University Student Mental Health: Service Utilization, Equity Gaps, And Strategies To Improve Access, Richard Mutua Kilonzo

Electronic Theses and Dissertations

Student mental health and access to care are pressing concerns in higher education. This study assesses mental health outcomes and access to campus mental health services at East Tennessee State University. Survey data from the 2023–2024 Healthy Minds Study were analyzed to report the prevalence of depression, anxiety, and suicidal ideation across the student population. The study evaluates disparities in these outcomes and barriers to care across student groups, with particular attention to equity-impacted students, especially sexual and gender minority students.

Findings indicate widespread psychological distress alongside persistent barriers, including long wait times, limited-service availability, and stigma-related concerns. These barriers …

Addressing Substance Use Disorder In Rural Appalachia: Improving Access And Treatment Outcomes For Justice-Involved Individuals, Jessica Muldowney

Electronic Theses and Dissertations

Background: Opioid use disorder (OUD) represents a critical public health crisis disproportionately affecting justice-involved (JI) populations, with approximately 65% of incarcerated individuals having substance use disorders (James & Beatty, 2006). Rural Appalachian communities face compounded challenges due to limited healthcare access, provider shortages, and cultural stigma surrounding addiction treatment. Despite evidence demonstrating that medication-assisted treatment (MAT) reduces recidivism and overdose deaths, only 20% of correctional facilities offer these services (Klein & Seppala, 2019).

Objective: This mixed-methods study evaluated organizational readiness and infrastructure capacity for implementing evidence-based OUD interventions, specifically MAT programs across three rural counties in northwestern North Carolina.

Methods: …

Feasibility Of Assessing Dietary Patterns And Anxiety In College Students: A Pilot Study Using Nutrition Questionnaires, Gad-7, And Asq, Kylie Ford

Electronic Theses and Dissertations

Anxiety is highly prevalent among college students representing a significant public health concern. Research indicates that dietary patterns may influence mental health outcomes; however, the practicality of collecting comprehensive dietary and psychological data in college populations remains unclear. This pilot study assessed the feasibility of evaluating dietary patterns and anxiety using self-report instruments. Participants completed the Nutrition and Eating Habit questionnaire, the Generalized Anxiety Disorder-7 (GAD-7), and the Anxiety Sensitivity Questionnaire (ASQ). Although twenty-one students were recruited, survey completion rates were low, with only seven participants completing the nutrition questionnaire necessary to calculate the Dietary Inflammatory Index (DII). Descriptive analyses …

Ethical Engagement In Global Missions: A Qualitative Inquiry Into Planner Motivations And Host Experiences, Harrison J. Ihrig

Electronic Theses and Dissertations

Short-term mission (STM) trips are limited duration service experiences, commonly organized by faith-based organizations (FBO), in which volunteers travel domestically or international to provide ministry, community outreach, and/or health-related services. In recent decades, the number of these trips organized by organizations in the United States has increased exponentially, but the phenomenon is difficult to accurately measure due to its decentralized nature and the lack of standardized terminology. Despite their prominence, limited research has been conducted to examine planning, implementation, and evaluation processes of international STMs organized by FBO, particularly through a public health lens. The purpose of this study was …

Use Of Period- Or Fertility-Tracking Technologies Pre- And Post-Dobbs, Emily Neiman, Marta Bornstein Phd, Mph, Abigail Norris Turner, Megan L. Kavanaugh, Maria F. Gallo

Faculty Publications

Objectives

Study design

Sepsis As An Immune Continuum: Cytokine Storm To Lymphopenia And Pics, Chelsey King

