Digital Commons Network^™

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

Walden Dissertations and Doctoral Studies

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

Appearance Over Function - The Impact Of Long-Term Oral Contraceptive Use On Brain Development, Breast Tissue Composition, And Future Lactation Outcomes, Fiona M. Wang

Dissertations

This integrative review examines the long-term effects of combined oral contraceptive (COC) use beginning in puberty on brain development, breast tissue composition, and future breastfeeding outcomes. Puberty is a critical developmental stage during which hormonal changes significantly impact the neurological and reproductive systems. The introduction of synthetic estrogen and progestin through COC use during this time may disrupt natural hormonal pathways, potentially altering neuroendocrine signaling and breast tissue maturation. Such changes may have lasting consequences, including impaired milk production, a weakened milk ejection reflex, disrupted maternal-infant bonding, and reduced overall breastfeeding success. The review synthesizes findings from endocrinology, neuroscience, and …

Identifying Geographic Cold Spots Of Pcos Diagnosis In Texas: A Spatial Analysis Of Underdiagnosis And Rural Disparities, Ryan Ramphul, Geethika Yalavarthy, Jooyeon Lee

Faculty, Staff and Student Publications

Context: Polycystic ovary syndrome (PCOS) is a common yet underdiagnosed endocrine disorder with substantial reproductive and metabolic consequences. Although disparities in PCOS care have been documented, few studies have employed spatial methods to identify areas of potential underdiagnosis.

Objective: This study uses geospatial analysis to detect cold spots of PCOS clinical encounters across Texas and investigates neighborhood characteristics associated with these areas.

Methods: We analyzed inpatient and outpatient encounter data from the Texas Public Use Data File (PUDF) between 2018 and 2024 to identify PCOS-related visits (International Classification of Diseases, revision 10: E28.2). ZIP code tabulation area (ZCTA)-level PCOS encounter …

Routine Antenatal Ultrasound By Nurse-Midwives In Rural Kenya: A Pragmatic Trial Assessing Feasibility And Effects Of The Mimba Yangu (My Pregnancy) Project, Claudia Hanson, Lucy Nyaga, Nidhi Leekha, Michaela Mantel, Sarah Kedenge, Caroline Gitonga, Violet Naanyu, Jasmit Shah, Marleen Temmerman

Centre of Excellence in Women and Child Health

Introduction: Task-sharing of obstetric ultrasound between nurse-midwives and doctors has the potential to operationalize the World Health Organization’s recommendation of at least one ultrasound before 24 weeks of gestational age for every pregnant woman. Here, we report on the feasibility, acceptability, and effects of the Mimba Yangu (My Pregnancy) task-sharing approach in rural Kenya.

Methods: We conducted a pragmatic trial including 28 primary care facilities between April 2021 and March 2022, selected based on feasibility criteria. Fourteen facilities received the ultrasound intervention composed of (i) task-sharing with nurse-midwives, (ii) the use of portable ultrasound devices (Lumify™) connected to a tablet, …

Weight Gain Among Tuberculosis Patients And Its Association With Socio-Demographic Profile And Disease-Related Characteristics In Urban And Rural Areas Of Mysuru., Sana Khader M, Smitha Malenahalli Chandrashekarappa, Anchu R Nath, Arun Gopi

Digital Journal of Clinical Medicine

Background: Tuberculosis remains a major public health burden in India, accounting for 25% of the global tuberculosis cases. Weight gain during tuberculosis treatment is a key recovery indicator influenced by sociodemographic and clinical factors. Addressing these challenges is crucial for achieving India’s Tuberculosis elimination goal by 2025.

Objectives: To assess weight gain across different phases of anti tubercular therapy among tuberculosis patients in urban and rural Mysuru, and to determine its association with sociodemographic and disease-related characteristics.

