Digital Commons Network^™

Exploring The Association Between Smartphone-Based Place Visitation Data And Neighborhood-Level Coronary Heart Disease In The United States, Temitope Akinboyewa, Zhenlong Li, Huan Ning, M. Naser Lessani, Louisa M. Holmes, Shan Qiao Ph.D.

Faculty Publications

Coronary Heart Disease (CHD) is the leading cause of death in the United States, affecting over 20.5 million adults. Previous studies link health behaviors – such as dietary behavior, physical activity, smoking, and alcohol consumption – to CHD risk. These studies typically use surveys and interviews, which, despite their benefits, are resource-intensive and limited by small sample sizes. Using large-scale national level anonymized smartphone-based location data, our study examines whether health behaviors that are proxy measured by place visitation are associated with CHD prevalence across US census tracts. This study utilized data from multiple sources, including demographic and socioeconomic characteristics, …

Disentangling The Effect Of Criminal Legal System Involvement On Mental Health In The United States, Pui Ying Chan

Dissertations and Theses

BACKGROUND: Interactions with the criminal legal system (CLS), such as through arrest or incarceration, are relatively common in the United States (US) and are increasingly recognized as social risk factors for poor mental health. Previous studies have reported a positive association between CLS involvement and poor mental health, with some theoretical frameworks, including the ecosocial theory and the stress process paradigm, supporting a plausible causal relationship. However, prior research has significant limitations in providing casual evidence given possible reverse causation in cross-sectional studies and insufficient consideration for the dynamics between CLS exposures, mental health status, and related confounders over time …

Beyond Smoking: A Geospatial Investigation Of Factors Associated With Lung And Bronchus Cancer Risk In Pennsylvania, Tesla D. Dubois, Daniel Wiese, Kevin A. Henry, Shannon M. Lynch

Kimmel Cancer Center Faculty Papers

INTRODUCTION: While smoking is the leading cause of lung and bronchus cancer (LBC), additional exposures have been implicated and may explain the rise in LBC among never-smokers. To better understand the spatial distribution of LBC incidence and associated risk factors, this study aims to identify geographic areas with significantly elevated incidence rates in Pennsylvania and investigate the potential underlying risk factors.

METHODS: Using cancer registry data aggregated to the census tract level, spatial scan statistics were applied to detect areas of higher-than-expected LBC incidence across the state. Associations were then tested between census tract inclusion in a high-incidence area and …

An Evidence-Based Intervention To Increase Trypanosoma Cruzi, A Neglected Parasitic Infection, Diagnosis In Rural And Moderate-Size-City Us Clinics, M K. Lynn, Hunter M. Boehme, Jeffrey Hall, Patrick Kent, Alain H. Litwin, Quang H. Pham, Melissa Nolan Ph.D., Mph, Prisma Chagas Team

Faculty Publications

Background

Chagas disease is a chronic, insidious parasitic infection (Trypanosoma cruzi) that slowly develops to irreversible organomegaly over several decades. The disease is traditionally acquired in endemic Latin American countries during childhood; < 1% of foreign-born adult residents in the United States have been diagnosed or treated with this potentially fatal disease. Low physician knowledge is a primary factor leading to misdiagnosis.

Methods

Starting in April 2022, a 4-part T cruzi clinical education intervention began, which included (i) 2 grand rounds presentations to >100 internal medicine providers; (ii) implementation of a “clinical Chagas champions program” incorporating 14 key clinical staff at varying departments and administrative levels educated on their specific role related to T cruzi screening, diagnosis confirmation, clinical management, and medical billing; ( …

Increasing Implementation Of The Comfortable Cafeteria Program To Promote School-Age Children’S Mental Health And Well-Being, Reinecka Mondesir, Angela Labrie Blackwell Phd, Otr

