Medicine and Health Sciences Commons^™

Tort Liability For Failure To Age Gate: A Promising Regulatory Response To Digital Public Health Hazards, Matthew B. Lawrence, Brett Frischmann, Avi Sholkoff

Faculty Articles

Tort liability for failure to “age gate” is a promising legal response to the public health hazards of AI, social media, sports gambling, and other digital spaces. Tort liability for failure to “age gate” hinges liability for harms to minors on an app’s failure to take reasonable steps to prevent minors from gaining access or otherwise to apply appropriate governance rules, such as privacy-protective default settings or ensuring genuine parental consent. While no one legal response is a panacea, tort liability for failure to age gate carries several distinctive advantages that make it a particularly promising option at this stage …

Constitutionalizing Climate Rights, Mark P. Nevitt

Faculty Articles

This Essay proceeds in three Parts. In Part I, I describe and analyze which states have climate and environmental amendments within their state constitutions. Here, I focus on three states (Hawaii, Montana, and Pennsylvania) that have comparably strong Green Amendments and have experienced litigation in recent years enforcing these constitutional provisions. I describe and analyze three cases: Navahine F. v. Hawaii Department of Transportation (Hawaii), Held v. Montana (Montana), and Robinson Township (Pennsylvania). I argue that these three decisions—all of which enjoyed varying degrees of success—will spur greater efforts to constitutionalize state environmental rights. Indeed, there are grassroot efforts within …

Association Of Out-Of-Pocket Expenditures With Continuation And Type Of Treatment Among New Adult Cancer Cases At Ahsania Mission Cancer And General Hospital In Bangladesh (2023-2024) : A Secondary Data Analysis, A K M Shahriar

Chulalongkorn University Theses and Dissertations (Chula ETD)

Background and Objective: Bangladesh faces a heavy cancer burden, with about 167,000 new cases annually and 68% of health spending paid out-of-pocket (OOP). High OOP costs cause financial toxicity, forcing patients to abandon treatment. This study examined associations between patient OOP expenditures and prescribed treatment continuation and treatment modality (others versus chemotherapy/radiotherapy) among adult cancer patients at a hospital in Dhaka. Methodology: We conducted a cross-sectional analysis of existing hospital records for all adult cancer patients (age ≥18) at Ahsania Mission Cancer and General Hospital between 01 January 2023 and 31 December 2024 (N = 12,907). Data included each patient’s …

Association Of Biomarker And Cardiovascular-Kidney-Metabolic Syndrome Among Older Chinese Adults : Findings From A Nationwide Study, Jiahao Shi

Chulalongkorn University Theses and Dissertations (Chula ETD)

Background: CKM syndrome poses a growing burden in aging populations, but early detection remains limited by the lack of integrated biomarkers. The C-reactive protein–triglyceride glucose index (CTI), which reflects inflammation and insulin resistance—two core drivers of CKM—has not yet been evaluated for its association with CKM status in large, aging Asian cohorts. This study addresses this gap.Objective: To investigate the association of C-reactive protein–triglyceride–glucose (CTI) index with cardiovascular-kidney-metabolic (CKM) syndrome in older Chinese adults.Methods: This cross-sectional study analyzed data from 10,318 participants aged ≥45 years in the 2015 China Health and Retirement Longitudinal Study (CHARLS). CKM syndrome was operationalized as …

Exploration Of The Mechanisms Of Benjakul’S Anti-Rheumatoid Arthritis Actions Through Network Pharmacology, Hongxiang Duan

Chulalongkorn University Theses and Dissertations (Chula ETD)

