Digital Commons Network^™

Behavioral Responses To The Medicare Part D Coverage Gap And Its Closure, Selene Urbatsch

Theses and Dissertations

The author examines how exposure to the Medicare Part D coverage gap affects future prescription drug use and whether the closure of the gap under the Affordable Care Act (ACA) altered beneficiary behavior. Using 2007–2019 MEPS data, the analysis compares Part D enrollees to similarly aged, privately insured individuals, producing first-differences and difference-in-differences estimates. Before the ACA, exposure to the gap was associated with 4.9 fewer prescription fills relative to comparable non-Part D individuals. After the ACA, the effect fell to a reduction of 2.2 generic fills, with no significant decline in branded use. Sudden out-of-pocket cost increases prompted sharp …

Out From Under: Stories Of Endometriosis, Prisca Edwards

Theses and Dissertations

Six individuals. One diagnosis. In Out From Under, people living with endometriosis gather for an art-centered workshop. Through collage and conversation, they transform isolating medical experiences into paths of connection and collective healing.

Endometriosis affects approximately one in ten women of reproductive age, yet diagnosis is often delayed by nearly a decade. During this time, many suffer from debilitating symptoms without adequate care or accessible treatment. Out From Under explores the lived experience of endometriosis through the lens of socially engaged documentary filmmaking. Participants share their medical histories, emotions, and frustrations in a structured yet open environment designed for intimacy, …

Dnp Final Report: Improving Adherence With Cms Sep-1 Sepsis Bundle In The Emergency Department, Emmanuel Bernards

DNP Final Reports

Adherence to the CMS SEP-1 Sepsis bundles is critical to sepsis management and leads to lower sepsis mortality, lower incidence of readmission, reduced length of hospital stay, and improved patient outcomes. This medical center has struggled to meet the required 71% adherence rate set by the Center for Medicaid and Medicare, representing the benchmark of acceptable care of sepsis patients. Therefore, the following PICOT question arises: among the hospitals’ ED physicians and nursing staff (P), how does a multimodal approach consisting of education, visual reminders, and audit and feedback (I) compared to a single approach (education) (C) affect adherence to …

The Interaction Between Physical Activity And Fruit And Vegetable Intake On Body Composition, Om S. Ghetia

Honors Scholar Theses

Objective: Fruit and Vegetable (FV) intake and Physical Activity (PA) are important lifestyle factors associated with body composition. This study assessed the combined impact of meeting FV intake and PA recommendations on body composition measures including body mass index (BMI), percent body fat (PBF), and waist circumference (WC) in adults aged 20–64 years from diverse backgrounds.

Design: A cross-sectional study conducted in Northeastern Connecticut.

Methods: A total of 124 participants completed a one-week dietary and PA record followed by anthropometric assessments. Participants were categorized into groups based on FV intake (≥400 g/day vs. < 400 g/day) and PA levels (≥600 MET-minutes/week vs. < 600 MET-minutes/week). Independent t-tests and chi-square tests were used to compare dietary intake, PA levels, and body composition outcomes across groups.

Results: Participants meeting FV recommendations had significantly …

A Pill Too Expensive: A Comprehensive Review For Exploring Medical Non-Adherence In The Age Of Rising Drug Prices, Vidhani Goel, Roberto Sagaribay

Undergraduate Research Symposium Lightning Talks

Prevalence & Health Disparities:

• Medication non-adherence is a major public health issue.
• High prescription drug costs are a significant barrier.
• Affects chronic conditions like diabetes, hypertension, and mental health disorders.

Potential Solutions:

• Patient assistance programs.
• Use of generic drugs.
• Policy reforms to reduce medication costs.

Future Directions & Solutions:

• Address research gaps in long-term outcomes.
• Explore broader policy interventions.
• Improve accessibility and awareness of assistance programs.

