Public Health Commons^™

We Can Do This / Juntos Sí Podemos: A Critical Discourse Analysis Of Government-Sponsored Covid-19 Public Service Announcements (Psas) In English And Spanish, Katalina R. Peterson

Scripps Senior Theses

Communication inequities are known to negatively impact people from socioeconomically and linguistically disadvantaged backgrounds during public health crises (Gomez-Aguinaga et al., 2021). In the United States, Hispanics—especially those who speak Spanish—have been among the communities most disproportionately affected by COVID-19 (National Center for Health Statistics, 2022). The pandemic has underscored the importance of understanding the linguistic and discursive strategies implemented by institutions entrusted with disseminating public health information to reach diverse audiences, especially the most vulnerable. This paper analyzes the linguistic practices used to create public service announcements (PSA) produced in English and Spanish by health agencies at both the …

The Role Of Porn Literacy In Comprehensive Sex Education To Reduce Endorsements Of Gendered Sexual Violence And Support Healthy Adolescent Development, Kiana Harnish

Scripps Senior Theses

Due to stigmatization of sex and insufficient sexual education, modern-day adolescents rely on free online pornography as a source of education about sex and relationships. This thesis provides a review of the connections between adolescent porn use and the socialization of sexual violence (SV) and coercion against women, comprehensive sex education (CSE) and healthy adolescent sexual development, and porn literacy (PL) and sexual attitude or behavior changes. Porn literacy aims to equip adolescents with tools to critically analyze sexualied media and messages, to empower them to make informed decisions to engage or disengage with porn and their sexuality in a …

Campus Sexual Violence In The Time Of Covid-L9, Hannah Holt

Master’s Theses

Campus sexual assault (CSA) was likely on the rise in the United States (Koss et al., 2022) even prior to the COVID-19 pandemic, during which there was a global increase in violence against women. The present study is a needed addition to the limited rigorous scientific studies on the impact of the COVID-19 pandemic on campus sexual assault (CSA). A mixed-methods, ecological, and critical feminist approach was used to investigate CSA during the mitigation period. The present study specifically utilized the Sexual Experiences Survey (Koss et al., 2007) to assess changes in frequency of victimization within two representative samples of …

Health Misinformation During Epidemiological Crises, Bethany Stefan, Alexis L. Emich, Katrina R. Lamp

Williams Honors College, Honors Research Projects

Health misinformation is more prevalent than ever in the modern age and poses serious risks for those who believe it. Medical fallacies can become especially harmful during periods of widespread disease when the misinformed respond in ways that increase threats to public health. The purpose of this systematic review is to describe and critically appraise the evidence about how health misinformation during endemics and pandemics can influence behaviors and responses, as well as the implications of interventions affecting these behaviors. A systematic search of the literature with inclusion/exclusion criteria using CINAHL Plus with Full Text, MEDLINE, and PsychINFO resulted in …

An Exploration Of Quality Of Life Perceptions Of Cochlear Implant Recipients And Their Frequent Communication Partners, Jessica L. Bishop, Ashley G. Flagge

Ashley Flagge Publications

Purpose: Quality of life (QoL) after cochlear implantation has been investigated using a variety of QoL questionnaires. However, few studies have examined the perceived QoL of cochlear implant (CI) recipients compared between the recipient and a frequent communication partner (FCP) using both hearing-related (hearing-specific), and health-general (health-general) measures.

Method: For this multiple case study, five participant pairs were recruited, consisting of five adult recipients who were implanted at least six months prior to the time of evaluation, and five adult frequent communication partners who lived with the recipient at the time of evaluation. All ten participants (five pairs) completed a …

Mental Health Treatment And The Criminal Justice System, Susana Lehan-Trasente

Walden Dissertations and Doctoral Studies

The criminal justice system has established interventions for those who have mental illness and have been charged with criminal complaints. In New York State, the Mental Health Court has been established to address these issues and is to be used by all counties. However, the treatment and probation interventions vary from county to county. Saratoga County uses a Single Point of Access (SPOA) which receives referrals from the general court and probation officers. SPOA refers clients to a variety of treatment interventions available in the county. In Monroe County, the Mental Health Court refers the criminally involved/mentally ill individual to …

Diagnosing Neurocysticercosis In Skeletonized Human Remains Of Forensic Importance, John O. Obafunwa, Karl Reinhard

