Digital Commons Network^™

Exercise Self-Efficacy And Physical Wellness In A Worksite Wellness Program: Exploring Factor Structure And Perceptions, Micah B. Mcglathery

Dissertations

Exploring Perceptions of Exercise Self-Efficacy and Physical Wellness in a Worksite Wellness Program

Abstract

Worksite wellness programs are increasingly adopted to address insufficient exercise participation and other health-related behaviors that put employees at risk of chronic disease. Although quantitative outcomes are well-documented, there is limited research exploring how employees perceive these programs' impact on personal behavior change, particularly in relation to exercise self-efficacy. Guided by the Social Cognitive Theory and the Exercise is Medicine initiative, this study qualitatively investigates employee perceptions of a worksite wellness program’s influence on physical wellness and confidence to exercise. A phenomenological approach using semi-structured interviews …

Policy Brief: North Dakota Maternal Mortality Committee, Kilyn R. Parisien

Public Health Student Publications

The following policy brief was created to examine North Dakota policies that are specific to maternal mortality and morbidity reviews. The North Dakota Maternal Mortality Committee (NDMMRC) is responsible for conducting maternal mortality and morbidity reviews in the state of North Dakota. This brief is guided by policies from North Dakota and MMRC reviews from surrounding states to inform six recommendations intended that guarantee the highest quality data collection and data reporting on maternal mortality and morbidity.

Montana Kinship Navigator Program: A Statewide Frontier Initiative Promoting Kinship Family Health And Wellness, Daniel J. Koltz Dr., Peyton Vining, Yu Jiang

GrandFamilies: The Contemporary Journal of Research, Practice and Policy

This practice brief report describes the development, implementation, and new updates of the Montana Kinship Navigator Program (MTKNP), a statewide initiative designed to support kinship caregivers in a large, rural frontier context. Montana’s geographic isolation, limited infrastructure, and sparse population create significant barriers for kinship families, including restricted access to healthcare, transportation, childcare, and social services. These challenges are compounded when caregivers unexpectedly assume responsibility for children, often with limited resources and support. MTKNP addresses these gaps through a comprehensive, evidence-informed model that integrates information and referral services with individualized case management. The program serves both formal and informal kinship …

Risk Factors For Metabolic Syndrome Among U.S.-Born And Non-U.S.-Born Hispanics In The United States, Banessa Maldonado

Walden Dissertations and Doctoral Studies

Current knowledge regarding risk factors for metabolic syndrome (METS) among Hispanic individuals of Mexican descent remains limited. Using data from NHANES 2017–2020, this study compared factors contributing to METS and included U.S.-born and non-U.S.-born Hispanic adults of Mexican descent aged ≥ 18 years living in the USA (N = 949) with assessed METS. Grounded in the social ecological model and social determinants of health, this research evaluated dietary habits, lifestyle patterns, and acculturation processes using multivariate logistic regression and stratified analyses. Educational attainment was associated with METS, but the association was not statistically significant in adjusted models p = 0.528. …

Cultural Traits May Replace Human Mobility Data In Forecasting Covid-19 Mortality: A Deep Learning Approach, Saif Abbas, Tamer Oraby, Michael G. Tyshenko, Samit Bhattacharyya

School of Mathematical & Statistical Sciences Faculty Publications

The COVID-19 pandemic highlighted the need for accurate epidemic forecasting to support public health decision-making. Most existing approaches depend heavily on human mobility data, while largely neglecting population behavior shaped by socio-cultural norms. In this study, we analyze daily COVID-19 mortality and Google mobility data from 72 countries during the first 130 d of the pandemic, a period characterized by high uncertainty and behavioral heterogeneity. In particular, we examine whether Hofstede’s country-level cultural dimensions can serve as latent behavioral forecasters of mortality in lieu of dynamic mobility indicators. Using 100 d for training and 30 d for forecasting, we employ …

Association Between Resource Availability And Wellbeing Of Autism Patients In Ghana, Kwabena Aduse-Poku

