Digital Commons Network^™

Universal School Meal Policies And Perceived Stigma: Quantitative Evidence From Eight Us States, Dania Orta-Aleman, Monica D. Zuercher, Leah Chapman, Marlene B. Schwartz, Caitlin D. French, Anisha I. Patel, Lorrene D. Ritchie, Juliana Cohen, Wendi Gosliner

Health Sciences Faculty Publications

Background

Universal school meals (USMs) policies, which provide free meals to all students regardless of income, have the potential to improve child nutrition and reduce stigma. Quantitative evidence on the association between USM and stigma is limited.

Methods

Leveraging a natural policy variation in state‐level USM implementation, we surveyed 1066 middle and high school students from eight US states (four with USM, four without) during the 2022–2023 school year. Stigma was measured as self‐reported embarrassment about eating school lunch. We used generalized estimating equations to examine the associations between USM, embarrassment, and lunch participation.

Results

Overall about one in nine …

The Effect Of Community-Based Exercise For Individuals With Pre-Existing Health Conditions, Amy M. Stahl

Doctoral Dissertations and Projects

Physical inactivity is a growing problem for the health and wellbeing of the world’s population. Increases in physical activity may help to improve health outcomes for the general population of the United States. This study is two-fold and seeks to determine if community-based exercise groups are successful in improving the health of people with preexisting conditions and encouraging community members to adhere to an exercise program. A quasi-experimental 12-week comparison study consists of a control group of standard care and an intervention group that participates in a three-day a week community walking group. The purpose of the group is to …

Healthcare Disparities Related To Income In South Carolina, Rebekka Byrd

Doctoral Dissertations and Projects

Low-income individuals and families in South Carolina face significant barriers to accessing healthcare, despite the presence of public health programs like Medicaid. Many fall into the healthcare coverage gap, earning too much to qualify for Medicaid but too little to afford private insurance. This study explored the consequences of the healthcare coverage gap by examining the relationships between income, healthcare access, and the ability to afford healthcare services among 500 adults aged 19–64 who participated in the National Health Interview Survey between 2018 and 2023. Utilizing a retrospective quantitative analysis of secondary data from the National Health Interview Survey (NHIS) …

The Impact Of Education And Awareness In Influencing Lifestyle Behaviors That Prevent And Treat Sarcopenia In Older Adults: A Mixed-Methods Cross-Sectional Research Study, Alan Lynn Jones

Doctoral Dissertations and Projects

This mixed-methods, cross-sectional study assessed the current level of knowledge and awareness among people aged 50 and older about sarcopenia, as well as their willingness to adopt lifestyle changes that could prevent or reverse the condition as they age. The study aimed to determine whether a lack of awareness and knowledge is linked to current lifestyle behaviors that contribute to or protect against the development of the disease. The population included men and women 50 and older, living independently in the community with no prior diagnosis of sarcopenia. The study used a custom-designed questionnaire and semi-structured interviews. A total of …

Medicaid Funding And Health-Related Social Needs: A Policy Analysis, Passion Ilea

Dissertations and Theses

The U.S. has disproportionately high health care spending compared to other high-income nations and comparatively poor health outcomes. The Centers for Medicare and Medicaid Services (CMS) have recently increased emphasis on addressing Medicaid member social needs. CMS believes addressing health-related social needs (HRSN) may reduce costs and improve health outcomes for Medicaid members. CMS has begun to test theories regarding the impact of member HRSN on health care by designing federal mechanisms to address HRSN, such as in lieu of services and settings-funded services, and by encouraging state Medicaid programs to develop their own approaches, such as Flexible Services. Information …

Social And Contextual Factors Influencing Hypertension Among Latino Men Living In California, Leslie Ivett Ortega

Walden Dissertations and Doctoral Studies

Hypertension remains a critical and often silent public health issue that disproportionately affects Latino men in California. This quantitative, retrospective cross-sectional study explored the social and contextual factors influencing hypertension among this vulnerable population. Using the 2019 Behavioral Risk Factor Surveillance System dataset, which included a sample size of 2,060 participants, the study examined the relationship between hypertension and key variables including primary care utilization, health insurance, smoking, physical activity, mental health, and marital status, while controlling for age, education, and income. Guided by the health belief model, binary logistic regression analyses found health insurance and primary care utilization significantly …

Influence And Excess: A Study Of Alcohol’S Governmental, Societal, Biochemical, And Enzymatic Impact In The U.S And Other Countries Around The World, Thomas W. Snider

