Digital Commons Network^™

Leading With Hope: A Clinical Communication Campaign To Promote Partner Hiv Testing In Assisted Partner Notification And Antenatal Care Programs In Uganda., Emily A. Hurley, Violet Gwokyala, Linda Kisaakye Nabitaka, Jolly Beyeza Kashesya, Mercylynn Agasha, Florence Namaganda, Nikolaus Schuetz, J Nalubega Ross, Joseph K B Matovu, Rhoda Wanyenze, Glenn Wagner, Kathy Goggin

Manuscripts, Articles, Book Chapters and Other Papers

Among heterosexual couples in sub-Saharan Africa, fears of relationship dissolution and inability to bear healthy children following an HIV-positive result remain barriers to HIV testing. Recently expanded availability of pre-exposure prophylaxis (PrEP) affords a critical opportunity to promote HIV testing with reassuring communication that highlights use for relationship preservation and healthy childbearing. We aimed to develop a theoretically-grounded communication intervention to promote partner HIV testing within assisted partner notification (APN) and antenatal care (ANC) programs in Uganda. Through an 18-month iterative co-creation process, we developed the HOPE Clinical Communication Campaign (HOPE-CCC) in collaboration with a project advisory board (PAB) of …

Exploring Sexually Explicit Material Literacy In Compressive Sex Education, Ashton Payne

Health, Human Performance and Recreation Undergraduate Honors Theses

Background: Adolescents increasingly encounter sexually explicit material (SEM) through digital media, often before receiving formal instruction about sexuality, relationships, or consent. This early and unmediated exposure has prompted growing interest in pornography literacy as a necessary component of comprehensive sex education (CSE). Purpose: This literature review synthesizes empirical research published between 2015 and 2025 examining pornography literacy pedagogy, its implementation within CSE, and its documented impacts on adolescent knowledge, attitudes, and behaviors. Methods: The University of Arkansas’s OneSearch served as the primary search engine, drawing from major academic databases including ProQuest, PubMed, Web of Science, JSTOR, and …

Barriers And Facilitators Of Childhood Immunization: A Mixed Methods Assessment Of Health Care And Community Health Professionals’ Observations, Jenny Dong

Theses/Capstones/Creative Projects

Childhood immunization has led to significant decreases in the burden of infectious disease morbidity and mortality. Despite these contributions, U.S. childhood vaccination rates have been declining in recent years, and updates to the federal immunization schedule have removed recommendations for several childhood vaccinations. Amid such an uncertain public health landscape, understanding how environmental conditions affect childhood immunization behaviors is crucial for ensuring that children receive the vital protections vaccines offer. Thus, the purpose of this study is to examine the barriers and facilitators of childhood immunization observed by Nebraska health care professionals (HCPs). This study utilized an online questionnaire and …

The Undergraduate Education And Scientific Literacy: Exploring How College Influences Student Perception Of Covid-19 Events, Peyton Brooking

Theses/Capstones/Creative Projects

Current undergraduate students received much of their education following the events of the COVID-19 pandemic. Many of these students experienced pandemic events before receiving any or most of their science-based higher education. Exploring their progress through higher education, and how it retroactively influenced their perception of pandemic events, serves as an informative research area. This study explores how undergraduate education in the sciences influences student engagement with complex recent events in science. In addition, this study asked how higher education builds confidence in interpreting this information. Additionally, students were surveyed to understand their scientific literacy baseline at the beginning of …

Navigating The Nicu Without Words: A Case Study Of A Spanish-Speaking Mother’S Healthcare Experience, Emma Norris

Honors Theses

Background: Few studies examine language barriers in the neonatal intensive care unit (NICU). Miscommunication and lack of understanding between the healthcare team and a NICU infant’s parents may easily occur when the relationship is inhibited by a language barrier. Previous studies show that a lack of parent-provider communication creates additional anxiety for parents. The purpose of this study is to explore and describe the experiences and barriers in communication between an English-speaking nurse, an English-Spanish bilingual nurse, and a Spanish-speaking mother of a NICU infant.

