Digital Commons Network^™

Quality Improvement Project: Implementation Of The Patient Health Questionnaire-9 Modified For Teens, Hedy Gerber, Leah Buchko, Jennifer Van Winkle

All Faculty and Staff Scholarship

Background: Adolescent depression is a prevalent and significant public health concern, strongly linked to increased suicidality, poor health outcomes, impaired psychosocial functioning, and substantial societal costs. Although measurement‑based care using validated screening instruments is recommended by clinical practice guidelines, routine use of standardized depression screening tools remains limited in mental health settings.

Objective: The purpose of this quality improvement project was to assess the impact of implementing the Patient Health Questionnaire-9 modified for teens (PHQ-9M) in depression screening rates among adolescents aged 11-17 years at an outpatient mental health clinic in Southern Colorado.

Methods: A quantitative, quasi‑experimental pre- and post-intervention …

Air Pollution And Public Health: Global Evidence And Implications, Mohammed Obaid Al-Mansoori

Al-Bahir

Globally, the issue of air pollution keep being one of most serious challenges that affecting environment and human health, coming from emissions of industries, transport, agriculture and also from the fuel people use in homes, in addition to natural events that make the situation worse. This review try to bring together the available evidences about the sources, types, and the health impacts of the main air pollutants, including the gaseous ones like SO₂, O₃, NO₂, and CO, and the particulate matter (PM₁₀, PM₂.₅). Exposure for short or long time to these pollutants is linked with many harmful outcomes, such as …

Using United States Medicare Program Claims To Identify Reliable Measures Of Low Value Services Influenced By Primary Care Physician Decisions, Chris Fleming, Dmitriy Poznyak, Rhea E. Powell, Claire Erba, Eunhae Shin, Rui Wang, Claire Burkhart, Arkadipta Ghosh, Eugene C. Rich

Division of Internal Medicine Faculty Papers & Presentations

BACKGROUND: Low-value services (LVS) are those that “… provide little to no benefit to patients….”¹ Among an existing set of 31 LVS are invasive procedures not typically performed by primary care physicians (PCPs), and other LVS that may be commonly provided by specialists. To facilitate research on the role of primary care physicians in low-value care, we sought to identify the reliability of two subsets of LVS measures that are more directly subject to PCPs’ decisions. We refer to these as primary care adjacent (“PCA”) LVS measures.

METHODS: Retrospective observational cohort study to identify which of a 31-item LVS …

Culturally Informed Approaches To Support Perinatal Mental Health: Perceptions And Experiences Of Perinatal Depression And Support Systems Among Postpartum African-Born Women In The United States, Joyce O. Imafidon

ETDs from 2020-2029

Perinatal mental health (PMH) of African-born women (ABW) is underrepresented in research and practice in the United States (US) despite known consequences of poor mental wellbeing on one’s overall health, relationships and productivity. Beyond their fundamental role in family support, ABW contribute significantly to the US workforce, education sector, and economy. This three-paper dissertation enhances understanding on PMH outcomes, perception and experiences of ABW in the US. Perinatal depression (PD), one of the most common mood disorders affecting 1 in 8 women, is highlighted. The overarching question is to what extent does the US health system address PMH of ABW …

Evaluating The Service Life Of A Respirator Cartridge When Exposed To Various Volatile Organic Compounds, Neha Murad Alwani

ETDs from 2020-2029

Inhalation is the most common exposure pathway. With the significant presence of respiratory exposure, respirator cartridges are widely used as personal protective equipment (PPE) to reduce exposure to gases, vapors, and volatile organic compounds (VOCs). This study evaluated the breakthrough time of respirator cartridges under various VOC environments commonly encountered in beauty salons and automotive repair shops. Breakthrough time is the duration a respirator cartridge can provide protection before contaminants can be inhaled and the respirator cartridge is no longer effective. The breakthrough time of three VOCs was examined: acetone, toluene, and m-xylene. Using a custom designed test chamber equipped …

Evaluation Of Occupational Exposure To Noise And Respirable Particulate Matter In Dentistry, Kabe Fetner