Walden Dissertations and Doctoral Studies

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that presents significant challenges for children and families in Ghana, where resources remain limited. Grounded in the social ecological model, this quantitative cross-sectional study examined the associations between autism management programs and wellbeing, defined briefly as independent functioning in daily life and learning of autism patients enrolled in selected institutions in Accra and Kumasi, Ghana. Data were collected from N=122 autism patients using structured questionnaires that were completed by caregivers and program staff. Binary logistic regression analyses were conducted to assess relationships between program type, regional location, and years of enrollment and …

Wellness Literature Review – 2025, Martin Huecker, Brian A. Ferguson

Journal of Wellness

Introduction: Clinician well-being remains a persistent challenge, with ongoing burnout and psychological distress despite efforts by systems and individuals. This Journal of Wellness annual review covers studies published in 2025.

Methods: The Editors searched PubMed and Google Scholar for prospective and interventional studies / clinical trials in humans, with focus on well-being. Authors utilized artificial intelligence (AI)–based large language model (LLM) (ChatGPT, OpenAI^TM) to assist with preliminary identification of relevant studies, however authors noted significant AI-associated errors and outright misrepresentations requiring hand curated product generation and manual PubMed searches.

Literature in Review: We continue to appreciate a shift …

Association Between Opioids And Leukemia/Lymphoma In Adults Living In The United States, Brenda Sue Newberry-Colasanti

Walden Dissertations and Doctoral Studies

Opioid prescribing rates and opioid misuse remain high throughout the United States. Exposure to opioids has been positively associated with various cancers; however, research evaluating associations between opioid exposure and hematologic cancers like leukemia and lymphoma is limited. Using the Socio- Ecological Model as a foundation, this quantitative cross-sectional study aimed to analyze the association between medicinal opioid use, opioid misuse, and leukemia/lymphoma while exploring how selected social determinants of health (SDOH) may modify that relationship. Secondary data were pooled from the 2015–20-year United States National Survey on Drug Use and Health (NSDUH). One thousand three hundred and twenty binary …

Health Literacy And Diabetes Self-Care Behavior, Eucharia Amaefule

Walden Dissertations and Doctoral Studies

Limited health literacy is a significant barrier to effective diabetes self-management among adults with type 2 diabetes mellitus (T2DM), yet nationally representative evidence using comprehensive health literacy measures remains limited. Guided by the health belief model, the purpose of this quantitative, secondary data analysis using cross-sectional data was to examine the relationship between health literacy and diabetes self-care behaviors among U.S. adults with T2DM and determine whether education level moderated this relationship. Data from the 2016 Behavioral Risk Factor Surveillance System were analyzed for U.S. adults (N = 9, 535) with self-reported T2DM. Diabetes self-care behaviors included blood glucose monitoring, …

Internalized Colorism As A Gendered Barrier To Skin Cancer Information Avoidance Among Hispanic College Students, Soo Yun Kim, Wan-Lin Chang

Communication Faculty Publications

Skin cancer disparities persist among racial and ethnic minority populations, yet sociocultural factors shaping engagement with preventive health information remain understudied. This study examines whether internalized colorism functions as a barrier to skin cancer information avoidance among Hispanic college students and whether these associations differ by sex. Using survey data from 300 undergraduates at a Hispanic-serving institution, hierarchical regression analyses examined how three dimensions of colorism, including self-concept, attractiveness, and upward mobility, were associated with skin cancer information avoidance. Results indicated that only the attractiveness dimension predicted information avoidance. This association was moderated by sex, such that attractiveness-based colorism was …

Experiences Of Cholesterol Management Among Obese Individuals: A Qualitative Exploration Of Statin Use, Diet, And Physical Activity, Ke'andra S. Foggie

Doctoral Dissertations and Projects

The prevalence of hypercholesterolemia has increased over the past decade, with obesity identified as a major contributing factor. This study examined how individuals with obesity and hypercholesterolemia managed cholesterol and experienced related challenges within their daily lives. Guided by the Chronic Care Model, the research explored participant-reported experiences of statin therapy and lifestyle practices, including dietary behaviors and physical activity, as components of cholesterol management. Qualitative data were collected through semi-structured interviews, observations, and document analysis to analyze participant-reported barriers, supports, and contextual factors that shape how these practices are incorporated into daily routines. Although extensive research has examined statin …

