Digital Commons Network^™

Development And Evaluation Of The Sex Positivity Inventory For Counselors, M. Ashley Burks, Jennifer Gerlach, Joshua C. Watson

Journal of Counseling Sexology & Sexual Wellness: Research, Practice, and Education

The purpose of the study was to clarify the definition of sex positivity and identify sex-positive attitudes, knowledge, and skills through the development and evaluation of the Sex Positivity Inventory for Counselors (SPI-C). The exploratory factor analysis supported a six-factor, 34-item scale, accounting for 32.9% of the variance within the study. The SPI-C had an excellent internal consistency of 0.96 and consisted of the following factors: 1) Procedural Sex Positivity, 2) Comfortability with Sexuality, 3) Perceived Sex Positivity, 4) Fundamental Sex Education, 5) Sexological Worldview, and 6) Unconditional Positive Sexual Regard. Implications for practice, counselor education, and supervision are discussed.

Pregnancy Intention And Maternal Morbidity In Oklahoma And Mississippi: A Moderation Analysis Of Abortion Restriction Policies, Vicki Johnson

Walden Dissertations and Doctoral Studies

More than half of all pregnancies are unintended (mistimed or unwanted), and women with unplanned pregnancies may face economic hardships for families and additional health consequences if they have pre-existing medical conditions. This quantitative study was conducted to examine the relationship between pregnancy intention levels and severe acute maternal morbidity, specifically chorioamnionitis, among women who gave birth in Oklahoma and Mississippi in 2022. Using secondary data (N=1939) from the Pregnancy Risk Assessment Monitoring System Automated Research Files and state-level abortion policy data from the Guttmacher Institute, this study employed Bronfenbrenner’s social ecological model framework to investigate the relationship between pregnancy …

Behçet's Disease Unraveled: Insights Into Clinical Manifestations, Diagnosis, And Management, Mansour Alghamdi, Stephen Lindsey

School of Medicine Faculty Publications

Behçet's disease is a rare and recurrent multisystem inflammatory disorder, primarily distinguished by systemic vasculitis that affects veins and arteries of various sizes. Clinically, Behçet's disease is characterized by the presence of recurrent oral and genital ulcers, skin lesions, and uveitis. The prevalence of this condition is significantly elevated along the historical Silk Road, particularly in Turkey; however, epidemiological data indicate variations across different regions and ethnic groups. The diagnosis of Behçet's disease is typically established during the third decade of life, with a more severe prognosis noted when the onset occurs before the age of 25. This review aims …

Historical Review: More Than Two Decades Understanding The Genetic Architecture Of Hemostasis And Thrombosis, Maria Sabater-Lleal, Florian Thibord, Paul S De Vries, Jennifer Huffman, Alisa S Wolberg, Charles J Lowenstein, Alanna C Morrison, Andrew D Johnson, Nicholas L Smith

Faculty, Staff and Student Publications

From the beginning of the millennium and the development of genome-wide analyses, the technical advances and remarkable increase in research sample sizes have led to an escalating number of discoveries revealing genetic determinants of levels of the main factors regulating hemostasis and thrombosis and demonstrating a clear polygenic complex regulation of most coagulation factors. These discoveries have been useful to understand the biology underlying hemostasis regulation and to understand risk of associated thrombotic disease, such as venous thromboembolism, coronary artery disease, and ischemic stroke. In this historical review, we outline the main discoveries in genetic studies of coagulation factors (fibrinogen …

Cardiovascular Disease And Pregnancy: Clinical Outcomes From A Tertiary Center Experience In Saudi Arabia, Nouf Alanazi, Sara Abou Al-Saud, Wareef Almousa, Ghada Alshalan, Jumana Alqahtani, Munira Alsharif, Abrar Alshahrani, Hessah Alothman

Journal of the Saudi Heart Association

Cardiovascular disease complicates pregnancy and elevates maternal and fetal risks. Local data in Saudi Arabia is scarce. This study examines pregnancy outcomes in women with cardiovascular disease at a tertiary center. A retrospective cohort study of 103 cardio-obstetric patients (2015-2023) at King Khalid University Hospital. Multivariable logistic regression identified risk factors for adverse maternal and neonatal outcomes, with significance at p