Senior Honors Theses

Sepsis is a leading cause of morbidity and mortality worldwide, driven by a dynamic immune continuum that progresses from early hyperinflammation to profound immunosuppression. This review examines the three overlapping phases of sepsis: the inflammation-mediated cytokine storm driven by dysregulated PRR activation, NF-κB signaling, and NETosis; apoptosis-driven lymphopenia involving caspase-mediated lymphocyte death, dendritic cell dysfunction, and metabolic exhaustion; and prolonged immunoparalysis culminating in persistent inflammation, immunosuppression, and catabolism syndrome (PICS). Key mechanisms linking these phases, including the co-existence of hyper- and hypo-inflammatory states, are synthesized alongside relevant clinical biomarkers such as IL-6, HLA-DR, and single-cell immune profiles. This review highlights …

Screening For Hypertension And Diabetes In Laundromats In The Largest Hispanic-Majority City In The U.S, Nicholas A Mccann, Vanessa Schick, Jack Tsai

Faculty, Staff and Student Publications

Purpose: This study aimed to assess the prevalence of hypertension and diabetes among laundromat users in San Antonio, Texas, and explore laundromats as a novel setting for health interventions regarding these 2 conditions.

Design: This descriptive, cross-sectional study involved demographic, blood pressure and HbA1c screenings to assess the health status of laundromat users.

Setting: The study took place in 7 laundromats in low-income areas of San Antonio.

Subjects: A total of 150 adults aged 18 and older who regularly used the laundromats and spoke either English or Spanish were eligible to participate.

>Measures: Hypertension was defined as a systolic BP …

An Integrated Framework For Early Detection And Transmissibility Assessment Of Emerging Variants In Wastewater, Xingwen Chen, Tin Phan, Wei Lin Lee, Katie Clark, Steven F Rhode, Samantha Brozak, Bruce Pell, Tsultrim Palden, Mats Leifels, Anna Gitter, Yang Kuang, Stefan Wuertz, Janelle Thompson, Kristina D Mena, Eric J Alm, Fuqing Wu

Faculty, Staff and Student Publications

Tracking the emergence of new viral variants is critical for epidemic preparedness, but remains challenging because variants typically circulate at low prevalence during the early phase of outbreaks. Here, we present an integrated framework that combines sensitive variant detection in wastewater with quantitative assessment of transmissibility through dynamic epidemic modeling. Using the SARS-CoV-2 Omicron variant as a proof of concept, we developed a novel nested allele-specific RT-qPCR assay (NAS-PCR) that achieved a thousand-fold increase in sensitivity compared with allele-specific RT-qPCR (limit of detection: 0.5 copies/μl). NAS-PCR detected Omicron in wastewater samples from the Greater Boston area starting in September 2021, …

Associations Of Blood Biomarkers Of Glial Cell Dysfunction And Neuronal Injury With Future Cognitive Decline And Incident Dementia, Srishti Shrestha, Xiaoqian Zhu, B Gwen Windham, Kevin J Sullivan, Priya Palta, Rebecca F Gottesman, Russell P Tracy, Clifford R Jack, Petrice M Cogswell, Prashanthi Vemuri, Sudha Seshadri, Thomas H Mosley, Michael E Griswold, Myriam Fornage

Faculty, Staff and Student Publications

Introduction: Prospective studies of blood-based biomarkers reflecting pathogenic processes, other than Alzheimer-specific pathologies, that contribute to dementia in diverse cohorts are lacking.

Methods: We jointly fitted linear mixed-effect models and proportional hazards models to examine associations of midlife glial fibrillary acidic protein (GFAP), chitinase-3-like protein 1 (YKL-40), soluble cluster of differentiation-14 (sCD14), neurofilament light chain (NfL), total tau (t-tau), and ubiquitin C-terminal hydrolase L1 (UCHL1) levels in serum (collected in 1993 to 1995) with cognitive decline and incident dementia (ascertained over 29 years through 2022) in the community-based Atherosclerosis Risk in Communities Study. sCD14 and YKL-40 were measured in 3082 …

Perceived Neighborhood Environment And Objectively Assessed, Habitual Physical Activity Among Us Adults: An All Of Us Research Program Study, Natalia I Heredia, Michael C Robertson, Christopher D Pfledderer, Ethan T Hunt, Timothy J Walker, Deborah Salvo

Faculty, Staff and Student Publications

Introduction: The purpose of this study was to assess the associations between perceived socioenvironmental neighborhood attributes and objectively assessed habitual physical activity among US adults as well as whether associations vary by sociodemographic characteristics.

