Public Health Commons^™

Universal Health Care, Oregon, Jennifer S. Arnold, Bethany Clouse, Alec Martin

OHSU-PSU School of Public Health Annual Conference

Historically, the US has chosen not to fund universal health care at every opportunity, leaving our nation as the only industrialized country without some system of health coverage for our citizens and with the worst health care outcomes of any high-income nation in the world. Health care in Oregon is no exception. Our current health care system is financially unsustainable, harmfully complex, and socially unjust, as well as inequitably delivered. Too many Oregonians, because of their race, age, income, geography, or insurance, endure vastly different health care access, varied health care quality, and wide-ranging health outcomes. In 2019, the Oregon …

Behind The Walls: The Implications Of Assisted Living Building Codes On Resident Safety, Adam Pennavaria, Lindsey Smith, Paula Carder, Cassandra Hua, Eric Jutkowitz, Kali Thomas

OHSU-PSU School of Public Health Annual Conference

As the US population collectively ages, issues related to assisted living (AL) resident safety have become an increasingly pressing issue for the general public, reflected by major media reporting in the last year. The building codes that govern ALs play an important role in mitigating the risks associated with falls, wandering, and other hazards, especially for residents living with Alzheimer’s disease and related dementias. We sought to understand how states vary in their approaches to building code regulations that might impact resident safety. We used search term-based text retrieval to identify areas of text relevant to locks, alarms, and egress …

Expanded Patient Reach At New Student Run Free Medical Clinic Location, Olivia Krol, Hana Warmflash, Alex Foster

OHSU-PSU School of Public Health Annual Conference

Background: Critical to modern medical education, student run free medical clinics (SRFCs) are present at more than 75% of AAMC member institutions. SRFCs educate students while providing low-barrier, free healthcare to underserved populations. SRFCs provide unique leadership and health systems management opportunities not traditionally emphasized in training, including leading logistical and operational changes.

In this project, we highlight the impact of a student-led operational initiative that transitioned our clinic from the River District Navigation Center (RDNC) to the Resource Center (RC), improving accessibility.

Methods:

Deidentified patient data from medical clinics from January 2024 to February 2025 were analyzed using RStudio …

Prenatal Exposure To Pm2.5 Concentration And Risk Of Preterm Birth In New Mexico; A Seasonal Pattern And Spatio-Temporal Modeling., Onyedikachi J. Okeke

Mathematics & Statistics ETDs

This study investigates the association between prenatal PM2.5 exposure and preterm birth risk in New Mexico (2014–2021). Using descriptive statistics, time series models, and spatial analyses, findings show an average preterm birth rate of 14.87 per 1,000 live births, with moderate correlation (r = 0.727) between PM2.5 levels and very preterm births. While traditional models revealed no significant global effect, spatial methods such as Geographically Weighted Regression (GWR) and Multiscale GWR uncovered strong spatial heterogeneity. PM2.5 effects varied by county (coefficients: -0.00154 to 0.00150), with clustering evident in 2018–2019 (Moran’s I = 0.155–0.174). Results highlight the limitations of global models …

A Cross-Sectional Analysis: Employment And Its Impact On Physical Activity, Academic Performance, And Quality Of Life Among Bellarmine University Students, Orlando Exposito Nuñez

Undergraduate Theses

Introduction: Half of undergraduate students are employed, meaning they must balance work with academics, physical activity (PA), and personal responsibilities. This study examines the potential negative impact of employment on PA, academic performance, and quality of life (QOL) among college students. Methods: The cross-sectional survey comprised 125 Bellarmine University students (Age 21.07 ± 3.40; 52% female, 48% male). Measures included the RAND SF-36 for QOL, the International Physical Activity Questionnaire Short Form (IPAQ-SF), and a custom academic and employment questionnaire. Racial and ethnic demographics included White (75.2%), Black or African American (11.2%), Hispanic or Latino (15.2%), Asian (4.8%), Multiracial (4.8%), …

