Digital Commons Network^™

Knowledge, Attitudes, And Practices (Kap) Of Parents Regarding The Prevention And Control Of Childhood Iron Deficiency Anemia In Egypt: A Cross-Sectional Study, Omnia Soliman

Theses and Dissertations

Childhood Iron Deficiency Anemia (IDA) remains a major public health challenge in Egypt, where its persistently high and rising prevalence carries substantial consequences for child growth, cognitive development, immunity, and long-term health outcomes. Globally, approximately 40% of children aged 6–59 months are affected by anemia (World Health Organization, 2025), and Egypt mirrors this burden, with national data showing a worsening trend in recent years. In Egypt, national strategies have traditionally focused on biomedical interventions such as iron supplementation and food fortification, while less attention has been directed toward behavioral and household-level determinants, particularly parental knowledge, attitudes, and practices (KAP) related …

An Assessment Of Accessibility And Affordability Of Inpatient Psychiatric Care In Tennessee, Kailee Havrda

Electronic Theses and Dissertations

Introduction: Access to mental health has seen changes over the past decade, but little research and attention have been given to access to inpatient psychiatric facilities. Inpatient psychiatric care is crucial for patients experiencing mental health emergencies who need immediate access to care. Gaps in spatial accessibility, affordability, and the access and assessment process were identified due to a lack of available information in the field.

Methods: Secondary data from the Tennessee Department of Health were used to assess financial accessibility through payer source charges and patient encounters, as well as through mapping of inpatient psychiatric facilities and conducting drive …

Rethinking Existing Extension Programming: A Foundation For Healthy Aging?, Nicholas J. Spokely, Sloane A. Montgomery, Kelsey J. Weitzel, Kristin A. Miller, Marta Novaes Oliveira, Stephen D. Ball, Breanne S. Baker

Journal of Extension

Muscle declines are becoming more prevalent in younger adults, driving the need for accessible exercise programs. The Stay Strong, Stay Healthy (SSSH) Extension program was developed for adults 60 years old or older, but for this study, we enrolled 135 participants aged less than 60 years old in rural and urban counties to assess if it could improve their muscle performance. We analyzed data with time and group comparisons using paired t-tests and 2 × 2 repeated measures ANOVAs. Younger adults significantly improved muscle performance after SSSH, and the results were similar between rural and urban counties. This study …

Environmental Predictors Of County-Level Drowning Rates In Georgia, Jeff Turner

Journal of the Georgia Public Health Association

Background: Recent increases in drowning rates, both nationally and within Georgia, have led to renewed interest in the individual, situational/behavioral, and environmental characteristics that impact drowning. This study examines the association between two environmental characteristics, natural surface water coverage and public pools, on drowning fatalities and drowning-related ER visits by county in Georgia

Methods: We gathered county-level data on drowning fatalities and drowning-related ER visits and the number of public pools from the Georgia DPH, surface water coverage from the US Census Bureau, and demographic measures from the CDC. We conducted a linear regression analysis to identify how …

The Impact Of Tobacco-Free School Laws On Student And Staff Smoking Behavior, Rachana Bhatt, Peter Hinrichs

Upjohn Institute Working Papers

A number of U.S. states have enacted bans on tobacco use by students, staff, and visitors anywhere on the grounds of public elementary and secondary schools statewide. These laws are intended to reduce tobacco use, reduce exposure to secondhand smoke, reinforce anti-tobacco curricula taught in schools, and prevent children from viewing their teachers and fellow students using tobacco products. We examine the impact that the laws have on the smoking behavior of students, teachers, and other school staff by using stacked difference-in-differences estimators that exploit the time variation in adoption of the laws across states. The results presented in this …

An Evaluation Of Southern Nevada’S Pediatric Care Ecosystem, David Damore, Tina Quigley, Nick Fiore