Methods: We used data from the All of Us research program, a longitudinal cohort study of a diverse sample of Americans. Perceived neighborhood social cohesion, physical and social disorder, walkability, and sociodemographic characteristics were self-reported. Habitual physical activity was ascertained using Fitbit-derived step counts over ≥24 weeks. Generalized additive mixed-effects models were used to test the associations between perceived socioenvironmental neighborhood attributes and daily step counts. …

Addressing Nonignorable Missing Data And Heterogeneity In Prognostic Biomarker Assessment, Xinran Huang, Ruosha Li, Jing Ning, For The Alzheimer's Disease Neuroimaging Initiative

Faculty, Staff and Student Publications

Covariate-specific and time-dependent area-under-curve (AUC) is often used to evaluate the discriminative performance of biomarkers with time-to-event outcomes, particularly when certain covariates influence biomarkers' accuracy. In biomarker research, despite extensive efforts, missing data remain unavoidable, with nonignorable missingness posing significant challenges. This article focuses on estimating the impact of covariates on time-dependent AUC in the presence of nonignorable missing biomarkers. Assuming a parametric model on the missing probability, we leverage instrumental variables to address the identifiable issue and estimate the unknown parameters. We integrate the inverse probability weighting approach into the score equation of a pseudo partial likelihood for estimation …

A Bilingual Ai-Based Chatbot For Nutrition Education In A Food Is Medicine Intervention For High-Risk Pregnant Women: Design And Development Study, Lorena Macias-Navarro, Nalini Ranjit, Gregory W Bounds, Brendon A Providence, Yesmeena Shmaitelly, Naomi M Tice, Shreela V Sharma

Faculty, Staff and Student Publications

Background: Conversational agents (artificial intelligence [AI]-based chatbots) offer a novel approach to health interventions by providing personalized, adaptive interactions that improve over time based on user engagement. In nutrition education, given the wide variation in knowledge, skills, and abilities across participants, AI-based chatbots have the potential to enhance accessibility, engagement, and behavior change. Food is Medicine (FIM) interventions, which aim to improve food security and diet quality among multicultural, at-risk populations, often face challenges related to sustained engagement and use.

Objective: This paper describes the design, development, and iterative refinement of a bilingual AI-driven nutrition chatbot integrated into an FIM …

Associations Between Water Intake, Dietary Quality, And Beverage Consumption Among University Students, Mohammad A. Qazi

Electronic Theses, Projects, and Dissertations

Title: Associations Between Water Intake, Dietary Quality, and Beverage Consumption Among University Students

Background and Aims: Sugar-sweetened beverage (SSB) and ultra-processed food (UPF) consumption significantly contribute to chronic disease risk and is often more common in underserved and racially/ethnically diverse communities. Drinking water is a low-cost, calorie-free behavior that may support healthier beverage and dietary patterns. Previous studies show that increased daily water consumption positively correlates with better diet quality and is inversely correlated with SSB and UPF consumption. This study aims to examine whether (1) increased daily water intake is associated with self-reported diet quality and (2) self-reported hydration …

Certified Health Education Specialist Exam Toolkit For Undergraduate Public Health Students, Briana C. Villari

Electronic Theses, Projects, and Dissertations

The Certified Health Education Specialists (CHES) is a credentialing exam that is offered by the National Commission for Health Education Credentialing, Inc (NCHEC) for public health professionals and students. With the completion of this exam, individuals can demonstrate their mastery of core health education skills and concepts. With the 2025 testing cycle, roughly 63 to 73 percent of test takers passed. The purpose of this project is to create a CHES exam toolkit for undergraduate public health students in preparation for their exam. The development of this toolkit was guided by the Health Education Specialists Practical Analysis (HESPA II 2020), …

