Digital Commons Network^™

The Effect Of The Affordable Care Act Medicaid Expansion On The Risk Of Hospital Closure And Adolescent Hpv Immunization In Rural Counties, Juliette Des Rosiers

Scripps Senior Theses

From 2005 to 2025, over 200 rural hospitals shut their doors, often citing increased operational costs, staffing shortages, low patient volume, regulatory barriers, financial challenges exacerbated by the COVID-19 pandemic, and uncompensated care as common contributors to the closures. Rural patients are often referred by their primary care physician to a hospital for regular immunizations, since smaller clinics have less capacity to provide immunizations due to a shortage of pediatricians and limited vaccine stock. A crucial vaccine that is not required by schools and underutilized in rural areas is that against human papillomavirus (HPV), a virus that infects cutaneous and …

Improving Maternal Health: Investigating The Early Impacts Of Medicaid Coverage Of Doulas In Oregon, Miriam Akhmetshin

Scripps Senior Theses

While the U.S. spends more per-capita than any country on healthcare, we experience the worst maternal health outcomes of high-income nations. In addition to hefty healthcare bills, an overwhelming majority of mothers experience pregnancy-related health issues that decrease productivity and utility. Thus, it is critical to research cost-effective solutions that can improve maternal health and promote equitable outcomes. Doulas are trained non-medical professionals who support mothers and families before, during and after birth. As a growing body of medical literature points to the role of doulas in decreasing costly medical interventions, insurance companies have begun covering their services. In 2014, …

Food Stamp Participation And Health Outcomes In Ca Immigrants, Esther Kang

Scripps Senior Theses

The U.S. social welfare system includes programs aiming to increase access to nutritious food to reduce nutrition insecurity. However, studies suggest that immigrants continue to face disproportionate risks of nutrition insecurity and may face barriers to enrollment due to legal status. This study, using secondary data from the 2023 California Health Interview Survey, examines the associations between food stamp participation, food insecurity, and clinical diagnosis of diabetes among adult U.S.-born, naturalized, and non-citizen adults in California. The findings suggest that those enrolled in food stamps are more likely to report food insecurity than those who are not enrolled, and that …

Rural Oral Health Access Coordination Program Proposal, Anna Luu

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Oral health disparities remain a major public health issue in the United States, particularly in rural Kentucky, with barriers such as limited access to preventive dental services, transportation, and insurance coverage contributing to delayed treatment and worsening oral health outcomes. In response, the proposed Rural Oral Health Access Coordination Program aims to improve care access by strengthening referral systems, integrating oral health screenings into public health settings, and enhancing care coordination for high-risk populations. The program intends to focus on the Kentucky River District Health Department Region, connecting individuals to existing services rather than providing direct clinical care. Expected outcomes …

“Eres Mujer Y Te Tienes Que Aguantar”: Hispanic Maternal Wellbeing, Stephanie Reyes Bravo

CISLA Senior Integrative Projects

No abstract provided.

Understanding The Underutilization Of The Campus Recreation Facility: A Mixed-Methods Examination Of Basic Psychological Need Satisfaction, Social Physique Anxiety, Sense Of Community, And Physical Environment Barriers, Caden M. Pfingsten

Master's Theses or Doctor of Nursing Practice

Campus recreation facilities have been identified as important contributors to student well-being, academic persistence, and institutional belonging. Despite these documented benefits, a persistent gap exists between available services and actual student utilization at many institutions. This study examined the psychological, social, and environmental factors associated with students' underutilization of the Campus Recreation Facility (CRF) at a mid-sized Midwestern public university in favor of paid off-campus commercial gym memberships.

Using a cross-sectional survey design, 169 students completed a battery of validated and researcher-adapted instruments assessing basic psychological need satisfaction (autonomy, competence, and relatedness), Sense of Community, and social physique anxiety across …

Racial Disparities In Maternal Mortality: The Role Of Explicit And Implicit Bias In U.S. Healthcare, Lailah Allen

Capstone Showcase

Maternal mortality in the United States remains a critical public health crisis, with disproportionately high rates among Black and other minority women. Despite advances in obstetric medicine, racial disparities in pregnancy-related deaths persist due to structural inequities, implicit bias in healthcare delivery, unequal access to prenatal and postpartum care, and broader social determinants of health. Nationally, Black women are significantly more likely to experience severe maternal morbidity and mortality compared to White women, reflecting longstanding inequities embedded within the healthcare system. This paper examines the relationship between race, healthcare access, and maternal outcomes through a focused case study of and …

