Medicine and Health Sciences Commons^™

The Rural Cancer Paradox: When Poverty Outweighs Policy In Mississippi And Andalusia, 2010-2025, Elizabeth Hurst

Honors Theses

This thesis examines how regional economic histories and national healthcare policies interact to shape cancer care delivery in Mississippi (United States) and Andalusia (Spain)—two regions with parallel histories of agricultural dominance followed by economic decline, yet operating under fundamentally different healthcare systems. Through comparative policy analysis focused on the Affordable Care Act (2010) and Spain's Royal Decree Law 16/2012, this research challenges conventional fixation on healthcare system type as the primary determinant of patient outcomes. Instead, it reveals a “rural cancer paradox” where historically impoverished regions face similar barriers to effective cancer care despite their contrasting funding models. The research …

From Vector To Consequence: Integrating Vector Surveillance, Environmental Drivers, And Public Health Impact Into Lyme Disease Risk Management, Kathleen E. Angell

Theses & Dissertations

Lyme disease is the most common vector-borne disease in North America. This dissertation examines (1) how crowd-sourced compares to active vector surveillance and whether they are associated with Lyme disease, (2) how ecological factors relate to tick abundance and whether they can predict high disease years, and (3) estimated health and economic burden of Lyme disease and savings when interventions are applied. Tick abundance data from active and passive surveillance were compared and tested for association with Lyme disease in the first aim. We found differences in tick life-stage, species, and seasonality. Tick observations were positively correlated with Lyme disease. …

Let-7 Restrains An Epigenetic Circuit In At2 Cells To Prevent Fibrogenic Intermediates In Pulmonary Fibrosis, Matthew J Seasock, Md Shafiquzzaman, Maria E Ruiz-Echartea, Rupa S Kanchi, Brandon T Tran, Lukas M Simon, Matthew D Meyer, Phillip A Erice, Shivani L Lotlikar, Stephanie C Wenlock, Scott A Ochsner, Anton Enright, Alex F Carisey, Freddy Romero, Ivan O Rosas, Katherine Y King, Neil J Mckenna, Cristian Coarfa, Antony Rodriguez

Faculty, Staff and Students Publications

MicroRNA-mediated post-transcriptional regulation of lung alveolar type 2 (AT2) and AT1 cell differentiation remains understudied. Here, we demonstrate that the let-7 miRNA family plays a homeostatic role in AT2 quiescence by preventing the uncontrolled accumulation of AT2 transitional cells and promoting AT1 differentiation. Using mouse and organoid models, we show that genetic ablation of let-7a1/let-7f1/let-7d cluster (let-7afd) in AT2 cells prevents AT1 differentiation and leads to KRT8 transitional cell accumulation in progressive pulmonary fibrosis. Integration of AGO2-eCLIP with RNA-sequencing identified direct let-7 targets within an oncogene feed-forward regulatory network, including BACH1/EZH2/MYC, which drives an aberrant fibrotic cascade. Additional CUT&RUN-sequencing analyses …

Integrating Positive Psychology And Spirituality To Foster Meaning And Well-Being In Older Adults, Crystal Morris

Adultspan Journal

This perspective article explores the integration of positive psychology interventions (PPIs) and spirituality in therapy to foster meaning and well-being in older adults. It highlights exercises such as the positive introduction, positive legacy, character strengths, mindfulness, mindful-based yoga, and a manifestation prayer journaling. The interventions presented are tools to support older adults that may experience depression, difficult life transitions, and the search for renewed meaning. Therapists who integrate PPIs and spirituality into therapy can promote a holistic, non-pathological approach to treatment.

How Does Snap Access Prior To Pregnancy Affect Maternal And Infant Health Outcomes?, Sarah Hamersma, Mitch Mcfarlane

Center for Policy Research

Consistent access to healthy food even before pregnancy can play a role in maternal and child health. The Supplemental Nutrition Assistance Program (SNAP) provides food assistance to low-income individuals, including those who do not yet have children (often classified as Able-Bodied Adults Without Dependents, or ABAWDs). Our study uses ABAWD work requirement waivers – which vary within and across counties over a 15-year-period – as a measure of SNAP access for childless women. We use this variation to investigate pre-pregnancy SNAP access and the health of mothers and their infants. Using rich, population-wide Vital Statistics data combined with county-level SNAP …