Methodology: A retrospective cross-sectional study was done using secondary data of tuberculosis patients who attended primary health care centers in …

Steroid Hormone Biosynthesis And Dietary Related Metabolites Associated With Excessive Daytime Sleepiness, Tariq Faquih, Kaitlin S Potts, Pavithra Nagarajan, Bing Yu, Robert Kaplan, Carmen R Isasi, Qibin Qi, Kent D Taylor, Peter Y Liu, Satu J Strausz, Hanna M Ollila, Tianyi Huang, Russell P Tracy, Craig Johnson, Stephen S Rich, Clary B Clish, Jerome I Rotter, Susan Redline, Tamar Sofer, Heming Wang

Faculty, Staff and Student Publications

Background: Excessive daytime sleepiness (EDS) is a complex sleep problem that affects approximately 33% of the United States population. Although EDS usually occurs in conjunction with insufficient sleep and other sleep and circadian disorders, recent studies have shown unique genetic markers and metabolic pathways underlying EDS. Here, we aimed to further elucidate the biological profile of EDS using large-scale single- and pathway-level metabolomics analyses.

Methods: Metabolomics data were available for 877 metabolites in 6071 individuals from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). EDS was assessed using the Epworth Sleepiness Scale (ESS) questionnaire. We performed linear regression for each …

Access To Information On Toddler Family Development Program And Family Participation In Child Growth And Development, Dita Dhammayanti, Demsa Simbolon, Lissa Ervina, Yusran Fauzi

Kesmas

The comprehension of the Toddler Family Development (TFD) Program among families in Indonesia remains limited, likely due to insufficient access to information and low participation rates. Limited participation can negatively affect a family’s ability to support optimal child growth and development. This study examined the relationship between access to information on the TFD Program and family participation in child growth and development. Using secondary data from the 2019 Program Performance and Accountability Survey in Indonesia, the cross-sectional analysis included 21,497 respondents. The results revealed an association between access to information on the TFD Program and family participation in child growth …

Nursing Students’ Sociodemographic Characteristics And Consumer Preferences’ Prediction Level Of Perceived Food Literacy, Sinan Duru

Makara Journal of Health Research

Background: Food literacy, which is a critical competency for nursing students, plays a pivotal role in promoting evidence-based nutrition behaviors and contributes effectively to public health. This study aimed to determine the level of perceived food literacy among nursing students.

Methods: This cross-sectional study involved 488 nursing students from two universities in the south of Turkey. The research data were collected face to face via the Personal Information Form, the Consumer Preferences Form, and Self Perceived Food Literacy. The data was analyzed using the Independent Sample t Test, One Way ANOVA, and multiple linear regression.

Results: The …

A Study On Nutritional Status Among Regular Gym Goers In And Around Chennai, India, Ettiyappan Thirumurugan, Kalpana Devi Venkatesan, Pavithra Tamilmani, Devika Preetha, Joyce Albert Princy Mariya Selvanathan, Dhanyasree Mohandas, Ameer Basha Sathik, Santhosh Kumar Manjunathan, Ashika Kannadhas Sheeba

Makara Journal of Health Research

Background: The increasing sales of sports supplements indicate a concerning trend, as many gym-goers may misuse these products owing to misinformation and insufficient knowledge, potentially impacting their performance. This issue is further compounded by specific gym trainers who may lack comprehensive information and inadvertently influence their clients' choices. To address this concern, the present study evaluated dietary supplement practices and sports nutrition knowledge among regular gym-goers at fitness centers in Chennai, India.

Methods: A cross-sectional survey was conducted from November 2023 to May 2024 using a validated questionnaire distributed across Chennai, India. A total of 450 participants were …

Assessment Of The Dietary Supplements Effects On Maternal Underweight In Nigeria, Chukwuebuka Jude Chiobi, Uzoamaka Angela Chiobi, Ambrose Nnaemeka Omeje, Ikechukwu Andrew Mobosi, Michael Okike Ugwu, Nnamdi Simeon Ugwu

Kesmas

Maternal underweight continues to rise and, if not properly managed, will lead to increased mortality. This contradicts the United Nations Sustainable Development Goal of reducing maternal mortality by 2050. Therefore, this study aimed to determine the probable effect of dietary supplements on maternal underweight in Nigeria. This study employed probit estimation using the maximum likelihood technique in 2022, with the 2018 Nigeria Demographic Health Survey data as the basis for analysis. The results showed a statistically significant effect of dietary supplements on maternal underweight in Nigeria. The likelihood of dietary supplements impacting maternal underweight was approximately 0.4% lower, on average, …

