Digital Commons Network^™

Accessibility And Daily Cigarette Consumption Among Indonesian Adolescents: A Descriptive Study, Noviana Lathifah, Istiqomah Hanifah Rachman, Anisa Isnaini, Gloria Threesia Piliphinsa Simatupang

Journal of Indonesian Health Policy and Administration

Despite restrictive regulations, Indonesia faces a high prevalence of adolescent smoking, facilitated by easy access to tobacco products. This descriptive study aims to describe cigarette accessibility patterns and daily consumption trends among Indonesian adolescents. A cross-sectional study was conducted using secondary data from the 2019 Global Youth Tobacco Survey (GYTS) involving 9,208 respondents. Descriptive analysis was performed to examine the distribution of age at smoking initiation, daily cigarette consumption, and purchasing accessibility. The majority of respondents started smoking at ≥14 years of age. Daily cigarette consumption showed an increasing trend with age, with older adolescents more likely to consume more …

Deadline-Chasing In Digital Health: Forecasting Emr Adoption Dynamics And Regulatory Impact In Indonesian Primary Care, Suryo Satrio, Bukhori Muhammad Aqid

Journal of Indonesian Health Policy and Administration

Indonesia is accelerating digital health adoption under Minister of Health Regulation No. 24/2022, which mandates the use and integration of Electronic Medical Records (EMRs) with SATUSEHAT. However, evidence on how quickly primary health care facilities (Fasilitas Kesehatan Tingkat Pertama – FKTP) are adopting EMRs and what the adoption curve looks like remains limited. Survey findings also suggest key barriers and enablers, including security and data migration concerns, as well as human resource and infrastructure constraints. This observational study used provider-network data from a single EMR vendor. Key measures included cumulative registered facilities, monthly registrations, same-month activation (total_active/monthly inflow) as …

Optimizing Vitamin A Intervention: Strengthening Supplementation With Targeted Biscuit Fortification, Mayfa Yemima Simanjuntak, Nadia Amanda, Yuli Berliana Simanjuntak, Carissa Wityadarda, Lesta Livolina Simamora

Journal of Indonesian Health Policy and Administration

Vitamin A deficiency (VAD) remains a persistent public health challenge in Indonesia, particularly among children under five and breastfeeding mothers. This study aimed to analyze the distribution of vitamin A interventions and assess the potential of biscuit fortification as a complementary strategy. This study employs a literature review using the Health Policy Triangle (HPT) framework, examining policy context, content, key actors, and implementation processes related to vitamin A interventions. The analysis was conducted using secondary data from government reports, international agencies, and peer-reviewed literature published between 2018 and 2025, with comparative evidence from Vietnam, Bangladesh, and Ghana. The findings show …

Intervention Levers For Stunting Reduction In Indonesia: Evidence From The 2023 Indonesian Health Survey Data, Iwan Ariawan, Hafizah Jusril, Zahra Izza Afifa, Azka Fitri, Elmarizha Sekar Utami, Mikail Hasan, Dwi Puspasari

Kesmas

Stunting remains the largest public health challenge among macro-nutrition problems in Indonesia, affecting almost a quarter of children under five in 2023. The prevalence is considered high according to the World Health Organization standard. This study analyzed 15 aggregated provincial variables from the 2023 Indonesian Health Survey using Structural Equation Modeling (SEM), focusing on determinants of stunting among children under two to identify primary intervention levers. Findings indicated that intervention urgency should focus on the first 1,000 days, particularly the steep increase in stunting prevalence observed in the 12–24-month age range. While the highest prevalence is in Eastern provinces (e.g., …

Referral Patterns From Primary Care To Referral Care By Icd-10 Codes In Indonesia: Cross-Sectional Analysis Of National Claims Data (2017–2024), Della Dwi Ayu, Syarif Rahman Hasibuan, Putu Erma Pradnyani, Nisrina Widyasanti

