Digital Commons Network^™

Exploring Public Health Nurses’ Perceptions Of Syringe Services Programs In Southern Rural Areas, Joel Lowery

Walden Dissertations and Doctoral Studies

Public health nurses are potentially key stakeholders in syringe services program (SSP) implementation in rural areas, where they can act as liaisons between public health, private healthcare, and the community. However, little research reflects an in-depth understanding of how public health nurses perceive SSPs in rural areas. The purpose of this qualitative study was to explore the perceptions of syringe services programs held by public health nurses practicing in rural areas with no existing SSPs in southern states and ascertain their potential roles in facilitating harm reduction for people who inject drugs. This study was guided by a conceptual framework …

Cancer Screening Disparities Among Women With Disabilities In The United States, Kathleen Young

Walden Dissertations and Doctoral Studies

Breast and cervical cancer screening reduces mortality; however, women with disabilities and mental health challenges experience persistent disparities in access to preventive services. The purpose of this quantitative study was to examine the relationships between self-reported serious difficulty hearing, serious difficulty seeing, and frequent mental distress with breast (mammogram) and cervical (Pap test) cancer screening use among women in the United States (mammogram model, n = 844; Pap model n = 774), using the 2023 Behavioral Risk Factor Surveillance System dataset. The social-ecological model provided the framework. Two logistic regression models were conducted, adjusting for age, race/ethnicity, education, income, marital …

Social Vulnerability Associations With Hypopharyngeal Carcinoma Treatment And Prognostic Disparities, Camaren M. Cuenca, David M. Bruss, David J. Fei-Zhang, Jill N. D'Souza, Anthony M. Sheyn, Jeffrey C. Rastatter, Daniel C. Chelius

School of Medicine Faculty Publications

Objectives: Prior studies investigating the impacts of social determinants of health (SDoH) on hypopharyngeal cancer have only assessed the impact of individual factors on patient outcomes. This study uses the CDC's Social Vulnerability Index (SVI) and a national patient cohort to examine how the interrelational influence of SDoH affect hypopharyngeal cancer prognosis, treatment, and follow-up. Methods: This retrospective cohort study analyzed patients from 1975 to 2017 with a diagnosis of hypopharyngeal carcinoma in the NCI-SEER database. Net social vulnerability and its contributions from 15 SDoH variables were ranked and scored across all US counties, yielding a SVI. SVI scores were …

Creation And Evaluation Of Standardized Electronic Health Record Templates For Transition Of Care In Sickle Cell Disease: A Pilot Study, Stephanie Howe Guarino, Mohan Madisetti, Payal C. Desai, Akshat Jain, Kenneth Rivlin, Jerome A. Osheroff, Robin Miller, Brandi Campanella, Sophie Lanzkron, Julie Kanter

Cardeza Foundation for Hematologic Research

Objective The objective of this pilot project was to create a standardized Transition Note in the electronic health record (EHR) to facilitate clinician communication during the transition process from pediatric to adult care for youth with sickle cell disease (SCD). Methods Using a modified Delphi process, consensus was reached among 78 member centers from the National Alliance of Sickle Cell Centers (NASCC) on the essential health data elements for a standardized EHR Transition Note. Templates were created in 2 different EHR systems and piloted at 2 SCD centers. Perceived clinician acceptability, appropriateness, and feasibility were assessed using the AIM-IAM-FAM measures …

Mold Exposure And Cognitive Health During Menopausal Transitions: A Quantitative Analysis Using Secondary Data, Holly Jeannette Burns

Walden Dissertations and Doctoral Studies

Mold exposure and menopausal transition have been independently linked to cognitive decline, yet their interaction among socioeconomically disadvantaged populations has not been well examined. This quantitative study is an exploration of how menopausal transition influences the relationship between mold exposure and cognitive health outcomes among women aged 40 to 60 living in low-income housing in the United States. Bronfenbrenner’s ecological systems theory was used to guide the cross-sectional design using secondary data from the 2005–2006 National Health and Nutrition Examination Survey (NHANES; N = 149). Weighted logistic regression and Hayes’ PROCESS (Models 2 and 4) were used to test associations …