Social And Contextual Factors Influencing Hypertension Among Latino Men Living In California, Leslie Ivett Ortega

Walden Dissertations and Doctoral Studies

Hypertension remains a critical and often silent public health issue that disproportionately affects Latino men in California. This quantitative, retrospective cross-sectional study explored the social and contextual factors influencing hypertension among this vulnerable population. Using the 2019 Behavioral Risk Factor Surveillance System dataset, which included a sample size of 2,060 participants, the study examined the relationship between hypertension and key variables including primary care utilization, health insurance, smoking, physical activity, mental health, and marital status, while controlling for age, education, and income. Guided by the health belief model, binary logistic regression analyses found health insurance and primary care utilization significantly …

Influence And Excess: A Study Of Alcohol’S Governmental, Societal, Biochemical, And Enzymatic Impact In The U.S And Other Countries Around The World, Thomas W. Snider

Senior Honors Theses

The conduct of the thesis is to explore the intricacies of alcohol consumption. The thesis will outline the history of alcohol and the societal pressures and conduct of drinking with relation to the government. After the history of alcohol has been defined, the thesis will move into the chemistry portion, delineating the absorption, digestion, metabolism, and excretion of alcohol. This is the portion of the thesis that will contain the quantitative data and source material as much research has already been conducted regarding these components of alcohol consumption. The condition of the research is that the data will be collected …

Across The Pond, Across The Waistline: A Comparative Look At The Childhood Obesity Crisis In The United States And United Kingdom, Samantha N. Eales

Honors College Theses

Childhood obesity is no longer just a local concern; it’s a global epidemic shaping the health of future generations. This paper compares how two similar nations with drastically different healthcare systems, the United States and the United Kingdom, tackle this growing crisis. Although both countries struggle with fast food culture, sedentary lifestyles, and targeted marketing, their health policy strategies differ dramatically. The U.S. leans on community programs and education, while the U.K. enforces stronger national regulations and advertising restrictions. By examining nutrition, physical activity, and policy, this thesis explores what each country does well and where they fall short. It …

Assessing Neurocognitive Functioning Among Adults Ageing With And Without Hiv At The Kenyan Coast: Measurement Issues And Correlates, Patrick Nzivo Mwangala, Carophine Nasambu, Ryan Wagner, Mihaela Duta, Gaia Scerif, Charles Newton, Amina Abubakar

Institute for Human Development, East Africa

Background: Cognitive impairment is one of the most prevalent complications of HIV infection, with significant medical and functional impacts. However, valid, and reliable assessment tools are lacking for the newly emergent ageing population of people living with HIV (PLWH) in many parts of sub-Saharan Africa (SSA), including Kenya. Without these tools, critical intervention opportunities, e.g., psychoeducation, treatment and additional support, are missed. To bridge this gap in Kenya, we adapted the Oxford Cognitive Screen Plus (OCSPlus), a tablet-based cognitive assessment tool designed for low-literacy settings, with adults ageing with HIV ≥ 50 years and their uninfected peers. This study examines …

Burden Of Neurodevelopmental Disorders In Kenyan Children, Symon Kariuki, Patricia Kipkemoi, Martha Kombe, Mary Bitta, Jacqueline Phillips Owen, Amina Abubakar, Charles Newton

Institute for Human Development, East Africa

Importance: Neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and intellectual disability contribute to one-tenth of the global burden of mental and neurologic disorders. The burden of NDDs is not well documented in Africa.

Objective:To assess the prevalence, risk factors, and comorbidities of NDDs in young Kenyan children.

Design, setting and participants: This cross-sectional study was conducted among children aged 6 to 9 years residing in the Kilifi Health and Demographic Surveillance System in Kenya. In stage I of the study, children were screened for NDDs from March 16, 2015, to September 14, 2016; those …

A Quantitative Exploration Of Risk And Protective Factors Affecting The Mental Health Of Chitimacha Tribal Youth, Daphnie Vilcan-Tanner

LSU New Orleans Theses and Dissertations

This study examines the relationships between demographics, risk factors, and protective factors with mental distress among Chitimacha Tribal adolescents aged 12 to 18. Using a Positive Youth Development framework, the research aimed to identify the prevalence of mental distress, trauma, discrimination, and protective factors, as well as their collective and individual impacts on mental health. Data were collected through online surveys completed by 73 participants residing on or near the Chitimacha Tribal Reservation. Descriptive statistics and multiple linear regression analyses were conducted to analyze the data. Results revealed that while trauma and discrimination collectively predicted mental distress, family and community …