Methods For Community-Engaged Data Collection And Analysis In Implementation Research, Lawrence A. Palinkas, Benjamin Springgate, Leopoldo J. Cabassa, Michelle Shin, Samantha Garcia, Benjamin F. Crabtree, Jennifer Tsui

School of Medicine Faculty Publications

BACKGROUND: Community engagement is widely recognized as critical to successful and equitable implementation of evidence-based practices, programs, and policies. However, there are no clear guidelines for community involvement in data collection and analysis in implementation research. METHODS: We describe three specific methods for engaging community members in data collection and analysis: concept mapping, rapid ethnographic assessment, and Photovoice. Common elements are identified from a case study of each method: 1) selection and adaptation of evidence-based strategies for improving adolescent HPV vaccine initiation rates in disadvantaged communities, 2) strategies for implementing medication for opioid use disorders among low-income Medicaid enrollees during …

No Vaccine? Why Not: Causes Of Vaccine Hesitancy And How Governments Can Stop It, Alexander (Alec) Mccarty '25

Honor Scholar Theses

Vaccine hesitancy is a term that has entered the spotlight since the beginning of the COVID-19 pandemic. With concerns about efficacy, safety, and individual choice, many people have developed a hesitancy toward receiving any vaccine, creating concerns for public and global health. Through responses from local and state health departments about their actions during the COVID-19 pandemic, and through analysis of state vaccine rates based on political affiliation, this study suggests that vaccine hesitancy is a current issue that is likely politically motivated. States that are Republican affiliated have lower rates of vaccine uptake, and in turn they have higher …

Building Empathy Through Storytelling: A Living Library Program Focused On Women’S Health, Jess King, Belinda Boelter, Catherine Medici-Thiemann

Posters and Presentations: Leon S. McGoogan Health Sciences Library

An academic health sciences library hosted a grant-funded living library program titled “Bringing Stories of Women’s Health to the Forefront.” With a campus that is increasingly focused on incorporating the humanities into medical education, the library added to this momentum by offering a program which encouraged empathy through the art of storytelling. The program was delivered via three routes: an in-person event for the city’s metro community, a virtual event for the university community and their clinical partners, and oral interview video recordings that are hosted on the library website. In order to host a successful event that met the …

Findings From A Qualitative Analysis: Social Media Influencers Of Color As Trusted Messengers Of Hpv Vaccination Messages, Amelia Burke-Garcia, Erin Cutroneo, Dasha Afanaseva, Kayla Madden, Angela Sustaita-Ruiz, Preethi Selvan, Estefany Rivera Sanchez, Amy Leader

Department of Medical Oncology Faculty Papers

BACKGROUND: Despite HPV vaccination reducing the prevalence of cervical cancer by 90%, vaccination rates remain lower among communities of color due to vaccine hesitancy and mistrust in traditional public health messengers. The emergence of social media influencers, a newer kind of messenger, presents a unique opportunity to share immunization messages in new ways with a variety of communities. This paper reviews the qualitative findings from a study aimed at assessing influencers' perceptions of and approaches to sharing messaging about the HPV vaccine.

METHODS: Guided by several theories (Theory of Planned Behavior, Narrative Theory, and Opinion Leader Theory), the study team …

Evaluating The Current State Of Quality Measure Reporting In The Merit-Based Incentive Payment System, Kinan Sawar, Geoffrey Potts Md

Medical Student Research Symposium

The Merit-Based Incentive Payment System (MIPS) requires physicians to report quality measures along with other metrics that are used to determine an annual percentage adjustment to physician Medicare Part B payments. Unfortunately, physicians have been forced to choose from an ineffective, limited set of quality measures. This has led to an overreliance on process measures, which fail to stratify physician performance effectively; it has also led to differences in the number of reporting options across specialties, resulting in unequal opportunity for physicians to succeed in MIPS. Using Centers for Medicare and Medicaid Services (CMS) public use file data from 2021-2024, …

