Population Health Commons^™

Bpa: Effects Of The "Plastic Era", Bianca G. Pietrangeli

Student Work

Infographic review of sources of BPA and its impacts on human health with a focus on osteoporosis.

Feeding Missoula: Food Insecurity In Rural Children And Youth, Chani Brammer, Braelee Cheeks, Jordin Holland, Rayne Mccollough, Laurel Palmer, Therese Solomon

Undergraduate Theses, Professional Papers, and Capstone Artifacts

In Montana, approximately one in seven children live in a food-insecure household, with rural Montanans in particular facing significant barriers. Existing needs-based food assistance programs, such as SNAP and WIC, have structural weaknesses: SNAP benefits are often not sufficient to last through the month, and those eligible for these programs face a confusing application process, shame and stigma, and logistical hurdles, such as limited transportation.

“Feeding Missoula” began with an evaluation of how current food assistance programs met or failed to meet the needs of rural youth. Our methodology integrated a comprehensive review of existing literature and structured interviews with …

Investigating The Relationship Between Drug Overdose Deaths, Excessive Alcohol Drinking, And Adult Smoking In Urban And Rural Ohio Counties In 2025, Sumin Byoun, Anne Griffin

Scholarship in Medicine - All Papers

Deaths from drug overdoses have been increasing each year. Ohio ranks among states with the highest number of drug overdose deaths per year. There is a gap in the literature regarding discussions of how excessive alcohol drinking and cigarette smoking rates may predict drug overdose death rates in a community. First, this study investigates differences in excessive drinking, adult smoking, and drug overdose deaths between urban and rural counties in Ohio. Second, this study explores whether excessive drinking and smoking behaviors can predict drug overdose death rates in urban and rural Ohio counties. Data exclusive to Ohio counties was obtained …

Understanding The Impacts Of Food Insecurity On Education Outcomes In Ohio, Maria El Biri, Sreya Tummalapalli

Scholarship in Medicine - All Papers

Background: Food insecurity has been a growing concern in the United States, and prior research has shown how food insecurity in youth can correspond to negative psychosocial outcomes. Additionally, there are known disparities with access to food based on living in rural or urban counties. Objective: The goal of this study was to determine how differences in food security can impact youth educational outcomes in Ohio. Methods: Data from County Health Rankings & Roadmaps were obtained on variables such as access to healthy foods, food insecurity, high school graduation rates, average grade performance, and percentage of the population living in …

Infant Mortality In Ohio, Isabella Bacon, Alexis Jackson

Scholarship in Medicine - All Papers

Introduction: Infant mortality continues to occur at alarming rates that differ among various groups and states. Despite this, there has been a lack of intersectional examination of risk- and protective-factors. Methods: We examine how smoking status, education level, primary care to population ratio, teen birth rates, and urban vs rural status impact infant mortality rates in Ohio, Kentucky, Michigan, and Indiana using County Health Rankings data. Results: Ohio was shown to have no significant difference between urban and rural infant mortality rates; however,  risk-and-protective factors did differ. In urban counties, high school completion, teen birth rates, and primary care ratios …

Primary Care Access And Preventable Hospitalizations: A Multi-Variable Analysis Of Medicare Populations In California (2022–2025), Mariam Shenouda, Suchetha Shashi

Scholarship in Medicine - All Papers

Background: Based on prior literature, limited access to primary care has been linked to higher preventable hospitalization rate. Particularly, rural communities often face physician shortages, contributing to disparities in health outcomes. Objective: To understand the relationship between primary care access and preventable hospitalization rates among medicare populations in California. Methods: The data was gathered from County Health Rankings & Roadmaps for 56 California counties, excluding Sierra and Alpine. This study used unpaired t-tests to determine the difference in the PCP ratio and preventable hospitalization rate between rural and urban counties in California in 2025. A paired t-test was performed to …

Factors Affecting Percentage Of Low Birth Weight In Ohio, Maureen Schmid, Mira Krishnan