Identifying Barriers For Community Pharmacies As Vaccines For Children (Vfc) Providers In Rural Alabama: Opportunities For Solutions, Myra Bajwa

Honors Theses

Significant Human papillomavirus (HPV) vaccination disparities exist between rural and urban areas in the US. A primary contributor is low access to preventive care in rural areas. Among the most promising strategies to overcome this is increasing access through offering HPV vaccination in non-traditional, convenient health settings such as pharmacies. In rural areas, community pharmacies are trusted, convenient pillars of the community. In Alabama, community pharmacies are eligible for enrollment in the Vaccines for Children (VFC) Program, a federally-funded program that provides free vaccines to children and adolescents under 18 years old who are uninsured, underinsured, American Indian, or Alaska …

Enhancing Crna's Knowledge Of Radiation Safety Through Online Education, Angela Iledan, Madeline Pousson

Doctoral Projects

Although ionizing radiation is frequently used in anesthesia-related procedures, many CRNAs receive minimal training in radiation safety principles and protective measures. This knowledge gap increases the risk of cumulative radiation exposure for providers and patients. To address the issue, this doctoral project developed and implemented an online educational intervention designed to enhance CRNAs’ understanding of radiation safety, ultimately promoting safer practices in radiation-prone environments.

The doctoral project follows a QI and EBP approach that incorporated diverse adult learning styles to enhance engagement and knowledge retention of CRNAs. The online educational module was designed and delivered to CRNAs that currently practice …

Cultural Adaptation Of An Innovative Reproductive Health Assessment Tool For Dementia Research In Africa: Insights From The Fember-Africa Study, Alice Moraa Ondieki, Anne Njogu, Cynthia I Sabel Smith, Edna Bosire, Karen Blackmon, Harrison Kaleli, Jasmit Shah, Rachel Maina, Sheila Waa, Chinedu Momoh

Brain and Mind Institute

Background: Dementia research accounts for only 0.1% of all research in Africa,making it the lowest among all low- and middle-income country (LMIC) regions. Thedevelopment and adaptation of biological and psychosocial measures in ethnicallyand culturally diverse populations remain limited but are essential for culturallyinformed research. This is particularly critical for examining sex- and gender-basedvulnerabilities to Alzheimer’s disease and related dementias (ADRD), including factorssuch as reproductive health and fertility.

Method: We conducted a thorough review of our clinical and health questionnaires forcultural relevance and sensitivity through a series (n = 3) of focus groups discussions.These focus groups included a diverse range of …

Large-Scale Experimental Study On The Impact Of Air Cleaning & Ventilation On Indoor Air Quality And Student Illness-Related Absenteeism, Daud Nosham

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

This large-scale randomized experimental field study investigated the effect of portable air purifiers (PAPs) on classroom’s air quality and student’s illness related absenteeism. PAPs were installed in 317 classrooms from various school districts located in Eastern Nebraska. The classrooms were randomly assigned into four conditions: three treatment conditions (T1, T2 & T3) and one control condition (device without any filter). T1 was equipped with HEPA filters, T2 added Activated Carbon (AC) layer to HEPA, and T3 further integrated Germicidal Ultraviolet (GUV) alongside HEPA and AC filters. The measured variables were carbon dioxide (CO2), fine particles (PN2.5) and coarse particles (PNcoarse), …

Evaluation And Identification Of Risk Factors For Stress Among Maquiladora Workers Based On The Mexican Official Standard 035 Survey Tool, Andrea Baca Melendez

Open Access Theses & Dissertations

Background and significance: Occupational psychosocial risk factors are workplace conditions that can trigger physiological, emotional, cognitive, and behavioral changes. They are strongly associated with mental health issues such as anxiety and depression, as well as non-mental health conditions like myocardial infarction, stroke, and occupational injuries. Analyzing these risks from a sociodemographic perspective provides valuable insights for improving work environments and workers’ well-being. Purpose: This study aimed to identify and determine the levels of occupational psychosocial risk factors among workers in a manufacturing company in Cd. Juárez, Chihuahua, and to examine their relationship with sociodemographic variables to inform future interventions in …