Journal of Indonesian Health Policy and Administration

Primary health care (PHC) facilities serve as gatekeepers within Indonesia’s tiered health system. However, PHC referral patterns to hospitals still show substantial variation and remain insufficiently characterized by disease groupings based on the International Classification of Diseases, 10th Revision (ICD-10). This study aimed to identify the most frequently referred diagnoses from PHC to secondary or tertiary care facilities and to determine the participant characteristics associated with referrals. This observational study employed a cross-sectional design using secondary data from the National Health Insurance (Jaminan Kesehatan Nasional – JKN) claims database for the period 2017–2024. The unit of analysis was each …

Factors Associated With The Performance Of Essential Public Health Efforts At Primary Health Centers In Jember Regency, Griselda Ardelia Hibatullah, Nuryadi Nuryadi, Yennike Tri Herawati

Journal of Indonesian Health Policy and Administration

Performance assessment of primary health centers is essential to ensure the quality of healthcare services, including the delivery of essential public health efforts. The performance target for essential public health efforts in Jember Regency is set at ≥82%. This study aimed to analyze factors associated with the performance of essential public health efforts. The study employed an analytical cross-sectional design conducted from April to May 2025, with a sample of 37 out of 50 units selected through simple random sampling. Primary data were collected using questionnaires, while secondary data were obtained from primary health center (Pusat Kesehatan Masyarakat – …

Navigating Trust: The Impact Of Social Media Influencers On Gen Z Health Behaviors, Abigail Stelling

Honors Thesis

Social media plays a defining role in the daily lives of Gen Z, influencing how people communicate, access information, and make decisions. More than a form of entertainment, social media is a powerful source that shapes identity, perceptions, and behaviors. As the first generation to grow up fully immersed in a digital world, Gen Z is uniquely impacted by the content and interactions that occur on social media platforms. Within this digital landscape, social media influencers have emerged as powerful figures. These individuals use large online platforms to promote lifestyles, products, and behaviors. Influencers often have the ability to shape …

Clinician Perspectives On Fistula Mental Health, Victoria K. Leonard

Doctoral Dissertations

Background – Obstetric fistula is a childbirth injury caused by prolonged labor that leads to stillbirth and incontinence, spurring social exclusion and isolation. These layers of trauma put women with fistula at great risk for psychological suffering, which has profound negative socioeconomic impacts on them, their families, and communities. This study captured treatment as usual at Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), the country’s largest provider of fistula care.

Method – Improving holistic fistula treatment requires engaging the clinicians who care for women with fistula. This study aimed to investigate the training, beliefs, and treatment approaches of nurses and …

Knowledge, Attitudes, And Practices Among Hepatitis B Patients In Jakarta, Indonesia: A Cross-Sectional Study, Hashem S. Arkok, Tri Yunis Miko Wahyono, Nurhayati Adnan Prihartono, Dipo Aldila

Kesmas

Hepatitis B remains a major public health problem in Indonesia. This study assessed the knowledge, attitudes, and practices (KAP) of hepatitis B patients in Jakarta to identify gaps in prevention and control and to explore relationships among KAP components. A cross-sectional study was conducted among 128 patients at a government hospital in South Jakarta, using a structured questionnaire that collected demographic information and assessed knowledge, attitudes, and practices regarding hepatitis B transmission and prevention. Despite moderate knowledge levels, major gaps remained. Only a small proportion (10.9%) correctly identified common symptoms, transmission routes (10.2%), and possible complications (18.8%). Misconceptions about transmission …

Development And Validation Of An Indonesian Questionnaire For Assessing Paracetamol Self-Medication Knowledge, Attitude, And Practice, Widyana Sagita Putri, Rani Sauriasari, Priharika Septyowati

Kesmas

Paracetamol is a widely used over-the-counter medicine for self-medication and is often perceived as completely safe. However, inappropriate use may result in hepatotoxicity and other adverse effects, particularly at high doses. This study aimed to develop and validate a questionnaire to assess the general Indonesian population’s knowledge, attitude, and practice (KAP) regarding paracetamol self-medication. The validation procedure consisted of three stages: content, face, and construct validation. Three experts assessed the relevance of the items using the Content Validity Index, and five respondents were interviewed to assess the linguistic clarity and comprehensibility of the questions. Construct validity and reliability were assessed …

