publications

Background: Tuberculosis (TB) treatment monitoring is hindered by the lack of a rapidly measured biomarker that accurately predicts clinically relevant outcomes. Symptom screening poorly correlates with bacillary burden. Although culture is a direct measure of viable bacillary burden, the long turnaround time makes it clinically irrelevant.

Methods: The TB treatment monitoring potential of stool-based, quantitative polymerase chain reaction (qPCR) was prospectively assessed among 231 participants of all ages from Eswatini, Tanzania, and Mozambique with microbiologically confirmed TB. Stool qPCR results were compared to sputum culture, persistent symptoms, drug resistance, and World Health Organization TB outcomes.

Results: Quantitative bacillary burden measured …

Digital Tools To Promote Or Measure Health Literacy In Children Aged 3–5 Years: Scoping Review, Caron Molster, Jennifer Irvine, Amanda Devine, Ruth Wallace, Lennie Barblett, Leesa Costello

Research outputs 2022 to 2026

Health literacy is a determinant of health that should be promoted and measured in early childhood. In the era of digitalization, this could involve digital platforms. However, little knowledge exists on the extent, range, and nature of literature on digital tools for promoting or measuring young children’s health literacy. Addressing this gap, a scoping review was undertaken to explore what digital health literacy tools for children aged 3–5 years could be identified in the literature, what their key features were, how they were designed, whether children were codesigners, and whether the tools had been evaluated. Eligibility criteria included the literature …

Determinants Of School Health Unit Program Implementation In Junior High Schools Of Boyolali District, Indonesia, Ayu Khoirotul Umaroh, Noor Alis Setiyadi, Kusuma Estu Werdani, Tanjung Anitasari Indah Kusumaningrum, Purwo Setiyo Nugroho

Kesmas

Adolescent health problems such as stunting, attempted suicide, and tobacco use in Indonesia require attention. To address these challenges, the School Health Unit Program, a school-based health initiative, aims to improve student health and academic achievement. This study examined the relationship between human resources, teachers’ knowledge, facilities and infrastructure, financial resources, and the planning process for implementing the School Health Unit Program in junior high schools in Boyolali District, Indonesia. A cross-sectional design was utilized, involving 50 junior high school teachers responsible for the School Health Unit as respondents, with data collected through structured questionnaires. Multivariate logistic regression analysis revealed …

From Disappointment To Predominance: Medicare Advantage's Ascendancy And Transformation Of Medicare, Rick Mayes, Micah Johnson

Health Studies Faculty Publications

From 2004 to 2024, Medicare Advantage (MA) went from being a “policy disappointment,” covering 12% of all Medicare beneficiaries, to predominance, covering more than one-half (52%), with more growth predicted in the future. Drawing on an extensive review and synthesis of the literature, Medicare Payment Advisory Commission (MedPAC) reports, congressional committee hearings, and Centers for Medicare and Medicaid Services (CMS) data, this paper analyzes the evolution of Medicare and managed care in three parts. First, it briefly traces the early efforts to build an integrated managed care option to the traditional, fragmented fee-for-service Medicare program and highlights four key changes …

Tackling Data Quality Challenges In Remote Sensing: Solutions For Reliable Urban Heat Island Analysis, Wei Xia, Aqil Tariq, Hesham El-Askary, Rana Waqar Aslam, Elgar Barboza, Dmitry E. Kucher, Youssef M. Youssef, Habib Kraiem

Mathematics, Physics, and Computer Science Faculty Articles and Research

Urban heat islands (UHIs) pose critical challenges to public health, energy demand, and environmental sustainability, particularly in rapidly expanding urban regions. This study examines the complex relationship between building configurations and integrated green spaces, as well as their combined impact on thermal regulation. It focuses on addressing data quality issues commonly encountered in remote sensing applications. Using high-resolution multispectral and thermal imagery, we developed an integrated modeling approach that captures the collective influence of built form and green infrastructure on urban microclimates. A key finding is the significant linear inverse relationship between green space coverage and land surface temperature, underscoring …

Sustaining Digital Health Interventions For Long-Term Cardiovascular Disease Prevention In The Energy Industry, Yul Isnadi, L. Meily Kurniawidjaja, Doni Hikmat Ramdhan

Kesmas

Cardiovascular disease (CVD) is a major health concern for energy industry workers due to occupational risks. Digital health interventions (DHIs) offer innovative strategies for CVD prevention in this high-risk group. This study aimed to explore the effectiveness and sustainability of DHI by incorporating behavior change theories, behavior change techniques, and principles of persuasive system design. A literature review was performed using PubMed, Scopus, Web of Science, and CINAHL databases to collect relevant information on interventions for CVD prevention among energy sector workers. The results indicated that while DHI could improve physical activity, dietary habits, and medication adherence in the short …

