Digital Commons Network^™

Access To Appropriate Care, Mortality, And Cost Of Inpatient Hospitalization In Infants With Omphalocele And Gastroschisis In The United States, Treeva A. Jaff

Electronic Theses & Dissertations (2024 - present)

Congenital abdominal wall defects (AWDs), including omphalocele (OM) and gastroschisis (GS), are rare but clinically significant conditions that require immediate surgical intervention and prolonged neonatal intensive care. OM is a midline defect in which abdominal organs protrude into the umbilical cord covered by a membranous sac, while GS is a full-thickness defect typically located to the right of the umbilicus through which organs protrude without protective coverage. OM is frequently associated with major co-occurring congenital anomalies and chromosomal abnormalities, while GS more commonly occurs as an isolated defect but requires more intensive surgical management. As survival rates have improved, research …

Food Apartheid And The Retail Food Environment In The Bronx, Aissatou Barry

CUNY Mexican Studies Institute

This project examines the structural mechanisms that contribute to unequal food access, both historical and ongoing, in the South Bronx, and applies the food apartheid framework created by Bronx food activist Karen Washington. This paper applies the framework to two food retail initiatives in NYC: the New York State Regional Hub and the New York City FRESH food program to assess whether their policies address the structural mechanisms that contribute to food inequality. I ask: How does the unequal distribution of healthy food access in the Bronx reflect broader patterns of racial and economic exclusion? To what extent do current …

Associations Between Social Media Usage, Physical Activity And Flourishing In Rural University Students, Anna Dysart, Minu Sara Thomas

Journal of Appalachian Health

Introduction: Most adolescents and young adults report significant use of social media.^1-3 However, there is limited research on the effect of social media use, specifically on physical activity and flourishing.

Purpose: This pilot research study examines the correlation between social media usage and the physical activity and flourishing levels of college students at a rural university in Appalachia.

Methods: The authors conducted a survey including the validated Secure Flourishing Index and Stanford Leisure-Time Activity Categorical Item, containing questions on social media use and demographics. Spearman’s rho was used for nonparametric correlations. Pearson’s correlation was used to determine the correlation …

Impact Of West Virginia Abortion Ban On West Virginia Physician Trainee Practice Intentions, Rebecca Wald, Kristy Ward, Sarah Dotson

Journal of Appalachian Health

In June 2022, the Dobbs v Jackson Women’s Health Organization overturned the constitutional right to abortion established by Roe vs. Wade. Shortly after, West Virginia (WV) began enforcing a near total ban on abortion. Statewide restrictions on access to reproductive health care have important implications for the recruitment and retention of physicians. This project aimed to determine overall awareness of the 2022 changes in abortion laws among physician trainees, and whether the law influenced the intention of resident/fellow physicians to practice medicine in the state following completion of their medical training. A total of 178 resident and fellow physicians at …

Geospatial Analysis Of Breast Cancer Incidence, Mortality, And Access To Screening In Rural And Appalachian Virginia, Jennifer Osher, Caleb Brown, Phillip Nichols, Tariq Ayubi, Jeremy Powers

Journal of Appalachian Health

Introduction: Breast cancer is the most common malignancy among women in the United States (U.S.), despite recent survival rates improving nationally. However, rural and Appalachian regions have experienced slower mortality declines. These communities face unique health care-related challenges that may contribute to observed disparities.

Purpose: The purpose of this study is to assess differences in breast cancer incidence, mortality, and mortality-to-incidence ratio (MIR) between Appalachian and non-Appalachian counties, as well as rural and non-rural counties in Virginia (VA). Furthermore, we aim to evaluate whether availability of mammography is associated with these differences.

Methods: County-level breast cancer incidence and mortality data …

Enhancing Public Health Strategies: Addressing The Rsv Burden In Alabama Through Clinical Treatment, Community Prevention, And Surveillance Approaches, Martha K. Findley Roper, Jennifer S. Dawson

Journal of Public Health in the Deep South

Introduction: Respiratory Syncytial Virus (RSV) is a highly contagious pathogen driving morbidity, hospitalizations, and economic burden. This review uses the epidemiological triad and National Wastewater Surveillance System data to assess transmission, viral load spikes in Alabama, and strategies for treatment and prevention.