A Zinc Chelate Of Lysine/Glutamic Acid Reduces Alcohol-Induced Ciliary Dysfunction, Emily Do, Daren L. Knoell, Christopher Bauer, Deanna Mosley, Deandra R. Smith, Derrick R. Samuelson, Todd A. Wyatt

Journal Articles: Environmental, Agricultural & Occupational Health

Alcohol misuse is a known risk factor for pneumonia, and up to 50% of individuals who misuse alcohol are zinc deficient. Chronic alcohol misuse can lead to alcohol-induced ciliary dysfunction (AICD), preventing effective mucociliary clearance and protection against lung infection. Because zinc salts fail to alter AICD, we hypothesized a form of zinc (Zinpro Zinc LG) with enhanced cell uptake would protect against AICD. Human and mouse airway epithelial cells were treated with 50 mM ethanol for 1-24 h followed by the ciliostimulatory agents. Cilia beat frequency (CBF) and cAMP-dependent protein kinase (PKA) activity were assayed. Cyclic AMP or beta …

Analysis Of Risk Factors And Current Programs For Addressing Injuries In Children And Adolescents, Jahfel Nial Jones Iii

Theses and Dissertations

Unintentional injuries are a leading cause of morbidity and mortality among children and adolescents in the United States. These injuries result from various causes, including motor vehicle crashes, falls, suffocation, and poisoning. This capstone project examines the prevalence, risk factors, and prevention strategies for unintentional injuries among infants, children, and adolescents. Using a public health approach, this research explores evidence-based interventions and community-based programs that effectively reduce injury-related mortality. The project also incorporates data and insights from the Safe Kids Columbus program at Piedmont Columbus Regional, where various injury prevention initiatives have been implemented.

Findings revealed that motor vehicle crashes …

Risques De Blessures Professionnelles Et Leurs Déterminants Parmi Les Jeunes En Emploi Au Québec Entre 2015 Et 2021 : Analyses Selon Les Parcours D'Emploi Et D'Études, Jaunathan Bilodeau, Marc-Antoine Busque, Martin Lebeau, Gabriel Beauchamp

Rapports de recherche scientifique

Les blessures professionnelles parmi les jeunes demeurent un enjeu de santé publique majeur. Bien que les jeunes soient considérés comme une des populations à mettre en avant pour la prévention de la santé et la sécurité du travail, les mécanismes et processus impliqués dans leurs blessures au travail demeurent à explorer. Cette étude vise ainsi à mieux comprendre les facteurs contribuant aux risques de blessures professionnelles et de leur récurrence parmi les jeunes âgés de 15 à 24 ans. Plus particulièrement, l’objectif consiste à (1) documenter l’association entre les profils de parcours professionnel ainsi que d’études et le risque de …

The Divide Of Women’S Health: Systematic Thinking Of Women, Tasfia T. Howlader

Honors Theses

Women’s health has constantly been changing- from public health infrastructure to health policies, and even medical advancements. Yet, the struggles are persistent within the gaps present in women’s health. The Socio-Ecological Model (SEM) explains interactions between different levels of relationships, which result in health outcomes that vary from individual factors to environmental factors. Applying the SEM to describe health disparities can help explain how the relationships an individual has influenced their health. This project serves to exemplify these different levels while discussing the tailoring of services to the needs and the importance of populations based on their experiences. Specifically, adhering …

Fitness To Work Evaluation In A Combined Physical And Office Working Activity With Piriformis Syndrome: A Case Report, Arif Prasetya, Nuri Purwito Adi

Occupational and Environmental Medicine Journal of Indonesia

Background Piriformis syndrome (PS) is a neuromuscular disorder with significant impact on workforce productivity. This case report presents a comprehensive evaluation of fitness for work and job modification strategies for a patient with PS in a combined physical and sedentary working environment. A 44-year-old male medical facility supervisor presented with left buttock pain, radiating to the left leg, diagnosed with left gluteal piriformis syndrome. Despite undergoing multiple conservative therapies by Physical Medicine and Rehabilitation Specialist, the patient showed minimal improvement.

Methods A seven-step fitness for work assessment approach was implemented following Indonesian Association of Occupational Medicine Specialists guidelines. The evaluation …

Factors Associated With The Atherogenic Index Of Plasma Among Workers At A National Respiratory Hospital In Jakarta, Muhammad Abror Rizani Fahmi, Herqutanto Herqutanto, Iqbal Mochtar, Dewi Yunia Fitriani, Marsen Isbayuputra, Resultanti Resultanti, Ariningsih Ariningsih

Occupational and Environmental Medicine Journal of Indonesia

Background Cardiovascular diseases (CVD) represent the primary cause of mortality globally. The atherogenic index of plasma (AIP) can predict the risk of CVD more accurately than other indices. Hospital workers are at risk of developing CVD. There are several factors that can influence the AIP. No studies have specifically investigated these associations in Indonesia, particularly regarding the AIP in hospital workers. This study aims to determine factors associated with the AIP among workers at a national respiratory hospital in Jakarta.

