Medicine and Health Sciences Commons^™

Exploring Systemic Challenges In The Western North Carolina Dental Safety Net: A Qualitative Analysis, Blaire Mirmow, Bill Milner, Nadia Laniado

Journal of Appalachian Health

Introduction: Despite statewide growth, rural communities in Western North Carolina (WNC) face persistent barriers to oral health care driven by chronic dental workforce shortages and systemic geographic disparities. Within this Appalachian region, the dental safety net serves as a vital yet strained support system, struggling with limited financial resources and a lack of provider participation that leaves many underserved populations without essential oral health services.

Purpose: This study aims to explore the experiences of individuals working within the WNC dental safety net to identify barriers and strategies required to strengthen the delivery of oral health care in high-need rural settings. …

Efficacy Of Phone Call Intervention For Vaccine Participation - A Retrospective Chart Review, Jenna Taha, Paige Schlechter, Autumn Dye

Research Day

Vaccine hesitancy is on the rise in the United States due to multiple factors. Causes of vaccine hesitancy in pediatric patient populations include fear of harmful side effects due to misinformation and social media (Lafnitzegger, A) as well as questioning the necessity of vaccination (Cataldi, J). Previous efforts to increase rates of pediatric vaccination include community efforts such as partnering with faith-based organizations in an attempt to campaign for increased vaccination rates (Crosby, L), as well as acknowledging the need to tackle the pain and fear of needles associated with vaccinations in pediatric populations (Taddio, A).

In the city of …

Mapping Burdens And Inequalities Of Polycystic Ovary Syndrome In Young Females Across 953 Locations 1990–2040 With Deep Learning Forecasts, Yaling Wu, Wenxiang Cai, Mao Chen, Susu Luo, Robert J Norman, Mahnaz Bahri Khomami, Lisa Moran, Heping Zhang, Suhaniya N S Samarasinghe, Salman Rawaf, Davd A Ehrmann, Liming Pan, Kexin Ding, Shuxian Ma, Lili Zheng, Xian Shao, You Zuo, Baozhen Huang, Fei Li, Mingyang Xue, Tongrui Shang, Guangyao Cai, Yuanyuan Chen, Ying Wang, Yutong Lu, Dong Wang, Yuanyuan Wan, Ningning Wu, Ciqing Lin, Wei Pan, Rui Zhang, Tingting Yao, Yiming Xiong, Kai Chen, Jianli Zhao, Shunrong Li, Liling Zhu, Luyuan Tan, Yinduo Zeng, You Zeng, Lukasz Szarpak, Nadia M Hamdy, Claire Chenwen Zhong, Fa Yuan, Yihang Chu, Xiao Jia, Peng Wu, Linjiang Wei, Yanfang Ye, João Conde, Zimeng Wu, Jinjin Zhang, Yamei Tang, Pengpeng Ye, Dongzi Yang, Shixuan Wang, Azeem Majeed, Helena Teede, Wenyi Jin, Queran Lin

Faculty, Staff and Students Publications

Polycystic ovary syndrome (PCOS) is the most common reproductive endocrine disorder impacting the health of young female populations. Using harmonized estimates from 953 locations, we assessed temporal trends, geographic inequalities, and forecasts of PCOS among individuals aged 10-24 years from 1990 to 2040. Between 1990 and 2021, global prevalence and disability burden increased by more than 30%, with the highest burden observed among those aged 20-24 years. Substantial geographic heterogeneity was identified, with particularly high prevalence in Europe and East Asia. While high-income regions carried the greatest absolute burden, low- and middle-income regions showed the fastest growth, accompanied by widening …

Geographic Variation In Adrd Prevalence And Mortality And Their Association With Social Vulnerability Across Us Counties: A Spatial Epidemiological Analysis Using Norc And Cdc Svi Data, Dean Kyne

Sociology Faculty Publications

Introduction: Geographic disparities in Alzheimer’s disease and related dementias (ADRDs) remain insufficiently understood at the national scale, limiting efforts to address inequities in dementia burden across USA communities. This study examined county-level variation in ADRD prevalence and mortality and evaluates the association between social vulnerability and these outcomes.

