Auricular Point Acupressure Self-Management (Apa-Sm) Program For Chronic Musculoskeletal Pain Among Rural Populations: A Protocol For A Pragmatic, Randomized Controlled Trial, Jennifer Kawi, Jane Bolin, Hulin Wu, Jungkyung Min, Rupsikha Bora, Sarah Pace, Idara N Akpan, Alee Lockman, Tonychris Nnaka

Faculty, Staff and Student Publications

Introduction: Chronic musculoskeletal pain (CMP) is a leading cause of incurred personal healthcare costs and disability in the USA. It disproportionately affects rural populations, who are more likely to be uninsured, lack access to a regular healthcare provider and experience a higher prevalence of CMP. As a result of reduced access to non-pharmacological care, there is greater reliance on opioids. The Auricular Point Acupressure - Self-Management (APA-SM) program is a simple, needleless, evidence-based therapy that empowers individuals to self-manage their pain. Preliminary studies, including a recent UG3 pilot testing, demonstrated feasibility, safety and significant improvements in pain and function. Guided …

Assessing Indoor Heat Vulnerability And Cooling Strategies In Three Mobile Home Communities In Boulder, Colorado, Usa, Mehdi P. Heris, Skye Niles, Alana Wilson, Megan Mccurdy, Amy Lacourse, Nick Lankau

Biology, Chemistry, and Environmental Sciences Faculty Articles and Research

Extreme heat is an increasing public health and environmental threat shaped by both physical and social factors. This study assesses the vulnerability of mobile homes and their residents at three mobile home parks in Boulder, Colorado. We examined indoor temperature, housing conditions, and social and personal risk factors of the households. We monitored indoor and outdoor temperatures using 27 indoor and 5 outdoor temperature data loggers, comparing mobile homes with air conditioning, swamp coolers, and passive cooling designs. This work provides a detailed analysis of indoor temperature patterns and demonstrates how evaluating trends yields insights into the performance and effectiveness …

Multidomain Expert Evaluation Of Leading Large Language Models As Providers Of Vaccination And Preventive Medicine Information, Marcello Di Pumpo, Leonardo Villani, Vittorio Maio, Maria Rosaria Gualano, Eleonora Marziali, Lucia De Maio, Rossella Mancini, Stefania Boccia, Walter Ricciardi, Patrizia Laurenti

College of Population Health Faculty Papers

OBJECTIVES: Vaccination is one of the most effective public health interventions. Large language models (LLMs) show great capability for providing health information. This study compared the performance of ChatGPT 3.5 (G3E), ChatGPT 4o in English (G4E), Claude 3.0 (CDE), Gemini 1.5 (GME), and ChatGPT 4o in Italian (G4I) in delivering information on vaccination and preventive medicine.

STUDY DESIGN: Mixed-method analysis evaluating large language models.

METHODS: Twenty-six expert-designed healthcare scenarios were used to evaluate each model through an adapted DISCERN-based instrument. Four experts independently rated outputs across six domains: Information Reliability, Information Quality, Medical Appropriateness, Impact on Vaccine Hesitancy, Potential for …

Extraction Of Key Themes In Online Health Discourse Using Unsupervised Learning And Large Language Models, Miranda G. Scully

Computer Science Senior Theses

Health online discussion boards are a modern platform that allow patients to interact with each other and the healthcare system as a whole, making them valuable sources of information for clinicians seeking to better anticipate treatment experiences and barriers. This study focuses on one such community, r/suboxone, a subreddit where patients using Suboxone share their experiences and ask questions. Our analysis is motivated by previous work that proposes event-based classification systems for such posts which buckets posts from r/suboxone into one or more of five high-level labels (Access Logistics, Co-Occurring Drug Usage, Medication for Opioid Use Disorder Administration, Psychophysical Effects, …

The Impact Of The Covid-19 Pandemic On Obstetric Access In Rural And Urban Areas In The United States, Sandali Chandradasa

Walden Dissertations and Doctoral Studies

No abstract provided.