Uncovering The Path To Diagnosis Among Adults With Attention-Deficit/Hyperactivity Disorder: A Constructivist Grounded Theory Mini-Study, Jeffrey D. Whitaker, Rick Zoucha, Melissa Kalarchian

Graduate Student Research Symposium

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood, yet many adults are first diagnosed only after years of functional strain, compensation, and alternative explanations for their difficulties. Purpose: This study explored how adults first diagnosed with ADHD in adulthood described navigating the process of obtaining a formal diagnosis. Methods: A constructivist grounded theory mini-study was conducted with seven adults, ages 27 to 43, who reported receiving their first formal ADHD diagnosis at age 18 or later. Participants completed semi-structured Zoom interviews focused on early experiences, symptom interpretation, help-seeking, and formal assessment. Data were analyzed using initial, focused, and theoretical …

Association Between Occupational Stress, Sleep Quality, And Premature Ejaculation Among Indonesian Information Technology Workers, Muhammad Faisal Ratman, Suryo Wibowo, Muhammad Ilyas, Retno Asti Werdhani, Dewi Yunia Fitriani

Occupational and Environmental Medicine Journal of Indonesia

Introduction Premature ejaculation (PE) is a common sexual dysfunction that significantly impacts quality of life. Occupational stress and poor sleep quality are hypothesized as risk factors, particularly among Information and Technology (IT) workers who experience unique occupational stressors. This study aimed to evaluate the proportion of PE, examine the influence of occupational stress and sleep quality on PE, and determine whether sleep quality mediates the relationship between occupational stress and PE among Indonesian IT workers.

Methods This cross-sectional study involved 89 married male IT workers who completed online questionnaires, including the Premature Ejaculation Diagnostic Tool (PEDT), Perceived Occupational Stress (POS) …

Food And Drug Administration Audit Outcomes And Their Association With Class I And Class Ii Food Recalls, Mark Baker

Walden Dissertations and Doctoral Studies

Foodborne illness and food recalls remain major public health concerns in the United States. Guided by the Theory of Planned Behavior, the purpose of this quantitative secondary analysis was to examine whether Food and Drug Administration (FDA) inspection classifications, warning letters, and prior 24-month inspection frequency were associated with facility involvement in a subsequent Class I or Class II food recall. Question-specific analytic files were created from publicly available FDA administrative records. Eligible records included FDA-regulated food facilities with qualifying inspection or warning letter events and sufficient data to assess recall involvement within a 12-month follow-up period. The final analytic …

Examining Hiv Testing In Black Americans In The Southern United States: Association Between Sexual Orientation, Gender Identity, Healthcare Access, And Hiv High-Risk Behaviors, Shavon Wolfe

Walden Dissertations and Doctoral Studies

Examining factors that affect HIV testing in the Black/African American population is important because socioeconomic hardship, stigma, and restricted access to healthcare all lead to gaps in early diagnosis and prevention treatment to prevent further spread of infection. However, most studies have focused on these factors separately, leaving less understanding of how they work together to influence HIV testing behavior. Guided by the health belief model, this study examined the relationship between sexual orientation, gender identity, healthcare access, and HIV high-risk behaviors. The study examined the relationship between sexual orientation, gender identity, healthcare access, and HIV testing, and the influence …

Community Health Workers’ Experiences Distributing Harm Reduction Supplies During Covid-19 In The Barren River Area Development District, Angel Nichole Shoemake

Walden Dissertations and Doctoral Studies

Community health workers (CHWs) distributing sterile injecting equipment help reduce infectious disease transmission among people who inject drugs; however, limited research exists regarding their experiences delivering harm reduction services during public health emergencies in rural areas. The purpose of this qualitative study was to explore CHWs’ experiences and perceptions of health risks, operational barriers, and social influences affecting harm reduction service delivery during the COVID-19 pandemic in the Barren River Area Development District. The health belief model guided this study, emphasizing perceived susceptibility, severity, barriers, benefits, and self-efficacy. Data were collected through semistructured Zoom interviews with eight purposively sampled CHWs …