Senior Honors Theses

The conduct of the thesis is to explore the intricacies of alcohol consumption. The thesis will outline the history of alcohol and the societal pressures and conduct of drinking with relation to the government. After the history of alcohol has been defined, the thesis will move into the chemistry portion, delineating the absorption, digestion, metabolism, and excretion of alcohol. This is the portion of the thesis that will contain the quantitative data and source material as much research has already been conducted regarding these components of alcohol consumption. The condition of the research is that the data will be collected …

Examining The Association Between User Fee Exemptions And Maternal Healthcare Utilization In Northern Ghana, Martina Hilton-Ansah

Walden Dissertations and Doctoral Studies

Abstract In Ghana, the user fee exemption policy, implemented in 2008, provides free maternal health services, which are a key component of the National Health Insurance Scheme (NHIS). Grounded in the Health Access Livelihood Framework, the purpose of this study was to determine the association between the user fee exemption policy and the utilization of antenatal care, facility-based delivery, and postnatal care in Northern Ghana, while controlling for sociodemographic factors. A quantitative approach was employed using secondary data from the Ghana Demographic and Health Surveys, encompassing women of reproductive age (15–49 years; N = 6,948). Logistic regression was used to …

Engaging Ukrainian Tf-Cbt Therapists In A Practice Skills Course To Support Their Wellbeing, Elisabeth Pollio, Esther Deblinger, Beth Cooper, Maike Garbade, Julie P Harrison, Elisa Pfeiffer

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Background: Burnout and secondary traumatic stress (STS) are common among therapists working with trauma-exposed clients, which can negatively impact them professionally and personally. The shared trauma of war exposure may put therapists at greater risk. To help support their wellbeing, an eight-session course was offered to Ukrainian therapists following training in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). This course involves therapists personally utilizing the PRACTICE skills taught to clients in TF-CBT for professional and personal benefit.

Objective: The objective was to gather preliminary evidence on the potential impact of implementing the course with Ukrainian therapists providing TF-CBT during a period of …

Factors Associated With Emergency Hospitalization Of Kidney Disease Patients In A National Hospital Kenya., Dorcus Miyombe

MSc in Advanced Practice Nursing

Introduction: Emergency hospitalizations among End Stage Kidney Disease (ESKD) is a major global health burden, with low- and middle-income countries in sub-Saharan Africa (SSA), experiencing the highest rates of morbidity and mortality. Limited resource, economic burden, and insufficient health infrastructure were the main challenges. Emergency hospitalizations at Kenyatta National Hospital remains high due to systemic gaps and poor continuity of care. Prerenal, intrarenal, post-renal injuries, as well as any combination of these, are the primary causes of ESKD. There are stipulated guidelines for ESKD patients’ management however, realization of these goals has not been achieved leading to hospitalization KDIGO …

Community Health Promoters’ Experiences In Mitigation Of Cardiovascular Diseases In Lari Sub-County - Kiambu County, Kenya, Emily Njeri Muchina

MSc in Advanced Practice Nursing

Background: Cardiovascular diseases (CVDs) are a rising public health issue in low- and middle-income countries, including Kenya, where there is an escalation of their deaths and preventable risk factors. Community health promoters (CHPs) have a crucial role in the prevention of CVDs. Yet, low knowledge of CVD prevention and low detection of CVD risk factors characterise most underserved communities in Kenya. Little has been documented about CHPs' experiences in mitigating CVDs despite the presence of multilevel barriers and facilitators that can shape their experiences.

Aim: To gain an in-depth insight into the experiences of CHPs in mitigating CVD …

Optimal Anthropometric Discharge Criteria From Treatment Of Wasting: Meta-Analysis Of Individual Patient Data From 34 Studies, Lilia Bliznashka, Sandhya Chaudhary, Susan Rattigan, Sheila Isanaka, Ruth Adah, Tahmeed Ahmed, Nur Alam, Rodrigue Alitanou, Paluku Bahwere, Helen Nabwera

Paediatrics and Child Health, East Africa

Background: Community-based treatment of acute malnutrition saves lives, but recovered children remain at risk of relapse post-discharge. Strategies to reduce this risk may include modification of anthropometric discharge criteria.

Objectives: This study aims to compare the diagnostic accuracy of anthropometric indices to reduce post-discharge relapse risk.

