Digital Commons Network^™

Understanding Factors Influencing Multiple Tobacco Product Use Among Adolescents In Thailand: A Structural Equation Modeling Approach, Chaowalit Srisoem

Graduate Doctoral Dissertations

Tobacco use among Thai adolescents is shaped by personal, environmental, and product-related factors. However, the pathways linking these influences to actual behavior remain unclear. This study examined how personal, environmental, and product-related factors, along with intentions to use, relate to tobacco use among Thai adolescents. A cross-sectional secondary analysis was conducted using data from the 2022 Thailand Global Youth Tobacco Survey of 6,235 students aged 13–15 years. Survey weights methods were applied to produce nationally representative estimates. Confirmatory factor analysis and structural equation modeling assessed latent constructs, and multinomial logistic regression examined predictors of single, dual, and multiple product use. …

Early Immune Dysregulation In Mtb/Siv Co-Infection Resists Cart Treatment At The Single-Cell Level, Riti Sharan, Yi Zou, Zhao Lai, Korri Weldon, Todd Bradley, Xi Luo, Hulin Wu, Shabaana A Khader, Deepak Kaushal

Faculty, Staff and Student Publications

Using single-cell transcriptomics of bronchoalveolar lavage cells from Mtb/SIV co-infected rhesus macaques on cART, we reveal profound immune dysregulation during early SIV co-infection of latent tuberculosis. SIV induces a sharp decline in CD4+ T cells, NK, and NKT cells, with incomplete recovery of Mtb-specific TH1 effector responses despite viral suppression. Instead, a persistent TH17-skewed environment emerges, alongside sustained myeloid inflammation driven by Type I interferon signaling and pro-inflammatory regulators such as KLF6 and NFKB1. Ligand-receptor network analyses demonstrate expanded CD4+ T cell-macrophage crosstalk and loss of immune homeostasis that cART fails to fully restore. These findings expose …

Navigating The Maternal Health Crisis: Enhancing Maternal Health Outcomes In New Jersey, Nyrobi Barnes

Doctoral Dissertations and Projects

The purpose of the study was to better understand the implications of race and ethnicity on perinatal health experiences and maternal health outcomes in non-Hispanic Black women (nHBw) in New Jersey and mitigate the maternal health crisis. A secondary outcome was to propose an evidence-based initiative to elicit equitable care in New Jersey via grant-funded programs at the New Jersey Department of Health. Although New Jersey has made progress in improving maternal and infant health outcomes, racial disparities continue to persist. The research aims to further understand implications of race and ethnicity on adverse perinatal health experiences and maternal health …

Post-Pandemic Telebehavioral Health: Sustaining And Regulating Remote Mental Health Care As A Core Modality, Weiqiao Dong

Dartmouth College Master’s Theses

The United States continues to face a persistent mental health crisis after the COVID-19 pandemic, raising a policy question about the long-term role and regulation of telebehavioral health as a core modality of care. This thesis examines that question through a case study of New York State, an early center of the pandemic and a leader in telehealth policy reform.

Guided by the Health Policy Triangle framework, this thesis integrates longitudinal data from all 62 New York counties for 2010-2025 with a 2025 cross-sectional dataset covering 61 counties. Seventeen standardized indicators are organized into four dimensions: geographic, economic, demographic, and …

Can The Safety Net Support Families Through Childbirth?, Hyojeong Kim, Colleen Heflin, Taryn Morrissey

Center for Policy Research

Childbirth is a life event that often disrupts maternal employment and household earnings just as family expenses increase. In the United States, families do not have access to a national paid parental leave program and must rely on a patchwork of safety net programs that were not designed specifically to support households during pregnancy and the immediate postpartum period. This brief uses linked administrative data from the Virginia Longitudinal Data System (2016–2021) to describe changes in household earnings and social welfare benefits before and after childbirth among low-income mothers receiving the Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for …

Osteoporosis Knowledge, Health Beliefs, And Calcium Intake Among Malaysian Chinese Adults In Perak: A Cross-Sectional Study, Thean Hui Ru, Nurul Aimi Ab Kadir, Fatin Izzaty Mohd Shahrin

Makara Journal of Health Research

Background: The Malaysian Chinese population records the highest national prevalence of osteoporotic hip fractures. This study investigated the relationships between osteoporosis knowledge, health beliefs, and calcium intake among Malaysian Chinese adults.