Methods: This cross-sectional ecological study analyzes 2020 county-level ADRD prevalence and all-cause mortality among Medicare beneficiaries from the NORC Dementia DataHub. The analytic sample included 3,108 USA counties in the contiguous USA and the District of Columbia. ADRD outcomes included (1) prevalence of highly likely ADRD and (2) prevalence of all determinations, …

A Mixed-Methods Research Study: Nc Health Department Directors’ Perspective On Local Impact Of Early Medicaid Expansion, Asma Warrich

MUSC Theses and Dissertations

North Carolina became the 41^st state to expand Medicaid under the Affordable Care Act. The bipartisan expansion addressed longstanding challenges; however, little is known about how Local Health Departments (LHDs) adapted to this policy change, especially in the 24 months following expansion. This study sought to fill that gap by documenting the perspectives of LHD Directors in North Carolina utilizing a ten-question REDCap survey with closed- and open-ended questions. Purposeful sampling targeted all 86 LHD Directors. Data was collected anonymously between November 2025 and January 2026. Descriptive and thematic analyses were conducted. Thirty LHD Directors completed the survey, which …

Co-Designing An Adolescent Perinatal Mental Health Intervention In Kenya And Mozambique: The Inspire Project, Tatiana Salisbury, Fernando Chissale, Margrette Hanselmann, Evaline Langat, Sarah Kinja, Violet Naanyu, Mark Nyalumbe, Mellan Lilumbi, Lucy Nyaga, Marleen Temmerman

Centre of Excellence in Women and Child Health

Background Interventions to support adolescent perinatal mental health are limited and largely developed for delivery in high-income countries. This study aimed to co-design an intervention to improve mental health outcomes among pregnant and post-partum adolescent girls in Mozambique and Kenya.

Methods 159 adolescent girls (aged 15–19 years) and young women (aged 20–24 years) with experience of a pregnancy during adolescence, their partners and family members, service providers and community influencers were recruited in Kilifi County, Kenya and Moatize District, Mozambique. Those who consented took part in individual interviews, focus group discussions, observations, and workshops to identify key priorities for supporting …

Hlt 101 Introduction To Public Health, Elyse Gruttadauria

Open Educational Resources

The syllabus, created by Professor Elyse Gruttadauria as part of the CUNY OER Initiatives for HLT 101 contains a course description, course objectives, course readings divided by week and a link to four OER textbooks.

Global Trends In Bioterrorism And Biosecurity Research Publications (1997–2025): A Scopus Bibliometric Analysis, Festus Mulakoli, Samuel Gesaka, John Mbataru

School of Nursing & Midwifery, East Africa

Introduction: Bioterrorism and biosecurity preparedness are critical pillars of global public health protection and resilience of health systems worldwide. Although this field has grown over the past few decades, there remains limited clarity on how research efforts have evolved and where critical gaps persist, particularly regarding global collaboration and emerging biological threats. To address this, we conducted a bibliometric analysis to map publication trends, influential contributors, and collaboration networks in bioterrorism and biosecurity from 1997 to 2025. This study analyzed global research output, collaboration, and thematic evolution in bioterrorism and biosecurity and identified gaps relevant to preparedness and policy. …

Promoting A Culture Of Academic Integrity In The Context Of Artificial Intelligence: Lessons From One School Of Public Health In The Southeast, Gregory Pavela, Lindsay C. Aycock, Mercy Aula, Angela Sullivan, Matthew Fifolt

Journal of Public Health in the Deep South

No abstract provided.

