Digital Commons Network^™

Factors Affecting School Readiness And Level Of Distraction Among Black Children During Virtual Learning In The United States, Imani Barnes

Walden Dissertations and Doctoral Studies

The COVID-19 pandemic necessitated an shift to mandatory virtual learning (VL) for kindergarten through grade 12 students, disrupting educational systems globally and exposing systemic inequities. Although researchers had explored health and education disparities separately, they had not adequately examined the intersection of child health, specifically body mass index (BMI) and health-affected ability, with school readiness and level of distraction in VL environments. The purpose of this quantitative, cross-sectional study was to examine associations between BMI, health affected ability, school readiness, and distraction levels among U.S. Black children engaged in VL in the 2020 school year, controlling for gender, age, and …

Pxj Volume 12 – Key Theme Summary And Article Index, Patient Experience Journal

Patient Experience Journal

Volume 12 of the Patient Experience Journal showcases a global dedication to advancing human experience in healthcare, illuminating both existing challenges and crucial emerging practices. The content, spanning three issues, emphasizes that improving the human experience is not a temporary initiative but rather the essential foundation for building trust, ensuring safety, facilitating healing, and sustaining organizational resilience. The overarching message of Volume 12 is that human experience is the heart of healthcare. It is actively shaped through shared purpose, design, empathy, communication, and partnership. The journal calls for a future where every voice is heard, every story matters, every …

Evaluating Fall Prevention Outcomes: Fall Rates, Staff Fall Knowledge, And Perceptions On Safety Culture, Priscilla Greco

Student Scholarly Projects

Practice Problem: The practice problem addressed in this project was the elevated fall rates on a 46-bed medical–surgical unit with a reported sentinel fall event, prompting the need to evaluate the current fall prevention program.

PICOT: The PICOT question that guided this project was: In nursing staff on a medical–surgical unit (P), how does the implementation of an evidence-based fall prevention program evaluation using AHRQ tools (I), compared with no formal program evaluation (C), influence staff knowledge, perceptions of safety culture, and fall rates (O) over 8-weeks (T)?

Evidence: Evidence supporting this project emphasized that structured staff education, strong communication, …

Healthcare Access, Economic Stability, And Food Security And Inflammatory Bowel Disease In Hispanic Adults Living In The United States, Jennifer Rodriguez

Walden Dissertations and Doctoral Studies

Hispanic adults in the United States experience disparities in chronic disease detection and outcomes, including inflammatory bowel disease (IBD). Social determinants of health (SDoH), including economic stability, healthcare access, and food security, play a crucial role in shaping health risks and diagnostic opportunities in this population. The purpose of this quantitative cross-sectional study was to examine the relationship between selected SDoH factors and self-reported IBD diagnosis among U.S. Hispanic adults. This study utilized survey data from the 2023 National Health Interview Survey (n = 29,457). Weighted descriptive statistics and logistic regression were used to analyze the relationships between variables while …

The Use Of Storytelling In Covid-19 Vaccine Promotion: A Scoping Review Of Interventions And Campaigns, Suha Ballout, Sabreen A. Darwish, Patricia J. Kelly, Teresa Keller, Ross Shegog, Basil H. Aboul-Enein

College of Nursing Faculty Papers & Presentations

BACKGROUND: The development of the COVID-19 vaccine, a groundbreaking scientific advancement, also fueled vaccine hesitancy mainly due to vaccine misinformation and the limited public understanding of the new technology and its rapid pace of development and deployment. A variety of public health communication strategies have been used that include engaging the community in identifying and developing messages, using culturally appropriate communication methods, applying behavioral health principles, and storytelling. The purpose of this scoping review was to assess the most relevant evidence from the research literature on storytelling interventions to mitigate COVID vaccine hesitancy during the pandemic.

METHODS: A scoping review …

Covid-19 Vaccine Acceptance Among People Who Smoke In Rural Southwest Georgia: Perspectives And Influencing Factors, Shadé Owolabi, Helen Singer, Katherine Reilly, Łucja T. Bundy Ma-Edm, J.K. Veluswamy, Carla Berg, Regine Haardörfer, James Hotz, Ajay Gehlot, Michelle Kegler

Journal of the Georgia Public Health Association

Background: The COVID-19 vaccine is a critical tool in reducing COVID-19 related morbidity and mortality. Unfortunately, vaccine hesitancy is an ongoing public health challenge, especially in certain geographic areas and sub-populations. This study assessed factors associated with COVID-19 vaccine uptake and hesitancy among individuals who smoke in rural communities in southwest Georgia, one of the first COVID-19 “hot spots” in the U.S.