Community Factors And County-Level Cancer Screening, Prevalence, And Mortality, Alexandra R. Drake, Eric W. Christensen, Augusto C. Ochoa, William Small, Jinel Scott, Elizabeth Y. Rula

School of Medicine Faculty Publications

IMPORTANCE Cancer screening, prevalence, and mortality vary across US counties; the broad set of community factors associated with these differences are not well understood. OBJECTIVE To assess the relative importance of diverse community measures for explaining county-level variance in cancer screening, prevalence, and mortality rates for breast, colorectal, lung, and prostate cancers. DESIGN, SETTING, AND PARTICIPANTS This geospatial cross-sectional analysis across all US counties used random forest algorithms to estimate the relative importance of 24 community measures—including health behaviors and lifestyle, socioeconomic, and environment factors—as explanatory factors for cancer screening, prevalence, and mortality. For each cancer, county-level cancer screening and …

Subjective Excessive Daytime Sleepiness And Frailty Progression In Veterans Over 50 With Insomnia, Mona Amirmazaheri

Walden Dissertations and Doctoral Studies

Frailty is common in aging veterans and linked to adverse outcomes. This retrospective cohort study of 6,824 veterans with insomnia examined whether excessive daytime sleepiness, sleep treatments, and PTSD affected frailty progression over four years. Frailty was measured using a validated index, with models adjusted for demographics and comorbidities, including chronic coronary insufficiency. Manuscript 1 showed that a higher Epworth Sleepiness Scale (ESS) score (range 0-24) was independently associated with a higher frailty index (FI) (p < .001). A clinical threshold of ≥11 indicated EDS and greater odds of frailty worsening compared to scores <11 (adjusted odds ratio (aOR) = 1.16, 95% CI [1.02, 1.32], p = .021). There was no significant interaction between ESS and time, suggesting that sEDS reflects persistently elevated frailty levels rather than accelerated decline. Manuscript 2 showed that nonpharmacologic sleep interventions were protective, while pharmacotherapy was associated with increased frailty risk. Cognitive behavioral therapy for insomnia was associated with lower odds of frailty worsening (aOR = 0.31, 95% CI [0.19, 0.53], p < .001), and continuous positive airway pressure therapy also reduced risk (aOR = 0.55, 95% CI [0.39, 0.76], p < .001). In contrast, sleep medications were associated with increased odds of frailty progression (aOR = 1.16, 95% CI [1.02, 1.32], p = .021). Manuscript 3 showed that PTSD was not associated with baseline frailty levels but showed a significant time interaction (B = 0.001, p = .008), indicating modest acceleration of frailty progression among affected veterans. Findings support positive social change through early sEDS screening and trauma-informed, nonpharmacologic sleep care to reduce frailty in veterans.

Mental Health Amongst African American Healthcare Workers And Covid Vaccine Mandates, Christopher Brandlin

Walden Dissertations and Doctoral Studies

This qualitative case study investigated vaccine hesitancy among African American healthcare workers in Los Angeles County, California in light of employment loss following the State Public Health Officer Order of August 5, 2021. The literature indicated that vaccination policies have impacted the psychological health of healthcare workers, especially those with vaccine doubts. The research problem addressed in this study was that the mental health effects among African American hospital workers who lost employment as a result of vaccine hesitancy was not known. The purpose of this generic qualitative case study was to explain the factors contributing to vaccine hesitancy in …

Adverse Childhood Experiences, Positive Childhood Experiences, And Digital Media Use Among Children And Adolescents In The United States, Elizabeth L. Crouch, Emma Boswell, Monique J. Brown Ph.D., Kevin J. Bennett

Publications

No abstract provided.