Summer 2025 OTD Capstone Symposium

Every Moment Counts (EMC) is a positive mental health promotion initiative that offers several initiatives to create inclusive environments that support student participation and emotional well-being throughout the school day. Comfortable Cafeteria, part of EMC, fosters positive mealtime experiences supporting peer interaction, emotional regulation, and inclusion. Many SBOT practitioners lack the resources to implement Comfortable Cafeteria, despite its benefits. This capstone project addresses the need for practical tools to help school-based occupational therapy (SBOT) practitioners integrate the Comfortable Cafeteria program into daily practice. Using the Multi-Tiered System of Supports (MTSS) framework, the project developed and disseminated an interactive, evidence-based video …

Lsu-Crescentcare Sexual Health Center: An Inter-Organizational Partnership Initiative To Improve Access To Sexual Health Services In New Orleans, Louisiana, United States, Stephanie N. Taylor, Rebecca A. Lillis, Ronald D. Wilcox, Laura Damioli, David H. Martin, Alice Riener, Julio E. Figueroa, M. Jacques Nsuami

School of Medicine Faculty Publications

Objectives: To describe a partnership between CrescentCare and Louisiana State University (LSU) School of Medicine that created a new Sexual Health Clinic in New Orleans, and to assess the health services that patients sought and received at the new clinic in the opening months of its creation. Methods: When the new clinic opened, signs were posted on New Orleans streets, flyers were placed in selected emergency rooms and healthcare facilities, radio and bus stop advertisements were purchased, and the CrescentCare website was updated with the addition of a page for the new clinic. The new clinic opened on 15 June …

Role Of Perceived Social Support And Knowledge Of Postpartum Depression Among Women In Anambra State, Eastern Nigeria, Raphael Oluwasina Babatola Folorunsho

Walden Dissertations and Doctoral Studies

Postpartum depression (PPD) is an increasingly pressing public health issue, particularly in low-resource settings like Nigeria, where maternal mental health tends to receive limited attention. This study explored the relationship between maternal awareness of PPD, perceived social support, and prevalence of depressive symptoms among postpartum women in the Nnewi North Local Government Area (LGA) of Anambra State. Grounded in the social support theory, health belief model, and socioecological model, the study used a descriptive cross-sectional research design. A total of 406 postpartum women attending primary healthcare centers were surveyed using validated instruments, including the PHQ-9 and MSPSS. Statistical analyses included …

Cardiometabolic Outcomes In The Obese African American Population With Rheumatoid Arthritis, Cecilia Jillo Walan

Walden Dissertations and Doctoral Studies

Rheumatoid arthritis (RA) disproportionately impacts African American adults, particularly those with obesity, due to overlapping cardiometabolic risks and health care disparities. The intersection of RA, obesity, and chronic conditions such as cardiovascular disease (CVD) and hypertension underscores the need for targeted public health interventions. This study investigated the association between RA and cardiometabolic outcomes among African American adults with obesity, aiming to identify significant predictors within this high-risk population. This quantitative study employed a cross-sectional design to analyze data from the 1999–2018 National Health and Nutrition Examination Survey undergirded by the social ecological change framework with N=23644 African American adults …

The Association Between Sunlight Exposure Duration, Region Of Birth And Skin Conditions Linked To Skin Cancer Risk Among Migrant Hispanic Farmworkers, Uchechukwu Fidelia Nnoruka

Walden Dissertations and Doctoral Studies

Prolonged exposure to sunlight increases the risk of developing skin conditions linked to skin cancer. Migrant Hispanic farmworkers are especially at risk due to extended outdoor labor, limited access to preventive care, and minimal occupational protections. The purpose of this quantitative study was to examine the association between sun exposure duration and region of birth with the presence of skin conditions associated with skin cancer among migrant Hispanic farmworkers in the United States. This study was grounded by the Social Ecological Model, which provided a comprehensive framework for examining multilevel factors influencing skin health outcomes. Using a cross-sectional design, secondary …

Senior Living: Filling The Gap, Katy J. Johnson

The Interactive Journal of Global Leadership and Learning

This white paper explores how colleges and universities can help address the housing crisis for Americans aged 65 and older by integrating seniors into college campuses. This approach not only helps to fill dormitories but also provides students with valuable work experience. The paper examines three key issues: the Silver Tsunami (the growing senior population), declining enrollment leading to campus housing vacancies, and the financial burden of higher education. By advocating for intergenerational living, the proposal offers an innovative solution that benefits seniors, students, and universities.