Characterizing Spatial Epidemiology In A Heterogeneous Transmission Landscape Using The Spatial Transmission Count Statistic, Leke Lyu, Gabriella Veytsel, Guppy Stott, Spencer Fox, Cody Dailey, Lambodhar Damodaran, Kayo Fujimoto, Pamela Brown, Roger Sealy, Armand Brown, Magdy Alabady, Justin Bahl

Faculty, Staff and Student Publications

Background: Viral genomes contain records of geographic movements and cross-scale transmission dynamics. However, the impact of regional heterogeneity, particularly among rural and urban centers, on viral spread and epidemic trajectory has been less explored due to limited data availability. Intensive and widespread efforts to collect and sequence SARS-CoV-2 viral samples have enabled the development of comparative genomic approaches to reconstruct spatial transmission history and understand viral transmission across different scales.

Methods: We proposed the spatial transmission count statistic that efficiently summarizes the geographic transmission patterns imprinted in viral phylogenies. Guided by a time-scaled tree with ancestral trait states, we identified …

Evaluating Algorithmic Bias On Biomarker Classification Of Breast Cancer Pathology Reports, Jordan Tschida, Mayanka Chandrashekar, Alina Peluso, Zachary Fox, Patrycja Krawczuk, Dakota Murdock, Xiao-Cheng Wu, John Gounley, Heidi A. Hanson

School of Public Health Faculty Publications

OBJECTIVES: This work evaluated algorithmic bias in biomarkers classification using electronic pathology reports from female breast cancer cases. Bias was assessed across 5 subgroups: cancer registry, race, Hispanic ethnicity, age at diagnosis, and socioeconomic status. MATERIALS AND METHODS: We utilized 594 875 electronic pathology reports from 178 121 tumors diagnosed in Kentucky, Louisiana, New Jersey, New Mexico, Seattle, and Utah to train 2 deep-learning algorithms to classify breast cancer patients using their biomarkers test results. We used balanced error rate (BER), demographic parity (DP), equalized odds (EOD), and equal opportunity (EOP) to assess bias. RESULTS: We found differences in predictive …

Achieving Health Equity For Minorities, Marginalized And Vulnerable Populations: The Ethical Challenge For Improving Addiction Health Services And Policies In The Health Care System, Jasia A. Baig

Electronic Theses and Dissertations

During the past few decades, health disparities and substance misuse have transformed into unprecedented healthcare crises facing contemporary society. Although enormous contributions through policies and interventions have been made to promote health equity, substantial health inequalities and disparities persist, particularly in addiction health services and policies at multiple healthcare system levels for the marginalized, minoritized, and vulnerable populations.

The thesis of this dissertation asserts that a biopsychosocial ‘systems’ thinking towards treating addictive disorders along with systematic interventions and coordinated improvements specifically focused on minorities, marginalized and vulnerable populations at research, clinical, public health and global levels will significantly reduce health …

Walk With Ease Benefiting South Dakota, Bailey Thooft, Jennifer Kerkvliet

Scholarship Pathways Program

The Walk With Ease (WWE) program is a free, evidence-based, six-week walking initiative originally developed by the Arthritis Foundation to support adults with arthritis and other chronic conditions. This study evaluates the impact of WWE in South Dakota, focusing on participant outcomes related to overall health, physical activity, and chronic condition management. Participants engaged in either instructor-led or self-directed formats and accessed an online portal for resources. Pre- and post-surveys revealed that most participants improved or maintained their health metrics, with 44% reporting improved management of chronic conditions and 30% increasing daily walking time. The online portal was well-received, with …

Demographic And Clinical Factors Associated With Mechanisms Of Open Globe Injury In The United States: A Multi-Center Study, Shruti Anant, Alicia Casella, Jason A. Greenfield, Sarah C. Miller, Kristine Y. Wang, Bita Momenaei, Karen Lee, Hana A. Mansour, Grant A. Justin, Kevin G. Makhoul, Racquel A. Bitar, Alice Lorch, Grayson W. Armstrong, Taku Wakabayashi, Yoshihiro Yonekawa, Kara M. Cavuoto, Fasika Woreta

Wills Eye Hospital Papers

PURPOSE: We sought to examine the demographic and clinical risk factors associated with specific mechanisms of open globe injuries (OGIs) and identify predictors of Zone III injuries across multiple tertiary eye care centers.