Alcohol Consumption And Cervical Carcinogenesis: Time To Draw Conclusions, Vivek Kashyap, Divya B. Kenchappa, Ajay K. Singh, Bhupesh Singh, Murali M. Yallapu, Everardo Cobos, Subhash C. Chauhan

School of Medicine Publications

Cervical cancer is the fourth most common cancer among women worldwide and remains a significant cause of cancer-related mortality. Alcohol consumption is linked to an increased risk of several cancers and is a controversial risk factor for developing cervical cancer. This review updates existing information on the correlation between alcohol consumption and the risk of developing cervical cancer. Several comprehensive studies from different geographical regions have shown that moderate and heavy drinking is positively correlated with the development of cervical cancer. There is a synergistic relationship between human papillomavirus (HPV) viral load and alcohol use among drinkers with a high …

Neighborhood Conditions And Screen-Time Impact On U.S. Children And Adolescents’ Mental Health, Robert L. Burries

Walden Dissertations and Doctoral Studies

Child and adolescent mental health problems are increasing, creating a critical public health concern. Both neighborhood disadvantage and excessive screen use have been implicated as risk factors, yet their interplay remains underexplored. This study investigated whether screen time mediates the relationship between neighborhood conditions and mental health outcomes in U.S. youth. Grounded in Bronfenbrenner’s ecological systems theory, the study addressed three questions: (a) Do neighborhood conditions predict youth mental health outcomes? (b) Is screen time associated with these outcomes? (c) Does screen time mediate the neighborhood–mental health relationship? A cross-sectional secondary analysis of the 2018–2019 National Survey of Children’s Health …

Econometric Analyses Across The Continuum Of Care For Individuals With Hearing Loss, Teresa I. Anthony

USF Tampa Graduate Theses and Dissertations

Hearing loss affects individuals across the age span and, if left untreated, can lead to developmental delays and health and well-being concerns. This dissertation applies econometric analyses to investigate factors influencing diagnostic outcomes in the neonatal intensive care unit (NICU), intervention enrollment rates among babies with permanent childhood hearing loss (PCHL), and utilization and hospitalization outcomes among adults with sensory impairment (SI). The first study evaluates the cost-effectiveness of automated auditory brainstem response (aABR) versus transient evoked otoacoustic emissions (TEOAE) for newborn hearing screenings in a Thailand hospital NICU. Decision tree modeling and economic evaluation suggested that although aABR is …

Association Between Diabetes Mellitus, Hypertension, Obesity, And Diagnosis Of Covid-19 In Puerto Rico, Julian Rene Rivera Rodriguez

Walden Dissertations and Doctoral Studies

The population of Puerto Rico has been heavily affected by chronic diseases; however, data remains limited on the influence of diabetes mellitus (DM), hypertension, and obesity on the probability of COVID-19 diagnosis. The purpose of this quantitative study was to evaluate the association between non-communicable diseases that included DM, obesity, hypertension, and COVID-19 diagnosis, controlling for age and sex and person exposure in Puerto Rico. The sample consisted of 1,463 participants who underwent a polymerase chain reaction (PCR) test for COVID-19 from April 1, 2020, to March 31, 2021. Results from adjusted multivariable logistic regression analyses established that obesity OR …

A Cross-Sectional Study On Teenage Pregnancy And Its Associated Factors In A District Of Eastern India, Ashifa Sultana, Jayita Pal, Purnashree Mandal, Manoj Ghosh

Internet Journal of Allied Health Sciences and Practice

Introduction: Teenage pregnancy is a global public health concern with wide-ranging consequences for adolescent mothers, their families, and society at large. By investigating sociodemographic factors, contraceptive knowledge, and family dynamics, this study aimed to gain a comprehensive understanding of the factors contributing to teenage pregnancy in Nadia district, West Bengal, India.

Materials & method: A cross-sectional study was conducted among 232 pregnant women of Chakdaha block. The study participants were selected by simple random sampling from the line list available at the sub-centres. The Chakdaha block of Nadia district was chosen by multistage sampling. All the pregnant women thus included …

Implicit Bias Training Standards In Health Care: Did Michigan Get It Right? A Policy And Ethical Framework Analysis, Megan Gailliard, Kieran Fogarty, Mary Lagerwey

The Open Journal of Occupational Therapy

In 2022, Michigan joined a handful of states requiring implicit bias training for its health care professionals. In its ideal application, implicit bias training of health care professionals will result in a reduction of the implicit biases held by health care providers. This bias reduction will, in theory, contribute to improved equity in the delivery of health care services. Ultimately, the less biased health professional, now delivering health care services with a more equitable hand, will help reduce health disparities in the State of Michigan.

