Digital Commons Network^™

The Village Determinants Of Self-Rated Health And Mental Health: A Multilevel Analysis Of Environments In Rural Honduran Villages, Marnen Elizabeth Decker

Public Health Theses

I investigated the associations of village structural, behavioral, and social environments with self-rated health and mental health among adults residing in remote rural villages in the mountainous Copán region of Honduras. I estimated nested multilevel logistic models with 17,318 adults in 174 villages. All models controlled for individual characteristics to distill true village-level effects, and nested structure was employed to facilitate direct comparison across models. Both poor self-rated health and mental health were inversely associated with village size and positively associated with coffee cultivation. Poor self-rated health was also positively associated with friend/adversary tie ratio, and poor self-rated mental health …

Assessing The Costs Of Illness Attributable To Leptospirosis, Alyssa Chetrick

Public Health Theses

Leptospirosis, caused by the spirochetes of the genus Leptospira, is a zoonotic bacterialdisease endemic to tropical regions and lower middle income countries (LMICs). Leptospirosis causes an estimated 1 million cases and more than 58,900 deaths annually.(Costa et al., 2015; Torgeson et al., 2015) In addition to human health, leptospirosis significantly impacts animal health and the livestock industry, particularly through reproductive losses, increased treatment costs, and decreased milk production, which exacerbates global insecurity.(Bennet, 2015; Torgeson et al., 2015) The estimated global cost loss to productivity due to disease is estimated at Int$ 29.3 billion. (Agampodi et al., 2023) Because of its …

Association Between Primary Covid-19 Vaccine Type And Booster Uptake Among Incarcerated People In Connecticut: A Retrospective Cohort Study, Michael Condon Elhardt

Public Health Theses

Importance: Booster doses of the COVID-19 vaccine are critical for maintaining protection against SARS-CoV-2, especially in high-risk settings such as correctional facilities. Understanding how initial vaccine type influences booster uptake can inform vaccination strategies in these and other underserved populations.Objective: To assess whether the type of COVID-19 vaccine received for the primary series—either viral vector (Janssen/Jcovden) or mRNA (Moderna/Spikevax or Pfizer-BioNTech/Comirnaty)—was associated with timing or likelihood of booster completion among incarcerated individuals. Design: Retrospective cohort study using survival analysis methods. The study period spanned from February 2, 2021, to May 31, 2023. Setting: Connecticut Department of Correction (DOC) facilities, including …

Swift: Strong-Signal Weighted Prs Integration For Fine-Tuning, Yikai Dong

Public Health Theses

Polygenic risk scores (PRS) hold immense promise for personalized medicine but suffer from reduced accuracy in non-European populations, hindering equitable application. We introduce SWIFT (Strong-signal Weighted PRS Integration for Fine-Tuning), a novel framework to enhance cross-population PRS prediction by optimally combining base scores from diverse ancestries using only GWAS summary statistics. SWIFT employs a GWAS subsampling technique based on data fission to generate internal training and tuning sets, circumventing the need for external validation cohorts. A key innovation is its focus on strong genetic signals (p < 0.1) for estimating robust combination weights via cross-validation, which mitigates overfitting and significantly reduces computational burden. We evaluated SWIFT across 22 complex traits using data from five populations (EUR, AFR, AMR, EAS, SAS) and independent validation cohorts (UK Biobank, All of Us). Applied to state-of-the art base methods (PRS-CSx, X-Wing, JointPRS), SWIFT achieved predictive accuracy comparable or superior to the recent LEOPARD integration method and baseline implementations. Crucially, SWIFT demonstrated a 3.5- to 9.5-fold reduction in computational runtime compared to LEOPARD and exhibited robust performance even when using a single, unified LD reference panel. SWIFT provides an efficient, robust, and practical approach to improve the accuracy and applicability of PRS across diverse populations, representing a significant step towards more equitable genomic medicine.