Contributing Factors:

• Leads to worse health outcomes.
• Increases hospitalizations and long-term healthcare costs.
• Affects vulnerable populations (i.e., elderly, uninsured, racial minorities)

Parental Vaccine Hesitancy And The Decision To Vaccinate Children Against Covid-19, Jessica Mckee

Walden Dissertations and Doctoral Studies

While there is a significant body of literature regarding vaccine hesitancy, there is a gap in the literature on its impact to parents’ decisions to vaccinate their children against a pandemic pathogen. The purpose of this study was to examine the relationship between parental vaccine hesitancy, measured using the health belief model (HBM) theoretical framework constructs of the Vaccine Hesitancy Scale (VHS; the degree to which an individual trusts in vaccine efficacy, safety, the reliability and trustworthiness of vaccine programs, community impact, perceived risks, and the importance of childhood vaccinations), and parents’ decision to vaccinate their children against COVID-19 with …

Evaluation Of Engagement And Collaboration Among Hospitals In The Maine Rural Maternity & Obstetrics Management Strategies (Rmoms) Network, Molly Volt, Lori Travis, Caroline Zimmerman, Erica Swan, Katherine Crothers, Anna Gilbert, Kate Allerding

Costas T. Lambrew Research Retreat 2025

Introduction

• Maine RMOMS Network: Grant awarded to Maine in 2022, 16 rural birthing hospitals & 5 state partners

• Network Goal: Improve access to maternity and obstetrics care for rural communities

• A qualitative Network Health Evaluation was conducted to diagnose strengths and areas of growth regarding engagement and collaboration

Community Health Workers: Putting "Community" In The Mainehealth Vision, Tim Cowan, Barbara Ginley, Leeanna Lavoie, Jennifer Maillet, Jemma Penberthy, Lori Travis

Costas T. Lambrew Research Retreat 2025

Community Health Workers (CHW) play an increasingly key role across the MaineHealth system. The integration of CHWs and growth of the workforce enhances care and improve patient engagement and outcomes. Utilizing data from FY24, modelling from the MH CHW Work Group as well as patient feedback, this poster illustrates the impact CHWs are having on the lives of patients, the care teams they support and the communities in which they live, work and play.

Pediatric Asthma Subspecialty Referral Practices In Rural Maine, Paras Patnaik, John Dipalazzo, James Bohnhoff

Costas T. Lambrew Research Retreat 2025

Over 7.2 million children in the United States have asthma.

• >300,000 asthma-related ED visits & hospitalizations yearly
• Both PCP’s and pediatric asthma subspecialists (allergist/immunologists and pediatric pulmonologists) provide long-term asthma care

Real-World Clinical Burden Of Patients Presenting With Vaginitis Symptoms In The United States, Justin Chen, Jenny Tse, Liucheng Shi, Mindy M. Cheng, Rebecca Lillis, Aimee M. Near

School of Medicine Faculty Publications

Background: While vaginitis is a leading cause of primary care visits among women with a gynecologic-related diagnosis, there are limited contemporary data on the healthcare burden. This study describes the real-world healthcare resource utilization (HCRU) of patients presenting with vaginitis symptoms in the United States (US) at symptom presentation and over long-term follow-up. Methods: This retrospective study utilized IQVIA's Longitudinal Prescription (LRx) and Medical Claims (Dx) databases to capture patients presenting with vaginitis symptoms from January 1, 2018 to September 30, 2022. The date of the first diagnosis code for vaginitis or related symptoms was considered the first clinical presentation …

Unseen And Underserved: A Narrative Review Of Binge Eating And Binge-Eating Disorder In Black Women, Vidhani Goel, Roberto Sagaribay, Kavya Gururaj, Laksh Ghai, Akriti Kapoor

Undergraduate Research Symposium Lightning Talks

Prevalence & Health Disparities:

Black women engage in binge eating at similar or higher rates than White women. Lower diagnosis and treatment in black women.

Barriers to Treatment:

Limited access to mental health resources. Implicit bias in clinical settings. Lack of culturally tailored interventions.

Future Directions & Solutions:

Need for inclusive clinical research. Culturally responsive treatment models. Policy reforms to improve healthcare accessibility.