Predictors Of Employment Attrition In Lebanon During Multifaceted Crises: The Role Of Chronic Diseases – A National Cross-Sectional Study, Myriam Dagher, Ali Abboud, Ghada E. Saad, Rita Itani, Rindala Fayyad, Hala Ghattas Ph.D., Stephen J. Mccall, Jocelyn Dejong, Malak Ghezzawi, Nisreen Salti, Sasha Fahme, Serena Canaan

Faculty Publications

The COVID-19 pandemic and Lebanon’s ongoing economic crisis exacerbated existing workforce and health disparities. This study explored the predictors of employment attrition during Lebanon’s concurrent crises and examined the association between chronic conditions and employment attrition. This cross-sectional study recruited adults aged 19–64 years residing in Lebanon through random digit dialing (January – July 2024). Data collected included socio-demographics, household characteristics, employment history and characteristics, and self-reported chronic conditions. The outcome was loss of paid employment (employment attrition) during the crises. Predictors were identified through a Least Absolute Shrinkage and Selection Operator (LASSO) regression, and model discrimination and calibration were …

Engagement Patterns With #Naturalremedies On Tiktok: Formative Analysis, Apeksha Mewani, Corey H. Basch, Keanu Renne-Glover, Vincent Jones Ii, Cristiana Cordero, Adea Gutiqi

Publications and Research

This research letter provides formative evidence from a cross-sectional analysis of 118 TikTok videos under #NaturalRemedies, identifying content formats and expertise cues associated with higher engagement, while also demonstrating the feasibility of using engagement metrics and thematic coding to analyze health narratives on emerging platforms such as TikTok.

Firearm Violence Prevention: Analysis Of Physical Therapy Political Action Committee Financial Contributions And Congressional Voting, Kim D. Dao, Edward P. Mulligan, Michael Siegel, Liana Wooten

Internet Journal of Allied Health Sciences and Practice

Purpose. The American Physical Therapy Association (APTA) declared firearm violence a public health crisis in 2019. This investigation aimed to understand relationships between the amount of APTA political action committee (PTPAC) donations received by a federal candidate and (1) their voting records on FV prevention legislation; and (2) their voting records on other APTA-supported legislation. Methods. Data pertaining to the identification and amount of PTPAC donations to federal Congressional candidates during the 2020 and 2022 election cycles were gathered from the public resource, Open Secrets. Public voting records were compiled on firearm and other APTA-supported legislation. Results. 222 candidates received …

Incidence Vs. Prevalence, Allen Vean Dmd

Metro Denver Dental Society Articulator Magazine

Despite advances in dental technology, dental caries remain the most common chronic disease in children and adults. This reflection highlights the ongoing challenge of early childhood caries and the critical role of parental supervision, preventive care and collaboration with medical providers.

The Mississippi Violence Injury Prevention Program (Ms-Vip): Building A Community-Driven Model For Healing And Safety, Rukia Lumumba

Journal of Public Health in the Deep South

No abstract provided.

Patterns Of Tobacco Marketing And User Engagement On Social Media In Indonesia: Challenges For Digital Public Health, Resti Yulianti Sutrisno, Nopryan Ekadinata, Sutantri Sutantri, Dinasti Pudang Binoriang, Enrico Aditjondro, Rachfiansyah Rachfiansyah, Yosef Rabindanata, Silvia Dini, Rebecca Perl, Riska Rachmawati, Bertha Tesma Wulandari, Dianita Sugiyo

Kesmas

Large-scale tobacco marketing on social media has resulted in widespread population-level exposure, particularly in Indonesia, which faces growing challenges in digital public health. This study aimed to assess the associations between platform type and marketing tactics and identify correlations of user engagement. An analytical cross-sectional study was conducted using secondary data from the Tobacco Enforcement and Reporting Movement (TERM), collected from January 2022 to August 2023. A total of 21,255 tobacco marketing posts from social media were analyzed. Platform–tactic associations were examined using Chi-square tests, and multivariable Poisson regression was used to identify factors associated with user engagement. The findings …