Determinants Of Behavioral Intention To Change Sexual And Reproductive Health Practices Among Adolescents: A Hierarchical Multiple Linear Regression Analysis, Md Mizanur Rahman, Gerraint Gillan Ahi, Rafazila Ramli, Rasitasam Safii, Jacey Lynn Minoi, Stephanie Chua Hui Li, Ahmad Sofian Bin Shminan, Lee Jun Choi

Kesmas

Conventional and web-based sexual and reproductive health (SRH) interventions are increasingly used with adolescents, yet their comparative effectiveness and underlying mechanisms remain unclear. This study compared the two formats and examined the Theory of Planned Behavior (TPB) constructs as predictors of changes in intention to adopt health-protective SRH practices (including contraceptive use, service utilization, and parent–child communication) among Malaysian adolescents. A randomized controlled trial allocated adolescents to conventional or web-based SRH education. Intention-to-change behavior towards sexual and reproductive health scores was assessed at baseline, 1 month, and 3 months; change scores were modeled using hierarchical linear regression, including intervention type, …

Factors Associated With Public Health Centers’ Achievement Of Health Service Target In Yahukimo District, Highland Papua Province, Indonesia, Emaus Heluka, Venty Suryanti, Indasah Indasah, Prima Dewi Kusumawati

Kesmas

The achievement of the Minimum Service Standards (MSS) in Yahukimo District, Highland Papua Province, Indonesia, warrants examination. This study aimed to analyze factors associated with the achievement of health service targets among Public Health Centers (PHCs) in Yahukimo District. An ecological study design was employed. The participants were 400 health workers from 33 PHCs and were examined using Likert-scale questionnaires. Data were processed using Structural Equation Modeling-Partial Least Squares (SEM-PLS) to assess the association of each variable. The results showed that health target indicators were associated with the achievement of health service targets (T = 3.320; p-value = 0.012). Health …

Extending The Global Impact Of Dnp Education: Integrating Scholarly Dissemination And International Practice Projects, Cynthia Plonien, Pricilla Muisyo, Deborah Behan, Kristine Cope, Cathy Brown

Nursing Faculty Publications & Presentations

The Doctor of Nursing Practice (DNP) Program at the University of Texas at Arlington initiated a global outreach effort in 2024 through two complementary strategies: expansion of a digital repository to support dissemination of DNP scholarly work and implementation of pilot DNP projects in Kenya. Together, these initiatives represent an integrated model for global engagement that combines knowledge dissemination with application of practice-based scholarship. The repository has facilitated international access to DNP projects, demonstrating significant global reach across multiple countries. Concurrently, a pilot project in Kenya was established through a strategic in-country professional partnership, enabling culturally relevant and sustainable implementation …

Do Rural-Urban Disparities Translate Into Nursing Complexity At Hospital Admission? Evidence From A Single Tertiary-Care Pediatric Hospital In Italy, Manuele Cesare, Gianfranco Damiani, Gloria Anderson, Jessica Preziosi, Rosemary Frasso, Leonardo Villani, Nursing And Public Health Group, Vittorio Maio, Antonello Cocchieri

College of Population Health Faculty Papers

BACKGROUND/OBJECTIVES: Rural-urban disparities are well documented in pediatric healthcare, influencing access, service organization, and outcomes. However, whether these differences extend to the domain of nursing care remains unclear. This study examined the association between degree of urbanization and nursing complexity among children admitted to a single tertiary-care pediatric hospital, comparing clinical, organizational, and nursing characteristics across geographic groups.

