Digital Commons Network^™

The Legacy Of Trust Promises: Native American Healthcare (Note), Hailey Trawick

The Scholar: St. Mary's Law Review on Race and Social Justice

From European colonialism to the establishment of the United States, the rights, history, and independence of Native Americans have been systematically stripped away. The American government expanded rapidly, forcibly displacing indigenous populations from their native lands and moving them to reservations with inferior resources and space. During a forced removal, often instituted by treaties between American Indian tribes and the federal government, government officials offered protection and access to resources in exchange for vast tribal land. Although treaty-making with American tribes ended over a century ago, their deleterious and often broken promises continue to haunt us.

Part I of this …

Real-World Experience Of Pediatric Patients Treated With Peanut (Arachis Hypogaea) Allergen Powder-Dnfp., Jay M. Portnoy, Jodi Shroba, Stephen Tilles, Hela Romdhani, Sarah M. Donelson, Dominick Latremouille-Viau, Rebecca Bungay, Kathleen Chen, William Mccann

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Peanut (Arachis hypogaea) allergen powder-dnfp (PTAH) is the first oral immunotherapy indicated for children aged 4 to 17 years with peanut allergy. There are limited real-world data on patients treated with PTAH.

OBJECTIVE: To characterize pediatric patients treated with PTAH and associated treatment patterns in US clinical practice.

METHODS: US-based physicians with allergy and immunology training treating patients with peanut allergy aged 4 to 17 years with PTAH were recruited from an existing physician panel and completed an online case report form (October to December 2021) with data abstracted from patient medical charts. Physician practice circumstances, patient characteristics, and …

Rationale And Design Of Integrating A Parents First Obesity Intervention With A Pediatric Weight Management Intervention For Rural Families - Evaluating The Ripple Effect., Ann M. Davis, Christie A. Befort, Brittany D. Lancaster, Chris Tuck, Barbara J. Polivka, Jordan A. Carlson, Kandace Fleming, Rebecca Swinburne Romine, Kelsey Dean, Megan Murray

Manuscripts, Articles, Book Chapters and Other Papers

Rural families are disproportionately affected by obesity. Obesity often runs in families and is impacted by hereditary components, the shared home environment, and parent modeling/child observational learning. Moreover, parent changes in weight predict child changes in weight. Thus, targeting the family unit has the potential to enhance outcomes for adults and children simultaneously. Additionally, engaging rural nurses in medical clinics and schools may be important in determining whether rural telehealth programs are successfully implemented and sustained. This paper describes the rationale and design of a randomized control trial (RCT) evaluating the effectiveness of an integrated adult- and child-focused obesity treatment …

Electronic Monitoring Of Mom's Schedule (Emomstm): Recruitment Of Pregnant Populations With Elevated Bmi In A Feasibility Randomized Controlled Trial, Lisette T. Jacobson, Michael Wolfe, Rosey Zackula, Hayrettin Okut, Faith E. Hampton, David A. Grainger, Adrianne K. Griebel-Thompson, Kai Ling Kong, Christie Befort

Manuscripts, Articles, Book Chapters and Other Papers

Underrepresentation of pregnant populations in randomized controlled trials of lifestyle change interventions is concerning due to high attrition and providers' limited clinical time. The purpose of this evaluative study was to assess intervention uptake of pregnant individuals enrolled in a three-arm feasibility randomized controlled trial, electronic Monitoring Of Mom's Schedule (eMOMSTM), examining lifestyle changes and lactation support alone, and in combination. Measures included: (1) participation and completion rates, and characteristics of intervention completers versus other eligible participants; and (2) provider experiences with screening and enrolling pregnant participants. Pregnant people with a pre-pregnancy body mass index ≥ 25 and < 35 kg/m2 were enrolled into the eMOMSTM trial between September 2019 - December 2020. Of the 44 consented participants, 35 were randomized, at a participation rate of 35%, and 26 completed the intervention, resulting in a completion rate of 74%. Intervention completers were slightly older and entered the study earlier in pregnancy compared to non-completers. Completers were more likely to be first-time mothers, resided in urban areas, had higher educational attainment, and were slightly more racially and ethnically diverse. A majority of providers reported willingness to participate, believed the study aligned with their organization's mission, and were satisfied with using iPads for screening. Lessons learned to guide recruitment success include use of: (1) designated research staff in combination with physician support; and (2) user-friendly technology to help mitigate time burden on physicians and their staff. Future work should focus on successful strategies to recruit/retain pregnant populations in clinical trials.

