Medicine and Health Sciences Commons^™

From Coverage To Care: Evaluating The Effects Of Aca Medicaid Expansion On Birth Outcomes, Bailey R. Lengfelder

Economics Honors Projects

I examine the impact of the Affordable Care Act’s Medicaid expansion on maternal and fetal health outcomes using National Center for Health Statistics Natality data from 2006 to 2023. I exploit staggered state adoption as a quasi-experiment, and the staggered differences-in-differences estimates indicate an increase in the share of Medicaid births but broadly no impact on maternal prenatal care, maternal health, and fetal health. The absence of statistically significant effects is consistent across heterogeneity groups. These null findings indicate that expanded insurance access through the Affordable Care Act may be insufficient to improve health outcomes. I do find a statistically …

Spectral Frequency And Broadband Noise Analysis Of The Firefighter Environment: Potential Implications For Cardiac Health, James Blando, Catherine Reed, Amya Turner

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Firefighters are well known to have elevated risk of adverse health outcomes across a wide range of diseases and injuries, including cancer, hearing loss, fatal cardiac events, post-traumatic stress disorder (PTSD), sleep disorders, and many other adverse outcomes. It has been speculated that the noise environment is a significant risk factor for several of these diseases. In particular, the impact of noise on cardiac outcomes has recently been identified. An environmental survey of noise that included spectral and broadband analysis was conducted across all 14 firehouses in a southeastern city in the United States as a first step to investigate …

First-Job Contract Review Cheat Sheet, Johanna Jones-Morris, Ashlee Martellacci

Teaching and Learning Resources

This cheat sheet helps first-time employees understand what to review before signing an employment contract. It highlights job duties, compensation, scheduling, employment terms, benefits, restrictive clauses, worker classification, and common red flags so that individuals can ask informed questions and recognize potentially unfair or unclear terms.

Exploring Relational Leadership And Psychological Safety During Ai Integration In The Workplace, Solmaz Kaynama

Antioch University Dissertations & Theses

This study explores employee psychological safety, or its lack, during artificial intelligence (AI) integration in the workplace through a relational leadership lens. The population included employees of for-profit business corporations currently integrating or adopting AI technologies (N = 14). Participants completed in-depth, semi-structured interviews. Results showed eight themes: relational leadership creates a psychologically safe workplace climate; unsupportive and dysfunctional leadership erodes trust and psychological safety; psychological safety determines whether employees speak up openly or hold back; employees’ experience daily work through workplace culture, pace, and remote or hybrid conditions; AI may delivers immediate productivity benefits while introducing new psychological and …

Beyond The Diagnosis: A Qualitative Exploration Of Men Living With Hiv, David R. Romanelli

Antioch University Dissertations & Theses

This qualitative study explored the lived experiences of men (18+ years old) living with HIV to better understand how they navigate identity, mental health, relationships, and healthcare systems after diagnosis. The method included a qualitative thematic analysis with 10 participants. Eight themes emerged from the data: (1) reactions, reflections, and meaning-making after diagnosis; (2) managing medication, treatment, and co-occurring conditions; (3) stigma, disclosure, and negotiation of identity; (4) substance use, housing instability, and socioeconomic stressors; (5) navigating the changing HIV landscape; (6) experiences with family and intimate relationships; (7) implications for mental health counseling; and (8) the role of community …

How To Reduce Inpatient Violence: A Theory Synthesis From Four Models, Arthur Walker

Antioch University Dissertations & Theses

Working in an inpatient setting inherently involves an increased risk of violence. This violence can affect both staff and patients alike and can lead to psychological trauma, serious bodily injury, and even death. To mitigate this risk, many models for preventing inpatient violence have been proposed for hospitals to implement. However, the evidence for the efficacy of these methods is inconsistent, and the theoretical underpinnings are varied and slim. This dissertation seeks to improve these models by re-examining the theoretical structures for common themes of four models for inpatient violence reduction and proposing additional recommendations informed by this synthesis. First, …