Rheumatoid arthritis (RA) is driven by chronic inflammation and matrix degradation; traditional Thai formula Benjakul (BJK) is empirically used for inflammatory conditions, but its mechanisms are not well defined. To assess the antioxidant capacity of BJK and to elucidate potential anti-inflammatory targets and signaling pathways relevant to RA. BJK and its five constituent herbs were extracted with 99% ethanol and evaluated for TPC, TFC, FRAP, and DPPH assays. LC–MS/MS was used to profile key bioactive compounds, which were further filtered by SwissADME and subjected to target prediction using SwissTargetPrediction. Overlapping targets with RA-related genes were analyzed by GO and KEGG. …

"Factors Associated With Knowledge, Attitude And Practice (Kap) Towards The Prevention Of Type 2 Diabetes Mellitus Among The Middle-Aged Group Adults In Dhaka City, Bangladesh : A Cross-Sectional Study", Sabrina Rahman

Chulalongkorn University Theses and Dissertations (Chula ETD)

Background: Type 2 Diabetes Mellitus has emerged as a critical public health challenge in Bangladesh, particularly in urban areas, like Dhaka city, due to rapid urbanization, sedentary lifestyles, dietary transitions, and increasing obesity rates. However, there is limited research related to influencing factors of knowledge, attitude, and practice towards diabetes prevention in Bangladesh. Objective: This study aims to identify the level of knowledge, attitude, and practices (KAP) towards the prevention of Type 2 Diabetes Mellitus and their associated factors among middle-aged adults in Dhaka City, Bangladesh. Methods: A cross-sectional study design was conducted in participants aged 30–64 years, with a …

Association Between Knowledge, Attitude, Risk Perception, Expectancies And Cannabis Use Among International University Students In Thailand : A Cross-Sectional Study, Yueting Liu

Chulalongkorn University Theses and Dissertations (Chula ETD)

The global increase in cannabis use, particularly among young individuals, poses a serious public health risk. Thailand decriminalized cannabis in 2022, under this situation, international students are experiencing changes in social attitudes toward cannabis use and have increasing access to sources of cannabis. There is currently lack of research on cannabis use among this group in Thailand. This study aimed to analyze the associations between knowledge, attitudes, risk perceptions, and expectancies and cannabis use among international university students in Thailand. This cross-sectional study was conducted among international university students aged 18 years and older in Thailand. Participants were collected through …

Impacts Of Physical Inactivity Models On Endothelial Function: A Systematic Review, Joel E. Harden, J. David Branch, Leryn J. Reynolds

Exercise Science Faculty Publications

Background

Endothelial dysfunction is associated with cardiovascular disease and cardiac events. Numerous studies demonstrate that a reduction in physical activity/exercise levels are associated with poor endothelial function. Yet, these studies use a plethora of models to mimic reduced activity levels which may have widely different results on endothelial function. It is pertinent to collectively review these articles to provide a comprehensive understanding of the impact of reduced activity on vascular health, as endothelial function is one of many factors that influences vascular tone.

Objective

The purpose of this systematic review is to examine and synthesize the current literature regarding the …

Cause Of Death? -- It's Probably Not What's Reported On The Death Certificate, Lauren R. Roth

Lewis & Clark Law Review

In the age of big data, this country has a data problem—inaccurate and incomplete information in death certificates. The problem has long been hidden by the numbers reported—as have the people whose deaths go uncounted, but the COVID-19 pandemic unveiled the scope of the issue. Since the beginning of the pandemic, “excess deaths” (i.e., any deaths above the number predicted by existing mortality models) have increased significantly. Most of these excess deaths are likely attributable to COVID-19 because the decedent was never tested for COVID-19 or it was one of multiple factors contributing to their death. Other deaths are uncounted …

The Association Between Food Benefit Online Ordering And Redemptions: Evidence From The Special Supplemental Nutrition Program For Women, Infants, And Children, Junzhou Zhang, Chuanyi Tang, Kayoung Park, Qi Zhang

Marketing Faculty Publications

Objective:

To examine how the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) online food benefit ordering could influence WIC benefit redemptions.

Design:

A cross-sectional study. We compare the average redemption rates between online ordering early adopters and non-adopters among WIC customers before and after implementing WIC online ordering. A propensity score-weighted difference-in-difference model was used to estimate the coefficients.