Cross-Cultural Differences Among Children And Youth With Special Health Care Needs: A Mixed-Methods Analysis Of Chinese, Spanish, And English-Speaking Families, Kathleen Mcgrath, Miriam Franco, Amy Morales-Lara, Karen Bonuck Phd, Joanne Siegel

Developmental Disabilities Network Journal

One in five U.S. children has a special health care need, with prevalence rates rising each year. Children and youth with special health care needs (CYSHCN) from immigrant and/or non-English speaking families face heightened barriers to care, unmet health needs, and worsened health outcomes. This mixed-methods study explores cross-cultural similarities and differences among English-, Spanish-, and Chinese-speaking families of CYSHCN across four key domains – (1) the diagnostic process, (2) access to essential services, (3) community integration, and (4) social supports. As part of a statewide, New York State Department of Health funded initiative implemented across three University Centers for …

Bullying, Early Sexual Debut, And Sexual Health Behaviors Among Adolescents In New York City, Valentina I. Ramirez

Dissertations and Theses

Adolescent sexual and reproductive health remains a critical public health priority in the United States, particularly given the persistent burden of HIV and sexually transmitted infections (STIs) among young people. Adolescents and young adults account for a disproportionate share of STI cases, reflecting ongoing gaps in prevention, early detection, treatment, and equitable access to sexual health care and services. These patterns are shaped not only by individual behaviors but also by broader social, structural, and developmental contexts that influence adolescents’ opportunities to engage in preventive sexual health care.

This dissertation examined associations between early sexual debut, experiences of bullying, and …

Operational And Implementation Evaluation Of A Short-Term Medical Service Program In Rural Guatemala, Mitchell M. Michalak, Shamecka Douglas, Oscar Gonzalez, Giovanna Sanguinetti, Ashley Sweat

Internet Journal of Allied Health Sciences and Practice

Fall Risk And Lower Extremity Strength In Diabetic And Non-Diabetic Older Adults: A Comparative Cross-Sectional Study, Maimoona Shahid, Yasha Sajjad, Shumail Fatima, Ayesha Tuba, Wajida Perveen, Asim Raza

Internet Journal of Allied Health Sciences and Practice

Purpose: Many studies have been conducted on falls in individuals older than 60 years of age with diabetes, so the current study focused on comparing and contrasting the fall risk and lower extremity strength in diabetic and non-diabetic people of 50 years of age and above and early identification of fall risk. Methods: This comparative cross-sectional study recruited 210 older adults 50 years of age and older from community dwelling areas. Thirty-one (31) participants were healthy and free of diabetes, while 179 of the same age range were diagnosed with diabetes mellitus. The study was conducted over a period of …

Epstein–Barr Virus Common And Rare Complications In Iraq: Review Paper, Ameer Mohammed Kadhim, M. Jafar Zainaldeen, Zainab Haider Abdulmajeed

Maaen Journal for Medical Sciences

Background: Epstein–Barr Virus (EBV) is a highly ubiquitous herpesvirus found globally, it is associated to both a wide range of condition including common, pervasive infections and severe, rare diseases. In Iraq, despite a significant increased incident of chronic illnesses and viral- related malignancies, the local overview of EBV-associated complications remains fragmented. Aim: This review synthesizes the current available Iraqi literature to delineate the dual nature of EBV’s impact, distinguishing between common epidemiological manifestations and its role in severe clinical complications in local cohorts. Key Findings: high seroprevalence (~80%) of EBV in healthy Iraqi population, with noteworthy association observed in autoimmune …

The Life Study: A Cross-Sectional Study Protocol For Lifestyle Risk Factors For Chronic Disease Across The Stages Of Reproductive Ageing, Laura E. Pernoud, Jamie L. Noll, Paul A. Gardiner, Melinda Dean, Kathryn M. Broadhouse, Meegan Anne Walker, Hattie H. Wright, Anthony Villani, Joseph Scott, Alexandra P. Metse, Mia A. Schaumberg