Methods This cross-sectional study collects data from the medical check-up records of workers at Persahabatan Hospital in 2024, who met …

Health Matters: Advancing Pediatric Health Equity Through Accessible And Engaging Health Literacy Activity Books, Lorraine Sheldon

2026

This poster describes the development and implementation of the Health Matters activity book series, a health literacy initiative designed to provide engaging, accessible, and developmentally appropriate health education for pediatric patients and their families. Through multidisciplinary collaboration, audience-centered design, and distribution across more than 30 departments, the project demonstrates how interactive educational materials can advance pediatric health equity, support family engagement, and improve health literacy outcomes.

Behavioral And Psychological Financial Hardship Among Caregivers Of Pediatric Cancer Patients, Josiane Kabayundo, Cheng Zheng, Edward S. Peters, Don W. Coulter, Shinobu Watanabe-Galloway

Journal Articles: Epidemiology

BACKGROUND: Financial hardship encompasses material, behavioral, and psychological domains; however, most research among caregivers of pediatric cancer patients has focused on material hardship. This study examined factors associated with behavioral and psychological financial hardship among caregivers of pediatric cancer patients in Nebraska.

METHODS: We conducted a cross-sectional survey of caregivers of children diagnosed within the past 5 years and treated at two pediatric oncology specialty clinics. Behavioral hardship was defined as delaying medical or mental healthcare due to cost, while psychological hardship was measured by worry about ability to pay medical bills. Descriptive statistics and poisson regression with robust variance …

Three Essays On Disparities And Outcomes Among Patients With Diabetes, Aiemere O. Oikeh

Theses and Dissertations--Health Services Research (HSR)

The American Diabetes Association (ADA) recommends that patients with diabetes adopt 7 preventive care measures to improve their health outcomes. The recommendations are to check their blood glucose levels daily, undergo biennial hemoglobin A1c tests, undergo dilated eye exams once every 2 years, engage in regular physical activity, check their feet daily, have annual feet examinations performed by a clinician, and receive diabetes self-management education services (DSMES). Marital status has been found to be associated with positive health outcomes; thus, it is ideal to evaluate if there is an association between marital status and diabetes preventive care. The ADA also …

The Correlation Between 25(Oh)D, Blood Lead Levels, And Delta-Aminolevulinic Acid Dehydratase Activity Among Indonesia Male Workers, Ratih Fadhillah, Muhammad Ilyas, Liem Jen Fuk, Levina Chandra Khoe, Muchtaruddin Mansyur

Occupational and Environmental Medicine Journal of Indonesia

Background Lead exposure disrupts the heme synthesis pathway by modifying the activity of Delta-Aminolevulinic Acid Dehydratase (ALAD), contributing to oxidative stress. Vitamin D has been suggested as an antioxidant to influence oxidative balance, but evidence regarding its association with ALAD activity in lead-exposed populations remains limited. This study aimed to analyze the associations between blood lead levels (BLL), serum 25-hydroxyvitamin D [25(OH)D], ALAD activity, and the 25(OH)D/BLL ratio among Indonesian male workers.

Methods A cross-sectional study was conducted among 90 male workers exposed to lead as part of either their occupation or living environment in Java, Indonesia. Serum 25(OH)D, BLL …

Return To Work After Percutaneous Coronary Intervention In Employee With Metabolic Comorbidities: An Evidence-Based Case Report, Bramantyo Eko Wahyudi Mr, Levina Khoe

Occupational and Environmental Medicine Journal of Indonesia

Background This evidence-based case report examines whether metabolic comorbidities independently predict return to work (RTW) after percutaneous coronary intervention (PCI) for myocardial infarction. A 52-year-old male senior manager with type 2 diabetes, hypertension, dyslipidaemia, and central obesity underwent PCI and required structured occupational assessment.

Methods A systematic literature search identified five eligible studies—one national registry cohort, three prospective cohort studies, and one narrative systematic review—critically appraised using Oxford Centre for Evidence-Based Medicine criteria.