Methods: We searched PubMed from inception to June 2022. We included studies that enrolled children aged 0–59 mo successfully treated for severe or moderate acute malnutrition (SAM or MAM), assessed anthropometry at discharge, and had ≥1 follow-up assessment ≤6 mo post-discharge. Pooled sensitivity and specificity for anthropometric indices at discharge over multiple cutoffs were …

Food Access And Food Insecurity Among Early Childhood Educators And Staff Prior To And During The Covid-19 Pandemic: A Mixed Methods Pilot Study, Rahel Mathews, Leah Pylate, Will Davis, Elizabeth Thorne, Jamila Taylor, Shecoya White, Bennett Pope, Emma Bryant

Journal of Human Sciences and Extension

Emerging research indicates that 40% of early childhood education (ECE) workers experience food insecurity. The purpose of this study was to describe the food insecurity and food access of Head Start teachers and staff in Mississippi before the COVID-19 pandemic and to understand how COVID-19 affected food access. A mixed-methods design was employed using cross-sectional surveys, at two different time points, and three focus groups. Three Head Start centers from the Mississippi Coast participated. Approximately 52% of teacher and staff respondents experienced food insecurity before COVID-19; during the pandemic, their level of food insecurity worsened from low to very low …

Referral Strategies For Recruitment And Engagement Of Community Adults Into Online Extension Health Programs, Cheryl L. Eschbach, Dawn A. Contreras, Holly B. Tiret

Journal of Human Sciences and Extension

This article shares details behind building organizational capacity to establish program referrals for statewide recruitment of community adults into Cooperative Extension’s online health programs. This study explores the role of intentional recruitment strategies (active and passive) to increase participant program enrollment into health education and shares examples from one state that has created a trained workforce that offers ongoing research- and evidence-based programs. After many years of trying paper, phone, and electronic medical record methods to increase program reach, Michigan State University Extension tried an electronic referral process via a QR code and web link, accompanied by program marketing, to …

The Role Of Fast-Food Consumption, Residential Fast-Food Exposures, And Urinary Essential Trace Heavy Metals In Colorectal Cancer (Crc) Outcomes., Jeevan Adhikari

Electronic Theses and Dissertations

Background: Colorectal cancer (CRC) is a public health concern. Within the United States (US), fast-food consumption and environmental exposure to heavy metals have increased. The impact of fast-food consumption frequency from fast-food restaurants, residential fast-food exposures, and urinary essential trace heavy metals in relation to CRC outcomes have not yet been rigorously evaluated in the US. Methods: Within the LEAPS-CRC study, we used geographic information systems (GIS) and logistic regression to study the association of fast-food consumption, residential proximity to a fast-food outlet, and urinary essential trace metals with CRC incidence. Additionally, within Kentucky Cancer Registry (KCR) CRC cases, the …

Residential Segregation And Breast Cancer In Louisville: Impact Of Race And Contextual Factors On Advanced-Stage Diagnosis, Delayed Treatment, And Disease-Specific Mortality., Toheeb Ajani Mustapha

Electronic Theses and Dissertations

Female breast cancer (BC) remains the most commonly diagnosed non-skin cancer and the second leading cause of cancer death among U.S. women. Despite advances in detection and treatment, substantial inequities in BC outcomes persist, driven in part by structural forces such as residential segregation. This dissertation examined the relationship between residential segregation, BC outcomes, and key contextual factors in Louisville, Kentucky. Using data from the Kentucky Cancer Registry, American Community Survey, CDC’s Population-Level Analyses and Community Estimates, and the National Neighborhood Data Archive, the study tested two hypotheses: (1) higher Black/low-income segregation is associated with elevated risks of adverse BC …

Diabetes And Hypertension Frequencies And Trends In The Health Districts Of Sololá, Alejandro Cerón, Sophie Perfetto, Ana Textor, Sidona Alemayehu, Emilia Alvear Escobar, Adele Beard, Sarah Berson, Rachel Bryant, Jennifer Calzontzi, Rylee Castro, Eva Cress Palencia, Jake Czarnecki, Jordyn Epstein, Nikki Harris, Patience Hinojos, Max Hippisley, Erin House, Jackson Hullett, Nathan Johnson, Amelie King, Saule Lankelyte, Juan Loya, Ashley Mackenzie, Ilana Mighdoll, Molly Morrill, Maria De Jesus Ramos Jimenez, Lilly Teklemedhin, Joseph Trujillo, Lauren Verachtert, Nathan Verachtert, Violet Vreeland, Alex Welch, Jada Wright