Research outputs 2022 to 2026

Introduction: The dynamic physiological and hormonal changes through the menopause transition predispose women to an increased risk of chronic diseases including cardiovascular disease, metabolic disease, depression and dementia. The underlying mechanisms remain unclear, yet it is thought that chronic systemic inflammation and changes to lifestyle behaviours play important roles. The LIfestyle risk Factors for chronic disease across the stagEs of reproductive ageing (LIFE study) is a cross-sectional study aimed to characterise how hormonal and lifestyle (physical activity, diet and sleep) differences across pre, peri and postmenopause influence chronic systemic inflammation, visceral adiposity, cognitive function and sleep health. Methods and analysis: …

A Qualitative Exploration Of Unanticipated Effects Experienced By People With Chronic Obstructive Pulmonary Disease Who Participated In Interventions Designed To Reduce Sedentary Behaviour, Fiona Coll, Vinicius Cavalheri, Daniel F. Gucciardi, Kylie Hill

Research outputs 2022 to 2026

Introduction: This study explored the lived experiences of people with chronic obstructive pulmonary disease (COPD) who participated in interventions designed to reduce the accumulation of sedentary behaviour in prolonged uninterrupted bouts. Methods: Ten participants with stable COPD participated in a multi-component intervention that spanned over 9 months and was designed to address the intervention message ‘If you have been sitting or resting continuously for 30 min, stand up and move’. Interventions comprised participation in an 8-week programme of supervised exercise training coupled with behaviour change techniques. Throughout the intervention period the person delivering the intervention kept detailed notes of their …

The Association Of Motherhood And Maternal-Related Life Events And Cardiovascular-Related Health, Disease Events, And Mortality, Taishayla Mckitt

ETDs from 2020-2029

More than 40% of U.S. women have cardiovascular disease (CVD), and nearly half have at least one major risk factor. Sparse evidence exists related to the role of childrearing (regardless of prior pregnancy) on CVD. A recent literature review highlighted the influence of reproduction on CVD and health and identified opportunities for advancement. At present, it has yet to be discovered from prospective epidemiologic studies the extent to which parenting and maternal events have influence on cardiovascular health and clinical events. It has been demonstrated that parous women have greater prevalence of cardiovascular risk factors (e.g., short sleep duration and …

Exploring The Association Between Social Media Use Frequency And Violence-Related Behaviors Among U.S. High School Students: A Cross-Sectional Analysis Of The 2023 Youth Risk Behavior Survey, Luma Hammoudi

ETDs from 2020-2029

Youth violence remains a major public health concern in the United States (U.S.), with firearm injuries now the leading cause of death among children and adolescents. At the same time, social media use has become nearly universal among youth, raising concerns about how online interactions may influence violence-related behaviors. Social media platforms can facilitate peer conflict, electronic bullying, and public exposure to aggressive behaviors, which may extend into offline environments such as schools and communities. However, the relationship between social media use frequency and youth violence remains understudied. This study examined the relationship between frequency of social media use and …

An Examination Of Physical Activity And Arterial Stiffness Among Urban And Rural Older Adults, Michael J. Hankes

ETDs from 2020-2029

Rural populations in the United States experience a disproportionate burden of cardiovas-cular disease, yet how rural‑urban context shapes physical activity (PA) and vascular health is not fully understood. Because vascular dysfunction links PA to cardiovascular risk, rural‑urban differences in movement may help explain disparities in cardiovascular health. Rurality is often treated as a static, binary exposure, which may obscure meaning-ful geographic variation and accumulated life course influences. The overarching goal of this dissertation was to examine associations among rural‑urban exposure, objectively measured PA, and vascular health using national cohort data and a pilot study. This dissertation begins with a conceptual …

Socioeconomic Inequalities In Health-Related Quality Of Life During The Covid-19 Pandemic: A Six-Country Comparison Using The Eq-5d-5 L, Joëlle Eijkens, Joshua M. Bonsel, You-Shan Feng, M. F. Bas Janssen, Erica I. Lubetkin, Juanita A. Haagsma

Publications and Research

Purpose

Despite the growing attention to health inequalities, there is no global consensus on how to measure socio-economic status. This study examined inequalities in health-related quality of life (HRQoL) during the early phase of the COVID-19 pandemic across six countries—China, Italy, the Netherlands, Sweden, the United Kingdom (UK), and the United States (US)—using three SES indicators: education level, income, and work status.

