Medicine and Health Sciences Commons^™

Relationship Between Food Security, Nutrition Security, And Diabetes: The Role Of Supplemental Nutrition Assistance Program Participation, Maha Almohamad, Jayna M Dave, Eric E Calloway, Ruosha Li, Shreela Sharma

Faculty, Staff and Student Publications

BACKGROUND: Inadequate nutrition and poor diet quality are associated with a heightened risk of diabetes. The connection between food insecurity measures and diabetes has been established, with evidence indicating that Supplemental Nutrition Assistance Program (SNAP) participation contributes to reductions in food insecurity. Recently developed nutrition security measures, defined as the ability to acquire healthful foods to prevent diseases, and their association with diabetes and SNAP participation are not yet understood.

OBJECTIVES: This study aimed to assess the relationship between food security and nutrition security in relation to diabetes overall and by SNAP participation and nutrition security as potential modifiers.

METHODS: …

Patterns Of Undertreatment And Overtreatment In Adjuvant Radiotherapy For Early-Stage Endometrial Cancer Based On Molecular Classification, Otilia Ciobanu, Yixuan He, Alicia R Martin, Jill S Remick, Joseph W Shelton, Tony Y Eng, David C Qian

Faculty, Staff and Student Publications

The quality improvement study examines the use of risk-adaptive adjuvant radiotherapy in women with non–mismatch repair deficiency endometrial cancer.

Translating Motivational Interviewing For The Hpv Vaccine Into A Computable Ontology Model For Automated Ai Conversational Interaction, Nicole Moore, Muhammad Amith, Ana C Neumann, Jane Hamilton, Lu Tang, Lara S Savas, Cui Tao

Faculty, Staff and Student Publications

Human papillomavirus (HPV) vaccinations are lower than expected. To protect the onset of head and neck cancers, innovative strategies to improve the rates are needed. Artificial intelligence may offer some solutions, specifically conversational agents to perform counseling methods. We present our efforts in developing a dialogue model for automating motivational interviewing (MI) to encourage HPV vaccination. We developed a formalized dialogue model for MI using an existing ontology-based framework to manifest a computable representation using OWL2. New utterance classifications were identified along with the ontology that encodes the dialogue model. Our work is available on GitHub under the GPL v.3. …

Physical Activity Policies At National And Subnational Levels: A Study In Colombia, Costa Rica, Ecuador, And Mexico, Juliana Mejía Grueso, Michael Pratt, Eugen Resendiz, Deborah Salvo, Gloria Isabel Niño Cruz, Nubia Yaneth Ruiz Gómez, Rafael Alexander Leandro Gómez, Inés Revuelta Sánchez, Gerardo Alonso Araya Vargas, Angélica María Ochoa Avilés, Raúl Francisco Pérez Tasigchana, Alejandra Jáuregui, Pedro C Hallal, Andrea Ramírez Varela

Faculty, Staff and Student Publications

Background: National physical activity (PA) policy processes are only beginning to be studied in Latin America, and little attention has focused at the subnational level. This study examined national-subnational relations in the policy process (agenda setting, policy formulation, adoption, implementation, and evaluation) in selected Latin American countries.

Methods: The Global Observatory for Physical Activity's (GoPA!) INTEGRATE-PA-Pol tool was applied in Colombia, Costa Rica, Ecuador, and Mexico. Data were collected in matched pairs of the capital plus one noncapital city among national and subnational policymakers (n = 27), previously identified by the GoPA! Country Contacts. PA policy development and implementation were …

Risk Evaluation In Occupational Safety And Health Research: Results From A Benchmarking Exercise Of Federal And Academic Irbs, Sarah A Felknor, Jessica M K Streit, Angela M Morley, John D Piacentino

Faculty, Staff and Student Publications

OBJECTIVE: Research involving working populations can pose unique ethical and risk evaluation challenges. The purpose of this benchmarking project was to assess how federal agencies and academic institutions approach the interpretation and application of key risk evaluation concepts in research involving workers in their places of employment.