Implementing Age-Appropriate, School-Based Comprehensive Sexuality Education, Emira Romero

DNP Qualifying Manuscripts

Background: Sexual and reproductive health (SRH) education is a critical component of early health literacy and health promotion. Yet, there are no federal education requirements for sexuality education in the United States, leading to inconsistent and inadequate instruction.

Methods: In an effort to better understand the barriers beyond policy variability that affect successful implementation of SRH education, a literature search was conducted on CINAHL and ERIC with the following search terms and Boolean operators: (sex* education OR reproductive educat*) AND (elementary school OR school based) AND (United States OR California). The years of publication were limited to the past five …

Addressing Psychosocial Barriers To Participation In People Experiencing Homelessness: An Occupational Therapy Workshop, Preston Bender, Steven M. Gerardi, Lacey Spark

Summer 2025 OTD Capstone Symposium

Despite the occupational therapy (OT) profession's emphasis on holistic, person-centered care, many OT practitioners and students report feeling a lack of self-efficacy and preparedness to navigate the complex psychological, social, and systemic barriers that hinder occupational participation in people experiencing homelessness (PEH). This capstone project aimed to address the perceived unpreparedness among clinicians through the creation of an 8-hour interactive educational workshop aligned with Experiential Learning Theory. The content is grounded in the Model of Human Occupation (MOHO) and informed by the Bridging the Transition from Homelessness: A Social Justice Framework (BTTF), trauma-informed care (TIC), harm reduction, and diversity, equity, …

Comparative Analysis Of Risk Factors Associated With Guinea Worm Disease In Five Endemic Countries, Junerlyn Virrey Agua

Walden Dissertations and Doctoral Studies

Guinea worm disease (GWD) has persisted in a small number of endemic countries despite decades of eradication efforts. Ongoing GWD transmission in these countries underscores the need to examine behavioral, environmental, and surveillance-related drivers. The purpose of this quantitative study was to assess associations among risk factors, including dog tethering, pond treatment with Abate, and community awareness, and GWD incidence. The study also examined the relationship between climate-related environmental factors and GWD case distribution, as well as the influence of awareness levels on GWD rumor reports. Guided by the PRECEDE–PROCEED framework, this retrospective secondary analysis used data from national eradication …

Tracing Sars-Cov-2 Clusters Across Local Scales Using Genomic Data, Cody Dailey, Kayo Fujimoto, Ryker Penn, Pamela Brown, Roger Sealy, Justin Bahl

Faculty, Staff and Student Publications

A quantitative understanding of local transmission dynamics is essential for designing effective prevention strategies. In this study, we developed a computational workflow to identify viral introductions and trace locally circulating clusters. We analyzed over 26,000 SARS-CoV-2 genomes and their associated metadata, collected between January and October 2021, to explore introduction and local dispersal patterns in Greater Houston, a major metropolitan area known for its demographic diversity. Our analysis identified more than 1,000 independent introduction events, resulting in clusters of varying sizes. The majority of introductions originated from domestic sources, while international introductions occurred earlier and were associated with larger cluster …

Changes In Mental Health Care Utilisation Before And During The Covid-19 Pandemic Among People Living With Hiv In The Usa: A Retrospective Cohort Study Using The All Of Us Dataset, Atena Pasha, Shan Qiao, Jiajia Zhang Ph.D., Ruilie Cai, Buwei He, Xueying Yang, Chen Liang Ph.D., Sharon Weissman, Xiaoming Li Ph.D.

Faculty Publications

Introduction Despite the profound impact of the COVID-19 pandemic on people living with HIV (PLWH) mental health, large-scale, real-world data on mental healthcare utilisation and associated factors among PLWH remain limited. This study explores mental healthcare utilisation and associated factors among PLWH during the COVID-19 pandemic.