Noncommunicable Diseases (Hypertension Or Diabetes Mellitus) Among Private University Lecturers And Related Factors, Ummi Kalsum, Melati Puti Andini, Hendra Dhermawan Sitanggang, Helmi Suryani Nasution

Kesmas

Excessive workload, lack of rest, poor diet, stress, and insufficient physical activity are some contributing factors to a high risk of noncommunicable diseases (NCDs) for lecturers. This study aimed to develop a predictive model for the risk of NCDs among lecturers at a private university in Jambi City, Indonesia. A cross-sectional design was used, and the sample included 93 lecturers who met the inclusion criteria. The independent variables were workload, rest pattern, diet, physical activity, stress, smoking, and family history. The dependent variable was NCDs (hypertension or diabetes mellitus), measured through interviews based on a doctor's diagnosis. Data analysis was …

Shifting From Crisis To Prevention: Community-Generated Materials From The Core Sipp Listening Sessions (Version 1), Camille Velarde, Mahtab Soleimani, Yvonnie Baik, Theresa Cruz

Reports & Documents

The Core State Injury Prevention Program (CORE SIPP) in New Mexico sought to understand how communities can prevent injury and violence before crisis occurs. In 2025, the University of New Mexico Prevention Research Center, in partnership with the New Mexico Department of Health, listened to service providers, advocates, and community leaders working with youth and families across the state. Participants described overlapping challenges, including poverty, unsafe housing, limited mental health care, transportation gaps, and a lack of safe spaces for young people, and emphasized that real prevention must start early and address families’ basic needs. From these sessions, community members …

Assessment Of Covid-19 Risks Related To Behaviour And Body Resistance In The Remote Area: Case Study In Jeneponto, Basri Basri, Andi Tilka Muftiah Ridjal, Lukman Setiawan, Renaldi M

Journal of Environmental Science and Sustainable Development

COVID-19 has posed significant global health threats, with responses varying across populations due to differences in risk perception, behaviour, and biological vulnerability. In Indonesia, most research has focused on urban settings, with limited attention paid to rural or remote communities. This study assesses COVID-19- risks related—specifically behavioural and immunity-related-factors—in the remote area of both Bontoramba Subdistrict, Jeneponto Regency. A cross-sectional study was conducted using cluster random sampling across eight villages, with 183 participants selected from a total of 12,242 households. Data were collected between November to December 2020 using a validated structured questionnaire, administered both online and face-to-face interviews. The …

The Effectiveness Of Remote Patient Monitoring In Reducing The Risk Of Rehospitalizations In Covid-19 Patients: A Meta-Analysis, Dela Riadi, Indang Trihandini, Dewi Nirmala Sari, Fikri Wijaya

Kesmas

An integrated analysis of various Remote Patient Monitoring (RPM) studies is needed to evaluate the reduction rate of the risk of rehospitalization in COVID-19 patients. This meta-analysis aimed to provide an overview of the effectiveness of RPM. A literature search through online databases (PubMed, Science Direct, Scopus, ProQuest, and Embase) was conducted from 2019 to 2022. After using the Cochrane Collaboration's risk of bias tool, five studies on COVID-19 were selected. Based on the data collected from 2,685 participants (intervention = 1,060, control = 1,625), the use of RPM was found to reduce rehospitalization by 0.56 times compared to not …

Supporting And Hindering Factors Associated With Covid-19 Health Protocol Adherence Among Online Motorcycle Taxi Riders In Samarinda City, Indonesia, Dina Lusiana Setyowati, Tanti Asrianti, Ismail Kamba, Rina Tri Agustini

Kesmas

The COVID-19 pandemic has underscored the importance of preventive health protocols, especially for high-contact occupations, such as online motorcycle taxi riders. However, adherence among these riders is inconsistent, particularly in economically constrained regions, such as Samarinda, a buffer zone for Indonesia's new capital. This study examined the influence of supporting and hindering factors on COVID-19 protocol compliance. A cross-sectional design was employed with 87 riders selected through quota sampling. Data were collected using structured questionnaires and analyzed using Spearman's rank correlation to assess the relationships between influencing factors and compliance levels. Economic barriers, especially high personal protective equipment (PPE) costs …

Health Economics Perspective On Indonesian Telemedicine Platform Practices: A Qualitative Study, Yossico Ria Wibowo, Rina Djunita Pasaribu