This analysis of Mich. Admin. Code R.338.7004 - Implicit bias training standards for licensed and …

Managing User Conflicts In A Water Aerobics Program On Behalf Of A Veteran’S Group: A Short Case Study, Hadley Blankenship, Steven N. Waller Ph.D., Jason L. Scott

International Journal of Aquatic Research and Education

This article captures an experience in conflict management that happened during the summer of 2024 as a recreational therapy intern with an adaptive sport and recreation organization located in the Southeastern United States. The backdrop to the case is that a recreational therapy intern worked with various special needs populations – mainly with paraplegic (adult and youth) athletes and veterans. In many organizations, user conflicts and poor communication regarding service provision and scheduling hinder the implementation of programs for special populations, such as veteran groups. In this case, a problem occurred with the scheduling of a water aerobics program for …

Curbing Fatal And Non-Fatal Drowning Deaths: An Effort To Reach Under-Resourced Children In Baltimore, Maryland, Ashton P. Christo, William D. Ramos

International Journal of Aquatic Research and Education

Drowning remains a significant public health problem in the United States, with The Centers for Disease Control and Prevention (CDC) reporting approximately 4,000 drowning deaths annually. Children aged 1-4 face the highest risk, and African American children are disproportionately affected–7.6 times more likely to drown than white children (CDC, 2024). In a city on the East Coast that is predominantly African American, limited access to swimming lessons heightens the risk. To reduce drowning rates, a collaborative swimming program was established between a city high school and a public school enrichment program. The initiative provided essential water safety and swimming skills …

Diversity In Aquatics:4th Special Issue, Tiffany M. Quash Ph.D., Angela K. Beale-Tawfeeq, Steven N. Waller Ph.D.

International Journal of Aquatic Research and Education

The theme of this special issue is “Building a Community of Champions.” The purpose of this theme is to highlight and promote a civic engagement perspective that engages, advocates, and supports communities of Black, Indigenous, People of Color (BIPOC) in addressing the national, regional, and local evolving health-related issue of drowning. Aquatic Settings have been a pivotal focal point of social justice, water safety, and public health, not only in the past but also in our present day (Beale-Tawfeeq, Quash, et al, 2023 and Waller and Bemiller, 2023). Diversity In Aquatics (DIA) strives to positively impact the field of aquatics …

Teaching Swimming To Children With Disabilities: A Qualitative Analysis Of Swim Instructorstea, Stephanie S. Garcia-Hidalgo, Martin E. Block

International Journal of Aquatic Research and Education

When teaching children with disabilities, swim instructors need to be able to assess the unique strengths and needs of each child to determine modifications needed to instruction, equipment, and the setting and then be flexible enough to make changes in real-time to ensure success for the child. Unfortunately, many swim instructors only work seasonally and have the occasional child with a disability, and as a result are likely to have limited training and experiences with children with disabilities. The purpose of this pilot qualitative study is to examine backgrounds, training, and experiences of six swim instructors who work with children …

Promising Practices For Increasing The Number Of Equity-Owed Lifeguards In Canada And The United States Of America, Sofia Pantano, Audrey R. Giles

International Journal of Aquatic Research and Education

Currently a shortage of lifeguards exists in Canada and the United States (US) (Frommer, 2023; Santucci, 2024), and those who are working as lifeguards often do not reflect the diversity of the communities they serve (Martinez, 2020). Increasing the number of lifeguards from equity-owed groups is a potential way of increasing the lifeguard workforce and decreasing the shortage of workers in these important roles, as well as a moral imperative. In this paper I explore challenges to and promising practices aimed at increasing the representation of members equity-owed groups in lifeguarding. I begin with an overview of lifeguarding in Canada …