Assessing The Needs Of Public Health Professionals In The Inland Empire, Esteban Silva-Garcia

Electronic Theses, Projects, and Dissertations

An effective public health system relies on the need for highly trained professionals with degrees or certifications within the field of public health. As public health continues to evolve, professionals are required to improve and evolve with the pace of technology and knowledge advancements. This project focuses on reviewing literature on the current ongoing needs of public health professionals and providing them with resources that are available at low to no cost. It surveys the needs of public health professionals in the Inland Empire and the solutions created by organizations and federal agencies to support professional development for current and …

The Quantification Of Fluoride Water Quality And Its Significance On Oral Health, Harleen Kaur Maroak

Electronic Theses, Projects, and Dissertations

Fluoride is a naturally occurring mineral and studies have shown that when added to community water supplies, it effectively reduces dental caries. According to the U.S. Public Health Services (PHS), 0.7mg/L is the optimal fluoride level in drinking water to prevent tooth decay. This study focuses on examining the fluoride levels in water in San Bernardino County (SBC) and Riverside County (RC). Data is collected from recently published articles, databases along with assessing the laboratory water sample (n=45) analysis to determine if the fluoride levels are meeting the optimal standards. In SBC, there are total of 154 water systems with …

Evaluating The Impact Of Myplate-Based Expanded Food And Nutrition Education Program (Efnep) On Healthy Dietary Choices Among Low-Income Families, Theresa N. Agbonome

Electronic Theses, Projects, and Dissertations

Dietary behaviors towards healthy food choices remain a major public health issue in the United States, with prevalence among low-income families. The University of California Agriculture and Natural Resources (UCANR) with Expanded Food and Nutrition Education Program (EFNEP) trains both health educators and volunteers to provide community-based nutrition education, which prioritizes low-income families. The initiative employs the MyPlate guidelines that are composed of 5 different food groups which include fruits, vegetables, protein, grains, and dairy products. This project focuses on evaluating nutritional habits of disadvantaged families within San Bernardino County (SBC) by using an evidence-based evaluation tool known as the …

Development Of An Employee Leave Guide Handbook At The California University Of Science And Medicine, Leyal Nidal Fakhreddine

Electronic Theses, Projects, and Dissertations

Employee leave policies play an important role in supporting workforce well-being, organizational compliance, and retention of skilled labor, especially in medical and educational health institutions. However, employees still experience confusion when trying to make sense of complicated leave options such as the Family and Medical Leave Act (FMLA), maternity and paternity leave, and military leave. The lack of clear, centralized guidance can result in delays, miscommunication, and increased workplace stress.

This project was carried out as a part of the Master of Public Health (MPH) program integrative learning experience requirements at California State University, San Bernardino, and was conducted during …

Treatment And Interventions For Sexual Assault In Humanitarian Contexts: Addressing Gaps In Refugee And Idp Camp Care In Myanmar, Erin Nash

Capstone Experience: Master of Public Health

Sexual and gender-based violence (SGBV) remains a pervasive yet under-addressed issue in humanitarian settings. Refugee and internally displaced person (IDP) camps along the Thai– Myanmar border represent a complex nexus of protracted displacement, ethnic conflict, and limited access to medical and psychosocial care. Although the prevalence of sexual assault in these contexts is well-documented, there is a critical gap in the literature regarding effective, context-specific treatment and intervention strategies. This capstone project conducts a comprehensive review of existing research on sexual assault care in humanitarian crises worldwide and assesses its applicability to displaced ethnic minorities from Myanmar. The analysis considers …

Plan To Develop A Theory-Based Diabetes Social Media Campaign For Spanish-Speaking Adults In Finney County, Ks: Integration Of A Promotora, Focused Discussion Groups, And Community Feedback To Ensure Cultural Appropriateness, Julevi P. Bernido

Capstone Experience: Master of Public Health

The 2025 Community Health Needs Assessment (CHNA) shows that over 11% of adults in Finney County, Kansas, have diabetes, which surpasses both state and national averages. Census data from 2016-2020 indicate that 42.6% of residents ages five and older speak a language other than English at home, and 36.1% speak Spanish (United States Census Bureau, n.d.). The CHNA further highlights concerns about language and cultural barriers to care, especially among the Spanish-speaking population. Notably, 21.74% of residents have limited English proficiency—much higher than the state’s 12.1% (CHNA, 2025).

