Digital Commons Network^™

Exploring Public Health Nurses’ Perceptions Of Syringe Services Programs In Southern Rural Areas, Joel Lowery

Walden Dissertations and Doctoral Studies

Public health nurses are potentially key stakeholders in syringe services program (SSP) implementation in rural areas, where they can act as liaisons between public health, private healthcare, and the community. However, little research reflects an in-depth understanding of how public health nurses perceive SSPs in rural areas. The purpose of this qualitative study was to explore the perceptions of syringe services programs held by public health nurses practicing in rural areas with no existing SSPs in southern states and ascertain their potential roles in facilitating harm reduction for people who inject drugs. This study was guided by a conceptual framework …

Promising Practices For Increasing The Number Of Equity-Owed Lifeguards In Canada And The United States Of America, Sofia Pantano, Audrey R. Giles

International Journal of Aquatic Research and Education

Currently a shortage of lifeguards exists in Canada and the United States (US) (Frommer, 2023; Santucci, 2024), and those who are working as lifeguards often do not reflect the diversity of the communities they serve (Martinez, 2020). Increasing the number of lifeguards from equity-owed groups is a potential way of increasing the lifeguard workforce and decreasing the shortage of workers in these important roles, as well as a moral imperative. In this paper I explore challenges to and promising practices aimed at increasing the representation of members equity-owed groups in lifeguarding. I begin with an overview of lifeguarding in Canada …

A Social Media Campaign And Web-Based Survey About Prostate Cancer Genetics: Mixed Methods Study, Amy Leader, Stacy Loeb, Preethi Selvan, Ashley Hunter, Rebecca Hartman, Scott Keith, Veda Giri

Department of Medical Oncology Faculty Papers

BACKGROUND: Germline genetic variants are important for prostate cancer (PCa) management and hereditary cancer risk assessment, but testing is underused. Furthermore, patients are often unaware of the genetic connections to PCa. Social media is increasingly serving as a source of awareness for health information and a method to gather data from a large population.

OBJECTIVE: There were three objectives: to (1) create and test social media messages related to PCa genetics and genetic testing, (2) determine which social media message was most engaging, and (3) assess knowledge of and attitudes toward PCa genetic testing through an online survey using the …

Problem-Solving Training To Improve Caregiver Burden And Depressive Symptoms Among Dementia Caregivers: Personal And Clinical Factors Of Responders Vs. Non-Responders, Shannon B. Juengst, Matthew Lee Smith, Kristin Wilmoth, Brittany Wright, Gang Han, Charlene Supnet, Gladys Maestre

School of Medicine Publications

Introduction: Metacognitive strategy training interventions, like Problem-Solving Training/Descubriendo Soluciones Juntos (PST/DSJ), have efficacy for improving caregiver burden and depressive symptoms. We previously demonstrated that PST/DSJ improved caregiver burden and depressive symptoms among caregivers of adults with Alzheimer’s Disease and related dementias (ADRD), regardless of the number of sessions or boosters received. However, these results did not examine factors characterizing those who responded (improvement in caregiver burden or depressive symptoms) or did not respond to the intervention.

Objective: To identify key personal and clinical factors associated with response to PST/DSJ. Personal factors included age, gender, race, Hispanic ethnicity, education, and employment …

Alternative And Traditional Schooling On Sexual Risk Behaviors Among Alaska Native Youth In The Lower Kuskokwim, Nathaniel Hebert

Walden Dissertations and Doctoral Studies

Alaska Native youth experience disproportionately high rates of sexual risk, yet disaggregated data and school-contextual analyses remain limited. Understanding how school type (alternative vs. traditional) and individual factors influence sexual risk among Alaska Native youth is essential for informing targeted, culturally responsive health interventions and addressing ongoing health disparities. This quantitative study aimed to examine the association between three behaviors (condom use, multiple sexual partners, and substance use) by school type, controlling for gender, grade level, body mass index, and afterschool activity. Guided by the social-ecological model, this cross-sectional study provided new insights into the relationship between school type and …

