Digital Commons Network^™

Long Work Hours, Suboptimal Diabetes Management, And Differences By Sex And Race/Ethnicity, Nhanes (2011-2018), Tailisha Gonzalez, Margrethe Horlyck-Romanovsky, Terry T.-K. Huang, Sandra E. Echeverria

Publications and Research

In the United States (US), occupational segregation by sex and race/ethnicity can contribute to health disparities. Although work schedule characteristics have been previously linked to elevated cardiovascular risk, little is known about the effects on chronic disease management in women and minoritized workers. We examined the association between work hours and diabetes management among US workers, testing for differences by sex and race/ethnicity. We utilized 2011–2018 National Health and Nutrition Examination Survey (NHANES) data on working adults (age ≥20 years) with diagnosed diabetes (n = 1041). Suboptimal diabetes management was defined as HbA1c ≥7%. Work hours were categorized per WHO …

Evaluating An Lgbtq+ Adolescent Sexual Health Toolkit: Boosting Confidence And Provider Knowledge, Joslyn Lypka

Doctoral Dissertations & Projects

When leveraged correctly, sexual health education empowers youth to build resilience, deepen self-understanding, and confidently navigate gender and sexual identities. However, many school-based programs emphasize cisgender and heterosexual norms, leaving LGBTQ+ adolescents with limited access to inclusive and affirming sexual health information. This project aimed to develop and evaluate an online sexual health education toolkit designed to increase knowledge and support self-advocacy among LGBTQ+ adolescents, parents/caregivers, and healthcare providers. In collaboration with a Midwest nonprofit organization serving sexual and gender-diverse individuals, an online toolkit was developed and evaluated using two sequential Plan–Do–Study–Act (PDSA) cycles. During the first cycle, subject matter …

From Tradition To Transition: Evaluating Culinary Medicine As A Tool For Metabolic Health Among Nigerian Immigrants In The United States And The United Kingdom, Simi Oduwole M.S.

Department of Nutrition Student Projects

This scoping review examines existing publications to evaluate whether Culinary Medicine can be used as a tool for metabolic health among Nigerian immigrants in the United States and the United Kingdom. Nigeria is one of the fastest-growing populations globally, with increasing migration to high-income countries such as the United States and the United Kingdom. Evidence suggests that Nigerian immigrants experience a rise in diet-related chronic diseases, including obesity, diabetes, and cardiovascular disease, as duration of residence increases. This phenomenon is often attributed to dietary acculturation and shifts toward Westernized eating patterns. This scoping review evaluates whether culinary medicine can mitigate …

Evaluating The Feasibility And Preliminary Effectiveness Of A Tailored Diabetes Education Program For Rural Residents, Brittany L. Smalls, Oluwatosin Leshi, Suraksha Khanal, Grejika E. Abram-Erby

Journal of Appalachian Health

Introduction: Diabetes is a top ten Rural Healthy People 2030 priority for health improvement among rural Americans. Socioeconomic, environmental, geographic and political barriers contribute to the type 2 diabetes (T2D) prevalence and its disparate impact in rural communities. However, promoting proper self-care behaviors via self-management education can help people with diabetes better manage their condition.

Purpose: To account for the social environmental factors that affect rural residents, a tailored diabetes education program was developed, and the program’s effectiveness in improving diabetes knowledge and T2D-related health outcomes was assessed.

Methods: Using data collected from Appalachian Kentucky residents enrolled in a six-week, …

Mplus Data For Campus Mental Health Study 2026 - Flourishing Paper, Alice Ann Crandall, Carl L. Hanson

ScholarsArchive Data

MPlus Data file, input file, and output file.