METHODS: Key informant interviews were conducted to ascertain current practices related to assessing soundness of research design, determining risk reasonableness and research relatedness of risks, and evaluating the risk of noninvasive clinical tests in occupational settings.

RESULTS: There were noteworthy commonalities among the approaches described to review and address critical aspects of risk …

Patient Understanding Of Fetal Sex Versus Gender In The Context Of Routine Cell-Free Dna Screening, Mindy Kolodziejski

Dissertations and Theses (Open Access)

Non-invasive prenatal testing (NIPT) is the current standard of care to screen for fetal aneuploidy using cell-free DNA (cfDNA). NIPT screens for sex chromosome aneuploidies (SCAs) and in doing so, can predict fetal chromosomal sex. Despite sex and gender being distinct concepts, many patients refer to NIPT as “the gender test” and elect testing in order to find out predicted fetal sex and assume gender. Our study aimed to evaluate and describe patient understanding of sex and gender in the context of receiving routine prenatal genetics education (PGE) on NIPT. A survey was developed with the goal of assessing patient …

Inclusion Of Adoption As A Pregnancy Management Option In Prenatal Genetic Counseling Practice, Emma Billings

Dissertations and Theses (Open Access)

Prenatal genetic counselors are essential to providing education, psychosocial support, and guidance on pregnancy options to patients who receive a fetal diagnosis of an anomaly or genetic condition. Therefore, genetic counselors should be well-educated on comprehensive pregnancy management options consisting of parenting, abortion, and adoption. The landscape of adoption education in genetic counseling practice was last characterized in 2010 by Perry and Henry, revealing substantial variability in both the inclusion of adoption-specific education in genetic counseling program (GCP) curricula and the discussion of pregnancy options with patients in prenatal practice. As a result, the authors published a call to action …

Challenges Beyond Addiction: Maternal Experiences With Postpartum Substance Use Disorder Recovery And Perspectives Of Reproductive Healthcare Providers, Leah Holcomb

All Dissertations

Substance use disorders (SUD) impact millions of pregnant and postpartum people in the United States. With the increasing rates of perinatal substance use and the risk of overdose and death during the postpartum period, understanding overall functioning and the needs of postpartum persons is critical for informing interventions to reduce the impact of substance use within the perinatal period. The goal of this research is to explore the needs of postpartum people navigating SUD recovery.

This dissertation investigates postpartum maternal functioning within the context of early SUD recovery, as well as the comfort of reproductive healthcare providers (RHPs) to care …

Examining Current Capacity Of Healthcare Systems: Identifying Potential Adaptations For Children And Youth With Special Healthcare Needs, Caitlin Koob

All Dissertations

Children and youth with special healthcare needs (CYSHCN) are a growing proportion of the pediatric population, accounting for 23% of children in South Carolina (SC). Children with medical complexity (CMC) are a subgroup of CYSHCN who experience the most complex conditions and comprise

This dissertation investigates equitable healthcare access, service quality, and health and well-being among CYSHCN and their families, within the context of SC’s healthcare system. Three studies make up this dissertation, focusing on various aspects of healthcare access and experiences of CYSHCN and their families.

Stillbirth Mortality By Robson Ten-Group Classification System: A Cross-Sectional Registry Of 80 663 Births From 16 Hospital In Sub-Saharan Africa, Claudia Hanson, Kristi Annerstedt, Maria Alsina, Muzdalfat Abeid, Hussein Kidanto, Helle Alvesson, Andrea Pembe, Peter Waiswa, Jean-Paul Dossou, Effie Chipeta

Centre of Excellence in Women and Child Health

Objective To assess stillbirth mortality by Robson ten-group classification and the usefulness of this approach for understanding trends.

Design Cross-sectional study.

Setting Prospectively collected perinatal e-registry data from 16 hospitals in Benin, Malawi, Tanzania and Uganda.