Methods: A review of literature on supportive care, vaccination, monoclonal antibodies, and emerging nanomedicine was reviewed to evaluate strategies for reducing viral burden and complications.

Results: Trends from December 2024–January 2025 were assessed with National Wastewater Surveillance System data. Primary prevention includes immunization, hygiene, air quality maintenance, and early diagnostics. Tertiary care addresses complications such as secondary …

Analysis Of The Health Access Initiatives Available For Newly Resettled Immigrants And Refugees In Charlotte, North Carolina, Yetunde Akinyelu

Doctoral Dissertations and Projects

The Health Access Initiative for Newly Arrived Immigrants and Refugees in Charlotte, North Carolina addresses the major obstacles which prevent these populations from obtaining vital healthcare services (P Iqbal., et al 2022). The research investigated healthcare difficulties faced by immigrant and refugee populations after their arrival in the United States while developing solutions to enhance their healthcare accessibility and results. The research employed qualitative methods to gather data through semi-structured interviews with immigrants and refugees who resided in Charlotte (Alkhawaldeh, et al., 2023). The research took place in community-based locations to create an environment where participants could freely discuss their …

Mapping Climatic And Environmental Determinants Of Parasitic Helminth Prevalence In Southeast Asia, Angelica Avisado

UNLV Theses, Dissertations, Professional Papers, and Capstones

Climate change is reshaping environmental conditions across Southeast Asia (SEA) through rising temperatures, altered precipitation patterns, and increased droughts. These changes alter transmission dynamics of neglected tropical diseases (NTDs) by shifting spatial distribution, increasing larval development rates, faster pathogen growth development, and increasing transmission rates. NTDs are a group of preventable and treatable infections that disproportionately affect more than 1 billion people globally, specifically in tropical and subtropical regions. A subgroup of NTDs, parasitic helminth infections (PHIs) - particularly schistosomiasis, soil-transmitted helminths, and lymphatic filariasis remains a public health concern in the Southeast Asian region. PHIs and their ecological responses …

Disaster Risk Reduction In Rural Indonesia: Evaluation Of The Japan Red Cross Program In Pujiharjo Village, Meyralda Dara Adisa, Pujo Widodo, Anwar Kurniadi, Wilopo Wilopo

Preventia: The Indonesian Journal of Public Health

Pujiharjo Village in Malang Regency, Indonesia, is highly vulnerable to natural disasters. In 2021, the Indonesian Red Cross (PMI) partnered with the Japanese Red Cross Society (JRCS) to implement a community-based disaster preparedness program. This study evaluates the program's effectiveness in terms of community participation, institutional support, and alignment with the Sendai Framework for Disaster Risk Reduction 2015–2030. Using a qualitative case study, data were collected through document analysis of Vulnerability and Capacity Assessments (VCA), Community Action Plans (CAP), and local SOPs. Thematic analysis explored disaster risk perception, governance, mitigation investment, and emergency preparedness. The program successfully improved risk awareness, …

Travel Time To Treating Facility And Mortality In Men With Prostate Cancer, Stephan M. Korn, Filippo Dagnino, Danesha Daniels, Zhiyu Qian, Hanna Zurl, Klara K. Pohl, Mei Chin Hsieh, Brenda Y. Hernandez, Andrea Piccolini, Alexander P. Cole, Amanda J. Reich, Joel S. Weissman, Quoc Dien Trinh, Hari S. Iyer

