Digital Commons Network^™

Multi-Level Barriers And Facilitators To Hiv Care Engagement Among Women Exposed To Intimate Partner Violence, Bernard Frempong

Public Health Theses

Background: WLWH face persistent gaps in HIV care engagement, and IPV is a critical determinant of health in this population. Few studies have examined barriers and facilitators to care by current IPV exposure and relationship status using mixed methods.Methods: We analyzed cross-sectional baseline data from 158 WLWH (M age=54.9 years [SD=10.41]) with lifetime IPV exposure enrolled in the I-CARE study in Connecticut. Participants were grouped by: (1) IPV with a current partner (n=74, 46.8%), (2) currently partnered without IPV (n=19, 12.0%), and (3) not currently partnered (n=65, 41.1%). Barriers and facilitators to HIV care engagement were assessed quantitatively and qualitatively …

Ethics Training For Community Researchers Engaged In Participatory Research: An Analysis Investigating Current Practices In Low-Income Countries, Chioma Chukwunedu

Public Health Theses

Participatory Research (PR) involves individuals affected by a research problem as active collaborators rather than passive subjects. While this approach emphasizes ethical and contextually relevant practices, existing literature suggests that ethics training for community researchers in low-income countries is inconsistently implemented and often not culturally adapted. This study examines how ethics training is currently provided to community researchers engaged in PR in low-income countries.A secondary analysis was conducted using manuscripts identified through a prior systematic review of PR studies in low-income settings. Corresponding authors of included studies were invited to complete an online Qualtrics survey regarding ethics training, participatory research …

The Effect Of Flood Risk Perception On County-Level Excess Mortality Due To Flooding In The U.S., Jane Elise Fortna

Public Health Theses

Introduction: Flood events due to heavy precipitation, hurricanes, rising sea levels, and overflowing rivers are increasing under climate change, resulting in both direct and indirect health impacts. This study investigates the relationship between excess flood mortality and flood risk perception at the U.S. county level. Methods: This study utilizes nationwide, county-level flood mortality data from 2018-2020 and flood risk perception survey data from 2024. We applied a generalized linear model to examine the association between the proportion worried about flooding and the excess flood mortality, while controlling for flood hazard exposure, poverty, disability, health uninsurance rate, and unmeasured spatial confounding …

Intergenerational Meaning-Making In Cambodian Americans, Caitlin Gojuk

Public Health Theses

Background: Cambodian Americans face high psychological distress yet remain underrepresented in research, especially second-generation individuals. Intergenerational trauma, stigma, and family dynamics shape mental health understanding and expression. Objective: This study examines how Cambodian American young adults make sense of mental health and distress through cultural identity, family relationships, and inherited meanings of trauma. Methods: In-depth semi-structured interviews were conducted with six second-generation Cambodian American young adults residing in Massachusetts, United States. Participants completed brief measures of depression and anxiety symptoms (PHQ-8; GAD-7) to provide a descriptive context. Interviews were analyzed using inductive thematic analysis informed by relational, narrative, and ecological …

A Mendelian Randomization Study Of Maternal Thyroid Function And Cerebral Palsy, Yuewen Ge

Public Health Theses

Cerebral palsy (CP) is a neuromotor disorder that is strongly associated with adverse perinatal conditions. Thyroid dysfunction in pregnancy was suggested to affect CP risk in a few cohort studies, but the evidence is not yet conclusive. We conducted a two-sample MR study to explore the effect of thyroid function on the risk of CP in offspring, and preterm birth as a potential mediator. Genetic instruments for hyperthyroidism and hypothyroidism were obtained from a large European genome-wide association study (GWAS) by Sakaue et al. (2021), instruments for free thyroxine (FT4) and thyrotropin (TSH) were derived from the ThyroidOmics Consortium, and …

Role Of Functional Social Support In Adherence To Hypertension Therapy: A Community-Based Study In Nepal, Shirish Gurung

Public Health Theses

Introduction: Despite evidence that adherence to hypertension therapy is associated with improved blood pressure control and health outcomes, adherence rates remain suboptimal. This study aims to examine the association between perceived functional social support and adherence to hypertension therapy in Nepal.