Kesmas

Telemedicine in Indonesia has experienced significant growth since its introduction in 2014. The financing system is regulated independently by each platform, leading to disparities in teleconsultation fees and medical incentives. This qualitative study, which involved a literature review and interviews with 33 participants, offered a health economics perspective on the implementation of telemedicine. The recommended teleconsultation fee ranges from USD 0.05 to USD 2.54, with medical incentives set at USD 1,59-3.18 for general practitioners and USD 4.77-6.36 for specialists, using telephone or video calls as the preferred means of teleconsultation. Although most patients and Indonesian Medical Association administrators generally agreed …

Google Review Analysis Of “Duta We Care” Excellent Service As A Featured Service At A Central General Hospital In Padang, Alfitri Alfitri, Ricvan Dana Nindrea, Adek Setiawan, Elsa Yuniarti

Kesmas

Improving healthcare service quality required both technical and interpersonal enhancements through a personalized approach, as demonstrated by the “Duta We Care” program at a Central General Hospital in Padang. This study aimed to evaluate the program’s effectiveness by analyzing patient feedback from Google Reviews. A descriptive quantitative design examined 2,035 patient reviews from March 2013 to June 2024. Using NVivo 12 software, the data analysis generated word clouds. The results showed that 68.20% of reviews received a 5-star rating, 9.48% a 4-star rating, 4.35% a 3-star rating, 2.27% a 2-star rating, and 15.70% a 1-star rating. Words like “friendly,” “professional,” …

Factors Of Anxiety Symptoms Due To Large-Scale Social Restriction Policy During The Covid-19 Pandemic In Indonesia, Indri Hapsari Susilowati, Sudibyo Alimoeso, Susiana Nugraha, Bonardo Prayogo Hasiholan, Magda Sabrina Theofany Simanjuntak, Nur Rachmat Satria

Kesmas

The Indonesian Government took some preventive measures to slow the spread of the COVID-19 virus, including social restrictions and encouraging individuals to stay at home and avoid needless gatherings. This study aimed to identify factors related to anxiety symptoms during large-scale social restrictions. This study employed a cross-sectional design using the snowball technique in an online survey. A total of 788 respondents comprised the target population to detect the smallest effect size (Cohen's dz = .2), with the level of power of 0.8 using G*Power 3.1, specifically targeting adults aged over 18 years. Out of 1,194 people who took part …

A Workplace Posture Initiative To Reduce Work-Related Musculoskeletal Disorders, Carrie Isaac

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Work-related musculoskeletal disorders (WRMSDs) are a leading cause of occupational injury and discomfort in industrial workplaces. Although an ergonomic program existed at the project site, a formalized process to detect postural misalignments early had not been established. Relying on employee self-reporting, delayed intervention, and limited opportunities to prevent injuries before they progress.

Aim of the Project: A proactive posture screening program using PostureScreen® was implemented to identify postural deviations that could contribute to WRMSDs. Emphasis was placed on supporting employees through early awareness of posture-related issues and evaluation of alignment improvements following individualized intervention.

Review of the Evidence: Evidence …

Integrating Circulating Tumor Dna Into Clinical Management Of Colorectal Cancer: Practical Implications And Therapeutic Challenges, Nikhil Vojjala, Viktoriya Gibatova, Raj N Shah, Sakshi Singal, Rishab Prabhu, Geetha Krishnamoorthy, Karen Riggins, Nagaishwarya Moka

Faculty, Staff and Students Publications

The American Cancer Society estimates that over 152,000 new cases of colorectal cancer (CRC) were diagnosed in 2024, with more than 105,000 cases affecting the colon and 46,000 involving the rectum. CRC remains the second leading cause of cancer-related deaths in the United States, with an estimated 53,010 deaths in 2024. In the era of precision medicine, which incorporates molecular and environmental information into clinical decision-making, identifying patients harboring a deficiency in Deoxyribonucleic acid (DNA) repair allowed for targeted immunotherapies and significantly reduced CRC-related mortality. A significant advancement in this domain is the application of liquid biopsy, which has emerged …

Inequality And Covid Risk At School: Racial Disparities In Indoor Density, Vaccination Rates, And Consequences For Absenteeism, Michael C. Quinn, Michah W. Rothbart, Amy Ellen Schwartz, Brian Elbel

Center for Policy Research

During the COVID pandemic, schools were widely believed to be a venue that facilitated disease transmission. While some worried Black and Hispanic students would disproportionately face greater risk of COVID exposure at school (school COVID risk) – given well-documented racially disparate school environments and resources – little empirical evidence exists documenting or refuting potential disparities in school COVID risk. This paper begins to fill this gap by examining racial disparities in the school environments that contribute to COVID risk at school—specifically, vaccination rates and classroom space per pupil (indoor density) - in New York City elementary schools. We then document …

Understanding Black American Pastors' Leadership Role And Interaction With Public Health During Covid-19, Stacy L. Tolbert