Public Privacy And Info-Liberal Authoritarianism, Christopher Hongach

Dissertations, Theses, and Capstone Projects

Neoliberalism’s promise of economic prosperity has proven itself futile, as growing disparities in inequality have resulted in both developing and developed countries. As neoliberalism has become a major influence in international relations and the global economy, its adaptive capacity has led to the emergence of new forms and functions of capital, especially through commodification and abstract labor. With the rise of information capitalism, neoliberalism has incorporated information of all sorts into the nexus of capitalism. Most especially through the advancement of the Internet and social media platforms, information capitalism reaches its highest form through developing surveillance technology and the brokerage …

A Twin Study Of Genetic Heritage And Environmental Influences On Tobacco Susceptibility And Initiation On Early Age, Yadi Liu

Capstone Experience: Master of Public Health

Purpose: Tobacco product susceptibility is defined as the interest a person has to start smoking. Tobacco product initiation refers to whether a person has ever used tobacco products. We aim to understand and explain how genetic and environmental factors affect tobacco products' susceptibility and initiation in children. Methods: The classical twin model estimates three sources of variance: additive genetic (A), shared environmental (C), and unique environments (E). Each source of variance is latent and is calculated from the similarity in the correlations of twin pairs on a phenotype. The magnitude of difference in the correlation of a particular …

Utilization Of Routine And Recommended Preventive Care Among Individuals With Disabilities In Nebraska, Snehal Jadhav

Capstone Experience: Master of Public Health

Background: Healthcare access disparities exist among individuals with and without disabilities (IWD, IWoD). There is a scarcity of studies focused on Nebraskans living with disabilities.

Methods: Access to Care Nebraska surveyed adults (age 19+) in Oct 2020-Mar 2021. We used Andersen’s model of healthcare utilization to group risk factors for non-compliance with routine care and recommended cancer screening. A multivariate log-binomial regression compared the non-compliance between IWD and IWoD to compute adjusted prevalence ratios (aPR) for risk factors.

Results: Of the 1101 participants,96(8.7%) were IWD. IWD had a higher proportion of non-compliance to routine preventive care (61.7% vs 54.1%) and …

A Systematic Literature Review On Long-Term Care Quality Improvement Initiatives In The United States, Daisy D. Pang

Capstone Experience: Master of Public Health

As the number of people 65 and older increases due to the baby boomer population, there will be a greater demand for long-term care (LTC) services. Quality improvement in LTC is essential to ensure positive health outcomes, patient satisfaction, and reduction in healthcare costs. The purpose of this systematic literature review is to identify the current quality initiatives for LTC in the United States and evaluate the outcomes, effects, and values of each quality initiative identified to support the claim that current the quality initiatives have a limited effect on quality improvement in LTC settings. The Preferred Reporting Items for …

Cultivating A Robust Safety Culture Through Identifying And Overcoming Barriers Within Organizations, Morgan Shradar

Capstone Experience: Master of Public Health

The hierarchical power structure within healthcare and response teams may impede communication about safety risks and violations. In developing or enhancing the safety culture within the emergency response to infectious disease events in healthcare organizations, the hierarchy of controls can be utilized to evaluate successful transmission prevention or further harm to responding teams. Within the tool, administrative controls focus on policies, procedures, and practices that minimize the risk of exposure/transmission. The idea of a safe culture emerged following the Chernobyl Disaster, in which a combination of human and system failures led to this emergency. Safety culture has been integrated into …

Reducing Burnout Using Emergency Planning: A Literature Review, Taylor Vaughn

Capstone Experience: Master of Public Health

Objective

The objective of this capstone is to gain knowledge on what burnout is, what causes it, what can be done to prevent it, and what can be added to public health emergency plans to reduce burnout in local emergency preparedness workforces.