Investigating The Risk Factors Affecting The Control Of Diabetes And Hypertension In The Refugees Living In Egypt, Noura Seada

Theses and Dissertations

Introduction: Non-Communicable Diseases (NCDs) account for 74% of global deaths, with high prevalence of Diabetes and Hypertension worldwide. Egypt hosts over 1 million registered refugees and asylum seekers, often lacking inclusion in social protection or insurance schemes. This study aimed to assess the factors affecting the control of Type 2 Diabetes (T2D) and Hypertension (HTN) among Syrian and Sudanese refugees in Egypt, focusing on healthcare access, sociodemographic characteristics, lifestyle, and health behaviours.

Methods: This study employed a cross-sectional design using a self-administered questionnaire and BMI measurement. Data were collected from 246 refugees diagnosed with type T2D and/or HTN in the …

Pandemic Mask Mandates And Closures Were Linked To Increased Gun Violence, Douglas A. Wolf, Emily W. Wiemers, Iliya Gutin, Jennifer Karas Montez, Shannon M. Monnat

Population Health Research Brief Series

Gun violence worsened substantially during the COVID-19 pandemic. This brief summarizes findings from a study using weekly gun violence casualty data from 2016-2021 for 304 U.S. counties from the Gun Violence Archive and COVID-19 policy data from county-level measures of activity restrictions and masking requirements. The authors find that policies requiring masking and activity restrictions were associated with significant increases in gun violence. Indoor masking requirements were linked to a 28% increase in gun violence, while activity restrictions were associated with a 4.2% increase.

Reflection Paper: What We Make Together: Art, Adolescence, And Collaborative Research In Action, Natepy Vann

Introduction to Public Health

No abstract provided.

Factors Influencing Sugary Drink Consumption Among Residential Students At Liberty University, Chinonso Felistas Eziechi

Masters Theses

Introduction/Background: Sugary drink consumption among college students remains a public health concern due to its association with obesity, diabetes, and cardiovascular disease. Despite high awareness of health risks, consumption among emerging adults remains elevated. Guided by the Social Cognitive Theory, this study examined the psychosocial, behavioral, and environmental determinants of sugary drink consumption among residential students at Liberty University. Objective: To identify key predictors of sugary drink consumption and evaluate how expectations, self-regulation, and environmental factors shape beverage behaviors. Design, Setting, Participants: This cross-sectional study used an anonymous Qualtrics survey distributed on campus. Of approximately 745 eligible residential students, 473 …

Dynamic Fib-4 Score Changes And Hcc Risk In Patients With Masld And Elevated Liver Enzymes: A Nationwide Cohort Study, Yee Hui Yeo, Hsiu J Ho, Tsai-Wei Huang, Teng-Yu Lee, Ju Dong Yang, George Cholankeril, Chien-Jen Chen, Hawi-I Yang, Chuen-Fei Chen, Hung-Chuen Chang, Chun-Ying Wu

Faculty, Staff and Students Publications

Introduction: Hepatocellular carcinoma (HCC) can develop in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) without cirrhosis, especially in those with elevated liver enzymes. However, there is currently no low-cost, scalable screening tool for this population. To address this need, we investigated the association between serial changes in FIB-4 (fibrosis-4) scores over a 3-year period and the risk of developing HCC in a large, diverse cohort of patients with MASLD without cirrhosis.

Methods: This study utilized a nationwide cohort from the National Health Insurance Research Database (NHIRD), including 810,698 patients with MASLD who had demographic and laboratory data at baseline …

High-Sensitivity Cardiac Troponin I And Frailty: Associations With The Frailty Index And Fried Phenotype In Older Women, Jedd Pratt, Abadi K. Gebre, Carlos J. Toro-Huamanchumo, Elsa Dent, Trent Bozanich, Wai E. Lim, Elizabeth Byrnes, Julee Mcdonagh, Caleb Ferguson, Craig Sale, Kun Zhu, Carl Schultz, Richard L. Prince, Joshua R. Lewis, Marc Sim