Karl Reinhard Publications

Neurocysticercosis is endemic in many parts of the underdeveloped and developing countries, with continuous presence in developed countries due to the influx of migrants from regions where the diseases are endemic. Neuroimaging, anatomic pathological techniques, immunodiagnostic tests, clinical examination and epidemiologic considerations will easily provide the diagnosis. However, physicians in developed countries are perhaps progressively missing the diagnosis, and need to re-acquaint themselves with the condition and acquire a high suspicion index. The authors present a medicolegal case where the forensic team made a conclusion of neurocysticercosis (among other diagnoses), following post mortem examination of a largely skeletonized and mummified …

Exploring The Evolution Of Trypanosoma Cruzi And The Emergence Of Chagas Disease In The Context Of Environmental Change: Applying The Stockholm Paradigm To Archaeoparasitology, Part I, Aida Romera Barbera, Daniel R. Brooks, T. Michael Fink, Karl J. Reinhard

Karl Reinhard Publications

The Stockholm Paradigm is an evolutionary synthesis that explains the emergence of novel pathogens in the context of environmental disturbances. Considering the urgent climate change situation, anticipation stands as key to prevent and mitigate the effects that climate change can have in the emergence of pathogens. However, the success of preventive measures is hindered by a limited knowledge of the interplaying dynamics between biology, environment, and culture leading to emerging infectious diseases. For many decades, bioarchaeologists have been gathering data on past human-environment interactions, therefore contributing to the conversation. Archaeoparasitology, at the intersection between pathology, bioarchaeology, and biology, is uniquely …

Documenting The Presence Of Chagas Disease In Prehistoric North America: Applying The Stockholm Paradigm To Archaeoparasitology, Part Ii, Karl J. Reinhard, Daniel R. Brooks, Aida Romera Barbera, T. Michael Fink

Karl Reinhard Publications

The DAMA protocol (Document, Assess, Monitor, Act) is the applied aspect of the Stockholm Paradigm. Evidence from archaeology and history of medicine has a demonstrated value in documenting infection risk for specific study areas. Bioarchaeological remains and historical documents show vivid examples of pathology related to the Chagas disease life cycle. The science of archaeology defines the lifestyles that created risk of triatomine kissing bug infestations and trypanosome protozoa infections. Paleogenetics, in the form of molecular analyses of Trypanosoma cruzi, elucidate the temporal origins of genetic variants and adaptation to human environments. We illustrate how these fields reveal the risk …

Covid-19 Stress And Cognitive Failures In Daily Life: A Multilevel Examination Of Within- And Between-Persons Patterns, Nadyanna M. Majeed, K. T. A. Sandeeshwara Kasturiratna, Mingyao Li, Jonathan L. Chia, Verity Y. Q. Lua, Andree Hartanto

Research Collection School of Social Sciences

The COVID-19 pandemic has claimed an extremely high number of lives worldwide, causing widespread panic and stress. The current research examined whether COVID-19 stress was associated with everyday cognitive failures, using data from a seven-day daily diary study of 253 young adults in Singapore. Multilevel modeling revealed that COVID-19 stress was significantly associated with cognitive failures even after adjusting for demographic factors, both at the within-person and between-persons levels. Specifically, individuals experienced more cognitive failures on days they experienced more COVID-19 stress (as compared to their own average levels of COVID-19 stress), and individuals who experienced more COVID-19 stress overall …

Relieving The Gambling Itch Through Alcohol Consumption: The Impact Of Covid-19 Restrictions On Australian Casino Patrons, Tenghao Zhang, Pi-Shen Seet, Janice Redmond, Jalleh Sharafizad

Research outputs 2022 to 2026

This paper extends our understanding of how casino patrons are affected by COVID-19 restrictions and how they cope by substituting gambling with alcohol consumption. We conducted two studies using a nationwide survey sample collected in Australia during the pandemic lockdown. Study 1 compares the casino patrons with two reference groups (other gambling patrons and non-gambling individuals) and investigates the lockdown restrictions on respondents’ relational strength, and their potential impact on mental health and future prospects. Study 2 applies the stress-response dampening model (SRD) and tests how respondents used alcohol consumption to cope with the lack of access to casinos during …