Policy Briefs and Reports

In 2024, The Lincy Institute and the Nevada Health and Bioscience Corporation released a report prepared by the consulting firm Tripp Umbach detailing the case for a stand-alone children’s hospital in Southern Nevada. Shortly thereafter, Intermountain Health announced it would build Nevada’s first such facility in Las Vegas, expected to open in 2030. To complement the hospital’s development, The Lincy Institute undertook an independent evaluation of the regional pediatric care landscape. The analysis draws on secondary data and discussions with advocates, health system administrators, practitioners, and providers. The report examines:

• Fiscal, resource, and workforce challenges underlying Nevada’s poor population-level pediatric …

A Spatiotemporal Study Of Environmentally Associated Pulmonary Diseases In Georgia, Jason Raymond Baum

Walden Dissertations and Doctoral Studies

Exposures to particulate dust matter (PM10 and smaller) from aggregate comminution facilities (ACF) can lead to the onset of environmentally associated pulmonary diseases (EAPDs); acute and chronic asthma (Type I allergic hypersensitivity reaction), chronic pulmonary disease, interstitial lung disease (ILD), and lung cancer. In this environmental epidemiological research study, three primary spatial and spatiotemporal research questions related to nonoccupational exposures from 118 facilities across Georgia were evaluated. Secondary data analysis was conducted from the Centers for Disease Control and Prevention’s (CDC) 2018–2023 Behavioral Risk Factor Surveillance System (BRFSS) and the Metropolitan Statistical Areas, Micropolitan Statistical Areas, and Metropolitan Divisions to …

Sociodemographic And Geographic Factors Underlying Breast Cancer Survival Disparities Among Women In The United States, Colletta Brabham-Orr

Walden Dissertations and Doctoral Studies

Breast cancer-specific mortality in the United States remains higher among women in rural and socioeconomically disadvantaged areas, yet few population-based studies have been conducted to jointly scrutinize demographic and structural determinants of this disparity. Informed by the social determinants of health framework, this secondary data analysis, using records from the SEER Research Plus database, examined the association between age at diagnosis, race and ethnicity, rural/urban residence, county-level median household income, and breast cancer-specific mortality among U.S. women aged 18 and older diagnosed with malignant invasive breast cancer between 2010 and 2020 (N = 285,865). Bivariate chi-square tests and binary logistic …

New York City Women’S Experiences With Perinatal Depression Inquiries, Diagnosis, And Treatment Initiation, Caterina Pisciotta

Dissertations, Theses, and Capstone Projects

Perinatal depression represents a significant public health concern, yet many women who experience depression symptoms during the perinatal period (either during pregnancy and/or after birth) do not receive treatment. Initiatives, such as ThriveNYC, were designed to address these gaps by screening and treating perinatal women for maternal depression, integrating screening into routine perinatal care and strengthening pathways to treatment. Using representative survey data collected between 2016 and 2021 via the Center for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System (PRAMS), this study examined trends in perinatal depression inquiries (a proxy for “screening”) and postpartum diagnosis, as well as …

Provincial Disparities In Adolescent Fertility In Indonesia: An Ecological Analysis Of Child Marriage, Median Age At First Marriage, And Family Development Index, Andi Nisa Fathimiyah Afidah, Milla Herdayati

Kesmas

Adolescent fertility remains a public health concern in Indonesia, with substantial variations across provinces. However, the evidence explaining provincial disparities using population-level indicators remains limited. This study aimed to examine provincial disparities in adolescent fertility and assess the association of child marriage, median age at first marriage among women, and the Family Development Index called iBangga with adolescent fertility across Indonesia. This ecological, cross-sectional study used aggregated data from 34 Indonesian provinces. Descriptive statistics, spatial visualization, Pearson’s correlation, and multiple linear regression analyses were performed. The mean adolescent fertility rate was 25.0 births per 1,000 female adolescents aged 15–19 years, …

Spatial Association Of Acute Respiratory Infection, Diarrhea, And Low Birth Weight With Stunting Prevalence In Indonesia, 2024, Dian Rosadi, Husaini Husaini, Triawanti Triawanti, Musafaah Musafaah