ETDs from 2020-2029

Dental procedures can result in occupational exposures to both noise and particulate matter. Dental professionals routinely operate high-speed instruments and mechanical tools that may produce elevated sound levels and aerosolized particles during clinical treatment. Although these exposures are common in dental environments, limited data exist describing full-shift occupational exposure levels during routine dental procedures. The purpose of this study was to evaluate occupational exposure to noise and respirable particulate matter (RPM) during routine dental procedures in a clinical setting. Area noise monitoring and real-time aerosol monitoring were conducted over six clinical days while common dental procedures were performed, including fillings, …

Epidemiology And Ultrasonographic Observations Of Urogenital Schistosomiasis Related Urinary Tract Morbidity In Itilima District, Simiyu Region, Tanzania, Coletha Yohana, Bruno A. Nyundo, Jared S. Bakuza, Peter F. Rambau, Safari M. Kinung’Hi

Tanzania Journal of Science

Chronic infection of urogenital schistosomiasis in humans is a major cause of urinary tract morbidity in endemic areas. However, information on the prevalence of schistosomiasisrelated urinary tract morbidity is lacking in most endemic countries including Tanzania. This study was conducted to determine the prevalence of schistosomiasis-related urinary tract morbidity in schoolchildren and adults in Itilima District. Urine samples from 682 residents were examined for Schistosoma haematobium infection using urine filtration technique. Urinary tract morbidity was examined by ultrasound. The prevalence of S. haematobium infection was 16.4% (112/682) and varied significantly between villages (range 3.2% to 29.5%, χ2 = 48.467, p < 0.001). There was no significant variation of S. haematobium infection between male and female (8.3 % vs 8.1%, χ2 = 0.679, p = 0.410). Majority (93.8%) had light infections (

Breaking Bread And Barriers: Interprofessional Strategies To Improve Mental And Nutritional Health In Family Caregivers, Candy Ratliff

The Journal of the Research Association of Minority Professors

Family caregivers provide essential unpaid support to individuals with chronic illness, disability, dementia, and age-related decline; however, caregiving responsibilities often place caregivers at increased risk for psychological, physical, nutritional, and social challenges. This literature review examines the mental health and nutritional implications of family caregiving and explores barriers that contribute to declining caregiver wellness. Findings reveal elevated rates of depression, anxiety, emotional exhaustion, social isolation, food insecurity, sleep disturbances, financial strain, and chronic stress among caregivers. The literature further highlights the interconnected relationship between mental health, nutrition, and overall quality of life. Given the multidimensional nature of caregiver burden, interprofessional …

Parental Perspectives On Their Children’S Mental Health Changes During And After The Covid-19 Pandemic In A Florida Community, Brianna Yumul

Walden Dissertations and Doctoral Studies

No abstract provided.

Hiv Preexposure Prophylaxis (Prep) Satisfaction Amongst Female Sex Workers And Men Who Have Sex With Men In Cameroon, Zacheaus Zeh Akiy

Walden Dissertations and Doctoral Studies

No abstract provided.

Examining Diversity And Cultural Competency Within A Historically Black College And University (Hbcu) Public Health Curriculum, Alyce L. Hays, Yalanda M. Barner, Latarsha Michael

The Journal of the Research Association of Minority Professors

Integrating diversity and cultural competency content into public health curricula is vital in preparing future health professionals to optimize health outcomes of all individuals; however, very few studies have examined whether diversity and cultural competencies are taught in public health curricula. Studies have consistently incorporated diversity, equity, and inclusion in education for healthcare professionals such as nursing, community health workers, health educators, etc. The purpose of this study was to assess the presence of course content diversity, equity, inclusion, cultural competency, or other related topics. A formative assessment approach utilizing a four-step evaluation process was used to review the inclusion …

Advancing Culturally Relevant Mindfulness In Public Health, Marcus Johnson, Candy Ratliff

The Journal of the Research Association of Minority Professors

Mindfulness-based interventions (MBIs) have gained significant traction in public health, education, and clinical settings due to their demonstrated benefits for stress reduction and psychological well-being. However, these interventions often originate from Eurocentric frameworks that insufficiently reflect the cultural, historical, and structural contexts of diverse and historically marginalized communities. This commentary proposes a Culturally Relevant Mindfulness (CRM) framework that centers the lived experiences, healing traditions, and epistemologies of underrepresented populations. Drawing on interdisciplinary literature and critiques of conventional mindfulness models, the article articulates four guiding principles of CRM: cultural identity affirmation, historical consciousness, ancestral integration, and community-centered practice. Rather than merely …

Psycho-Behavioral And Psychosocial Factors Influencing Childhood Obesity In The United States, Nadia Ntori Nkansah

Walden Dissertations and Doctoral Studies

No abstract provided.