Depressive Symptoms And Functional Disability Among Older Adults In Nakhon Ratchasima Province, Thailand: A Cross-Sectional Population-Based Study, Jiranya Bureemas, Atthawit Singsalasang

Journal of Health Research

Background: Depressive symptoms have been associated with activities of daily living (ADL) disability; however, evidence among Thai older adults remains limited and inconsistent. This study investigates the association between depressive symptoms and ADL disability in older Thai adults.

Methods: A cross-sectional analytic study was conducted among 312 older adults in Nakhon Ratchasima, Thailand, who were selected using a multistage sampling method. Data were collected between April and July 2023 using structured questionnaires covering demographic and environmental variables. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale. ADL disability was measured using the Barthel and Chula ADL Indices. Multiple logistic …

Brief Of Public Health And Health Law Scholars As Amici Curiae Urging Affirmance In Support Of Plaintiffs-Appellees, Rachel L. Zacharias, Zeinab Bakhet, Kevin Costello, Maya Manian

Amicus Briefs & Court Filings

INTRODUCTION: Physicians’ use of their judgment and expertise to prescribe drugs and devices for purposes other than those approved by the Food and Drug Administration (“FDA”)—colloquially known as off-label use—is an indispensable feature of modern medicine. The FDA approves drugs as “safe and effective for specific indications.” Christopher M. Wittich, Christopher M. Burkle & William L. Lanier, Ten Common Questions (and Their Answers) About OffLabel Drug Use, 87 Mayo Clinic Procs. 982, 982 (2012). Federal law then generally leaves prescribing decisions, including off-label use of FDA-approved drugs and devices for a patient’s particular indication, to physicians acting under state law …

Llm-As-A-Judge For Infection Prevention And Control And Antimicrobial Resistance Impact: Comparing Three Main Llms Vs. Human Experts' Assessment, Marcello Di Pumpo, Leonardo Villani, Maria Rosaria Gualano, Danilo Buonsenso, Francesca Raffaelli, Daniele Donà, Patrizia Laurenti, Vittorio Maio, Stefania Boccia, Walter Ricciardi

College of Population Health Faculty Papers

BACKGROUND: Large language models (LLMs) are increasingly used to generate health information, yet their reliability as evaluators remains unclear. This study investigated the feasibility of an LLM-as-a-judge methodology in the context of infection prevention and antimicrobial resistance (AMR), comparing automated ratings with human expert benchmarks.

METHODS: We performed a secondary analysis of an expert-annotated dataset of health messages. Three leading LLMs (ChatGPT, Claude, Gemini) independently evaluated the same messages using an adapted DISCERN tool across five domains: information reliability, quality, AMR impact, persuasiveness, and overall score. We utilized descriptive statistics, intra-rater reliability tests, and mixed-effects ordinal regression to analyze divergence …

Exploring Lifestyle Transitions And Perceptions Of Weight And Health Among College Students In Huntsville, Texas, Keyonna Nicole Thomas

Walden Dissertations and Doctoral Studies

College students aged 18–25 transitioning to independent living often experience changes in diet, physical activity, stress, and time management that increase health risks. These challenges may be amplified in semi-urban communities by limited access to healthy food, transportation barriers, and scheduling constraints. This qualitative phenomenological study explored how college students in Huntsville, Texas, perceived and interpreted these lifestyle changes and their influence on perceptions of health and weight. Guided by the social ecological model, the study included 12 participants who were 18–25 years old, enrolled in college, living independently in Huntsville, Texas, and able to describe their experiences with lifestyle …

The Association Between Food Insecurity, Housing Insecurity, Self-Care Practice And Depression Among Black Immigrants In The United States, Beatrice Ngozi Mbaocha