Exploring Intersectional Risks Of Substance Use Disorder, Mental Health, Hiv/Aids, And Hepatitis C Among Hispanic Adults On The Tx-Mx Border: A Mixed-Methods Study, Md Mohsin

Open Access Theses & Dissertations

Purpose: The purpose of this study was to explore intersectional risks of substance use disorders, mental health, HIV/AIDS, and HCV among Mexican-origin Hispanic adults on the Texas-Mexico border. Methods: The study employed an exploratory sequential mixed-methods approach, which involved collecting and analyzing qualitative data first, followed by quantitative data collection. Selected purposively, 15 in-depth interviews were conducted among the target population. Using convenient sampling, 106 cross-sectional surveys were conducted. Qualitative interview data were analyzed manually using thematic analysis. Quantitative data analyses included univariate descriptive analysis, bivariate, and multivariable penalized logistic regression, negative binomial, and zero-inflated negative binomial regression. Results: The …

Relationships Between Social Determinants Of Health And Pain Outcome Changes After Exercise In Adults With Knee Osteoarthritis, Klarissa Siebert

Open Access Theses & Dissertations

Background: Knee osteoarthritis (KOA) is a common musculoskeletal disease with pain as the primary symptom. KOA pain is a major contributor to disability and reduced quality of life and has been associated with social determinants of health (SDOH) variables. As for treatments of KOA pain, exercise such as stationary cycling is a first-line and recommended treatment. However, limited research has examined how SDOH influence pain outcomes following such interventions. Objective: This study investigated whether income level, education level, employment status, acculturative stress, and perceived ethnic discrimination are associated with changes in pain following a standardized cycling ergometer exercise in adults …

Public Health Trade-Offs During A Pandemic: Mobility Decline And Hypertension Risk In India, Arpita Khanna, Tomoki Fujii

Research Collection School Of Economics

The Covid pandemic dramatically altered patterns of daily life, particularly through widespread declines in mobility due to lockdowns and social distancing measures. While the economic and epidemiological effects of these restrictions have been widely studied, their broader health implications remain underexplored. This paper investigates the relationship between mobility decline during the Covid pandemic and hypertension outcomes in India. Leveraging district-level variation in mobility from Google Community Mobility Reports and health data from the 2019–2021 Indian Demographic and Health Survey (DHS), we find that a 1 percentage point reduction in mobility over the 30 days prior to interview is associated with …

Association Of Epigenetic Age Acceleration And Mitochondrial Dna-Based Aging Metrics Provides Insights Into Mechanisms Of Aging-Related Diseases, Mengyao Wang, Yinan Zheng, Meng Lai, Emmanuel Saake, Xue Liu, Xiuqing Guo, Kent D Taylor, Tianxiao Huan, Roby Joehanes, Drew R Nannini, Kai Zhang, Nicole J Lake, Christina A Castellani, Stephen S Rich, Jerome I Rotter, Yongmei Liu, Laura M Raffield, April P Carson, Myriam Fornage, Jiantao Ma, Dan E Arking, Lifang Hou, Daniel Levy, Chunyu Liu

Faculty, Staff and Student Publications

Investigating the interplay between mitochondrial DNA (mtDNA) variations and epigenetic aging metrics may elucidate biological mechanisms associated with age-related diseases. We estimated epigenetic age acceleration (EAA) metrics from DNA methylation data and derived mtDNA metrics, including heteroplasmic variants and mtDNA copy number (mtDNA CN) from whole genome sequencing. Linear regressions and meta-analyses were conducted to assess associations between EAA and mtDNA metrics, adjusting for chronological age, self-identified sex, and other covariates in 6,316 participants (58% female, 41% non-White Americans). Mediation analysis was conducted to examine whether EAA mediated the relationship between mtDNA CN and metabolic traits. A higher burden of …

The Microstructure Of Metastatic Bone Lesions Suggests Tumor Mediated Alterations In Bone Mineralization, Hanwen Fan, Zhan Xu, Carla Berrospe Rodriguez, Noah Dover, Andrei Demkov, Morgan Lilly, Guillermo Aguilar, Larry J Suva, Xiang H-F Zhang, Yuxiao Zhou

