Digital Commons Network^™

Surviving Staten Island: Black Women’S Narratives Of Resilience, Motherwork, And Embodied Trauma, Jazmin Rivera

Student Theses

This oral history dissertation centers the experiences of six Black women who had formative experiences navigating hostile school and community-based settings on Staten Island during the 1970s, 1980s, and early 1990s. Guided by a conceptual framework that draws on Black orality, Black feminist thought, and endarkened feminist epistemology, this study demonstrates how Black women were required to cross geographic and social boundaries to survive hostile conditions in Staten Island communities and schools. Findings from this study highlight Black women’s use of community cultural wealth to inform their survival strategies and resilience. At the same time, their experiences indicate the potential …

Respiratory Health And Environmental Risks Among California Children: The Role Of Socioeconomic Status, Wen Chieh Chia

Walden Dissertations and Doctoral Studies

Abstract Air pollution has been cited as a factor in the development of respiratory illness in children. Socioeconomic differences can intensify the effects of air pollution exposure on low-income children compared to higher-income children. This correlational study examined the relationship between air pollution exposure and respiratory health outcomes among California children, as well as the moderating role of socioeconomic status. The study was guided by the environmental health disparities framework and used secondary data from the California Environmental Health Tracking Program, analyzing data from 49 California counties (n = 49). Independent variables were PM2.5 concentrations and the number of ozone …

Cancer Literacy And Social Determinants Of Health: An Epidemiological Analysis Of Trust, Digital Engagement, And Healthcare Utilization In Cancer Information Seeking, Kimberly Leeann Hazel

Walden Dissertations and Doctoral Studies

The rise of online health information has increased access to cancer resources but also amplified misinformation, creating trust gaps that threaten prevention, treatment, and health equity. This study examined how trust in cancer information sources, online information-seeking, and healthcare perceptions relate among U.S. adults. Guided by the health information seeking behavior, the socioecological model, and the structural influence model of health communication, data from the 2022 Health Information National Trends Survey (N = 6,197) were analyzed with logistic regression, mediation, and moderation modeling, controlling for demographics. Trust in government agencies predicted greater cancer information seeking (odds ratio [OR] = 1.94, …

Guidelines For Community Engaged Health Research, Carrie Leach, Hayley Thompson, Alex Sass, Patricia Wren, Rodlescia Sneed, Rhonda Dailey, Elizabeth Towner, Maha Albdour, Carla Caringi, Alyssa W. Beavers, Theresa A. Hastert, Vanessa Rorai, Peter A. Lichtenberg, Angulique Outlaw, Ijeoma Nnodim Opara

Institute of Gerontology

Executive Summary:

Wayne State University’s Guidelines for Community Engaged Health Research provide a practical framework for designing, conducting, and evaluating ethical, equitable, and impactful health research that engages community experts in projects that advance health equity in Detroit.

Purpose 

Developed for WSU faculty, staff, and research teams, the guidelines support the meaningful involvement of community experts across all phases of research. They respond to common challenges in community-engaged work, including limited experience with engagement approaches, the need for reflexive and equitable practices, and the time and coordination required for authentic collaboration.

The document defines Community-Engaged Research (CEnR) as collaborative work …

West Nile Virus Transmission Suitability Modeling For Culex Pipiens Via Temperature And Humidity, Hunter Jones, David Brett-Major, Joseph R. Fauver, Yeongjin Gwon, Jesse E. Bell

Journal Articles: Epidemiology

West Nile Virus (WNV) is the leading cause of mosquito-borne disease in the United States, yet predicting its transmission remains a significant challenge for public health officials. Many studies use correlative statistical models to predict disease cases using temperature and humidity, but accessible mechanistic approaches that simulate mosquito behavior traits can capture more of the transmission process. This study adapts an existing R-language package, the Mosquito-borne Viral Suitability Estimator (MVSE), which was created to model Aedes aegypti mosquito transmission of dengue, and tunes it to Culex pipiens transmission of WNV. Equations for mortality, biting rate, and incubation period were updated, …

Trends Among Suspected Opioid Overdose Emergency Medical Service (Ems) Incidents In Georgia From 2019-2023, Ashton Harris