School of Public Health Faculty Publications

IMPORTANCE Geographic access to prostate cancer care may influence outcomes but is often measured using straight-line distance, which may not accurately capture the travel burden experienced by patients. OBJECTIVE To evaluate the association between estimated travel time from patients’ residence to treatment facilities and all-cause and prostate cancer–specific mortality. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the Multilevel Epidemiologic Tumor Registry for Oncology, a nationally representative, investigatorinitiated, population-based cancer registry that integrates geomasked residential and treatment facility information from multiple US state cancer registries. The study included patients aged 40 to 99 years from Hawaii, Louisiana, …

A Multilevel Analysis To Evaluate Variability In Sdoh Clusters Within Rurality And Its Effects On Cancer-Specific And All-Cause Mortality In The Us., Stephie Ann Abraham

Electronic Theses and Dissertations

Social determinants of health (SDOH) factors have consistently been shown to impact all-cause and cancer-specific mortality. Area-level SDOH factors that coexist to form “high-risk” clusters are more prevalent in rural than urban areas. However, heterogeneity within rural and urban areas may contribute to variations in SDOH factors that could influence higher mortality rates and is not considered in other studies. The primary objective of this study was to utilize ecological and individual-level data to determine if the composition of SDOH clusters within counties in the rural-urban continuum contributes to differences in all-cause (AC) and cancer-specific mortality rates of lung and …

Power, Interests, And Maternal Health Care: A Political Economy Analysis Of Service Delivery Redesign In Kenya, Jacinta Nzinga, Easter Olwanda, Kennedy Opondo, Hillary Kimutai, Jan Cooper, Brian Arwah, Benjamin Tsofa, Edwine Barasa, Kevin Croke

Institute for Human Development, East Africa

The maternal and newborn health (MNH) service delivery redesign (SDR) in Kakamega County, Kenya, represents the country's first system-level reorganization of MNH services. The reform aimed to improve care quality and reduce mortality by centralizing delivery services at designated hubs. Using a political economy lens, we examined how ideology, political dynamics, and institutional structures shaped the agenda-setting, adoption, implementation, and sustainability of SDR. We drew on data from document reviews, stakeholder analysis, semi-structured interviews, and non-participant observation to assess the structural, contextual, and institutional factors influencing the reform. Ambiguity around SDR's purpose contributed to the community's uncertain engagement characterized by …

Across The Pond, Across The Waistline: A Comparative Look At The Childhood Obesity Crisis In The United States And United Kingdom, Samantha N. Eales

Honors College Theses

Childhood obesity is no longer just a local concern; it’s a global epidemic shaping the health of future generations. This paper compares how two similar nations with drastically different healthcare systems, the United States and the United Kingdom, tackle this growing crisis. Although both countries struggle with fast food culture, sedentary lifestyles, and targeted marketing, their health policy strategies differ dramatically. The U.S. leans on community programs and education, while the U.K. enforces stronger national regulations and advertising restrictions. By examining nutrition, physical activity, and policy, this thesis explores what each country does well and where they fall short. It …

Analysis Of The Hospital Medical Surge Preparedness Index In Relation To Hospital Characteristics And Social Determinants Of Health, Philipp Lirk

Capstone Experience: Master of Public Health

Objective

Substantial investments have been made in hospital emergency preparedness. The Hospital Medical Surge Preparedness Index (HMSPI) has been proposed as a metric to assess health system readiness. This index summarizes hospital system characteristics, space and facilities, staff availability, and supply planning.

Methods

The primary objective was to evaluate the relationship between the HMSPI and characteristics of the respective hospitals, including size, type, location, performance on the Hospital Resilience Index (HRI), and Social Determinants of Health (SDoH).