Methods: A cross-sectional study was conducted among 205 Malaysian Chinese adults in Kampar, Perak, using the adapted Osteoporosis Prevention and Awareness Tool (OPAAT), Osteoporosis Health Belief Scale (OHBS), and a 30-item Food Frequency Questionnaire (FFQ).

Results: Participants demonstrated low osteoporosis knowledge (6.84 ± 2.92), with low perceived susceptibility (14.87 ± 5.00), moderate perceived seriousness (17.81 ± 5.20), and barriers to calcium intake (15.61 ± 4.15), and …

Assessing Healthcare Access Among Overweight And Obese Individuals In Türkiye Using Latent Variable Modeling, Banu Beyaz Sipahi

Makara Journal of Health Research

Background: Overweight and obesity are critical determinants of healthcare access, yet evidence on how the COVID-19 pandemic reshaped these dynamics in Türkiye remains limited. This study investigates whether the early post-pandemic recovery period altered healthcare access patterns for individuals with excess weight.

Methods: Using nationally representative microdata from the 2014, 2016, 2019, and 2022 Turkish Health Surveys, we constructed a latent Healthcare Access Index based on six indicators of unmet care needs. Probit models were estimated to assess associations between BMI categories and healthcare access, controlling for socioeconomic and demographic factors. The 2022 wave serves as the early …

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

Theses & Dissertations

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

Fall Risk In Community-Dwelling Adults: A Comparison Of English And Spanish-Speaking Individuals, Jesus D. Gomez

Dissertations, 2020-current

Falls are a leading cause of injury-related mortality among middle-aged and older adults. Although vestibular dysfunction, hearing loss, behavioral factors, and social determinants of health have been associated with increased fall risk, few studies have examined these relationships. Furthermore, limited research in audiology and vestibular science has investigated fall-risk vulnerability among Spanish-speaking individuals.

This study aimed to: (1) estimate the prevalence of fall risk among community-dwelling adults and compare prevalence between English-speaking and Spanish-speaking participants; (2) assess the prevalence of previously undiagnosed benign paroxysmal positional vertigo (BPPV) and compare prevalence between language groups; and (3) develop predictive models of fall …

Cultural Tailoring Of Digital Nutrition Interventions: A Scoping Review Of Adaptation Strategies, Evaluation Methods, And Evidence Gaps, Wendy Liang

Master's Projects and Capstones

Background: Nutrition-related chronic diseases disproportionately affect culturally diverse populations, highlighting the need for effective and equitable interventions. Digital nutrition interventions have expanded rapidly due to their accessibility; however, the extent to which they incorporate and evaluate cultural tailoring remains unclear.

Research aim: This scoping review maps the existing evidence on culturally tailored digital nutrition interventions, describes cultural adaptation strategies used, examines methods used to evaluate cultural appropriateness, and identifies gaps for future research and public health practice.

Methods: A scoping review was conducted following the PRISMA-ScR guidelines.

Findings: Culturally tailored digital nutrition interventions generally improved participant engagement, acceptability, and dietary …

Standardizing Gestational Diabetes Mellitus Education To Improve Patient Knowledge And Care Consistency In A Prenatal Clinic Setting, Wynn Zara

Master's Projects and Capstones

The gestational diabetes mellitus (GDM) group visit framework aims to improve consistency of GDM education by standardizing referral processes, educational materials, staff workflows, and patient communication. Although evidence-based GDM education supports patient self-management and improved maternal-fetal outcomes, variability in education delivery contributed to inconsistent care within the outpatient maternal-fetal medicine setting. This quality improvement project was conducted in an outpatient maternal-fetal medicine clinic in Santa Clara County serving pregnant patients diagnosed with GDM. To address this gap, a standardized GDM group visit framework was developed and implemented using structured educational resources, referral criteria, and communication workflows. The intervention was evaluated …

What Do Children Think About Bouncy Bands: A Mixed Methods Examination Of Bouncy Bands' Influence On Attention And Physical Activity, Ken Murfay, Sarah Collins

International Journal of Physical Activity and Health

Purpose: To examine how bouncy bands put onto elementary students’ classroom desks influenced students’ physical activity and attention/concentration, in addition to exploring students’/teachers’ opinions of the bands. Methods: Students within both experimental and control groups wore pedometers to assess movement during instruction and completed the d2 test for attention. Results: The group with bouncy bands on the desks had significantly more movement compared to the control group. For d2 scores, there was no significant difference between the two groups, nor was there a significant linear relationship between movement and d2 scores. Interviews were conducted with the students in the experimental …

Improving Diabetes Self-Management Through A Partnership Between Clinical Providers And Community Educators In Appalachian Communities, Soghra Jarvandi, Lydia Hoskins, Karen Carver, Andrew May

Journal of Appalachian Health

Introduction: The burden of diabetes is an increasing public health challenge, especially in the Appalachian Region.