Kesmas

Stunting remains unevenly distributed across Indonesia, but national evidence integrating spatial analysis and spatial regression is limited. This study examined the spatial distribution of stunting and its associations with acute respiratory infection (ARI), diarrhea, and low birth weight (LBW) across Indonesian provinces. An ecological cross-sectional study used data from the 2024 Indonesian Nutritional Status Survey. Stunting-only analyses included all 38 provinces, whereas analyses involving ARI, diarrhea, and LBW included 37 provinces with complete data. Spatial analyses used a row-standardized symmetric four-nearest-neighbor spatial weights matrix and included Global Moran’s I, bivariate spatial analysis, Local Indicators of Spatial Association, ordinary least squares, …

Advancing Maternal Health Equity In Nebraska: Examining Prenatal Care Access Disparities, Policy Context, And Doula Integration As A Complementary Solution, Marlette Grace Dulcinee Mabiala-Maye

Theses & Dissertations

Maternal health inequities persist across the United States, with Black, Native American, and immigrant-origin women facing disproportionate barriers to timely prenatal care. This dissertation examined access to prenatal care in Nebraska, a mixed rural and urban state with extensive maternity care deserts, through three interrelated aims. Aim 1 analyzed PRAMS data using survey-weighted regression with race-by-socioeconomic-status interactions to characterize disparities in the timing and barriers to care. Aim 2 evaluated the state’s October 2020 Medicaid expansion across pre-pandemic, acute pandemic, and post-expansion periods. Aim 3 applied qualitative description and the Consolidated Framework for Implementation Research to interviews withtwenty-three maternity care …

Prenatal Health Factors Of Pregnant People Associated With Second Degree Postpartum Hemorrhage Across The United States, Elizabeth Simpler

Walden Dissertations and Doctoral Studies

Secondary postpartum hemorrhage (SPPH) is a significant contributor to maternal morbidity in the United States and occurs after hospital discharge during the postpartum period. Persistent disparities in terms of maternal outcomes suggest access to prenatal care alone may not adequately address clinical and social factors associated with SPPH. Guided by the Social Ecological Model, which recognizes that health outcomes are influenced by a collective approach to examining health. The purpose of this study was to examine associations between SPPH, prenatal care access, and social determinants of health from 2019 to 2022 while controlling for maternal age, race, and delivery type. …

School-Centered Tobacco Retailer Exposure And Neighborhood Opportunity Across Urban And Rural Tennessee, Sima Namin Dr, Jacob Black, Jennifer Ferris, Robert E. Heidel Dr

Journal of Appalachian Health

Introduction: Tobacco retailer availability contributes to youth tobacco use, and retailers are concentrated in socioeconomically disadvantaged communities. However, few studies have examined how school-centered retailer exposure intersects with neighborhood opportunity in a predominantly rural Appalachian state.

Purpose: The purpose of this study is to assess the association between neighborhood opportunity and school-centered tobacco retailer exposure across Tennessee (TN), including differences by rurality and Appalachian status.

Methods: We constructed a tract-level, school-centered youth tobacco exposure index for TN using tobacco retailer locations and public and private K-12 school data. The index incorporated retailer proximity, density, and distance-decay accessibility measures. Child Opportunity …

Disparities In Access To Medicare-Approved Medical Specialists In Rural Kentucky, Logan Hurm, Jacob A. Welch, James Adkins

Journal of Appalachian Health

Introduction: Approximately 20% of the United States population resides in a rural community; however, only 10% of all healthcare resources and physicians are dedicated to these areas. Appalachia, and Kentucky (KY) in particular, have higher populations living in rural areas which leads to a greater number of individuals affected by medical access disparities. As of 2026, 21% of KY’s population is eligible for Medicare, making access to Medicare-accepting specialty physicians crucial for the state’s population.