Results

Higher HMSPI scores were found in suburban compared to rural hospitals, a higher HMSPI in larger hospitals with greater patient volumes and …

Assessing Post-Pandemic Engagement In The Supplemental Nutrition Program For Women, Infants, And Children (Wic) In Northeast Tennessee, Christen Minnick

Electronic Theses and Dissertations

Since 1974, the federal Supplemental Nutrition Program for Women, Infants, and Children (WIC) has provided healthy food resources, nutrition education, and provider referrals for families at risk for poor nutrition. Public health professionals have consistently presented evidence that WIC engagement reduces premature births and infant mortality, improves child health and development, and increases specialized care access for participants. While average monthly participation in WIC has increased since the program’s inception, trends indicate that only around half of eligible families have consistently engaged with the program since 2011. Research has linked declining WIC participation to administrative burden, citing learning, psychological, compliance, …

Deficiencies In Non-Emergency Medical Transportation For Aging Rural Residents Of Iosco County, Michigan, Richard L. Douglass, Donald Stansloski, James Mortimer, Sam Purdy, Dale Evilsizer, Scott Rice

Michigan Journal of Public Health

Introduction: The rural aging population in Michigan struggles to access medical care often available only at significant distances due to limited health system resources and provider shortages. Access to routine care is challenged by lack of non-emergency medical transportation (NEMT). The Iosco County Commission on Aging provides home-delivered meals to eligible county residents. The Rural Health Group investigated the needs of home-delivered meal recipients (aged ≥60 years) for healthcare transportation access. Utilizing data from this investigation, we examined if medical care needs were hindered by problems with transportation in rural Iosco County, Michigan.

Methods: We conducted a cross-sectional survey with …

Clinical Phenotypes Of Motor Neurone Disease In A Kenyan Hospital-Based Population, Effie Nailah Kamadi, Jasmit Shah, Juzar Hooker, Thomas Jenkins, Dilraj Sokhi

Internal Medicine, East Africa

Background: Motor neurone disease (MND) presentation is globally heterogenous and data on the clinical phenotype in Sub-Saharan Africa (SSA) is scarce. We sought to address this by describing the profile of MND patients in a Kenyan hospital-based population.

Methods: The medical charts of all adult MND patients assessed in the facility between January 2010 and December 2023 were retrospectively reviewed. The biographical data and clinical features of these patients were captured from their electronic and manual health records and statistical analysis performed.

Results: In total, 160 patients had their data analyzed. The male to female ratio was 1.76:1. The median …

Income Inequality And Self-Reported Health: A Difference-In-Differences Study, Kola Adegoke

Health & Biomedical Sciences Faculty Publications

Background: Health disparities in the United States (US) are closely linked to income inequality. While many studies have reported associations between income and health, causal evidence remains limited.

Objective: To estimate the causal effect of income-equalizing state policies, such as minimum wage increases, Medicaid expansion, and Earned Income Tax Credit (EITC) adjustments, on adult self-rated health using a difference-in-differences (DiD) framework.

Methods: Using the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) data from 2018 to 2023, a 2-way fixed-effects DiD model was employed to compare changes in the proportion of adults reporting fair or …

Burnout Assessment Tool Development And Validation For Healthcare Workers: A Psychometric Approach Using Rasch Modelling And Exploratory Factor Analysis, Rosnah Ismail, Suriya Kumareswaran Vallasamy

Kesmas

Burnout remains a significant occupational threat to healthcare workers (HCWs). Existing instruments, e.g., the Maslach Burnout Inventory, have limited applicability in healthcare-specific contexts. This study aimed to develop and validate the Burnout Scale for Assessing Stress in Healthcare Workers (BSAS-HCW), designed to measure cognitive and emotional exhaustion. A cross-sectional survey was conducted among 245 Malaysian HCWs representing diverse roles, including staff nurses (57.7%), house officers (14.3%), medical officers (13.5%), specialists (5.7%), pharmacists (4.5%), and other HCWs. Exploratory factor analysis revealed a two-factor structure with strong internal consistency (Cronbach's alpha: cognitive = 0.95; emotional = 0.97), and all items loaded above …

Analysis Of Public Knowledge, Attitudes, And Practices In Food And Drug Selection In Indonesia, Tina Wikara, Sri Astuti, Sri Nurhayati, Rotua Uli Carolina, Evi Ratna Sari