Purpose: This study assessed the impact of a community-based diabetes education program on glycemic control.

Methods: Health Extension for Diabetes (HED) is a 4-month diabetes education program offered by Extension educators in collaboration with clinical providers. Participants’ data were collected via phone interviews at baseline and after completing the program. Assessments included self-reported HbA1c, socio-demographics, diabetes knowledge, self-efficacy, and self-management behaviors. Data were analyzed by SAS software using paired analyses.

Results: Of the 105 participants in the program, 87 (83%) completed the post-assessment. Among …

Understanding Brain Fog During Menopause, Cris Meier, Moth Huenemann, Ashley Yaugher, Cara Murray

All Current Publications

Brain fog is an inability to concentrate or think clearly and is a common symptom of perimenopause and early in the menopause phase. While not everyone who goes through menopause will have brain fog, it is a common symptom, and it can be helpful to understand why brain fog occurs. This fact sheet provides helpful information to understand brain fog and ideas you can use to manage it.

Hubungan Paparan Informasi Anemia Dan Tablet Tambah Darah (Ttd) Melalui Media Digital Dengan Kebiasaan Konsumsi Makanan Ibu Hamil Berdasarkan Food Frequency Questionnaire (Ffq), Muthiah Salsabilah, Bernadette Oktavia Jelita, Thariq Zafar Surapati, Alya Khairunnissa, Primasti Nuryandari Putri, Ratu Ayu Dewi Sartika

Perilaku dan Promosi Kesehatan : Indonesian Journal of Health Promotion and Behavior

Background: Proper nutrition is important for the mother and baby. The media is an important source of information for every pregnant woman, but the information might be inaccurate.

Aim: This study aims to examine the association between exposure to digital media information on anemia and iron-folic acid (IFA) supplementation and the food consumption habits of pregnant women as measured by the Food Frequency Questionnaire (FFQ) at Puskesmas Kecamatan Beji, Depok City in 2024.

Method: This study utilized a cross-sectional design involving secondary data analysis of the 2024 antenatal care (ANC) survey conducted at Beji Primary Health Center, Depok City. Purposive …

Centering Community Voices To Address Healthcare Inequities In Underserved Utah Populations, Karishma Shah, Jazmine Abril, May Shaaban, Silvia Soule, Sonia Sehgal, Rawad Farhat, Jeannette Villalta, Oreta Tupola, Valentine Mukundente, Cathy Wolfsfeld, Ivana Holiday, Walter Watchman, Carrie Olvera, Lauren Gleave, Kamaile Tripp, Alexander Sperber, Rita Osborn

Patient Experience Journal

Persistent disparities in health outcomes across the United States are often driven by systemic inequities and social determinants of health. In Utah, these inequities are particularly pronounced among racially, ethnically, and geographically underserved populations. Community healthcare workers (CHWs) who share lived experiences with these communities are uniquely positioned to bridge the gap between patients and a fragmented healthcare system. This study aimed to explore how underserved communities in Utah perceive and interact with the healthcare system, centering their lived experiences to inform more equitable care models. We conducted eight focus groups with 73 participants from six medically underserved communities: African …

Staphylococcus Aureus Urease Is Controlled By A Complex Regulatory Network To Promote Dissemination During Cauti, Jana Gomez, Jesus Duran-Ramirez, Maristhela Alvarez, Shane Cristy, Jennifer N Walker

Faculty, Staff and Student Publications

Catheter-associated urinary tract infections (CAUTIs) are one of the most common hospital-associated infections in the United States, accounting for >1 million cases annually. One CAUTI pathogen, Staphylococcus aureus, is commonly found persisting asymptomatically in the bladder of catheterized individuals, increasing these individuals' risk of developing infection. Importantly, S. aureus is not only associated with severe symptoms during CAUTI, including bacteremia and septic shock, but it also produces a common uropathogen-associated virulence factor, urease. Despite its importance, urease has only been well-studied in another uropathogen, Proteus mirabilis. While previous studies identified three S. aureus urease regulators, including CodY, …

Addressing Obesity In Rural Health Clinics, Morgan P. Trusley

Student Scholarly Projects

Practice Problem: According to the Centers for Disease Control and Prevention (CDC), more than 2 in 5 adults in the United States are obese (CDC, 2024a). In a rural primary care clinic in South Carolina, approximately 70% of patients are obese and there is no current intervention in place to help educate and guide these patients in weight loss strategies.