College of Graduate Studies: Theses & Dissertations

Opioid overdoses remain a problem in the United States, underscoring the need for additional surveillance tools to monitor trends in opioid overdoses. Emergency Medical Services (EMS) data is a timely surveillance method that captures more potential overdoses than hospitals by representing the pre-hospital setting. Research questions in the study assess EMS responses to suspect opioid overdose incidents from 2019-2023 in Georgia to encompass the following characteristics: timeframe (pre, during, post-pandemic), urban versus rural counties, race/ethnicity, categorical type of first responder, mean dosage of naloxone in milligrams administered, and death. 84,359 records meeting the inclusion criteria were initially retrieved from the …

Addressing Obesity And Diabetes In Appalachian Kentucky, Hannah E. Orens

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Type 2 diabetes and obesity are major public health concerns in Appalachian Kentucky. Populations in this region experience much higher rates of chronic disease than the rest of the state, have limited access to preventive care, and ongoing economic challenges that affect health. Many rural counties face increased poverty, transportation challenges, and shortages of healthcare professionals, all of which contributed to poor health outcomes and reduced access to evidence-based prevention programs. As a result, there is a strong need for focused, feasible, community-based interventions that improve access to evidence-based prevention while addressing the social and economic factors influencing health in …

Health Disparities In Cardiovascular Care: The Impact Of Diabetes Education And Post-Discharge Interventions For African American Adults At Risk For And After Myocardial Infarction, Trinity L. Billingsley

Nursing | Senior Theses

Background: Cardiovascular disease is the leading cause of death in the United States, affecting African American adults at higher rates compared to other racial and ethnic groups. Diabetes as a comorbidity is one of the risk factors of experiencing a myocardial infarction, remaining one of the leading causes of death among individuals with diabetes. Objective: To examine the effectiveness of structured diabetes education tailored to African American adults who are at risk for and after a myocardial infarction. Additionally assessing the complications of a myocardial infarction, the outcomes associated with structured education will be compared to the outcomes of …

Investigating The Relationship Between Drug Overdose Deaths, Excessive Alcohol Drinking, And Adult Smoking In Urban And Rural Ohio Counties In 2025, Sumin Byoun, Anne Griffin

Scholarship in Medicine - All Papers

Deaths from drug overdoses have been increasing each year. Ohio ranks among states with the highest number of drug overdose deaths per year. There is a gap in the literature regarding discussions of how excessive alcohol drinking and cigarette smoking rates may predict drug overdose death rates in a community. First, this study investigates differences in excessive drinking, adult smoking, and drug overdose deaths between urban and rural counties in Ohio. Second, this study explores whether excessive drinking and smoking behaviors can predict drug overdose death rates in urban and rural Ohio counties. Data exclusive to Ohio counties was obtained …

Hardin Health Link: A Community-Integrated Paramedicine (Cip) Program In Hardin County, Kentucky, Samantha Jones

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Rural and mixed rural–urban communities face persistent disparities in access to timely emergency medical services (EMS), contributing to preventable morbidity and mortality from time-sensitive conditions such as cardiovascular disease, stroke, and injury. Hardin County, Kentucky, reflects these challenges due to its geographically dispersed population, high burden of chronic disease, and variability in EMS response times. This capstone proposes Hardin Health Link, a Community-Integrated Paramedicine (CIP) program designed to expand the traditional role of EMS providers through in-home health assessments, chronic disease monitoring, post-discharge follow-up, medication reconciliation, and connection to clinical and social services.

Guided by an evidence-informed framework, the program …

Momentum For Healthy Births-Hardin County, Ky, Brittany R. Jackson

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Maternal and infant health disparities in Hardin County, Kentucky, reflect persistent gaps in timely access to care, particularly among rural and underserved populations. Structural barriers, including transportation limitations and unmet social needs, contribute to delayed prenatal care initiation and low postpartum follow-up, increasing the risk of adverse outcomes. This capstone project proposes the MOMentum (Maternal Outreach and Monitoring for Mothers) Program, an integrated care model designed to strengthen access, improve care coordination, and enhance continuity across the prenatal and postpartum period.