Assessment Of Spatio-Temporal Variations In Pm2.5 And Associated Long-Range Air Mass Transport And Mortality In South Asia, Md Sariful Islam, Shimul Roy, Tanmoy Roy Tusher, Mizanur Rahman, Ryley C. Harris

Political Science & Geography Faculty Publications

Fine particulate matter (PM_2.5) is associated with adverse impacts on ambient air quality and human mortality; the situation is especially dire in developing countries experiencing rapid industrialization and urban development. This study assessed the spatio-temporal variations of PM_2.5 and its health impacts in the South Asian region. Both satellite and station-based data were used to monitor the variations in PM_2.5 over time. Additionally, mortality data associated with ambient particulate matter were used to depict the overall impacts of air pollution in this region. We applied the Mann–Kendall and Sen’s slope trend analysis tool to investigate the …

Modeling Spatial Access To Healthcare, Yaxiong Shao

Graduate Research Theses & Dissertations

Health disparity has been a persistent concern in the United States, and the COVID-19 pandemic has brought more attention to this ongoing challenge. Improving access to healthcare is a crucial step toward achieving health equity and starts with accurately measuring and portraying the existing landscape of access to healthcare. Even though numerous spatial accessibility models have been proposed to measure the spatial accessibility to healthcare, many gaps still exist. The main purpose of this dissertation is to develop novel models and leverage recently available datasets for a more accurate portrayal of true spatial accessibility. Three models were developed to address …

Expanding Medicaid To Reduce Human Immunodeficiency Virus Transmission In Houston, Texas: Insights From A Modeling Study, Francis Lee, Aditya S Khanna, Camden J Hallmark, Richa Lavingia, Marlene Mcneese, Jing Zhao, Melanie L Mcneese, Salma Khuwaja, Babak M Ardestani, Nicholson Collier, Jonathan Ozik, Anna L Hotton, Nina T Harawa, John A Schneider, Kayo Fujimoto

Faculty, Staff and Student Publications

CONTEXT: Medicaid expansion has been nationally shown to improve engagement in the human immunodeficiency virus (HIV) treatment and prevention continua, which are vital steps to stopping the HIV epidemic. New HIV infections in the United States are disproportionately concentrated among young Black men who have sex with men (YBMSM). Houston, TX, is the most populous city in the Southern United States with a racially/ethnically diverse population that is located in 1 of 11 US states that have not yet expanded Medicaid coverage as of 2021.

METHODS: An agent-based model that incorporated the sexual networks of YBMSM was used to simulate …

A Coalition-Driven Examination Of Organization Capacity To Address Food Insecurity In Greater Houston: A Qualitative Research Study, Jemima C John, Jennifer Gonzalez, Sara-Grace Chan, Heidi Mcpherson, Jennifer N Aiyer, Esperanza Galvan, Nicole Browning, Shreela V Sharma

Faculty, Staff and Student Publications

BACKGROUND: Economic and social hardships have worsened food insecurity, particularly among low income and racial-ethnic minority groups. Given the core goal of the 150+ member Houston Health Equity Collective (HEC) to reduce food insecurity by 5% in 2025, we explored member organizations' capacity and challenges faced in screening and responding to food insecurity through care coordination efforts.

METHODS: A twice-administered Qualtrics XM survey (Provo, Utah) with 76 organizations, followed by five focus groups with 22 of these organizations, explored reach and response efforts to food insecurity. Qualitative assessments lasted between 0.5 to 1.5 h, were audio-recorded, cleaned, coded, and thematically …

Using Implementation Mapping To Increase Uptake And Use Of Salud En Mis Manos: A Breast And Cervical Cancer Screening And Hpv Vaccination Intervention For Latinas, Lara S Savas, Preena Loomba, Ross Shegog, Angelita Alaniz, Crystal Costa, Emily Adlparvar, Marlyn A Allicock, Roshanda Chenier, Margaret Goetz, Christine M Markham, Maria E Fernandez

Faculty, Staff and Student Publications

BACKGROUND: Despite CDC recommendations for breast and cervical cancer screening and HPV vaccination, cancer control behaviors are underutilized among low-income Latinas.