Kesmas

As consumers, the public plays a vital role in ensuring the safe and appropriate use of products. This study aimed to assess awareness of food and drug safety and quality among the Indonesian population. Using a cross-sectional survey, the authors measured public awareness across three key dimensions: knowledge, attitudes, and practices. Data were collected from 20,610 respondents aged 17–65 years from 34 provinces in Indonesia. The survey approach employed a three-stage stratified sampling design. Data were collected through structured face-to-face interviews, and the results were presented as an index ranging from 0 to 100 (low to high awareness). The respondents …

Association Between Food Insecurity And Nervous System Disorders In Caddo Parish, La: A Call To Action For Health, Megan Gremillion, Morgan Uebinger, Claire Crosby, Kaitlyn Tholen, Marie Vazquez Morgan, Ammar Husan

Journal of the Louisiana Public Health Association

Background: Food insecurity (FI)–the lack of access to affordable, nutritious food–affects millions of Americans. Caddo Parish, Louisiana, is of interest due to high FI prevalence and socioeconomic risk factors. While FI is known to exacerbate chronic health issues, its association with neurological health remains understudied, especially in high-risk communities. Methods: A cross-sectional study was conducted among adult patients in Caddo Parish in 2022 using Epic Electronic Medical Record data to identify diagnoses of migraine, dementia, and stroke—the top neurological causes of disability-adjusted life years (DALYs) in the United States. FI status was determined using the Hunger Vital Sign screening questionnaire. …

Risk Factors For Unexpected Death In Patients Identified By A Communication And Resolution Program, Peter Lodato, Neal D. Goldstein, Alexandra M, Mapp, Adebayo Gbadebo, David A. Paul

Department of Pediatrics Faculty Papers

Many patients experience unexpected harm while receiving healthcare, with a lasting impact on patients, families, and caregivers. Communication and Resolution Programs are being adopted with increased frequency, as a more systematic, transparent, and equitable approach to these unexpected outcomes. The aim of this study was to identify whether demographic factors played a role in identifying patients with unexpected death, as managed in our CRP. This nested case-controlled compared 236 patients who experienced an unanticipated death with 2,360 controls who died expectedly over a 10-year period. Patients with unexpected death were more likely to be Black (AOR 2.18 95% CI 1.01-4.68), …

State Of Ohio Adversity And Resilience (Soar) Study Protocol: A Comprehensive, Multimodal, Family-Based, Longitudinal Observational Investigation Of Risk And Resilience In Mental Health And Substance Use Disorders, Chris Flask, Martha Sajatovic

Faculty Scholarship

Introduction Deaths related to drug overdose and suicide in the USA have increased 500% and 35%, respectively, over the last two decades. The human and economic costs to society associated with these - €- deaths of despair' are immense. Great efforts and substantial investments have been made in treatment and prevention, yet these efforts have not abated these increasing trajectories of deaths over time. The COVID-19 pandemic has exacerbated and highlighted these problems. Notably, some geographical areas (eg, Appalachia, farmland) and some communities (eg, low-income persons, - €- essential workers', minoritised populations) have been disproportionately affected. Risk factors have been …

From Urban Models To Rural Realities: Adapting Hepatitis C (Hcv) Care For Underserved Communities, Caitlin A. Mccain

2025 Fall Honors Capstones Projects - Archive

This literature review examines how Hepatitis C (HCV) screening and care programs can better serve underserved populations, particularly Spanish-speaking rural communities in border states. The research supports the Hep C- Colonias Advancing & Restoring Esperanza (C.A.R.E) program’s mission by incorporating recent findings from 32 studies gathered through PubMed, Medline and Google Scholar. Hep C C.A.R.E expanded from the HepVISTA expansion project provides HCV screening, education, vaccination and linkage to care for uninsured patients at partner sites in Laredo and Maverick County. Results indicate that while HCV elimination is feasible, significant gaps persist among rural uninsured and minority populations. Effective strategies …

Shape: Spatial Health And Population Estimator, Emma M. Von Hoene, Aanya Gupta, Hamdi Kavak, Amira Roess, Taylor Anderson

Annual Symposium on Biomathematics and Ecology Education and Research

No abstract provided.