Hubungan Kualitas Pemeriksaan Kehamilan Terhadap Kejadian Stunting Pada Anak Usia 6-23 Bulan Di Indonesia (Analisis Ski 2023), Hanna Audila, Helda Helda, Sudarto Ronoatmodjo

Jurnal Epidemiologi Kesehatan Indonesia

Stunting is still a nutritional problem and remains a major public health issue. Especially in Indonesia, the prevalence of stunting among children under two years old (toddlers) remains high, at 18.50%. The annual average rate of reduction of stunting among toddlers has been relatively slow for over the past 10 years. Therefore, optimizing stunting interventions-particularly during the first 1000 days of life is essential, including through antenatal care (ANC). This study aims to analyze the relationship between the quality of antenatal care and the incidence of stunting among children aged 6-23 months-old in Indonesia, after being controlled by the other …

Analisis Potensial Kejadian Luar Biasa Dbd Berdasarkan Kasus Dbd 5 Tahun Terakhir 2019-2024 : Studi Ekologi Di Kota Lubuklinggau Provinsi Sumatera Selatan, Sely Anggraini, Tri Yunis Miko Wahyono, Fitria Fitria, Nadia Putri

Jurnal Epidemiologi Kesehatan Indonesia

Dengue Hemorrhagic Fever (DHF) is an endemic disease in Indonesia, with a high potential for outbreaks, particularly in tropical and densely populated regions such as Lubuklinggau City. This study aimed to assess the outbreak potential of DHF in Lubuklinggau by analyzing the five-year trend of minimum and maximum case numbers (2019–2023) and comparing them with 2024 data using the epidemic threshold approach. A descriptive ecological study design was employed, with all primary health centers (puskesmas) in the city as units of analysis. Data sources included annual DHF surveillance reports from the District Health Office, field observations, demographic data from the …

Exploring Stunting In South Kalimantan Province Using R Programming-Based Data Visualization, Muhammad Hudaya, Wahyudin Nor, Mellani Yuliastina, Muhammad Nordiansyah

Kesmas

South Kalimantan Province continues to face the challenge of relatively high stunting prevalence despite being endowed with abundant coal resources that could serve as a source of funding for public health. Therefore, this study aimed to examine differences in stunting prevalence among cities, mining districts, and non-mining districts in South Kalimantan to raise stakeholder awareness of disparities across these regional types. This study was conducted between April and December 2024, using secondary data obtained from the Indonesian Ministry of Health and the South Kalimantan Provincial Government. R programming was used to process the data, generate visualizations, and perform analysis of …

Low Economic Level And The Risk Of Overweight Among Indonesian Junior And Senior High School Students, Ariyanto Nugroho, Purwo Setiyo Nugroho, Amarin Yudhana, Sri Sunarti

Kesmas

Overweight and obesity among Indonesian adolescents have emerged as a pressing public health issue, reflecting global trends. This study examines the relationship between economic status and overweight prevalence among junior and senior high school students in Indonesia, using secondary data from the Global School-based Health Survey (GSHS). This study analyzed data from 9,977 students aged 11–18 years through a cross-sectional design and binary logistic regression, adjusting for dietary habits, physical activity, and sedentary behavior. Overall, 14.7% of students were overweight; the prevalence was notably higher among low-income students (27.4%) compared to high-income groups (14.2%). Students from lower economic backgrounds were …

Government Health Spending And Life Expectancy: Evidence From Cities And Districts In Indonesia, Kurnia Sari, Budi Hidayat, Amal Chalik Sjaaf, Mardiati Nadjib

Kesmas

Life expectancy is widely recognized as a fundamental indicator of population health, and its improvement is often linked to government health spending, particularly in decentralized health systems. This study aimed to investigate the relationship between local government health expenditures and life expectancy in decentralized Indonesia. Data from 492 cities and districts, spanning from 2015 to 2019, were analyzed using a two-way fixed effects regression model to control for time-invariant district characteristics and common temporal shocks. The findings indicated that a 10% increase per capita in government health expenditure was associated with a 0.01% increase in life expectancy. This association was …