Methodology

A literature review was completed through peer-reviewed articles, and documents from professional and governmental organizations. The results were used to search current plans to determine whether burnout-related recommendations were present.

Results

Burnout prevention at the personal level includes a good diet, routine exercise, and mindfulness activities. At the organizational level it should include providing emotional support, emphasizing …

Comprehensive Literature Review: Assessing The Impact Of Covid-19 Policies, School Closures And Social Distancing, On The Mental Health Of School Age Children, Fatuma A. Hassan

Capstone Experience: Master of Public Health

Mental health is vital to the well-being of all individuals, especially children. COVID-19 unveiled a significant public health issue with poor mental health during the pandemic. There is limited literature about the mental health implications of COVID-19 policies for children and adolescents and preventive strategies for future pandemics. This comprehensive literature review seeks to further investigate the mental health impacts of school shutdowns and social distancing, which were nonpharmaceutical strategies, on school-aged children, 5-18 years old, and propose recommendations for public health officials to mitigate the mental health impacts for future pandemics. Additionally, the review aims to highlight the potential …

Exploring How Social Determinants Of Health Affects Rates Of Chronic Obstructive Pulmonary Disease (Copd) In The Des Moines Metro, Kyla Winkelman

Capstone Experience: Master of Public Health

Chronic Obstructive Pulmonary Disease (COPD) is consistently in the top ten leading causes of death and most recently ranked fourth in the United States (Heron, 2021). Research on health disparities and SDOH has increased recently as investigators learn their importance in diagnosing chronic conditions. Several studies show that a person’s life and environment can determine their risk of exposure, susceptibility, course, and disease outcome. UnityPoint Health (UPH) clinics were utilized for this project to explore how the social determinants of health and health disparities affect COPD rates in Des Moines, Iowa. Initial data was obtained surrounding COPD statistics in the …

The Association Of Apgar Score Outcomes With The Number Of Midwife Antenatal Care Visits Among Infants Born To Rohingya Refugees In Cox’S Bazar, Bangladesh, Vickie Doss

Capstone Experience: Master of Public Health

A cross-sectional study was conducted at the HOPE Foundation for Women and Children of Bangladesh Field Hospital in Cox’s Bazar, Bangladesh, to examine the relationship between the number of antenatal care visits (ANCV) and Apgar scores. This study aims to explore the association between the number of ANCV and Apgar scores in neonates born to Rohingya refugee women. The medical records at HOPE Field Hospital of 182 post-delivery Rohingya women in the Mhodhurchora refugee camp were collected through a medical chart review to

obtain the number of ANCV and 1-minute and 5-minute Apgar scores. The Apgar scoring system is a …

Examining The Effects Of Experiencing A Tornado On Rates Of Suicide, Jessica Lowder

Capstone Experience: Master of Public Health

Background: Suicide rates in the United States have been on the rise in recent years. As of 2020, suicide was the 12^th leading cause of death in the country. Climate change has also contributed to an increase in tornadoes. Studies have found that experiencing a natural disaster is associated with an increase in suicide rates. Studies examining suicide rates and tornadoes, specifically, are virtually nonexistent.