Methods Using a retrospective cohort design, we identified and included 4575 PLWH through computational phenotyping based on relevant Observational Medical Outcomes Partnership Common Data Model concept sets from the All of Us programme between March 2018 and March 2022. Mental healthcare utilisation was measured using the yearly count of mental healthcare visits and compared …

Differential Mirna Expressions Linking Environmental Risk Factors To Triple-Negative Breast Cancer Stages At Diagnosis, Amjila Bam, Yawen Hu, Xiaocheng Wu, Meng Luo, Nubaira Rizvi, Luis Del Valle, Arnold H. Zea, Fokhrul Hossain, Denise Moore Danos, Jovanny Zabaleta, Augusto Ochoa, Lucio Miele, Edward Trapido, Qingzhao Yu

School of Public Health Faculty Publications

Background/Objectives: Triple negative breast cancer (TNBC) is an aggressive, molecularly heterogeneous subtype of breast cancer, accounting for approximately 10–15% of all cases. While reproductive and metabolic factors contribute to breast cancer development, growing concerns about environmental exposures, alongside biological and socio-cultural influences, underscore the need for targeted prevention strategies across diverse populations. Despite increasing evidence linking biological, socioeconomic, and environmental factors to TNBC outcomes, the molecular mechanisms underlying these relationships remain poorly understood. Micro-RNAs (miRNAs), which regulate gene expression and play critical roles in cancer development, have emerged as potential mediators between environmental exposures and TNBC progression. The goal of …

Mental Distress And Resource Insecurity In The Kingdom Of Tonga After The 2022 Volcanic Eruption: Associations Of Water And Food Insecurity With Mental Distress, Hilary J. Bethanancourt, Indira Bose, Lupe Moala Tupou, Melissa Meinhart, Edward A. Frongillo Jr. Ph.D., Amelia Greaves, Sera L. Young

Faculty Publications

Background Water and food insecurity can harm mental health; all 3 may, in turn, be exacerbated by humanitarian crises. The linkages between food insecurity, water insecurity, and mental health are gaining attention but have not been investigated after a natural disaster.

Objective To investigate the associations between food insecurity, water insecurity, and mental distress, and how these relationships may differ between women and men, in the aftermath of the January 15, 2022, volcanic eruption in the Kingdom of Tonga.

Design Secondary analysis of nationally representative cross-sectional data from the Equality Insights Rapid survey collected 4 to 5 months after the …

Neighborhood Socioeconomic Status And Overall Survival Among Children With Acute Lymphoblastic Leukemia, Anna Hoppmann, Debroah M. Hurley, Stuart Cramer, Monique J. Brown Ph.D., Mph

Faculty Publications

A disadvantaged neighborhood, as represented by area-level socioeconomic status (SES) has been associated with adverse outcomes among children with acute lymphoblastic leukemia (ALL) in the US, but the duration of impact after ALL diagnosis is not well understood. This retrospective cohort study utilized the National Cancer Database (NCDB) to examine the impact of area-level SES on overall survival among children with ALL. Median income and education quartiles based on residential zip code were used to create a composite area-level SES variable. Individual-level variables included age, sex, race, year of diagnosis, primary payer, distance to care, rurality, time to treatment, and …

Kind Kids, Healthy Teens: Child Prosociality And Fruit And Vegetable Intake, Farah Qureshi, Krista P. Woodward, Laura D. Kubzansky, Julia K. Boehm

Psychology Faculty Articles and Research

Introduction

Methods

Waking Up The Youth: Sleep Is Essential For Health, Mansoor A. Rahman Mr

Manipal Journal of Medical Sciences

Letter to editor:

Waking Up The Youth: Sleep Is Essential For Health

According to the World Sleep Society, sleep, like good food and exercise, is a behavior essential to physical, mental and social well-being. Adequate sleep at appropriate time is necessary for optimal health and safety, while changes in sleep time and duration are intertwined with a variety of metabolic, cardiovascular, endocrine, and neurological disorders^1,2.Therefore,sleep, which is directly related to health and quality of life, is considered a basic human need to maintain his/ her bio-psycho-social and cultural functions³.