Research outputs 2022 to 2026

Despite the nexus between cardiovascular health and frailty, the relevance of high-sensitivity cardiac troponin I (hs-cTnI), a biomarker of myocardial injury, to frailty is poorly understood. We examined whether hs-cTnI concentrations were associated with frailty in a well-characterized cohort of older women. A total of 1151 community-dwelling women from the Perth Longitudinal Study of Aging Women (mean age ± SD = 75.2 ± 2.7 years) were included. Frailty was operationalized using a validated frailty index (FI) of cumulative deficits and a modified Fried phenotype. Plasma hs-cTnI were categorized into quartiles. Cross-sectional associations between hs-cTnI quartiles and frailty were assessed using …

Queens, Pearls And Spirochaetes, Radu Suciu

Artl@s Bulletin

Abstract: In December 2019, the New Zealand AIDS Foundation (now the Burnett Foundation) released a public health campaign raising awareness about the increasing rates of syphilis infections in New Zealand. The campaign consisted of photographs that contrasted contemporary backgrounds of bars and nightclubs with actors wearing theatrical costumes akin to the Elizabethan period. This reinforced the perceived idea that syphilis was a disease resurging from the distant past. This paper discusses one of the campaign’s most iconic portraits by analysing its shared cultural, artistic, and medical references (explicit or implicit) and their shifting meanings through time.

Résumé: En décembre 2019, …

Covid-19 Infection And Hypertension In Correlation With Race, Elizabeth Durkin

The Pegasus Review: UCF Undergraduate Research Journal

Healthcare disparities exist in the U.S. between different races. This study investigated the frequency of COVID-19 infections and hypertension cases among five different racial groups (White, Black, Asian, Native American, and Native Hawaiian). The study also examined the correlation between COVID-19 infections and hypertension with the hypothesis that because of disease predisposition and socioeconomic barriers, Black populations would have the highest rates of COVID-19 infections and hypertension. We used data from the Kaiser Family Foundation regarding COVID-19 cases and race in conjunction with Census population data to determine whether COVID-19 case frequency means differed by race. Data on hypertension and …

The Prediction Of All-Cause Mortality In End-Stage Kidney Disease Patients Using Social Determinants Of Health: A Machine Learning Framework, Addy Smith, Maxwell Donelan, Hossein Moradi Rekabdarkolaee, Patti Brooks, Brandon Varilek, Surachat Ngorsuraches, Jerry Schrier, Adam Dell, Semhar Michael

Journal Articles: College of Nursing

End-stage kidney disease (ESKD) is the irreversible final stage of chronic kidney disease in which the kidneys lose their independent function. This study presents a machine learning framework to predict all-cause mortality in ESKD patients by the end of a follow-up period. We combined patient-specific clinical factors with social determinants of health (SDOH) to assess their influence on survival outcomes. Data were obtained from the United States Renal Data System, including patients admitted in 2015 and followed through August 2021. Community-level SDOH data were integrated from the Agency for Healthcare Research and Quality, with variable screening techniques and expert input …

From Vision To Impact: Strategic Planning For The South Health District, Jason D. Butler Jr

College of Graduate Studies: Theses & Dissertations

This study presents a community health assessment and strategic planning process for the South Health District (SHD), a rural, multi-county public health district.  Using a mixed-methods approach, quantitative surveys and qualitative data from County Nurse Managers, County Boards of Health, and internal staff were integrated with secondary sources to identify community health priorities and organizational gaps.  Broad stakeholder engagement through surveys, SWOT workshops, and town-hall meetings ensured credibility and contextual relevance.