Navigating Mental Wellness: A Peer-Led Journey Into Adult Services, Kristin G. Haberek

DSW Capstone Projects

Students with severe emotional disturbances (SED) occupy one of the most underserved intersections in American education and mental health care. As they age out of children’s services, they face abrupt service discontinuation, disrupted therapeutic relationships, and adult systems ill-equipped to meet their needs. These vulnerabilities, including heightened risks of crisis, hospitalization, homelessness, and justice involvement, constitute a central practice problem. This capstone addresses these transitions across three scholarly products: a systematic literature review, a theoretical concept paper, and a practical application paper, tracing a unified arc from diagnosing structural failures to proposing an evidence-informed, equity-oriented clinical response. Synthesizing key findings …

Association Between Neighborhood Social Determinants Of Health And Stillbirth, Tetsuya Kawakita, Misa Hayasaka, Ann M. Harper, John Brush, George Saade

Department of Obstetrics & Gynecology Faculty Publications

OBJECTIVE:

To examine the association between neighborhood-level social determinants of health and stillbirth.

METHODS:

We performed a retrospective cohort study of deliveries that occurred at a gestational age of at least 20 weeks within a five-hospital system (2012-2022). Electronic health record data mapped to the Observational Medical Outcomes Partnership Common Data Model were geocoded using addresses at the time of delivery and linked to neighborhood health indices, which included the Area Deprivation Index (ADI), Maternal Vulnerability Index (MVI), and Social Vulnerability Index (SVI) at the Census tract level. Stillbirths were adjudicated by medical record review. Modified Poisson regression generated relative …

Mediating Effect Of Social Determinants Of Health Between Race And Phthalate Biomarkers In Pregnancy, Tetsuya Kawakita, Misa Hayasaka, Carole Barake, Trinity Soto, Jillian Fleming, Amir Lueth, Stevens Danielle, Alfred Abuhamad, Ann Pryzybylska, Elena Sinkovskaya, Kelly K. Ferguson, George Saade

Department of Obstetrics & Gynecology Faculty Publications

Introduction

Prenatal phthalate exposure is linked to adverse reproductive and developmental outcomes and is consistently higher among non‐Hispanic Black compared to non‐Hispanic White pregnant individuals, yet the factors responsible for these disparities are poorly characterized. We sought to quantify Black–White differences in repeated urinary concentrations of phthalate biomarkers during pregnancy and to estimate the extent to which neighborhood‐level social determinants of health (SDoH) mediate these disparities.

Methods

This secondary analysis used data from the Human Placenta Project Study, a prospective observational cohort study conducted at two academic institutions between 2016 and 2018. Eligible participants had singleton pregnancies, were recruited before …

Differential Impact Of Admission Type And Clinical Complexity On Diabetes Hospitalization Costs Among African American And Hispanic Patients In Southeastern Virginia, Ismail El Moudden, Asra Amidi, Reem Sharaf-Alddin, Michael C. Bittner, Qi Zhang

Department of Obstetrics & Gynecology Faculty Publications

Background

Diabetes mellitus (DM) imposes substantial healthcare costs with documented disparities among African Americans and Hispanic patients. To inform care delivery and resource allocation, this study identified hospitalization cost predictors among African American and Hispanic patients with diabetes in Southeastern Virginia.