Setting:

The Oklahoma WIC programme and a grocery store chain in Oklahoma.

Participants:

12743 Oklahoma WIC households that had redeemed their food benefits at the grocery store chain in 2020.

Results:

WIC online ordering significantly positively affected redemption …

Educational Interventions To Improve Pediatric Emergency Care: A Qualitative Assessment Of The Perspectives Of African Healthcare Workers, Emily A. Hartford, Chris A. Rees, Isaac Kihurani, Raana Hussain, Elena Seifert, Alexis Schmid, Tigist Bacha, Carol C. Chen, Megan L. Schultz

Paediatrics and Child Health, East Africa

Pediatric emergency care (PEC) training for health care workers (HCWs) is commonly offered in the form of short courses. This study gathers the perspectives of HCWs from eight African countries on how to best deliver and implement short training courses in PEC. This is a qualitative study using semi-structured key informant (KI) interviews. Utilizing the African Federation for Emergency Medicine (AFEM) member list serve, we identified African HCWs who had previous experience participating in and/or delivering short training courses in PEC. From this cohort, four interviewers were selected. These interviewers all received training in qualitative interviewing and then each recruited …

A Qualitative Study Of End-Stage Liver Disease And Liver Transplant Referral Practices Among Primary Care Providers In Nonurban America, Vashisht Madabhushi, Matthew Wright, Gabriel Orozco, Allison Murphy, Antonio R. Garcia, Natalie D. Pope, Xiaonan Mei, Alexandra Cocca, Roberto Gedaly, Meera Gupta

Surgery Faculty Publications

Purpose: In rural America, the road to obtaining a liver transplant (LTX) often starts at the primary care provider’s (PCP’s) office. Patients with end-stage liver disease (ESLD) in rural communities experience lower rates of wait-listing and higher mortality. This study identifies issues related to the knowledge and perceptions of ESLD and LTX referral among PCPs in rural Kentucky (KY).

Methods: The study protocol involved relying upon a semistructured outline to explore the knowledge, attitude, and perceptions of PCPs toward ESLD and LTX referral among PCPs in rural KY. Inductive thematic analysis was utilized to identify, analyze, and report themes.

Findings: …

Man With An Itchy Back, Katherine Schaffer, Nevin Adamski, Brittany Ambrose, Kathleen Anderson

Department of Emergency Medicine Faculty Publications

[First paragraph] A 61-year old man with no significant past medical history presented with painful bug bites on his lower back 1 day after a 1.5-week-long visit to Africa. He noticed bug bites on his lower back 3 days ago; since then, they have increased in size and become more painful. He was prescribed doxycycline at urgent care earlier that morning and had taken 1 dose. He is taking prophylactic medications for malaria and has had no fever at home. Vital signs, exquisitely tender papular lesions with a central punctum and surrounding erythema in the bilateral paralumbar regions.

Blood Biomarkers In Down Syndrome: Facilitating Alzheimer’S Disease Detection And Monitoring, Melissa E. Petersen, Lisi Flores-Aguilar, Elizabeth Head, Laia Montoliu-Gaya, Andre Strydom, Sarah E. Pape, Juan Fortea, Nicholas J. Ashton, Chinedu Udeh-Momoh, Sid E. O’Bryant, Dwight German, Florin Despa, Mark Mapstone, Henrik Zetterberg

Neurology Faculty Publications

Blood-based biomarkers continue to be explored for disease detection, monitoring of progression, and therapeutic outcomes as the diagnostic determination of Alzheimer’s Disease in Down Syndrome (DS-AD) remains challenging in clinical settings. This perspective highlights the current status of this effort. Overall, amyloid (A), tau (T), and neurodegeneration (AT[N]) blood-based biomarkers have been shown to increase with disease pathology for individuals with DS. Phosphorylated tau biomarkers (p-tau217, p-tau181) have been consistently shown to track disease progression for DS-AD and are likely good candidates for use in clinical settings. Biomarkers of inflammation (glial fibrillary acidic protein) also show promise; however, additional work …