Methods

Between April and June 2020, individuals aged 18–75 years old completed a web-based survey. HRQoL was measured using the EQ-5D-5L Level Sum Score (LSS), where higher scores indicate poorer health. Country-specific differences in LSS across SES groups …

Development And Validation Of The Lifetime Sense Of Safety Scale In Kenyan Adults, Karen Blackmon, Anne Nyambura, Anne Gitere, Levi Muyela, Catherine Onyancha, Kendi Muchungi, Catherine Ajalo, Litha Musili, Rachel Maina, Edna Bosire, Lukoye Atwoli, Zul Merali, Chinedu Momoh

Brain and Mind Institute

Background. Safety supports psychological wellbeing and potentially shapes brain aging yet existing scales overlook cumulative lifespan safety experiences.

Methods. To address this gap, we developed and validated the Lifetime Sense of Safety (LSS) scale in Kenyan adults. The LSS uses visual analog scaling with a red-to-green color gradient to retrospectively rate felt safety across life stages and settings. We evaluated scale psychometrics and associations with social determinants of health and indicators of brain health.

Results. The LSS shows adequate internal consistency and test-retest reliability, with two distinct but correlated factors representing childhood and adulthood safety. Women and …

Alara+: Summit On Radiation And Orthopedic Risks In Fluoroscopic Laboratories: Endorsed By Acc, Acvp, Ase, Hrs, Scai, Sir, Snis, Svin, And Svs, Arash Salavitabar, Amit N. Vora, Dorothea Altschul, J. Fritz Angle, Chelsea Ballinger, Andrew Bojanowski, Anna E. Bortnick, Kyle Bugg, Emily Carpenter, Robert E. Foster, Joanna Ghobrial, Matthew Glogoza, Atul Gupta, James B. Hermiller, A. Kyle Jones, Summer L. Kaplan, Steven J. Kraus, Omar Khalique, Andrea Klein, Nick Morse, Preethi Ramchand, David G. Rizik, Lucy M. Safi, Cheryl C. Schultz, Kamala P. Tamirisa, R. Jay Widmer, Kristi Wilson, Jonathan X. Fang, Arnold Seto, Robert F. Riley

Department of Neurosurgery Faculty Papers

Occupational radiation exposure has a clear association with long-term health effects and has a particular impact on women, trainees, and supporting staff. There is a reliance on limited, traditional radiation protection and nonergonomic equipment, which carries associated orthopedic injury rates with adverse impacts on both individual career trajectories and health systems, and with significant challenges to widespread implementation of enhanced radiation protection devices. During the 2025 Society for Cardiovascular Angiography & Interventions Scientific Sessions in Washington, DC, a multidisciplinary Think Tank summit was convened and included representatives from multiple stakeholders, including other professional societies, advocacy groups, and industry partners. The …

Geographic And Systemic Disparities In Maternal Health: A Systems Analysis Of Prenatal Care Access Across Rural Oregon, Cecelia Petrik

University Honors Theses

Objectives: In Oregon, 51% of hospitals providing labor and delivery services are located in rural areas. Consolidation of these hospitals and provider shortages has created severe geographic and systemic disparities in maternal healthcare. This thesis explores how geographic isolation and inadequate prenatal care access contribute to widening disparities in severe maternal morbidity (SMM) and mortality across Oregon's rural and frontier counties.

Methods: This study utilizes data from the Oregon Health Authority (OHA) Center for Health Statistics (2024) and analyzes spatial correlations across all 36 Oregon counties. A bivariate choropleth map was constructed to examine the structural intersection between health infrastructure …

Moving Beyond Traditional Cost Containment For Glp-1 Coverage Within Oregon's Proposed Universal Health Plan, Manoj Rajesh

