Digital Commons Network^™

Health And Nutrition In The First 1000 Days Of Life, Yaojiang Shi, Qi Zhang, Yiliang Zhu, Jingchun Nie

Health Behavior, Policy & Management Faculty Publications

Malnutrition and health issues remain persistent global crises, with developing regions bearing the brunt of the burden. According to the World Health Organization, nearly half of under-five deaths in low-and middle-income countries are linked to malnutrition, while stunting, wasting, and micronutrient deficiencies impair the development of millions of children annually. The studies in this special issue focus on countries facing distinct yet interconnected challenges: Sub-Saharan African nations grapple with high rates of stunting and maternal high-risk fertility behaviors; China confronts rural-urban disparities in dietary diversity and grandparenting practices; Colombia struggles with intersectional inequalities driving infant mortality; and Zambia faces unique …

Advancing Food Equity Through Explainable Ai (Xai): Identifying Place-Based Factors And Conditions Of Food Security, Leslie Hoglund, Hyoshin Park

Health Behavior, Policy & Management Faculty Publications

Food behaviors, food security, and their association with socioeconomic factors constitute a critical area of study with implications for public health, economic stability, and social equity. Understanding these relationships are essential for developing effective policies and interventions that promote sustainable, healthy food systems and greater food equity. This paper employs explainable artificial intelligence (XAI) methods to identify key features influencing household food behaviors. The insights gained from the XAI analysis are further utilized in conjunction with inverse reinforcement learning (IRL) to examine expert behaviors related to eating habits satisfaction. The XAI results reveal that household health conditions, spending patterns, and …

Association Between A Lifestyle Medicine Score And Stroke In U.S. Adults With Hyperglycemia: 2007- 2010 Nhanes, Swarnima Naithani

UNF Graduate Theses and Dissertations

The relationship between glycemic control and cardiovascular disease (CVD) is well- established, however, lifestyle modifications to prevent CVD warrant further investigation. Purpose: This study aimed to evaluate the relationship between adherence to the six lifestyle medicine pillars promoted by the American College of Lifestyle Medicine and stroke in U.S. adults with hyperglycemia. A lifestyle medicine composite score (LMS) was developed to quantify adherence with the hypothesis that a higher LMS (greater adherence to lifestyle recommendations) correlates with lower odds of stroke in adults with hyperglycemia. Methods: The study sample (n=2,079) included adult (≥ 40 years of age) participants in the …

Simulation Training In Radiation Oncology, Michael C. Schell, Andrew W. Beavis, Derek W. Brown, Michael Milano, Michael O'Neill, Yan Yu, Daniel C. Pavord, Peter Dunscombe

Department of Radiation Oncology Faculty Papers

Simulation training can be used in the design of new processes or, more commonly, to train and re-train healthcare personnel in standard processes. Simulation training is one avenue to making radiation oncology a high reliability health care intervention. In this paper, we explore the relevance of simulation training to the provision of high-quality and safe radiation oncology practice against the background of simulation training conducted in high reliability industries. The use of simulation training in healthcare, as well as specific examples in radiation oncology, is reviewed. An outline of the steps for developing a simulation training program is provided. Simulation …

Natural Resource Rents And Energy Poverty Nexus In Next Eleven Economies, Muhammad Salah Uddin, Ayub Ali, Zobayer Ahmed, Md Nasir Uddin Sikdar, Ahsan Habib, Abdullah Elah Al-Mahde

Finance Faculty Publications

Energy poverty (EP) remains a persistent global challenge with important implications for economic development, public health, and social welfare. While natural resources, particularly oil and gas, are often viewed as key sources of energy access, their effectiveness in mitigating EP remains underexplored in emerging economies. This study examines the relationship between natural resource rents (NRR), specifically oil rents (OR) and natural gas rents (NGR), and energy poverty (EP) in the Next Eleven (N-11) countries from 2000 to 2020. The primary objective is to assess how NRR influences EP at various levels of poverty using the Method of Moments Quantile Regression …

State-Level Variations In School Physical Activity Policies And Their Impact On Student Physical Activity In Arkansas And Oklahoma, Sydney K. Crees, Erin Howie Hickey

2026 Honors Symposium

Regular physical activity is critical for children's health and development, yet most U.S. children fall short of recommended daily activity levels. Schools represent a key opportunity to address this gap through PE and recess, though state policies governing these vary widely. This cross-sectional study compared school-based physical activity in Arkansas and Oklahoma, two states with distinct policies. Arkansas mandates 40 minutes of daily recess and 40 minutes of PE per week, while Oklahoma requires 60 minutes of weekly PE and 60 minutes of additional weekly physical activity but does not mandate recess. Surveys were distributed to principals and PE teachers …