The timing and duration of sleep for …

Bridging Evidence With Community: Five Routes To Diabetes Prevention In Latino Adults, Ann M. Maliackal

Doctor of Nursing Practice Final Project Abstract

Bridging Evidence with Community: Five Routes to Diabetes Prevention in Latino Adults

Background: This project used the Eightfold Path policy analysis approach to identify and recommend an evidence-based diabetes prevention program (DPP) for Latino adults in the Rio Grande Valley (RGV). The aim was to reduce diabetes prevalence by selecting an intervention that is culturally appropriate and effective for this population.

Methodology: The Eightfold Path policy analysis approach guided this project. A comprehensive literature review identified diabetes prevention programs (DPPs) tailored for Latino adults, and the Critical Appraisal Skills Programme (CASP) was used to assess study quality. Five DPPs were …

Holistic Approach To Managing Grade 3 Vaginismus: An Obg Physiotherapy Perspective, Nagma Khan

Internet Journal of Allied Health Sciences and Practice

Background: Vaginismus is a condition characterized by involuntary pelvic floor muscle contractions, which can make vaginal penetration painful or impossible. This disorder has both physical and psychological components, often leading to significant emotional distress, anxiety, and relationship difficulties. Effective management requires a holistic, multidisciplinary approach, combining physical therapy with psychological support. This case report examines the treatment of a 29-year-old woman with grade 3 vaginismus, highlighting the role of Obstetrics & Gynaecology (OBG) physiotherapy in improving both physical symptoms and emotional well-being.

Case Presentation: A 29-year-old female presented with grade 3 vaginismus, with a history of severe pelvic floor tension …

Dietary, Behavioral, And Psychosocial Factors Related To Cardiovascular Disease Risk Among South Asian Americans: A Scoping Review, Lakshmi Meyyappan, Peggy A. Ursuy, Olivia S. Anderson

Internet Journal of Allied Health Sciences and Practice

Purpose: South Asian Americans disproportionately represent the world’s prevalence of cardiovascular disease. This scoping review assessed the dietary and psychosocial factors associated with cardiovascular disease risk that South Asian Americans encounter and concluded with considerations for health professionals who encounter this population in practice. Method: Inclusion criteria included studies with the primary population as South Asian Americans and investigated diet or psychosocial factors as variables and cardiovascular disease as an outcome variable. Results: Thirteen studies were included. Analysis of nutritional factors showed that South Asian Americans have high dietary quality yet eating non-vegetarian diets and high alcohol consumption is associated …

Increasing The Feasibility, Impact, And Equity Of The Medicare Annual Wellness Visit (Awv) With A Practice Tailored Awv Intervention: A Stepped Wedge Clinical Trial Protocol, Chi-Hong Tseng, Neil S. Wenger

Faculty Scholarship

Background Older adults vastly underutilize evidence-based preventive health services and screenings that reduce illness, morbidity and mortality. The free-to-patient Medicare Annual Wellness Visit (AWV) is an opportunity to enhance preventive healthcare use, but also is underused. Objectives To evaluate the effect of a practice-tailored intervention on the sustained use of Medicare AWVs and on guideline-recommended preventive services and racial/ethnic disparities in 3 types of practice settings. Methods This is a stepped wedge cluster randomized controlled trial. The intervention will be implemented at the practice level in 24 primary care practices across the country (8 community-based, 8 academic, and 8 serving …

Eco-Emotions And Climate Activism In Adolescents, Julianna Sahoo

Master's Projects and Capstones

Background. Youth are especially vulnerable to climate change, both physically and psychologically. Combatting climate change will require a coordinated, global effort. Understanding the motivations and emotions behind climate activism is essential to coordinate efforts to combat climate change.

Methods. This research uses survey data collected from first and second year undergraduates (n=521) at a private, urban university in California in the Fall of 2022. Youth were surveyed on emotions related to climate change, activism, compassion, eco-anxiety, and well-being.

Results. Experiencing positive emotions had a stronger relationship with environmental activism compared to negative emotions.