Methods

We analyzed 6,011 hospital discharges from the Virginia Health Information database (2016-2020) for adults aged 18-85 with diabetes. Discharges were classified by Medicare Severity Diagnosis-Related Groups: DM with complications/comorbidities (DCC, n = 3,328), DM with major complications/comorbidities (DMCC, n = 1,518), and DM without major complications/comorbidities (DWO, n = 1,165). Because cost distributions were right-skewed (skewness 3.5-8.24), we …

The Limits Of Daca: Affordability- And Access-Related Barriers To Health Professions Education, Nicole Perez, Laura Hirshfield

Journal of College Access

The U.S. is currently facing a shortage of health professionals from underrepresented backgrounds. One potential pathway to decrease this shortage is through the Deferred Action for Childhood Arrivals (DACA) program, a policy that provides temporary relief from deportation for individuals who migrated to the U.S. before age 16. This study, using 15 life-history narrative interviews, investigates the experiences of Latinx young adults who were pursuing health professions education or working as health professionals. Nine of the participants were DACA recipients, while the remaining six were second-generation (i.e., children of immigrants). An iterative, inductive approach to data analysis was used to …

Understanding The Progression Of Borderline Personality Disorder During Adolescence: A Clinical Case Study, Anjali Chandak, Megha Sadashiv, Bhawna Sharma, Bhargav Mulpuru

Digital Journal of Clinical Medicine

Borderline Personality Disorder (BPD) often emerges during adolescence, but remains relatively understudied in this population. This case report explores the sociobiological factors shaping symptom expression in an adolescent girl. Longitudinal clinical evaluation revealed hallmark features, including affective instability, identity disturbance, interpersonal relations, and self-harming behaviour. Early attachment disruptions, emotional regulation difficulties, and heightened sensitivity to relational stressors were identified as key developmental risk factors. Diagnostic and therapeutic considerations are presented, highlighting the need for prompt, developmentally informed, and evidence-based interventions. The case further emphasises how prognosis and chronicity may be significantly influenced by an adopting developmental approach, providing insight into …

State Social Benefit Schemes For Women In Continuity Of Psychiatric Care: A Case Report, Mathumitha A, Kishor M. Manohar Rao Professor

Digital Journal of Clinical Medicine

Mental health disorders are a major global public health challenge. The disorders affect over a billion people worldwide, while depressive and bipolar spectrum disorders also contribute substantially to disability and reduced quality of life. According to the World Health Organization, major depression alone affects more than 300 million people globally and is considered a leading cause of years lived with disability. Beyond clinical morbidity, mental illnesses exert a profound economic impact, with depression and anxiety accounting for an estimated USD 1 trillion annually in lost productivity worldwide, while the overall global economic burden of mental disorders is projected to reach …

Comorbid Psychosis In The General Population, Mariam Sankoh

Theses and Dissertations

Psychosis is a complex psychiatric phenotype characterized by substantial heterogeneity in symptom presentation, psychosis diagnosis, comorbidity patterns, and genetic architecture across diverse populations in the general population. Despite advances in psychiatric epidemiology and genomics, important gaps remain in understanding how psychosis symptoms and psychosis-related diagnoses manifest across racial and ethnic groups and how evolutionary genomic factors may contribute to disease risk and cross-ancestry genetic prediction. This dissertation, Characterizing Comorbidity in Psychosis in the General Population, integrates epidemiological, psychometric, and evolutionary genetic approaches to examine psychosis across diverse populations.

Aim 1 examined racial and ethnic differences in psychosis comorbidity patterns …

24-H Circadian Rest-Activity Rhythms And Physical Frailty In Older Adults: A Biopsychosocial Perspective On Sex Differences And Social Capital, Jisu Kim

Theses and Dissertations

Physical frailty is a prevalent geriatric syndrome characterized by age-related decline across multiple physiological systems. Physical frailty is associated with an elevated risk of adverse health outcomes, including chronic disease progression and all-cause mortality, representing a significant and growing public health concern. Disrupted circadian rest-activity rhythms (RARs) are increasingly recognized as clinically meaningful markers of physical frailty in older adults. However, the extent to which biological sex and social determinants of health (SDoH), particularly social capital, contribute to or modify the associations between RARs and physical frailty remains underexplored.