Effect Of The Lifestyle, Exercise And Nutrition (Lean) Weight Loss Intervention On Stress Among Breast Cancer Survivors, Wenxin Gu

Public Health Theses

Background: Stress, experienced by over one-third of breast cancer survivors, not only leads to significant symptoms and mental health issues, but also increases the risk of breast cancer recurrence and impacts survival. While weight loss lifestyle interventions have been effective in helping breast cancer survivors with obesity lose weight and potentially enhance survival, their impact on stress levels has been inconsistent. The aim of the secondary analysis was to evaluate the effects of a 6-month diet and exercise weight loss intervention on perceived stress in breast cancer survivors.Methods: Breast cancer survivors with a BMI of 25.0 kg/m2 or higher (n=151) …

Environmental Gentrification And Health: An Exploratory Analysis Of New York City, Joyce Hu

Public Health Theses

Background: Environmental gentrification is an emerging field seeking to understand the integrated effects of environmental improvements and gentrification. To date, we have a limited understanding of how to analyze environmental gentrification with intersecting health impacts. Our exploratory study investigates this relationship in New York City, where environmental improvement policies coincided with gentrification between 2000-2016. Methods: Using a census tract-level index of gentrification and corresponding environmental exposure data on air quality and vegetation, we conducted a clustering analysis to group and label census tracts according to environmental gentrification patterns. We then performed covariate-adjusted multivariable regression analyses to evaluate the association between …

Effect Of The Lifestyle, Exercise, And Nutrition Weight Loss Intervention On Depressive Symptomatology Among Breast Cancer Survivors, Ziyuan Ma

Public Health Theses

Background: Breast cancer patients have up to a five-fold higher risk of depression compared with the general population, with an estimated prevalence of depressive symptoms of 25%. Depressive symptoms among breast cancer patients can affect treatment adherence, quality of life, and mortality. Some studies indicate lifestyle interventions can lower depression symptoms in general population samples; however, few studies have examined changes in depression among breast cancer survivors enrolled in lifestyle interventions. The purpose of this study was to examine the effect of a 6-month diet-and exercise-induced weight loss intervention versus usual care on depressive symptomatology among breast cancer survivors.Methods: 151 …

Evaluating The Implications Of Class And Regional Stereotypes On Attributions Of Blame During Hurricane Helene: A Reflexive Content Analysis Of Tiktok, Abby Ong

Public Health Theses

Background and Objectives: Hurricane Helene devastated entire towns across the Southern and Appalachian U.S. Following the hurricane, people who lived in impacted regions were derided for their perceived failures in evacuating. Utilizing Bernard Weiner’s attribution theory of social motivation, this study sought to analyze potential implications of regional stereotypes on how people blamed or supported disaster victims. Primary objectives were to: (1) to analyze content regarding residents’ decisions to evacuate or not evacuate during the storm, (2) to document attributions of blame or support and how those experiencing the disaster and outside observers responded to these attributions, and (3) to …

From Success To Setbacks: A Case Study Of The Sex Wrap And The Impact Of Instagram's Evolving Policies On Sexual Health Education, Megan Piller

Public Health Theses

Due to the inconsistent and noncomprehensive nature of sexual health education across the United States, many adolescents and emerging adults are turning to digital platforms, specifically social media, for necessary information. The Sex Wrap (TSW), a podcast and Instagram-focused intervention, was established to fill critical knowledge gaps among these populations and empower them in their sexual decision-making. To serve as a case study, engagement metrics from TSW’s Instagram account between October 2020 and September 2021 were analyzed to determine which post types, tones, and thematic categories resonated most with users across the platform. However, Instagram, once a highly effective tool …

A Pilot Rct Of Mhealth & Chw Intervention For Art Adherence, Shivesh Shourya

Public Health Theses

Despite the availability of antiretroviral therapy (ART), only 66% of people with HIV in the U.S. achieve viral suppression, often due to suboptimal ART adherence. Barriers such as limited access to care and forgetfulness impact adherence, which must be ≥95% to prevent viral rebound. Combining community health worker (CHW) support with mobile health (mHealth) technologies may help address these barriers and improve outcomes. This pilot study evaluated the feasibility, acceptability, and preliminary efficacy of the remotely delivered Community Health Worker and mHealth to Improve Viral Suppression (CHAMPS) intervention, which combines the WiseApp, CHW support, and the CleverCap smart pill bottle. …

Examining Healthcare Access Disparities: Social Determinants And Patient Experiences At Valley Healthcare, Mikaila Larmond

Theses and Dissertations

Persistent disparities in healthcare access continued to affect low-income, rural, and underserved populations across the United States. This capstone project explored these disparities within Valley HealthCare, a regional provider in Columbus, Georgia, by examining how social determinants such as income, education, geography, and transportation shaped healthcare engagement among adult patients. A mixed-methods case study design was used to analyze survey data, patient satisfaction feedback, and organizational reports from a sample of 80 adult patients between January and March 2025.