Review Of Current Research Describing The Influence Of Non-Health Care Drivers Of Health In Rural And Urban Populations, Katie Youngen, Julia Cecil, Tyrone F. Borders

Rural & Underserved Health Research Center Publications

Social determinants of health (SDOH) (also called social drivers of health) are the conditions of the environment where people live, learn, work, and play that are known to affect health outcomes.¹ The primary objective of this literature review is to summarize the most recent literature related to the Healthy People 2030 domains of a) economic stability, b) education access and quality, c) neighborhood and built environment, and d) social and community context.² Our particular focus is on non-health care drivers of health. The secondary objective is to identify gaps in literature applied to rural populations.

Management Of Cardiovascular Disease Risk Factors By Rural And Urban Primary Care Practices, Lars E. Peterson, Zachary J. Morgan

Rural & Underserved Health Research Center Publications

In the United States, over 650,000 people die annually from cardiovascular disease (CVD) with high associated health care and economic costs.1 Despite a strong scientific basis for their beneficial impact on health,2 rates of preventive screening remain low.3 Levels of adherence to preventive guidelines are even lower in African American populations, socioeconomically disadvantaged populations, and underserved rural populations.4 Rural populations have higher rates of modifiable risk factors—obesity, smoking, physical inactivity—for CVD than urban populations and bear a disproportionate burden from CVD.5–7 Rates of undiagnosed and poorly treated high blood pressure are more common in rural areas.8,9 Racial/ethnic minority populations also …

Rural-Urban Differences In Dental Care Utilization After A Public Health Emergency, Quazi Minhaz Tabassum, Redwan Bin Abdul Baten, Ahmed A. Arif

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• Past year dental clinic visits declined among both rural and urban populations after the COVID-19 pandemic. However, rural patients are more likely to report delayed dental service utilization than their urban counterparts.

• Participants residing in Medicaid expansion states or with health insurance coverage were 16% less likely to delay dental visits overall.

• The COVID-19 pandemic further worsened the existing challenges in dental healthcare access for urban and rural communities.

Sleep Problems In Children With Adhd: Associations With Internalizing Symptoms And Physical Activity, Xiao Liang, Mengping Zhao, Li Su, Justin A. Haegele, Richard H. Xu, Jiayue Li, Jinxian Guo, Choi-Yeung Tse, Shirley X. Li, David H. K. Shum

Human Movement Studies & Special Education Faculty Publications

Children with attention deficit hyperactivity disorder (ADHD) experience high rates of sleep problems and are at increased risk for developing internalizing problems. This study aimed to examine the association of sleep problems and physical activity with internalizing symptoms in children with ADHD. This cross-sectional study included 188 children with ADHD (M age = 8.60 ± 1.38, 78.7% boys). Self-reported questionnaires were used to assess sleep problems (Pittsburgh Sleep Quality Index [PSQI]) and internalizing symptoms (Depression Anxiety Stress Scale 21 [DASS 21]). The presence of sleep problems was defined as a PSQI score > 5. Physical activity was recorded by an ActiGraph …

Associations Between Accelerometer-Measured Physical Activity And Sleep Duration And Health Indicators In Children And Adolescents With Attention-Deficit Hyperactivity Disorder: A Systematic Review And Meta-Analysis, Xiao Liang, Hui Qiu, Justin A. Haegele, Xiao Li, Minghui Li, Jiayue Li, Shirley Xin Li

Human Movement Studies & Special Education Faculty Publications

Objective

This systematic review and meta-analysis synthesized available studies to explore relationships between accelerometer-measured physical activity (PA) levels or sleep duration and health-related outcomes in children and adolescents with attention-deficit hyperactivity disorder (ADHD).

Methods

Following the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines, the six databases APA PsychInfo, CINAHL Ultimate, Embase, MEDLINE, SPORTDiscus with Full Text and Web of Science were searched from inception through July 2024. The correlation coefficient (r) was employed to determine the effect size in the meta-analysis. A random-effects model was utilised to estimate the potentially heterogeneously distributed effect sizes with a 95 % …

Accelerometer-Measured Physical Activity Among Children And Adolescents With And Without Neurodevelopmental Disorders: A Systematic Review And Meta-Analysis, Xiao Liang, Raffy C.F. Chan, Justin A. Haegele, Sean Healy, Richard H. Xu, Chang Liu, Ming Chen, Minghui Li, Hui Zhang, Cindy H.P. Sit, David H.K. Shum

Human Movement Studies & Special Education Faculty Publications

Purpose

Physical inactivity is a health concern for children and adolescents with neurodevelopmental disorders (NDDs) as it directly increases their risk of developing various health problems. Evidence on differences in accelerometer-assessed physical activity between children and adolescents with and without NDDs is inconclusive. And age- and body mass index (BMI)-related effects on physical activity remain unclear.