This capstone will develop a theory-based social media campaign plan to support …

Gestational Diabetes And Social Determinants Of Health In Black Women, Darianne Greenwood

Capstone Experience: Master of Public Health

Gestational Diabetes Mellitus (GDM) poses significant health risks, specifically increasing the risk of developing Type 2 Diabetes post-delivery, as well as increasing the risk of adverse neonatal and maternal outcomes. Black women, in particular, experience disproportionately higher rates of GDM incidence, severity, and complications in comparison to White women. Biological factors alone do not account for these disparities, necessitating a deeper examination into how systemic factors, particularly the social environment, influence these inequitable health outcomes. The purpose of this comprehensive literature review is to answer the question: “How do the Social Determinants of Health (SDoH), such as residential segregation, food …

A Literature Review Of Estrogen Synthesis And Metabolizing Enzymes Produced By The Human Gut Microbiome And Their Correlation With Cancer, Rebecca Cederberg

Capstone Experience: Master of Public Health

The link between estrogen and cancer initiation or progression has been well established; such that the World Health Organization’s International Agency for Research on Cancer (WHO IARC) has classified several estrogen therapies and estrogenic compounds as group 1 carcinogens. Estrogen and/or its receptors have been associated with reproductive cancers such as breast, ovarian, endometrial, and prostate, as well as lymphomas, lung, and colon cancers. Additionally, elevated levels of estrogen and altered gut microbiomes are also associated with increased rates of breast cancer. More recently, microbial genes that are capable of synthesizing estrogen and deconjugating estrogen metabolites have been identified, and …

Exploratory Proxy Occupational Health Risk Assessment On Pm2.5 Exposure Among Outdoor Personnel At International Ports Of Entry, Josdell Maria Guerra Ruiz

Open Access Theses & Dissertations

Despite growing public health concerns on PM2.5 exposure and its respiratory health effects, no documented evidence has been found on the application of proxy methods to perform occupational health risk assessments for PM2.5 exposure among outdoor personnel. The purpose of this research study was to conduct a descriptive and predictive occupational health risk assessment for cancer and non-cancer respiratory health outcomes related to PM2.5 exposure among outdoor personnel at targeted international ports of entry (IPOE). A total of 61 samples were collected, for 24 hours, at two targeted IPOEs (every sixth day) over 12-month period. Samples included measurements on PM2.5 …

Health Disparities In El Paso's Low-Income Hispanic Communities: A Mixed-Methods Analysis Of Acculturation, Obesity Metrics, And Socio-Cultural Determinants, Karen Del Rio

Open Access Theses & Dissertations

Health disparities among low-income Hispanic immigrants in the United States are shaped by complex interactions between acculturation, structural inequality, and socio-cultural determinants that behavioral and epidemiological models have not fully explained. This dissertation examines the relationship between acculturation and obesity-related outcomes among uninsured and low-income Hispanic adults of Mexican descent in El Paso, Texas, using a three-article, sequential, explanatory, mixed-methods design grounded in Latina/o Critical Race Theory (LatCrit).Article 1 presents a systematic review of 20 peer-reviewed studies examining acculturation and obesity among Mexican Americans, finding consistent evidence that longer U.S. residence is associated with increased BMI and obesity prevalence, mediated …

Human Papillomavirus (Hpv) Vaccine Acceptance: A Mixed-Methods Study And Randomized Controlled Trial Examining Messengers Of Hpv Vaccine Information Among Hispanic Parents, Alyssa Andrea Martinez