Assessing Middle Eastern American Attitudes Towards Substance Use Disorders, Hazem Alata, Hussein Bazzi, Saleh Al-Juburi, Angie Achkar, Liam Browning, Nicole Oska, Adam Chaban, Arash Javanbakht

Medical Student Research Symposium

Assessing Middle Eastern American Attitudes Towards Substance Use Disorders

Introduction:

Substance use disorders (SUD) among Middle Eastern and North African (MENA) populations remain largely understudied, despite evidence of high prevalence rates and lower rates of treatment engagement. Unique cultural conceptualizations and beliefs surrounding substance use disorders may perpetuate stigma, further contributing to disparities in access to and utilization of treatment services. This study aims to explore the attitudes and perspectives of individuals from MENA communities regarding substance use disorders, with the goal of identifying and addressing barriers to treatment.

Methods:

An anonymous bilingual Qualtrics survey was administered, gathering responses from …

A Mapping Review And Critique Of The Literature On Translation, Dissemination, And Implementation Capacity Building Initiatives For Different Audiences, Ana A Baumann, Danielle R Adams, Laura-Mae Baldwin, Rachel G Tabak, Sara Malone, Maura M Kepper, Anita D Misra-Hebert, Kathleen R Stevens, Maria E Fernandez, Sunil Kripalani

Faculty, Staff and Student Publications

Background: Capacity building is critical for research and practice as the fields of dissemination, implementation and translation science continue to grow. Some scholars state that capacity building should be grounded in competencies. However, the fields are unclear in determining which competencies are relevant for whom, including the content and appropriate level of information and skills for different roles. The goal of this study was to catalogue competencies across current D&I capacity building initiatives.

Methods: We conducted a mapping review to examine to what extent are theories or frameworks used to guide capacity building, who is being trained, to what extent …

Growing The Good: A Communal Garden Case Study Among Marginalized, Rural Populations, Claire Barbier

LSU Master's Theses

Community and Communal gardens (CG) have been documented as early as the late 1800s during periods of economic recessions and high food insecurity (The MIT Press Reader, 2022). However, C.G. adoption rates are expanding on a global scale as communities and municipalities see the potential for the tool to bring relief to environments in dire need of additional resources. Utilizing a communal garden can be used to address a surplus of systemic barriers a community faces; it has a significant opportunity to bring forth the interconnected tiers of public health altogether (Twiss et. al, 2003). Modernized C.G projects bring forth …

Implementation Of Performance-Based Budgeting For Public Health Care Service Delivery In An Emerging Economy, Isaac O. Randa, Christine A. Adere

Southern African Journal of Policy and Development

This study investigates the determinants and implications of the implementation of performance-based budgeting (PBB) on public health care service delivery at the Ministry of Health and Social Services (MoHSS) in Windhoek, Namibia. Using a cross-sectional survey research design targeting 100 respondents, this study employed a quantitative research approach involving MoHSS's budgeting and health care services departments. Data were analysed using partial least squares structural equation modelling. Communication, bureaucratic structures, and implementers’ disposition significantly influenced PBB implementation alignment, thereby enhancing service delivery. However, resource utilisation showed no significant effect. Additionally, implementation alignment effectively mediated the relationship between latent exogenous variables and …

Strengthening Local Health Systems And Governance For Universal Health Coverage: Experiences And Lessons From The Covid-19 Pandemic Response In Quezon City, Philippines, Esperanza Anita Escano-Arias, Ramona Asuncion D.G. Abarquez, Rolando V. Cruz, Rosalie Espeleta, Madeline Mae Ong, Arianna Maever L. Amit, Veincent Christian Pepito, Vida Gomez, Manuel M. Dayrit

Ateneo School of Medicine and Public Health Publications

The COVID-19 pandemic has disrupted the Philippines's transition toward universal health coverage. However, some local government units in the country made use of the pandemic as a catalyst to strengthen their local health system, scale-up the provision of preventive and primary care services, and improve health governance to make it more prepared to face future pandemics and realize the aims of the country's new Universal Healthcare Act. This paper describes the response of the local government of Quezon City, Philippines, to COVID-19 and how it strengthened local health systems. We also discuss enablers such as partnerships, collaborations, and foresight to …