Associations Between Factors Of Unhealthy Lifestyle, Mental Health Issues, Chronic Illnesses, Environmental Health Risks, And Infertility In Females: A Cross-Sectional Study, Richard L. Huang

Doctoral Dissertations and Projects

Infertility has risen rapidly in recent decades and has become the third-largest public health concern in the world. It has significantly threatened individuals’ psychological, physical, and social well-being, and it could be an early sign of severe health problems in the future. Furthermore, it also threatens the continuation of life and human civilization. The purpose of this study was to examine the relationship between individuals’ daily lifestyle behaviors, mental health status, chronic conditions, environmental health factors, and infertility by using cross-sectional quantitative methods. It benefits the public as the study raised awareness of potential risks and provided guidance to avoid …

Evaluating Inclusion Rates Of Oral-Systemic Health Connection Coursework In Dental And Medical Professional Programs' Admissions Requirements, Wendy Marie Carry

Doctoral Dissertations and Projects

Oral systemic health connections (OSHC) are bidirectional, life-threatening, and a significant public health concern. Studies have identified over 200 OSHCs; however, the prevalence of foundational OSHC education in dental and medical professional programs remains unknown. This quantitative descriptive comparative pilot study aimed to explore the prevalence of predictor variables, dental and medical professional programs in the United States, and the criterion variable, including an OSHC admissions requirement for the 2025 academic year. The point-in-time count methodology served as the theoretical framework guiding this study and the development of the PiT-PARCI instrument. The proposed testing was replaced with alternative testing based …

Mortality And Heart Failure Exacerbations With Incretin-Mimetic Drugs For Weight Loss In Patients With Obesity-Related Heart Failure With Preserved Ejection Fraction, Leila Humphreys, Salvatore Carbone, Syed Imran Ahmed

Cardiovascular Research Symposium

Research has shown that incretin-mimetic agents approved and used for weight loss may help treat heart failure by improving their quality of life and functional capacity. Whether differences exist between these agents in the HFpEF population has not been tested before. Our study set out to see if these agents affected risk of all-cause mortality and further heart failure related hospitalizations in patients with obesity-related HFpEF and whether differences exist among them.

Partner Collective Impact Survey Final Evaluation Report, Courtney A. Fitzgerald, Theresa H. Cruz, Havana Maisano

Reports & Documents

The Healthy Here coalition, based in Bernalillo and Santa Fe Counties, brings together over 30 organizations working across four key areas: healthy eating, active living, family healthy weight, and vaccinations. In summer 2025, the coalition conducted a PARTNER Collective Impact Survey to evaluate its network structure, contributions, and effectiveness. The survey, completed by 29 organizations (87.9% response rate), provided insights into how member organizations collaborate, the resources they contribute, and how trust and value are perceived across the network.

Findings show that coalition members most frequently contributed community connections, content expertise, and information sharing, with Presbyterian Community Health and the …

The Association Between Malnutrition And Gingivitis Among Residents In St. Louis, Missouri, Alyssa Detrick

Walden Dissertations and Doctoral Studies

Malnutrition and gingivitis are common diagnoses in primary medical and dental care. The purpose of this quantitative study was to understand the association between malnutrition and gingivitis among residents in St. Louis, Missouri. The study was based on the social ecological model (SEM). The cross-sectional design involved secondary data (N = 2,553) from a Federally Qualified Health Center in St. Louis, Missouri that included de-identified patient demographic and diagnosis information of St. Louis City residents with a medical and dental visit in 2024. This study examined the relationship between malnutrition and gingivitis while controlling for ethnicity, preferred language, race, and …

Hepcidin, Incident Heart Failure, And Cardiac Dysfunction In Older Adults: The Aric Study, Iman A F Aboelsaad, Brian L Claggett, Victoria Lamberson, Pranav Dorbala, Kunihiro Matsushita, Pamela Lutsey, Bing Yu, Brandon W Lennep, Youssef M K Farag, Amil M Shah, Leo F Buckley

Faculty, Staff and Student Publications

Aims: Hepcidin regulates plasma and tissue iron levels. We studied the association of hepcidin levels with the risk of incident heart failure (HF) and cardiac dysfunction in older adults.