Contributing Factors:

Racial stress, trauma, and socioeconomic constraints. Food insecurity, stigma, and healthcare disparities.

Sweet Snacks Effects On Hispanic/Latino Childhood Obesity, Lemlen Belete, Brisa Rodriguez Alcantar

Undergraduate Research Symposium Lightning Talks

Background:

Obesity rates in children has become a growing concern in the Hispanic/Latino community in Nevada. This study examines the availability of sweet snacks in the home and its association with children's dietary behavior.

Methods:

Data was analyzed from a survey of 155 Latina mothers using logistic regression while controlling for income, education, and acculturation. The survey was conducted in Nevada, between October 2022 and March 2024.

Results:

The frequency of keeping sweets in the home was significantly associated with children's consumption of various sweets. For every increase in keeping sweets at home, the odds of children consuming: • Chocolate …

Analyzing Healthcare As A Right, Instead Of A Privilege, Saidt Gutierrez

Undergraduate Research Symposium Podium Presentations

Healthcare is a fundamental necessity, yet in many countries including the United States, it remains a privilege rather than a right. This research examines the benefits of universal healthcare by analyzing its impact in countries that have successfully implemented healthcare such as Canada, the United Kingdom, and Germany. This study evaluates the healthcare accessibility, cost efficiency, and health outcomes in these countries against the U.S. This finding will suggest that universal health care leads to lower overall healthcare costs, improve public health, and reduce financial burdens on individuals. By ensuring healthcare as a right, rather than a privilege, the U.S …

Costing Care: Unpacking The Drivers Of Medicaid Spending For Nicu Admissions In Nevada, Vidhani Goel, Ana L. Reyes, Bertille Assoumou, Dodds P. Simangan, Farooq Abdulla, Deborah A. Kuhls

Undergraduate Research Symposium Podium Presentations

Overview This study examines how maternal and neonatal factors influence Medicaid spending for NICU admissions in Nevada, with an emphasis on identifying cost-driving health disparities. Approach: A retrospective analysis was conducted using linked data from Nevada’s Birth Registry and Medicaid claims (2015–2021). Infant records were analyzed using univariate and bivariate statistics, and logistic regression models identified associations between maternal/neonatal characteristics and above-median Medicaid spending. Cost trends were assessed using NICU case costs, annual growth rates, and year-to-year fluctuations. Key Objectives: Analyze trends in NICU-related Medicaid spending over a seven-year period. Identify maternal and neonatal characteristics linked to higher NICU costs. …

Beyond The Nursery: Unraveling Maternal And Neonatal Factors Associated With Nicu Admissions In Nevada (2015–2021), Vidhani Goel, Ana L. Reyes, Bertille Assoumou, Dodds P. Simangan, Farooq Abdulla, Deborah A. Kuhls

Undergraduate Research Symposium Podium Presentations

Overview

This project focuses on investigating the relationship between maternal medical conditions, socioeconomic factors, and NICU admission levels among Medicaid beneficiaries in Nevada.

Approach:

•A retrospective analysis was conducted using linked data from the Birth Registry and Nevada Medicaid Claims from 2015 to 2021.

•Infant records were analyzed using univariate and bivariate statistical methods, with a significance level set at 5%.

•Logistic regression models were used to examine associations between maternal characteristics and NICU admission levels.

Key Objectives:

•Analyze NICU admission trends among Medicaid beneficiaries.

•Identify maternal health risk factors linked to NICU admissions.

•Examine neonatal characteristics influencing NICU admissions.

Leukemia And Thyroid Cancer In Relation To Reca Boundaries, Cora Marinos

Undergraduate Research Symposium Posters

A total of 1,054 test were conducted by the United States between 1945 and 1992. This is more Atomic tests than all other countries combined. Of those tests 928 were conducted at the Nevada Test Site located 65 miles from Las Vegas, Nevada.