Walden Dissertations and Doctoral Studies

The prevalence and poor prognosis of depressive symptoms remain significant among adult Black immigrants in the United States. This study examined the complex interplay between food insecurity, housing insecurity, self-care practices, and depression among adult Black immigrants in the United States. Grounded in the socioecological model, this quantitative cross-sectional study analyzed data from N = 469 noninstitutionalized Black immigrant adults (54.2% female, 45.8% male) using the 2023 National Health Interview Survey. Binary logistic regression was employed to assess the probability of depressive symptoms as a function of food insecurity, housing insecurity, and self-care practices, controlling for age, gender, and employment …

Promoting Equity For Children And Adolescents Through Implementation Processes In Health And Social Care: A Scoping Review, Michelle Gooey, Heather Morris, Rebecca Madill, Callie Walsh-Bailey, Ahlia Griffiths, Melissa Savaglio, Claire Blewitt, Amanda O'Connor, Sara Holton, Helia Khalesi, Sofia Grage-Moore, Maria Fernandez, Echezona E Ezeanolue, Allison Metz, Ana Baumann, Helen Skouteris

Faculty, Staff and Student Publications

Background: Despite the many existing implementation methods, theories, and frameworks, implementation science is insufficiently closing the research-to-practice gap. Bridging this gap is critical to achieving healthy and thriving communities globally, and requires implementation processes that promote equity and reach diverse populations, especially those most in need. The aim of this scoping review was to identify, thematically analyse, categorise, and provide examples of implementation processes described in equity-focused literature, with a focus on health and social care interventions for children and adolescents from birth to 18 years of age.

Methods: A comprehensive search of literature was undertaken across six electronic databases …

Lgbtq+: What Utahns Need To Know, Susan R. Madsen, Deborah Lin

Marketing and Strategy Faculty Publications

LGBTQ+ Utahns who identify as girls and women thrive when they are valued and accepted for who they are. Creating environments where they feel safe, welcomed, and empowered to participate fully strengthens their health, wellbeing, and sense of belonging. Communities also benefit when LGBTQ+ women and girls are encouraged to share their perspectives, talents, and leadership. When diverse voices are welcomed into dialogue and collaborative decision-making, organizations and communities are better equipped to serve everyone. By fostering belonging, representation, and meaningful participation, Utah can create communities where every person has the opportunity to thrive.

Penilaian Safety Climate Di Area Quarry Pada Pabrik Semen Di Indonesia, Andrizqa Andrizqa, Mufti Wirawan, Raden Ismail Haq, Asep Zaenal Muttaqien, Muhammad Arifin Ramzy Lubis

National Journal of Occupational Health and Safety

Work in the quarry area of the cement industry has a high risk of occupational accidents. Workers' understanding of the safety climate is important to prevent workplace accidents and injuries. This study aimed to assess the safety climate in the quarry area of a cement plant in Indonesia while identifying aspects that still require improvement. This study employed a descriptive quantitative approach using a questionnaire adapted from the Loughborough Safety Climate Assessment Toolkit (LSCAT). The sample consisted of all workers in the quarry area, including 49 permanent workers and 90 contract workers. The results showed that the average safety climate …

Sleep Disturbances Affect Sleep Quality Of Hospitalized Adults, Tonjia Hardesty

Dissertations

Abstract

Background: Sleep disturbances affect the quality of sleep hospitalized adults experience, possibly extending patient recovery time. Treatment of insomnia frequently includes pharmacological interventions exposing patients to potential side effects, leading to negative patient outcomes.  The purpose of this project was to determine if a sleep hygiene toolkit including eye masks, earplugs, advocacy cards, and removal of nicotine patches at bedtime would improve patient sleep quality without use of pharmacological interventions.