Food For Thought: The Impact Of The Gut-Brain Axis On Mental Health, Emily S. Miiller

Honors Thesis

Research regarding the role of the human microbiome has grown over the years as professionals develop a better understanding of the gut-brain axis. New studies and expanding knowledge on the relationship between the nervous system and gut microbiome promote a deeper understanding of the impact of diet on mental health. Diet plays a crucial role in maintaining a healthy balance between the gut and the brain. Incorporating nutritional modulators, such as probiotics, prebiotics, and vitamins, is crucial for supporting the gut-brain axis by influencing neurotransmitter production, managing inflammation, and promoting the growth of beneficial gut bacteria. On the other hand, …

What's Missing From Value-Based Care-Accounting For The Costs And Benefits Of Quality Improvement, Donald E. Casey

College of Population Health Faculty Papers

No abstract provided.

Exploring The Web And Language Accessibility Of Medical Tourism Providers’ Websites: Implications For Online Marketing And Patient Recruitment Practices, Alicia Mason, Elizabeth Spencer, Kristen Livingston, Treyton Meyers

Faculty Submissions

Background: Web accessibility as an attribute of the digital presence of organizations has been studied across domains and contexts. Our study aims to add to existing lines of research inquiry by examining the web and language accessibility of medical tourism provider (MTP) websites commonly used to market and promote international medical tourism treatments and services globally.

Objective: This study aims to (1) systematically analyze the web and language accessibility of MTP online health messages and (2) discuss challenges and implications for medical tourists’ user experiences when seeking health information online.

Method: We conducted an exploratory quantitative content analysis of web …

Physiotherapy In Community-Based Rehabilitation In Middle And Low-Income Countries: A Scoping Review, Er D. Petil Jr., Napoleon R. Caballero

Philippine Journal of Physical Therapy

Introduction: Community-based rehabilitation (CBR) is a widely recognized approach to address the rehabilitation needs of individuals with disabilities in low- and middle-income countries (LMICs). Physical therapy (PT) plays a crucial role within CBR programs. This study aimed to synthesize the current state of literature regarding the integration of PT in CBR programs in LMICs across Asia, Africa, and Latin America, examining key characteristics, reported outcomes, and challenges to implementation.

Methods: A comprehensive review of literature was conducted, focusing on studies published in the past decade. Data were extracted and synthesized in matrix format to compare and contrast findings across the …

Delta-8 Tetrahydrocannabinol Policy And Related Health Impact Among College-Aged Individuals In South Carolina: A Scoping Review, Emily K. Luoma

Senior Theses

After the 2018 Farm Bill passed, loopholes were quickly found that led to the popularization of delta-8 THC, a derivative of delta-9 THC, more commonly known as marijuana. Use of this substance became particularly high in states that criminalized marijuana, such as South Carolina. This scoping review aimed to assess South Carolina’s current delta-8 policies in the context of health-related impacts among college-aged students. Comprehensively analyzing the results of relevant studies, it was determined that there are three commonly observed threats to public health that are direct outcomes of existing policies: 1) a lack of quality control standards; 2) misleading …

The Stigma Surrounding Sex And Sexuality In American Culture, Sophia L. Pollock

Senior Theses

An important question to examine is the origin and implications of the taboo against sex and sexuality. The stigma against these topics encourages negative public health implications like poor sex education, high rates of sexually transmitted infections, and teen pregnancy. History of sexual stigma was examined through physical media and digital articles from the Thomas Cooper Library databases. The background and global perspective of these stigmas are covered, examining how past and distant cultures deal with sex. How sex is portrayed in the media, why a healthy sex life is important, and the subject of sex education are also addressed. …