Methods

The systematic literature searches were performed in 6 databases up to March 2025. Methodological quality was evaluated by the Newcastle-Ottawa Scales. Data were pooled using a random-effects model. Hedges' g was used to express the effect size index with 95 % confidence interval …

Felt Ambivalence Weakens The Attitude-Intention Pathway For Regular Leisure-Time Physical Activity In Chinese Adolescents: A Three-Wavee Prospective Study, Yaogang Han, Yubing Wang, Pan Li, Guohua Zheng

Human Movement Studies & Special Education Faculty Publications

Background: Favorable attitudes toward regular leisure-time physical activity may not always translate into intention if adolescents feel ambivalent about the behavior. This study tested whether felt ambivalence weakens the prospective attitude–intention association and the indirect effect of attitude on later behavior through intention. Methods: Chinese adolescents (N = 1714; Grades 7–12; mean age = 15.0 years) completed a three-wave survey at approximately two-week intervals. Wave 1 assessed attitudes toward regular leisure-time moderate-to-vigorous physical activity, felt ambivalence, and physical activity habit; Wave 2 assessed intention; and Wave 3 assessed leisure-time physical activity. Moderated mediation was tested in a structural equation model …

Modélisation Spatiotemporelle De La Maladie De Lyme : Évaluation Du Risque D'Exposition Chez Les Travailleurs En Plein Air Au Québec, Mathieu Varin, Alberto Quezada Garcia, Gilles Joanisse, Virginie Millien, Batistin Bour, Bilel Chalghaf, Kirsten Crandall, François Milord, Jade Savage

Rapports de recherche scientifique

La maladie de Lyme, transmise par la tique à pattes noires, devient un problème de plus en plus important au Québec. Depuis 2009, les cas humains ont fortement augmenté, surtout dans le sud de la province. Les changements climatiques et les transformations du territoire issues des activités humaines favorisent la présence des tiques et de leurs hôtes, ce qui augmente le risque pour les personnes qui travaillent à l’extérieur.

Ce projet avait pour but de mieux comprendre où et quand ce risque est le plus élevé afin d’aider à protéger les travailleurs. Pour y arriver, nous avons combiné :

• des …

A Cost-Consequence Analysis Of The Children’S Administration Oxygenation Strategies Trial (Coast) In Severe Pneumonia, Orlagh U. Carroll, Richard Grieve, Sarah Kiguli, Peter Olupot-Olupot, Robert Opoka, Charles Engoru, Florence Alaroker, Abner Tagoola, Mainga Hamaluba, Eva Nabawanuka

Paediatrics and Child Health, East Africa

Oxygen supplementation is a recommended treatment for children with severe pneumonia or hypoxaemia. The open, fractional-factorial Children’s Oxygen Administration Strategies Trial (COAST) recruited Kenyan and Ugandan children with severe pneumonia and hypoxaemia. Participants in the severe hypoxaemia stratum (SpO₂ <  80%) were randomised to high-flow nasal therapy (HFNT) or low-flow oxygen (LFO), and in the hypoxaemia stratum (SpO₂ 80–91%) to HFNT, LFO or permissive hypoxaemia (ratio 1:1:2). The trial stopped early and there is ongoing uncertainty about the clinical benefits of the alternative strategies. There is a lack of evidence about the relative costs, of alternative oxygen delivery for critically-ill children in low- and middle- income countries. We used data from COAST to conduct a cost-consequence analysis …

Practicing Law From Home During The Pandemic: Findings From The University Of Michigan Law School Alumni Survey, David L. Chambers

Bibliography of Research Using UMLS Alumni Survey Data

The University of Michigan Law School, through its Alumni Survey Project, conducts annual surveys of its graduates regarding their current work and their careers as a whole.  In the surveys conducted in 2022, 2023, and 2024, the Project included questions about the impacts of the coronavirus pandemic on various aspects of graduates’ work – their productivity, their co-worker relationships, their client relationships, the balance of their work and family life, and their income – as well as on their work experience overall. 819 graduates who had practiced law fulltime during the pandemic responded to the questions and more than half …

"It's A Dance": Examining Midwives As Choreographers Of Reproduction In Maine, Annie Goldstein