Results Metabolic comorbidities showed consistent directional associations with reduced RTW probability in bivariate analyses and independently predicted longterm labour-market exit. However, in multivariate models across three of …

Étude Multidisciplinaire Du Confort Des Bouchons D'Oreilles : Vers Une Protection Auditive Efficace En Milieu De Travail, Olivier Doutres, Franck Sgard, Alessia Negrini, Alain Berry, Chantal Gauvin

Rapports de recherche scientifique

L'utilisation de protecteurs auditifs individuels (PICB), tels que les casques ou les bouchons d’oreilles souvent recommandés comme mesure temporaire, reste souvent le seul moyen d'assurer la protection des travailleuses et travailleurs exposés quotidiennement à des niveaux de bruit dangereux. Actuellement, le choix d'un PICB est principalement basé sur des considérations liées à l’atténuation acoustique qu’il offre (et mesurée en laboratoire par des organisations certifiées), et/ou à des caractéristiques de l'environnement de travail, telles que la chaleur, l'hygiène et la compatibilité avec d'autres équipements de protection individuelle (EPI). Le port de PICB est connu pour générer de nombreux inconforts qui peuvent …

The Weight Of Stigma, Rebekah A. King, Michael S. Sinha

All Faculty Scholarship

Many health care providers, both implicitly and explicitly, perpetuate stigma in their treatment of patients classified as obese. While medical professionals understand that a one-size-fits-all approach to treatment is ineffective, patients classified as obese are frequently offered limited treatment options that fail to account for their unique needs. Access to a range of effective treatment options has historically been limited, but new GLP-1 receptor agonist medicines like Wegovy (semaglutide) and Zepbound (tirzepatide), have shown incredible promise in addressing the obesity crisis. Unfortunately, these transformative drugs are costly, in high demand, and not widely covered by insurance, rendering them inaccessible for …

Wise Beyond Our Years: Menopause, Negative Body-Image, And Art As A Catalyst To Self-Acceptance, Nicole Lea

Art Therapy | Master's Theses

This mixed methods study examined the impact of menopause on women’s body image and self-acceptance through an arts-based group intervention. Quantitative data was collected using the Body Image Self-Compassion Scale, and qualitative data was gathered through art-making, group discussion, and individual interviews. Participants were (n=5) menopausal women aged 46-52 from the Bay Area who reported negative body image related to menopause. The intervention consisted of four one-hour open studio workshops with a fifth meeting added in which participants created altered books while engaging in peer support and discussion. Descriptive statistics indicated an increase in mean body image self-compassion scores from …

Improving The Continuity Of Care For Opioid Use Disorder: Investigating Fentanyl Overdose Outcomes And Pharmacy-Level Buprenorphine Access, Lyn Yuen Choo

Graduate Theses, Dissertations, and Problem Reports (ETD)

Opioid overdose (OD) deaths remain a leading cause of injury-related death in the United States (US) and approximately 76,516 drug OD deaths were predicted in the past year prior to April 2025. While previous research has focused on fatal opioid ODs, less is known about outcomes following non-fatal opioid ODs (NFOO) involving fentanyl. Patients who experienced a fentanyl OD may develop significant morbidity and inpatient mortality due to fentanyl’s high potency, rapid onset of action, and decreased response to naloxone. Research efforts to improve continuity of care for opioid use disorder (OUD) are highly needed to ensure appropriate follow-up care …

Association Between A Lifestyle Medicine Score And Stroke In U.S. Adults With Hyperglycemia: 2007- 2010 Nhanes, Swarnima Naithani

UNF Graduate Theses and Dissertations

The relationship between glycemic control and cardiovascular disease (CVD) is well- established, however, lifestyle modifications to prevent CVD warrant further investigation. Purpose: This study aimed to evaluate the relationship between adherence to the six lifestyle medicine pillars promoted by the American College of Lifestyle Medicine and stroke in U.S. adults with hyperglycemia. A lifestyle medicine composite score (LMS) was developed to quantify adherence with the hypothesis that a higher LMS (greater adherence to lifestyle recommendations) correlates with lower odds of stroke in adults with hyperglycemia. Methods: The study sample (n=2,079) included adult (≥ 40 years of age) participants in the …

Neighborhood Deprivation Associated With Impaired Sit-To-Stand Performance In Middle-Aged And Older Adults: A Cross-Sectional Analysis With Clinical Implications, Kenneth Harrison, Silvia Campos-Vargas, Brandon M. Peoples, Keven G. Santamaria-Guzman, David T. Redden, Michael A. Samaan, Jaimie A. Roper

Kinesiology and Health Promotion Faculty Publications

Background: Socioeconomic factors significantly influence health outcomes in older adults, yet their impact on specific aspects of mobility remains unclear. This study investigates the relationship between area-level socioeconomic disadvantage and mobility health in older adults.