Methods: This project was a case study using an exploratory mixed methods qualitative design. Qualitative …

Ambient Air Pollution In New Mexico: Nurse Practitioner Awareness, Mckenzie Hemmes, Grayson Kemp

Doctor of Nursing Practice Scholarly Projects

Ambient air pollution is a significant public health concern in New Mexico and contributes to respiratory disease, cardiovascular illness, and adverse pregnancy outcomes (Dominski et al., 2021; Di et al., 2022). Despite well-established evidence linking environmental exposures to health outcomes, environmental exposure screening is not routinely incorporated into clinical practice. The purpose of this Doctor of Nursing Practice (DNP) project was to improve environmental health literacy (EHL) among advanced practice registered nurses (APRNs) in New Mexico and to increase their intention to integrate ambient air pollution exposure screening and mitigation counseling into routine clinical practice. A virtual educational intervention guided …

The Birthing Ground Podcast: Assessing The Impact Of Shared Doula Experiences On New Doula Confidence, Arrieanna D. Martinez

Capstone Projects and Master's Theses

There are too few confident, experienced doulas available in Monterey County to meet the needs of birthing families. Community-based maternal health programs face challenges related to limited confidence and experience among newly trained doulas, which affect the quality and consistency of care provided to families. This project addressed the needs of new doulas serving Medi-Cal–eligible families in Monterey County. The purpose of this capstone project was to increase confidence and preparedness among new doulas through a mentorship-based learning intervention. The project was implemented at the Parenting Connection of Monterey County and included new doulas and experienced mentor doulas. Key activities …

Chemical Variability In The Unregulated Opioid Supply In The South Bronx, Yeireline Rodriguez

Student Theses

The unregulated drug supply in the United States has become increasingly unpredictable, contributing to persistently high overdose mortality, particularly in structurally marginalized communities such as the South Bronx. While drug adulteration has long been present in illicit markets, the number and pharmacological diversity of adulterants remained limited for much of the twentieth century. Over the past decade, however, the drug supply has undergone a significant transformation marked by the proliferation of potent synthetic opioids such as fentanyl and its analogues, frequently combined with novel sedatives and chemically diverse adulterants. These shifts have introduced increasing chemical complexity into the street drug …

From Prescription To Plate: Redefining The Pharmacist’S Role In Food Is Medicine Initiatives, Aleena R. Thomas

Honors Scholar Theses

Produce prescription (PRx) programs are an emerging Food is Medicine intervention designed to address diet-related chronic diseases and food insecurity by integrating healthcare delivery with access to fruits and vegetables. Diet-related conditions such as type 2 diabetes, hypertension, and cardiovascular disease represent a major public health burden in the United States, particularly among populations with limited access to nutritious food. Despite growing evidence supporting PRx programs, pharmacists -- who routinely manage these conditions and monitor outcomes -- are underutilized in program implementation. The objective of this project is to translate the public health aspects of PRx programs into an accessible, …

Addressing Substance Use Disorder In Rural Appalachia: Improving Access And Treatment Outcomes For Justice-Involved Individuals, Jessica Muldowney

Electronic Theses and Dissertations

Background: Opioid use disorder (OUD) represents a critical public health crisis disproportionately affecting justice-involved (JI) populations, with approximately 65% of incarcerated individuals having substance use disorders (James & Beatty, 2006). Rural Appalachian communities face compounded challenges due to limited healthcare access, provider shortages, and cultural stigma surrounding addiction treatment. Despite evidence demonstrating that medication-assisted treatment (MAT) reduces recidivism and overdose deaths, only 20% of correctional facilities offer these services (Klein & Seppala, 2019).

Objective: This mixed-methods study evaluated organizational readiness and infrastructure capacity for implementing evidence-based OUD interventions, specifically MAT programs across three rural counties in northwestern North Carolina.