University Honors Theses

In 2022, Oregon voters passed Measure 111, constitutionally mandating access to affordable health care. As the Universal Health Plan Governance Board (UHPGB) designs the state's proposed single-payer system, it faces an unprecedented financial vulnerability: the clinical demand for GLP-1 receptor agonists. These high-cost, indefinite-use medications for obesity and metabolic syndrome threaten to overwhelm fixed public budgets. Historically, both the Oregon Health Plan's Medicaid framework and commercial private insurers have relied on static cost-containment models—categorical exclusions, step therapy, and aggressive utilization management—that achieve short-term fiscal solvency at the expense of comprehensive preventative care. This thesis argues that to fulfill the mandate …

Reflections And Revisionism: Rethinking The U.S. Response To Covid-19, Wendy E. Parmet

Michigan Law Review

A review of In Covid’s Wake: How Our Politics Failed Us. By Stephen Macedo and Frances Lee.

Exploring Racial And Ethnic Diversity Trajectories And Diabetes Prevalence In The United States, Jiue-An Yang, Calvin P Tribby, Anna Dmowska, Qian Xiao, Marta M Jankowska

Faculty, Staff and Student Publications

This study investigates whether long-term changes in neighborhood racial and ethnic diversity are associated with adult diabetes prevalence across the contiguous United States. We calculated diversity indexes for US census tracts (n = 72,033) using decennial census data from 1990 to 2020. Five diversity trajectory clusters were identified using K-means clustering. Diabetes prevalence in 2019 was obtained from the CDC's PLACES dataset. Linear mixed models (LMMs) assessed global associations between diversity trajectories and diabetes prevalence, adjusting for age, sex, poverty, marital status, and public insurance. Geographically weighted regression (GWR) examined local variations in these associations. Compared to the reference group …

Barriers And Facilitators To The Implementation Of The Diabetes Prevention Program (Dpp) In Health Settings: Protocol For A Mixed Methods Systematic Review, Miquel Colom-Rosselló, Manuela Abbate, Laura Capitán-Moyano, Elena Pastor-Ramon, Maria E Fernández, Aina M Yañez, Miquel Bennasar-Veny

Faculty, Staff and Student Publications

This is the protocol of a Campbell Systematic Review. The objectives are as follows: to identify implementation determinants from the perspectives of both participants and implementers, and to assess their influence on specific implementation outcomes, thereby clarifying why certain aspects of the implementation process succeed or fail. If sufficient data is available, variations in perceived barriers or facilitators related to individuals and program characteristics will also be explored.

Dental Care Utilization Among Sexual And Gender Minority Individuals, Ishita Singh, Oladipo Afolayan, Sarah S Jackson, Irene Tamí-Maury

Faculty, Staff and Student Publications

Objectives: Sexual and gender minority (SGM) individuals can experience notable health disparities, including higher HIV prevalence, social isolation, substance abuse, lack of culturally competent providers, and poorer health outcomes compared to heterosexuals due to stigma and discrimination. This study aims to identify predictors of dental care utilization across sexual minorities using the 2023 TEXAS PRIDE Survey.

Methods: We analyzed data from 517 SGM individuals, assessing sociodemographic characteristics, health behaviors, and recent medical and dental visits. Multivariable logistic regression identified predictors of dental care utilization (i.e., a dental visit in the past year).

Results: Among sexual orientation groups, reported dental care …

Association Of Insulin Resistance And Fracture Risk In The Osteoporotic Fractures In Men (Mros) Cohort, Jeonghoon Ha, Li-Yung Lui, Kristine Ensrud, Qian Xiao, Andrew R Hoffman, Joy Y Wu

Faculty, Staff and Student Publications

Context: Insulin resistance (IR) is more prevalent in men than in women, but evidence directly linking IR to fracture risk in older men remains limited.

Objective: To evaluate the association between insulin resistance (IR), estimated using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and the triglyceride-glucose (TyG) index, and fracture risk in older men.