PATIENTS AND METHODS: 1570 patients with OGIs presenting to the Wilmer Eye Institute, the Bascom Palmer Eye Institute, Massachusetts Eye and Ear, and Wills Eye Hospital between 2018-2021 were retrospectively reviewed. Multinomial and binomial logistic regression models were used to evaluate associations between demographic and clinical risk factors with injury mechanisms and Zone III injuries.

RESULTS: Among the study population (74.2% male, mean age 48.2 years), falls …

Investigating Social Network Peer Effects On Hiv Care Engagement Using A Fuzzy-Like Matching Approach: Cross-Sectional Secondary Analysis Of The N2 Cohort Study, Cho-Hee Shrader, Dustin T Duncan, Redd Driver, Juan G Arroyo-Flores, Makella S Coudray, Raymond Moody, Yen-Tyng Chen, Britt Skaathun, Lindsay Young, Natascha Del Vecchio, Kayo Fujimoto, Justin R Knox, Mariano Kanamori, John A Schneider

Faculty, Staff and Student Publications

BACKGROUND: Social network data are essential and informative for public health research and implementation as they provide details on individuals and their social context. For example, health information and behaviors, such as HIV-related prevention and care, may disseminate within a network or across society. By harmonizing egocentric and digital networks, researchers may construct a sociocentric-like "fuzzy" network based on a subgroup of the population.

OBJECTIVE: We aimed to generate a more complete sociocentric-like "fuzzy" network by harmonizing alternative sources of egocentric and digital network data to examine relationships between participants in the Neighborhoods and Networks (N2) cohort study. Further, we …

Is Anterior Cervical Discectomy And Fusion More Expensive At Quaternary Care Centers? An Application Of Time-Driven Activity-Based Costing, Jay Trivedi, Advith Sarikonda, Adam Leibold, D. Mitchell Self, Nikolaos Mouchtouris, Steven R. Glener, Ashmal Sami, Kavantissa M. Keppetipola, Emily Isch, Joshua Pelta-Heller, Srinivas Prasad, Ashwini Sharan, James Harrop, Alex R. Vaccaro, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

OBJECTIVE: Hospital setting is postulated to be a key driver of cost variation for neurosurgical procedures. Limitations in contemporary costing methodologies have led to the development of time-driven activity-based costing (TDABC). This study applies TDABC to anterior cervical discectomy and fusion (ACDF) to compare intraoperative costs at quaternary care centers versus satellite hospitals affiliated with the same health network.

METHODS: Nine hundred and fifty-eight ACDF cases performed at two quaternary care hospitals (n = 806) and six satellite hospitals (n = 152) were reviewed. Process maps were created to map the intraoperative episode, and TDABC methodology was used to calculate …

Rationale For A 4-Month, Parallel-Group, Randomized Controlled Trial To Assess The Feasibility And Efficacy Of A Remotely Delivered Exercise Training Intervention For Hispanics/Latinos With Multiple Sclerosis (Ferla Ms), Victoria A Flores, Stephanie L Silveira, David X Marquez, Dominique Kinnett-Hopkins, Augusto Miravalle, Fabian Sierra-Morales, Zulma Hernández-Peraza, Robert W Motl

Faculty, Staff and Student Publications

Background: Hispanic/Latino individuals with multiple sclerosis (MS) face greater disease burden and comorbidity due to limited healthcare access, underrepresentation in research, and social determinants of health (SDOH). Exercise training could manage health outcomes, but existing intervention research lacks Hispanic/Latino representation.

Methods: We propose a feasibility and efficacy study of a theory-based, remotely delivered exercise training intervention for enhancing health outcomes in Hispanics/Latinos with MS. This study involves a randomized controlled trial (RCT) design and compares an MS-specific exercise training program with an active control condition over a 4-month period in a sample of 50 individuals who self-identified as Hispanic/Latino with …

Investigating The Association Between Metabolically Healthy And Metabolically Unhealthy Obesity With Disease, Colleen Marie Cohick