Therefore, this dissertation summarizes the existing literature on age-related changes in …

What’S Sleep Got To Do With It? A Mixed Methods Exploration Of The Feasibility, Acceptability, And Initial Outcomes Of Group Cbt For Insomnia In Parkinson’S Disease, Claire M. Williams

Theses and Dissertations

Parkinson’s disease is a progressive neurodegenerative disease that is commonly associated with sleep disturbances, affecting up to 80 percent of individuals with Parkinson’s. Effective and accessible treatments for sleep problems in Parkinson’s disease remain limited. Cognitive Behavioral Therapy for Insomnia (CBTi) is a well-established, non-pharmacological treatment for insomnia but has been minimally studied in Parkinson’s populations. This study evaluated the feasibility, acceptability, and preliminary outcomes of a group-based CBTi intervention adapted for individuals with Parkinson’s disease. Participants engaged in a six-week group intervention that incorporated Parkinson’s-specific adaptations. Preliminary findings indicated that the adapted group CBTi intervention was generally feasible and …

Survivors Of Historical Intergenerational And Familial Trauma Scale For Black American Descendants Of Enslaved People: A Development And Initial Validation Study, Loryn Chás Kimbrough

Graduate Research Theses & Dissertations

Despite extensive research documenting cultural and racialized trauma, no validated assessment tool had previously captured the intrafamilial mechanisms of trauma transmission specific to the BADEP population, whose trauma lineage is rooted in slavery. The present study addresses this gap through the development and initial validation of the Survivors of Historical Intergenerational and Familial Trauma Scale (SHIFTS), a culturally grounded instrument designed to measure the transmission of historical trauma (HT) and ongoing intergenerational trauma (IGT) among Black American Descendants of Enslaved People (BADEPs). The SHIFTS examines how HT gives rise to the continued transmission of two interrelated legacies: survival-based and trauma-rooted …

Assessing Sustainable E-Cigarette Prevention Messaging In Public Health Communication, Addo Anim Adinkrah

Graduate Research Theses & Dissertations

This study examines the sustainability of e-cigarette or vaping prevention messaging on X (formerly Twitter) and the message-design strategies used by public health institutions to maintain message visibility over time. Using the McGuire Communication/Persuasion Model and Media Framing theoretical frameworks, the research employs a qualitative thematic analysis based on Braun and Clarke’s six-phase approach to analyze 506 tweets from official accounts affiliated with the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA). The findings reveal that prevention messages are sustained through repeated core warnings and reinforcement of institutional authority rooted in scientific and …

Incorporating New Guidelines Into School-Based Asthma Management, Jessica Michala Jindra, Angela Duff Hogan

Department of Pediatrics Faculty Publications

Purpose of the Review

The aim of this review is to identify barriers and provide solutions to the implementation of inhaled corticosteroid-formoterol as rescue therapy within schools.

Recent findings

GINA guidelines in 2019 and NAEPP in 2020 recommended inhaled corticosteroids combined with formoterol for a rescue inhaler over the traditional short-acting beta-agonist.

Summary

The findings discussed in this article describe the barriers to the implementation of inhaled corticosteroids combined with formoterol for a rescue inhaler in school systems. Traditional asthma action plans, school nursing and parental education, and differences in dosing are some barriers identified. This paper provides solutions for …

The Impact Of Medicaid Policy Limitations On Access To Eating Disorder Treatment: Uncovering The Consequences Of A System Built To Fail, Meghan Frost

DSW Capstone Projects

Individuals who rely on Medicaid face major barriers when trying to access eating disorder (ED) treatment, reflecting broader patterns of structural disadvantage in publicly funded health care. Research shows delayed diagnosis, limited access to ED specialists, and frequent denials for recommended services. These gaps occur because Medicaid policies do not match the needs of evidence based ED care, resulting in delayed or incomplete care for many individuals with eating disorders.