Methods: The exposure groups were those living in three different tornado-affected regions. The comparison group consisted of those living in the larger geographical region. Mortality data was obtained from the CDC, tornado-related data was …

A Qualitative Survey Research Study: The United States Department Of Agriculture Commodity Supplemental Food Program: An Examination Of Operational Challenges And Recommendations, Brianna Cochran

Capstone Experience: Master of Public Health

Background

The United States Department of Agriculture (USDA)’s Commodity Supplemental Food Program (CSFP) has been nationally adopted in 60 states or Indian Tribal Organizations (ITOs) to improve the health of low-income persons at least 60 years of age by supplementing their diets with nutritious USDA Foods. Despite the potential effectiveness of the program, less is known about the operational challenges in the program implementation at the state and local health department. The goal of the study is to identify factors related to program operations including facilitators and barriers of implementation of the USDA CSFP under a national lens.

Methods

An …

Quality Improvement Intervention To Improve Hpv Immunization Rates In Rural Primary Care Settings: Policy Recommendations From Post Intervention Survey, Isabel Stock

Capstone Experience: Master of Public Health

It is estimated that 8 billion dollars annually fund the prevention and treatment of Human Papillomavirus (HPV) associated cancers in the U.S. The HPV vaccine is the most effective way in preventing associated cancers when administered on-time, during adolescence. With HPV vaccination rates remaining low across the country, organizations have been researching effective interventions to improve uptake of the vaccine. In this paper we conducted a descriptive analysis of a survey completed by clinicians upon completion of an eighteen-month quality improvement (QI) intervention to increase HPV vaccination rates in rural primary care settings. New research indicates that differences in HPV …

Associations Between Demographic, Social Determinant, And Health Factors And Self-Management Measures Among Insured Individuals With Type 2 Diabetes, Shari Bowers-Dueker

Capstone Experience: Master of Public Health

Background: Ensuring that individuals with type 2 diabetes properly manage their chronic condition is a nation-wide challenge, even among individuals who have health insurance coverage and access to the treatment they need. There exist several literature sources that suggest various factors that may influence an individual’s lack of self-management of type 2 diabetes. This study investigated some of these factors by determining whether various demographic, social determinant, and health factors were associated with three self-management measures among individuals with type 2 diabetes.

Methods: The self-management measures of interest included (i) whether the annual recommended two primary care visits were attended …

Food Insecurity And Child Development In Nebraska: The Role Of Income, Home Learning Environment, And Family Socio-Demographic Factors, Marlette Grace Dulcinee Mabiala-Maye

Capstone Experience: Master of Public Health

Food insecurity is a well-known risk factor for delayed child development. Still, the contribution of other factors, such as income, home learning environment (HLE), and family socio-demographic factors, remains to be determined. Therefore, the study aimed to determine the association between food insecurity and child development and assess the role of income, HLE, and family socio-demographic factors in that association. We used secondary data from the Nebraska Early Childhood Study, a cross-sectional study of caregivers of children under five years old in Omaha and Lincoln. Child development, food insecurity, and HLE were measured using a caregiver report of child development. …

A Scoping Review Of The Predictive Values And Use Of The Oraquick In-Home Hiv Test, Mariah Zinn

Capstone Experience: Master of Public Health

The OraQuick In-Home HIV Test was FDA-approved for over-the-counter use for people aged 17 years and older in 2012. The FDA reported on the sensitivity and specificity of the test, which looks at the accuracy of a test relative to a reference standard. However, the predictive values that account for prevalence still need to be thoroughly examined among tests distributed through community-based means. In this review, we looked at the predictive values for the OraQuick In-Home HIV Test for people aged 15 years and older when the test is distributed through community-based means. We calculated the predictive values for each …

Association Between Socioeconomic And Behavioral Characteristics With Urinary Neonicotinoid Levels In The United States, 2015-2016, Komi Nomessi Akliku