Walden Dissertations and Doctoral Studies

Obesity is a global health concern, affecting individuals of all ages and ethnicities worldwide. A key factor in health concerns related to obesity is metabolic health: Obese individuals are either metabolically healthy obese or metabolically unhealthy obese, leading to different degrees of risk for cardiovascular disease and diabetes.. There is a lack of comprehensive research examining the association between metabolic health status among obese individuals and kidney, liver, and stomach diseases. This quantitative cross-sectional study was conducted to examine whether metabolic health status is a significant predictor of kidney, liver, and stomach diseases among obese individuals when lifestyle is a …

Over-The-Counter Cold Medication Usage Self-Efficacy Among Undergraduate Students In The United States, Ray Goodwin

Honors Theses

Background

This study looks at the trends in over-the-counter medication usage and self-efficacy among undergraduate college students in the United States. Over-the-counter (OTC) medications serve as the most easily accessible and commonly purchased medications and can be used as a basis to determine this demographic’s attitudes and behaviors towards self-medication. In addition, undergraduates represent a diverse population for analyzing differences among demographic groups.

Methods

A Qualtrics survey was sent out to undergraduates across the US via a panel, and the team received 403 useable responses. As part of a larger study, the survey presented participants with four different scenarios at …

Institutional Connectedness And Social Support Among College Students: Links To Campus Involvement, Carissa Strum

Honors Theses

Background. College is a pivotal period in the lives of students, and an important aspect of the experience is involvement within the campus. College student wellness is also a growing area of interest in higher education, with increased attention on ways to help students thrive. This study explores which aspects of campus involvement contribute to students’ feelings of connectedness and social support. This study aims to 1) assess the association between campus involvement and social support among college students, 2) assess the association between campus involvement and institutional connectedness among college students, and 3) examine whether the association between campus …

A Local Assessment Of Glp-1 Use For Weight Loss: An Interview Study, Maci Bradley

Honors Theses

Glucagon-like peptide-1 (GLP-1) receptor agonists are a novel class of medications used primarily for the treatment of type 2 diabetes, as well as for chronic weight management. The first GLP-1 medication, exenatide, was FDA-approved in April of 2005 for glycemic control, however, it was not until December of 2014 when liraglutide became the first GLP-1 FDA-approved for weight loss. There are now eight FDA-approved GLP-1s, only two of which are approved for weight loss. GLP-1 use has become increasingly popular in recent years, even extending to the college-aged population. The purpose of this study is to examine the trends in …

Empowering Youth Through Cooking Classes, Jamiya C. Mason

Honors Theses

Chronic health issues and poor dietary habits continue to disproportionately impact rural communities in Mississippi, especially among children. Research has shown that early exposure to healthy foods and cooking practices can positively influence lifelong health behaviors. Cooking classes have also been linked to improved food literacy, culinary confidence, and willingness to try new foods. The purpose of this study was to assess the effects of a short-term culinary program on children’s cooking self-efficacy and food behaviors in Quitman County, Mississippi.

Four cooking classes were conducted with youth (grades 4–7) in a local after-school program. Lessons included vegetable-based recipes, including zucchini …

Building Community Through Food And Health: Student Initiatives To Address Food Insecurity In Mississippi, Sarah E. Sawaya

Honors Theses

This thesis explores food insecurity in Oxford and Lafayette County, Mississippi, within the broader context of state, national, and global challenges. Over a four-year period, student-led and community organizations collaborated to design programs that addressed both food access and chronic illness prevention through education, outreach, and direct service. Community input was gathered through health screenings, campus engagement, and informal interviews with residents, which guided the development of practical tools like recipe kits, QR code-based cookbooks, and on-site health education. These efforts were rooted in local partnerships and shaped by the lived experiences of those most affected. This project demonstrates that …

Tackling Social Stigma: An Ethical Obligation In Healthcare Intervention To Involuntary Childlessness, Persis Naumann

Electronic Theses and Dissertations

The stigma associated with involuntary childlessness has negatively affected health and well-being for several decades. This situation is particularly exacerbated for women within the Tamil socio-cultural context, resulting in feelings of shame, neglect, denial, isolation, and constituting a significant barrier to long-term access to healthcare services. Although advancements have been made in the provision of biomedical care, the psychosocial support remains inadequately addressed. Moreover, there are currently no healthcare interventions that specifically target the stigma associated with this issue, which hinders open communication with healthcare providers, delays necessary treatments, and adversely impacts overall health outcomes. The central thesis of this …