Scholarship in Medicine - All Papers

A multitude of environmental factors correlate to negative outcomes on maternal and fetal health such as low birth weight. While studies reveal that housing quality, air pollution, and stress contribute to negative birth outcomes, it is unclear which housing factors have the greatest impact and how rural, suburban, and urban settings in the U.S. differ. The objective of this study was to delve into how environmental factors such as housing quality and community type impact low birth weight in Ohio. This study used publicly available data from County Health Rankings and Roadmaps to examine how different housing conditions correlate to …

Exploring Demographic Factors Relating To Low Birth Weight In Rural Vs Urban Ohio, Meghan Curran, Jessica Terrell

Scholarship in Medicine - All Papers

Although medical advancements have improved the outcomes for infants born with low birth weight (LBW), these interventions are very expensive and low birth weight still was attributed to 16.1% of infant deaths in the United States in 20201. By understanding the factors that influence the incidence of low birth weight in the United States, preventative measures can be implemented to reduce the need for costly interventions and enhance infant health outcomes. In this study, we focused on 38 counties in Ohio that had either 75% or greater rural regions or 30% or less rural regions. Additionally, we focused on four …

What Is The Evolving Role Of Nurses In Telehealth As Future Healthcare Professionals?, Emma G. Lowry

Honors College Theses

Telehealth has evolved into an essential component of healthcare delivery in today's world, something that occurred alongside the COVID-19 pandemic. As healthcare professionals, nurses must be adequately prepared and equipped to use the tools for telehealth. This paper examines the evolving role of nurses in telehealth by assessing undergraduate nursing students’ and practicing nurses’ knowledge, attitudes, and perceived competencies. Data will be collected through a Qualtrics survey utilizing the Awareness, Knowledge, Attitude, and Skills (AKAS) Scale for Telemedicine, supplemented by interviews with telehealth practitioners to provide qualitative context. It is expected that variations in proficiency and attitudes, from previous biased …

Bringing Awareness And Education To Rural Areas About The Role Occupational Therapy (Ot) Has In Infant Care, Makenzi Richwald

Occupational Therapy Doctorate Capstone Posters

This capstone project focused on education and advocacy. The aim of my capstone project was to provide education to parents of eastern Kentucky (KY) about what Occupational Therapy (OT) can address with infants aged 0-18 months. I saw a gap in knowledge in the eastern KY community about what OT could do for infants and wanted to address this. Through my research, consultation with my mentors, and collaboration with the occupational therapists at my site (BPT) I discerned 14 areas of development and/or common reasons of needed referral for OT services by this age group. These educational materials aimed to …

Preventing Teen Pregnancy Through Expanded Contraceptive Access In Mccreary County, Kentucky, Dacey B. Chitwood

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

This capstone project proposes a school-based Condom Availability Program to reduce teen pregnancy risk by expanding discreet contraceptive access for adolescents in McCreary County, Kentucky. Teen pregnancy remains a persistent public health concern in rural communities where stigma, privacy concerns, transportation barriers, and limited healthcare access can prevent adolescents from obtaining reproductive health resources. McCreary County faces elevated teen birth rates, socioeconomic disadvantage, and limited maternal healthcare infrastructure, making teen pregnancy prevention an important local priority. The proposed program would place free latex and non-latex condoms in student restrooms at McCreary Central High School, with QR-code-linked information connecting students to …

Measles Vaccine Hesitancy Improvement Bundle To Improve Vaccination Rates In A Rural Outpatient Clinic, Ramie Malone

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction

Despite the Centers for Disease Control and Prevention's recommendations to vaccinate children against measles, a decline in measles vaccination rates has been observed at a rural family medicine clinic. While numerous factors contribute to the decline in vaccination rates—including parental doubts about the necessity of vaccination, concerns about vaccine side effects, and insufficient education—the latter remains a fundamental underlying cause of suboptimal vaccination coverage.

Objectives

This project focused on surveying, educating, and boosting parents' confidence in measles vaccines for children under five to raise the measles vaccination rate.

Methods

This project used a pre- and post-intervention bundle over an …

Environmental Predictors Of Human Lyme Disease Incidence Across Appalachian Counties In Kentucky, Virginia, And West Virginia, 2000-2019, Karlie D. Rennison

Theses and Dissertations--Epidemiology and Biostatistics

This ecological study examined county-level environmental, landscape, and host-related predictors of Lyme disease incidence across Kentucky, Virginia, and West Virginia from 2000-2019. Lyme disease is an emerging public health concern in the Appalachian region, where geographic expansion and shifting ecological conditions may influence disease risk.