Purpose: This research aims to quantify healthcare disparities among rural communities in KY through quantification of the potential distance required to travel to access specialty …

Public Perceptions Regarding Surveillance Of Lyme Disease In Tennessee, Shaheena Yasmin Asad

Walden Dissertations and Doctoral Studies

Lyme disease (LD), a tick-borne illness, has been a growing concern in the state of Tennessee. Studies have established environmental concerns regarding a growing tick population and identified a gap between reported cases and disease burden in Tennessee. Despite this information, it remains classified as a low-incidence reporting state, raising concerns about underreporting that indicate an ineffective current surveillance system. Because the public perception regarding surveillance of LD is unknown, the purpose of this qualitative study was to explore how adults in Tennessee perceived LD as a credible public health threat within the context of the current surveillance system. Guided …

Conceptual Framework And Key Considerations For Field-Based Infrastructure In Food Is Medicine Research, Shreela V Sharma, Colleen Tewksbury, Christopher R Long, Colleen Spees, Ronit A Ridberg, Reshma Gupta, Erin P Ferranti, Naomi Tice, Eric Peterson, Brian Levine

Faculty, Staff and Student Publications

In 2023, the American Heart Association launched the Healthcare by Food (HCXF) initiative to establish a rigorous evidence base for Food Is Medicine (FIM) programs, so that patients with acute or chronic disease could access FIM programs as a covered benefit under their health insurance. The HCXF initiative is engaging in research, advocacy, and education to support the development and testing of interventions that improve health outcomes. The HCXF initiative launched 9 task forces aligned with research progress, including the Field-Based Infrastructure task force designed to examine broader questions to help support either earlier or later stages of the HCXF …

Rural/Urban Disparities In Utilization Of Diabetes Self-Management Training (Dsmt) To The Fee-For-Service Medicare Population, 2017–2024, Wanying Zhu, Aleksandr Taraskin, Jeffrerey Talbert

Rural & Underserved Health Research Center Publications

Key Report Highlights

• A significant rural DSMT access gap exists. Rural beneficiaries accounted for 20.1% of Medicare beneficiaries with diabetes but only 7.8% of DSMT participants.

• Geographic availability remains limited. Only 16.8% of counties with DSMT utilization were rural.

• Access, not demand, appears to be the primary challenge. Rural counties offering DSMT achieved utilization rates more than twice those observed in urban counties (6.0% vs. 2.5%).

• Expanding rural DSMT capacity may represent a high-impact opportunity to improve diabetes self-management support among underserved Medicare beneficiaries.

High-Deductible Health Plans In Rural And Urban Populations: Outpatient Utilization And Out-Of-Pocket Costs, Aaron P. Smith, Jefferey Talbert

Rural & Underserved Health Research Center Publications

Overview of Key Findings This policy brief explores rural-urban differences in High-Deductible Health Plan (HDHP) enrollment, subsequent healthcare utilization, and out-of-pocket (OOP) costs. ▪ HDHP enrollment was uncommon. Rural residents were slightly less likely to enroll than urban residents across all demographic groups. ▪ Switching plans influenced utilization. Compared to those who did not change healthcare plans, switching from a Traditional plan to a HDHP was associated with a larger reduction in 2022 outpatient visits for both rural and urban residents. Moving from a HDHP to a Traditional plan was associated with a smaller reduction in 2022 outpatient visits for …

Essays On Opioid Prescription Limit Policy Diffusion, Evaluation, And Opioid Use Disorder Treatment Utilization, Md Ashiqur Rab

All Dissertations

The drivers of the opioid epidemic in the United States include the oversupply of prescription opioids, the availability of illicit drugs, under-resourced healthcare settings, and several socio-economic factors. Federal and state-level initiatives, including policy interventions to curb the oversupply of prescription opioids, providing access to healthcare, prevention and recovery support services, and community-level engagement, have been adopted to combat the opioid epidemic. Motivated by the need to better understand the policy and recovery efforts to address the epidemic, this dissertation examines opioid prescription limit policy diffusion, evaluation, and treatment utilization patterns. This dissertation comprises three manuscripts that offer a comprehensive …

Global Prevalence Of Depression Among University Students: A Comprehensive Umbrella Review, Gilda Yun Kai Sam, Xun Ci Soh, Harshitha Balaji, Gabriel X. D. Tan, Shu Fen Diong, Meilan Hu, Andree Hartanto, Nadyanna M. Majeed