PICOT: In obese adults over the age of 18 at a rural health clinic with a Body Mass Index (BMI) greater than or equal to 30, does implementing weekly virtual and in person multicomponent behavioral intervention educational sessions compared to …

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

Faculty, Staff and Student Publications

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

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

Rural & Underserved Health Research Center Publications

Key Report Highlights

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

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

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

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

Baseline Nutrition Knowledge And Feasibility Of A Whatsapp-Delivered Nutrition Education Intervention Among California Wildland-Urban Interface Firefighters, Lauren E. Anderson

Master's Theses

Wildland firefighters perform physically demanding work under challenging environmental conditions that place substantial demands on nutritional health and occupational performance. Despite the importance of nutrition in supporting physical performance, recovery, and long-term health, limited research has examined nutrition knowledge and dietary behaviors among California wildland firefighters or evaluated the feasibility of remotely delivered nutrition education interventions within this occupational population. Therefore, the purpose of this pilot study was to assess baseline nutrition knowledge, nutrition self-efficacy, and dietary behaviors while evaluating the feasibility of a 12-week WhatsApp-delivered nutrition education intervention among California wildland firefighters.

Twenty-four firefighters completed the baseline assessment and …

Addressing Food Pantry Capacity To Offer Medically Tailored Groceries For Food Insecure Individuals With Chronic Disease In Rural South Carolina, Anna G. Taylor

All Theses

This study examines the feasibility of implementing medically tailored grocery (MTG) programs within rural food pantries in South Carolina to better serve food-insecure individuals living with chronic diseases. Using a mixed-methods design, the study aimed to assess current pantry capacity, identify barriers and facilitators to MTG implementation, and evaluate strategies to strengthen MTG delivery.

The intervention was guided by three implementation science frameworks: the Six-Step Knowledge Sharing Model, the Consolidated Framework for Implementation Research (CFIR), and the RE-AIM evaluation framework. Data collection occurred in two phases. In Phase 1, statewide focus groups, capacity surveys, and inventory assessments were conducted to …

Prevalence Of Type 2 Diabetes Risk Factors Among Landscaping Workers In El Paso, Texas, Valeria Fontes

Open Access Theses & Dissertations

Type 2 diabetes mellitus (T2DM) is a significant public health challenge worldwide, yet little is known about the prevalence of diabetes risk factors among landscaping workers, an understudied occupational group. The purpose of this pilot study was to estimate the prevalence of type 2 diabetes risk factors among landscaping workers in El Paso, Texas. A descriptive cross-sectional study was conducted using a convenience sample of 20 landscaping workers. Participants completed a structured questionnaire and underwent anthropometric measurements, blood pressure assessment, point-of-care lipid and glucose testing, and vitamin D screening. Sixteen type 2 diabetes risk factors were assessed across seven domains: …

Behavioral And Dietary Associations Of Vitamin D Deficiency Among Landscaping Workers: An Analytical Cross-Sectional Study In El Paso, Texas., Cristela Anahi Avila

Open Access Theses & Dissertations

Background: Vitamin D deficiency is a persistent public health concern, even among outdoor workers who receive substantial sunlight exposure. Landscaping workers may still be at risk because sun-protective clothing, early work hours, behavioral practices, and low dietary intake can reduce effective vitamin D synthesis. Purpose: This pilot study examined dietary vitamin D intake, sun exposure behaviors, and serum 25-hydroxyvitamin D status among male landscaping workers in El Paso, Texas, to identify behavioral and nutritional factors associated with deficiency. Methods: Twenty participants completed a culturally adapted food frequency questionnaire and behavioral assessment and underwent capillary point-of-care testing for serum 25(OH)D. Descriptive …