Methods: …

Ethical Engagement In Global Missions: A Qualitative Inquiry Into Planner Motivations And Host Experiences, Harrison J. Ihrig

Electronic Theses and Dissertations

Short-term mission (STM) trips are limited duration service experiences, commonly organized by faith-based organizations (FBO), in which volunteers travel domestically or international to provide ministry, community outreach, and/or health-related services. In recent decades, the number of these trips organized by organizations in the United States has increased exponentially, but the phenomenon is difficult to accurately measure due to its decentralized nature and the lack of standardized terminology. Despite their prominence, limited research has been conducted to examine planning, implementation, and evaluation processes of international STMs organized by FBO, particularly through a public health lens. The purpose of this study was …

Use Of Period- Or Fertility-Tracking Technologies Pre- And Post-Dobbs, Emily Neiman, Marta Bornstein Phd, Mph, Abigail Norris Turner, Megan L. Kavanaugh, Maria F. Gallo

Faculty Publications

Objectives

Study design

Screening For Hypertension And Diabetes In Laundromats In The Largest Hispanic-Majority City In The U.S, Nicholas A Mccann, Vanessa Schick, Jack Tsai

Faculty, Staff and Student Publications

Purpose: This study aimed to assess the prevalence of hypertension and diabetes among laundromat users in San Antonio, Texas, and explore laundromats as a novel setting for health interventions regarding these 2 conditions.

Design: This descriptive, cross-sectional study involved demographic, blood pressure and HbA1c screenings to assess the health status of laundromat users.

Setting: The study took place in 7 laundromats in low-income areas of San Antonio.

Subjects: A total of 150 adults aged 18 and older who regularly used the laundromats and spoke either English or Spanish were eligible to participate.

>Measures: Hypertension was defined as a systolic BP …

An Integrated Framework For Early Detection And Transmissibility Assessment Of Emerging Variants In Wastewater, Xingwen Chen, Tin Phan, Wei Lin Lee, Katie Clark, Steven F Rhode, Samantha Brozak, Bruce Pell, Tsultrim Palden, Mats Leifels, Anna Gitter, Yang Kuang, Stefan Wuertz, Janelle Thompson, Kristina D Mena, Eric J Alm, Fuqing Wu

Faculty, Staff and Student Publications

Tracking the emergence of new viral variants is critical for epidemic preparedness, but remains challenging because variants typically circulate at low prevalence during the early phase of outbreaks. Here, we present an integrated framework that combines sensitive variant detection in wastewater with quantitative assessment of transmissibility through dynamic epidemic modeling. Using the SARS-CoV-2 Omicron variant as a proof of concept, we developed a novel nested allele-specific RT-qPCR assay (NAS-PCR) that achieved a thousand-fold increase in sensitivity compared with allele-specific RT-qPCR (limit of detection: 0.5 copies/μl). NAS-PCR detected Omicron in wastewater samples from the Greater Boston area starting in September 2021, …

Associations Of Blood Biomarkers Of Glial Cell Dysfunction And Neuronal Injury With Future Cognitive Decline And Incident Dementia, Srishti Shrestha, Xiaoqian Zhu, B Gwen Windham, Kevin J Sullivan, Priya Palta, Rebecca F Gottesman, Russell P Tracy, Clifford R Jack, Petrice M Cogswell, Prashanthi Vemuri, Sudha Seshadri, Thomas H Mosley, Michael E Griswold, Myriam Fornage

Faculty, Staff and Student Publications

Introduction: Prospective studies of blood-based biomarkers reflecting pathogenic processes, other than Alzheimer-specific pathologies, that contribute to dementia in diverse cohorts are lacking.

Methods: We jointly fitted linear mixed-effect models and proportional hazards models to examine associations of midlife glial fibrillary acidic protein (GFAP), chitinase-3-like protein 1 (YKL-40), soluble cluster of differentiation-14 (sCD14), neurofilament light chain (NfL), total tau (t-tau), and ubiquitin C-terminal hydrolase L1 (UCHL1) levels in serum (collected in 1993 to 1995) with cognitive decline and incident dementia (ascertained over 29 years through 2022) in the community-based Atherosclerosis Risk in Communities Study. sCD14 and YKL-40 were measured in 3082 …

Perceived Neighborhood Environment And Objectively Assessed, Habitual Physical Activity Among Us Adults: An All Of Us Research Program Study, Natalia I Heredia, Michael C Robertson, Christopher D Pfledderer, Ethan T Hunt, Timothy J Walker, Deborah Salvo

Faculty, Staff and Student Publications

Introduction: The purpose of this study was to assess the associations between perceived socioenvironmental neighborhood attributes and objectively assessed habitual physical activity among US adults as well as whether associations vary by sociodemographic characteristics.