METHODS: Routinely collected electronic nursing documentation and hospital administrative records were retrospectively examined in a tertiary-care pediatric hospital in Rome, Italy. Children aged 2 to < 18 years were consecutively included. Degree of urbanization was defined using the ISTAT-derived DEGURBA classification. The study outcome for nursing complexity corresponded to the number of nursing diagnoses documented at hospital admission. Descriptive analyses and a multivariable negative binomial regression model assessed the association between urbanization and nursing complexity, adjusting for age, sex, DRG weight, number of medical diagnoses, and chronic conditions.

RESULTS: Among 1652 pediatric hospitalizations, those from rural areas showed a higher clinical burden, with significantly higher …

Evaluating Stroke Recognition And Prehospital Quality Metrics In Emergency Dispatch: A Retrospective Cohort Study Comparing Mimics And Confirmed Strokes, Nedim Leto, Elisabeth Farbu, Paul Barach, Conrad Arnfinn Bjørshol, Martin Kurz, Soffien Ajmi, Annette Fromm, Christopher Kalhagen Bjerkvig, Thomas Lindner

College of Population Health Faculty Papers

OBJECTIVES: Accurate identification of acute stroke by the Emergency Medical Dispatch Centre (EMDC) is essential for timely treatment and efficient resource use. However, stroke mimics-conditions resembling stroke can often lead to overtriage, complicating emergency care. We aimed to quantify EMDC stroke overtriage and compare characteristics of stroke mimics with confirmed stroke cases.

DESIGN: Retrospective cohort study.

SETTING: Patients with suspected stroke identified by the EMDC in Western Norway between 1 January 2021 and 31 December 2022.

PARTICIPANTS: A total of 8,261 patients with EMDC suspected stroke were included. Stroke suspicion was determined using the Norwegian Medical Priority Dispatch System, which …

Expert Recommendations To Strengthen Chikungunya Outbreak Surveillance And Reporting For Traveler Health Protection, Daniel C. Payne, Karoun H. Bagamian, Jeffery Goad, Nathan D. Grubaugh, Michael A. Johansson, Moritz U. G. Kraemer, Eyal Leshem, Francesca F. Norman, Alfonso J. Rodríguez-Morales, Henrik Salje, Stephen Thomas, Scott C. Weaver, Lindsey A. Laytner, Rebecca Sturgis, Suzanne K. Scheele, Davidson H. Hamer

Pharmacy Faculty Articles and Research

Chikungunya, a debilitating mosquito-borne disease caused by chikungunya virus, has surged dramatically in the past two decades. Chikungunya outbreaks can intensify rapidly, with infections posing a significant endemic health burden in tropical/subtropical areas and for travelers. Health professionals require timely and accurate outbreak information to adequately protect travelers and assess chikungunya risk. However, detection is often insufficient in the areas most susceptible to outbreaks, leading to diagnostic and reporting delays. Consequently, travelers are often unaware of increased chikungunya infection risk at their destination. We assessed chikungunya surveillance and reporting resources, and we developed expert recommendations for traveler health protection. Because …

Internalized Homophobia As An Influence On Participation In Hiv Prevention Among Young Men Who Have Sex With Men (Ymsm), Kasey I. Brazee

Honors Scholar Theses

Stigma is a known barrier to accessing preventative services for human immunodeficiency virus (HIV), however, the types of stigmas involved in this relationship remain not well defined. Homophobia, or negative attitudes directed towards homosexuality, is a particularly important type of stigma considering the disproportionate effect of HIV on men who have sex with men (MSM). Young MSM (YMSM) are especially impacted, making them a key population in the context of HIV prevention research.  Internalized homophobia, which refers to homophobia that one directs towards themselves, is under researched regarding its role in participating in HIV prevention. In this study, we aimed …

Lessons Learned In Providing Infant And Early Childhood Mental Health Consultation During The Covid-19 Pandemic, Rashele Wade

Journal of Global Awareness

Access to quality childcare is a protective factor from lifelong issues such as school failure, school drop-out, and incarceration. Conversely, preschool suspension and expulsion are significant risk factors. Evidence-based interventions, such as Infant and Early Childhood Mental Health Consultation, aim to reduce and eliminate the incidence of preschool suspensions and expulsions. The COVID-19 pandemic disrupted access to quality childcare for many children across the country and globally. This study utilized a qualitative action research approach and generic qualitative inquiry to examine the research question, “How can we improve Infant and Early Childhood Mental Health Consultation through lessons learned during the …

Psychological Strain And Infrastructure Deficit And The Decision To Migrate Among Healthcare Workers From Lagos, Nigeria, Fatima Adeboye

Walden Dissertations and Doctoral Studies

No abstract provided.