Adopting Stuart Hall’S “Race, The Floating Signifier” As A Conceptual Framework Within Aquatic Research And Education, Kurt J. Cordice

International Journal of Aquatic Research and Education

During his 1997 lecture at Goldsmiths College in London, Stuart Hall, renowned for his contributions to sociology and cultural studies, offered his argument that the concept of race functions as a Floating Signifier. In this essay, Stuart Hall’s Race, the Floating Signifier is presented as a strong conceptual framework to support more accurate and effective positioning of race as an important consideration within aquatic research and education. Evidence from a range of disciplines, including historical research, is presented to establish both the importance and challenge of race within aquatic research and education. This evidence is also used to demonstrate …

Large Language Models As Information Providers For Appropriate Antimicrobial Use: Computational Text Analysis And Expert-Rated Comparison Of Chatgpt, Claude And Gemini, Marcello Di Pumpo, Maria Rosaria Gualano, Danilo Buonsenso, Francesca Raffaelli, Daniele Donà, Vittorio Maio, Patrizia Laurenti, Walter Ricciardi, Leonardo Villani

College of Population Health Faculty Papers

OBJECTIVES: Antimicrobial resistance is a critical public health threat. Large language models (LLMs) show great capability for providing health information. This study evaluates the effectiveness of LLMs in providing information on antibiotic use and infection management.

METHODS: Using a mixed-method approach, responses to healthcare expert-designed scenarios from ChatGPT 3.5, ChatGPT 4.0, Claude 2.0 and Gemini 1.0, in both Italian and English, were analysed. Computational text analysis assessed readability, lexical diversity and sentiment, while content quality was assessed by three experts via DISCERN tool.

RESULTS: 16 scenarios were developed. A total of 101 outputs and 5454 Likert-scale (1-5) scores were obtained …

Building Swimming Skills In A Community Based Program For Black Youth: An Evaluation, Tyler Lennon Md, Mph, Ashley Hayes Mph, Leonardo Barrera Mph, Amy Hill Ms, Mph, Andy Miner, Michelle Macy Md, Ms

International Journal of Aquatic Research and Education

Black youth in the United States disproportionately experience fatal drowning at rates up to five times higher than their white peers. Eliminating these inequities requires new approaches that address historical and structural barriers of learning to swim. The objective of this study was to evaluate the three-week long swimming component of a community-based discovery program to empower Black youth in Evanston, IL. Participants were Black youth ages 8-10 years enrolled in summer 2023 and 2024. Swim skills were assessed by instructors using the Pictorial Scale of Perceived Water Competence (PSPWC). Caregiver surveys, collected post-intervention, also assessed perceived changes in swim …

An Innovative Approach Addressing Childhood Drowning: Making Use Of Collegiate Aquatic Facilities And Expertise, Gennette Cordova, Natasha Lloyd, Chezik Tsunoda

International Journal of Aquatic Research and Education

The silent epidemic of childhood drowning, and the racial disparities associated with it require scalable and innovative approaches that both break cycles of exclusion and circumvent our societal tendency to overlook drowning as a matter in need of urgent resolution. No More Under, a Seattle-based water safety organization whose mission is to eradicate childhood drowning, has launched the Swim Safely Series. The series is a national program uniquely poised to overcome the various barriers associated with racial and socioeconomic drowning disparities by tapping into underutilized collegiate aquatic spaces and merging water safety with mentorship and social intervention.

Eye On The Prize: Expanding Student Awareness Of Optometry As A Profession, Lorena Flores-Hernandez

MedEd Teaching Certificate Program

The proposed Doctor of Optometry program at UTRGV has the potential to positively enhance the ocular health of our communities. Implementing an outreach program highlighting a career path in optometry will be essential for the future of eyecare in the Rio Grande Valley.

According to data from the US Bureau of Labor Statistics, the optometric workforce is projected to grow over the next decade. The increased demand for optometrists is related to multiple factors including an aging population with chronic diseases and a nationwide shortage of ophthalmology practitioners.