Methods: We used data from the All of Us research program, a longitudinal cohort study of a diverse sample of Americans. Perceived neighborhood social cohesion, physical and social disorder, walkability, and sociodemographic characteristics were self-reported. Habitual physical activity was ascertained using Fitbit-derived step counts over ≥24 weeks. Generalized additive mixed-effects models were used to test the associations between perceived socioenvironmental neighborhood attributes and daily step counts. …

Addressing Nonignorable Missing Data And Heterogeneity In Prognostic Biomarker Assessment, Xinran Huang, Ruosha Li, Jing Ning, For The Alzheimer's Disease Neuroimaging Initiative

Faculty, Staff and Student Publications

Covariate-specific and time-dependent area-under-curve (AUC) is often used to evaluate the discriminative performance of biomarkers with time-to-event outcomes, particularly when certain covariates influence biomarkers' accuracy. In biomarker research, despite extensive efforts, missing data remain unavoidable, with nonignorable missingness posing significant challenges. This article focuses on estimating the impact of covariates on time-dependent AUC in the presence of nonignorable missing biomarkers. Assuming a parametric model on the missing probability, we leverage instrumental variables to address the identifiable issue and estimate the unknown parameters. We integrate the inverse probability weighting approach into the score equation of a pseudo partial likelihood for estimation …

A Bilingual Ai-Based Chatbot For Nutrition Education In A Food Is Medicine Intervention For High-Risk Pregnant Women: Design And Development Study, Lorena Macias-Navarro, Nalini Ranjit, Gregory W Bounds, Brendon A Providence, Yesmeena Shmaitelly, Naomi M Tice, Shreela V Sharma

Faculty, Staff and Student Publications

Background: Conversational agents (artificial intelligence [AI]-based chatbots) offer a novel approach to health interventions by providing personalized, adaptive interactions that improve over time based on user engagement. In nutrition education, given the wide variation in knowledge, skills, and abilities across participants, AI-based chatbots have the potential to enhance accessibility, engagement, and behavior change. Food is Medicine (FIM) interventions, which aim to improve food security and diet quality among multicultural, at-risk populations, often face challenges related to sustained engagement and use.

Objective: This paper describes the design, development, and iterative refinement of a bilingual AI-driven nutrition chatbot integrated into an FIM …

Evaluating The Impact Of Myplate-Based Expanded Food And Nutrition Education Program (Efnep) On Healthy Dietary Choices Among Low-Income Families, Theresa N. Agbonome

Electronic Theses, Projects, and Dissertations

Dietary behaviors towards healthy food choices remain a major public health issue in the United States, with prevalence among low-income families. The University of California Agriculture and Natural Resources (UCANR) with Expanded Food and Nutrition Education Program (EFNEP) trains both health educators and volunteers to provide community-based nutrition education, which prioritizes low-income families. The initiative employs the MyPlate guidelines that are composed of 5 different food groups which include fruits, vegetables, protein, grains, and dairy products. This project focuses on evaluating nutritional habits of disadvantaged families within San Bernardino County (SBC) by using an evidence-based evaluation tool known as the …

Treatment And Interventions For Sexual Assault In Humanitarian Contexts: Addressing Gaps In Refugee And Idp Camp Care In Myanmar, Erin Nash

Capstone Experience: Master of Public Health

Sexual and gender-based violence (SGBV) remains a pervasive yet under-addressed issue in humanitarian settings. Refugee and internally displaced person (IDP) camps along the Thai– Myanmar border represent a complex nexus of protracted displacement, ethnic conflict, and limited access to medical and psychosocial care. Although the prevalence of sexual assault in these contexts is well-documented, there is a critical gap in the literature regarding effective, context-specific treatment and intervention strategies. This capstone project conducts a comprehensive review of existing research on sexual assault care in humanitarian crises worldwide and assesses its applicability to displaced ethnic minorities from Myanmar. The analysis considers …