Honors Theses

This thesis examines the contemporary work of community-based Maine midwives through the theoretical framework of choreography. In the context of this work, choreography can be understood as the well-thought-out, purposeful undertaking of a process during which negotiation, coordination, and improvisation are required to adapt to constantly changing circumstances. Using choreography, this thesis attempts to understand how Maine midwives navigate global market processes and practice under authoritative forms of biomedicine, ultimately linking them to other midwives across various global sites. Situated within Maine’s maternal health landscape that is characterized by the ongoing closure of labor and delivery units and rural hospitals, …

Meconium Metal Concentrations And Infant Temperament And Development, Fiona Fogarty

Dissertations and Theses

BACKGROUND: Prenatal exposure to metals poses significant health consequences for early childhood development. Understanding the factors influencing metal concentrations that infants are exposed to in-utero is crucial for developing targeted interventions, particularly when maternal characteristics and environmental factors, may contribute to varying levels. Meconium offers insight into in-utero exposures for the developing infant, and the effect of each individual metal may be mediated or exacerbated by another and therefore should be studied in the context of a mixture. The effect of metal mixture exposure, as measured in meconium, on milestone and temperament outcomes has yet to be determined.

DESIGN: …

Ebola In The Drc: A Different Problem Compounded By Violence, David Brett-Major

Journal Articles: Epidemiology

A Public Health Emergency of International Concern (PHEIC) has been declared in the Democratic Republic of Congo (DRC) due to Ebola disease from Bundibugyo virus. Non-health-focused factors should be fundamental to how DRC and its partners respond to and recover from the current emergency. Filovirus emergencies are violent in every sense-the disease experience of patients and their caregivers, the tumult in impacted communities, sometimes the physical manifestations of frustration against healthcare services, the fits and starts of concerted response, and the milieu of conflict in which this emergency occurred. Yet, interpersonal and organized violence may contribute to frequency of health …

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

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

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

Purchasing A Healthier Future: A Nutrition-Focused, Community-Centered Approach To Reduce Obesity And Diabetes In Graves County, Kentucky, Marissa Stephens

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

Obesity and type 2 diabetes are among the most significant public health challenges in the United States, with Kentucky consistently ranking among the states with the highest prevalence of both conditions. Together, these conditions contribute to reduced quality of life, rising healthcare costs, and increased morbidity and mortality, underscoring the need for targeted, community-centered interventions. The disease burden of obesity and diabetes is particularly pronounced in rural areas, including the state’s westernmost region, the Jackson Purchase. Among rural populations, chronic disease risk is driven by a combination of factors, including low socioeconomic status, limited access to healthcare/supermarket options, and food …

Enhancing Breast Cancer Screening Uptake In Hispanic Women Residing In Rural Texas Through A Quality Improvement Project, Bianca Batchelor-Salazar

Doctor of Nursing Practice (DNP) Scholarly Projects

Background: Breast cancer remains a leading cause of cancer-related mortality among women in the United States. Despite the effectiveness of mammography in early detection, Hispanic women in rural communities experience lower screening rates due to socioeconomic, cultural, and access-related barriers. At a rural South Texas clinic, the baseline screening rate among Hispanic women aged 50–74 years was 70.6%, below national benchmarks.

Purpose: To increase breast cancer screening compliance among Hispanic women aged 50–74 years in a rural South Texas family practice clinic.

Methods: Guided by the Lean A3 quality improvement framework, this project implemented a multifaceted intervention bundle that included …

A Chronic Pain Self-Management Quality Improvement Bundle For Veterans, Srijana D. Baniya

Doctor of Nursing Practice (DNP) Scholarly Projects

Introduction: Veterans often face challenges accessing care services due to limited awareness of available resources for support, Self-care, and mental health (Harding et al., 2019; Patel et al., 2024). Given the high prevalence of Chronic pain and opioid use in this population, Self-management (SM) education and non-pharmacologic interventions are required to address the biological, psychological, and social effects of pain (Bair et al., 2015; Mumba et al., 2024; Nahin, 2017; Higgins et al., 2020). This Quality improvement project aims to determine whether implementing an evidence-based SM bundle for chronic pain improved Pain severity scores and increased understanding of SM strategies. …

Photovoice Exploration Of Afghan Refugee Background Women's Food-Related Well-Being, Eileen C. Lindemann

Graduate Research Theses & Dissertations

More than 117,000 Afghans have been relocated to the United States following the U.S. military withdrawal in August 2021. Research indicates that Afghan refugees resettled in the U.S. are at increased risk of psychological distress, with Afghan women particularly susceptible compared with Afghan men, and diet-related chronic disease. However, research also shows that traditional food and eating customs foster cultural identity, social support, integration, and well-being. The purpose of this study was to collaboratively explore the food-related well-being and daily life contexts of resettled refugee participants through the photovoice method, a participatory research strategy in which participants photograph aspects of …