The program combines a Community Health Worker (CHW)-led navigation model with enhanced postpartum care supported by telehealth services and …

The Impact Of Food Insecurity And Associated Variables On Colon Cancer In Kentucky: An Ecologic Study, Claire E. Lynch

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objective: Given colorectal cancer incidence rates are increasing, especially in socioeconomic disadvantaged areas, this study aims to determine if there is an association between specific socioeconomic variables, such as food insecurity, and colon cancer at the county-level in Kentucky.

Methods: Colorectal cancer age-adjusted incidence rates at the county-level were collected from the Kentucky Cancer Registry. Conty-level data was collected from County Health Ranking, The U.S Census Bureau, National Institute on Minority Health and Health Disparities and the Behavioral Risk Factor Surveillance System from 2019 to 2023. R was used to run statical analyses such as a linear regression and a …

Socio-Spatial Patterns Of Suicide Mortality In The United States, Kushagra Tiwari, M. Amin Rahimian, Marie-Laure Charpignon, Philippe J. Giabbanelli, Praveen Kumar

VMASC Publications

Suicides cause more than 49,000 deaths per year in the United States, including 55% associated with the use of a firearm. Across states and counties in the US, suicide mortality exhibits substantial geographical and sociodemographic heterogeneity. However, the role of large-scale social networks in shaping this variation remains underexplored. To assess how both the risk of suicide mortality and the effect of firearm restriction policies propagate through inter-county social ties, we integrate data on county-level suicide mortality (2010–2022) and the Facebook Social Connectedness Index (SCI), a continuous measure of the strength of social ties between counties used to derive weighted …

Exploring The Impact Of Adverse Childhood Experiences On Preventive Healthcare Utilization In Rural Georgia, Ryan R. Traylor

College of Graduate Studies: Theses & Dissertations

This study examines the relationship between Adverse Childhood Experiences (ACEs) and preventive healthcare use among adults in Georgia, specifically within rural populations facing structural barriers. Using 2023 Georgia Behavioral Risk Factor Surveillance System (BRFSS) data, the research analyzes associations between ACE exposure, rural residence, and preventive care outcomes, including physical exams and flu vaccinations. Guided by an intersectionally adapted version of Andersen’s Behavioral Model of Health Services Use, the study evaluates how predisposing factors, enabling resources, and perceived barriers relate to healthcare engagement. Logistic regression analyses assess the correlation of ACE exposure, cost barriers, provider access, and sociodemographics with preventive …

Healthcare Access And Community Nursing Outreach Effectiveness In Underserved Zip Codes In Central Florida, Miah Sanchez

Honors Undergraduate Theses

Access to healthcare depends on more than whether healthcare services are available. A person’s ZIP code, income, education, transportation options, health literacy, and neighborhood resources can all affect whether care is reached at the right time and in an appropriate setting. This literature review examines healthcare access and the role of community nursing outreach in underserved ZIP codes across Central Florida. The review synthesizes current literature on social determinants of health, geographic disparities, medically underserved populations, and community-based nursing interventions to better understand how these factors shape access to care. Across the literature, poverty, limited transportation, lower educational attainment, neighborhood …

Aging With A Chronic Illness: Symptom Burden, Everyday Challenges, And Quality Of Life Among Older Adults With Multiple Sclerosis, Swasati Handique

Social Work Dissertations

This three-article study examined the quality of life and everyday lived experience of older adults living with multiple sclerosis (MS). The first article is a scoping review of 14 peer-reviewed studies published between 2012 and 2025, conducted in accordance with Arksey and O’Malley’s five-stage framework and the PRISMA checklist. The second article is a cross-sectional study using the Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) Phase II data set of 60 older adults living with MS. Multiple linear regression and moderation analysis was conducted to examine the association between physical symptom burden and quality of life, and whether participation …

Understanding Ehlers-Danlos Syndrome: A Claims-Based Analysis Of Healthcare Cost Patterns, Samson A Oyediran, Youngran Kim, Zhanna Novikov, Trudy M Krause

Faculty, Staff and Student Publications

Background: Ehlers-Danlos Syndrome (EDS) is a rare connective tissue disorder associated with substantial clinical complexity and healthcare utilization. Despite increasing recognition of EDS, little is known about its economic burden in the United States.