Lyme disease case rates (per 10,000 population) were analyzed in relation to climate variables, land cover metrics, host density measures, and rurality using publicly available data sources. Descriptive and regression analyses were conducted to evaluate associations between candidate predictors and disease incidence.

Substantial geographic variation in Lyme disease incidence was observed, with higher case rates …

Understanding The Underutilization Of The Campus Recreation Facility: A Mixed-Methods Examination Of Basic Psychological Need Satisfaction, Social Physique Anxiety, Sense Of Community, And Physical Environment Barriers, Caden M. Pfingsten

Master's Theses or Doctor of Nursing Practice

Campus recreation facilities have been identified as important contributors to student well-being, academic persistence, and institutional belonging. Despite these documented benefits, a persistent gap exists between available services and actual student utilization at many institutions. This study examined the psychological, social, and environmental factors associated with students' underutilization of the Campus Recreation Facility (CRF) at a mid-sized Midwestern public university in favor of paid off-campus commercial gym memberships.

Using a cross-sectional survey design, 169 students completed a battery of validated and researcher-adapted instruments assessing basic psychological need satisfaction (autonomy, competence, and relatedness), Sense of Community, and social physique anxiety across …

Facilitating Shared Reading Exposure To Promote Health Outcomes In A Rural Pediatric Primary Care Clinic, Meredith L. Longino

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of this scholarly project was to address a gap in early literacy promotion for rural children by incorporating the Reach Out and Read program. This program bolsters foundational literacy by providing a book and anticipatory guidance at every well-child visit from birth through age 5. This project was expected to decrease no-show well-child attendance rates and improve provider morale.

Background

The project was implemented in an established rural pediatric primary care clinic in Northeast Texas. 

Methodology

Process implementation was measured through books distributed and EHR documentation of the intervention. Process objectives were measured by no-show rates for …

Socioeconomic Influences On Doula Access And Perceived Care Quality Among Black Women Experiencing Severe Maternal Morbidity, Deborah Esene

2026 Spring Honors Capstones Projects

Black women experience disproportionately high rates of maternal morbidity and mortality, making it essential to examine access to and the perceived impact of doula support. This study examines whether socioeconomic status influences access to and the perceived benefits of doula support among Black women who experienced severe maternal morbidity (SMM). Researchers surveyed Black women ages 18-49 who had a live birth within the past two years and experienced SMM. Participants were recruited and completed an online survey in late 2020. Key variables included income, education, doula use, and perceived quality of prenatal, intrapartum, and postpartum care. Among 188 participants, 12.2% …

Promoting Maternal And Infant Health In Franklin County, Ky: A Community-Based Physical Activity And Education Intervention, Subin Kim

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

Maternal and infant health outcomes are key indicators of population health, yet persistent disparities exist in rural communities across the United States. In Kentucky, Franklin County reflects this pattern, with concerning maternal and infant health indicators despite relatively favorable socioeconomic conditions. Identified challenges include elevated rates of poor physical and mental health days, high drug overdose mortality, provider shortages, and ongoing reproductive health concerns such as tobacco use during pregnancy and increased infant mortality associated with elevated maternal body mass index.

To address these gaps, a three-pronged, community-based prenatal and postpartum physical activity and education program is proposed. The program …

The Effect Of The Affordable Care Act Medicaid Expansion On The Risk Of Hospital Closure And Adolescent Hpv Immunization In Rural Counties, Juliette Des Rosiers

Scripps Senior Theses

From 2005 to 2025, over 200 rural hospitals shut their doors, often citing increased operational costs, staffing shortages, low patient volume, regulatory barriers, financial challenges exacerbated by the COVID-19 pandemic, and uncompensated care as common contributors to the closures. Rural patients are often referred by their primary care physician to a hospital for regular immunizations, since smaller clinics have less capacity to provide immunizations due to a shortage of pediatricians and limited vaccine stock. A crucial vaccine that is not required by schools and underutilized in rural areas is that against human papillomavirus (HPV), a virus that infects cutaneous and …