Methods: We conducted qualitative interviews (n=23) using a semi-structured interview guide, informed by the Integrated Behavioral Model (IBM), that assessed vaccine-related behavior, intention to be vaccinated, perceived risk, social norms, attitudes, and environmental barriers and facilitators …

The Timing Of Pubertal Onset Affects Adults Anxiety Behavior In A Sex-Specific Manner, Evan Raubenolt

Honors Projects

This study aims to look at the relationship between the timing of pubertal onset and its long-term effects on adult anxiety behavior in rats. Though the topic of pubertal onset has been frequently discussed in developmental research, its exact effects have been inconsistent. Human models have shown that early and late maturing males are associated with a notable increase in adult anxiety behavior, while in rat models, similar sex-specific effects regarding anxiety have been demonstrated, though those studies focus on a causal relationship between exposure to stress and age of pubertal onset. This study first aims to examine that relationship …

Exploring Mediated Psychosocial Effects On Dating Violence Perpetration And Victimization In The Me & You Building Healthy Relationships Program For Middle School Students, Ross Shegog, Jeffery Temple, Susan Tortolero Emery, Melissa F Peskin

Faculty, Staff and Student Publications

Teen dating violence (TDV) is a prevalent and injurious public health threat affecting adolescent populations across the globe. In response, a plethora of interventions have been developed and implemented with various effects emerging from evaluation studies of these prevention initiatives. The purpose of this study was to investigate whether attitudes toward sexting, gender-based norms toward violence, and constructive conflict resolution skills mediate the main effects of a TDV intervention. Specifically, this study leverages data from the original efficacy trial of the

Improving Communication To Enhance Health Literacy And Self-Management Of Heart Failure: Protocol For A Multimethod Study, Neda Karimi, Francesco De Toni, Walter Abhayaratna, Blake Askelin, Philip Currie, Karol Edge, Christopher Etherton-Beer, Elizabeth Fewster, Liza Goncharov, Nisha Jijo, Susy Macqueen, Nilufeur Mckay, Suzanne Raine, Amineh Rashidi, Christopher Rouen, Rosemary Saunders, Peter Schulz, Rhea Tecson, Diana Slade

Research outputs 2022 to 2026

Introduction Self-care plays a pivotal role in the management of heart failure (HF). Health literacy and empowerment are considered the prerequisites of effective self-care. This project aims to improve self-management in people with HF by describing, analysing and enhancing the communication practices of clinicians and patients to support people with HF to increase their health literacy skills and participate in shared decision-making. Methods and analysis A multimethod research design incorporating an interview component, a concurrent mixed-methods component and a pilot intervention study is used. The study is currently being conducted at two Australian hospitals in metropolitan areas (one public and …

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.

The Impact Of Education And Awareness In Influencing Lifestyle Behaviors That Prevent And Treat Sarcopenia In Older Adults: A Mixed-Methods Cross-Sectional Research Study, Alan Lynn Jones

Doctoral Dissertations and Projects

This mixed-methods, cross-sectional study assessed the current level of knowledge and awareness among people aged 50 and older about sarcopenia, as well as their willingness to adopt lifestyle changes that could prevent or reverse the condition as they age. The study aimed to determine whether a lack of awareness and knowledge is linked to current lifestyle behaviors that contribute to or protect against the development of the disease. The population included men and women 50 and older, living independently in the community with no prior diagnosis of sarcopenia. The study used a custom-designed questionnaire and semi-structured interviews. A total of …

Asian College Students' Well-Being During A Period Of Rising Anti-Asian Sentiment, Kyuhan Choi, Ying Shi, Maria Zhu

Center for Policy Research

We use a large survey of students in U.S. colleges to study the distinct ways in which the COVID-19 pandemic and accompanying anti-Asian rhetoric shaped the experiences of Asian and Pacific Islanders (APIs). Using a difference-in-differences approach, we find that the pandemic led to Asian students experiencing more discrimination, feeling less safe during the day, and using fewer mental health services compared to White peers. The increase in discrimination and the perceived lower safety are concentrated among East and Southeast Asians, while South Asians were not affected. Despite these effects, we detect no relative deterioration in severe psychological distress or …

Universal School Meal Policies And Perceived Stigma: Quantitative Evidence From Eight Us States, Dania Orta-Aleman, Monica D. Zuercher, Leah Chapman, Marlene B. Schwartz, Caitlin D. French, Anisha I. Patel, Lorrene D. Ritchie, Juliana Cohen, Wendi Gosliner

Health Sciences Faculty Publications

Background

Universal school meals (USMs) policies, which provide free meals to all students regardless of income, have the potential to improve child nutrition and reduce stigma. Quantitative evidence on the association between USM and stigma is limited.