Healing Right Way: A Stepped Wedge Cluster Randomised Controlled Trial Aiming To Enhance Quality Of Life For Aboriginal Australian Survivors Of Stroke And Traumatic Brain Injury, Elizabeth Armstrong, Tapan Rai, Judith M. Katzenellenbogen, Sandra J. Thompson, Meaghan Mcallister, Natalie Ciccone, Deborah Hersh, Leon Flicker, Dominique A. Cadilhac, Erin Godecke, Graeme J. Hankey, Neil Drew, Colleen Hayward, Deborah Woods, Mel Robinson, Ivan Lin, Sanita Kratina, Jane White, Juli Coffin

Research outputs 2022 to 2026

Objective: To determine the effect of cultural security training (CST) for health professionals and access to an Aboriginal Brain Injury Coordinator (ABIC) for Aboriginal Australians with stroke or traumatic brain injury (TBI). Design: A stepped wedge cluster randomised controlled trial; the intervention package consisted of CST for hospital professionals and 6-month access to ABICs providing education, support, liaison and advocacy; the commencement order of the intervention phase was randomised. Setting: Four urban and four rural hospitals in Western Australia, 2018–2022. Participants: Aboriginal adults ≥ 18 years hospitalised with stroke or TBI. Main Outcome Measures: Primary outcome was quality of life …

Validation Of The Jefferson Health-Related Social Needs Screener, Sara Beachy, Kristin L. Rising, Richard W. Hass, Terry Hyslop, Isabella Muti, Mackenzie Kemp, Rhea E. Powell, Cara Martino, Baligh R. Yehia, Joseph G. Cacchione, Patricia C. Henwood

Jefferson Hospital Staff Papers and Presentations

INTRODUCTION: Screening for health-related social needs (HRSN) is a growing national health priority. While multiple HRSN screening tools currently exist, none to our knowledge have been evaluated using robust statistical analyses. The goal of this work is to provide results from a validation study of the Jefferson HRSN screener conducted across inpatient and outpatient settings.

METHODS: This retrospective cross-sectional psychometric study included HRSN assessments conducted across inpatient and outpatient settings with adult patients from March 2023 to May 2024. The study was conducted across a 17-hospital academic health system serving a diverse community in a 9-county area crossing two states …

A Case Study Of Long-Term Disease Burden In A Rural Community Near An Open Burn Facility, Arundhati Bakshi, Liana Baconguis, Md Abdullah Al-Mamun, Qingzhao Yu, Jennifer Richmond-Bryant, Stephania A. Cormier

School of Public Health Faculty Publications

Open burning and open detonation (OB/OD) of explosive and hazardous wastes creates various toxic waste products, including particulate matter, that is released into the atmosphere and capable of generating significant health impacts upon exposure. The last commercially run OB/OD thermal treatment facility in operation in the United States is located near the rural community of Colfax in central Louisiana. To evaluate the community’s concerns about the potential health impacts from air pollution due to the facility’s regular open burning of explosive and hazardous wastes, we examined the disease burden in Colfax compared to the surrounding parish and state. In a …

Geographic Disparities In Birth Outcomes: County-Level Investigation On Pm2.5 And Low Birth Weight In The United States, Eunice Y. Park, Ranju Mainali

Department of Public Health Scholarship and Creative Works

Exposure to air pollution adversely affects health and is highly associated with birth outcomes. This study analyzes the relationship between air pollution and low birth weight (LBW; less than 2,500 g at birth) at the county level in the United States. Using the latest publicly available data from the County Health Rankings and Roadmaps across 3,027 counties and equivalents, simple and quantile regression analyses were conducted to test the association between the average daily density of fine particulate matter (PM2.5) and LBW. The LBW data were from 2016 to 2022 from the National Center for Health Statistics and PM2.5 data …

Identifying Barriers And Place-Based Solutions To Physical Activity For Older Adults In East Tennessee, Lydia Hoskins, Jodi Southerland

Journal of Appalachian Health

Introduction: Older adults in East Tennessee (TN), the fastest growing demographic, face significant health challenges, with 44% reporting four or more chronic conditions. The state ranks 45th in physical inactivity among older adults, exacerbating chronic disease risks, fall-related injuries, and mental health issues. Urban-rural disparities in East TN further complicate efforts to promote active living, particularly for rural residents.