These tests spread nuclear fallout throughout the United States causing the people in nearby communities to become sick. The public outcry spurred the passing of the Radiation Exposure Compensation Act in 1990 (RECA) It’s scope of coverage was broaded in 2000. Despite many groups fighting for further expansion, the Act expired in June of 2024.

Of the …

Stress And Glucose Regulation In Adults At Risk For Type 2 Diabetes Mellitus: A Secondary Analysis From A Randomized Controlled Trial, Sophia Lysne, Regina Dispa, Brenna Way, Bea Francene Pilnade, Donya Shahamati, Romina Ballesteros, Christopher Acosta, Keren Morales, Esther Adaji, Ohis Egbaidomeh

Undergraduate Research Symposium Posters

Type 2 Diabetes Mellitus (T2DM) is a major public health concern, significantly increasing the risk of cardiovascular diseases (CVDs). Additionally, prediabetes is a critical precursor, as it elevates the risk of developing both T2DM and CVDs. (2)

Recent literature reveals among individuals with severe perceived stress, there is a higher likelihood of HbA1c% levels meeting the criteria for prediabetes (5.7– 6.4%) as compared to those with lower perceived stress. (3)

Studies show that psychological stress has hyperglycemic effects in individuals with T2DM, suggesting that stress is associated with poorer blood glucose control. (4)

Examining Demographic, Geographic, And Temporal Patterns Of Melanoma Incidence In Texas From 2000 To 2018: Retrospective Study, Kehe Zhang, Madison M Taylor, Jocelyn Hunyadi, Hung Q Doan, Adewole S Adamson, Paige Miller, Kelly C Nelson, Cici Bauer

Faculty, Staff and Student Publications

Background: Melanoma currently ranks as the fifth leading cancer diagnosis and is projected to become the second most common cancer in the United States by 2040. Melanoma detected at earlier stages may be treated with less-risky and less-costly therapeutic options.

Objective: This study aims to analyze temporal and spatial trends in melanoma incidence by stage at diagnosis (overall, early, and late) in Texas from 2000 to 2018, focusing on demographic and geographic variations to identify high-risk populations and regions for targeted prevention efforts.

Methods: We used melanoma incidence data from all 254 Texas counties from the Texas Cancer Registry (TCR) …

Conflict, Human Development, And Neonatal Health: A Regional Analysis Of The Eastern Mediterranean, Zynub A. Al-Sherri

Honors Theses

Background. The effects of war and conflict on a population are direct and indirect in nature. One of the most devastating consequences is the destruction of healthcare infrastructure, which severely disrupts access to essential services and impedes long-term socioeconomic development. Among those most affected are newborns, as the neonatal period represents the most vulnerable stage of a child’s life and serves as a sensitive indicator of a society’s overall health and socioeconomic conditions. Given the persistent instability in the Eastern Mediterranean Region (EMR), this study aimed to explore how conflict and human development are associated with neonatal health outcomes …

Optimising Non-Cycloplegic Screening Strategies For Early Detection Of Pre-Myopia And Myopia In Young Children, Síofra Harrington, Michael Moore, James Loughman, Ian Flitcroft, Veronica O'Dwyer

Articles

Purpose: Early detection of myopia is essential to delay its onset and progression. Pre-myopia, defined by an inadequate hyperopic reserve, increases myopia risk in childhood. However, effective screening methods remain limited. This study aimed to develop practical non-cycloplegic screening methods for pre-myopia and myopia in 6- to 7-year-olds to support earlier interventions.