Methods: This study utilized cross-sectional baseline data collected from an ongoing community health worker-led hypertension prevention and control trial in Sindhupalchok District, Nepal. Adherence to hypertension therapy was measured using the Hill-Bone High Blood Pressure Therapy Compliance Scale, and perceived functional social support was measured using the Medical Outcomes Study Social Support Survey. Modified Poisson regression with robust standard …

Family-Related Stressors And Mental Health Among Internally Displaced Young Adults In Mozambique: A Mixed-Methods Study With Implications For Global Mental Health Interventions, Jaspreet Kandola

Public Health Theses

Mental health outcomes among displaced populations are shaped by post-displacement stressors, yet the role of family dynamics, specifically, remains insufficiently understood. This study examines how family-related stressors are associated with mental health among internally displaced young adults in Nampula Province, Mozambique. Using a convergent parallel mixed methods design, this study integrated survey data from 601 participants with qualitative data from in-depth interviews with a subsample of 16 participants. Quantitative analyses showed that family separation and concern for family members in conflict zones were associated with higher posttraumatic stress disorder (PTSD) symptoms, with family separation also linked to higher anxiety and …

Indoor Environmental Quality Perceptions And Self-Reported Symptoms Among West Haven Va Healthcare Employees, Joseph Hyong Kim

Public Health Theses

Background: Indoor environmental quality in workplace settings influences worker well-being, yet the relationship between perceived workplace environment and reported symptoms remains less well characterized in heterogeneous healthcare settings. This study describes perceived workplace environmental quality and self-reported symptoms among employees at the West Haven Veterans Affairs (VA) Medical Center.

Methods: An observational, cross-sectional study was conducted of VA employees across clinical and non-clinical roles to assess perceived work environment, symptoms and indoor exposures using an electronic survey and personal and area air monitoring of indoor volatile organic compounds (VOCs) and viruses. Perceived workplace environmental quality was assessed using the MM-40 …

Understanding The Influence Of Hiv Status On Perceived Barriers To Reproductive Care For Pregnant Haitian Women: A Framework-Guided Qualitative Analysis, Olivia Mccarthy

Public Health Theses

Background: Haiti has the highest maternal mortality rate in Latin America and the Caribbean, where pregnant women face substantial structural, social, and economic barriers to care. Women living with HIV encounter additional challenges, including stigma, breaches of privacy, and discrimination within healthcare settings. Although prior research has examined maternal health and HIV related stigma in Haiti, little is known about how HIV status differentially shapes pregnant women’s perceptions of barriers to maternal healthcare.Methods: This study draws on data from seven focus groups conducted in rural communities in Haiti’s Centre Department between 2018 and 2019. Participants included 65 pregnant women, representing …

Telehealth Adaptation Of Bright Bodies Program, A Pediatric Intensive Lifestyle Intervention For Obesity: Caregiver Experiences And Implications For Future Implementation, Xiayu "Katniss" Ni

Public Health Theses

Introduction: The Virtual Bright Bodies Program is a telehealth adaptation of Yale's evidence-based family-based intensive lifestyle intervention targeting pediatric obesity, delivered through video conferencing during and following the COVID-19 pandemic. This retrospective cross-sectional study evaluated caregiver experiences with the telehealth-adapted program among 25 caregivers of children aged 7-16 years who completed a post-program survey.

Method: Caregiver perceptions were assessed using the adapted Telehealth Satisfaction Questionnaire (TSQ, 13 items), the adapted Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ, 4 items), and the Acceptability of Intervention Measure (AIM, 4 items). Quantitative data were analyzed descriptively, followed by exploratory subgroup analyses examined whether acceptability …

Triangulating Clinical Guideline Recommendations To Map The Standard Of Care For Hypertensive Disorders Of Pregnancy During Pregnancy And Postpartum, Caralie Price

Public Health Theses

Hypertensive disorders of pregnancy (HDP) are one of the leading causes of maternal morbidity and mortality in the United States. HDP represent a severe health equity issue and present concerns for the health of mother and child, highlighting the importance of early detection and management. This paper systematically documented current clinical practice guidelines from the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) for preventing, identifying, and treating HDP during the prenatal, intrapartum, and postpartum periods. ACOG provides recommendations for HDP across different types of clinical guidance documents. Overall, 60 recommendations were extracted across …

Perceptions Of Sexual Health Stigma Among Adolescents And Pediatric Primary Care Providers In The United States: A Qualitative Exploration, Avanti Shah

Public Health Theses

Background: In the United States (U.S.), young people aged 13–24 experience disproportionately poor sexual health outcomes. Sexual health stigma has been identified as a key barrier to uptake of sexual health services (e.g., STI/HIV testing), particularly for adolescents younger than age 18. This study aimed to describe and compare how U.S. adolescents and pediatric primary care providers perceive sexual health stigma and its potential influence on adolescent sexual health service access and utilization.