METHODS: We used Implementation Mapping to create SEMM-Dissemination and Implementation Assistance (SEMM-DIA), a set of implementation strategies designed to support implementation and maintenance of SEMM in clinic settings. Specifically, we used Implementation Mapping's five iterative tasks to guide the use of theories and frameworks, evidence, new data, and stakeholder input to develop strategies to accelerate and improve implementation fidelity, reach, and maintenance of the SEMM intervention. The resulting implementation mapping logic model also guides the SEMM-DIA evaluation plan to …

Health-Related Quality Of Life And Recovery Capital Among Recovery Residents Taking Medication For Opioid Use Disorder In Texas, Elizabeth O Obekpa, Sheryl A Mccurdy, Vanessa Schick, Christine M Markham, Kathryn R Gallardo, Johnny Michael Wilkerson

Faculty, Staff and Student Publications

BACKGROUND: Recovery from opioid use disorder (OUD) includes improvements in health-related quality of life (HRQOL) and is supported by recovery capital (RC). Little is known about RC and HRQOL among recovery residents taking medication for OUD. We described HRQOL and RC and identified predictors of HRQOL.

METHODS: Project HOMES is an ongoing longitudinal study implemented in 14 recovery homes in Texas. This is a cross-sectional analysis of data from 358 participants' on HRQOL (five EQ-5D-5L dimensions-mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and RC (Assessment of Recovery Capital scores) collected from April 2021 to June 2023. Statistical analyses were conducted …

Understanding The Implications Of Under-Reporting, Vaccine Efficiency And Social Behavior On The Post-Pandemic Spread Using Physics Informed Neural Networks: A Case Study Of China, Samiran Ghosh, Alonso Ogueda-Oliva, Aditi Ghosh, Malay Banerjee, Padmanabhan Seshaiyer

Faculty, Staff and Student Publications

In late 2019, the emergence of COVID-19 in Wuhan, China, led to the implementation of stringent measures forming the zero-COVID policy aimed at eliminating transmission. Zero-COVID policy basically aimed at completely eliminating the transmission of COVID-19. However, the relaxation of this policy in late 2022 reportedly resulted in a rapid surge of COVID-19 cases. The aim of this work is to investigate the factors contributing to this outbreak using a new SEIR-type epidemic model with time-dependent level of immunity. Our model incorporates a time-dependent level of immunity considering vaccine doses administered and time-post-vaccination dependent vaccine efficacy. We find that vaccine …

Fakestack: Hierarchical Tri-Bert-Cnn-Lstm Stacked Model For Effective Fake News Detection, Ashfia Jannat Keya, Hasibul Hossain Shajeeb, Md Saifur Rahman, M F Mridha

Faculty, Staff and Student Publications

False news articles pose a serious challenge in today's information landscape, impacting public opinion and decision-making. Efforts to counter this issue have led to research in deep learning and machine learning methods. However, a gap exists in effectively using contextual cues and skip connections within models, limiting the development of comprehensive detection systems that harness contextual information and vital data propagation. Thus, we propose a model of deep learning, FakeStack, in order to identify bogus news accurately. The model combines the power of pre-trained Bidirectional Encoder Representation of Transformers (BERT) embeddings with a deep Convolutional Neural Network (CNN) having skip …

Age And Sex-Specific Stroke Epidemiology In Covid-19, Youngran Kim, Maria A Parekh, Xiaojin Li, Yan Huang, Guo-Qiang Zhang, Bharti Manwani

Faculty, Staff and Student Publications

BACKGROUND: COVID-19 has emerged as an independent risk factor for stroke. We aimed to determine age and sex-specific stroke incidence and risk factors with COVID-19 in the US using a large electronic health record (EHR) that included both inpatients and outpatients.

METHODS: A retrospective cohort study was conducted using individual-level data from Optum

RESULTS: Of 387,330 COVID-19 patients, 2,752 patients (0.71%, 95% CI 0.68-0.74) developed stroke during the 180-day follow-up, AIS in 0.65% (95% CI 0.62-0.67), and ICH in 0.11% (95% CI 0.10-0.12). Of strokes among COVID-19 patients, 57% occurred within 3 days. Advanced age was associated with a substantially …

Understanding The Influence Of Atomizing Power On Electronic Cigarette Aerosol Size And Inhalation Dose Estimation, Jinho Lee, Wei-Chung Su, Inkyu Han