Methods: A descriptive observational design was used in this quality improvement (QI) project. A convenience sample of 37 (N =37) participants over the age of 18 years and …

Identification Of Prognostic Factors For Disease Recurrence-Free Survival (Drfs) In Breast Cancer Patients Using The Cox Proportional Hazards Model, Dwi Cahyaning Putri, Veny Prabaningrum, Samsul Arifin

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

Breast cancer remains one of the most common malignancies among women worldwide, with recurrence remaining a major clinical challenge. Despite various treatment efforts, the mortality rate from breast cancer remains high, particularly among patients with worse clinical and molecular conditions. This study aims to identify factors influencing the survival of breast cancer patients using the Cox proportional hazards model. The study analyzes clinical and molecular data of breast cancer patients to identify key risk factors affecting Disease Recurrence-Free Survival (DRFS). Analysis was conducted using Kaplan-Meier, the Log Rank test, and the Cox proportional hazards model. The results showed that nodal …

Cytoskeletal Protein Expression In Autism Spectrum Disorder: A Psychoneuroimmunological Perspective On Sars-Cov-2, James Birch

Walden Dissertations and Doctoral Studies

The COVID-19 pandemic heightened concerns about health disparities among individuals with autism spectrum disorder (ASD). Limited understanding of the biological factors underlying health variability may hinder efforts to reduce disparities and improve care for neurodivergent populations. Guided by the psychoneuroimmunology framework, this quantitative study investigated whether cytoskeletal gene expression was associated with neuroimmune variability in ASD and SARS-CoV-2 populations. Three genes –Nck-associated protein 1 (NCKAP1), WAS/WASL-interacting protein family member 1 (WIPF1), and actin-related protein 2/3 complex subunit 1B (ARPC1B)—were evaluated using two publicly available Gene Expression Omnibus datasets GSE212645 (ASD vs. sibling-matched controls, N = 40) and GSE152641 (SARS-CoV-2-positive vs. …

Global Trends In School Disaster Preparedness Research: Bibliometric Analysis Impacts On Public Health And Safety, Muhammad Farid, Muhammad Agita Hutomo, Oktomi Wijaya, Dian Ika Puspitasari

Chulalongkorn Medical Journal

Background: Disasters disrupt daily human activities, arising from natural or artificial triggers, with varying impacts based on community vulnerability and resource capacity. Effective disaster management involves a cycle of mitigation, preparedness, response, and recovery. One of the mitigation measures is to establish school disaster preparedness that integrate education and capacity building.

Objective: The aim of this research is to conduct a bibliometric analysis based on Scopus publications regarding school disaster preparedness.

Methods: A bibliometric analysis was performed on publications indexed in Scopus from 1965 to 2024. Data were processed and visualized using VOSviewer to explore trends in annual outputs, contributing …

Mammography: What Utahns Need To Know, Brie Sparks, Susan R. Madsen

Marketing and Strategy Faculty Publications

Mammography is a critical preventative health tool that enables early detection of breast cancer and improves the likelihood of successful treatment. In Utah, screening behaviors are shaped by access to care, personal perceptions, healthcare experiences, and broader social and structural factors. Understanding both measurable trends and attitudes toward preventative care provides essential context for improving screening rates. Together, these factors influence how, when, and whether Utah women utilize mammography services, ultimately impacting early detection outcomes across the state.

Applying The Ottawa Charter To Evaluate Health Literacy Outcomes Of The Little Aussie Bugs Course For Australian Early Childhood Educators, Amelia Ruscoe, Elizabeth J. Cook, Eleanor K. O'Brien, Leesa N. Costello, Gillian Kirk, Ros Sambell, Theresa Rayfield, Amanda Devine, Ruth M. Wallace

Research outputs 2022 to 2026

Early childhood offers an important opportunity to lay the foundations for lifelong health literacy. The Little Aussie Bugs (LAB) dialogic book series and online professional development (PD) course were designed to support Early Childhood Education and Care (ECEC) educators to embed health literacy concepts, including hygiene, healthy eating, and oral health, into everyday learning routines. This mixed methods study evaluated the course pilot and examined its contribution through the lens of the Ottawa Charter for Health Promotion—a framework comprising five interrelated action areas: building healthy public policy; creating supportive environments; strengthening community action; developing personal skills; and reorienting health services. …