Methods: The study utilized existing data from two qualitative studies that explored pediatric primary care providers’ awareness of state laws regulating minors’ access to confidential sexual health …

Vibriosis In Connecticut: Case Trends And Seasonality, 1997–2024, Lisa Michelle Stutzman

Public Health Theses

Vibrio bacteria species, including V. vulnificus and V. parahaemolyticus, cause vibriosis, which can present as gastrointestinal illnesses, wound infections, or septicemia. In the United States the geographical range of these infections is growing, with the northward expansion of Vibrio along the Atlantic coast highlights the importance of understanding trends in vibriosis in Connecticut. This analysis is based on surveillance data from the Connecticut Emerging Infections Program from January 1, 1997–December 31, 2024. Analyses were restricted to culture-confirmed cases to ensure consistent case definitions and conducted on data aggregated to the state level. Descriptive statistics were used to characterize trends in …

Modeling Pfoa And Pfos Infant Intake Through Breast Milk And Formula In The United States, Ka Hei Tang

Public Health Theses

Background: Per- and polyfluoroalkyl substances (PFAS), including PFOA and PFOS, may reach infants through breast milk and water used to reconstitute infant formula. However, current U.S. evidence is limited, and the absence of nationally representative breast milk PFAS data constrained estimation of early-life infant exposures.Methods: This thesis developed a state-level exposure modeling framework to estimate daily infant PFOA and PFOS intake across U.S. states at 3 and 6 months of age. Modeled intake included two feeding pathways, breast milk and formula-reconstitution water, using national maternal serum PFAS concentrations, state-level public drinking water PFAS concentrations, and infant feeding distributions. A total …

Redefining Hospital-Acquired Rsv: Epidemiologic Burden And Probabilistic Classification In A Large Health System, Anna Trinh

Public Health Theses

Healthcare acquired respiratory syncytial virus (HA RSV) is an important but under recognized infection in adult patients. Current surveillance definitions classify RSV as healthcare acquired when a positive test occurs ≥48–72 hours after admission, despite a broad incubation period of 2–8 days which would allow community acquired infections to present several days into hospitalization. This thesis has two aims: (1) to describe the epidemiology of adult HA RSV cases in the Yale New Haven Health System (YNHHS) from 2021–2025, and (2) to develop an incubation period-based probabilistic model to assess the plausibility of each HA RSV classification. Among 2,905 laboratory-confirmed …

Trends And Prevalence Of Autism Among Asian American Subgroups In California, Qinyue Wang

Public Health Theses

AbstractBackground: Autism spectrum disorder (ASD) affects a growing number of children in the United States (US), yet substantial heterogeneity in its remains poorly understood. While previous studies have identified racial and ethnic disparities in ASD prevalence, the Asian American population is frequently treated as a single, monolithic group. This aggregation masks critical variation across distinct Asian ethnic subgroups, potentially obscuring unique barriers to diagnosis and care. This analysis aimed to investigate trends in ASD by age 6 among seven distinct maternal Asian subgroups born between 2007 and 2015 in California and evaluate the influences from maternal demographic factors and neighborhood-level …

Assessing Cardiovascular Disease Risk And Healthcare Access Barriers To Identify Prevention Strategies Among Market Vendors In Uganda, Yumi Yang

Public Health Theses

Background: Cardiovascular disease (CVD) accounts for 10% of all deaths in Uganda, making it the leading cause of death among non-communicable diseases (NCDs) in the country. Across sub-Saharan Africa, urban market vendors serve as key participants in the informal workforce. Research from West Africa suggests that vendors, many of whom are women, are a vulnerable population with high prevalence of CVD risk factors and structural barriers to healthcare access. However, limited research has examined this population in East Africa, and the present study is the first to characterize 10-year CVD risk and assess healthcare barriers among market vendors in Uganda.Methods: …

Examination Of Awareness And Frequency Of Behavioral Masking/Camouflaging Based On Life Experiences, Elizabeth M. Smith