Population All women aged 13–49 years who gave birth to a live or stillborn baby weighting >1000 g between July 2021 and December 2022.

Methods We compared stillbirth risk by Robson ten-group classification, and across countries, and calculated proportional contributions to mortality.

Main outcome measures Stillbirth mortality, defined as antepartum and intrapartum stillbirths.

Results We included 80 663 babies born to 78 085 women; …

Breaking Barriers: An Innovative Tool To Assess The National And City-Level Physical Activity Policy Development To Practice Disconnect, Eugen Resendiz, Andrea Ramírez-Varela, Juliana Mejía-Grueso, Jane Moon, Josef Mitáš, Ross C Brownson, Deborah Salvo, Michael Pratt

Faculty, Staff and Student Publications

Background: Population-level physical activity increases are improbable without intersectoral collaboration across government levels and sectors to develop and implement physical activity promotion policies. This study aims to provide information about the development of the Interaction between National and Local Government Levels in Development and Implementation of Physical Activity Policies Tool (INTEGRATE PA-Pol). A framework was created to examine the development and implementation of national and subnational physical activity policies and the (mis)alignment between government levels.

Methods: The work was conducted in 3 phases: (1) a scoping review was carried out to identify local government physical activity promotion policies and instruments …

Ictal Central Apnea Is Predictive Of Mesial Temporal Seizure Onset: An Intracranial Investigation, Nuria Lacuey, Blanca Talavera, Oman Magana-Tellez, Oscar Mancera-Páez, Norma Hupp, Xi Luo, Johnson P Hampson, Jaison Hampson, M R Sandhya Rani, Manuela Ochoa-Urrea, Omar A Alamoudi, Stephen Melius, Sandipan Pati, Jay Gavvala, Nitin Tandon, John C Mosher, Samden D Lhatoo

Faculty, Staff and Student Publications

Objective: Ictal central apnea (ICA) is a semiological sign of focal epilepsy, associated with temporal and frontal lobe seizures. In this study, using qualitative and quantitative approaches, we aimed to assess the localizational value of ICA. We also aimed to compare ICA clinical utility in relation to other seizure semiological features of focal epilepsy.

Methods: We analyzed seizures in patients with medically refractory focal epilepsy undergoing intracranial stereotactic electroencephalographic (SEEG) evaluations with simultaneous multimodal cardiorespiratory monitoring. A total of 179 seizures in 72 patients with reliable artifact-free respiratory signal were analyzed.

Results: ICA was seen in 55 of 179 (30.7%) …

Early Life Cardiovascular Risk Factors And Midlife Epigenetic Aging: An Enduring Legacy, Paul S De Vries, Anthony S Zannas

Faculty, Staff and Student Publications

No abstract provided.

Phase Ib/Ii Study Of Lacnotuzumab In Combination With Spartalizumab In Patients With Advanced Malignancies, Jibran Ahmed, Bettzy Stephen, Yali Yang, Evan Kwiatkowski, Chinenye Lynette Ejezie, Shubham Pant

Faculty, Staff and Student Publications

INTRODUCTION: Blocking the colony-stimulating factor 1 (CSF-1) signal on tumor-associated macrophages can lead to an upregulation of checkpoint molecules, such as programmed cell death ligand 1 (PD-L1), thus causing resistance to this blockade. Combining spartalizumab (PDR001), a high-affinity, ligand-blocking, humanized anti-PD-1 immunoglobulin G4 antibody, with lacnotuzumab (MCS110), a high-affinity, humanized monoclonal antibody directed against human CSF-1 can potentially overcome this resistance.