Research Collection School of Social Sciences

Depression has become a major concern for educational institutes due to its increasing incidence and detrimental impacts on students’ well-being. However, its global prevalence in the context of tertiary education remains unclear. This umbrella review summarised existing meta-analyses and systematic reviews to examine the worldwide prevalence of depression among university students. Several sociodemographic and methodological factors, including differences in depression prevalence before, during, and after COVID-19, were examined as moderators. Structured and exhaustive searches were conducted in five bibliographic databases and five journals, alongside two sources of grey literature. A total of 61 meta-analyses and systematic reviews were included in …

The Association Between Apoe Genotype, Race, And Dementia: An Analysis Of 7 Population-Based Cohort Studies, Natalia Lakomski, Katherine Giorgio, John Stephen, Maxwell Mansolf, Aïcha Soumaré, Alden L Gross, Allison E Aiello, Archana Singh-Manoux, M Arfan Ikram, Catherine Helmer, Claudia L Satizabal, Deborah A Levine, Donald M Lloyd-Jones, Emily M Briceño, Farzaneh A Sorond, Frank J Wolters, Jayandra J Himali, Lenore J Launer, Djass Mbangdadji, David Li, Lihui Zhao, Oscar L Lopez, Stéphanie Debette, Sudha Seshadri, Suzanne E Judd, Timothy M Hughes, Vilmundur Guðnason, Michael Griswold, Paul S De Vries, Alison Fohner, Pamela L Lutsey, Rachel Zmora, Elizabeth A Peterson, Denise Scholtens, Norrina B Allen, Sanaz Sedaghat

Faculty, Staff and Student Publications

Background and objectives: The apolipoprotein E (APOE) haplotypes are known to be associated with dementia, with the ε4 haplotype associated with higher risk. It has been suggested that the APOE ε2 allele serves as a protective factor for dementia. However, data on the effects of the homozygous APOE ε2/ε2 genotype are limited, likely due to the rarity of the APOE ε2/ε2 genotype. Furthermore, the association between APOE genotypes and dementia may differ across self-reported race. We aim to investigate the association between APOE genotypes and dementia overall and across self-reported race, with a focus on the potential protective …

Yorga Moorditj Koort: Aboriginal And Torres Strait Islander Women’S Perspectives About Heart Health On Noongar Boodjar, Elia Bidgood, Cathy Garlett, Richard Chenhall, Amie Bingham, Francine Eades, Emily Banks, Melinda J. Carrington, Grace Joshy, Sandra Eades, Tabassum Rahman

Research outputs 2022 to 2026

In Australia, despite overall declines in cardiovascular disease (CVD)-related mortality, Aboriginal and Torres Strait Islander women develop heart disease earlier and experience more than twice the rate of related morbidity and mortality compared with non-Indigenous women. This study explores Aboriginal women’s understandings of the factors that shape their heart health and lived experiences of CVD. We spoke with 28 Aboriginal women aged ≥18 years—15 semistructured interviews and two yarning circles with an additional 13 Aboriginal women—with/without pre-existing CVD, and 10 healthcare professionals (HCPs) working with Aboriginal communities in the Perth metropolitan region, between May 2024 and April 2025. Data were …

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

Doctoral Dissertations and Projects

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

Clearing The Air: Tracking Spatial And Temporal Pm2.5 Variability Along A Biking Transect In Chicago, Beau R. Rass

DePaul Discoveries

Fine particulate matter (PM₂.₅) poses significant risks to human health and disproportionately affects marginalized communities in urban environments (World Health Organization [WHO], 2021; Tessum et al., 2021). Using low-cost mobile sensors, this study explored spatiotemporal PM₂.₅ concentration patterns along a north–south transect of Halsted Street in Chicago. A 2B Technologies Portable Aerosol Monitor (PAM) mounted on a bicycle was used to continuously record PM₂.₅ concentrations with associated GPS coordinates at approximately two-second intervals during 16 sampling events between 08-12-2025 and 10-05-2025. PM₂.₅ concentrations did not differ significantly among the South Side, West Loop, and North Side regions, contrary to the …