Faculty, Staff and Student Publications

Although many studies have estimated the inhalation dose of aerosols emitted from electronic cigarettes (e-cigs), the association between the atomizing power and inhalation dose of e-cig aerosols has not been fully examined. The aim of this study was to determine the mass and inhalation doses of e-cig aerosols and their association with the atomizing power of vaping devices. Size-segregated aerosol masses were collected using an 11-stage cascade impactor and the deposition dose in the human respiratory tract was estimated using the size-segregated aerosol mass. The results showed that an increase in atomizing power was positively associated with the amount of …

Association Of The Gut Microbiome With Kidney Function And Damage In The Hispanic Community Health Study/Study Of Latinos (Hchs/Sol), Brandilyn A Peters, Qibin Qi, Mykhaylo Usyk, Martha L Daviglus, Jianwen Cai, Nora Franceschini, James P Lash, Marc D Gellman, Bing Yu, Eric Boerwinkle, Rob Knight, Robert D Burk, Robert C Kaplan

Faculty, Staff and Student Publications

BACKGROUND: The gut microbiome is altered in chronic kidney disease (CKD), potentially contributing to CKD progression and co-morbidities, but population-based studies of the gut microbiome across a wide range of kidney function and damage are lacking.

METHODS: In the Hispanic Community Health Study/Study of Latinos, gut microbiome was assessed by shotgun sequencing of stool (

RESULTS: Higher eGFR was associated with overall gut microbiome composition, greater abundance of species from Prevotella, Faecalibacterium, Roseburia, and Eubacterium, and microbial functions related to synthesis of long-chain fatty acids and carbamoyl-phosphate. Higher UAC ratio and CKD were related to lower gut microbiome diversity and …

Examining Neighborhood-Level Hot And Cold Spots Of Food Insecurity In Relation To Social Vulnerability In Houston, Texas, Ryan Ramphul, Linda Highfield, Shreela Sharma

Faculty, Staff and Student Publications

Food insecurity is prevalent and associated with poor health outcomes, but little is known about its geographical nature. The aim of this study is to utilize geospatial modeling of individual-level food insecurity screening data ascertained in health care settings to test for neighborhood hot and cold spots of food insecurity in a large metropolitan area, and then compare these hot spot neighborhoods to cold spot neighborhoods in terms of the CDC's Social Vulnerability Index. In this cross-sectional secondary data analysis, we geocoded the home addresses of 6,749 unique participants screened for food insecurity at health care locations participating in CMS's …

The Impact Of A Parent-Only Pediatric Obesity Intervention Program On Quality Of Life In Racially Diverse Children, Taylor Vashro

Theses and Dissertations

Pediatric obesity has been associated with significant decrements in pediatric quality of life (QOL) comparable with severe pediatric diseases such as cancer. Parenting interventions have yielded health benefits for children with obesity; however, few studies have investigated the impact of parent-focused interventions on QOL in children with overweight and obesity. This study investigated the impact of a 6-week intensive parenting intervention program on the QOL of 5-12 year old, predominantly Black children with overweight and obesity. Parents were randomized into either the parenting intervention (NOURISH+) or a control group, and QOL, as well as variables related to child and parenting …

Sexual Reproductive Healthcare: Reproductive Autonomy, Access Inequity And The Call For Service Expansion, Elizabeth Johnson

DSW Capstone Projects

Sexual Reproductive Healthcare (SRH) is a key component of not only women’s healthcare but healthcare for every one of every age. SRH impacts not only physical health and social emotional well-being but foundations of families, communities and society including the economic impacts and the challenges of inequity. By examining the history of sexual reproductive health care, including advances in access and subsequent barriers, funding and lack thereof, the impact bias in obtaining care and the ever-changing law, policies and regulations impacting care this Capstone highlights the current yet ever changing status of sexual reproductive health care in the United States. …

Assessing Pandemic Preparedness, Response, And Lessons Learned From The Covid-19 Pandemic In Four South American Countries: Agenda For The Future, Andrea Ramírez Varela, Michael Touchton, J Jaime Miranda, Juliana Mejía Grueso, Rachid Laajaj, Gabriel Carrasquilla, Martha Vives Florez, Ana María Vesga Gaviria, Ana María Ortiz Hoyos, Esteban Orlando Vanegas Duarte, Alejandra Velásquez Morales, Nubia Velasco, Silvia Restrepo Restrepo

Faculty, Staff and Student Publications

INTRODUCTION: The COVID-19 pandemic emerged in a context that lacked adequate prevention, preparedness, and response (PPR) activities, and global, regional, and national leadership. South American countries were among world's hardest hit by the pandemic, accounting for 10.1% of total cases and 20.1% of global deaths.