Purpose: This qualitative study explored socioecological barriers and solutions to increase physical activity (PA).

Methods: In April 2024, two focus group were conducted in East TN, with a total of 11 participants composed of six community partners and five older adults. …

Establishing Best Practices Guidelines For Collaborative Research In Global Surgery: Developing A Delphi Survey, Ramitha Eshan Ruwanpathirana, Swati Deshpande, Sophia Abdulhai, Mathilde Djeneba Billau, Sumeja Catic, Theresa L Chin, Julia N Harrison, Pratyush Kumar, Maria Cecilia T Leyson, Helen W Li, Katayoun S Madani, Arthur Serumaga, Margaret Tarpley, Grayson Wright, Nia N Zalamea, Joshua S Ng-Kamstra

Faculty, Staff and Students Publications

Background: Collaborative research in global surgery has resulted in the rapid development of the field via knowledge creation and dissemination, research capacity building, and direct improvements in the delivery of clinical care. Yet the establishment and maintenance of trans-boundary collaborations carries significant risk to health systems, clinicians, patients, and researchers, particularly if such collaborations are not developed thoughtfully and with appropriate guardrails. In recent years, there has been significant growth in the literature on the pervasiveness and impact of neocolonialism on global health research.

Methods: To harness the benefits of global surgery research collaboration while mitigating these risks, we reviewed …

Improving The Reporting On Health Equity In Observational Research (Strobe-Equity): Extension Checklist And Elaboration, Omar Dewidar, Larissa Shamseer, G J. Melendez-Torres, Elie A. Akl, Jacqueline Ramke, Xiaoqin Wang, Oyekola Oloyede, Taryn Young, Stuart G. Nicholls, Zulfiqar Ahmed Bhutta

Institute for Global Health and Development

Data on health equity to inform societally relevant evidence based decisions and policy making are lacking in the research literature. Observational studies have the potential to provide data on health equity. Yet, guidance on how to report health equity data and considerations in observational research is inadequate. The STROBE-Equity extension addresses this gap by providing a structured set of criteria to enhance the reporting of health equity data and considerations.

Bridging Gaps In Breast Cancer Care: A Breast Cancer Care Quality Index To Improve Outcomes Worldwide, Eduardo Cazap, Benjamin Anderson, Giuseppe Curigliano, Sandeep Sehdev, Fatima Cardoso, Ana Gonzalez, Emad Shash, Cheng-Har Yip, André Mattar, Miriam Mutebi

General Surgery, East Africa

Background: Breast cancer (BC) care faces challenges in early detection, timely diagnosis and comprehensive management. Disparities persist, with underserved populations facing the greatest barriers. Addressing these requires policies that support consistent, evidence-based practices and enhance healthcare capacity and technology advancements. This document presents the development of the Breast Cancer Care Quality Index (BCCQI), supported by evidence to promote equitable care and improve BC outcomes globally, and discusses its adoption as a strategic tool within National Cancer Control Plans.

Methods: A two-part methodology identified challenges in BC care and defined dimensions, targets and indicators for the BCCQI, aligned with …

Racial Moderation Of Infant Mortality Risk And Protective Factors In The United States, Temitope Oluwaseun Akinsola

Walden Dissertations and Doctoral Studies

The rate of infant mortality is a pressing health issue in the United States, as ethnic minorities are disproportionately affected. This study addressed how race controls the predictive power of demographic, socioeconomic, and geographic factors on infant mortality. Using a quantitative correlational design, secondary data from 181 individuals listed in the CDC-National Vital Statistics System database were used, which contains nationally aggregated data related to infant mortality rates. Bronfenbrenner’s social ecological model guided the study, and multiple regression and moderation models were used to examine socioeconomic status and access to healthcare on infant mortality outcomes. Results indicated that race significantly …