Walden Dissertations and Doctoral Studies

The COVID-19 pandemic tested the leadership, response, and resilience of Black American pastors and their communities. These pastors played a crucial role in supporting their communities to lessen the impact the virus had on underlying health conditions and socioeconomic hardships that were exacerbated by the pandemic. Despite their efforts, Black American pastors frequently encountered challenges helping their community. The current research sought to understand the lived experiences of Black American pastors during the pandemic and their interactions with public health institutions to secure resources for their communities through Interpretative Phenomenological Analysis (IPA). The study was guided by the research question, …

Barriers And Facilitators To Occupational Therapy For The Frail Older Person Within Primary Care In Belgium, Anne Ledoux, Stijn De Baets, Thérèse Van Durme, Patricia De Vriendt, Dominique Van De Velde, Sophie Thunus

Internet Journal of Allied Health Sciences and Practice

Introduction: The population is quickly aging in Belgium and there is an increasing number of older frail adults. Occupational therapy (OT) in primary care (PC) favors the stay-at-home of frail older persons through its preventive action on the person, the environment, and/or the task. However, OT is not well implemented in Belgian PC. We aimed to investigate the implementation of OT, to support the frail older person living at home, within primary care in Belgium. Methods: We performed a secondary thematic analysis, based on data collected during an implementation study of an OT guideline for this population. Data were collected …

A Model For Teaching Social Determinants Of Health In Doctor Of Physical Therapy Programs, Elise N. Bjork, Rupal M. Patel Pt, Phd, Rebecca Operacz, Deandrea B. Melvey, Luciano Garcia Iii

Internet Journal of Allied Health Sciences and Practice

Purpose: The purpose of this study was to 1) describe the development and implementation of a novel educational module on social determinants of health (SDOH) for Doctor of Physical Therapy (DPT) students, and 2) to assess the effectiveness of the module on altering DPT students’ knowledge, attitudes, beliefs, and barriers in addressing SDOH. Methods: Drawing on current literature, content expert feedback, identity theory, and experiential learning theory, a two-hour module on SDOH was created and delivered at two universities. The Physical Therapy Social Determinants of Health Scale (PT-SDHS) was used to assess change in students’ knowledge, attitudes, beliefs, and barriers …

Explore Toolkit, Kimberly Page, Janet Page Reeves, Ivan De La Rosa, Marie Alice Scott, Christina Phillips, Maria Sanchez, Andrew Gorvetzian, Joe Albright, Cynthia Killough, Randall Benalli

Epidemiology, Biostatistics, and Preventive Medicine

Welcome to the Exploring Health Beliefs for Community Engagement and Diversity in Clinical Trials (EXPLORE) Toolkit, a resource designed to support researchers and frontline workers addressing substance use in the Borderlands. The EXPLORE Toolkit was designed by an interdisciplinary team of epidemiologists, social workers, anthropologists, and public health professionals to enhance the engagement of underrepresented communities in substance use clinical trials. Utilizing a strength-based approach, the toolkit addresses equity, stigma, and participation barriers, promoting culturally sensitive and community-centered research practices. This toolkit is an ideal tool for clinical trials researchers and community health workers who are interested in learning more …

Association Between Sociocultural Factors, Obesity, And Depression In The Hispanic/Latino Population, Maia Junco

Walden Dissertations and Doctoral Studies

The increasing prevalence of obesity and mental health disparities among Hispanic/Latino populations in the United States underscores the need to understand how sociocultural factors shape physical and psychological health. The purpose of this study was to examine how acculturation, diet quality, and fiber intake affect BMI and depressive symptoms over time. The study was guided by acculturation theory and the biopsychosocial model. The study used longitudinal secondary data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) with a sample of N=8,816, including adults who completed examination visits, 1 (2008–2011) and 2 (2014–2017). Path analysis was conducted to assess direct …

Living In Fear: Be Empathetic (Life)-Tool Kit, Desiree A. Díaz, Heather Peralta, Samantha Stephenson, Danny Hernandez, Geraldine Luzincourt, Syretta Spears, Ann Marie Parker, Trysten Altamirano

Nursing Handouts, Tools, and Other Documents

Open source materials to immerse learners in rural and public health experiences are needed to ensure the new work force is equipped to care for a variety of people in differing circumstances. Public health remains a vital yet underemphasized component within healthcare education, specifically nursing education. This often limits opportunities for students to develop the skills necessary to become strong advocates for equity and systemic change. A

This project emerged from a commitment to provide experiential opportunities replicating the communities we serve. A Empathy Walk and LIFE Clinic (Díaz et al., 2025) was created as a strategy designed to engage …