Methods and results: We included adults from the ongoing, longitudinal Atherosclerosis Risk in Communities (ARIC) study, who were free from prevalent anaemia and HF at Visit 5 (2011-13) and had available hepcidin and covariate data. Associations of plasma hepcidin levels with overall adjudicated incident HF, HF with reduced ejection fraction (HFrEF), and HF with preserved ejection fraction (HFpEF) were assessed using multivariable Cox proportional hazards regression models. Cross-sectional associations of hepcidin …

Family Healthy Weight Program: Smart Movestm Pilot Project Evaluation Report, Camille Velarde, Theresa H. Cruz Dr., Elena Martinez

Reports & Documents

The Smart Moves™ Family Healthy Weight Program is an evidence-based, family-centered intervention designed to address childhood overweight and obesity through nutrition education, physical activity, social-emotional learning, and caregiver engagement. In spring 2025, Presbyterian Community Health piloted Smart Moves™ in a South Valley community health clinic as part of the Healthy Here initiative, with evaluation conducted by the University of New Mexico Prevention Research Center.

The pilot, adapted from a 12-lesson curriculum to 8 core lessons plus orientation and celebration, included bilingual instruction, cooking in a teaching kitchen, and family-based incentives. Evaluation methods combined quantitative and qualitative data, including pre/post BMI …

Blenderized Tube Feeding Formulas: Attitudes, Barriers, And Clinical Benefits As Perceived By Registered Dietitians In Pediatric Care, Savannah Smiley Keeler

Master's Theses

Blenderized tube feeding formulas (BTFF) are increasingly recognized as a viable alternative to conventional commercial tube feeding formulas (CTFF) for pediatric patients requiring enteral nutrition. This cross-sectional, exploratory study aimed to assess the experiences, attitudes, and perceived clinical benefits of BTFF use among Registered Dietitian Nutritionists (RDNs) working with gastrostomy-tube-dependent pediatric populations in the United States. A total of 146 RDNs completed a 45-item online survey, which gathered quantitative and qualitative data on BTFF familiarity, feasibility, clinical outcomes, caregiver factors, and institutional barriers. Findings revealed that while BTFF use remains variable across clinical settings, 55.8% of RDNs reported increased utilization …

Lactation Management Training In Graduate Nutrition And Dietetics Programs: A Preliminary Report, Laura Ashton Gillin

Master's Theses

The American Academy of Pediatrics recommends exclusive breastfeeding (BF) for the first six months and continued breastfeeding for at least two years with complementary food. Despite this recommendation, only 24.9% of infants in the United States are exclusively breastfed at six months (Breastfeeding Report Card 2022). Breastfeeding support and lactation management are critical to promoting a successful breastfeeding experience. Specifically, qualified support from a Registered Dietitian Nutritionist (RDN) is recommended, yet graduate students in Nutrition and Dietetics do not receive adequate training regarding breastfeeding intervention. This study aimed to evaluate graduate Nutrition and Dietetic programs to determine the amount of …

Vitamin B12 Deficiency: Confidence, Perspectives, And Practices Among Registered Dietitian Nutritionists, Avery Miller Adams

Master's Theses

Vitamin B12 deficiency is common in the United States, occurring in 20% of adults aged 60 and above (Andres et al., 2004). Veterans are susceptible to B12 deficiency due to tobacco product usage, alcohol consumption, and poor diet quality. Megaloblastic anemia is the second most prevalent vitamin deficiency disorder recorded in military personnel from 1997 to 2015 (Knapik et al., 2021). This exploratory, analytic research aims to assess registered dietitian RDN nutritionists’ (RDN) knowledge, perceptions, and intentions regarding treating vitamin B12 deficiency in a clinical setting. Due to population prevalence differences, responses from VA and non-VA practicing registered dietitian-nutritionists (RDNs) …

Is There An Association Between Food Literacy And Diet Quality In Young Adult College Men?, Morgan Claire Mayeux