Objective: To assess the all-cause healthcare costs for individuals with newly diagnosed EDS during the pre-diagnosis year and the first 2 years post-diagnosis.

Methods: A retrospective cohort study was conducted using the Merative™ MarketScan® Commercial Claims and Encounters Database (2016-2022). Newly diagnosed patients were identified using ICD-10-CM codes, with the first observed diagnosis defined as the index date. Continuous enrollment for 12 months pre-index and 24 …

Adapting A Smartphone-Based Auricular Point Acupressure Self-Management Program For Rural Chronic Musculoskeletal Pain: Qualitative Study, Jungkyung Min, Peiyin Hung, Jane N Bolin, Rupsikha Bora, Sarah Pace, Patricia Pitones, Hulin Wu, Jennifer Kawi

Faculty, Staff and Student Publications

Background: Chronic musculoskeletal pain is more prevalent in rural areas where access to pain interventions, including complementary approaches like Auricular Point Acupressure (APA), remains limited. APA is a non-invasive, needle-free approach, and its smartphone-based self-management delivery model has not been optimized for rural contexts.

Objectives: To explore the perspectives of rural partners on adapting a smartphone-based Auricular Point Acupressure-Self-Management (APA-SM) program to better meet rural needs. Study objectives were to: (1) refine the APA-SM program for rural adults, (2) identify implementation barriers, (3) understand practice workflows and engagement, and (4) identify strategies to integrate the APA-SM program into rural pain …

Food Delivery Services For Enhancing Participation In The Special Supplemental Nutrition Program For Women, Infants, And Children (Wic) In The United States: Bridging The Wic-Eligible Access Gap, Jingjing Gao, Muinat Abolore Idris, Lilian O Ademu, Bryan Colby Griffin, Yue Zhang, Yun Hang, Gabriela A Gallegos

Faculty, Staff and Student Publications

Background: Diet-related health disparities among U.S. children persist despite the availability of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits to eligible women, infants, and children. Participation remains suboptimal: only 51.2% of eligible individuals were enrolled in 2021. Transportation and food-environment constraints pose salient barriers, especially for caregivers of infants in food deserts. Emerging online ordering and delivery options may reduce access frictions, but grocery delivery coverage is limited, and fees are often not covered by benefits.

Methods: We linked USDA Food and Nutrition Service state-level WIC participation data (November 2024 vs. September 2025) with demographic, …

Building The Infection Prevention Workforce: Development, Implementation And Evaluation Of Texas Epidemic Public Health Institute Infection Prevention And Control 300 Series, Kayla E Ruch, Janelle Rios

Faculty, Staff and Student Publications

Background: The Texas Epidemic Public Health Institute (TEPHI) was established to strengthen infectious disease preparedness across Texas. The Infection Prevention and Control (IPC) 300 Series represents the third year of a multi-tiered educational initiative designed to provide free, accessible, evidence-based IPC training and continuing education credits for the healthcare workforce.

Methods: Registration and attendance data were collected through Zoom™ and Microsoft Teams™. Knowledge assessments, post-module surveys, and mid- and end-of-series evaluations were administered through QuestionPro™. Module content was informed by guidance from APIC, CDC, CMS, and OSHA. Descriptive statistics and the Kirkpatrick Model of Training Evaluation were used to assess …

Feasibility And Preliminary Outcomes Of A Remotely-Delivered Exercise Training Intervention For English-Speaking Hispanics/Latinos With Multiple Sclerosis: Results From The Ferla Ms Study, Victoria A Flores, Stephanie L Silveira, David X Marquez, Dominique Kinnett-Hopkins, Augusto Miravalle, Fabian Sierra-Morales, Robert W Motl

Faculty, Staff and Student Publications

Background: There is limited evidence on the feasibility of remotely delivered exercise interventions for English-speaking Hispanics/Latinos with MS.

Objectives: To evaluate the feasibility and exploratory efficacy of a remotely-delivered, home-based exercise program for English-speaking Hispanics/Latinos with MS and to explore associations among feasibility metrics, outcomes, and social determinants of health (SDOH).