This issue is highly relevant to social work practice because the policies shaping these barriers are complex and difficult for clients and ED providers to navigate. Social workers across clinics, …

How To Create Accessible Osce Exams For Learners With Disabilities, Lisa M. Meeks, Jordan Juliao, Emily Langham, Anne Lewis, Judith Brenner

University Administration Publications

[Introduction] Objective structured clinical examinations (OSCEs) are widely used across health professions education to assess learners' clinical skills through structured encounters with standardised patients [1]. OSCEs also present a known barrier to disability access for medical students with disabilities [2-6], a rapidly growing population. Using trained actors, also known as standardised patients who portray the same clinical scenario for all learners, these examinations allow for assessment of medical knowledge, clinical reasoning, communication skills and elements of the physical examination in a controlled and standardised setting [1]. They may be used for formative feedback, summative assessment or progression decisions, and they …

Seeing Public Health In Color: Phenomenological Perspectives Of Bipoc Women In Leadership, Jasmyn Spicer

All Graduate Theses, Dissertations, and Other Capstone Projects

Public health is a complex, ever-changing industry that holds pivotal capacity to impact society on a larger scale. For the United States, disparities and inequity in public health have had significant consequences for Black, Indigenous, and People of Color (BIPOC) communities. Effective leadership in public health has the potential to impact roles, policy development, and the overall scope of oversight regarding the quality of care that communities are provided in the industry. While BIPOC women are underrepresented in public health leadership roles, they have the capacity to advance equity in the field and contribute to culturally responsive care in foundational …

Understanding Motivations And Health Outcomes Of College-Aged Triathletes During Covid-19: A Mixed-Methods Study, Patrick Wilson, Eddie Hill, Justin Haegele, Xihe Zhu

Human Movement Studies & Special Education Faculty Publications

A triathlon is a multi-sport event that consists of three simultaneous events: swimming, biking, and running. This sport has experienced significant growth in the past few decades, with colleges and universities now participating. This exploratory mixed-methods study examined the motivations and perceived health benefits of college triathletes during the COVID-19 pandemic, using the Means-Ends of Recreation Scale and the Perceived Health Outcomes of Recreation Scale (N = 29), as well as semi-structured interviews (N = 4). Results indicate no difference in motives or health outcomes between male and female survey respondents. The thematic analysis of open-ended interview questions highlighted lived …

Health Literacy/Numeracy-Related Factors Affecting Interpretation In Medical Laboratory Values, Rachel L. Childs

School of Medical Diagnostics & Translational Sciences Publications

Background

Health literacy and numeracy are broad terms that relate to a patient’s understanding of their health information. While there is a substantial amount of research on this topic in a general sense as well as in relation to how deficiencies in these skills impact patients’ understanding of laboratory results, little is known regarding the extent to which underlying factors, which are impacted by health literacy/numeracy, affect how patients interpret their results. This literature review attempts to shed light on the current literature on this more focused and narrow issue, including recommendations to address these barriers.

Content

To perform this …

Maintaining Trust In Uncertain Times: Funding Pauses And The Ethical Cost To Community-Engaged Research, Brynn E. Sheehan

Department Psychiatry & Behavioral Science Faculty Publications

Federal funding pauses, once considered rare, are increasingly disrupting the stability and continuity of community‐engaged research. Even projects with active, awarded grants are experiencing the strain of funding uncertainty, raising substantive concerns among research teams and community partners. These disruptions extend beyond operational delays; they jeopardize the continuity of relationships developed through sustained, collaborative engagement. In the absence of clear information about a project's future, uncertainty undermines trust and challenges the ethical principles that guide human subjects research, particularly beneficence and justice. This paper draws on direct experience and insights from the broader field to examine the practical and ethical …

Improving Pediatric Emergency Department Lethal Means Safety Documentation Rates For Adolescents With Mental Health Concerns, Cassandra L. Stegall, Ana-Maria Mcgill, John Fanton, Paul C. Mullan

Department Psychiatry & Behavioral Science Faculty Publications

Introduction:

Lethal means safety counseling (LMSC) is recommended for children presenting to the emergency department (ED) for a mental health (MH) evaluation. Currently, no gold-standard guidelines exist for documenting LMSC in the ED.