Methods: This cross-sectional study of 621 Irish schoolchildren (mean age: 7.12 ± 0.45 years; 51.8% boys) assessed uncorrected distance visual acuity (UDVA). Cycloplegic spherical equivalent refraction (SER) classified refractive status (myopia: SER ≤ −0.50D; pre-myopia: SER > −0.50 ≤ 0.75D). Pre- and post-cycloplegic SER were measured using the Welch …

A Tobacco Treatment Training Program Expands The Number Of Healthcare Providers Trained To Use Evidence-Based Practices And Methods, Alex Hurst, Maher Karam-Hage, Jennifer Cofer, Mehwish Javaid, Diane Beneventi, Janice Blalock, Tiffany Winter, Paul M. Cinciripini, Ernest Hawk

Advances in Cancer Education and Quality Improvement

Tobacco-use disorder remains a global health challenge, despite declining rates, and is a leading cause of morbidity and mortality, especially among special populations that disproportionally do not have access to comprehensive treatment services. The lack of trained providers and slow dissemination of new tobacco treatment knowledge are obstacles to accessing comprehensive evidence-based treatments. Less is known about the impact of specialized training programs on healthcare professionals' ability to effectively treat tobacco use. This paper reports on the evaluation of the tobacco treatment training program, training methodology, and the demographics of the specialists trained.

MD Anderson’s Tobacco Treatment Training Program (TTTP) …

Impact Wv: Adapting Patient Navigation Models Of Care To Improve Services To Caregivers Of Infants Exposed To Substances In Utero, Charlotte S. Workman Bsms, Ccrp, Lesley Cottrell, Mawyah Bashatah, Aisha Hashmi, Kayla Richard, Poornima Murthy, Susan Harrison, Ashleigh Mckinsey, Amy Bott, Sydney Leary, Cody Smith, Melina Danko

Journal of Appalachian Health

Patient navigation (PN) is a healthcare service delivery model designed to partner clients with service providers to reduce challenges to health care, as well as to improve access to care by identifying opportunities to coordinate services for clients. The IMPACT WV project at the West Virginia University Center for Excellence in Disabilities (WVU CED) implemented PN models of care for caregivers of infants exposed to substances in utero. The purpose of this program was to reduce burden for potentially at-risk families and improve caregiver and infant outcomes as a result. To understand the processes that influence the implementation of PN …

Drive Time Analysis Of New Gynecologic Oncology Patients At West Virginia University, Kassandra Whitfield, Ariel Cohen, Krista Pfaendler, Kristy Ward

Journal of Appalachian Health

Introduction: West Virginia is a rural mountain state; access to medical care, especially specialty care, can be difficult for patients.

Purpose: The purpose of this study is to analyze the geographic status and transportation times of new gynecologic oncology patients.

Methods: Home zip codes for new patient gynecologic oncology patients were analyzed for drive times to the cancer center. Zip codes of oncology providers in the state were compared to the location of patients.

Results: A total of 1,097 new gynecologic oncology patients lived within a 240-minute drive of MBRCC; nearly half (48.9%) of them drove greater than 60 minutes. …

Patient-Clinician Communication In The Appalachian Region: A Scoping Review, Kawther Al Ksir, Hadii M. Mamudu, Chidiebube J. Ugwu, Emily K. Flores, Tracy Fasolino, Holly Wei, Rick L. Wallace, Florence M. Weierbach

Journal of Appalachian Health

Introduction: Effective communication between patients and clinicians is a critical component of quality health care, influencing disease prevention, management, and outcomes. In regions with unique socioeconomic and geographic challenges, communication barriers can further exacerbate health disparities. Understanding the factors that facilitate or hinder patient-clinician communication is essential for developing targeted interventions that improve health care delivery.

Purpose: This review explores the existing literature on patient-clinician communication concerning cardiovascular disease (CVD) in the Appalachian Region with the aim to understand existing gaps and interventions.

Methods: PubMed and Web of Science databases were utilized to conduct a systematic search. The Population, Concept, …

Using Photovoice To Define The Experiences, Needs, Strengths, And Priorities Of Gay Men In South Central Appalachia, Ana D. Sucaldito, Lilli Mann-Jackson, Jorge Alonzo, John W. Chaffin, Scott D. Rhodes

Journal of Appalachian Health

Introduction: Gay, bisexual, queer, and other men who have sex with men and transgender and nonbinary persons living in rural Appalachia experience profound health disparities. Limited research, however, has focused on the needs, strengths, and priorities of these communities.