Assessment Of Clinical And Neuroimaging Efficacy Of Treatment Targeting Tau Pathology In Mild Cognitive Impairment And Mild To Moderate Alzheimer’S Disease With Hydromethylthionine Mesylate Using External Control Data, Bjoern O. Schelter, Helen Shiells, Serena Lo, Nafeesa Nazlee, Emily Evans, Peter Bentham, Serge Gauthier, Henrik Zetterberg, Gordon K. Wilcock, Lutz Froelich, Alistair Burns, Emer Macsweeney, Clive Ballard, Jin-Tai Yu, Tay Siew Choon, Vahe Asvatourian, Natalia Muehlemann, Jan Priel, Karin Kook, Tenecia Sullivan, Diane Downie, Sonya Miller, Carol Pringle, John M. D. Storey, Tom Baddeley, Charles R. Harrington, Roger Staff, Anca-Larisa Sandu, Claire Hull, Richard G. Stefanacci, Claude M. Wischik

College of Population Health Faculty Papers

BACKGROUND: Hydromethylthionine mesylate (HMTM) targets tau pathology and also has tau-independent symptomatic activity. A traditional randomised placebo-controlled trial (RCT) was precluded by loss of blinding due to urinary colouration and therapeutic activity at the minimum dose required to maintain blinding.

OBJECTIVE: To evaluate the efficacy of HMTM in participants with mild cognitive impairment (MCI) and mild to moderate dementia due to Alzheimer's disease (AD).

METHODS: Because a traditional RCT was not feasible without loss of blinding, we compared HMTM 16 mg/day in TRx-237-039 with propensity score matched true placebo controls from the FDA-sponsored Critical Path for AD (CPAD) database with …

Assessing The Aesthetic Responsiveness Among Patients In A Free Clinic Setting, Jack E. Pitts

Student Scholar Showcase

Art therapy has increasingly been recognized as a complementary intervention in healthcare settings, with demonstrated benefits for stress reduction and overall biopsychosocial well-being. However, limited research has explored aesthetic engagement within medically underserved and economically disadvantaged populations. This study examines aesthetic responsiveness among patients receiving care at the Free Clinic of Central Virginia using a standardized Aesthetic Responsiveness Assessment. The assessment consists of 14 Likert-scale questions assessing individuals’ cumulative aptitude across three domains: aesthetic appreciation, intense aesthetic experience, and creative behavior. Responses and data were collected voluntarily and anonymously, and they were analyzed to better understand how patients in an …

Experiences Of Maternal Care In The Gypsy, Roma, And Traveller Population In The United Kingdom: A Cultural Care Model, Sarah Englebert Crowson

Walden Dissertations and Doctoral Studies

Gypsy, Roma, and Traveller women (GRT) in the United Kingdom face persistent maternal health disparities and show poor engagement with healthcare services. Exclusion, discrimination, and a lack of cultural competence from healthcare professionals contribute to poor health outcomes including preterm births; and GRT women have more babies born with congenital anomalies than non-GRT women in the United Kingdom. The purpose of this focused ethnographic qualitative study was to explore how self-identified GRT women living in the United Kingdom experienced maternal care and how cultural identity and social structures influenced their interactions with healthcare providers based on Madeleine Leininger’s cultural care …

A Multilevel Analysis Of Prescriber-Reported Buprenorphine Induction Challenges In Fentanyl-Endemic Settings, Alyssa Vawn Long

Walden Dissertations and Doctoral Studies

The emergence of illicitly manufactured fentanyl has increased clinical uncertainty during buprenorphine induction in medication-assisted treatment for opioid use disorder. The purpose of this quantitative, retrospective cohort study, guided by the Transtheoretical Model (TTM), was to examine whether prescriber-level buprenorphine induction practices and experiences with precipitated withdrawal were associated with reported buprenorphine induction challenges, and whether county-level fentanyl prevalence contributed to these challenges after accounting for geographic clustering. Secondary, de-identified archival data were obtained from the National Institute on Drug Abuse Clinical Trials Network study CTN-0134 and included 64 prescribers practicing in fentanyl-endemic settings. Buprenorphine induction challenges were operationalized as …

A Scoping Review Of The Objective Structured Assessment Of Technical Surgical Skills (Osats), David J. O'Regan, Christopher Caddy, Retnagowri Rajandram, Paul Barach