Post-Vaccination Confidence In Covid-19 Vaccines And Associated Determinants In Post-War Context Of Tigray, Northern Ethiopia: A Mixed-Methods Study, Genanew Kassie Getahun, Yohannes Addisu Wondimagegne, Alemayehu Deressa, Barkot Tamiru, Trhas Tadesse Berhe, Moges Mekonnen, Tsegay Hadgu, Znabu Hadush Kahsay, Mussie Alemayehu, Gebrehaweria Gebrekurstos, Joy Kenyi, Eshetu Girma, Finina Abebe Ware, Nardos Gelana, Menen Tsegaw, Eyob Ketema Bogale, Asaye Alamneh Gebeyehu

Research outputs 2022 to 2026

Introduction It is widely recognized that access to and utilization of health services are negatively impacted by war. These effects worsen particularly when combined with pandemics such as COVID-19. Therefore, this study aimed to assess adults' COVID-19 post-vaccination confidence in the conflict-affected region of Tigray, Northern Ethiopia. Methods The study employed a concurrent parallel mixed-methods design, combining a quantitative survey of 1599 adults and six key informant interviews and six focus group discussions. Survey participants were selected using a multistage cluster sampling technique, while qualitative participants were purposively sampled. Quantitative data were collected using a pre-tested, structured questionnaire administered via …

Hope Kit Program, Monica Reuber

Capstone Experience: Master of Public Health

Suicide is a leading cause of death in adolescents and young adults, with a disproportionate burden of those deaths in rural areas such as Kansas. High rates of depressive symptoms, suicidal thoughts, and suicidal attempts, combined with a shortage of mental health providers, emphasize the need for community-based intervention.

This capstone is designed to develop a plan for Hope Kits, a proposed suicide prevention program, among youth in grades 7-12 in Sheridan County, Kansas to improve coping skills, promote help-seeking behavior, and reduce suicide risks.

A logic model guides the program development, which aligns with available literature and Social Cognitive …

Full Issue: The International Undergraduate Journal Of Health Sciences, Volume 6, Issue 1, July 2026

International Undergraduate Journal of Health Sciences

Full Issue: The International Undergraduate Journal of Health Sciences, Volume 6, Issue 1, July 2026.

Examining Variations In Non-Conventional Health Care Utilization Among Students At A Hispanic-Serving Institution, Monideepa B. Becerra, Karina E. Corral

Journal of Social, Behavioral, and Health Sciences

The use of non-conventional health care, such as complementary and alternative medicine (CAM) and traditional healing practices, is increasing in the United States. Little is known, however, about its prevalence and influencing factors among college students—especially of varied racial/ethnic background. This study examined these patterns among college students using a cross-sectional survey conducted at a Hispanic-serving institution. Participants reported their use of non-conventional care, and demographic and motivational factors were analyzed using descriptive and bivariate analyses. Of the 641 participants, a majority reported CAM use (96%) and visits to a traditional healer (83%), with higher prevalence among Hispanic and female …

Medical Recommendations And Bmi Among Black And Hispanic Adolescent Females, Dorothea Polk

Walden Dissertations and Doctoral Studies

Adolescent obesity persists as a critical public health challenge in the United States, with Black and Hispanic adolescent females experiencing elevated rates. Adolescent obesity contributes to serious long-term health risks, but provider counseling may support body mass index (BMI) management. Guided by the social-ecological model, this study examined whether receiving medical recommendations to control or lose weight was associated with BMI among Black and Hispanic adolescent females aged 16–19 years and whether meal preparation habits and food security status moderated this association, controlling for age, household income, and race/ethnicity. This quantitative, cross-sectional secondary analysis used multiple linear regression analyses to …

Exercise Self-Efficacy And Physical Wellness In A Worksite Wellness Program: Exploring Factor Structure And Perceptions, Micah B. Mcglathery

Dissertations

Exploring Perceptions of Exercise Self-Efficacy and Physical Wellness in a Worksite Wellness Program

Abstract

Worksite wellness programs are increasingly adopted to address insufficient exercise participation and other health-related behaviors that put employees at risk of chronic disease. Although quantitative outcomes are well-documented, there is limited research exploring how employees perceive these programs' impact on personal behavior change, particularly in relation to exercise self-efficacy. Guided by the Social Cognitive Theory and the Exercise is Medicine initiative, this study qualitatively investigates employee perceptions of a worksite wellness program’s influence on physical wellness and confidence to exercise. A phenomenological approach using semi-structured interviews …