Purpose: This study sought to better understand the lived experiences of the vulnerable, underrepresented, and underserved Appalachian gay male community by working with a small group of self-identified gay Appalachian men.

Methods: As part of a larger community-based participatory research study (the Appalachian Access Project), four self-identified gay men participated in a photovoice project. Participants took photos based on …

Determinants Of Willingness To Share Wearable Health Data With Health Care Providers In Appalachian Populations: An Exploratory Study, Gilbert Munoz Cornejo, Joonghee Lee

Journal of Appalachian Health

Background: Wearable health devices capture metrics (e.g., physical activity, ECG, sleep) that can enhance care when shared with providers. Yet, willingness to share wearable data may differ in Appalachia, where chronic disease burdens, mistrust, and limited infrastructure pose unique challenges.

Objective: This study explored (1) which sociodemographic, health, and digital behaviors correlate with willingness to share wearable data and (2) how these insights can guide region-specific interventions in Appalachia.

Methods: We analyzed 320 Appalachian respondents from the Health Information National Trends Survey (HINTS 6). Descriptive statistics and logistic regression models examined willingness to share wearable data. Because of small cell …

Heartache In The Heartland: Unraveling The Social Roots Of Deaths Of Despair In Kentucky, Lyndsey K. Blair, Madeline M. Tomlinson, Michele Abee-Biskis, Jessica Hume, Gabri Warren

Journal of Appalachian Health

Introduction: Deaths of despair (DoD), encompassing suicides, drug overdoses, and alcohol-related liver diseases, have emerged as a critical public health crisis in the United States, with their rise particularly pronounced from 1995 to 2013 and exacerbated by the COVID-19 pandemic. Kentucky, grappling with high rates of substance use disorder, poor mental health, and economic hardship, is at the forefront of this issue, particularly in its rural and Appalachian regions.

Purpose: This study explores the social determinants contributing to DoD in Kentucky, focusing on economic and social factors that influence rising rates of suicide, drug overdose, and alcohol-related liver disease. The …

Finding Freedom In Appalachia: Evaluating A Mental Health Intervention In West Virginia, Elizabeth A. Claydon, Karen Haring, Jessica Haring, Kelsey Riggi, Beth Currence

Journal of Appalachian Health

Introduction: Rural areas have limited capacity to provide comprehensive mental health treatment and resources. This creates the need for interventions to ensure individuals with mental health concerns have access to resources to improve their mental health.

Purpose: The purpose of this mixed-methods evaluation was to assess the effectiveness and impact of Libera, a mental health program tailored for girls and women within the Appalachian region.

Methods: Quantitative surveys, including validated measures for depression, anxiety, and eating disorder symptoms, and life satisfaction, were collected pre- and post-Libera intervention for participants. Simultaneously, annual surveys were sent to Listeners in addition to qualitative …

Time And Location: Physical Activity Trends In Parents And Children In A Rural Region During Covid-19, Brooke C. Towner, Robert Broce, Rebecca A. Battista

Journal of Appalachian Health

Introduction: COVID-19 restrictions altered the structure of the school and workday for families with children and led to changes in active transportation. Continued restrictions impacted access to many community locations and led to changes in physical activity (PA) behavior.

Purpose: The objectives of the study were to describe the changes in the 1) amount of PA time per day, 2) frequency of PA, and 3) sitting time. Information about how PA changed for parents and children during the COVID-19 pandemic will have potential implications for education, public health, and recreation management.

Methods: This cross-sectional study enlisted participants via an online …

Children Living With Type 1 Diabetes In The Public School System, Madison M. Wilson

Kentucky Undergraduate Journal for the Health Humanities

Type 1 Diabetes is a worldwide chronic condition that typically develops during adolescence and requires life-long treatment and management. Management of this disease is extremely complicated for a child to manage on their own and requires a community of individuals to help them. With children spending most of their days at school, the school’s teachers and staff are vital to the care and management of their condition while attending public school. Children with Type 1 Diabetes in public school systems face many disparities and a reform is needed. Looking at this population through a holistic health science lens can help …