Timelines Of Care: Analyzing Treatment Access For Women With Ongoing Reproductive Health Needs, Nyla M. Keith

Honors Undergraduate Theses

Mandates in the United States created pressure on an already strained healthcare system post-COVID-19 pandemic. With new regulations placed upon abortion care forcing the closing of low-cost health clinics such as Planned Parenthood, legislation that has made health insurance more expensive, and rising pharmaceutical prices, women’s OB/GYN care in America has struggled to meet patient needs. A cross-sectional survey was developed and distributed to four clinics in the Orlando area to assess patients' perceived access to care and identify barriers to receiving OB/GYN care. The survey took approximately 10 – 15 minutes to complete, was available in print and online …

Oral Health Access Among Ethnic Minority Older Adults In The United States, Jasleen K. Sodhi

Honors Undergraduate Theses

Oral healthcare is a critical yet often overlooked component of overall health among U.S. adults. Ethnic minorities for older adults face heightened risks of poor oral health and related health conditions, while experiencing disparities in access to care. This study aimed to systematically examine and synthesize existing literature to assess the extent to which oral health disparities exist among ethnic minority older adults in the U.S. and explore the roles of socioeconomic factors on these disparities. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, we conducted a systematic review of peer-reviewed articles published in English …

Rurality, Infant Feeding Practices, And Perinatal Cardiovascular Health Behaviors, Elly Marie Marshall

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Cardiovascular diseases are a leading cause of pregnancy-related deaths in the United States, with higher rates in rural areas. While limited healthcare access contributes to this disparity, other factors remain unclear. Breastfeeding provides long-term protection against cardiovascular disease, but modern infant feeding practices are complex and may impact maternal cardiovascular health (CVH) in unexpected ways. Healthy CVH behaviors of sufficient sleep duration, adequate physical activity, a healthy diet, and nicotine avoidance can enhance protection against future cardiovascular disease risk. Therefore, the aims of this dissertation are to 1) assess associations between rurality and first trimester CVH behaviors; 2) synthesize …

Una Nueva Herramienta Para Estimar El Volumen Muscular Independientemente De La Edad, El Sexo Y El Nivel De Actividad Física, José J. Rivera-Sánchez, Laura P. Burgos-Morelos, Daniel Castillo-Castillo, Gerardo Méndez-Suárez, Juan C. Lopez-Alvarenga, Damián Carrillo-Ruíz

School of Medicine Publications

Antecedentes: Actualmente, la evaluación del volumen muscular requiere técnicas invasivas o de imagen, lo que aumenta los costos y retrasa la evaluación, y las mediciones antropométricas con frecuencia son inexactas.

Objetivo: Desarrollar una fórmula matemática para estimar el volumen del cuádriceps.

Material y métodos: Se evaluaron 127 sujetos: 40 adultos sedentarios de 20 a 35 años, 47 atletas adultos de 20 a 45 años y 40 adultos sedentarios de 70 a 94 años. Se dividieron en grupos de desarrollo y de validación. Se realizaron mediciones de variables antropométricas y fuerza de agarre, y se desarrolló la fórmula de predicción del …

Assessment Of Major Adverse Cardiovascular Event Across Diverse Racial Groups Of Psoriasis Patients On Biologic Therapy: A Retrospective Cohort Study, Chunghwan Ro, Ana Ormaza Vera, Waleed Adawi, Clinton W. Enos

Department Dermatology Faculty Publications

Psoriasis is associated with an increased risk of major adverse cardiovascular events (MACE), and biologic therapy may reduce this risk by targeting systemic inflammation. However, limited data exist on whether long term MACE risk differs by biologic class or across racial groups. We conducted a retrospective cohort study to assess the risk of primary MACE in psoriasis patients receiving biological therapies, stratified by biological class, compared with biologic-naïve psoriasis patients. Whether MACE risk among biologic-treated patients varied by race was further examined. After 1:1 propensity score matching, 36 330 biologic-treated patients were compared with 36 330 non-biologic-treated patients. Incident MACE …

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, …

Adult Healthy Habits, Belinda E. Vicuna, Mahtab Soleimani, Yvonnie Baik, Elena Martinez, Theresa H. Cruz

Reports & Documents

No abstract provided.