The results showed that patients residing in lower-income or geographically isolated areas reported significantly higher rates of missed appointments. Individuals with …

How Do Young Adults With Drug Use Disorder (Dud) Utilize Treatment? Exploring And Examining Lived Experiences Towards Treatment Completion In Indonesia, Dewi Kartikawatiningsih

Electronic Theses & Dissertations (2024 - present)

In Indonesia which has the highest rate of drug addiction in Southeast Asia, there is currently little knowledge about how young adults perceive the barriers faced when completing treatment or how treatment providers' perspectives influence their treatment completion. Understanding and identifying barriers to treatment completion is essential to making drug treatment more effective. The purpose of this study is to explore the perspectives and live experiences of young adults with DUD and their addiction counselors to develop a deeper understanding of treatment needs. This study interviewed 33 clients and 15 counselors from the rehabilitation center of the Badan Nasional Narkotika …

Place, Culture, And Care: A Socioecological Examination Of Type 2 Diabetes Among Hispanics In The U.S., Danielle Montoya

Theses and Dissertations

Introduction: Type 2 diabetes (T2D) disproportionately affects U.S. Hispanic populations. This dissertation examined whether structural determinants fundamentally drive T2D disparities among Hispanics, with attention to within-group racial heterogeneity.

Methods: Three studies utilized nationally representative data. Study 1 examined neighborhood segregation and ethnic enclave residence associations with T2D using restricted NHANES data (2011-2018, n=5,056). Study 2 investigated acculturation and T2D associations using restricted NHANES data (2011-2018, n=4,540). Study 3 analyzed patient-provider racial/ethnic concordance and adequate diabetes care using MEPS data (2008-2021, n=17,138).

Results: Structural factors demonstrated primacy across all studies. Neighborhood segregation (aOR=1.17, p>0.05) and ethnic enclave residence showed no …

Modeling Vaccination Strategies And Intervention Impacts On Infectious Disease Dynamics, Elizabeth B. Amona

Theses and Dissertations

This dissertation explores how mathematical and statistical modeling can inform vaccination strategies and evaluate the impact of interventions during infectious disease outbreaks. Motivated by the challenges observed during the COVID-19 pandemic, the research integrates compartmental modeling, Bayesian inference, and agent-based simulation to assess policy effectiveness and disease control across varying contexts. The first study develops a SEIRDV model that incorporates government interventions and vaccination rollout to examine COVID-19 dynamics in Qatar. A Bayesian approach is used to estimate parameters and compute time-varying transmission rates. The model captures shifts in transmission following policy changes and quantifies the reduction in deaths attributable …

Financial Health Literacy Of Community-Dwelling Older Adults: A Qualitative Research Study, Kimberly Davis

Theses and Dissertations

Background: Financial health literacy (FHL) is an emerging concept with unique application to older adults. Multiple complexities converge in older age that create increased financial vulnerability (e.g., retirement, chronic disease). However, low financial and health literacy are common in older adults, impacting their ability to self-manage. The AWV’s focus on prevention offers an opportunity to incorporate a proactive approach to financial-related assessment. This study will explore the perceived value of assessing FHL in primary care settings and the financial-related barriers and facilitators to implementing the personalized prevention plan.

Methods: The conceptual framework was guided by the Individual and Family Self-Management …

Sustaining Substance Use Recovery Housing For People Taking Medications For Opioid Use Disorder: Diverse Funding, Strategic Partnerships, And Charging Rent, I Niles Zoschke, Kathryn R Gallardo, Danielle Gillespie, Hannah L N Stewart, Serena A Rodriguez, Sheryl A Mccurdy, J Michael Wilkerson

Faculty, Staff and Student Publications

Introduction: Opioid use disorder is a U.S. epidemic, and recovery housing plays a critical role by providing stable, supportive environments that promote long-term recovery. However, little is known about the sustainability of recovery homes, particularly those serving people taking medications for opioid use disorder.