College of Population Health Faculty Papers

BACKGROUND: Objective structured assessment of technical skills (OSATS) offers an objective tool for assessing bowel anastomosis on a benchtop. It was developed in 1997 to set appropriate standards and expectations for the surgical trainee. OSATS have become the gold standard of assessment across many disciplines. A global Likert rating scale, including respect for tissues, instrument handling, economy of movement, and flow of the operation predominates the literature. This has led to many questioning OSATS objectivity, claiming the process to be time-consuming, subjective, demanding human resources, and requiring extensive training of the trainer. We believe OSATS scoring has omitted the 22-point …

Coverage, Traits, And Geographic Distribution Of Online Surgeon Reviews: Large-Scale Cross-Sectional Analysis, Michael Geng, Carlos Riveros, Yash B. Shah, Sanjana Ranganathan, Kai Fok, Renil Sinu Titus, Vatsala Mundra, Eusebio Luna Velasquez, Dharam Kaushik, Allan S. Detsky, Angela Jerath, Benjamin N. Breyer, Yusuke Tsugawa, Christopher J. D. Wallis, Raj Satkunasivam

Student Papers, Posters & Projects

BACKGROUND: The use of online physician rating platforms has significantly increased and has been shown to influence physician selection. There are limited data on the use of these platforms for rating surgeons.

OBJECTIVE: In this study, we sought to assess the geographic distribution of and patterns in rating scores of surgeons in the United States. Additionally, we examined rating volumes across different surgical specialties and the association between peer-nominated and patient-initiated ratings on online rating platforms in the United States.

METHODS: We conducted a cross-sectional study by identifying 201,154 surgeons in the United States via the National Plan and Provider …

Assessing Current Telehealth Mobile Applications In The United States: Accessibility, Privacy, And Care Delivery, Rosemary K. Frugé

Honors Theses

Telehealth has improved patient access by reducing barriers to convenient, cost-effective, and quality health care. Telehealth mobile applications allow individuals to remotely access services through smartphone-based platforms. The purpose of this study was to evaluate leading telehealth applications available in the United States, analyzing key factors that influence platform selection, including cost, prescribing and diagnostic capabilities, user feedback, and data privacy practices. Applications were identified through keyword-based searches of major app stores using the term “telehealth,” and each app was systematically evaluated using predefined criteria. Findings highlight variability across platforms in pricing transparency, service offerings, and privacy disclosures, despite generally …

Digital Touchpoints: Investigating Contact Page Accessibility And Visual Authenticity Within Medical Tourism Health Websites, Alicia Mason, Elizabeth Spencer, Kristen Livingston, Treyton Meyers, Sakshi Bhati, Himika Akram

Faculty Submissions

This study examines two critical digital touchpoints on medical tourism provider (MTP) websites: (1) the accessibility of contact pages which often function as entry points for inquiries, scheduling, and pre-travel coordination, and (2) the authenticity of visual imagery used to shape expectations about care environments, personnel, and technological capacity. A sample of 105 MTPs across all six World Health Organization regions were analyzed using quantitative web accessibility testing and qualitative visual analysis. Results indicate pervasive accessibility errors on contact-page touchpoints and extensive reliance on inauthentic imagery to depict patients, providers, and medical technologies. Together, these practices may distort user expectations …

Health Insurance Literacy Among College Students At The University Of South Carolina, Emma J. Smith, Lorie Donelle Phd, Rn, Fcan, Robin Dawson

Caroliniana Undergraduate Research Journal

Purpose: This study aims to investigate the health insurance literacy skills of graduate college students and undergraduate college students.

Methods: A cross-sectional research design incorporated a 20-item questionnaire to examine college students’ knowledge of common health insurance terms and definitions, as well as their perceived understanding of health insurance. Descriptive analyses were conducted of participant demographics, health insurance literacy scores were summarized, and common health insurance policies were tested through a readability checker.