Methods

Leveraging a natural policy variation in state‐level USM implementation, we surveyed 1066 middle and high school students from eight US states (four with USM, four without) during the 2022–2023 school year. Stigma was measured as self‐reported embarrassment about eating school lunch. We used generalized estimating equations to examine the associations between USM, embarrassment, and lunch participation.

Results

Overall about one in nine …

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 …

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 …

Medicaid Funding And Health-Related Social Needs: A Policy Analysis, Passion Ilea

Dissertations and Theses

The U.S. has disproportionately high health care spending compared to other high-income nations and comparatively poor health outcomes. The Centers for Medicare and Medicaid Services (CMS) have recently increased emphasis on addressing Medicaid member social needs. CMS believes addressing health-related social needs (HRSN) may reduce costs and improve health outcomes for Medicaid members. CMS has begun to test theories regarding the impact of member HRSN on health care by designing federal mechanisms to address HRSN, such as in lieu of services and settings-funded services, and by encouraging state Medicaid programs to develop their own approaches, such as Flexible Services. Information …

Engaging Ukrainian Tf-Cbt Therapists In A Practice Skills Course To Support Their Wellbeing, Elisabeth Pollio, Esther Deblinger, Beth Cooper, Maike Garbade, Julie P Harrison, Elisa Pfeiffer

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Background: Burnout and secondary traumatic stress (STS) are common among therapists working with trauma-exposed clients, which can negatively impact them professionally and personally. The shared trauma of war exposure may put therapists at greater risk. To help support their wellbeing, an eight-session course was offered to Ukrainian therapists following training in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). This course involves therapists personally utilizing the PRACTICE skills taught to clients in TF-CBT for professional and personal benefit.

Objective: The objective was to gather preliminary evidence on the potential impact of implementing the course with Ukrainian therapists providing TF-CBT during a period of …

Factors Associated With Emergency Hospitalization Of Kidney Disease Patients In A National Hospital Kenya., Dorcus Miyombe

MSc in Advanced Practice Nursing

Introduction: Emergency hospitalizations among End Stage Kidney Disease (ESKD) is a major global health burden, with low- and middle-income countries in sub-Saharan Africa (SSA), experiencing the highest rates of morbidity and mortality. Limited resource, economic burden, and insufficient health infrastructure were the main challenges. Emergency hospitalizations at Kenyatta National Hospital remains high due to systemic gaps and poor continuity of care. Prerenal, intrarenal, post-renal injuries, as well as any combination of these, are the primary causes of ESKD. There are stipulated guidelines for ESKD patients’ management however, realization of these goals has not been achieved leading to hospitalization KDIGO …

Residential Segregation And Breast Cancer In Louisville: Impact Of Race And Contextual Factors On Advanced-Stage Diagnosis, Delayed Treatment, And Disease-Specific Mortality., Toheeb Ajani Mustapha

Electronic Theses and Dissertations

Female breast cancer (BC) remains the most commonly diagnosed non-skin cancer and the second leading cause of cancer death among U.S. women. Despite advances in detection and treatment, substantial inequities in BC outcomes persist, driven in part by structural forces such as residential segregation. This dissertation examined the relationship between residential segregation, BC outcomes, and key contextual factors in Louisville, Kentucky. Using data from the Kentucky Cancer Registry, American Community Survey, CDC’s Population-Level Analyses and Community Estimates, and the National Neighborhood Data Archive, the study tested two hypotheses: (1) higher Black/low-income segregation is associated with elevated risks of adverse BC …

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 …

Quality Of Life And Mental Health: A Qualitative Exploration Of Perceived Factors That Impact Older Adults, Chasiti Herring