METHODS: This was a multicenter, phase Ib/II trial using a combination of spartalizumab with lacnotuzumab in patients with advanced cancers, including anti-PD-1/PD-L1 treatment-resistant melanoma, and anti-PD-1/PD-L1 treatment-naïve triple-negative breast cancer, pancreatic cancer, and endometrial cancer (ClinicalTrials.gov identifier: NCT02807844). The …

An Examination Of Products That University Of Mississippi Students Consume For Managing Their Stress, Kiersten Rickard

Honors Theses

Students are notoriously one of the most stressed groups in our society. Stress is a complex topic; causes, mitigation methods, and manifestations of stress all vary in an individual. Being that stress is an universal experience, this research capitalizes on the importance of stress and the methods used to mitigate stress. This study looks at, among other ideas, stress on the University of Mississippi campus in regards to demographics and the products (caffeine, sleep aids, over the counter medicines, stress supplements, and CBD) that students use. Results demonstrate that, overall, higher stress levels correlate to higher product usage rates. The …

Factors Affecting The Use Of Food Pantries By California State University Students, Beyza Aktepe

Electronic Theses, Projects, and Dissertations

Food insecurity is one of the major public health issues world-wide including the United States. A significant proportion of students within the California State University (CSU) system, approximately 41.6%, experience food insecurity. The purposes of this study was 1) to determine the factors and barriers that affect the use of campus food pantries by university students on seven CSU campuses, 2) to determine the improvements that can be implemented in the on-campus food pantries, 3) to evaluate the effectiveness of the management of food pantries, and 4) to evaluate the effectiveness and utilization of nutrition education services provided in conjunction …

Impact Of Medicaid Redetermination On Underserved Populations In Region 7 States: A Review, Brianna Parr

Capstone Experience: Master of Public Health

When the COVID-19 Public Health Emergency ended in May of 2023, Medicaid began the process of redetermination across the states and returned to its original eligibility rules. Because of this, the healthcare status of many Americans was affected, resulting in the loss of healthcare coverage for millions of people. Of those who have lost coverage, children make up almost half of the total. This paper assesses the negative effects of Medicaid redetermination on children and other underserved populations in communities across the four states in Region 7 (Nebraska, Iowa, Missouri, and Kansas) and identifies programs that these states can implement …

How To Evacuate When Disaster Strikes: A Literature Review Of Hospital Evacuations, Grant Orr

Capstone Experience: Master of Public Health

Hospitals are an essential component of any community’s infrastructure, and due to the nature of their services they are vulnerable when a disaster strikes. If a disaster is severe enough to warrant a hospital evacuation, both hospital and community leaders must decide how to proceed with the resources at their disposal. Organizations such as the World Health Organization, the United Nations, and the United States Department of Health and Human Services offer general guidance, but specifics as to how a hospital should proceed with an evacuation are left to individual hospital leaders and emergency management teams. This capstone project will …

Evaluation Of Community Healthcare Workers Of Faith-Based Workers In Northern Omaha, Ashley Piwkiewicz

Capstone Experience: Master of Public Health

The University of Nebraska Medical Center (UNMC) developed a training and certificate program for Community Health Workers (CHWs) in faith-based organizations in Northern Omaha. Each recruited trainee developed an experimental program they implemented in their faith-based community. This research study aims to explore and analyze the implementation of these programs in the community, the effects that these programs have on the community, and the extent to which the goals of the CHWs' implemented programs were met.

To achieve this, data was collected through a 41-question survey administered via REDCap to 12 CHW trainees. Descriptive statistics of this data were analyzed …

Identifying Barriers To Healthcare Access And Utilization Experienced By Lgbtq+ Adults With Chronic Diseases Through The Lens Of The Social Ecological Model, Devin Mottier

Capstone Experience: Master of Public Health

The purpose of this literature review is to comprehensively examine and synthesize existing research on present barriers to health access and utilization that contribute to the disparities in chronic disease prevalence within the adult LGBTQ+ population. In the context of this review, the social-ecological model (SEM) was used to describe the nuanced and multifaceted nature of healthcare access and utilization. This literature review was based upon the following question: ‘Using the social-ecological model, what are the barriers to health access and utilization that contribute to high rates of chronic disease in LGBTQ+ adults?’ Outcome measures of interest included the following …