Anthropology: Undergraduate Student Scholarship

This report was prepared by the students, Graduate Teaching Assistants, and instructor of “The Social Determination of Health” class taught in the fall of 2025 at the University of Denver. The report was prepared for Dr. Luis Pablo Méndez, of the Vice Ministry of Health Regulation, Surveillance and Control, of the Ministry of Public Health and Social Assistance of Guatemala. The work used the following guiding question: How can available data about service production can be used to inform the planning process for the implementation of the Global Hearts Initiative’s HEARTS technical package in the Distrito de Redes Integradas de …

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

Honors College Theses

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

Sustaining Community Health Through Impactful Snap-Ed Initiatives In Utah, Lacee Jimenez, Kristi Strongo, Lea Palmer, Lendel K. Narine, Heidi Leblanc

Outcomes and Impact Quarterly

Create Better Health (CBH), Utah’s SNAP-Ed program, addresses food insecurity and chronic disease prevention through nutrition education, policy, systems, and environmental (PSE) initiatives, and social media marketing. From 2024 to 2025, CBH reached over 13,500 Utahns through direct education and 81,000 through community interventions. Evaluation results showed significant improvements in nutrition behaviors, including increased fruit and vegetable intake, food resource management, and label use. Follow-up surveys showed sustained behavior change. CBH’s comprehensive approach demonstrates measurable public health impact and points to the importance of continued investment in nutrition education and food access programs to build healthier, food-secure communities.

Health Workforce Issues And Recommended Practices In The Implementation Of Universal Health Coverage In The Philippines: A Qualitative Study, Veincent Christian Pepito, Arianna Maever Loreche, Ruth Shane Legaspi, Ryan Camado Guinaran, Theo Prudencio Juhani Z. Capeding, Madeline Mae A. Ong, Manuel M. Dayrit

Ateneo School of Medicine and Public Health Publications

Background

The transition towards Universal Health Coverage (UHC) in a devolved healthcare system such as the Philippines is beset by health workforce issues considering that it is among the world’s leading source countries for health workers. This study aims to document health workforce issues and recommended practices in the implementation of UHC in the Philippines.

Methods

We conducted focus group discussions and key informant interviews with health policymakers and UHC implementers in the national, regional, and local levels. Participants included local chief executives, healthcare facility administrators, and healthcare providers at tertiary, secondary, and primary levels, as well as patients. We …

Burden Of Neurodevelopmental Disorders In Kenyan Children, Symon Kariuki, Patricia Kipkemoi, Martha Kombe, Mary Bitta, Jacqueline Phillips Owen, Amina Abubakar, Charles Newton

Institute for Human Development, East Africa

Importance: Neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and intellectual disability contribute to one-tenth of the global burden of mental and neurologic disorders. The burden of NDDs is not well documented in Africa.

Objective:To assess the prevalence, risk factors, and comorbidities of NDDs in young Kenyan children.

Design, setting and participants: This cross-sectional study was conducted among children aged 6 to 9 years residing in the Kilifi Health and Demographic Surveillance System in Kenya. In stage I of the study, children were screened for NDDs from March 16, 2015, to September 14, 2016; those …

Influence Of Rec-Connect On Youth Physical Activity: A Multi-Year Look At Behavior Change, Cailyn A. Van Camp, Bree Bode, Jocelyn Hayward, Lauryn Lin, Nicole Jess, Marci Scott

Michigan Journal of Public Health

Background: Physical activity (PA) engagement in youth is associated with numerous health benefits. However, youth PA behaviors are influenced by a complex set of factors including school and community environments and broader societal influences. Rec-Connect^TM is a community-based intervention that aims to impact PA behavior in youth. Purpose: To assess changes in youth PA behavior across multiple years of Rec-Connect^TM implementation. Methods: SNAP-eligible youth [aged 8 to 17 (n=261, matched)] who participated in Rec-Connect^TM completed a pre and post survey to assess PA knowledge and behavior change. Educators completed implementation fidelity logs. Descriptives were conducted to examine …

Environmental Sanitation In Long-Term Care Facilities: A Focus On Regulations And Implementations, Ruwan Dissanayake Dissanayake Mudiyanselage

All Theses

Environmental sanitation is a fundamental component of infection prevention in long-term care facilities (LTCFs), where residents are at increased risk due to advanced age, underlying health conditions, and communal living arrangements. Despite its critical role, significant gaps remain in implementing environmental sanitation procedures and the regulatory frameworks that guide them.