Methods:

This quality improvement project was conducted in the ED of a tertiary children's hospital. Baseline data were analyzed for access to any LMSC documentation (ALD) for "firearms/guns," "sharps," or "medication," and for complete LMSC documentation (CLD) if access to all 3 types was documented. The first intervention period added open-ended screening questions about access to lethal means to the MH-licensed clinical social worker note template. Intervention …

Cross-Domain Identity Development In Bipoc Autistic Adults: A Grounded Theory Study, Ginnylyne Mariano Guisadio

Antioch University Dissertations & Theses

Racial and autistic identity development both involve navigating stigma, seeking community, and contending with dominant frameworks that constrain authentic self-expression, yet existing research has not examined how these processes interact for individuals holding both identities. These interactions unfold within structural conditions such as diagnostic disparities, culturally specific ableism, and racialized consequences of visible autistic expression, which shape how identity development proceeds for BIPOC autistic adults. This study investigated whether and how the core identity processes of exploration and commitment proceeded for this population. Nine BIPOC autistic adults participated in written interviews analyzed through constructivist grounded theory, with identity status theory …

Le Parcours Des Travailleurs Immigrants Blessés Et Son Incidence Sur L’Alliance Thérapeutique : Une Étude De Cas Longitudinale En Contexte De Réadaptation Au Travail Au Québec, Maude Arsenault, Jessica Dubé, Daniel Côté

Études primaires

Cette étude explore l’incidence du parcours prélésionnel des travailleuses et travailleurs immigrants (TI) blessés sur l’alliance thérapeutique (AT) en réadaptation au travail. À partir d’une ethnographie longitudinale menée dans une clinique québécoise, sept trajectoires ont été analysées selon leurs dimensions migratoires, socioprofessionnelles et linguistiques. Les résultats montrent que le déclassement professionnel, la précarité de l’emploi, les barrières linguistiques et les expériences de racisme fragilisent la construction du lien de confiance et la définition partagée des objectifs de retour au travail. Lorsque l’emploi prélésionnel est perçu comme transitoire ou inadéquat, l’obligation institutionnelle d’y retourner crée une rupture symbolique qui entre en …

A Scoping Review To Conceptualize Social Privilege For Studying Patients' Health Outcomes And Health Disparities, Elizabeth A. Brown, Priyanka Patel, Esther May B. Sarino, Vladimir Markovic, Carles Muntaner

Health Behavior, Policy & Management Faculty Publications

Background

The continued reliance on single-category self-reported demographic data (e.g., race/ethnicity) reflects conceptual limitations that hinder the study and understanding of health outcomes research. There is a pressing need for more precise measures of social privilege that conceptualize privilege and oppression while enabling the examination of their effects on health outcomes in the United States (US) healthcare system.

Objective

The purpose of this scoping review was to review the literature, determine how researchers have measured aspects of privilege and oppression, and develop a conceptual framework to study patients' social privilege in the US healthcare system and public health research.

Methods …

Startle Habituation And Vagally Mediated Heart Rate Variability Influence The Use Of Emotion Regulation Strategies, Xiao Yang, Fang Fang, Angela Ximena Babb

Psychology Faculty Publications

Emotion regulation refers to the processes through which people modulate their emotional experiences and expressions, and difficulties in these processes underpin many forms of psychopathology. According to the process model, emotion regulation encompasses five classes of strategies, commonly grouped into antecedent-focused strategies (e.g., cognitive reappraisal) and response-focused strategies (e.g., expressive suppression). These strategies involve both explicit and implicit processes, which can be objectively assessed using physiological indices. The present study examined the effects of startle habituation and vagally mediated heart rate variability (vmHRV) on the use of cognitive appraisal and suppression. Forty-nine college-aged participants were recruited, and their resting heart …