Master's Theses

Food literacy skills can improve dietary intake in young adults as it provides them with the tools they need to make healthier food-related decisions. The benefits of improving food literacy includes the reduction in the risk of prevalent, preventable dietrelated diseases such as obesity, T2DM, heart disease, and other chronic diseases that plague the Unites States today. Previous literature reports primarily on college female samples. Because a large proportion of the samples in the available studies are female, the current literature may not reflect young adult men’s food literacy and its comparison to their overall diet quality. The purpose of …

Using The R = Mc2 Heuristic To Assess Whole-Of-School Physical Activity Implementation In Elementary Schools: A Cross-Sectional Study, Derek W Craig, Kevin Lanza, Christopher D Pfledderer, Andjelka Pavlovic, Kempson Onadeko, Natalia I Heredia, Jizyah Injil, Laura F Defina, Timothy J Walker

Faculty, Staff and Student Publications

Background: Schools are recommended to use a whole-of-school (WOS) approach to promote physical activity opportunities before, during, and after school. Yet, the barriers and facilitators to implementing a WOS approach successfully are not well understood. The R = MC2 heuristic, which defines readiness for implementation as a combination of an organization's motivation and capacity to implement, can enhance our understanding of implementation in the school setting. This study examines associations between constructs from the R = MC2 heuristic and schools' implementation of a WOS approach.

Methods: We conducted a secondary analysis of cross-sectional data from U.S. elementary schools participating in …

Premenopausal And Postmenopausal Malignant Cervical Cancer Diagnosis Among Disaggregated Subethnic Groups Of Asian American Women In The United States, Nilofar Haider Mirza

Walden Dissertations and Doctoral Studies

Despite being the United States' fastest-growing and diverse population, Asian Americans are often aggregated with Native Hawaiian and Pacific Islanders in prior research, resulting in masking disparities in cervical cancer screening/diagnosis among Asian American subethnic groups. Guided by Bronfenbrenner's ecological model, the association between disaggregated subethnic groups and cervical cancer diagnosis among Asian American women aged 20+ in the United States was examined using binary logistic regression. How histology type/behavior and age at diagnosis moderate the relationship between disaggregated subethnic groups and cervical cancer diagnosis was also explored. A quantitative cross-sectional design was employed using cases (N=1014) from the U.S. …

Changes In Self-Reported Excessive Daytime Sleepiness Are Associated With 5-Year All-Cause Mortality Risk Among Veterans, Katherine G Bay, Arash Maghsoudi, Amin Ramezani, Drew A Helmer, Amir Sharafkhaneh, Javad Razjouyan

Faculty, Staff and Students Publications

Excessive daytime sleepiness (EDS) is linked to adverse clinical outcomes. This study evaluated changes in a validated tool to assess EDS, the Epworth Sleepiness Scale (ESS) and mortality risk. This retrospective cohort study included Veterans receiving sleep-related services in the Department of Veterans Affairs (VA) from October 4, 1999 to August 18, 2018, with two qualifying ESS measures. ESS values were extracted from patient notes using a validated natural language processing (NLP) pipeline (96% accuracy). ESS scores were categorised as Normal (0-10) or Abnormal (11-24). Patients were grouped based on ESS changes: Normal-Normal, Normal-Abnormal, Abnormal-Abnormal and Abnormal-Normal. Cox proportional hazards …

Causes Of Symptoms And Symptom Persistence In Long Covid And Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Anthony L Komaroff, Robert Dantzer

Faculty, Staff and Student Publications

Debilitating symptoms for many years can follow acute COVID-19 ("long COVID"), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and various post-acute infection syndromes (PAISs). Together, long COVID and ME/CFS affect 60-400 million individuals, globally. Many similar underlying biological abnormalities have been identified in both conditions including autoantibodies against neural targets, endothelial dysfunction, acquired mitochondrial dysfunction, and a pro-inflammatory gut microbiome. Each of these abnormalities may directly cause some of the symptoms. In addition, the symptoms also may be caused by ancient, evolutionarily conserved symptomatic and metabolic responses to vital threats-sickness behavior and torpor-responses mediated by specific, recently discovered neural circuits. These neural …