A Case Study In Program Evaluation, Soma Dutta

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Program evaluation is a systematic process of assessing a program’s design, implementation, and outcomes to determine its effectiveness, efficiency, and impact, guiding data-driven improvements and decision-making. The Centers for Disease Control and Prevention (CDC) Evaluation Framework provides a structured approach to assessing public health programs, ensuring they are effective, accountable, and continuously improving. By systematically applying this framework, evaluations can provide actionable insights that inform program improvements, guide resource allocation, and ensure that evaluations are practical and meaningful to all stakeholders involved (Centers for Disease Control and Prevention, 2024).

The Bourbon County Health Department (BCHD) has implemented a Physical Activity …

A Case Study In Program Evaluation: Evaluation Of The Bourbon County Physical Activity Initiative, Michaela D. Amburgey

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

This evaluation examines the Bourbon County Physical Activity Initiative, which aims to increase physical activity levels in Bourbon County, Kentucky. The initiative includes increased access to exercise opportunities, community events, and an incentive-based activity tracking system. This evaluation assesses the program’s implementation, effectiveness, and provides recommendations for improvement. By utilizing evaluation findings, public health practitioners can enhance decision-making, optimize resource allocation, and improve population health outcomes.

Bones And Brains: The Association Between Osteoporosis And Depression, Mason Taylor

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Introduction: Osteoporosis and depression are two public health problems that are increasing in prevalence. Previous studies have found a positive association between the two variables in women and men and women together, but there is a gap when looking at men. Therefore, it was important to investigate the odds of depression in men, women, and men and women together to make comparisons by sex.

Methods: 1,602 participants aged 65 and older were included in the study from the National Health and Nutrition Examination Survey (NHANES) 2017 – March 2020 Pre-Pandemic dataset. One unadjusted and seven adjusted models were created for …

Evaluation Of The Bourbon County Health Department Physical Activity Program, Walker S. Hancock

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Bourbon County has a low physical activity rate. A program has been implemented to increase rates of physical activity. An evaluation has been performed using the CDC’s 6-step program evaluation process framework.

According the the framework, two recommendations were made. The first one is to increase access to parks or exercise facilities for those outside of Paris city limits. The second one is to increase the number of indoor facilities for people to use during the cold, winter months.

A Case Study In Program Evaluation: Evaluation Of A Program To Increase Physical Activity, Megan M. Harper

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Public health revolves around 3 core functions: assessment, policy development, and assurance.¹ For public health initiatives to have long-term success, we must determine if the intended effects of those programs are met in the beginning stages of program development and implementation; thus, program evaluation relates to the core function of assessment. The Centers for Disease Control and Prevention (CDC) developed a framework to facilitate this process and enable subsequent informed decisions on how to improve public health programs, which relates to policy development.² The CDC framework is comprised of 6 interconnected steps and 4 groups of standards; together, …

Understanding The Impact Of Pharmacist Prescriptive Authority On Hiv Pre-Exposure Prophylaxis At The State Level, Cameron G. King

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

HIV transmission, with relative risk reductions of up to 99%. However, real world data have revealed that even with large increases in PrEP use, new HIV diagnoses may only slightly decline. This disparity suggests that access to PrEP may be suboptimal, especially among high-risk subgroups, who are often hard to maintain on the continuum of HIV care. Pharmacists, because of their accessibility, trusted role in their communities, and growing scope of practice, could serve as an intervention point to improve access to PrEP.