Exploring The Impact Of Adverse Childhood Experiences On Preventive Healthcare Utilization In Rural Georgia, Ryan R. Traylor

College of Graduate Studies: Theses & Dissertations

This study examines the relationship between Adverse Childhood Experiences (ACEs) and preventive healthcare use among adults in Georgia, specifically within rural populations facing structural barriers. Using 2023 Georgia Behavioral Risk Factor Surveillance System (BRFSS) data, the research analyzes associations between ACE exposure, rural residence, and preventive care outcomes, including physical exams and flu vaccinations. Guided by an intersectionally adapted version of Andersen’s Behavioral Model of Health Services Use, the study evaluates how predisposing factors, enabling resources, and perceived barriers relate to healthcare engagement. Logistic regression analyses assess the correlation of ACE exposure, cost barriers, provider access, and sociodemographics with preventive …

Clinical Challenges Associated With Enhancing Hypertension Among The Underserved African American Population, Ashley Richardson

Doctor of Nursing Practice (DNP) Scholarly Projects

Background 

African Americans face a significantly higher prevalence of hypertension, tend to develop complications at younger ages, and have disproportionately higher mortality rates. Key social determinants of health (SDoH)—including food deserts, unequal access to healthcare, and geographic disparities in healthcare resources—contribute to these ongoing inequities. Addressing both systemic and individual barriers is crucial for effective hypertension management.

Objective

This study aims to assess the effectiveness of a culturally relevant, community-based intervention designed to reduce both systolic and diastolic blood pressure among Black adults with uncontrolled hypertension.

Methods 

Quality improvement (QI) initiatives typically employ multicomponent, equity-focused models. The primary components of …

The Association Between Social Vulnerability And Racial Disparities In Preterm Birth, Anita Pershad, Gabby Adams, Lindsay Robbins, George Saade, Tetsuya Kawakita

Department of Obstetrics & Gynecology Faculty Publications

Objective

To evaluate the association between county-level social vulnerability and preterm birth and assess whether racial disparities vary across levels of vulnerability.

Methods

This cross-sectional study utilized restricted Centers for Disease Control and Prevention natality data from 2023. We included Black or White births with singleton pregnancies across 3123 US counties from 50 US states and the District of Columbia. Participants were grouped into quartiles based on the county-level Social Vulnerability Index (SVI), with quartile 4 representing the most socially vulnerable populations. The primary outcome was preterm birth, defined as delivery before 37 weeks. Secondary outcomes included small for gestational …

Net Effects Of Correlated Determinants Of Health Among U.S. Older Adults, Haomiao Jia, E I. Lubetkin

Publications and Research

Background

The health effect produced by a contributing factor alone may be different from the effect when other interacting factors are present. The effects of a set of contributors, estimated by regression coefficients, may be invalid or inappropriate if some of the predictors are correlated or the model has interaction and nonlinear terms. The net effect (NE) of a given contributing factor is the effect produced by the factor alone, not by other factors due to their correlations with the factor of interest. This study estimated NE of selected determinants of health for U.S. older adults.

Methods

Participants, aged ≥ …

Design And Implementation Of Data Quality Controls In The Eq-Daphnie Study: Insights From The Pilot Phase And 15-Country Analysis, Fatima Al Sayah, Hilary Short, Juan M. Ramos-Goñi, Rosalie Viney, Erica I. Lubetkin, Mathieu F. Janssen, Jeffrey A. Johnson

Publications and Research

Objective

The EQ-DAPHNIE (EuroQol Data for Assessment of Population Health Needs and Instrument Evaluation) project is a large, multi-country survey initiative designed to generate population norms and enable comparative research using self-reported health measures. This paper describes the quality control processes and summarizes data quality metrics from the United Kingdom (UK) pilot and full implementation across 15 countries.

Methods

Representative samples were recruited via Dynata, an online survey panel provider, using quota sampling by age, sex, income, community setting, and language (where applicable). The UK pilot (n = 3012) informed survey refinements ahead of full rollout (n = 68,411). Quality …