Nationally, the Optometry Gives Me Life campaign, launched by the Association of …

Strategies For Addressing Covid-19 Vaccine Equity With Intermediaries, Prevention Research Centers, And The Vaccine Confidence Network, Kelianne K Hara-Hubbard, Allison Beaulieu, Anais Mendiola, Pooja Gandhi, Nicole Kuiper, Richard Quartarone, Jinni Tang, Olivia Dominguez, Maritza Bond, Dorothy Cohen, Margaret Goetz, Nasra Mohamed, Paula Cuccaro, Peggy A Hannon, Maria E Fernandez, Jackson Higginbottom, Rafael Pérez-Escamilla, Bárbara Baquero

Faculty, Staff and Student Publications

In April 2021, the CDC provided supplemental funding to all 26 Prevention Research Centers (PRCs) to create the PRC Vaccine Confidence Network (VCN) to increase COVID-19 vaccine confidence and uptake in communities disparately impacted by COVID-19 and/or in vaccine hesitant populations. A key strategy to building vaccine confidence was engaging with intermediaries (i.e., mutually trusted community and practice-based organizations conducting community outreach and intervention activities) to address barriers for our shared communities of focus. These intermediaries were key in building community trust, addressing community needs and concerns, and in turn, building vaccine confidence and demand in areas and communities disproportionately …

Silent Signals: Human Trafficking And The Dental Professional’S Duty To Act, Pamela Zarkowski

Journal of the American College of Dentists

Human trafficking is a global public health and human rights crisis that includes forced labor and commercial sexual exploitation. Dental professionals are uniquely positioned to recognize signs of trafficking, as many victims encounter healthcare settings, including dental offices, during their exploitation. This article introduces the types and prevalence of trafficking, outlines legal and ethical responsibilities, and provides clinical red flags, case scenarios, and actionable strategies for screening and reporting. Myths that hinder detection are also addressed. By recognizing their ethical duty to protect vulnerable patients, dental professionals can become vital allies in the identification and support of trafficking survivors.

21st-Century Dental Public Health: Revisiting The Role Of Community Water Fluoridation, Larry Williams, Preetha Kanjirath

Journal of the American College of Dentists

Community water fluoridation (CWF) has been celebrated as a major public health achievement, significantly reducing dental caries and narrowing oral health disparities. While historically effective, today’s fluoride exposure landscape has shifted, with multiple sources contributing to cumulative intake. This article reviews the scientific foundation, mechanisms of action, public health benefits, and ethical considerations surrounding CWF, alongside real-world outcomes from policy reversals. It examines contemporary concerns, including potential neurodevelopmental risks and vulnerable populations, and calls for recalibrated policies that maintain caries prevention benefits while monitoring total fluoride exposure to ensure safety in modern contexts.

Ethical Dilemmas Surrounding Community Water Fluoridation, Roopwant Kaur, Herminio Perez, Mark Moss

Journal of the American College of Dentists

Since the 1950s, community water fluoridation (CWF) has stood as a cornerstone of dental public health. However, a growing amount of public scrutiny necessitates reflection on the ethical basis for coming to a firm position on the topic. Aside from CWF, fluoride in the form of ingestible supplements has recently been identified as a concern by the US Food and Drug Administration. Indeed, it is challenging to wade through the facts, opinions, misinformation, and policy shifts. This article examines the ethical dilemmas that surround CWF through the lens of the American Dental Association (ADA) Principles of Ethics and Code of …

J Am Coll Dent 2025 92 1

Journal of the American College of Dentists

The Journal of the American College of Dentists (JACD) publishes scholarly articles, editorials, essays, and reflections addressing the ethical, professional, and social dimensions of dentistry. The Journal serves as a forum for advancing ethics, professionalism, leadership, and excellence within the dental community. By fostering dialogue across disciplines and perspectives, JACD provides readers with insights that encourage ethical, professional practice, lifelong learning, and service to the public, reinforcing dentistry’s commitment to advancing oral healthcare and the common good.