Plan To Develop A Theory-Based Diabetes Social Media Campaign For Spanish-Speaking Adults In Finney County, Ks: Integration Of A Promotora, Focused Discussion Groups, And Community Feedback To Ensure Cultural Appropriateness, Julevi P. Bernido

Capstone Experience: Master of Public Health

The 2025 Community Health Needs Assessment (CHNA) shows that over 11% of adults in Finney County, Kansas, have diabetes, which surpasses both state and national averages. Census data from 2016-2020 indicate that 42.6% of residents ages five and older speak a language other than English at home, and 36.1% speak Spanish (United States Census Bureau, n.d.). The CHNA further highlights concerns about language and cultural barriers to care, especially among the Spanish-speaking population. Notably, 21.74% of residents have limited English proficiency—much higher than the state’s 12.1% (CHNA, 2025).

This capstone will develop a theory-based social media campaign plan to support …

A Literature Review Of Estrogen Synthesis And Metabolizing Enzymes Produced By The Human Gut Microbiome And Their Correlation With Cancer, Rebecca Cederberg

Capstone Experience: Master of Public Health

The link between estrogen and cancer initiation or progression has been well established; such that the World Health Organization’s International Agency for Research on Cancer (WHO IARC) has classified several estrogen therapies and estrogenic compounds as group 1 carcinogens. Estrogen and/or its receptors have been associated with reproductive cancers such as breast, ovarian, endometrial, and prostate, as well as lymphomas, lung, and colon cancers. Additionally, elevated levels of estrogen and altered gut microbiomes are also associated with increased rates of breast cancer. More recently, microbial genes that are capable of synthesizing estrogen and deconjugating estrogen metabolites have been identified, and …

Health Disparities In El Paso's Low-Income Hispanic Communities: A Mixed-Methods Analysis Of Acculturation, Obesity Metrics, And Socio-Cultural Determinants, Karen Del Rio

Open Access Theses & Dissertations

Health disparities among low-income Hispanic immigrants in the United States are shaped by complex interactions between acculturation, structural inequality, and socio-cultural determinants that behavioral and epidemiological models have not fully explained. This dissertation examines the relationship between acculturation and obesity-related outcomes among uninsured and low-income Hispanic adults of Mexican descent in El Paso, Texas, using a three-article, sequential, explanatory, mixed-methods design grounded in Latina/o Critical Race Theory (LatCrit).Article 1 presents a systematic review of 20 peer-reviewed studies examining acculturation and obesity among Mexican Americans, finding consistent evidence that longer U.S. residence is associated with increased BMI and obesity prevalence, mediated …

Human Papillomavirus (Hpv) Vaccine Acceptance: A Mixed-Methods Study And Randomized Controlled Trial Examining Messengers Of Hpv Vaccine Information Among Hispanic Parents, Alyssa Andrea Martinez

Open Access Theses & Dissertations

Hispanics make up 19.5% of the U.S. population, making them the nation's largest ethnic minority. Hispanics are disproportionately impacted by health outcomes, including many different types of cancers that are caused by the Human Papillomavirus (HPV). An HPV vaccine is available that can prevent 90% of HPV associated cancers. The purpose of this mixed-methods study and randomized experiment is to develop and test data-driven digital health messages to promote the HPV vaccine in Hispanic parents. Four specific aims were conducted among three major studies. Aim 1 (Study 1): A cross-sectional survey was conducted to obtain preliminary evidence on trusted messengers …

Social Correlates Of Trauma And Posttraumatic Stress Disorder: The Importance Of Context, Lukoye Atwoli, Linnet Ongeri

Internal Medicine, East Africa

Understanding trauma and posttraumatic stress disorder (PTSD) requires a contextual perspective that considers historical legacies, social environments, and cultural realities. This paper draws on empirical evidence from Kenya and Uganda to demonstrate the limitations of applying trauma frameworks developed in high-income countries to African contexts. Findings from the Orphaned and Separated Children’s Assessment Related to Their Health and Well-Being (OSCAR) study challenge assumptions about care environments. The study reveals higher PTSD rates among orphans in family-based settings compared to institutional care, and highlights the protective roles of religion and social support. The Neuropsychiatric Genetics of African Populations-Psychosis (NeuroGAP-Psychosis) study provides …

Observation And Reflection Of Neighborhood And Community 2026: Education, Access To Healthy Foods, Neighborhood & Physical Environment, Economic Stability, Taylor Brown, Tanya Bhardwaj, Sara Komaiha, Duncan Mcleod, Jonah Harman, Jai Kukreja, Dominic Marsalese, Elizabeth O'Brien

Patient Education Projects

No abstract provided.