Slouching Towards Inefficiency? The Cardiometabolic And Cognitive Costs Of Poor Posture, Ava Mae Fitzenrider

Honors Projects

Posture affects all of our lives. It is both static and dynamic, adapting continuously to environmental demands. One postural alteration frequently observed in occupational settings is hyperkyphosis, which can be induced by sitting position. During computer use, individuals commonly adopt a slouched posture, which can exacerbate hyperkyphosis, and contribute to dis-ease within the body. Previous research has demonstrated that such postural deviations can negatively affect pulmonary function, as well as other bodily functions. Despite these findings, the effects of acute hyperkyphosis (“slouching”) on cardiometabolic function and cognition remain largely unexplored. Therefore, the purpose of this study was to examine the …

Somatic Prosthetics For Planetary Resonance, Disha Dharesh Kumar R

Masters Theses

This thesis investigates how industrial design can transcend extractive technological paradigms in favor of relational interfaces that foster planetary attunement. Framing the climate crisis as a 'crisis of imagination', the research challenges the Western bifurcation of nature and culture by drawing on Indic cosmologies- which recognize stones, plants, and ecosystems as conscious at different levels and participants in a shared cosmic field. By synthesizing research in Biosemiotics, Quantum Information Pansycishm, and Neuroscience, the project redefines intelligence as a distributed, more-than-human phenomenon.

The research materializes as a speculative design artifact: a device that functions as a somatic prosthetic for planetary resonance. …

Evaluating The Association Between Chronic Health Conditions And Caregiver Burden For Male Dementia Caregivers, Dareion D. Hill-Smith

Walden Dissertations and Doctoral Studies

No abstract provided.

Titanium Dioxide: An Inquiry Into The Mechanisms And Implications Of Exposure In Gut Dysbiosis And Metabolic Disorders, Meghan Gardiner

Senior Honors Theses

Titanium dioxide (TiO₂) is one of the most prevalent food additives utilized in commercial products in the United States. While TiO₂ was originally hailed as a nontoxic and cost-effective additive, studies are beginning to reveal that TiO₂ is not as safe as it once seemed. TiO₂ may contribute to the development of insulin resistance and metabolic disorders through direct and indirect mechanisms. The compound induces gut dysbiosis, leading to alterations in bacterial metabolites and pro-inflammatory cytokines, which results in the selective resistance of glucocorticoid receptors. Additionally, TiO₂ itself can translocate from the gut to …

Community Engagement To Rebuild Confidence In Public Health, Donna L. Williams

Journal of the Louisiana Public Health Association

No abstract provided.

Vol 6. May '26 Full Issue, Donna L. Williams

Journal of the Louisiana Public Health Association

No abstract provided.

Co-Occurring Clonal Hematopoiesis Exhibits Strong Selection And High Leukemia Risk, Kara M Barnao, Aubrey K Hubbard, Irenaeus C C Chan, Weiyin Zhou, Yasminka A Jakubek, Giulio Genovese, Wendy S W Wong, Rebecca L Kelly, Corey D Young, Derek W Brown, Wen-Yi Huang, Neal D Freedman, Kristine Jones, Amy Hutchinson, Belynda Hicks, Duc Tran, Donna Arnett, Kathleen C Barnes, Joshua C Bis, Eric Boerwinkle, Jennifer A Brody, April P Carson, Daniel I Chasman, Michael H Cho, Pinkal Desai, Margaret F Doyle, Myriam Fornage, Xiuqing Guo, Nancy Heard-Costa, Marguerite Ryan Irvin, Andrew D Johnson, Sharon L R Kardia, Charles Kooperberg, Daniel Levy, Joshua P Lewis, Yun Li, Ruth J F Loos, Taralynn M Mack, Rasika A Mathias, Braxton D Mitchell, Kari E North, Nathan Pankratz, Patricia A Peyser, Michael H Preuss, Bruce M Psaty, Laura M Raffield, Susan Redline, Stephen S Rich, Jerome I Rotter, Edwin K Silverman, Albert V Smith, Jennifer A Smith, Adrienne Stilp, Yin Cao, Paul Scheet, Alexander P Reiner, Alexander G Bick, Stephen J Chanock, Paul L Auer, Kelly L Bolton, Mitchell J Machiela