Methods: We applied thematic analysis to interviews with 29 staff and operators from 10 recovery homes serving people taking medications for opioid use disorder across five Texas cities.

Results: Operators relied on diverse funding sources, leveraged strategic partnerships and professional certifications, and planned to charge rent when public funding ended. Staff and operators balanced financial sustainability …

Assessing Sun Protection Policies In Texas School Districts Located In Counties With The Lowest And Highest Melanoma Risk: Content Analysis And Cross-Sectional Study, Nabeel Ahmad, Brooke Bartley, Stephanie Zhang, Madison M Taylor, Karl Schrader, Kehe Zhang, Hung Quoc Doan, Cici Bauer, Kelly C Nelson, Jennifer Cofer

Faculty, Staff and Student Publications

Introduction

School policy can encourage sun safe habits, such as wearing hats and applying sunscreen. However, sun safety policies (SSP) have not been formally assessed for Texas independent school districts (ISDs), particularly in counties with the highest melanoma incidence relative risk (RR). This study aims to assess the presence, strength, and intent of SSPs across Texas ISDs located in counties with the highest and lowest melanoma incidence. We also identify factors correlated with stronger SSP.

Methods

Eleven components of SSPs from 102 ISDs were evaluated in this cross-sectional study by examining school district websites, official documents, social media, media appearances, …

A Comparison Of The Effect Of Remimazolam And Midazolam On Recovery And Preserved Memory Function For Patients With Dental Extraction Anxiety, Quan Jing, Weijia Wang, Limeng Wu, Lejunzi Wang, Boru Yuan, Yan Wang, Chengbin Wang, Lin Liu, Lei Guan, Riyue Yu, Yuelun Zhang, Daniel I Sessler, Yuguang Huang, Kuo Wan, Lijian Pei

Faculty, Staff and Student Publications

Purpose: Remimazolam is an ultrashort-acting benzodiazepine, which has been indicated to be effective in endoscopic surgery and general anaesthesia. Research on its use in outpatient dental procedures remains limited. This triple-blinded randomized clinical trial was designed to determine whether the quality of postoperative recovery is better with continuous intravenous remimazolam administration compared with midazolam administration for impacted wisdom tooth extraction in patients with dental anxiety.

Patients and methods: This study was a randomized, parallel triple-blinded, superiority trial conducted between 30 April 2022 and 24 June 2024. Participants aged ≥18 years who exhibited dental anxiety and who were eligible for impacted …

A Systematic Review Of Trauma-Informed Sexual Health Education Interventions For Adolescents And Young Adults Within The United States And Canada, Gabrielle S Evans-Mitchell, Lea Sacca, Christine Markham, Katie Schultz, Sheryl Mccurdy, Lauren Tingey, Melissa F Peskin

Faculty, Staff and Student Publications

nterventions developed for adolescents and young adults and describe how they integrate key principles of a trauma-informed approach.

Methods: Using the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guidelines, Substance Abuse and Mental Health Services Administration (SAMHSA) principles, and Khan et al.'s review methodology, we reviewed sexual health intervention studies described as trauma-informed published between 2014 and 2023 within the United States and Canada.

Results: The review found three interventions integrated five to six aspects of a trauma-informed approach relative to Kahn's definition and SAMHSA's principles.

Conclusions: Based on the limited number of trauma-informed interventions being identified, …

Optimizing Community-Based Hepatitis B And C Care For Engaging Housing-Insecure Individuals, Vanessa Schick, Abigail Grace, F Tiffany Quan, Cathy Troisi, Jack Tsai

Faculty, Staff and Student Publications

Introduction

Hepatitis B and C (HBV/HCV) are bloodborne infections, with individuals who have histories of substance use and homelessness bearing a disproportionate risk. Long-standing difficulties in engaging these populations have made testing and treatment challenging. This retrospective observational study describes a community-based approach to HBV/HCV prevention and treatment, comparing the effectiveness of different engagement site types in reaching and engaging this high-need population.