Miserly Thinking: Understanding The Factors Shaping Public Support Towards Project Wolbachia In Singapore, Shirley S. Ho, Agnes S. F. Chuah, Fiona J. W. Goh, Nova Mengxia Huang, Mengxue Qu, Hye Kyung Kim, Sonny Rosenthal

Research Collection College of Integrative Studies

Project Wolbachia is a vector control method that releases male Wolbachia-infected Aedes mosquitoes to curb dengue transmission in Singapore. While research has primarily focused on its efficacy, few studies have examined public opinion. This study draws upon the cognitive miser model and scientific literacy model to examine the factors shaping public support for Project Wolbachia. A nationally representative door-to-door survey was conducted in Singapore (N = 1,000) using multi-stage stratified random sampling. Our findings revealed that while knowledge about Project Wolbachia explains public support, laypeople may often rely on cognitive shortcuts, such as value predispositions, media attention, and pre-existing perceptions, …

The Relationship Between Obesity Among Children And Adolescents With Dietary Intake And Physical Activity: A Scoping Review, Devi Dwi Yolani, Tania Okta Wardhani, Rani Aqilah Ni’Matul Maula, Almira Sitasari, Tri Siswati

Indonesian Journal of Public Health Nutrition (IJPHN)

Childhood and adolescent obesity remain a significant public health issue worldwide. This review summarizes research on the relationship among obesity, physical activity, and diet. This study aims to investigate the relationship between children's and adolescents' obesity, their physical activity levels, and diet. A scoping review was conducted by assessing 81 research journal articles from 2014 to 2023 from electronic databases such as Google Scholar and PubMed. The search strategy used Boolean operators as follows: (“child*” OR “adolescent”) AND (“obesity”) AND (“diet” OR “food intake”) AND (“physical activity”), selected based on the inclusion criteria of children and adolescents aged 1-18 years …

Documentation And Dashboard Driven Quality And Safety Improvement In Interpreter Services For Limited English Proficient Patients, Richard T. Dillehay, Samuel Verkhovsky, Andrew Bohm, Harley Friedman, Dawn Welshman, Ann Morong, Vidya Karthikeyan, Jessica Dampier, Amanda Racine, Brant Oliver

Patient Experience Journal

Limited English Proficiency is known as an independent driver of disparities in patient's access to healthcare and their healthcare outcomes. The Joint Commission standards require that health systems document language services delivery to patients with limited English proficiency in a systematic way. Our health system had not historically utilized a methodical system for documenting language services utilization prior to the launch of this initiative. By utilizing a Lean Six Sigma approach, a project team comprised of leaders from interpreter services, operations, data analytics, and data informatics codesigned an Epic SmartForm data collection instrument and series of Tableau dashboards to monitor …

From Talking The Talk To Walking The Walk: Reflection On Dartmouth Health's Care Experience Week, Rosie Bartel, Corey Kimpson, Tanya Lord, Victoria Lyons, Tony Serge, Brant Oliver

Patient Experience Journal

This article explores the participation of expert members from the Beryl Institute's Global Patient and Family Advisory Board (GPFAB) during Dartmouth Health's Care Experience Week, under the theme ``From Talking the Talk to Walking the Walk.'' This week aligns with the national Patient Experience Week. The Patient Family Advisor (PFA) presenters and authors of this article have shared their lived experience locally, nationally, and internationally through conferences, webinars, podcasts, videos, blogs, white papers, journal articles, books, and in many other ways for and as PFA members of a multitude of healthcare organizations co-create change that improves outcomes for all human …