Methods: Data from 5994 men (≥65 years) in the MrOS cohort were analyzed. A total of 5416 participants were included in the HOMA-IR analysis and 5384 in the TyG index analysis. Fractures were self-reported and confirmed radiographically. Participants were grouped into quartiles based on IR …

A Predictive Coding Account Of Spatial Working Memory Following Prophylactic Levetiracetam Administration Prior To Traumatic Brain Injury, Omeima Mutwali

Dissertations, Theses, and Capstone Projects

Traumatic brain injury (TBI) symptom prevention and remediation is an important area of research that would benefit vulnerable groups, including active-duty and veteran soldiers. These patients can sustain penetrative forces in fields of combat or in training, which result in focal lesions that trigger inflammatory and degenerative processes in the brain. Both primary and secondary injuries are associated with changes to cognition, behavior and affective state. This disease poses increased risk of epileptogenesis, as well. Given these outcomes, prior research has evaluated levetiracetam (LEV) as a prophylactic treatment for seizures, cognitive deficits and negative emotionality. LEV acts as a presynaptic …

Screening Tools For Maternal Mental Health In Africa: A Systematic Review, Joyce Jebet, Irene Mageto, Benard Mutwiri, Abednego Ongeso, Ruth Wagathu, Rose Maina, Denis Munene, Kawira Kithuci, Peter Gatiti

School of Nursing & Midwifery, East Africa

Background:

Maternal health during pregnancy and the postnatal period encompasses mental health, which is a key aspect in enhancing a positive outcome. Despite screening for other possible complications during pregnancy and the postnatal period, very little attention has been paid to screening for mental health. Screening is a key tool in early diagnosis and, eventually, timely diagnosis and management in cases where complications arise.

Aim:

This study aimed to assess the available maternal mental health screening tools and compare the outcome on their utilization during pregnancy and postnatal periods in the African continent.

Methodology:

This was a …

Family Planning Exemplar Country Selection Methodology: Time Lag And Trends Analysis, Zahid Memon, Abeer Mian, Ira Martopullo, Narjis Hussain, Zeba Sathar, Ali Mohammad Mir, Michael Mbizvo, Marleen Temmerman, Jen Drake, Zulfiqar Bhutta

Centre of Excellence in Women and Child Health

Introduction While many countries achieved notable gains in contraceptive use levels after the 1994 International Conference on Population and Development which redefined family planning (FP) as a human right, there was a long period of 15 years when contraceptive use levels did not receive due attention. It was only later that its subsequent inclusion in the Sustainable Development Goals and the 2012 London Summit on FP renewed global commitment and a focus towards FP. This paper aims to select countries that identify as ‘exemplar’ low-middle-income countries that have achieved exceptional progress in FP. Examining these outliers can uncover actionable drivers …

Accessibility And Daily Cigarette Consumption Among Indonesian Adolescents: A Descriptive Study, Noviana Lathifah, Istiqomah Hanifah Rachman, Anisa Isnaini, Gloria Threesia Piliphinsa Simatupang

Journal of Indonesian Health Policy and Administration

Despite restrictive regulations, Indonesia faces a high prevalence of adolescent smoking, facilitated by easy access to tobacco products. This descriptive study aims to describe cigarette accessibility patterns and daily consumption trends among Indonesian adolescents. A cross-sectional study was conducted using secondary data from the 2019 Global Youth Tobacco Survey (GYTS) involving 9,208 respondents. Descriptive analysis was performed to examine the distribution of age at smoking initiation, daily cigarette consumption, and purchasing accessibility. The majority of respondents started smoking at ≥14 years of age. Daily cigarette consumption showed an increasing trend with age, with older adolescents more likely to consume more …

Trends Of Pediatric Psychotropic Polypharmacy In Massachusetts Before And During The Covid-19 Pandemic, Gianna D'Ambrozio

Graduate Doctoral Dissertations

Youth in the U.S. and internationally are increasingly being diagnosed with depression and related psychiatric conditions (Murthy, 2021) many of whom are being subjected to non-evidence-based, or what has been termed irrational, psychotropic polypharmacy (Barnett & Concepcion Zayas, 2019). Psychotropic polypharmacy can be defined as “the use of 2 or more psychiatric medications in the same patient,” (Zito et al., 2021) though definitions can vary. Using data from the Center for Health Information Analysis’ Massachusetts All-Payer Claims Database, this study examined the sociodemographic factors associated with high rates of polypharmacy, a hypothesized increase in pediatric psychotropic polypharmacy rates in Massachusetts …