Capstone Experience: Master of Public Health

Neonicotinoids are a class of pesticides developed in the 1980s and widely used in agriculture and households. They are sources of health damage in mammals, as identified in experimental studies in rats. The health effects identified were acetamiprid: memory dysfunction, respiratory failure, and digestive troubles; imidacloprid: liver and brain cell necrosis through Nitric Oxide formation: Thiacloprid induces an increase of cytokine proinflammation and causes cell division disturbance and genotoxicity; thiamethoxam is incriminated in reproductive system toxicity and cardiotoxicity; clothianidin is found to be associated with fertility troubles affecting spermatozoids’ motility. They have been said to be associated with thyroid cancer …

Assessing Occupational Exposure Risk And Covid-19 Incidence Rates In Nebraska By Industry And Occupation, 2020, Christopher Austin

Capstone Experience: Master of Public Health

Occupational outbreaks of COVID-19 have been described during the pandemic, yet the epidemiology of COVID-19 across a larger workforce population is currently not well characterized in the United States. Describing COVID-19 incident rates by industry and occupation will elucidate how the pandemic affected the workforce in Nebraska. However, nonresponse bias occurs in the employment information when participants are unwilling or unable to respond to contract tracer questions, thus affecting the results. Nonresponse bias will be analyzed, and appropriate statistical approaches will be utilized to adjust for any bias in the data. Adjusting for bias, incidence rates by detailed industry and …

Planning A Multiple Myeloma Needs Assessment For Omaha Nebraska, Judith Ngozi Obodougo

Capstone Experience: Master of Public Health

Literature Review

Worldwide, approximately 176,404 people had Multiple Myeloma in 2020, which caused about 117,077 deaths in the same period. Multiple Myeloma is a rare type of blood cancer currently considered a curable malignancy.

Objectives

This public health capstone aims to create a plan for a community needs assessment for multiple Myeloma in Omaha, Nebraska.

Methods

This capstone project modified the Centers for Disease Control and Prevention (CDC) community needs assessment guidelines to create a Multiple Myeloma needs assessment plan for Omaha, Nebraska.

Results

All seven steps outlined in the CDC community needs assessment planning steps were relevant. Omaha, Nebraska, …

Program Evaluation: Utilizing Health Department’S Community Health Needs Assessment Data To Improve Emergency Preparedness Plans, Kathleen Gottschalk

Capstone Experience: Master of Public Health

Public health officials conducting emergency response plans must know how to easily identify the vulnerable populations in their community or jurisdiction. It is beneficial for access and functional needs appendices to include information and resources directed at the identified vulnerable groups before an emergency event to improve health outcomes. Community Health Needs Assessments (CHNA) can provide population-level statistics and information needed to easily identify vulnerable or at-risk groups. This report aims to evaluate the use of the CHNA data to guide the development of inclusive emergency response plans that account for vulnerable populations in local health department jurisdictions. The 2021 …

A Review Of Nebraska Public School Active Shooter/Armed Intruder Preparedness Requirements Compared To Other States, Anna Hansen

Capstone Experience: Master of Public Health

Approximately 17% of mass shootings which occurred between 2000 and 2013 took place in the public school K-12 setting. The incidence of school shootings is on the rise, with a particularly concerning increase in annual incidents beginning around 2010. A review of legal requirements for public school active shooter preparedness in FEMA Region VII, which includes the states Nebraska, Iowa, Kansas, and Missouri, was conducted. While Iowa clearly requires an emergency operations plan including provisions for the active shooter scenario, Nebraska and Kansas do not clearly require such provisions in school emergency operations plans, and Missouri does not appear to …

Utilization Of Community Health Workers In Emergency Preparedness And Response: A Literature Review, Amelia P. Stoltman

Capstone Experience: Master of Public Health

As the frequency and magnitude of disasters worldwide continues to rise, so too does the devastation that follows. This devastation extends to the whole community. In guidance put forward by the Federal Emergency Management Agency (FEMA), emergency preparedness must be represented in and reflective of the whole community, but marginalized groups or segments of the population may be left out of the conversation. Community Health Workers (CHW)s serve as a trusted liaisons and community advocates within the health care landscape. That landscape, as recent events demonstrate, includes emergency preparedness and response. This literature review is designed to assess available publications …