Iot Sensors As A Tool For Assessing Spatiotemporal Risk To Extreme Heat, Kijin Seong, Seung Jun Choi, Junfeng Jiao

Research Collection College of Integrative Studies

The safety of urban populations sensitive to extreme heat is under increasing threat. Few studies examine the potential benefits of deploying IoT environmental sensors in the urban context and their integration with large-scale human activity data. This paper examines the deployment of IoT sensors in high-resolution extreme heat risk assessment in the case of Seoul, South Korea. This study conducted spatiotemporal analysis on heat exposure with IoT sensors, compared it with an existing land surface temperature map for validation, combined it with human activity data for risk assessment, and finally discussed the benefits of IoTs in detecting abnormal weather events. …

Old Frames On New Media: Health Misinformation In Black Digital Communities, Merriah Croston

Brown School Graduate Student Theses and Dissertations

Growing evidence suggests that health misinformation has the potential to proliferate on social media. However, our understanding of the problem’s magnitude continues to evolve. Despite several studies on health misinformation and Black communities in the United States (U.S.), few of these studies characterize misinformation within digital settings. This dissertation seeks to address this gap by: 1) synthesizing the literature on health misinformation and Black communities to identify prevalent misinformation topics and claims, characteristics of exposure to and belief in these topics and claims, and successful intervention strategies; 2) quantifying and characterizing the volume of COVID-19 misinformation on Black Twitter during …

Predicting Cardiovascular Mortality In Hampton Roads Using Social Determinants Of Health, Mohan D. Pant, Aditya Chakraborty, Prachi P. Chavan, George Mcleod, Brett J. Sierra, Glenn A. Yap, Brian C. Martin, Ebbie Kalan, Gregory T. Scott

Cardiovascular Research Symposium

Background: In Virginia’s Hampton Roads (HR) region, minority populations experience notably higher mortality rates than white populations. Despite abundant research on the association between social determinants of health (SDOH) and cardiovascular mortality rates at the state and national levels, there is a lack of research examining this association in the HR region.

Objective: The main objective of this study is to train and validate a geospatial-temporal predictive model to examine the association between SDOH and cardiovascular mortality, in the HR region.

Methods: Utilizing a longitudinal dataset (2010–2021) from the Virginia Department of Health and the U.S. Census Bureau, we trained …

Opioid Overdose Bystander Assistance And Harm Reduction In Pennsylvania, Walkirya Peralta

Walden Dissertations and Doctoral Studies

Bystanders play a vital role in reducing opioid overdose deaths by administering naloxone, a medication that can reverse the effects of opioids when used promptly. With opioid-related fatalities considered a public health emergency in the United States, increasing public access to naloxone and education on overdose prevention has become a key strategy in harm reduction. Research shows that these efforts effectively lower overdose deaths in affected communities. As part of this public health approach, many states allow individuals to obtain naloxone without a prescription through standing orders at pharmacies and community programs. Additionally, legal protections such as Good Samaritan laws …

A Developmental Evaluation Of A Dental Hygiene Program And A Community Health Partnership, Laura Jacob

Higher Education: Doctoral Research Projects

Today, dental hygiene education commonly occurs in community college settings which are removed from dental schools thus dental hygiene students graduate with relatively little to no exposure to dentistry or directly with a clinically practicing dentist. With dental hygiene workforce shortages at an extremely high level, locally and nationally, it is imperative to matriculate students who are poised to be successful in the changing landscape of healthcare.

The purpose of this program evaluation was to investigate via the developmental program evaluation model, the perceived benefits of a potential collaboration between the Colorado Mountain College (CMC) dental hygiene program and a …

Analyzing Food Access: An Investigation Of Food Insecurity Amongst Latinos In Rural Nebraska, Natalia Santos

Theses & Dissertations

Background: Food insecurity is a public health issue in the United States, with disproportionately higher rates among Latino/Hispanic households. Rural communities face unique geographical, socioeconomic, and systemic barriers that often exacerbate food access disparities. Despite the growing Latino population in rural areas, particularly in Midwestern states like Nebraska, there remains a critical gap in comprehensive research that integrates both objective and subjective understandings of their food environments. Understanding these multifaceted influences is crucial for developing effective, culturally sensitive interventions.