Preferences And Willingness For Starting Daily, On-Demand, And Long-Acting Injectable Hiv Pre-Exposure Prophylaxis Among Transfeminine Persons In The Us, 2022-2023, Duygu Islek, Travis Sanchez, Stefan Baral, Carolyn Brown, Joanna A. Caldwell, Jennifer L. Glick, Danielle Friedman Nestadt, Jeb Jones, Iaah L. Lucas, Supriya Sarkar, Annemiek De Ruiter, Patrick S. Sullivan, Mariah Valentine-Graves, Savannah Winter, Vani Vannappagari

School of Public Health Faculty Publications

Background There remains limited information concerning US transfeminine persons preferences across varying PrEP options. We examined PrEP option willingness, preferences, and associated factors among a US nationwide sample of transfeminine persons. Methods Sexually active transfeminine persons age 15 + were recruited online between June 2022-October 2023 through social media advertisements. Transfeminine persons not diagnosed with HIV were asked about willingness to initiate, and ranked preference, of three PrEP options- daily oral (DO), on-demand, and long-acting injectable (LA-PrEP). Log-binomial models were used to examine PrEP modality willingness and associated sociodemographic and behavioral characteristics. Results Among 2657 transfeminine persons not currently using …

Understanding Adolescent Perinatal Wellbeing In Rural Parts Of Kenya: A Qualitative Study, Evaline Chepchirchir Langat, Marleen Temmerman, Margrette Hanselmann, Kethakie Lamahewa, Violet Naanyu, Mellan Lilumbi, Tatiana Taylor Salisbury

Centre of Excellence in Women and Child Health

Introduction: Despite global efforts to reduce adolescent birth rates, the problem persists in low- and middleincome countries. Sub-Saharan Africa has the highest rates (97.9 births per 1000 women). In Kenya, more than 15 % of adolescent girls become pregnant. Forty-three percent of these develop depression. This study investigated adolescent pregnancy in rural Kenya to understand the challenges and context-specific factors that can help adolescents maintain good mental health during pregnancy and the motherhood.

Methods: An exploratory qualitative study was conducted in Kilifi County between October and November 2021. A total of 73 participants consented to participate in the …

Impacts On College-Aged Asian American Mental Health, Zahra Soherwardy

Senior Theses

This study explores the relationship between different forms of racial harassment and mental health issues in Asian American college students. Asian American mental health is a growing concern in the field of public health. Asian Americans have the lowest treatment rates and some of the highest stigma levels of any demographic. They are also impacted by the model minority myth and discrimination, further alienating them from getting help. The topics of subtle racism, blatant racism, and current racial discrimination were compared to depressive symptoms, anxiety, self-esteem, and four domains of aggression using survey data. Subtle racism was found to be …

Estimation Of Therapeutic Threshold For Tuberculosis Using Adapted Nominal Group Technique And Clinical Vignettes In Clinical And Community Settings In Southern Africa, Alfred Kipyegon Keter, Alastair Van Heerden, Tom Decroo, Tom Boyles, Shannon Bosman, Thandanani Madonsela, Lindani Innocent Msimango, Lenika Naiken, Carlos Kiyan, Mashaete Kamele

Population Health, East Africa

Background: When confronted with diagnostic uncertainty and a decision on whether to start treatment or not, clinicians consider the potential harm and benefit of offering versus withholding treatment. Treatment can be offered if the probability of tuberculosis (TB) in the patient is above the “therapeutic threshold” (ThT): the probability of disease at which the expected utility of treating and not treating is the same. We estimated ThT for TB in clinical and community settings in Southern Africa using two methods: an adapted nominal group technique (aNGT), and decisions made based on clinical vignettes (CVs).

Methods: We enrolled health …

Selected Social And Lifestyle Correlates Of Brain Health Markers: The Cross-Cohort Collaboration Consortium, Leslie Grasset, Joshua C Bis, Stefan Frenzel, Daniel Kojis, Jeannette Simino, Amber Yaqub, Alexa Beiser, Claudine Berr, Jan Bressler, Robin Bülow, Charles S Decarli, Alison E Fohner, Laura B Harrington, Catherine Helmer, M Arfan Ikram, Rozenn N Lemaitre, Oscar L Lopez, W T Longstreth, Julia Neitzel, Michelle C Odden, Priya Palta, Carsten O Schmidt, Rajesh Talluri, Meike W Vernooij, Henry Völzke, Trudy Voortman, Quest Whalen, Katharina Wittfeld, Hans J Grabe, Thomas H Mosley, Bruce M Psaty, Frank J Wolters, Sudha Seshadri, Carole Dufouil

Faculty, Staff and Student Publications

Introduction: To investigate the associations of education level, marital status, and physical activity with dementia risk and brain MRI markers.