Conclusion. Results suggest climate change communications should …

Exploring The Self-Efficacy And Experiences Of Caregivers Using Thickened Liquids To Manage Pediatric Dysphagia, Jaimee E. Conmy

Electronic Theses and Dissertations

Pediatric dysphagia affects 1 in 37 typically developing children under five, with increased prevalence in at-risk populations. Thickened liquids are often used as an intervention despite limited evidence supporting their effectiveness in the pediatric population. Caregivers play a critical role in managing their child’s dysphagia, yet their experiences, self-efficacy, and challenges with thickened liquids remain underexplored. This mixed-methods study surveyed 57 caregivers of children on thickened liquid diets, to assess their self-efficacy, education, perceptions of effectiveness, and overall impact on their quality of life. Findings highlight gaps in caregiver training, concerns about preparation, and benefits and/or challenges experienced by caregivers. …

A Comprehensive Evidence-Based Educational Initiative For Improving Hand Hygiene, Lyanna L. Chan

Master's Projects and Capstones

Abstract

Problem: Healthcare-associated infections (HAIs) are a persistent concern in assisted living facilities, often resulting from inconsistent hand hygiene practices. Although national guidelines exist, adherence remains suboptimal, especially where staff training and compliance monitoring are limited.

Context: This project took place in a 53-bed assisted living facility without a formal system to track or reinforce hand hygiene. The aim was to improve staff knowledge and promote infection prevention through education.

Interventions: A Clinical Nurse Leader (CNL) led an evidence-based hand hygiene education program. The intervention included interactive training, visual reminders, personal sanitizers, and leadership support during clinical huddles.

Measures: Pre- …

Effects Of Mode And Transitioning To A Mixed-Mode (Web/Phone) Design On Categorical Survey Estimates: Do Question Characteristics Matter?

Faculty, Staff and Student Publications

An increasing number of telephone surveys are introducing a web option. Limited experimental research has explored the implications of such design changes and how they vary by question characteristics. Using an experimental design and propensity score matching techniques, this study examines the effects of mode (web vs. telephone) and transitioning to a mixed-mode design (from telephone-only to the choice of web or telephone) on survey estimates and how effects differ by question characteristics. We draw upon an experiment embedded in the National Study of Caregiving (NSOC), in which half of NSOC-eligible caregivers were randomized to a telephone-only design and the …

The Lived Experience Of In-Home Social Distancing And Other Preventative Measures Among Covid-19-Positive Individuals And Other Household Members, Jimmette Naytwain Brooks

Walden Dissertations and Doctoral Studies

The novel Coronavirus Disease 2019 (COVID-19), first detected in Wuhan, China, is caused by a new virus strain: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On March 11, 2020, COVID-19 was classified as “the second pandemic of the 21st century” by the World Health Organization. To better control the spread of the virus, governments and communities adopted several established public health protocols to quell the spread of the disease and decrease the resulting morbidity and mortality. Specific measures included masking, hand hygiene, social distancing and disinfection. Though these are proven measures, not much was known about adherence in the home …

Amputation Trends Among People Who Use Drugs In The Context Of Philadelphia’S Increasingly Xylazine Adulterated Drug Supply, Rose Laurano, Monika Pogorzelska-Maziarz, Traci C. Green, Sara Beachy, Kristin L. Rising, Jeffrey K. Hom, Megan K. Reed

Jefferson Center for Connected Care Faculty Papers

BACKGROUND: Xylazine-adulterated fentanyl has rapidly spread across the United States and has been increasingly detected in overdose deaths in Philadelphia, PA through medical examiner reports, clinical testing, and widescale drug checking. Xylazine use has been associated with wounds which may lead to amputation, but the extent of this outcome has not been explored.

METHODS: Utilizing the 10th revision of the International Classification of Diseases (ICD-10) codes, we conducted a de-identified retrospective analysis of data for patients identified with opioid related disorders (ICD-10 code F11) admitted to four different hospitals in Philadelphia, PA between 2018 and 2023. Exposure to xylazine use …