Problem Statement: This dissertation aims to answer the central question: How does food access and food insecurity manifest amongst Latinos in …

An Evidence-Based Intervention To Increase Trypanosoma Cruzi, A Neglected Parasitic Infection, Diagnosis In Rural And Moderate-Size-City Us Clinics, M K. Lynn, Hunter M. Boehme, Jeffrey Hall, Patrick Kent, Alain H. Litwin, Quang H. Pham, Melissa Nolan Ph.D., Mph, Prisma Chagas Team

Faculty Publications

Background

Chagas disease is a chronic, insidious parasitic infection (Trypanosoma cruzi) that slowly develops to irreversible organomegaly over several decades. The disease is traditionally acquired in endemic Latin American countries during childhood; < 1% of foreign-born adult residents in the United States have been diagnosed or treated with this potentially fatal disease. Low physician knowledge is a primary factor leading to misdiagnosis.

Methods

Starting in April 2022, a 4-part T cruzi clinical education intervention began, which included (i) 2 grand rounds presentations to >100 internal medicine providers; (ii) implementation of a “clinical Chagas champions program” incorporating 14 key clinical staff at varying departments and administrative levels educated on their specific role related to T cruzi screening, diagnosis confirmation, clinical management, and medical billing; ( …

Beyond Smoking: A Geospatial Investigation Of Factors Associated With Lung And Bronchus Cancer Risk In Pennsylvania, Tesla D. Dubois, Daniel Wiese, Kevin A. Henry, Shannon M. Lynch

Kimmel Cancer Center Faculty Papers

INTRODUCTION: While smoking is the leading cause of lung and bronchus cancer (LBC), additional exposures have been implicated and may explain the rise in LBC among never-smokers. To better understand the spatial distribution of LBC incidence and associated risk factors, this study aims to identify geographic areas with significantly elevated incidence rates in Pennsylvania and investigate the potential underlying risk factors.

METHODS: Using cancer registry data aggregated to the census tract level, spatial scan statistics were applied to detect areas of higher-than-expected LBC incidence across the state. Associations were then tested between census tract inclusion in a high-incidence area and …

Kind Kids, Healthy Teens: Child Prosociality And Fruit And Vegetable Intake, Farah Qureshi, Krista P. Woodward, Laura D. Kubzansky, Julia K. Boehm

Psychology Faculty Articles and Research

Introduction

Methods

Eco-Emotions And Climate Activism In Adolescents, Julianna Sahoo

Master's Projects and Capstones

Background. Youth are especially vulnerable to climate change, both physically and psychologically. Combatting climate change will require a coordinated, global effort. Understanding the motivations and emotions behind climate activism is essential to coordinate efforts to combat climate change.

Methods. This research uses survey data collected from first and second year undergraduates (n=521) at a private, urban university in California in the Fall of 2022. Youth were surveyed on emotions related to climate change, activism, compassion, eco-anxiety, and well-being.

Results. Experiencing positive emotions had a stronger relationship with environmental activism compared to negative emotions.

Conclusion. Results suggest climate change communications should …

Enumerating Escherichia Coli (E. Coli) Concentrations And Evaluating Optical Brighteners As A Potential Indicator Of Human Wastewater Contamination In La Nana Bayou, Banita Creek, And Their Tributaries, Nacogdoches, Texas, Swastika Acharya, Matthew Mcbroom, Yuhui Weng, Yanli Zhang

Electronic Theses and Dissertations

La Nana Bayou was added to the Texas 303(d) list in 2000 after it failed to meet water quality standards set by the Texas Commission on Environmental Quality (TCEQ) for primary contact recreation due to elevated Escherichia coli (E. coli) levels. E. coli is a bacterial species commonly found in the intestines of humans and warm-blooded animals. It serves as an indicator of fecal contamination in freshwater, though its presence alone cannot identify the contamination source. Optical brighteners (OBs), chemicals found in laundry detergents, cleaning agents, toilet papers, and clothing, are unique to human wastewater. This study aimed …