This study combines two components: (1) an across-state regulatory review of environmental sanitation in LTCF regulations and (2) a cross-sectional survey assessing environmental sanitation characteristics of nursing homes (NHs) and assisted living facilities (ALFs) and Rural and Urban LTCF observation study in South Carolina (SC) . For the regulatory review …

Understanding Hepatitis C Risk And Harm Reduction Needs Among People Who Smoke Drugs: A Client-Centered Qualitative Inquiry, Maxwell Gustin

Anthropology

The spread of Hepatitis C virus (HCV) via non-injectable equipment is plausible, making people who smoke drugs (PWSD) at-risk for possible infection and transmission. While much research has been conducted into injection drug use (IDU), likely due to the rising opioid epidemic, limited studies focus on the risks PWSD face. Currently, state-funded syringe service programs (SSPs) provide harm reduction education and materials to combat these risks. Safer smoking initiatives have been created and are widely used by PWSD, and have access to SSPs. To gain better insight into the HCV and non-HCV-related risks and burdens PWSD face, a qualitative study …

Best Practice Recommendations For Anesthesia Providers In Preventing Postoperative Delirium In The Geriatric Population Undergoing Non-Cardiac Surgery, Ana Primeaux, Ashanti Reed

Doctoral Projects

Postoperative delirium (POD) is a significant and preventable complication in geriatric patients undergoing non-cardiac surgery. Such complication is associated with foreseeable consequences, such as prolonged hospitalization, long-term cognitive decline, increased morbidity and mortality, and increased costs. Despite the emerging awareness of evidence-based nonpharmacologic and pharmacologic interventional strategies, POD still represents a clinical challenge for anesthesia providers.

Currently, there is a lack of clinical guidelines to guide formalized education and evidence-based interventions on POD prevention across anesthesia practice settings. Consequently, there is a critical need to raise awareness that the lack of clinical guidelines and the high incidence of POD may …

Drought, Worry, And Preparing For The Future: The Ethnopsychology Of Climate Distress In Kilifi County, Kenya, Edna Bosire, Syed Wahid, Linda Khakali, Benjamin Oestericher, Felix Agoi, Anthony Ngugi, Rosebella Iseme, Jasmit Shah, Zul Merali, Lukoye Atwoli

Brain and Mind Institute

The impacts of climate change in sub-Saharan Africa (SSA) presents a chronic and intensifying disaster, with drought, flooding, and extreme heat, presenting unique challenges and profound disruptions. Growing evidence links such events to ecological grief, ecological anxiety, and solastalgia – negative affective states that reflects responses to climate change related destruction of nature, species, culturally significant or sacred spaces, and other ways of life. While this literature is expanding in the Global North, little is known about how communities in SSA perceive and respond to deteriorating or depleting natural ecosystems. This article explores the ethnopsychology of distress precipitated by environmental …

Title Page Only: Nuts, Seeds, And Specific Cardiometabolic Diseases: The Adventist Health Study 2, Montry Se-Lin Suprono

Loma Linda University Electronic Theses, Dissertations & Projects

No abstract provided.

The Importance Of Aged Care Policies In Assisting Older Adults Transition From Home To Permanent Residential Aged Care: A Focused Ethnographic Study, Stacey M. Scott, Annette J. Raynor, Julie S. Dare, Jennifer M. Grieve, Leesa N. Costello

Research outputs 2022 to 2026

Background: The Royal Commission into Aged Care Quality and Safety (RCAC) recommended a redesign of the Australian aged care system to ensure high quality care, respect, and dignity for residents. Responding to the RCAC recommendations, the Aged Care Quality Standards have been strengthened and continue to guide the delivery of safe, high quality care in Australia. This study investigated the experiences of new residents transitioning into an Australian residential care-facility, concentrating on how their experiences aligned with the core principles of the Aged Care Quality Standards. Methods: A focused ethnographic approach was used to address the aim of this study. …

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

Health & Biomedical Sciences Faculty Publications

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

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

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

Influence Of Food Insecurity On Adolescent Mental Health: A Comprehensive Literature Review, Sarah Foss

Capstone Experience: Master of Public Health

Food insecurity is a growing public health concern with significant implications for adolescent mental health. This literature review provides an overview of current research on the relationship between food insecurity and adolescents’ mental health in the United States. A literature review was completed to identify studies examining the association between food insecurity and anxiety, depression, or attention deficit disorder (ADD)/Attention Deficit Hyperactivity Disorder (ADHD). Evidence shows that the experience of food insecurity in adolescence is associated with a higher risk of developing or experiencing an exacerbation of anxiety, depression, or ADD/ ADHD. This review utilizes the socioecological model to explain …