Results: Of 340 individuals contacted, 112 were eligible (33%), 33 enrolled (9.7%), 30 randomized, and 26 completed (87% retention). Adherence averaged 81% (exercise) and 89% (control). No serious adverse events occurred. Exploratory within-group improvements were observed in the exercise group for physical activity (p = 0.03, d = …

Occupational Exposure To Pesticides Increases The Risk Of Amyotrophyc Lateral Sclerosis: A Systematic Review And Meta-Analysis, France Labrèche, Pamela Prudhomme, Maryse Gagnon, Nicolas Dupré, Sabrina Gravel

Études primaires

Objective To systematically review the evidence on the association between occupational exposure to pesticides and the risk of amyotrophic lateral sclerosis (ALS).

Methods A systematic search, conducted in eight bibliographic databases for publications between 1990 and 2025, identified observational studies estimating the risk of ALS after occupational pesticide exposure. Study quality was assessed using the WHO Risk of Bias (RoB) assessment instrument for systematic reviews, with the ROBINS-E (RoB in non-randomised studies of exposure) tool domains of bias. Pooled risk estimates were produced using random-effects models with restricted maximum likelihood, heterogeneity was assessed with I² statistics, and meta-regressions and publication …

Reflecting On Themes From Telehealth Consultations Early In The Pandemic: An Opportunity To Learn From Multiprofessional Colleagues, Maggie Meeks, Laura R. Joyce, John Dean, Lorna Davies, Tika Ormond, Philippa Seaton, Dale Sheehan, Dean Sutherland, Melanie Welfare, Arindam Basu

Research outputs 2022 to 2026

Aims: This study is aimed at documenting the reflections of New Zealand healthcare professionals on the use of synchronous telehealth consultations. Methods: A qualitative narrative inquiry was conducted to explore the practice of telehealth in New Zealand. Purposive sampling was used to identify clinicians from multiple professions who used telehealth during the initial phase of the COVID-19 pandemic. Fifteen semistructured interviews were conducted between October 2020 and May 2021 with clinicians from primary and secondary care, including multiple professional backgrounds. Interview transcripts were analysed thematically. Results: Six themes were identified: (1) equitable access: There were concerns regarding equitable access to …

Understanding The Syphilis Resurgence Among Females Of Childbearing Age: Informing Prevention Efforts In New York State, Salvatore Currenti

Electronic Theses & Dissertations (2024 - present)

Syphilis is caused by Treponema pallidum and transmitted through direct contact with infected mucosal lesions and via vertical transmission during pregnancy (i.e., congenital). Transmission of syphilis to an infant during pregnancy (i.e., congenital syphilis [CS]) can lead to early fetal death, stillbirth, neonatal death, preterm birth, low birthweight, and congenital infection in infants. The United States (U.S.) is experiencing epidemic increases in both females of reproductive age with syphilis and infants with CS. In New York State (NYS), these trends have also occurred, especially after COVID-19 emergence, and increases in reported cases and incidence rates are comparable to national statistics. …

Spatial Analyses Using Emergency Medical Services Data To Inform Healthcare., Jeffrey Alan Pesarsick

Graduate Theses, Dissertations, and Problem Reports (ETD)

Spatial analyses using Emergency Medical Services data to inform healthcare.

Jeffrey Pesarsick

Background

Emergency Medical Services (EMS) often serve as the initial entry point for patients into the healthcare system in the United States.  Rural health disparities, geographic isolation, socioeconomic disadvantages, and operational challenges create disparities in access to EMS services.  Disparities include prolonged response times, less resources available, and inequities in levels of care available.  The overall goal of these series of projects was to quantify the extent to which operational challenges in EMS data impact health, and how EMS data could be used to identify neighborhood level trends …

Maternal Healthcare In The United States: An Exploration Of The Organizational And Political Determinants Of Maternal Healthcare Quality And Outcomes, Tamaya S. Browder

College of Graduate Studies: Theses & Dissertations

Despite having an advanced U.S. healthcare system, childbirth remains risky in the US, especially for socially vulnerable populations. Medicaid covers a large portion of births and is equipped to implement large-scale interventions to improve maternity care and patient outcomes. Two studies were conducted to (a) examine the relationship between organizational factors in U.S. hospitals and adverse clinical outcomes among Medicaid-insured maternity patients, and (b) analyze state-level Medicaid bundled payment models for maternity care. Guided by the Donabedian Quality of Care Model, Study One used logistic regression on data from the 2018-2020 National Inpatient Sample to explore how hospital organizational factors …