Moving Beyond Occupational Health: Lessons From Implementing Integrated Worker Health Programs Among Informal Workers In Thailand, Orrapan Untimanon

Journal of Health Research

Background: This paper aims to present practical experiences and lessons learned from applying an integrated worker health approach among informal workers in Thailand. The approach draws on the concept of Total Worker Health (TWH) and is implemented through Primary Care Units (PCUs).

Methods: This is an invited commentary.  

Results: Key steps included: (1) identification of occupational health (OH) services provided by PCUs; (2) development and refinement of an integrated worker health assessment tool based on TWH principles; (3) assessment and problem identification among informal workers, highlighting combined occupational and lifestyle-related risks; (4) design and implementation of integrated interventions; and (5) …

If Pets Are Family: Pet Loss And The Need For Grief Equity In One Health, Michele L. Whitney

Journal of One Health Systems

One Health frameworks increasingly recognize pets as integral to human health and well-being. However, these models often overlook the health and equity implications of pet loss. Culturally mediated grief experiences following pet bereavement represent a critical grief equity gap in One Health systems. Drawing on findings from a qualitative study of African American adults who experienced pet loss, along with existing literature, this Viewpoint highlights how pet loss is not only an emotional experience but also a socially structured one shaped by cultural norms, social recognition, and access to support. These dynamics contribute to inequities in how grief is experienced …

(Re)Claiming Homeplace: Dance As Embodied Resistance & Healing For Health & Spatial Justice, Preeya G. Kannan

University Honors Theses

This thesis argues that dance functions as both an upstream public health intervention and a form of radical spatial resistance; creating healing, agency, and belonging among historically marginalized communities. Drawing on bell hooks' concept of homeplace, Jasbir Puar's assemblage theory, Nancy Krieger's eco-social theory, and Katherine McKittrick's Black geographies, I position the body as both an ecological and political landscape shaped by histories of colonialism, racial capitalism, displacement, and resilience.

Through this community-based participatory research study, Homeplace, I explore dance as a form of social prescription that centers liberation rather than pathology. Movement is often reduced in public health discourse …

Using Social Return On Investment To Evaluate Services That Support The Health Of People Experiencing Homelessness In Australia: A Scoping Review, Cate Mckenna, Christopher Rouen, Mary O'Loughlin

Research outputs 2022 to 2026

The increasing demand for homelessness services in Australia highlights the need for robust evaluation methodologies to assess their social impact. Traditional economic evaluation methods often struggle to capture the intangible social and health outcomes associated with homelessness. Social return on investment (SROI), an outcomes-based framework driven by stakeholders, offers a flexible and comprehensive approach to measuring social, economic and environmental impacts. This scoping review examines the application of SROI in evaluating services that support the health of people experiencing or at risk of homelessness in Australia. A total of 25 reports from grey literature (2010-2023) were reviewed. The findings reveal …

Rural–Urban Disparities In Monkeypox-Related Behaviors And Attitudes Among Men Who Have Sex With Men, Patcharaporn Krainara, Benjamas Klahan, Rungrot Jaiyong, Jitti Hanprasertpong

Journal of Health Research

Background: Monkeypox (Mpox) is a global health threat, particularly among men who have sex with men (MSM). Despite the predominance of urban cases in Thailand, rural–urban disparities in Mpox-related attitudes and behaviors remain underinvestigated. This study aimed to compare Mpox-related attitudes and preventive behaviors among urban (Chonburi) and rural (Nakhon Nayok) MSM and identify their influencing factors.