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

Social Work Dissertations

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

From Coverage To Care: Evaluating The Effects Of Aca Medicaid Expansion On Birth Outcomes, Bailey R. Lengfelder

Economics Honors Projects

I examine the impact of the Affordable Care Act’s Medicaid expansion on maternal and fetal health outcomes using National Center for Health Statistics Natality data from 2006 to 2023. I exploit staggered state adoption as a quasi-experiment, and the staggered differences-in-differences estimates indicate an increase in the share of Medicaid births but broadly no impact on maternal prenatal care, maternal health, and fetal health. The absence of statistically significant effects is consistent across heterogeneity groups. These null findings indicate that expanded insurance access through the Affordable Care Act may be insufficient to improve health outcomes. I do find a statistically …

Management-Driven Shifts In The Bison Fecal Microbiome And Its Relationship To Stec Prevalence, Ritesh Ray

Graduate Research Theses & Dissertations

Contamination of meat samples from pathogens such as Shiga toxin-producing E. coli (STEC), especially in ruminants, is an ever-growing issue for the safety of global meat production. Recent studies have reported STEC in the livestock and food industry with a limited focus on wildlife. Although cattle serve as the primary reservoir for STEC, American bison (Bison bison bison) is the largest ruminant inhabiting North America, sharing similar genetics, and grazing habits, making them an ideal alternative STEC reservoir. Re-introduction for prairie conservation and meat farming has brought bison herds closer to anthropic environments than before. Recently bison meat has become …

“Kuchoka”: Investigation Of Research Fatigue In Mosoriot, Kenya, Felishana Cherop, Violet Naanyu, Juddy Wachira, Lukoye Atwoli

Internal Medicine, East Africa

Background: Health research is key to the promotion of population and community health, however, conducting many research studies in a community can cause research fatigue.

Purpose: We determined the prevalence of research fatigue and associated factors in Mosoriot, Kenya.

Methods: We conducted a cross-sectional study in the Mosoriot community from Wednesday 28, May 2014, to Thursday 30, April 2015, involving (n = 327) community members who were randomly sampled to respond to self-administered and/or guided questionnaires. We analyzed descriptive statistics to summarise the data and used the Pearson Chi-Square test to assess the bivariate associations between the …

Longitudinal Implementation Of A Neurodevelopmental Screening Program For Children Born To Mothers Living With Hiv In Maternal–Child Clinics In Kenya: A Mixed Methods Study, Megan S. Mchenry, Eren Oyungu, Amina Abubakar, Ananda Roselyne Ombitsa, Micaela Gaviola, Cleophas Cherop, Beatrice Kaniaru, Carolyne Jerop, Alan Mcguire, Rachel C. Vreeman

Institute for Human Development, East Africa

Background: Children with perinatal HIV exposure are at increased risk for neurodevelopmental (ND) delays, yet little is known about ND screening implementation for this population.

Methods: This longitudinal study evaluated ND screening implementation at a health clinic in Kenya, from 9/2021 to 8/2023. Children aged 18-36 months with perinatal HIV exposure were screened using a 12-item general ND tool. Implementation outcomes—acceptability, feasibility, fidelity, and sustainability—were assessed through time-motion observations, clinic records, and semi-structured interviews with caregivers and staff.

Results: Of 507 eligible children, 405 (80%) were screened. Screening rates were consistent over 24 months, with average time …

Delivering Safe Sleep And Breastfeeding Education To Pregnant And New Mothers Through Private Facebook Groups: Study Protocol For A 4-Armed Randomized Controlled Trial, Rebecca F. Carlin, Margaret G. Parker, Ann L. Kellams, Fern R. Hauck, Stephen Kerr, Benjamin T. Cornwell, Marc T. Kiviniemi, Nicole Geller, Katherine E. Boguszewski, Michael J. Corwin, Eve R. Colson, Rachel Y. Moon

Health, Behavior & Society Faculty Publications

Background: Annually, more than 3500 US infants die suddenly and unexpectedly. Many sudden unexpected infant deaths (SUID) are preventable with greater adherence to safe infant sleep guidelines. There are racial and economic disparities in guideline adherence and SUID rates. Education alone has proven ineffective at altering behavior for many parents, and social networks and social norms regarding infant care have been found to influence rates of unsafe sleep. Using the power of social networks to shape social norms by delivering education through moderated online social media groups provides a unique opportunity to influence these practices in large groups of parents. …