Digital Commons Network^™

Spatial Distribution Patterns Of Determinants Of Hypertension In West Java In 2023, Meirina Nur Asih Susanti, Wahyu Septiono

Preventia: The Indonesian Journal of Public Health

Hypertension is a public health issue that is unevenly distributed across regions. The high prevalence in West Java (34.4%) with a large population makes the management of hypertension crucial. Differences in economic and environmental conditions are thought to influence the distribution of hypertension, thus requiring spatial analysis. This study used an ecological approach by analyzing data from districts/cities in West Java in 2023. Secondary data were used to measure hypertension prevalence and to assess socioeconomic and environmental factors. The analysis was conducted using univariate Moran's Index, Local Indicators of Spatial Association (LISA), and the Spatial Autoregressive Model (SAR). The prevalence …

Association Between Maternal Factors And Stunting Based On The Indonesia Family Life Survey 5 (Ifls-5), Charissa Otniel Sukamto, Siti Nur Fatimah, Noormarina Indraswari

Makara Journal of Health Research

Background: Stunting remains a major issue in Indonesia. Maternal factors during pregnancy are one of the key determinants in preventing stunting. This study aimed to analyze the association between maternal history during pregnancy (age, height, parity, and inter-pregnancy interval) and stunting, with a comparison between urban and rural areas.

Methods: This analytical cross-sectional study used data from 3,639 children aged 1-5 years old from the household survey of Indonesia Family Life Survey 5, conducted between late October 2014 and August 2015 within 13 provinces in Indonesia. Data was analyzed using chi-square and binary logistic regression methods.

Results: …

Using Geospatial Environmental And Income Variables As Predictors Of Diabetes In Appalachia, John Kunicki Huth

Walden Dissertations and Doctoral Studies

Diabetes remains disproportionately prevalent in Appalachia, and macroenvironmental contributors remain poorly understood. Guided by spatial epidemiology, this quantitative, cross-sectional ecological study examined whether county-level environmental factors including distance to mine, distance to landfill, distance to water, mean annual precipitation, mean annual temperature, forest classification, distance to impervious surface, and median income were independently and collectively associated with diabetes cases per capita in West Virginia, used as a surrogate for Appalachia. Research questions addressed environmental predictors of diabetes cases per capita with and without controlling for median income. Publicly available county-level data from 53 West Virginia counties representing adults aged 20 …

Infective Endocarditis Hospitalizations In Kentucky, 2008-2018: Spatial And Temporal Trends, Meera Marji, Steve Browning, W. Jay Christian, Richard Charnigo, Steve W. Leung, Anna Kucharska-Newton

Journal of Appalachian Health

Introduction: Infective endocarditis (IE) hospitalization rates have increased significantly in the last decade, primarily due to the opioid epidemic. In 2016, Kentucky (KY) ranked among the top ten states for opioid-related overdose deaths, but limited data exist on IE trends in KY.

Purpose: This study seeks to examine county-level spatial and temporal trends in IE hospitalization rates in KY.

Methods: Hospital inpatient discharge data from 2008–2018 for KY residents aged 18 and older were analyzed. IE admissions and drug use status were identified using ICD-9 & 10 diagnosis codes. U.S. Census data calculated yearly IE hospitalization rates per 100,000 residents. …

Starting With Story, Not Symptom: Narrative Collapse And Cultural Repair In Appalachia, Wayne Coombs Ph.D.

Journal of Appalachian Health

Appalachia’s opioid crisis reflects uneven burdens, especially in distressed coalfield counties, and it cannot be solved by symptom tracking alone. This commentary argues for a narrative shift, starting with story and cultural repair alongside clinical care. Narrative collapse is defined here as the loss of shared, dependable public meaning across groups, not the absence of storytelling in families, churches, and recovery circles. Trauma science suggests that chronic threat reshapes nervous systems across generations, making safety a prerequisite for renewed trust. Drawing on narrative identity research, the piece proposes peer story work as infrastructure that can reduce shame, support treatment engagement, …

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 …

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 …

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, …

Identifying Major Sources Of Leptospira Interrogans In San Juan Bay And Río Grande De Loíza Estuaries Of Puerto Rico, Logan Mccullers, Dave Bachoon