Methods: We conducted a cross-sectional study of 110 community-dwelling older adults recruited and collected using voluntary response sampling at eight health fairs across rural Southeast Alabama in 2022–2024 (60 ± 16 years, 80% female). Area-level socioeconomic status was measured using the Area Deprivation Index (ADI), a validated composite measure of neighborhood disadvantage. Mobility was assessed using the Instrumented Timed Up and Go (iTUG) test and …

Iron Deficiency And Iron Deficiency Anemia: Inconsistent Screening Practices And Delayed Result Processing In Children 12-18 Months, Madonna J. Mahoney Marshall

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction:

Iron deficiency and iron deficiency anemia in children aged 12 to 18 months are prevalent conditions that, if not identified and treated early, are associated with adverse neurodevelopmental outcomes.

Purpose:

This quality improvement project evaluated the impact of a standardized screening and follow-up protocol on laboratory result retrieval, provider review, and caregiver follow-through in a military pediatric clinic.

Method:

A pre-post intervention design guided by the Plan-Do-Study-Act framework was implemented over 11 weeks and included staff education, standardized workflows, and caregiver outreach.

Results:

The intervention improved laboratory completion and caregiver follow-up rates; however, sustainability was limited by staffing constraints …

Barriers To Immunity: Understanding Covid-19 Vaccine Uptake In Africa, Emilia Blechschmidt

Honors Theses

This thesis examines the factors influencing COVID-19 vaccine uptake across African countries, with a focus on structural, informational, and behavioral barriers to immunization. Drawing on cross-country data, the study analyzes how access to transportation, reliable information, and healthcare resources shape vaccination rates, alongside the effect of demographics and institutional factors in shaping individual perceptions of risk and vaccine safety.

The findings emphasize that the broader strength and preparedness of national health systems strongly influence vaccine uptake. Countries that demonstrated higher coverage of routine childhood immunizations, such as polio and hepatitis B, also tended to perform better in COVID-19 uptake efficiency …

Hallucinogen Use Among Parents Of Children In The United States: Associations With Mental Health And Substance Use, Maggie K. Richardson

Theses and Dissertations--Educational, School, and Counseling Psychology

Hallucinogen use has reemerged in the United States amid expanding clinical research and shifting social and policy contexts. However, population-based evidence remains limited regarding hallucinogen use among adults living with children and its relationship with mental health impairment severity in caregiving environments. Therefore, this study’s objective was to examine associations between past-year hallucinogen use and past-year mental health impairment among U.S. adults, and to test whether associations differ by parental status and number of children in the household. A secondary aim examined correlates of co-occurring substance use among those reporting hallucinogen use.

Data were drawn from the 2023 National Survey …

One-Stop-Shop (Oss): Community Health Nursing: (For Undergraduate Nurses), Sarmad Muhammad Soomar

Books

No abstract provided.

Adolescent Girls’ Experiences Of Digital Dating Abuse Through Social Media: A Scoping Review, Kiara E. Rodriguez

Social Work Theses

Teen dating violence (TDV) is a prevalent adverse childhood experience with lasting psychological and behavioral consequences. As adolescents increasingly engage with social media, with 95% of teens aged 13-17 reporting using it, digital spaces have become a significant context in which dating abuse can occur. Digital dating abuse (DDA) refers to patterns of abusive behaviors that are directed toward a dating partner through digital technologies, including social media and mobile phones. Despite the growing role of social media in adolescent relationships, research on how adolescent girls experience DDA in these contexts remains limited. The central question for this scoping review …

Les Répercussions Des Changements Climatiques Sur La Sst : État Des Lieux Et Pistes D'Action, Sophie De Serres, Alain Marchand

États de la question, rapports d’expertise et revues de littérature

Cet état des lieux expose les répercussions multidimensionnelles des changements climatiques (CC) sur la santé et la sécurité du travail (SST), en se concentrant sur les contextes nord-américain et européen. L'augmentation de la température moyenne mondiale, qui atteint désormais +1,2 °C par rapport à l'ère préindustrielle, transforme les conditions de travail et exacerbe les dangers professionnels existants. Le stress thermique induit par la chaleur excessive provoque des pathologies allant de l'épuisement au coup de chaleur mortel, tout en dégradant la vigilance et en augmentant le risque de blessures traumatiques. Au-delà des atteintes physiques, les CC aggravent les risques psychosociaux, engendrant …