Methods: Data from six community-based samples from the Cross-Cohort Collaboration Consortium were analyzed. Self-reported education level, marital status, and physical activity at age 60 to 75 years were harmonized. Subsamples of participants with brain MRI markers at time of exposure were selected. Associations with dementia risk and cross-sectional MRI markers were meta-analyzed.

Results: Higher education level was associated with lower dementia risk (hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.59; 0.72 vs low level) but not significantly …

The Impact Of Discretion On Human Service Workers Supporting The Health Of Unaccompanied Minors In Foster Care, Diana M. Clark

Senior Theses

Unaccompanied children (UCs) are a vulnerable population that enters government custody and accesses healthcare via the Office of Refugee Resettlement (ORR)'s system of care. While prior research has focused on generating policy recommendations to improve healthcare services available to UCs both in ORR custody and following release from custody, this thesis will instead expand upon the experiences of staff members working at ORR-contracted agencies. These workers make decisions that have short- and long-term implications on the health and wellbeing of UCs. Drawing from 65 in-depth interviews with human service workers in ORR-contracted voluntary agencies, this thesis uses street-level bureaucracy framework …

"Health Gatekeepers": The Influence Of Women On Health Practices In Rural, Central Appalachia, Reese Lycan

Senior Theses

Women have historically assumed leadership roles in familial and community health promotion, intervention, and facilitation. While the role of women in family health is globally understood and the historical importance of female leadership has been documented, there remains a gap in knowledge regarding the role of women as “health gatekeepers”. Furthermore, when considering the Appalachian region, there are limited studies regarding women’s place in leadership as far as health is concerned. Therefore, this study employs a hermeneutic phenomenological framework to explore the lived experiences of women in relation to their family and community’s health in rural, Central Appalachia- a region …

Managing The Cost Of Services For People With Disabilities: International Approach. Part Ii: Ohio, United States, Dana Pugh, Jaroslaw Richard Romaniuk

Faculty Scholarship

Introduction: Four years of managing a housing network for people with disabilities prompted a rethinking of the financial management of the services offered. Clients with different needs require diverse professional staff for their home care. Emergency situations require that professionals offering assistance maintain the highest level of education possible. Financial resources often limit the quality of care for people with disabilities. Method: This paper is based on a literature search and on professional experience (Dana Pugh) in the management of a housing program for people with disabilities in Cleveland, Ohio (USA). Findings: In Poland, people with disabilities usually live with …

The Intensity Of 10-Minute Classroom Physical Activity Breaks In Elementary School Children, Jeffery J. Honas, Amanda N. Szabo-Reed, Joe Sherman, Anna Rice, Robert Montgomery, Ken Murfay, Richard A. Washburn, Joseph E. Donnelly

International Journal of Physical Activity and Health

This study examined the intensity of different physical activity (PA) breaks for elementary school children in a simulated classroom setting. Researchers compared the energy expenditure (Kcals/min, METs) of PA breaks developed for the Physical Activity Across the Curriculum (PAAC-3) program, delivered via video or in-person, to commercially available GoNoodle^© videos. 71 children (age 9.0 ± 1.1 yrs., 47 males, 24 females, 18% minority) participated in 10-minute PA breaks. The intensity of activity breaks was assessed using a COSMED® K5 portable indirect calorimeter (weight ~ 1 kg) (COSMED®, Rome, Italy) and and portable accelerometer (ActiGraph GT3X+; ActiGraph LLC, Pensacola, FL) …