Income Inequality And Attitudes Towards Immigrants – How Increased Inequality Drives Division, Niamh Anderson, Vincent O'Sullivan

SURE Journal: Science Undergraduate Research Experience Journal

No abstract provided.

Examining Gender And Ethnic Disparities In Scientific Authorship To Promote A Culture Of Equity, Diversity And Inclusion At A University School Of Public Health, Paula Christen, Julia Michalow, Tristan Naidoo, Hillary Topazian, Sabine An Elsland, Abeer Arif, Marc Baguelin, Gemma Clunie, Sarah Essilfie-Quaye, Chinedu Momoh

Brain and Mind Institute

In public health research, diverse perspectives are vital to identify biases that homogenous teams might miss. Since publication metrics influence career progression, we investigated publication rate disparities within a School of Public Health. We analysed 18 322 peer-reviewed publications by 513 affiliated researchers between 2014 and 2023 using multivariable regression models and network analysis to assess the impact of gender, ethnicity, job level and centrality in the School’s research network on publication rates. We found a persistent gender gap in publication rates across job levels and ethnicities, with men publishing more than women (incidence rate ratio 1.30, 95% confidence interval …

Dysregulated Mitochondrial Energy Metabolism Drives The Progression Of Mucosal Field Effects To Invasive Bladder Cancer, Sangkyou Lee, Sung Yun Jung, Pawel Kuś, Jolanta Bondaruk, June Goo Lee, Roman Jaksik, Nagireddy Putluri, Khanh N Dinh, David Cogdell, Huiqin Chen, Yishan Wang, Jiansong Chen, Neema Navai, Colin Dinney, Cathy Mendelsohn, David Mcconkey, Richard R Behringer, Charles C Guo, Peng Wei, Marek Kimmel, Bogdan Czerniak

Faculty, Staff and Students Publications

Multiplatform mutational and gene expression profiling complemented with proteomic and metabolomic spatial mapping were used on the whole-organ scale to identify the molecular profile of bladder cancer evolution from field effects. Analysis of the mutational landscape identified three types of mutations, referred to as α, β, and γ. Time modeling of the mutations revealed that carcinogenesis may span 30 years and can be divided into dormant and progressive phases. The α mutations developed in the dormant phase. The progressive phase lasted 5 years and was signified by expanding β mutations, but it was driven to invasive cancer by γ mutations. …

The Ruling Relations Of Care: An Institutional Ethnography Of High-Risk Prenatal Care Experiences, Nicole L. Harris

USF Tampa Graduate Theses and Dissertations

Disrespect during pregnancy, labor, and delivery is common in the United States. The Centers for Disease Control and Prevention has estimated that approximately one in five women overall, and over 30% of Black women, report being ignored, dismissed, or verbally mistreated during their care. Public health efforts have primarily focused on individual-level interventions to improve patient-provider communication or reduce provider bias; however, these strategies have been critiqued for their limited scope and effectiveness in shifting outcomes. Instead, researchers and advocates have called for an examination of the structures that shape clinical encounters, including policies, protocols, workflows, and organizational culture. This …

What Drives Advanced Practice Nurses To Stay In Rural America? Insights From The 2022 National Survey Of Registered Nurses, Esita Patel, Chris Gillette, Jan Ostermann Phd, Chris Everett, Dawn Caviness, Sarah Garvick

Faculty Publications

Purpose: Recruiting and retaining a robust rural health care workforce is critical to advancing health outcomes in rural communities. Although increasing the rural provider workforce has been a policy focus for decades, rural access continues to worsen. Using a strengths-based approach, we identify factors that influence the decisions of advanced practice registered nurses (APRNs) to leave or stay in their jobs.

Methods: Secondary analysis of data from the 2022 National Sample Survey of Registered Nurses. We describe rates of turnover, retention, intention to leave, and reasons for leaving and staying by job rurality. We compare reasons by rurality using Pearson …