Results: The majority of students were between the ages of 18-25 and undergraduate students. More than half of the participants were female, and more …

Examining Outcomes Of Client Education Interventions To Reduce Caffeine Intake In The College-Age Population, Mackenzie Leonard, Mikayla Evans

James Madison Undergraduate Research Journal (JMURJ)

This scoping review aimed to explore health interventions that address excessive caffeine consumption in college students aged 18–23 years. Excess caffeine intake is associated with a range of health concerns, including neurological, cardiovascular, and behavioral issues, highlighting the need for effective interventions to mitigate its impact on overall wellness. The literature exploring interventions aimed at modifying health behaviors among the college student population is notably limited. Furthermore, there has been a lack of studies replicating interventions aimed at reducing caffeine intake. These gaps suggested the need for further investigation and exploration of reports pertaining to health promotion. The results of …

Connectivity, Classroom, And Contagion: An Ecological Analysis Of Testing Availability, Sex Education, And Sti Rates In The Upper Midwest, Macey M. Boerhave

Honors Thesis

Rural and frontier communities in the Upper Midwest face unique challenges that shape how young people access sexual health information and testing. While sexually transmitted infection (STI) rates continue to rise nationally, less is known about how sexual health education, digital access, and geographic distance influence these trends at a county level. This study examines the relationship between broadband internet access rates, poverty rates, proximity to free or low-cost STI testing sites, and county-level STI rates among individuals aged 15-24 in selected counties across South Dakota, North Dakota, Minnesota, Iowa, and Nebraska. Using an ecological, cross-sectional design, county-level STI surveillance …

Effects Of A Major Disruption On Mental Health Of Pregnant Women In South Carolina, Lizmarie Maldonado

MUSC Theses and Dissertations

Mental health conditions are a leading cause of death among pregnant and postpartum women, and untreated mental health conditions are associated with adverse maternal and birth outcomes. Major disruptions, such as pandemics, hurricanes, or wildfires, create unprecedented challenges and may impose additional stressors during an already vulnerable time. Community or medical care disruptions during such events may lead to adverse health outcomes. This dissertation seeks to characterize the impact of a recent major disruption on mental health outcomes among pregnant women using administrative claims data for all births in South Carolina in 2019 and 2020. By leveraging unique data sources, …

Epigenome-Wide Association Study Of Blood Proteome In The Atherosclerosis Risk In Communities Study, Yang Li, Aditya Surapaneni, Zulema Rodriguez-Hernandez, Pascal Schlosser, Eugene P Rhee, Eric Boerwinkle, Bing Yu, Megan L Grove, Kelly V Ruggles, Josef Coresh, Morgan Grams

Faculty, Staff and Student Publications

Characterizing the relationship between DNA methylation and circulating proteins is critical to understanding the epigenetic regulation of the human plasma proteome. Here, we performed an epigenome-wide association study of 5,032 circulating proteins in 1,449 White and 315 Black participants from the Atherosclerosis Risk in Communities cohort. We identified 12,500 significant protein quantitative trait methylation (pQTM)-protein associations involving 1,647 proteins. Among 7,796 unique pQTMs, 14.7% were classified as cis-pQTMs, which were enriched for fundamental cellular processes, whereas trans-pQTMs were predominantly linked to immune-related functions. Trans-pQTMs also exhibited stronger associations with demographic, lifestyle, and clinical traits as compared with cis-pQTMs. We identified …

Costs, Demographics, And Causative Agents In Patients Hospitalized For Drug Induced Liver Injury: Trends In A Large Academic Healthcare System, Megan Kozar, Yunisse Gonzalez, Dina Halegoua-De Marzio

Department of Medicine Faculty Papers

PURPOSE: Drug-induced liver injury (DILI) is an uncommon but potentially life-threatening condition. To date, the burden of DILI on a single, large healthcare system has not been investigated, preventing adequate resource allocation. This study aims to quantify DILI-related healthcare utilization within the Jefferson Health System (JHS) and identify case-related factors associated with high resource requirements; such information is crucial to focus efforts toward resource reduction.