Role Of Patient-Reported Measures (Prms) In Addressing Ethical Challenges During Telemedicine Consultation: A Narrative Review, Asiya Attar, Kasturi Shukla

Patient Experience Journal

Introduction: Telemedicine has revolutionized medical care delivery by emphasizing on Patient-Centred Care (PCC). Patient Reported Measures (PRMs) can assist in providing PCC since it assesses the treatment outcomes and patient experience. However, using PRMs is not just limited to gauging clinical efficiency; it can also play a role in addressing the ethical challenges in telemedicine. Yet this aspect of PRMs remains underexplored. Method: Literature search was conducted using a combination of keywords from the Google Scholar, Scopus, and Web of Science databases. 126 peer-reviewed journal articles in English from 2015 to 2024 were screened, and 34 relevant full-text …

Engaging In Movement At Work: Exploring Engagement And Physical Activity., Spencer A. Cavan

Electronic Theses and Dissertations

High levels of employee engagement provide organizations competitive advantages such as increased customer satisfaction, profits, and employee productivity. Despite potential benefits, the number of engaged employees is declining and organizations need to find innovative ways to enhance engagement. Emerging evidence suggests workplace physical activity may generate organizational benefits extending beyond health improvement. Therefore, the purpose of this study was to investigate perceptions of engagement among employees participating in a physical activity intervention at work. A qualitative design, guided by phenomenology, examined perceptions of workplace physical activity and perceived levels of engagement, as well as constraints related to involvement among university …

Social Cohesion, Trust, And Utilisation Of Maternal Health Services Among Refugee And Host Community Women In Bangladesh And Kenya, Haeun Lee, Ryan Rego, Neyat Fiseha, Ashok Barman, Nimo Sharif, Peninah Wachira, Joe Kolars, Akbar Waljee, Rubhana Raqib, Amina Abubakar

Institute for Human Development, East Africa

The global refugee crisis places significant pressure on host communities, particularly in low- and middle-income countries. Social cohesion and trust between refugee and host communities are critical for maternal health service utilisation. This study explores the relationship between host–refugee trust, social cohesion, and maternal health service use in Bangladesh and Kenya, focusing on facility-based delivery, antenatal care visits, and postnatal care attendance. To do so, a cross-sectional survey was administered among 649 refugee/displaced women and 371 host community women in the two locations. The results show high trust levels in both groups, while social cohesion is greater among refugee/displaced women. …

Resilience Of Interdependent Transportation And Healthcare Systems: A Simulation-Driven Framework Incorporating Social Equity And Facility Optimization, S. Yasaman Ahmadi

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

The overarching goal of this dissertation is to develop an integrated, simulation-driven framework to assess and enhance the resilience of interdependent transportation and healthcare systems before, during, and after natural hazards. By examining how spatial disruptions, social vulnerability, operational constraints, and infrastructure interdependencies affect access to and functionality of hospitals, this research offers a multifaceted evaluation of system performance under stress. This dissertation examines the impact of natural hazards, particularly floods, on the interdependent transportation and healthcare systems. The proposed approach combines and advances GIS-based network analysis, graph-theoretical modeling, and discrete-event simulation to evaluate system performance under different scenarios. The …

Evaluating The Impact Of Medicaid Expansion On Non-Small Cell Lung Cancer Care And Health Disparities, Marvin Idoteyin Okon

All Dissertations

Persistent disparities in non-small cell lung cancer (NSCLC) outcomes reflect broader structural inequities shaped by race, place, and socioeconomic conditions. This dissertation examined trends in NSCLC outcomes over the past two decades and evaluated the impact of Medicaid Expansion (ME) under the Affordable Care Act on improving outcomes and reducing disparities, especially in marginalized communities.

Using nationally representative datasets, three interrelated studies were conducted. The first assessed trends in NSCLC incidence, early-stage diagnosis, and 3-year survival from 2002-2021, stratified by metropolitan status, deprivation (Social Deprivation Index), and segregation (Index of Concentration at the Extremes). While incidence declined and early-stage diagnosis …