Perceptions Of Research Participation Among Underrepresented Groups: Insights Using Freelisting Methodology, Tamar Klaiman, Jasmine Silvestri, Emma Britez Ferrante, Dorothy Sheu, Adina Lieberman, Erich Dress, Modele Ogunniyi, Neal Dickert, Meghan Lane-Fall, Rosemary Frasso, Rachel Kohn

College of Population Health Faculty Papers

BACKGROUND: Low enrollment and retention in clinical research disproportionately impact Black, Hispanic or Latinx, women, and rural populations, undermining generalizability and perpetuating health disparities. However, few studies have compared mechanisms driving underrepresentation across populations. Freelisting is a qualitative methodology that elicits lists of terms, explores perspectives about domains, and identifies common themes within groups with shared characteristics; however, it has not been systematically applied to understand research participation across underrepresented populations.

OBJECTIVE: To explore perspectives on clinical research participation across underrepresented populations using freelisting methodology to ultimately inform culturally-responsive recruitment strategies.

METHODS: We conducted a web-based freelisting survey among adults …

Breaking Bread And Barriers: Interprofessional Strategies To Improve Mental And Nutritional Health In Family Caregivers, Candy Ratliff

The Journal of the Research Association of Minority Professors

Family caregivers provide essential unpaid support to individuals with chronic illness, disability, dementia, and age-related decline; however, caregiving responsibilities often place caregivers at increased risk for psychological, physical, nutritional, and social challenges. This literature review examines the mental health and nutritional implications of family caregiving and explores barriers that contribute to declining caregiver wellness. Findings reveal elevated rates of depression, anxiety, emotional exhaustion, social isolation, food insecurity, sleep disturbances, financial strain, and chronic stress among caregivers. The literature further highlights the interconnected relationship between mental health, nutrition, and overall quality of life. Given the multidimensional nature of caregiver burden, interprofessional …

(Re)Claiming Homeplace: Dance As Embodied Resistance & Healing For Health & Spatial Justice, Preeya G. Kannan

University Honors Theses

This thesis argues that dance functions as both an upstream public health intervention and a form of radical spatial resistance; creating healing, agency, and belonging among historically marginalized communities. Drawing on bell hooks' concept of homeplace, Jasbir Puar's assemblage theory, Nancy Krieger's eco-social theory, and Katherine McKittrick's Black geographies, I position the body as both an ecological and political landscape shaped by histories of colonialism, racial capitalism, displacement, and resilience.

Through this community-based participatory research study, Homeplace, I explore dance as a form of social prescription that centers liberation rather than pathology. Movement is often reduced in public health discourse …

Rural–Urban Disparities In Monkeypox-Related Behaviors And Attitudes Among Men Who Have Sex With Men, Patcharaporn Krainara, Benjamas Klahan, Rungrot Jaiyong, Jitti Hanprasertpong

Journal of Health Research

Background: Monkeypox (Mpox) is a global health threat, particularly among men who have sex with men (MSM). Despite the predominance of urban cases in Thailand, rural–urban disparities in Mpox-related attitudes and behaviors remain underinvestigated. This study aimed to compare Mpox-related attitudes and preventive behaviors among urban (Chonburi) and rural (Nakhon Nayok) MSM and identify their influencing factors.

Method: This cross-sectional study was conducted between March and April 2025. A total of  842 MSM (421 urban; 421 rural) were recruited via convenience sampling. Data were collected using paper-based, self-administered Health Belief Model (HBM) questionnaires and analyzed using descriptive statistics and multivariable …

The Gut Microbiome, The Gut-Brain Axis, And College Student Well-Being, Idi Mckay

University Honors Theses

This literature review examines how diet, stress, environmental exposure, and food accessibility may influence college students' mental health and academic performance through the gut microbiome and the Gut-Brain Axis (GBA). Current microbiome research often focuses on early childhood development, clinical disease populations, or older adults, while overlooking college-age students who experience significant social, environmental, and biological transitions. College students frequently face food insecurity, irregular eating patterns, chronic stress, inconsistent sleep schedules, and reduced access to nutrient-dense foods, all of which may influence microbial diversity and overall gut health.

This thesis explores how modern campus environments and lifestyle factors may contribute …