A previously validated algorithm using National Drug Codes (NDCs) and the International Classification of Disease, 10^{th …}

How Sleep Disorders And Sleep Duration Impact Memory, Alexandria J. Sims

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

INTRODUCTION: Sleep duration and sleep disorders can cause changes in memory function as populations age. Previous studies have shown that disordered sleep is associated with increased risk of cognitive dysfunction and long and short sleep durations can cause memory impairment. This study studies aims to find if there is an association between sleep disorders and sleep duration and the impacts on memory.

METHODS: In this study, 3,478 participants aged 60 year and older from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 dataset were included in adjusted and unadjusted models, comparing the sleep disorders and sleep duration exposures to …

Environmental And Behavioral Determinants Of Congenital Defects: An Ecologic Study In Kentucky, Amelia G. Floyd

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Congenital defects are a significant contributor to infant morbidity and mortality. The multifactorial etiology of such defects presents complex challenges for public health. This ecologic study investigates the association between environmental and behavioral exposures and congenital defects rates at the county level in Kentucky from 2010 to 2019. The Kentucky Department for Public Health, Office of Vital Statistics, provided all relevant defect data. County-level exposure data was collected from multiple sources.

Descriptive and geospatial analyses revealed substantial geographic variability, with notable high defect rates in northeastern Kentucky. Negative binomial regression models identified behavioral and socioeconomic factors to be the strongest …

Assessing The Impact Of A Physical Activity Program In Bourbon County Using The Cdc Evaluation Framework, Abigail Lay

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Physical inactivity is a significant public health concern, contributing to increased risks of chronic diseases such as obesity, cardiovascular disease, and diabetes (Centers for Disease Control and Prevention [CDC], 2022). To address this issue, communities across the United States have implemented physical activity programs to promote healthier lifestyles, including Bourbon County. This project evaluates the impact of a physical activity program in Bourbon County, KY, using the CDC Framework for Program Evaluation to assess its effectiveness, sustainability, and areas for improvement (CDC, 1999).

The primary objective of this evaluation is to determine whether the program has successfully increased participants' physical …

Changes In Local Public Health System Characteristics Before And After The Implementation Of Ohio’S Public Health Accreditation Board Policy For Local Public Health Departments., Christine Lynn Vazquez

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The Public Health Accreditation Board is a nationally recognized nonprofit organization that manages a series of programs including the national public health accreditation program. Public health accreditation is awarded to health departments that achieve a set of nationally recognized goals and standards for departments to adopt. The state of Ohio initiated policy requiring that Local Health Departments to achieve accreditation by 2018. In result, Ohio has the largest number of accredited local health departments. This study looked at the local health departments in Ohio responses to the National Longitudinal Survey of Public Health Systems to understand if services provided improved …

Evaluating Hiv Testing Strategies And Screening In The University Of Kentucky’S Target 4 Project, Emily E. Wagoner

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The University of Kentucky’s Target 4 project aims to expand HIV testing and provide accessible, confidential services throughout Kentucky, focusing on individuals at highest risk for HIV and Hepatitis C. In December 2023, the Target 4 project implemented a new, expanded HIV screening form, increasing the number of questions from seven to eighteen. This study analyzes the impact of the new screening form on risk factor identification and HIV positivity rates in Region 9, a 16-county area in central Kentucky, from September 2021 to November 2023. Data from 11,187 encounters before the implementation of the new screening form and 2,585 …

Epidemiology Of Recurrent Herpes Labialis Among Dentistry Students: A Cross-Sectional Survey In Egypt, Sara Abdelwahed, Dalia Ghalwash, Al Hassan Diab

Dentistry

Aim: Recurrent herpes labialis (RHL) is a common viral infection with significant psychosocial and clinical implications. Dental students are particularly vulnerable due to stress and frequent patient contact, yet data on their epidemiology in Egyptian cohorts are scarce. The study aimed to determine the prevalence, recurrence patterns, and associated risk factors of RHL among dentistry students in Egypt. Materials and Methods: A cross-sectional survey was conducted among 559 dentistry students at the British University in Egypt. A structured, self-administered questionnaire captured sociodemographic data, history of RHL episodes, frequency, severity, and triggering factors. Data were analyzed using descriptive statistics and Chi-square …