Senior Honors Theses and Projects

Camouflaging behaviors are typically employed by individuals with autism spectrum disorder (ASD) to appear more in line with societal norms and avoid social ostracization. This study examined the connections between camouflaging and theatre experience, mental health diagnostic status, and levels of self-monitoring. In the study, participants completed a brief, 30- minute survey online examining camouflaging, autistic traits, self-monitoring, and life experiences across individuals of different age ranges. All participants were 18 years of age or older, completed a consent form, and received a debriefing. All responses were completely anonymous. The results showed significantly higher levels of camouflaging behaviors in participants …

Food Insecurity In Older Adults With Cancer, Page Laborde

Senior Honors Theses and Projects

Food insecurity is a growing concern among older adults and is associated with poor health outcomes, particularly among those with cancer. Community-based programs such as Meals on Wheels may help address these challenges, but their role in supporting older adults with cancer is not well understood. This study examined the association between recent non-skin cancer diagnosis and food insecurity, as well as relationships with Meals on Wheels participation. A cross-sectional analysis was conducted using secondary data from Rounds 9 through 14 of the National Health and Aging Trends Study (NHATS), a nationally representative sample of U.S. adults aged 65 and …

Through A Glass Darkly: Targeting Cyber And Space Infrastructure In The Law Of War, Michael D. Minerva

Chapman Law Review

As modern militaries become more capable in the cyber and space domains, much of the legal debate has focused on how to legally conduct cyber and space operations. While important, that discussion has largely overlooked the legal implications for the rapidly growing cyber and space infrastructure that exists in the physical domain—commercial satellites like Starlink filling the night skies and data centers like those popping up all over northern Virginia. Most of this infrastructure is commercially developed and privately owned—presumptively civilian in nature—and yet used by militaries all over the world.

The same way bridges form critical ground lines of …

The Outer Space Legal Regime: Peace In Name, Power In Practice, And The Call For A New Treaty, Jaeden Esquivel

Chapman Law Review

Space warfare poses grave dangers that many fail to appreciate. Modern technologies and data-driven services have transformed the domain of space from a distant scientific frontier into the backbone of twenty-first century life. GPS navigation, supply chain logistics, aviation systems, weather forecasting, disaster planning, emergency services, and countless other essential, everyday data-driven systems depend on satellites operating in orbit. If these satellites were permanently disabled or destroyed, the critical Earth-bound infrastructure that relies on them would collapse as well.

For nearly fifty years, space as a geopolitical domain has relied on the 1967 Outer Space Treaty (OST) to ensure that …

Escaping The Labyrinth: Cutting Through The Maze Of Federal Sector Employment Laws To Streamline Appeals, Allow Faster And More Consistent Decisions, And Level The Playing Field Between Agencies And Employees, Christopher Ligatti

Chapman Law Review

Federal employees and their job protections have gained increased media attention due to the current presidential administration. Criticism has long been aimed primarily at the property interest and accompanying due process protections that federal employees have in their employment. However, this Article argues that while the federal sector employment law system is badly in need of reform, the issue is not the constitutionally required due process protections afforded to employees, but rather the additional statutory and regulatory protections Congress has granted employees. Currently, federal employees have multiple overlapping forums in which they can bring employment actions, may cross-appeal negative decisions …

Muted By The Machine: Expanding Ftc Authority To Address Algorithmic Review Suppression, Aubrey Adams

Chapman Law Review

As digital platforms increasingly shape consumer decision-making, the integrity of online reviews has become central to fair market competition. In 2024, the Federal Trade Commission (FTC) issued a final rule prohibiting deceptive practices involving consumer reviews, including traditional forms of review suppression. Yet the rule fails to address a more subtle threat: algorithmic review suppression.