Biology Theses

This study evaluated the presence of pathogenic Leptospira interrogans, potential carriers, and environmental factors influencing their occurrence in the San Juan Bay Estuary (SJBE) and Río Grande de Loíza (RGDL) watersheds of Puerto Rico from 2024–2025. Detection of this pathogen from water samples was performed using the lipL32 PCR assay. The likely hosts of L. interrogans were determined using fecal source tracking (FST) assays for human (HF-183), canine (BacCan-UCD), equine (HoF597), and rat mitochondrial DNA NADH dehydrogenase subunit 2 gene (RatMt) markers. In 2024, 91 samples were collected (March: 50; June: 41), and in 2025, 124 samples were collected …

Relationship Between Hepatitis B Virus Screening, Vaccination, And Spread In Sierra Leone, Muhammed Sarmodu Mansaray

Walden Dissertations and Doctoral Studies

Hepatitis B virus (HBV) presents a significant public health burden in Sierra Leone. Although the estimated prevalence was 8.7% in 2021, comprehensive statistical data has been limited in general. Programmatic interventions for HBV control such as systematic screening and vaccination have remained limited as well. The purpose of this quantitative cross-sectional study was to examine the relationship between screening and vaccination practices and HBV prevalence in Sierra Leone while controlling for age, sex, education and health care access. The theoretical framework incorporated the Integrated Screening Action model, which highlights screening as a critical disease prevention strategy, and the Social Ecological …

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.

Healthcare Systems & Policy Implications For The Impact Of State Medicaid Reimbursement Rates On Access To Primary Care Services In Rural Communities: Turning Knowledge Into Action, Miriam Martinez

Posters - 2026

• Where a child lives can determine whether they receive care or go without it. • Access to primary care is essential for prevention, early diagnosis, and treatment, but rural areas face persistent challenges such as provider shortages and geographic isolation. • Medicaid serves as the primary source of health coverage for low-income children; however, reimbursement rates vary by state and are often lower than other forms of insurance. • This study examines how Medicaid reimbursement policy contributes to disparities in access to care for rural children and reflects broader structural inequalities within the healthcare system.

Developing Scenario-Based Strategies For Health, Climate, And Environmental Preparedness: The One Health, One Earth Approach, Azar M Abadi, Kyle D Brumfield, Moiz Usmani, Gemma Jiang, T C Chakraborty, Yuzhou Wang, Zhijie Zhou, Cenlin He, Minghao Qiu, Jennifer D Stowell, Douglas Fritz, Sunil Kumar, Qiang Guo, Ying Xiong, Georgia Destouni, Qian Xiao, Xindi C Hu, Kelvin C Fong, Yun Hang, John Nielsen-Gammon, Rima Habre, Jennifer R Bratburd, Christopher W Tessum, Antarpreet Jutla, Rita R Colwell, Gabriel M Filippelli, Thanh H Nguyen

Faculty, Staff and Student Publications

Climate change amplifies many threats to human health. Despite advances in understanding climate change dynamics and impacts, there remains a critical gap in translating scientific knowledge into equitable, and community‐driven health interventions. The inaugural One Earth, One Health workshop sought to explore this gap through human‐centered design exercises involving interdisciplinary researchers from climate and Earth sciences, engineering, epidemiology, microbiology, and environmental health. Although participants did not co‐develop solutions with affected communities, they used stakeholder role‐playing to guide ideation and lay groundwork for actionable plans. Through these methods, participants identified community needs and proposed prototype solutions to alleviate health threats …

The All-Payer Claims Database After The Gobeille Supreme Court Decision: Assessing The Impact On Fatal Opioid-Related Overdose Research, Jack Cordes, Cici Bauer, Dana Bernson, Marc R Larochelle, Wenjun Li, Jiahao Cao, Olaf Dammann, Thomas J Stopka

Faculty, Staff and Student Publications

Objective: To determine the consequences of the Gobeille v. Liberty Mutual Supreme Court decision on the representativeness of the Massachusetts all-payer claims database (APCD). The loss of individuals captured in the APCD may vary demographically, geographically, and in the capture of fatal opioid-related overdose (OOD).