Methods

GRASSROOTS HEALTH was launched in 2018 to improve HBV/HCV care by providing on-site testing, HBV vaccination, treatment navigation, and adherence support across various housing and drop-in centers. Outcomes were tracked through REDCap and analyzed by engagement …

Heat Stress Prevention And Management In The Construction Industry: A Gap Analysis, Muinat Abolore Idris, Kristina D Mena, Christine Markham, William B Perkison

Faculty, Staff and Student Publications

Background: Despite decades of efforts to prevent heat stress, it remains a major health risk to workers in the construction industry. This health risk has been exacerbated by the rising ambient temperatures from climate change, as well as the increased susceptibility to heat stress in an aging workforce.

Objective: To develop a tailored occupational safety management framework for heat stress prevention in construction, advancing workers’ health, safety, and well-being.

Methods: We built on the findings of a systematic review and analyzed a large industrial company’s current heat stress prevention program through stakeholder engagement, evidence-based practices, and gap analysis. We reviewed …

Recovery Housing And On-The-Ground Research Priorities: A Scoping Study Through The Lens Of Community Based Participatory Research, Patrick F Hibbard, Cameron W Tice, Jodie M Dewey, Kathryn R Gallardo, James Tompkins, Justin S Bell, Jasleen Sandhu, Michelle A Cruz, Kathryn Babbitt, Amy A Mericle, Ashli J Sheidow

Faculty, Staff and Student Publications

Introduction: Though communities have featured recovery housing (RH) for several decades, the base of evidence for best practices continues to grow - especially evidence needed by, and known to, those who operate and receive these services. The Initiative for Justice and Emerging Adult Populations (JEAP) engaged with three community boards (CBs) - consisting of young adults with experience in recovery from substance use issues, people who have a history of criminal legal system involvement and recovery, and payers and provider of substance use services and harm reduction - to understand on-the-ground priorities for research into recovery support services.

Methods: JEAP …

Development, Delivery, And Evaluation Of The Texas Epidemic Public Health Institute Infection Control Module Program 200 Series, Kayla E Ruch, Anabel Rodríguez, Janelle Rios

Faculty, Staff and Student Publications

Background: The Texas Epidemic Public Health Institute (TEPHI) aims to safeguard public health and the Texas economy by preparing for infectious disease outbreaks. The Infection Prevention and Control (IPC) Webinar series was created to offer free educational resources and continuing education for public health and healthcare personnel responsible for IPC programs in rural regions of Texas. The IPC 200 Series succeeds the founding IPC 100 Series established by the TEPHI Small Rural Healthcare Preparedness.

Methods: IPC registration and attendance data were collected through WebEx® and Microsoft Teams®, which also served as the platforms for module delivery. Learning assessments and post-module …

Diversity In United States Dementia Prevention Trials: An Updated Systematic Review Of Eligibility Criteria And Recruitment Strategies, Najoua Lazaar, Sabine E Van Beek, Awaale F Rirash, Janne M Papma, Jaime Perales-Puchalt, Ashley R Shaw, Eric D Vidoni, Sanne Franzen

Faculty, Staff and Student Publications

Introduction: Given the elevated dementia risk in underrepresented demographic groups in the USA - particularly in Latino and Non-Latino Black individuals compared to Non-Latino White individuals - it is vital that these groups are well-represented in dementia prevention research. Eligibility criteria and recruitment strategies may play a key role in promoting participant diversity. The aim of this review was to examine eligibility criteria and recruitment strategies in US dementia prevention trials in light of participant diversity.

Methods: A systematic review was conducted using Medline (including PubMed), Embase, Cochrane Library, and CINAHL. We explored the percent White participants for trials using …

Use Of Digital Health Interventions For Cancer Prevention Among People Living With Disabilities In The United States: A Scoping Review, Chinenye Lynette Ejezie, Lea Sacca, Sylvia Ayieko, Sara Burgoa, Yasmine Zerrouki, Diana Lobaina, Goodness Okwaraji, Christine Markham

Faculty, Staff and Student Publications

BACKGROUND: The use of digital health strategies for cancer care increased dramatically in the United States over the past 4 years. However, a dearth of knowledge remains about the use of digital health for cancer prevention for some populations with heath disparities. Therefore, the purpose of the present scoping review was to identify digital health interventions for cancer prevention designed for people with disabilities.