Findings revealed challenges in behavioral health, substance abuse, chronic disease, access to preventive services, transportation, workforce capacity, communication, and infrastructure.  Four strategic issues—Communication, Workforce Development and Retention, Purpose-Driven District, …

Rapid Response To Recovery: Expand Integrated, Technology-Enabled Crisis Care, Madison Chandler

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

Behavioral health challenges in rural communities continue to place significant strain on healthcare systems, particularly through repeated reliance on emergency departments for crisis care. Nelson County, Kentucky, reflects this pattern, with higher reported rates of poor mental health and limited access to behavioral health providers. This paper proposes the Beacon Behavioral Health Response Program, a community-based, multidisciplinary crisis intervention model designed to improve access to timely care and strengthen continuity of support. The program combines mobile crisis response—delivered by a licensed clinical social worker and a peer support specialist—with a technology-enabled component using the Luma AI-supported mental health platform. Together, …

Understanding Risk And Protective Factors Of Intimate Partner Violence: A Public Health And Social Advocacy Approach, Mangai Natarajan, Yasemin Irvin-Erickson, Brittany Suh, Susan Nembhard, Lindsay Smith, Yi-Fang Lu

Sociology & Criminal Justice Faculty Publications

Intimate partner violence (IPV) is a recurring social problem that has individual, interpersonal, community, and societal level consequences necessitating interdisciplinary knowledge and a holistic, systemic approach for prevention. Recent research on IPV indicates the need to identify the implications of the COVID-19 pandemic for IPV risk and subsequent consequences to inform mitigation solutions. Using a mixed-methods design, this rapid assessment research aims to address an existing gap by gathering primary data on the perceived risk and protective factors in addressing IPV through interviews, focus group discussions (n = 102), and surveys (n = 324) from a purposive sample of victim …

Perceptions Of Illicit Drug Use And Perceived Drug Misuse Risks Among Individuals With Military Experience, Emilia Havlicek

Honors Undergraduate Theses

This study investigates perceptions of illicit drug use and perceived drug misuse risks among individuals with military experience in the United States, highlighting how military service shapes attitudes toward substance misuse. Using data from the National Survey on Drug Use and Health (NSDUH), this research examines the influence of military status, combat exposure, PTSD, gender, and sociodemographic factors on perceptions of drug-related risk. Findings indicate that while most individuals perceive illicit drug use as highly risky, important differences exist among subpopulations, particularly female veterans, who are more likely to perceive lower levels of risk. The study explores how military culture, …

Sewers To Solutions: A Guide To Wastewater Pathogen Monitoring, Justin R Clark, Anthony W Maresso

Faculty, Staff and Students Publications

Wastewater-based epidemiology (WBE) is the analysis of wastewater to detect pathogen levels or activity for public health awareness or action. Pioneered in the 1940s, WBE underwent a resurgence during the COVID-19 pandemic, providing important information about number of cases, outbreaks, and seasonal impact. With advancements in detection technologies and growing interest in environmental surveillance, WBE is poised to become a standard practice in public health monitoring. Here, we provide an overview of the current state of the art of pathogen WBE, including methods of molecular detection, analysis of wastewater data, real-world applications and programs, public health interventions, and benefits and …

A Cross-Sectional Study Investigating The Relationship Between The Fto Gene Polymorphism In Relation To Obesity Traits And Vitamin D Status In Adolescence, Ahmad Al-Serri, Rabeah A. Al-Temaimi, Abdullah Al-Taiar, Lemia Shaban, Reem Al-Sabah, Abdur Rahman, Ali H. Ziyab

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Background and Objective: Obesity affects 18%-25% of adolescents globally and represents a major public health challenge. Genetic factors contribute to obesity susceptibility, with the FTO gene variant rs9939609 consistently associated with obesity in adults; however, evidence in adolescents is limited. This study examined the association between FTO and obesity traits in adolescents and explored potential interactions with vitamin D status.

Methods: In this cross-sectional study, 509 adolescents aged 10-15 years were genotyped for FTO rs9939609. Obesity traits, including BMI, BMI z-score, and waist circumference, were assessed. Associations with genotype were analyzed using an additive genetic model, and potential interactions with …