Method: This cross-sectional study was conducted between March and April 2025. A total of  842 MSM (421 urban; 421 rural) were recruited via convenience sampling. Data were collected using paper-based, self-administered Health Belief Model (HBM) questionnaires and analyzed using descriptive statistics and multivariable …

School Policy, Health Equity, And Lgbtq+ Youth: Implications Of Mahmoud V. Taylor, Anna Folta

Online/Hybrid MPH Integrative Learning Experience (capstone projects)

School-based policy functions as a critical lever for reducing health disparities among LGBTQ+ youth, who face elevated risks of suicidality, bullying, unsafe school environments, and housing instability. An extensive body of research identifies inclusive school practices—such as affirming curricula, supportive staff, and student organizations—as key protective factors that foster belonging and improve mental health outcomes. However, recent political and legal developments threaten the implementation and consistency of these protections.

Using a structured literature review and comparative policy analysis of federal, state, and district responses, this project integrates public health evidence with legal interpretation to assess how emerging parental opt-out frameworks …

Aid As Leverage: How Humanitarian Assistance Shapes The Health Power Dynamics In Eastern Democratic Republic Of Congo, Emmanuella K. Mbuyu

University Honors Theses

This paper examines humanitarian aid in the Eastern Democratic Republic of Congo, where it serves as both relief and a force reshaping local power dynamics within ongoing conflict. Humanitarian organizations provide essential services in contexts of state collapse, but aid delivery is deeply embedded in systems of coercion, negotiation, and external influence. Drawing on critical humanitarianism and the aid economy, this study analyzes how humanitarian access is negotiated, how donor priorities shape definitions of need, and how temporary interventions create dependency and instability. The paper explores how humanitarian action can reinforce alternative structures of authority, particularly in weak or absent …

Testing Potential Correlations Between Childhood Lead Exposure And Authoritarianism In Adulthood, Kragen Anderson

University Honors Theses

A significant body of research links lead exposure during childhood to negative effects ranging from increased impulsivity to societal level effects such as an increased likelihood of committing violent crime in adulthood. Due to exposure vectors such as lead water pipes, lead solder, lead based paints, and leaded gasoline there was significant lead exposure during childhood for large portions of the American population. This paper tested and found a statistically significant association between average population level lead exposure in childhood and likelihood of voting for candidate Trump later in life.

Healthcare Access Challenges Among Asian Americans, Phyo Theingi

University Honors Theses

Asian Americans are the fastest growing racial ethnic group in the U.S. According to the 2023 U.S. Census Bureau population estimate, Asian Americans account for 25.2 million (or 7.4%) of the nation's population. Asian Americans are not a monolith and represent a diversity of rich histories, cultures, languages and ethnicities. According to research conducted by the Pew Research Center, most Asian Americans face discrimination of some kind, including being treated as a foreigner in the U.S and being stereotyped as a model minority. They also experience health care access barriers. Research found that Asian Americans face barriers related to language …

Flame Retardant Metabolites In Urine Samples Associated With U.S. Consumer Dietary Behaviors, Heather Marie Holliday

Walden Dissertations and Doctoral Studies

No abstract provided.

Motherwise In Nicaragua: The Implementation Of Culturally Adapted Relationship Education For Women During Pregnancy And Postpartum, Amanda Key Correa Love

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Intimate partner violence (IPV) is a concerning public health issue of global proportions, particularly within rural and under-resourced settings. Communities in these settings face elevated risk for relationship abuse, further compounded by barriers to access culturally responsive preventive intervention programming. This qualitative study investigated participant experiences, cultural adaptation, and implementation of the MotherWise program, a healthy relationship education intervention in rural Leon, Nicaragua. Semi-structured interviews were conducted with former and current program participants as well as the program facilitator following the initial program implementation. Data were analyzed using thematic analysis to identify patterns related to participant experiences, the types of …

Understanding Moral Injury In Emergency Department Clinicians: Predictors, Outcomes, And Evidence Gaps, Rose Doering Lightspeed

University Honors Theses

Moral injury (MI) is an emerging construct for understanding clinician distress in high-acuity healthcare settings, yet its application to Emergency Department (ED) clinicians remains limited. MI refers to psychological distress resulting from exposure to, or participation in, situations that conflict with deeply held moral or ethical standards, often due to systemic or organizational constraints. Although prior research has examined MI in heterogeneous healthcare samples, the ED remains underexamined despite its unique combination of high patient acuity, throughput pressure, and resource limitations.