Faculty, Staff and Students Publications

Breast, prostate and lung cancer cells frequently metastasize to bone, leading to disruption of the bone microstructure. This study utilized mechanical testing coupled with micro-CT imaging, digital volume correlation (DVC), and atomic force microscopy (AFM) nanomechanical testing to examine the mechanical property variations in mouse long bones (tibia) with metastatic lung cancer cell involvement, spanning from the whole-bone scale to the microstructural level. In addition, we also investigated how metastatic invasion alters the morphology of hydroxyapatite nanocrystals in bone at the nanometer scale. The biochemical composition within metastatic lesions was assessed using Raman spectroscopy and correlated with AFM mechanical testing …

Promoting Professionalism In Medical Education: A Toolbox For Effective Feedback And Remediation, Matthew R Carroll, Gal Barak, Tracy Byrne, Huma Farid

Faculty, Staff and Students Publications

No abstract provided.

The Role Of Fast-Food Consumption, Residential Fast-Food Exposures, And Urinary Essential Trace Heavy Metals In Colorectal Cancer (Crc) Outcomes., Jeevan Adhikari

Electronic Theses and Dissertations

Background: Colorectal cancer (CRC) is a public health concern. Within the United States (US), fast-food consumption and environmental exposure to heavy metals have increased. The impact of fast-food consumption frequency from fast-food restaurants, residential fast-food exposures, and urinary essential trace heavy metals in relation to CRC outcomes have not yet been rigorously evaluated in the US. Methods: Within the LEAPS-CRC study, we used geographic information systems (GIS) and logistic regression to study the association of fast-food consumption, residential proximity to a fast-food outlet, and urinary essential trace metals with CRC incidence. Additionally, within Kentucky Cancer Registry (KCR) CRC cases, the …

A Multilevel Analysis To Evaluate Variability In Sdoh Clusters Within Rurality And Its Effects On Cancer-Specific And All-Cause Mortality In The Us., Stephie Ann Abraham

Electronic Theses and Dissertations

Social determinants of health (SDOH) factors have consistently been shown to impact all-cause and cancer-specific mortality. Area-level SDOH factors that coexist to form “high-risk” clusters are more prevalent in rural than urban areas. However, heterogeneity within rural and urban areas may contribute to variations in SDOH factors that could influence higher mortality rates and is not considered in other studies. The primary objective of this study was to utilize ecological and individual-level data to determine if the composition of SDOH clusters within counties in the rural-urban continuum contributes to differences in all-cause (AC) and cancer-specific mortality rates of lung and …

Deficiencies In Non-Emergency Medical Transportation For Aging Rural Residents Of Iosco County, Michigan, Richard L. Douglass, Donald Stansloski, James Mortimer, Sam Purdy, Dale Evilsizer, Scott Rice

Michigan Journal of Public Health

Introduction: The rural aging population in Michigan struggles to access medical care often available only at significant distances due to limited health system resources and provider shortages. Access to routine care is challenged by lack of non-emergency medical transportation (NEMT). The Iosco County Commission on Aging provides home-delivered meals to eligible county residents. The Rural Health Group investigated the needs of home-delivered meal recipients (aged ≥60 years) for healthcare transportation access. Utilizing data from this investigation, we examined if medical care needs were hindered by problems with transportation in rural Iosco County, Michigan.

Methods: We conducted a cross-sectional survey with …

Physical Therapy Direct Access To Unrestricted Access In The State Of Michigan- Is Michigan Ready To Embrace Change? A Policy Analysis, Erica M. Fernandes, Mary D. Lagerwey, Kieran Fogarty

Michigan Journal of Public Health

Michigan’s Direct Access Provision of 2015 (Enrolled Senate Bill No. 690, 201), which aimed to increase patient access to physical therapy and reduce waiting times, has created hurdles for patient access and for physical therapy as an autonomous profession. The purposes of this policy analysis were: 1) to analyze the Direct Access (DA) policy including examining existing challenges resulting from implementation, 2) provide recommendations for implementing an alternative policy, and 3) outline the benefits of the alternative policy. The DA policy with provisions was examined using the Patton and Sawicki (1993) framework, which provides a basic approach that …