Development Of A Risk Score To Aid With The Diagnosis Of Infections After Spinal Cord Injury: Protocol For A Retrospective Cohort Study, Felicia Skelton, Larissa Grigoryan, Joann Pan, Ashley Collazo, Barbara Trautner

Faculty, Staff and Students Publications

Background: Patients with spinal cord injury (SCI) who develop urinary tract infection (UTI) present differently than the non-SCI population. UTIs can cause loss of quality of life and even lead to life-threatening complications including urosepsis. Challenges in SCI management include distinguishing symptomatic UTI from asymptomatic bacteriuria (ASB), which occurs often in patients with SCI, and the lack of standardization in UTI diagnosis in SCI.

Objective: This study aims to set the foundation for the development of a risk score to improve diagnostic accuracy of UTI after SCI.

Methods: This study will use data from the Veterans Health Administration Corporate Data …

Fall Incidences, Risk Factors, And Health Effects Among Early- And Middle-Aged Elderly People In Rural Areas Of Border Provinces In Southern Thailand, Phnom Sukchan, Tapanan Prateepko, Arinda Ma-A-Lee, Kruawan Hounkong, Penporn Sujiwattanarat, Gornganok Piboonpol

Journal of Health Research

Background: Elderly individuals with physical and psychological challenges face a high risk of falls. This study aimed to assess the incidence, health effects of, and risk factors for falls among those aged 60-79 years old in Thailand's three southern border provinces.

Methods: A community cross-sectional study was conducted between October 2021 and September 2022. Questionnaires were administered though verbal face-to-face conversations. Descriptive statistics, the Chi-square test, Fisher’s exact test, and logistic regression were used.

Results: A total of 419 elderly participants were recruited, while 374 participated in the study. The incidence of falls was 37.4% with an average of 1.7 …

A Multi-Modal Intervention To Improve Identification, Management, And Prevention Of Recurrent Urinary Tract Infections In The Urgent Care Clinic, Stephanie Krol

Evidence-Based Practice Project Reports

Nearly 60% of women will suffer from a urinary tract infection (UTI) in their lifetime, with 20- 40% of them suffering from multiple (Anger et al., 2022). The primary purpose of this evidence-based project was to implement a multi-modal intervention to improve identification of women who suffer from recurrent urinary tract infections (rUTIs) and to assist in the prevention and treatment of future UTIs. Additionally, the project aimed to increase the number of referrals to urology for better management of these patients. This project was implemented at an Urgent Care Clinic (UCC) in northwest Indiana. Eligible participants who presented with …

Podcasts In Mental, Physical, Or Combined Health Interventions For Adults: Scoping Review, Elizabeth M. Dascombe, Philip J. Morgan, Ryan J. Drew, Casey P. Regan, Gabrielle Turner-Mcgrievy, Myles D. Young

Faculty Publications

Background:

The increasing prevalence of poor mental and physical health in adults is a global health concern. Given the scope of this problem, scalable and effective treatment interventions are needed. While podcasts (online digital audio files) are becoming more popular, the extent of podcast use in mental, physical, or combined health interventions has not been reviewed.

Objective:

This scoping review primarily aims to summarize the available evidence regarding the use of podcasts in health promotion interventions. A series of 5 research questions was designed to systematically review and accurately represent podcast use in current research interventions.

Methods:

We conducted a …

Enhancing Healthcare-Associated Infection Prevention: The Role Of Hand Hygiene, Ppe, Isolation, And Vaccination Education, Kaitlyn N. Rollo

Aurora

Healthcare-associated infections (HAIs) represent a significant threat to patient safety in hospital environments. These infections are often linked to lapses in infection prevention protocols, including inadequate hand hygiene, improper use of personal protective equipment (PPE), and insufficient isolation procedures. This project aimed to evaluate compliance with infection control policies and identify areas for improvement at Lima Memorial Hospital. By focusing on auditing, education, and data analysis, the goal was to reduce HAI rates and strengthen overall infection prevention practices.

Methods included a comprehensive review of existing hospital infection prevention policies, followed by hand hygiene and PPE audits across the hospital’s …

Long-Term Care Services And Support In The Mountain West, 2023, Taylor Volk, Ivan Sun, Miguel Soriano Ralston, Kristian Thymianos, Caitlin J. Saladino, William E. Brown Jr.