This review synthesizes literature on MI among healthcare workers with a focus on ED clinicians, drawing on Industrial-Organizational psychology …

The Gut Microbiome, The Gut-Brain Axis, And College Student Well-Being, Idi Mckay

University Honors Theses

This literature review examines how diet, stress, environmental exposure, and food accessibility may influence college students' mental health and academic performance through the gut microbiome and the Gut-Brain Axis (GBA). Current microbiome research often focuses on early childhood development, clinical disease populations, or older adults, while overlooking college-age students who experience significant social, environmental, and biological transitions. College students frequently face food insecurity, irregular eating patterns, chronic stress, inconsistent sleep schedules, and reduced access to nutrient-dense foods, all of which may influence microbial diversity and overall gut health.

This thesis explores how modern campus environments and lifestyle factors may contribute …

The Role Of Project Managers And Pmp Principles In Improving Operational Efficiency In Healthcare Organizations, Karan Thakkar

Harrisburg University Dissertations and Theses

Healthcare organizations operate in increasingly complex, regulated, and resource-constrained environments while managing a growing volume of projects tied to digital transformation, process improvement, regulatory compliance, and infrastructure development. Despite the project-intensive nature of healthcare operations, many organizations do not formally employ trained project managers or consistently apply Project Management Professional (PMP) principles; project responsibilities are frequently absorbed by clinical or administrative leaders whose primary expertise lies outside formal project management. This qualitative study examined how the project manager role and PMP principles contribute to operational efficiency in healthcare organizations. The study was conducted as a qualitative document analysis and thematic …

When School Culture Excludes: Deficit Discourse, Microaggressions, And The Mental Health Of Marginalized Students – A Conceptual Framework With Implications For School Psychology Practice And Equity Policy, Modupe Mercy Oyewunmi

Publications

Deficit-laden language like ‘behavior problem,’ ‘not college material,’ ‘won’t fit in’, ‘not a cultural fit’, operates as a systemic form of implicit bias and microaggression in school settings. Despite decades of research on school belonging and well-being, school psychology has yet to integrate these exclusionary discursive practices into a coherent health-determinant model that also accounts for the current anti-diversity, equity, and inclusion (DEI) policy environment. This conceptual paper proposes a testable framework linking deficit discourse and school-based microaggressions to student identity suppression, academic impostor phenomenon, and educator moral injury, with downstream effects on school mental health outcomes. We situate these …

How Do Us States Define Person-Centered And Family-Involved Care In Assisted Living Regulations, Paula Carder, Lindsey Smith, Jennifer N. Bunker, Cassandra L. Hua, Erh-Chi Hsu, Isabelle Boun, Olivia M. Ainsworth, Kali S. Thomas, Eric Jutkowitz

Institute on Aging Publications

Introduction: A large share of assisted living (AL) residents have a diagnosis of dementia or cognitive impairment, and these individuals can benefit from person-centered care and family-involved care. This study examines whether and how states’ AL licenses address these topics.MethodsThis research analyzed a national database of 249 unique licensing requirements that govern 35,602 ALs in all states and associated regulations, including those that govern memory care (MC) services. We reviewed each regulation for the presence of person-centered or family involved care and then used content analysis of license requirements with at least one relevant policy to identify key categories and …

Auricular Point Acupressure Self-Management (Apa-Sm) Program For Chronic Musculoskeletal Pain Among Rural Populations: A Protocol For A Pragmatic, Randomized Controlled Trial, Jennifer Kawi, Jane Bolin, Hulin Wu, Jungkyung Min, Rupsikha Bora, Sarah Pace, Idara N Akpan, Alee Lockman, Tonychris Nnaka

Faculty, Staff and Student Publications

Introduction: Chronic musculoskeletal pain (CMP) is a leading cause of incurred personal healthcare costs and disability in the USA. It disproportionately affects rural populations, who are more likely to be uninsured, lack access to a regular healthcare provider and experience a higher prevalence of CMP. As a result of reduced access to non-pharmacological care, there is greater reliance on opioids. The Auricular Point Acupressure - Self-Management (APA-SM) program is a simple, needleless, evidence-based therapy that empowers individuals to self-manage their pain. Preliminary studies, including a recent UG3 pilot testing, demonstrated feasibility, safety and significant improvements in pain and function. Guided …