METHODS: This scoping review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews and the Arksey and O'Malley methodological framework. The Embase, PubMed, Ovid MEDLINE, and CINAHL/EBSCO databases were …

Establishing Psychiatry Clubs: Novel Approach To Enhance Psychiatry Teaching Learning In India, Akuti Khanna, Kishor M

Digital Journal of Clinical Medicine

Despite the fact that over 150 million Indians suffer from psychiatric disorders, the country faces a severe shortage of mental health professionals, with less than 1,300 psychiatrists graduating annually. One such solution is the establishment of Psychiatry Clubs in medical colleges, which can significantly enhance awareness, education, and community engagement in mental health. The Psychiatry Club at JSS Medical College, Mysuru, established on October 10, 2023, aims to promote mental well-being, provide peer support, as well as foster professional development through workshops, seminars, and collaborations with other mental health professionals and other student led organisations. These clubs offer a sustainable …

Assessment Of Effectiveness And Evaluation Of Perception Among Students Towards Flipped Classroom Learning: A Prospective Study., Nagaraja Prasad Sai, Vedavathi Hanumaiah, Shreenivas Prabhakar Revankar, Shruthi S. Lingesh, Avanthi Eshwar

Digital Journal of Clinical Medicine

BACKGROUND: Flipped learning (FL) is a teaching learning approach in andragogy. In FL students are involved in self-directed learning with the teacher acting as a facilitator and a moderator. Introduction of Competency Based Medical Education led many educators to shift from traditional teaching to blended teaching learning methods. This study was conducted to assess effectiveness and evaluate students’ perception towards FL.

AIM AND OBJECTIVES: To assess effectiveness of FL teaching in improvement of student scores and to evaluate student’s perception towards FL teaching.

MATERIALS AND METHODS: Pre-class activities included study materials in the form of PowerPoint slides …

Evaluating The Role Of Staff Nurses In Integrating Traditional And Alternative Medicine: Patients’ Perspectives From Rural Mysuru, Kaustubh Gaur, Jesymol Joy, Renuka M

Digital Journal of Clinical Medicine

Background: In rural India, nurses play a pivotal role as primary healthcare providers, due to limited physician availability. Their responsibilities often extend beyond routine care to include guiding patients in both modern and traditional healthcare approaches. However, there remains limited insight into how patients perceive this expanded role. This study aims to evaluate patients' perspectives on the role of nursing staff as primary healthcare providers in South Indian rural hospitals.

Methods: A cross-sectional study was conducted over a three-month period in the rural and urban field practice areas of JSS Medical College. A total of 256 adult patients who …

Use Of Augmented Reality For Mosquito Breeding Sites Identification, Venant Niyonkuru, Sylla Sekou, Jimmy J. Sinzinkayo

Digital Journal of Clinical Medicine

An augmented reality app is used for detecting the possible breeding locations of mosquitoes in different settings precisely. With the aid of the advanced augmented vision technology, the AR system recognizes water-containing containers that are frequent breeding places for mosquitoes according to the visual information obtained through a head-mounted display. It then overlays visual highlights and labels directly onto these containers within the user's field of view, allowing one to instantly identify and spot breeding sites in real time. By combining state-of-the-art AR functionality with powerful computer vision algorithms, the method provides real-time visual feedback for identifying and tagging mosquito …

Intestinal Oxygen Utilisation And Cellular Adaptation During Intestinal Ischaemia-Reperfusion Injury, Paraschos Archontakis-Barakakis, Theodoros Mavridis, David-Dimitris Chlorogiannis, Georgios Barakakis, Eleni Laou, Daniel I Sessler, George Gkiokas, Athanasios Chalkias

Faculty, Staff and Student Publications

The gastrointestinal tract can be deranged by ailments including sepsis, trauma and haemorrhage. Ischaemic injury provokes a common constellation of microscopic and macroscopic changes that, together with the paradoxical exacerbation of cellular dysfunction and death following restoration of blood flow, are collectively known as ischaemia-reperfusion injury (IRI). Although much of the gastrointestinal tract is normally hypoxemic, intestinal IRI results when there is inadequate oxygen availability due to poor supply (pathological hypoxia) or abnormal tissue oxygen use and metabolism (dysoxia). Intestinal oxygen uptake usually remains constant over a wide range of blood flows and pressures, with cellular function being substantively compromised …