Open Access Theses & Dissertations

Hispanics make up 19.5% of the U.S. population, making them the nation's largest ethnic minority. Hispanics are disproportionately impacted by health outcomes, including many different types of cancers that are caused by the Human Papillomavirus (HPV). An HPV vaccine is available that can prevent 90% of HPV associated cancers. The purpose of this mixed-methods study and randomized experiment is to develop and test data-driven digital health messages to promote the HPV vaccine in Hispanic parents. Four specific aims were conducted among three major studies. Aim 1 (Study 1): A cross-sectional survey was conducted to obtain preliminary evidence on trusted messengers …

Detecting Early Physiological Signs Of Work-Related Muscle Strain And Fatigue Using Quantitative Sensory Testing, Omar Alberto Cano

Open Access Theses & Dissertations

Background: Work-related musculoskeletal disorders (WRMSDs) are a major source of occupational disability and economic burden worldwide. Early detection of physiological strain remains challenging since traditional methods often rely on self-reported pain or diagnosis after symptom development. Quantitative Sensory Testing (QST) may provide an objective, non-invasive method for identifying early sensory changes associated with repetitive upper-extremity loading. Purpose: This pilot study examined the responsiveness of Pressure Pain Threshold (PPT) and Thermal Threshold Testing (TTT) for detecting Acute muscular strain and fatigue following repetitive manual task performance. Methods: A within-subject counterbalanced design was conducted with sixteen healthy participants. Each participant completed both …

Editorial: Grateful And Thankful, Michelle C. Dziurgot

The Journal of the Michigan Dental Association

Dr. Michelle Dziurgot reflects on her concluding three-year term as the Editor-in-Chief of the Michigan Dental Association Journal. She describes her personal growth through volunteerism, starting as a local component editor and advancing to the MDA Board of Trustees. The author emphasizes that the most value from membership comes through immersion and service, encouraging others to volunteer their time and talent to the association. She credits the MDA’s mentorship with shaping her professional career and practice.

The 2026 Mda Award Winners: Recognizing Outstanding Service, David Foe

The Journal of the Michigan Dental Association

This article lists the recipients of the 2026 MDA awards, highlighting their contributions to the dental profession and public health. Notable winners include Dr. Christopher Smiley, recipient of the Meritorious Award for a lifetime of achievement in dental journalism and leadership, and Dr. Charles Burling, honored as Dentist Citizen of the Year for his community service. The feature also recognizes educators, legislative advocates, and volunteers in the Donated Dental Services (DDS) program who provide care to vulnerable populations.

Developmental Assets And Risk-Related Restraint And Resistance Orientations Among Emerging Adult College Students: Examining Protective Associations, Summer N. Beck

Graduate Theses and Dissertations

Abstract Background: Although developmental assets are well established as protective factors during childhood and adolescence, less is known about their role during emerging adulthood, a period when the prevalence of several types of risk behaviors peak. For the U.S. college student, campus can provide ideal conditions for supporting the extended transition to adulthood. However, that same environment may increase exposure to health risk behaviors. This study examined associations between developmental assets and the risk-related restraint and resistance orientations involving sexual activity, alcohol, and illicit drugs among emerging adult college students. Methods: A cross-sectional correlational design was employed with a sample …

Social Correlates Of Trauma And Posttraumatic Stress Disorder: The Importance Of Context, Lukoye Atwoli, Linnet Ongeri

Internal Medicine, East Africa

Understanding trauma and posttraumatic stress disorder (PTSD) requires a contextual perspective that considers historical legacies, social environments, and cultural realities. This paper draws on empirical evidence from Kenya and Uganda to demonstrate the limitations of applying trauma frameworks developed in high-income countries to African contexts. Findings from the Orphaned and Separated Children’s Assessment Related to Their Health and Well-Being (OSCAR) study challenge assumptions about care environments. The study reveals higher PTSD rates among orphans in family-based settings compared to institutional care, and highlights the protective roles of religion and social support. The Neuropsychiatric Genetics of African Populations-Psychosis (NeuroGAP-Psychosis) study provides …