All-Inclusive List of Electronic Theses and Dissertations

Enhancing quality of life and well-being is a universal phenomenon across the lifespan. As the population ages, older adults are in great need of supportive services to enhance quality of life and their ability to manage their mental health. The purpose of this study is to examine the quality of life (QoL) of older adults. This study aimed to provide valuable research in the area of QoL through the exploration of perceived factors that impact the older adult population. This exploratory qualitative research study consisted of 10 older adult participants between the ages of 65 and 95. Research recruitment prioritized …

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 …

Well-Being And Quality Of Life Of Kenyan Nurses, Midwives And Community Health Volunteers: Measurement Properties And Correlates Of The Bbq And Who-5, Paul Mwangi, Sabina Odero, Rachel Odhiambo, Brenda Nzioka, Constance Shumba, Eunice Ndirangu, Amina Abubakar

Institute for Human Development, East Africa

Healthcare workers’ quality of life (QoL) and well-being is directly linked to the quality of services they deliver. However, there is a shortage of validated measures to assess QoL, well-being and their predictors among healthcare workers in Kenya, as in other LMICs. This study aimed to assess the reliability and validity of the Brunnsviken Brief Quality of Life Scale (BBQ) and WHO-5 well-being index (WHO-5) among nurses, midwives and community health volunteers (CHVs) in Kenya. The BBQ and WHO-5 were selected due to their established psychometric strengths, brevity, and prior use in healthcare settings. Additionally, the sociodemographic, psychological, and health …

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 …

The Impact Of Social Media Use On Postpartum Depression, Jaila Randle

Capstone Experience: Master of Public Health

Postpartum depression (PPD) is a serious form of depression that affects one in eight women. Symptoms include feeling sad all the time, being anxious, and having trouble bonding with their child. As social media sites like Facebook and Twitter become more important for moms to find support and health information, it has become a public health concern to learn how they affect mental health after giving birth. This literature review explores the positive and negative impacts of social media use on postpartum depression among mothers. A systematic search identified peer-reviewed studies published between 2014 and 2025. Studies were selected using …

The Effectiveness Of Interventions In Reducing Sexually Transmitted Infections Among African American Adolescents: A Comprehensive Literature Review, Brandy M. Leaver

Capstone Experience: Master of Public Health

In the United States, an estimated 20 million new sexually transmitted infections occur annually, with half of the cases occurring in adolescents. The infection rate among African American adolescents is four times higher than that among white adolescents. Although many types of interventions exist, few are specifically designed for African American adolescents. In conducting this comprehensive literature review and synthesis, I examined the effectiveness of existing interventions in creating behavioral change among African American adolescents by applying the health belief model to interpret and organize the findings. The databases PubMed, Embase, and Google Scholar were searched on October 1, 2025. …

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 …

Associations Between Food Insecurity And Gpa Among Full-Time California State University Undergraduates During Covid-19: The Impact Of Mental Health, Lindsey Jones

Master's Theses

Food insecurity is a persistent public health concern among college students that has been associated with student’s academic and mental health outcomes. This thesis examined the associations between food insecurity, academic performance (measured by GPA) and mental health (using Kessler 6 psychological distress and self-perceived mental health impacts on academic performance), among full-time undergraduate students within the California State University (CSU) system. Cross-sectional analyses were conducted using data from the Spring 2021 CSU National College Health Assessment, administered across all 23 campuses. Of the 20,167 respondents, 12,899 students were included in the analytical sample. Bivariate analyses were conducted to analyze …

The Frontal Assessment Battery In Older Multilingual Kenyan Adults, Anne Njoki Gitere, Anne Nyambura, Karen Blackmon, Levi Muyela, Rachel Maina, Olivera Nesic Taylor,, Jasmit Shah, Dilraj Sokhi, Sylvia Mbugua, Samuel Gitau, Sheila Waa, Juzar Hooker, Zul Merali, Chinedu Momoh, Karen Blackmon

Brain and Mind Institute

Background: The Frontal Assessment Battery (FAB) was developed as a short (6-item) bedside assessment of executive dysfunction in older adults with suspected neurodegeneration. This study describes psychometric features of the FAB in multilingual Kenyan adults with and without clinical diagnosis of dementia.

Method: The FAB consists of six items assessing verbal abstract reasoning, lexical fluency, motor learning, and inhibitory control. The score on each item ranges from 0-3, with higher scores indicating better performance. Bilingual English-Swahili study personnel translated, blind back-translated, and applied consensus-driven cultural adaptations. FAB was then administered to 95 participants [71 cognitively unimpaired (CU) controls; 24 people …

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 …