Disabilities And Snap Work Requirements: A Scoping Review, Jacquelyn Platt

Capstone Experience: Master of Public Health

This scoping review aims to assess if the criteria to determine Supplemental Nutrition Assistance Program (SNAP) work requirement exemptions provide equal access to individuals with disabilities (IWDs) using a modified PRISMA analysis framework. IWDs applying for SNAP must meet at least one of three requirements to be exempt from work requirements, but these requirements may be disproportionately burdensome for them. SNAP has a long history of expanding food security throughout the U.S., benefiting millions of families. Almost two-thirds of SNAP participants are children, older adults, or IWDs. Children and older adults are exempt from work requirements and IWDs may be …

Non-Tnfi Biologic And Targeted Synthetic Dmards In Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Comparative, Propensity Score-Matched Study Using National Veterans Affairs Data, Halie E. Frideres

Capstone Experience: Master of Public Health

Background/Objectives: There is a paucity of evidence on the safety and effectiveness of non- TNFi biologic therapies in RA-ILD, this study aimed to compare treatment outcomes in RA-ILD between rituximab, abatacept, IL-6i, and JAKi using the Target Trial Emulation Framework.

Methods: We emulated 3 trials comparing abatacept, IL-6i, and JAKi with rituximab (reference). Patients fulfilling validated RA-ILD algorithms initiating one of these non-TNFi b/tsDMARDs were propensity score (PS)-matched (1:1) using national Veterans Affairs (VA) data from 2006 to 2020. PS models included demographics, comorbidities, general health status indicators, and RA- and ILD-related severity measures. Study outcomes were death and respiratory-related …

Optimizing Malaria Control In Nigeria: A Comprehensive Review Of Llin Effectiveness And Policy Frameworks, Jash Mehta

Capstone Experience: Master of Public Health

This comprehensive literature review examines the effectiveness of Long-Lasting Insecticidal Nets (LLINs) and the policy frameworks governing their use in Nigeria, with the goal of optimizing malaria control strategies in the country. The review explores the scientific underpinnings of LLINs, evaluates their effect on malaria incidence, and examines the operational, sociocultural, and economic aspects that affect their use. It also examines Nigeria's policy environment, assessing the creation, application, and efficacy of policies pertaining to LLIN. The summary of research results from several studies emphasizes the importance of LLINs in preventing malaria and the challenges associated with implementing policies in different …

Examining The Impact Of Racial And Ethnic Disparities In Colorectal Cancer Screening Compliance In The United States And The Potential Of Targeted Interventions., Jessica Ware

Capstone Experience: Master of Public Health

Objectives:

Examine Colorectal cancer (CRC) screening compliance among racial and ethnic groups in the United States (US) based on the US Preventive Services Task Force (USPSTF) recommendations.

Identify targeted interventions to promote screening compliance, early diagnosis, and CRC survivorship.

Methods: This cross-sectional study utilized 165,878 selected participant responses from the 2022 Behavioral Risk Factor Surveillance System. We modeled and investigated CRC screening compliance based on the USPSTF recommendations as inclusion criteria between racial/ethnic groups in the US while adjusting for covariates using a weighted stepwise logistic regression.

Results: With covariates adjustment, Hispanics (POR 1.16 95%CI 1.04-1.29), Asian …

Assessing The Association Between Income And Breast Cancer Screening Practices, Hannah M. Zantow

Capstone Experience: Master of Public Health

Objectives

To determine how breast cancer screening practices differ between high- and low-income women aged 40-74. To determine the effects of sociodemographic factors on the relationship between income and breast cancer screening practices.

Methods

This was a cross sectional study. Survey data was obtained from women aged 40-74 who completed the Behavioral Risk Factor Surveillance Survey (BRFSS). The exposure was income. The outcome was if a woman ever received a mammogram. The final sample size was 171,111 participants. Regression models were used to assess the association between income and screening practices.