Longitudinal Trends In Body Mass Index And Risk Of Obesity Among Blue Cross & Blue Shield Of Nebraska Insured Sample Population During 2017-2022, Devi Venkata Naga Akshay Dwarabandam

Capstone Experience: Master of Public Health

Objective: To estimate and compare the longitudinal trends in the crude prevalence of obesity in the Blue Cross and Blue Shield of Nebraska (BCBSNE) sample of the adult population with the Behavioral Risk Factor Surveillance System (BRFSS) of Nebraska during the pre-pandemic period (2017-2019) and COVID-19 pandemic period (2020-2022) using standardization methods.

Background: Studying the obesity disease burden in a commercial insurance company's administrative claims data can provide critical insights that can inform policy, practice, and interventions aimed at improving health outcomes, managing costs, and reducing the burden of obesity at the population level.

Methods: This study utilized a cohort …

Assessing The Impact Of Ebola Virus Inoculum Size On Likelihood Of Infection, Joseph Lukowski

Capstone Experience: Master of Public Health

Background: Indirect transmission of Ebola virus disease (EVD) is not uncommon but is poorly understood. Improving the understanding of the potential risk of EVD transmission from fomites should result in new or updated prevention or control measures for suspected or confirmed EVD cases or outbreaks.

Objective: This study aims to compile and understand pertinent data from peer-reviewed literature, establish the dose-response relationship between inoculum doses introduced to mucous membranes, and finally estimate the risk of EVD transmission from fomites.

Methods: A literature search was conducted through PubMed to obtain relevant data. This study employed this data to perform Poisson regression …

Rural/Urban Differences In Five-Year Survivorship In Pediatric Cancer In United States, Hong Li

Capstone Experience: Master of Public Health

Background: In the United States, five-year survival rates for pediatric (ages 0-19 years) cancer have improved since the mid-1970s due to treatment improvement. Research on adult cancer patients suggested rural patients have worse survival than urban patients. However, there is a dearth of research on survivorship among children and adolescents diagnosed with cancer.

Aims: The aims of the study were to: 1) examine differences in five-year relative survival rates of pediatric cancer in the United States between children living in urban and rural areas from 2000-2014 and 2) examine differences in a risk of dying from pediatric cancer between children …

A Scoping Literature Review Of Workforce Development Strategies To Increase Indigenous Birth Workers, Danielle A. Thies

Capstone Experience: Master of Public Health

Objective/Aim: To review the literature on workforce development to increase Indigenous birth workers to improve birth outcomes in Indigenous populations.

Design: A systematic scoping review.

Data Sources: The following databases were accessed: PubMED, Embase, and CINAHL. Support relating to key words and appropriate databases was provided by a university librarian.

Review Methods: Search terms across databases were sourced identifying a total of 152 papers. Title/abstract searches were screened against the inclusion/exclusion criteria, resulting in 55 papers reaching full-text review. Of the 55 papers reviewed, 26 were eligible for inclusion in the final review.

Results/Findings: Thematic …

A Retrospective Analysis Of Rabies Lyssavirus Animal Testing In Nebraska, 2012 Through 2021, Elijah Theye

Capstone Experience: Master of Public Health

Background: Rabies is a zoonotic disease caused by a neurotropic virus that has been a public health issue for over 4,000 years, killing roughly 59,000 humans globally each year. This study examined the seasonality of bat-human exposures, the association between animal-human exposure types and animal rabies positivity, and using skunk monthly positivity rates to predict all non-skunk non-bat animal positivity rates with a lag time of six months, in Nebraska.

Methods: Animal rabies testing data from 2012-21 were extracted from Nebraska’s Electronic Disease Surveillance System. Animal tests that had a valid animal rabies test were included in the analyses. To …