PATIENTS AND METHODS: This study characterizes trends of 48 DILI cases within JHS, including demographics, payer status, causative agent, and DILI pattern. These variables were correlated with length of stay (LOS) and cost relating to …

Multi-Trait Polygenic Scores For Copd And Copd Exacerbations Implicate Druggable Proteins, Chengyue Zhang, Iain R Konigsberg, Yixuan He, Jingzhou Zhang, Tinashe Chikowore, William B Feldman, Xiaowei Hu, Yi Ding, Bogdan Pasaniuc, Diana Chang, Qingwen Chen, Jessica A Lasky-Su, Julian Hecker, Martin D Tobin, Jing Chen, Sean Kalra, Katherine A Pratte, Hae Kyung Im, Emily S Wan, Ani Manichaikul, Edwin K Silverman, Russell P Bowler, Leslie A Lange, Victor E Ortega, Alicia R Martin, Michael H Cho, Matthew R Moll

Faculty, Staff and Student Publications

BACKGROUND

We constructed multi-trait polygenic risk scores (PRSs) predicting chronic obstructive pulmonary disease (COPD) and exacerbations, validated their performance in diverse cohorts, and identified PRS-related proteins for potential therapeutic targeting.

METHODS

PRSmix+, a multi-trait PRS framework, is used to train a composite PRS (PRSmulti) in COPDGene non-Hispanic White participants (n = 6,647). Associations of PRSmulti with COPD status (GOLD 2–4 vs. GOLD 0 or ICD) and exacerbation frequency were tested in COPDGene African American (n = 2,466), ECLIPSE (n = 1,858), Mass General Brigham Biobank (n = 15,152), and All of Us (n = 118,566). …

Is Home Birth A Choice? Racial And Geographic Differences In Unintended Home Births In The U.S., Anna De La Paz

Population Health Research Brief Series

Home births that happen without planning or medical support (i.e., unintended home births) carry a higher likelihood of adverse outcomes, such as low birth weight, preterm birth, and hypothermia. This data slice summarizes findings using data from CDC WONDER (2017–2023) on racial, regional, and metropolitan status differences in home births among women ages 15–44 in the U.S. Findings show that unintended home births are disproportionately concentrated among non-Hispanic Black women, with rates varying substantially by region and metropolitan status.

Psychosocial Mediators Of A Physical Activity And Dietary Intervention In Pregnant Women With Overweight Or Obesity, Meghan Baruth, Sarah Wilcox, Jihong Liu, Rebecca Schlaff

Faculty Publications

Background

Mediation analyses provide insight into both ‘pieces’ of the mediation chain; they allow us to look into the ‘black box’ that is behavior change. They allow researchers to better understand the ‘how’ of an intervention’s effects and/or the ‘why’ behind why an intervention worked or did not work. The lack of publications in pregnant populations highlights the need for additional studies to be conducted and published. The purpose of this study is to examine the psychosocial mediators of physical activity and dietary outcomes in a sample of pregnant women with overweight or obesity participating in the Health in Pregnancy …

Does What Happens In Vegas Increase Pedestrian Safety? A Longitudinal Study On The Effectiveness Of Pedestrian Bridges, Jalen Paulos, Joaquin Miguel Del Mundo, Brock Wentz, Janel Pietryga

Department of Orthopaedics Faculty Research

Urban populations continue to rise and the frequency that pedestrians are exposed to vehicular traffic continues to increase. The result is an increase in automobile versus pedestrian collisions. This study aims to determine the efficacy of pedestrian bridges in reducing the rates of automobile‒pedestrian collisions. Data for all automobile versus pedestrian collisions and injuries from July 1997 through December 2023 at four distinct intersections along Las Vegas Boulevard were retrieved from the Nevada Department of Transportation. These sites were chosen because of their historically high rates of automobile versus pedestrian incidents and the construction of pedestrian bridges at three of …

Fast-Food Consumption And Metabolic Syndrome Risk In African Children And Adolescents, Norkinsha Willis

Walden Dissertations and Doctoral Studies

Childhood obesity and excessive fast-food intake represent a significant public health concern among African American children. Grounded in the social-ecological model, this quantitative, cross-sectional study examined whether frequency of fast-food or pizza meal consumption and reliance on low-cost food was associated with total cholesterol (mg/dL) and waist circumference among African American children and adolescents aged 6–15 years while controlling for key sociodemographic factors (age, gender, parental education status, and annual household income). Secondary data from the 2017–2018 National Health and Nutrition Examination Survey were analyzed (N=184). Descriptive statistics, nonparametric analyses, and a multiple linear regression model were used to analyze …