Results

There was a significant association between income and …

A Medical Perspective On Policy Prohibiting Gender-Affirming Care For Missouri Minors: A Policy Review, Hayley Lange

Capstone Experience: Master of Public Health

The Save Adolescents from Experimentation (SAFE) Act is a law enacted in August of 2023 that bans gender-affirming medical care for individuals under eighteen years old in Missouri and states any medical provider who gives medical gender-affirming care to a minor will have their professional medical license revoked. The impact of medical professionals withholding proven gender-affirming care is a clear concern for the medical community, advocates, and other care professionals.
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/="/">PURPOSE: The purpose of this policy review is to compare the content of the Missouri Save Adolescents from Experimentation (SAFE) Act with states with similar policies and standard-of-care …

One Year Follow Up Of A Cross-Sectional Study Of Hookworm Infection And Response To Deworming In Beposo, Ghana, Taylor Clarkson

Capstone Experience: Master of Public Health

Hookworms are soil-transmitted helminths that infect over 500 million people worldwide, primarily those in low-income countries. Infection with hookworm can cause anemia, malnutrition, and stunted physical and cognitive development. Deworming campaigns have attempted to combat hookworm infections in endemic areas for decades. However, there is growing variability in the effectiveness of deworming drugs, and post-treatment reinfections are abundant. There are significant gaps in our understanding of critical host-parasite factors that mediate hookworm infection, reinfection, and response to deworming treatment in endemic communities. A five-year prospective study was undertaken to better understand drivers of hookworm infection in rural Ghana and thus …

Evaluating The Association Of Influenza Vaccination On Long-Term Covid-19 Symptoms In U.S. Adults, Ratnakar Pingili

Capstone Experience: Master of Public Health

Objective. To evaluate the association of influenza vaccination in the past 12 months with Long COVID effects and clinical and sociodemographic factors.

Methods. Cross-sectional study with data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS), covering 415,132 non-institutionalized U.S. adults with a confirmed COVID-19 diagnosis and influenza vaccination reported within the last 12 months. Logistic regression was conducted between influenza vaccination (exposure) and Long COVID (outcome), controlling for demographic variables, pre-existing health conditions, and socioeconomic status.

Results. Of 120,603 participants, 21.89% reported Long COVID symptoms and 42.04% had received an influenza vaccine. Findings indicate a statistically significant 13% reduction …

Association Between Depression And Coronary Heart Disease: A Cross-Sectional Study Using Behavioral Risk Factor Surveillance System (Brfss), 2022, Juliana Monono

Capstone Experience: Master of Public Health

Objectives: To examine the association of depression and coronary heart disease in U.S. adults.

Methods: This cross-sectional study uses the Behavioral Risk Factor Surveillance System (BRFSS), 2022 data for non-institutionalized U.S adults aged 18 and older. The exposure variable is depression, the outcome is coronary heart disease (CHD), and covariates are age, race, education, and physical activity. Performed univariate, bivariate, and multivariate analyses to assess the association between depression and CHD.

Results: The analytical sample size consisted of 427,217 individuals. A total of 88,841(20.7%) of the population reported having coronary heart disease, while 338,376(70.3%) reported having no …

Association Between Long Covid-19 And Insurance Status Using The Behavioral Risk Factor Surveillance System (2022), Elizabeth E. Osbourn

Capstone Experience: Master of Public Health

Objective. To determine if insurance status can directly predict self-diagnosed Long COVID and what sociodemographic factors are significantly associated with a self-diagnosis of Long COVID among those who tested positive for COVID-19.

Methods. This cross-sectional study uses data from the 2022 Behavioral Risk Factor Surveillance System to conduct a multivariate logistic regression model analysis. Out of 445,132 participants, 110,402 participants were identified to be used in this study.

Results. After testing positive for COVID-19, 21.7% of individuals were self-diagnosed with Long COVID. After controlling for confounders, insurance status wasn't significant (p-value: 0.8458). However, in crude analysis, individuals with Medicaid (cPOR:1.44; …