Body Image Perception In African American Women, Ages 20-55 Years, Trina Suttles

College of Graduate Studies: Theses & Dissertations

This qualitative study explored the factors that influence body image perception among African American women in the metropolitan Atlanta, Georgia area and examined how these perceptions shape physical activity and dietary behaviors. Body image perception is a critical psychocultural factor influencing obesity-related behaviors, particularly among African American women who navigate culturally specific beauty standards and health beliefs. Guided by the Socioecological Model, this study addressed three research questions: (1) how African American women perceive their body image, (2) how these perceptions influence health behaviors, and (3) what multilevel factors shape body image perceptions. This study employed consensual qualitative research (CQR) …

Sociodemographic Differences In Sepsis-Related Medicare Hospitalizations: A State-Level Analysis Of Diagnosis-Related Groups For Severe Sepsis In 2019 And 2022, Alba Kuqi

College of Graduate Studies: Theses & Dissertations

Introduction: This state-level ecological repeated cross-sectional study examined sociodemographic differences in sepsis-related Medicare hospitalizations assigned to Medicare Severity Diagnosis-Related Groups (MS-DRGs) 871 and 872 in 2019 and 2022.

Objective: The study focused on three outcomes: changes in sepsis-related Medicare discharge volume, changes in average Medicare payment per sepsis discharge, and changes in the proportion of MS-DRG 871 discharges relative to MS-DRG 872 discharges.

Methods: Publicly available Medicare inpatient hospital data and state-level demographic data were used to evaluate whether age, race, gender composition, and median household income were associated with these changes across the 50 U.S. states and …

The Association Between Maternal-Fetal Medicine Physician Density And Pregnancy Outcomes, Tetsuya Kawakita, Rula Atwani, Misa Hayasaka, Lindsay Robbins, George Saade

Department of Obstetrics & Gynecology Faculty Publications

Objective

We sought to examine the association between maternal-fetal medicine (MFM) physician density and adverse pregnancy outcomes at the state level.

Study Design

This was a cross-sectional analysis of publicly available, state-level data from 2018 to 2021, including Natality, Multiple Cause-of-Death, and Fetal Death databases. The number of active MFM physicians per year was obtained for each state from the American Medical Association Masterfile. The primary exposure was the density of MFM per state, categorized into three groups: (1) low density (< 30 MFM physicians per 100,000 live births), (2) moderate density (30-59 MFM physicians per 100,000 live births), and (3) high density (≥60 MFM physicians per 100,000 live births). Our primary outcome was maternal mortality during pregnancy and up to 42 days postdelivery. Our secondary outcomes were pregnancy-related mortality up to 365 days postdelivery and stillbirth. We calculated adjusted incident rate ratios (aIRR) and average marginal effect (AME) with 95% confidence intervals (95% CI) using multivariable negative binomial mixed effects regression models.

Results

Overall, there were 14,792,743 live births, 3,440 maternal mortalities, 4,980 pregnancy-related mortalities, and 90,848 stillbirths included. The …

Seasonal And Geographic Patterns Of Gastroschisis In Canada: Protective Effect Of Periconceptional Sunlight Exposure, Shiliang Liu, Shin Jie Yong, Dunjin Chen, Gavin C. Hughes, Claude L. Hughes

Department of Medicine Faculty Publications

Background: Gastroschisis is a right-sided, full-thickness defect with extra-amnionic herniation of abdominal contents directly into the amniotic cavity. The causes of gastroschisis remain obscure. We hypothesized that limited periconceptional sunlight exposure might lead to insufficient vitamin D during fetal development and play a role in gastroschisis etiology.

Methods: We conducted a population-based cohort study of infants conceived in Canada between April 2006 and March 2020. We used winter months (i.e., November and December) and northern geographic latitudes as indicators of insufficient sunlight exposure, while summer months (July and August) and southern geographic latitudes were considered as reference. We examined the …