METHODS: This study explores how pandemic PPR were affected by political, socioeconomic, and health system contexts as well as how PPR may have shaped pandemic outcomes in Argentina, Brazil, Colombia, and Peru. We then identify lessons learned and advance an agenda for improving PPR capacity at regional and national levels. We do this through a …

Genetic Associations Between Sleep Traits And Cognitive Ageing Outcomes In The Hispanic Community Health Study/Study Of Latinos, Yuan Zhang, Michael Elgart, Einat Granot-Hershkovitz, Heming Wang, Wassim Tarraf, Alberto R Ramos, Ariana M Stickel, Donglin Zeng, Tanya P Garcia, Fernando D Testai, Sylvia Wassertheil-Smoller, Carmen R Isasi, Martha L Daviglus, Robert Kaplan, Myriam Fornage, Charles Decarli, Susan Redline, Hector M González, Tamar Sofer

Faculty, Staff and Student Publications

BACKGROUND: Sleep phenotypes have been reported to be associated with cognitive ageing outcomes. However, there is limited research using genetic variants as proxies for sleep traits to study their associations. We estimated associations between Polygenic Risk Scores (PRSs) for sleep duration, insomnia, daytime sleepiness, and obstructive sleep apnoea (OSA) and measures of cogntive ageing in Hispanic/Latino adults.

METHODS: We used summary statistics from published genome-wide association studies to construct PRSs representing the genetic basis of each sleep trait, then we studied the association of the PRSs of the sleep phenotypes with cognitive outcomes in the Hispanic Community Healthy Study/Study of …

Pregnancy-Related Covid Worry, Depressive Symptom Severity, And Mediation Through Sleep Disturbance In A Low-Income, Primarily Latinx Population In California’S Central Valley, Jennifer N Felder, Patience A Afulani, Kimberly Coleman-Phox, Serwaa S Omowale, Charles E Mcculloch, Lauren Lessard, Miriam Kuppermann

Faculty, Staff and Student Publications

Purpose: This study (1) assessed the psychometric properties of a pregnancy-related COVID worry scale, (2) explored variations in pregnancy-related COVID worry over the course of the pandemic, and (3) examined associations between pregnancy-related COVID worry and depressive symptom severity, and evaluated sleep disturbance as a mediator.

Methods: Data were drawn from an ongoing randomized trial comparing the effectiveness of two enhanced forms of prenatal care. The current analysis includes baseline pre-randomization data collected from participants who enrolled November 2020-November 2021 (n = 201). Participants were pregnant individuals with low income and primarily Latinx.

Results: Our 7-item scale was valid and …

Maternal Perceptions Of Vaccinating Boys Against Human Papillomavirus (Hpv) In Seoul, South Korea: A Descriptive Exploratory Qualitative Study, Jihye Choi, Christine Markham, Irene Tamí-Maury, Sooyoun Kim, Paula Cuccaro

Faculty, Staff and Student Publications

Human Papillomavirus (HPV) vaccination is of paramount importance to reduce HPV-associated cancers in both genders. In South Korea, the prophylactic vaccine is recognized as prevention of cervical cancer with little attention given to male HPV vaccination. The purpose of this study was to explore perceptions of male HPV vaccination and underlying factors for vaccine hesitancy among mothers of unvaccinated boys in Seoul, Korea using a qualitative method. We used a purposive sampling strategy to recruit mothers of unvaccinated middle school-aged boys living in one of the 25 districts in Seoul, supplemented by a snowball sampling approach. We conducted one-on-one telephone …

Personal Hardiness As An Unexamined Component Of The Healthy Volunteer Effect, Angelique E. Blann

Walden Dissertations and Doctoral Studies

Clinical trials are the standard for approving medicines for public use. To conduct trials, researchers depend on a declining number of volunteers. The healthy volunteer effect, a phenomenon in which participants demonstrate better outcomes than their peers, limits the generalizability of trial outcomes. The healthy volunteer effect does not fully explain the outcome difference between volunteers and nonvolunteers. The purpose of this cross-sectional quantitative study was to examine personal hardiness as an unexplored component of the healthy volunteer effect and determine whether personal hardiness is associated with willingness to participate. Hardiness was a personality construct that represented resilience to stress. …