Data sources and study setting: We used 2013-2021 data from the Massachusetts Public Health Data Warehouse (PHD), which links person-level APCD records to other datasets. The APCD includes commercially-insured health claims mandatorily reported pre-Gobeille. Post-Gobeille, reporting from self-insured plans, a subset of commercially-insured plans, became voluntary.

Study design: In a repeated cross-sectional design, we compared …

Education And Training In Water Operator Certification And Its Role In Water Utility System Performance, Heath A. Edelman

Educational Leadership & Workforce Development Theses & Dissertations

Access to safe and reliable drinking water is a foundational component of public health and environmental protection. The United States drinking water sector is highly regulated and increasingly challenged by workforce shortages, aging infrastructure, and variability in operator training requirements across states. Despite the federal mandate for operator certification under the Safe Drinking Water Act Amendments of 1996, empirical evidence on the effectiveness of certification policies in improving regulatory compliance outcomes remains limited.

This study examined the relationship between operator certification policies and drinking water compliance outcomes under the Safe Drinking Water Act, with particular attention to differences across violation …

Setting Research Priorities For The Use Of Digital Technology In The Self-Management Of Heart Health: The Results Of The James Lind Priority Setting Partnership, Lis Neubeck, Simon Nichols, Nicola Straiton, Louise J. Dunford, Amitava Banerjee, Susan Dawkes, Donna Fitzsimons, Maria Hayes, Alistair Lawson, Abigail A. Lyons, Mary Mcauley, Jill Mclaggan, Richard Mindham, Nicholas L. Mills, Rakesh Modi, Alice Pearsons, Amanda Pitkethly, Fiona E. Strachan, Coral L. Hanson

Research outputs 2022 to 2026

Aims: There are wide inequalities in access to cardiovascular care, and risk factors such as obesity, high blood pressure, and physical inactivity are often not well managed. We aim to identify the most important questions about how digital technologies can help people and their carers prevent cardiovascular disease and improve access to care. Methods and results: A priority setting partnership that aimed to generate a top 10 list of research priorities for the use of digital technology in the prevention and management of heart disease and heart conditions in the UK and Ireland, with equal input by people with lived …

Maternal Respiratory Syncytial Virus Vaccination And Preterm Birth A Utah Statewide Retrospective Cohort Study, Amy Solsman, Torri Metz, Josh Benton, Shana Godfred-Cato

Knowledge and Creativity Expo

We conducted a statewide, retrospective cohort study to evaluate the association between maternal receipt of the respiratory syncytial virus (RSV) vaccine and preterm birth. All individuals who delivered a singleton neonate in Utah and were between 32 0/7 and 36 6/7 weeks of gestation from September 2023 to February 2024 were included and followed up until delivery. Overall, 2,733 of 24,213 individuals (11.3%) received the vaccine. Vaccine receipt was associated with lower odds of preterm birth (5.5% vaccinated group vs 6.8% unvaccinated group, adjusted odds ratio 0.80, 95% CI, 0.67–0.95). Receipt of the RSV vaccine was not associated with any …

Mainstreaming Mistrust: The Shift In Us Vaccine Policy Under The Trump Administration, Sanjin Musa, Amy Estlund, Megan A. Berman

Faculty Scholarship

Department of Health and Human Services led by Robert F. Kennedy Jr., represents a significant departure from long-standing public health norms. This commentary explores how historically marginalized anti-vaccine activism has moved into the mainstream of government oversight. Key actions driving this transition include the wholesale replacement of the Advisory Committee on Immunization Practices, the departure of senior CDC officials, and the public questioning of established childhood immunization schedules. Furthermore, the administration has ceased financial support for global health entities like the World Health Organization and Gavi, the Vaccine Alliance, while canceling funding for innovative mRNA vaccine platforms. 

These domestic policy …

An Odd Protocol For An Agent-Based Model Of Hepatitis C Virus Transmission In A Two-Group Structural Heterogeneous Syringe-Sharing Network (M2), Seun Ale, Que Nguyen Dr., John D. Kelleher Prof., Elizabeth Hunter Dr.