Untangling Impacts Of Socioeconomic Position, Chronic Disease, And Low-Level Pm2.5 Exposure On Mortality Among Native American Medicare Beneficiaries, Judy Wendt Hess, Wenyaw Chan

Faculty, Staff and Student Publications

Ambient fine particulate matter (PM2.5) is associated with increased mortality at concentrations below current regulatory standards. Studies of low-level exposure often rely on large administrative cohorts whose geographic and demographic composition may influence observed associations. In a prior analysis, we observed an association between long-term PM2.5 and all-cause mortality among Native American Medicare beneficiaries living in zip codes within the lowest decile of PM2.5 exposure. The present study, a case-control analysis of 1,713,399 low-PM2.5-exposed beneficiaries enrolled in traditional Medicare during 2015-2016, evaluated whether this association could be explained by geographic context, socioeconomic position (SEP), or baseline health status. We used …

Single State Agency Licensure Requirements For Substance Use Disorder Treatment Programs In The United States: Results Of A National Survey, Brooks Yelton Ma, Lmsw, Melissa A. Westlake, Amanda J. Abraham, Colleen M. Grogan, Olivia Hinds, Christina M. Andrews

Faculty Publications

Background

Substance use disorder (SUD) remains a critical public health crisis in the United States, with high prevalence and overdose mortality rates. Despite the availability of effective treatments, including medications that significantly reduce overdose risk, fewer than 20% of Americans with active SUD receive treatment annually. Single State Agencies (SSAs), which oversee federal funding and regulate SUD treatment programs, hold significant authority to impose licensure and reporting requirements intended to promote treatment quality.

Methods

This study presents findings from a national survey of SSAs across 50 states and the District of Columbia (94% response rate) conducted between 2020 and 2021, …

Geographic Variation In Adrd Prevalence And Mortality And Their Association With Social Vulnerability Across Us Counties: A Spatial Epidemiological Analysis Using Norc And Cdc Svi Data, Dean Kyne

Sociology Faculty Publications

Introduction: Geographic disparities in Alzheimer’s disease and related dementias (ADRDs) remain insufficiently understood at the national scale, limiting efforts to address inequities in dementia burden across USA communities. This study examined county-level variation in ADRD prevalence and mortality and evaluates the association between social vulnerability and these outcomes.

Methods: This cross-sectional ecological study analyzes 2020 county-level ADRD prevalence and all-cause mortality among Medicare beneficiaries from the NORC Dementia DataHub. The analytic sample included 3,108 USA counties in the contiguous USA and the District of Columbia. ADRD outcomes included (1) prevalence of highly likely ADRD and (2) prevalence of all determinations, …

The History Of Women In Neuroradiology In North America From 1990 To The Present, Vijay M. Rao

Department of Radiology Faculty Papers

From 1990 to 2024, women neuroradiologists in North America have made tremendous progress in the areas of leadership, clinical innovation, research, education, diversity, equity and inclusion, and global outreach. This chapter begins with summaries of their key accomplishments in four broad domains, followed by short biographical sketches of numerous luminaries organized by leadership roles and areas of expertise, and ending with conclusions and future directions.

Postmarketing Safety Of Bimekizumab For Hidradenitis Suppurativa: An Early Pharmacovigilance Analysis Using The United States Food And Drug Administration Adverse Event Reporting System, Simona A. Alomary, Nicole J. Baker, Temitayo Ogunleye, Susan C. Taylor

Student Papers, Posters & Projects

No abstract provided.

Navigating End-Of-Life Decisions: Cultural Considerations For Latine Patients, Michelle Carbajal Hernandez

Honors Capstones

Healthcare professionals face many challenges when communicating terminal illness prognoses for individuals. This responsibility to address a terminal prognosis is further complicated when communicating with Latine patients who may face multiple barriers within the healthcare system and whose cultural preferences influence end-of-life care planning (Carrion, 2010). For example, Latines are less likely to enroll in end-of-life (EOL) care services (e.g., hospice) (Barragan-Carrillo et al., 2022). As well as engage in end-of-life care planning than White Non-Latines (Shen et al., 2016). To understand this hesitancy towards EOL care options, this literature review aims to explore how terminally ill Latine and …