Faculty, Staff and Student Publications

Clonal hematopoiesis of indeterminate potential (CHIP) and mosaic chromosomal alterations (mCAs) are two types of clonal hematopoiesis (CH) associated with hematological parameters and malignancy risk. Here we show, in genomic data from 546,090 biobank participants, that co-occurring CH (≥2 CH mutations detected) is present in 1.6% of cancer-free individuals and shows strong evidence for selection (up to 804x enrichment). Co-occurrence is more frequent in those with a prior cancer (3.6%), suggesting treatment-induced selection. Acquisition of CHIP usually precedes mCAs with co-occurrences manifesting stronger phenotypic disruptions in telomere attrition and hematologic parameters than component CH events. Individuals with co-occurring CH have …

Using The Socio-Ecological Model To Explore Parents' Resilience And Perceptions Of Adverse Childhood Experiences: A Qualitative Study In The Southeastern United States, Maribel G Dominguez, Christine Markham, Andrew E Springer, Louis D Brown

Faculty, Staff and Student Publications

Background: The negative impact of adverse childhood experiences (ACEs) on child development is documented. The parent-child relationship protects against ACEs and improves healthy child development, playing a crucial role in preventing and mitigating ACEs by strengthening parental resilience. However, there is a gap in the literature on our understanding of parental resilience's impact on the parent-child relationship within the social-ecological model (SEM) (i.e., intra- and interpersonal, community, and societal levels). Objective: This study explores parents' perspectives on parental resilience as a protective factor for preventing and mitigating ACEs at every level of the SEM. Method: This study uses a thematic …

Determinants Of Pre-Exposure Prophylaxis Medication Use Among People Aged 18–29 Years Living In Florida, Jeremiah Magraubin Mchaka Wandabwa

Walden Dissertations and Doctoral Studies

No abstract provided.

Factors Associated With Vaping Frequency Among University Students, Oluwatosin Marylyn Oduneye

Masters Theses

Electronic cigarette use among university students is a growing public health concern, with approximately 20-25% reporting current use. Despite extensive research on vaping initiation, factors associated with vaping frequency among established users remain understudied. This study examined stress-coping mechanisms, peer influence, and health risk perceptions as predictors of vaping frequency, guided by Bandura's Social Cognitive Theory (SCT). A quantitative cross-sectional survey was administered via Microsoft Forms to 399 university students aged 21-25 with recent vaping experience, recruited nationally through campus flyers and online platforms. Multiple linear regression was conducted in SAS OnDemand for Academics, with stress-coping, peer influence, and health …

Beyond Crisis: Patient Access And Sustainability, Miguel A. Mendoza

Doctoral Dissertations and Projects

Critical systems underwent drastic workflow adaptations during the COVID-19 pandemic. Many of these operational alterations persist today, while others have been reduced or eliminated. This is a qualitative study on the operational, technological, and human-centered challenges experienced by healthcare organizations providing primary care services in Southwest Ohio during and immediately after the pandemic. This flexible research design implements in-depth, semi-structured interviews with healthcare professionals leading primary care operations to capture a longitudinal perspective on pandemic-era service delivery, and the legacy systems still in place today. Thematic analysis revealed seven themes that determine the effectiveness of care delivery models. Social Determinants …