Reports

The model described in this ODD is an agent-based model of hepatitis C virus (HCV) transmission among people who inject drugs (PWID). The model extended a baseline homogeneous model by incorporating structural heterogeneity via a two-group interaction framework. The syringe-sharing population in the model is divided into inner and outer circle groups representing individuals with differing levels of syringe-sharing interaction intensity. While all agents share the same syringe-sharing probability and epidemiological processes remain identical across agents, the number of daily interaction opportunities differs between the two groups. Interactions in the model are generated dynamically using proximity-based sampling at each timestep …

Results From Jail-Based Substance Use Treatment In Tooele County, Matthew Huntington, Shianne Anderson

Outcomes and Impact Quarterly

This article describes the development and outcomes of a jail-based substance use treatment program in Tooele County, Utah. The program addresses the elevated overdose risk among individuals leaving incarceration through education, peer support, and coordinated reentry planning. Program outcomes include reduced recidivism and improved connection to recovery supports.

Undergraduate Health And Wellbeing Course And Study Away Program To Alaska, Lorraine S. Wallace, Steven J. Mousetes, Jennifer Bickley

Journal of Global Education and Research

High-impact practices, such as diversity/global education, have been shown to positively contribute to student development, engagement, and success. As the US is both culturally and linguistically diverse, domestic study away programs can offer students impactful multicultural educational experiences without leaving the country. The purpose of this study was to describe the design of a health and well-being academic course and accompanying study away program to Alaska for undergraduates at The Ohio State University (OSU). The authors (1) describe the application of the backward design process in guiding ELOs development, (2) provide a sample of course assignments and student responses, and …

An Odd Protocol For An Agent-Based Model Of Hepatitis C Virus Transmission In A Homogeneous Syringe-Sharing Network, Seun Ale, Que Thi Nguyet Nguyen Dr., John D. Kelleher Prof., Elizabeth Hunter Dr.

Reports

The model described in this ODD is an agent-based model of hepatitis C virus (HCV) transmission among people who inject drugs (PWID). The model assumes homogeneous mixing among syringe-sharing agents, without any form of heterogeneity in the agents interactions or syringe-sharing attitude. All syringe-sharing PWID are treated as identical in terms of their interaction frequency and syringe-sharing probability. Interactions are generated dynamically using proximity-based sampling at each timestep (one day), allowing agents to form syringe-sharing interactions based on spatial closeness. The number of daily interaction events is fixed at the population level, and each syringe-sharing agent has the same probability …

An Odd Protocol For An Agent-Based Model Of Hepatitis C Virus Transmission With Inter-Group Structural And Behavioural Heterogeneous Syringe-Sharing Networks (M4), Seun Ale, Que Nguyen Dr., John D. Kelleher Prof., Elizabeth Hunter Dr.

Reports

The model described in this ODD is an agent-based model of hepatitis C virus (HCV) transmission among people who inject drugs (PWID). The model incorporates structural heterogeneity through a three-group interaction framework and behavioural heterogeneity through group-specific syringe-sharing rates. The syringe-sharing population in the model is divided into core, inner, and outer circle groups representing individuals with high, moderate, and low levels of syringe-sharing interaction intensity, respectively. In addition to differences in the number of daily interaction opportunities across groups, agents in each group are assigned distinct syringe-sharing probabilities, reflecting variation in risk-taking behaviour across structural groups within the syringe-sharing …

School Climate As Primary Prevention: Mental Health And Violence Outcomes Among Lgbtq+ Youth In The U.S. South (2015–2024), Latarsha H. Michael, Brieah D. Hudson, Kenya T. Horne

Journal of Public Health in the Deep South

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) adolescents in the U.S. South experience disproportionately high rates of bullying, discrimination, depression, and suicidality. Supportive and inclusive school climates are identified as key protective factors that can mitigate these risks and function as primary prevention against violence. This systematic narrative review synthesizes peer-reviewed research and high-quality survey reports published between 2015 and 2024 that assess school climate, mental health, and violence-related outcomes among LGBTQ+ youth with representation from Southern states, including Mississippi, Alabama, and Louisiana. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 1,167 records …

Gun Violence And Maternal Mortality In The Mississippi Delta: A Dual Public Health Crisis, Nelson Atehortua, Mary Shaw-Ridley

Journal of Public Health in the Deep South

No abstract provided.