Metabolomic Signatures Of Prediabetes In Mexican Americans: The Role Of Genetics And Macronutrients, Shinhye Chung, Charles Evans, Charles F Burant, Han Chen, Bing Yu, David Aguilar, Eric L Brown, Craig L Hanis, Goo Jun

Faculty, Staff and Student Publications

Prediabetes is one of the main health concerns in public health, and various etiological factors contribute to its onset. This study aimed to evaluate genetic associations and gene‐macronutrient interaction with prediabetes‐related metabolites to understand how genetic variation and dietary intake contribute to dysglycemia. We analyzed a total of 482 self‐identified Mexican American participants recruited from Starr County, Texas in 2018‐2019. Untargeted metabolomic profiling was performed using LC‐MS. Nutrient densities of six macronutrients were derived from a 106‐item food frequency questionnaire. Genetic associations for each metabolite were tested using Generalized linear Mixed Model Association Tests (GMMAT). Gene‐macronutrient interactions on prediabetes‐associated metabolites …

Clinical And Genomic Characterization Of Serratia Bloodstream Infections, Roberta Monardo, Lawrence P Park, Felicia Ruffin, Phillip Cox, An Q Dinh, Rachel E Korn, Parisa Farahani, Marco Ripa, Antonella Castagna, Blake M Hanson, Vance G Fowler, Joshua T Thaden, Stacey A Maskarinec

Faculty, Staff and Student Publications

Background: Previously considered a rare opportunistic pathogen, Serratia is now an emerging cause of bacteremia. We compared the risk factors and outcomes of patients with Serratia bacteremia relative to other Enterobacterales in a cohort of hospitalized patients.

Methods: Patients were prospectively enrolled from 2002-2021 at Duke University. Characteristics and outcomes were compared among bacteremic patients due to Serratia and other Enterobacterales. Regression models were used to determine features associated with outcomes. Whole genome sequencing (WGS) was performed to characterize the phylogenetic diversity of Serratia isolates associated with device infections.

Results: Of 2676 patients, 173 (6.5%) had Serratia bacteremia. Among patients …

Neighborhood-Level Social Vulnerability, Race And Ethnicity, And Stage At Diagnosis: A Population-Based Study Of 12,957 Patients With Oral Cavity Cancer, Guillermo A Tortolero, Erich M Sturgis, Jose-Miguel Yamal, Melissa F Peskin, Cici Bauer, Caitlin C Murphy

Faculty, Staff and Student Publications

Background: Oral cavity cancer (OCC) is marked by racial and ethnic disparities. We examined these differences in OCC stage at diagnosis and whether neighborhood-level social vulnerability, a measure of susceptibility to hardship at the census-tract level, modifies disparities.

Methods: We identified adults newly diagnosed with OCC (1995 to 2020) from the Texas Cancer Registry. We estimated the association between stage at diagnosis and race and ethnicity using logistic regression and assessed effect modification by neighborhood-level social vulnerability.

Results: The sample included 12,957 reported OCC cases, 77% non-Hispanic White, 6% non-Hispanic Black, and 14% Hispanic patients, and 47.4% late stage at …

Maternal Folic Acid Supplement Use, Folate Intake, And Preterm Birth Among Infants With Spina Bifida, Renata H Benjamin, Katherine L Ludorf, Rachel P Allred, Jenil R Patel, Wendy N Nembhard, Gary M Shaw, Suzan L Carmichael, Tania A Desrosiers, Eirini Nestoridi, Eva M Williford, A J Agopian

Faculty, Staff and Student Publications

Background: We sought to assess the extent to which folic acid supplementation and dietary folate intake are associated with preterm delivery among infants with spina bifida.

Methods: We conducted a retrospective population-based study using the National Birth Defects Prevention Study (NBDPS; 1999-2011) and the Birth Defects Study To Evaluate Pregnancy exposureS (BD-STEPS; 2014-2019). We utilized robust Poisson regression to calculate the risk ratio (RR) and 95% confidence interval (CI) for the associations between preterm birth (< 37 weeks) and maternal use of folic acid-containing supplements, dietary folate intake quartile, and a combined variable accounting for supplementation and dietary folate status.

Results: Among 1199 infants with spina bifida (1011 in NBDPS, 188 in BD-STEPS), 217 (18.1%) were born preterm. There were no statistically significant associations …