Challenges Associated With Pfas Detection Method In Africa, Abdullahi Tunde Aborode, Ridwan Olamilekan Adesola, Ibrahim Idris, Waheed Sakariyau Adio, Segun Olapade, Gladys Oluwafisayo, Israel Ayobami Onifade, Sodiq Fakorede, Taiwo Bakare-Abidola, Jelil Olaoye, Adedeji Daniel Ogunyemi, Oluwaseun Adeolu Ogundijo, Olamilekan Gabriel Banwo, Adetolase Azizat Bakre, Peter Oladoye, Grace Adegoye, Noimat Abeni Jinadu

Chemistry & Biochemistry Faculty Publications

Per- and polyfluoroalkyl substances (PFAS) are a group of man-made chemicals that are widely present in many industries. Monitoring and analyzing PFAS in Africa is challenging due to the limited availability of mass spectrometry (MS), which is an essential technique for detecting PFAS. This review assesses the scope and impact of the shortage of mass spectrometry instruments in Africa, emphasizing the resulting limitations in monitoring environmental and public health threats. The review analyzes the existing PFAS monitoring, the accessibility of MS instruments, and the technical capabilities within the continent. This study suggests that fewer African countries have sufficient MS instruments, …

Clostridioides Difficile Infection Study Models And Prospectives For Probing The Microbe-Host Interface, Tatiana Zvonareva, David S. Courson, Erin B. Purcell

Chemistry & Biochemistry Faculty Publications

Clostridioides difficile infection (CDI) is an urgent public health threat with a high rate of recurrence and limited treatment options. In vivo models have been indispensable in understanding CDI pathophysiology and establishing treatment protocols and continue to be essential in pre-clinal testing. More importantly, in vivo models offer the opportunity to probe the complex systemic host response to the microbe, which is impossible to recapitulate in vitro. Nonetheless, constraints related to the availability of animal models, cost, ethical considerations, and regulatory control limit their accessibility for basic research. Furthermore, physiological and habitual divergences between animal models and humans often result …

Identifying The Feasible Maximum Contaminant Level For Per- And Polyfluoroalkyl Substances That Ensures Health And Safety While Maintaining Affordability And Equity Of Drinking Water And Implementation Of That Maximum Contaminant Level Within California By The State Water Resources Control Board, Jennifer Aguilar

CGU Theses & Dissertations

Per- and Polyfluoroalkyl Substances (PFAS) are a large group of man-made substances that do not occur naturally in the environment and are resistant to heat, water, oil, grease, and stains. PFAS has been used since the 1940s in a variety of commercial products including non-stick cookware, waterproof clothing, paper products, stain-resistant fabrics and carpets, industrial firefighting foams, and products that resist grease, water, and oil. While 97% of the U.S. population has been shown to have some level of PFAS within their blood, long term exposure to PFAS is potentially harmful to health. Individuals who are exposed regularly have been …

Swimming In Sh*T: Quantifying Lagoon Flushing Impacts On Fecal Indicator Bacteria In Surf Zones Of Three Beaches On The East End Of Long Island, Ny, Brody C. Eggert

Pomona Senior Theses

This thesis investigates how lagoon flushing influences fecal indicator bacteria (FIB) concentrations—specifically enterococcus bacteria—in the surf zones of East Hampton and Southampton, New York. Focusing on the coastal lagoons of Georgica Pond, Sagg Pond, and Mecox Bay, the study analyzes how episodic inlet openings and environmental conditions affect enterococcus levels at adjacent recreational beaches. Using over 700 observations from the Surfrider Foundation’s Blue Water Task Force (BWTF) database, I construct a series of statistical models ranging from ordinary least squares to mixed effects frameworks; this thesis shows my process in developing this model. My analysis reveals that open inlets between …