Navigating (M)Otherhood: Perception, Practice, & Policy Of Adolescent Pregnancy In The North Coast Of Perú, Mahir Rahman

USF Tampa Graduate Theses and Dissertations

“It’s a vicious circle”, the obstetricians of Huanchaco repeated time and time again after discussing a recently pregnant 13-year-old girl who had just moved to the North Coast of Perú. Adolescent pregnancy is an extremely stigmatized topic in global maternal and child health discourse. Pregnant adolescents are subject to educational policy, clinical protocol, and community practice. While global scholarship emphasizes adolescent pregnancy prevention, limited scholarship focuses on the conditions in which adolescent pregnancy is perceived, discussed, and managed. More importantly, these perspectives are even less documented amongst the North Coast of Perú.

This thesis serves as an ethnographic exploration of …

From Waitlist To Activation: Exploring Patient Barriers And Team Interactions In Kidney Transplant Readiness, Judith I. Eguzoikpe

Harrisburg University Dissertations and Theses

Kidney transplant candidates frequently experience prolonged inactive waitlist status due to incomplete readiness requirements, yet limited understanding exists regarding how patient barriers and team interactions intersect to influence activation timelines. This transcendental-phenomenological study explored how patient barriers and team dynamics contribute to delays in kidney transplant readiness, guided by Team Theory. Semi-structured interviews were conducted with 16 participants (8 patients, 8 healthcare professionals) between December 2025 and February 2026. Data were analyzed using systematic phenomenological methods to identify patterns that address patient barriers, team interaction effects, and the teamwork improvements needed for earlier activation. Five interconnected themes emerged: Navigating a …

The Relationship Between Social Determinants And Primary Care Utilization Among Medicaid Recipients In A Managed Care Community Health Worker Program, Rachel Elaine Rosensteel

Walden Dissertations and Doctoral Studies

Community health worker (CHW) programs are an increasingly important strategy for addressing social determinants of health (SDOH) within Medicaid systems. However, evidence on how specific SDOH impact healthcare utilization remains limited. In this quantitative, correlational study, the relationship between SDOH factors like housing instability, food insecurity, and transportation barriers, and primary care utilization among adult Medicaid recipients aged 18–65 who participated in a Medicaid managed care organization’s CHW program in Clark County, Nevada, during 2023 were examined. Retrospective administrative data from 441 participants were analyzed using negative binomial regression to assess associations between SDOH factors and postintervention primary care visits …

Global Public Health Feasibility: Digital Dentistry In Geriatric Population, Merna Amr Saleh

Theses and Dissertations

Oral health is a critical yet often overlooked determinant of well-being among older adults in Egypt, where mobility limitations, geographic barriers, and low awareness of preventive practices exacerbate dental disparities. DentalPal, a teledentistry-based mobile application, was developed to provide older adults with remote dental consultations, oral hygiene advice, and triage guidance. The platform enables users to submit oral photographs or radiographs for assessment, seek second opinions, and initiate follow-up chats directly with the healthcare provider. This flexible design allows users to access dental consultations on demand while ensuring continuity of care The question that guided this study was how older …

Beyond "Place Matters": Making Spatial Analysis Accessible With Dashboard-Driven Geography, Stephen Borders

Public Health

This article presents an instructional module that uses Tableau to teach spatial thinking and policy geography through an analysis of Supplemental Nutrition Assistance Program (SNAP) participation. Tableau’s ability to integrate custom spatial files with demographic and health data makes it an accessible platform for introducing geographic inquiry without requiring specialized GIS expertise. The lesson guides instructors through building maps, bullet charts, and scatterplots that highlight gaps between eligibility and enrolment, while connecting food insecurity to health outcomes. By lowering technical barriers, Tableau provides a pedagogical bridge that helps educators foster spatial literacy in diverse classroom contexts.

This article was published …