This Note argues that algorithmic review suppression, where platforms use automated systems to downrank or obscure negative reviews, creates a misleading impression of product quality while evading existing regulation. Unlike traditional suppression, these practices operate invisibly under the guise of content curation, distorting consumer perception …

Short-Window Market Reactions To Real Estate M&A: A Comparative Event Study Of Reits And Real Estate Services Firms, Aryan Kaila

CMC Senior Theses

Existing research on real estate mergers has largely focused on REIT acquirers in isolation, typically finding near-zero bidder reactions in short event windows. There is little work that directly compares REITs with publicly listed real estate services (RES) firms that operate in the same market cycles and conditions but follow different business models. Using a transaction-level dataset of 137 U.S. mergers from 1994 to 2024, this study applies event-study methodology and cross-sectional regression analysis to investigate whether equity markets respond differently to acquisitions undertaken by REITs and real estate services firms. The estimates show that REIT acquirers experience notably more …

Data From: Mass Mortality Of Avian Migrants In New Mexico, Usa, That Coincided With An Extreme Weather Event, Dylan M. Osterhaus, Allison J. Salas, Patricia L. Cutler, Mara E. Weisenberger, Kerry Mower, Abigail J. Lawon, Timothy F. Wright, Jeanne M. Fair, Martha J. Desmond

Fish, Wildlife, & Conservation Ecology: Datasets

No abstract provided.

Prep’S Communications Strategy: A Ten-Year Plan From 2025-2035, Piscataqua Region Estuaries Partnership (Prep)

PREP Reports & Publications

No abstract provided.

China-U.S Relations: Techno‑Nationalism, Strategic Entrapment, And Taiwan., Prince Y. Munya Mr.

Dissertations and Theses

Abstract

This thesis examines how China–U.S. relations evolved from a manageable strategic rivalry into a more rigid and increasingly difficult form of competition after the Obama administration’s “Pivot to Asia.” It argues that traditional explanations such as power transition theory alone cannot fully explain the deterioration of the relationship. Instead, the study introduces the concept of techno-nationalism, where technological leadership becomes tied to national identity, economic security, and geopolitical power, particularly in areas such as semiconductors, artificial intelligence, and supply-chain security. Through historical analysis and policy tracing, the thesis develops the concept of strategic entrapment to explain how both Washington …

The Limits Of Economic Sanctions: Why Western Efforts Did Not Fully Economically Isolate Russia After 2022 Invasion Of Ukraine, Jonibek Oblokulov

Dissertations and Theses

No abstract provided.

Examining Widely Held Propositions On Human Dietary Protein Needs And Benefits: A Critical Review Of The Science That Shapes Both The Data And Our Understanding Of An Essential Macronutrient, Mitchell M Kanter, Sally Aaron, Steven N Austad, Andrew W Brown, Nicholas A Burd, Wayne W Campbell, Mark Cope, Teresa A Davis, John W Erdman, Miguel Freitas, Kristen Hicks-Roof, Samuel Klein, Wantanee Kriengsinyos, Dudley W Lamming, Donald K Layman, Heather J Leidy, Kevin C Maki, Richard D Mattes, Shalene Mcneill, Daniel R Moore, Stefan M Pasiakos, Stuart M Phillips, David Raubenheimer, Wendy Reinhardt, Nancy R Rodriguez, Stephen Simpson, Hans H Stein, Luc J C Van Loon, Connie M Weaver, David B Allison

Children’s Nutrition Research Center Staff Publications

The essentiality of protein in the human diet is unequivocal. Yet researchers, clinicians, and lay people often believe numerous propositions about dietary protein despite insufficient supporting or refuting data in some instances. To address this disconnect, and to "pressure-test" current beliefs about dietary protein, the Indiana University School of Public Health-Bloomington convened a workshop in February 2025 titled "Human Dietary Protein Needs and Benefits: A Critical Assessment of Postulated Propositions." More than 20 international experts discussed (1) methodologic issues affecting data acquisition and interpretation; (2) "optimal" dietary protein intakes and effects on muscle protein synthesis rates, muscle protein accretion, …

Regulating Space-Based Solar Power: Challenges Under Both Space Law And Energy Law, Anne-Sophie Martin, Steven Freeland

Journal of Air Law and Commerce

Space-based solar power (SBSP) is emerging as a potential catalyst for global decarbonisation, driven by advances in wireless power transmission, in-orbit assembly, and photovoltaic technologies. Programmes such as the European Space Agency’s SOLARIS initiative, China’s planned megawatt-scale demonstrator, and private projects including Constant Aperture Solid State Integrated Orbital Phased Array and Caltech’s Space Solar Power Project illustrate the shift from theoretical models to operationalisation. SBSP offers continuous, weather-independent renewable energy capable of complementing terrestrial solar, wind, and hydro generation, enhancing grid stability, energy security, and progress toward the UN Sustainable Development Goals. It also supports future space activities by providing …