Health

This fact sheet presents data from the American Association of Retired Persons (AARP) report, “Long-Term Services and Supports 2023 State Scorecard Report,” comparing Long-Term Services and Supports (LTSS) systems across multiple dimensions of performance for older adults, people with physical disabilities, and family caregivers for all 50 states. This fact sheet focuses on state-level LTSS system data for the Mountain West states of Arizona, Colorado, Nevada, New Mexico, and Utah.

The Lasting Legacy Of Dr. Fritz Smith And Dr. Aminah Raheem: Founders Of Zero Balancing And Soul Lightening/Insight Acupressure, Deanna Waggy Otr

Journal of Transformative Touch

Dr. Fritz Smith and Dr. Aminah Raheem were pioneers in the field of holistic bodywork. Their innovative techniques, Zero Balancing (ZB) and Insight Acupressure (formerly Soul Lightening International), helped shape integrative medicine practitioners around the globe. Their marriage not only symbolized a personal union but also a professional synergy, with their complementary therapies offering a yin-yang approach to mind-body healing. Their legacy continues through the many practitioners trained in Zero Balancing and Soul Lightening/Insight Acupressure and the various organizations that uphold their commitment to research, education, and professional standards.

Psycho-Sociodemographic And Substance-Related Correlates Of Non-Suicidal Self-Injurious Behavior, Nicole Doyle, Krishen Samuel, Samantha Cohen-Winans Ms, M. Allison Ford, Vinayak K. Nahar, Oluwatoyin Olatunde, Juliet Igboanugo, Mercy Irungu, Robert E. Davis

Journal of Public Health in the Deep South

Background: College students face challenging environments in which risky coping mechanisms, such as non-suicidal self-injury (NSSI) and substance use may be used to mitigate psychological strain. The purpose of this research was to examine relationships between substance use, psychological distress, and various aspects of NSSI.

Methods: Cross-sectional survey data were collected from students recruited from a large university in the southern United States (n = 502). Instrumentation included validated and reliable scales on substance use, psychological conditions, NSSI behaviors, demographics, and suicidality measures.

Results: In all, 21% reported engagement in some form of NSSI within the past year. A …

Neighborhood Change As A Social Determinant Of Health: Assessing Associations With Mental Health And Psychosocial Attitudes Among Resident Clusters, Christopher Williams, Nathaniel Woodard, Charlene Kuo

Advances in Clinical Medical Research and Healthcare Delivery

Neighborhood change (NC) can be understood as a social determinant of health with direct psychosocial and economic impacts. Our objective was to define resident groups’ perceptions of NC and self-rated mental health in a community experiencing an intense form of NC known as gentrification. We conducted a cross-sectional study using random and convenience sampling. Our measures included a combination of scales and indexes that were used for conducting bivariate and cluster analyses. Our study included 143 responses from Phase II. Two of the three groups or clusters were statistically different in mental health and perceptions of NC impacts on community …

Latin American Prevalence Of Glaucoma: A Systematic Review And Meta-Analysis, Denisse J Mora-Paez, Jaime Guedes, Dillan Cunha Amaral, Marcelo Alves Ferreira, Bruno Fernandes, Sacha Pereira, Bruno Botton, Alisha Desai, Helena Messinger Pakter, Fabio Lavinsky, Adroaldo Alencar Costa Filho

Wills Eye Hospital Papers

We conducted a systematic review and meta-analysis to estimate the prevalence of all types of glaucoma in Latin America (LATAM) and evaluate potential demographic associations. This study followed PRISMA guidelines and was registered in PROSPERO (CRD42024506330). A comprehensive search of PubMed, SciELO, and Web of Science was conducted to identify population-based or cross-sectional studies reporting glaucoma prevalence in LATAM. Studies were categorized into two groups: Group 1 included general population studies without selection based on visual acuity (VA), and Group 2 included studies limited to individuals with VA < 20/60. Data from five studies in Group 1 (25,288 individuals) and eight studies in Group 2 (29,882 individuals) were analyzed using R software. The pooled prevalence of glaucoma was 4% (95% CI: 1–3%) in Group 1 and 1% (95% CI: 0–1%) in Group 2. No statistically significant associations were found between glaucoma prevalence and sex (p = 0.08) or age (p = 0.5669). Although our findings …