Public Health Commons^™

Increasing Implementation Of The Comfortable Cafeteria Program To Promote School-Age Children’S Mental Health And Well-Being, Reinecka Mondesir, Angela Labrie Blackwell Phd, Otr

Summer 2025 OTD Capstone Symposium

Every Moment Counts (EMC) is a positive mental health promotion initiative that offers several initiatives to create inclusive environments that support student participation and emotional well-being throughout the school day. Comfortable Cafeteria, part of EMC, fosters positive mealtime experiences supporting peer interaction, emotional regulation, and inclusion. Many SBOT practitioners lack the resources to implement Comfortable Cafeteria, despite its benefits. This capstone project addresses the need for practical tools to help school-based occupational therapy (SBOT) practitioners integrate the Comfortable Cafeteria program into daily practice. Using the Multi-Tiered System of Supports (MTSS) framework, the project developed and disseminated an interactive, evidence-based video …

Addressing Psychosocial Barriers To Participation In People Experiencing Homelessness: An Occupational Therapy Workshop, Preston Bender, Steven M. Gerardi, Lacey Spark

Summer 2025 OTD Capstone Symposium

Despite the occupational therapy (OT) profession's emphasis on holistic, person-centered care, many OT practitioners and students report feeling a lack of self-efficacy and preparedness to navigate the complex psychological, social, and systemic barriers that hinder occupational participation in people experiencing homelessness (PEH). This capstone project aimed to address the perceived unpreparedness among clinicians through the creation of an 8-hour interactive educational workshop aligned with Experiential Learning Theory. The content is grounded in the Model of Human Occupation (MOHO) and informed by the Bridging the Transition from Homelessness: A Social Justice Framework (BTTF), trauma-informed care (TIC), harm reduction, and diversity, equity, …

Differential Mirna Expressions Linking Environmental Risk Factors To Triple-Negative Breast Cancer Stages At Diagnosis, Amjila Bam, Yawen Hu, Xiaocheng Wu, Meng Luo, Nubaira Rizvi, Luis Del Valle, Arnold H. Zea, Fokhrul Hossain, Denise Moore Danos, Jovanny Zabaleta, Augusto Ochoa, Lucio Miele, Edward Trapido, Qingzhao Yu

School of Public Health Faculty Publications

Background/Objectives: Triple negative breast cancer (TNBC) is an aggressive, molecularly heterogeneous subtype of breast cancer, accounting for approximately 10–15% of all cases. While reproductive and metabolic factors contribute to breast cancer development, growing concerns about environmental exposures, alongside biological and socio-cultural influences, underscore the need for targeted prevention strategies across diverse populations. Despite increasing evidence linking biological, socioeconomic, and environmental factors to TNBC outcomes, the molecular mechanisms underlying these relationships remain poorly understood. Micro-RNAs (miRNAs), which regulate gene expression and play critical roles in cancer development, have emerged as potential mediators between environmental exposures and TNBC progression. The goal of …

Associations Between Social Drivers Of Health And Breast Cancer Stage At Diagnosis Among U.S. Black Women, Mollie Barnard, Bo Qin, Marc Emerson, Etienne Holder, Matthew Dunn, Shromona Sarkar, Nuo Xu, Yutong Li, Christine Ambrosone, Elisa Bandera, Julie Palmer, Melissa Troester, Terry Hyslop

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

U.S. Black women have disproportionately high breast cancer mortality, partly due to later-stage diagnoses. We examined how social drivers of health (SDOH) relate to stage at diagnosis by analyzing data from 4,995 breast cancer survivors in the Black Women's Health Study, Carolina Breast Cancer Study, and Women's Circle of Health Studies. SDOH were self-reported and stage was ascertained from medical records. We used polytomous logistic regression to estimate odds ratios (ORs) for diagnosis at stages III/IV or II versus stage I (referent), adjusting for age, insurance status, and income. Meta-analyzed results indicated that underutilization of screening mammography (OR = 3.21, …

Intergenerational Family Dynamics Among Caregivers And Children’S Social-Emotional Development In China, Weiman Xu

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

The early years of a child’s life are pivotal for social-emotional development. While extensive research has explored the role of family settings in fostering children's social-emotional development (Bornstein, 2005), the impact of grandparental involvement, particularly the caregiving dynamics between generations, remains less well understood. This study aims to fill this gap by examining two critical aspects of intergenerational dynamics among caregivers (i.e. parent-grandparent coparenting and parent-grandparent relationship quality) and their associations with children’s social-emotional development (i.e. social skills and problem behaviors). Two specific aims were delineated: 1) examine the unique contribution of parent-grandparent coparenting, especially the power and authority domain …

Adolescent Online Leisure, Media Literacy, Online Victimization, And Multifaceted Well-Being During Covid-19: The Role Of Parental Support, Yunqi Wang

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

The rapid advancement of the internet and digital technology has provided opportunities for adolescents to conduct leisure activities online on a daily basis. However, research on adolescent technology use and mental health often highlights negative effects without carefully examining the specific mechanisms, which overlooks the complexity of effects of online behaviors on adolescent well-being and the importance of developing adolescents’ media literacy skills. Moreover, despite the crucial role of family dynamics in adolescent development, research on how parental support and involvement might affect adolescent technology use and well-being is still limited. The current study retrieved data from Programme for International …

Resilience Of Interdependent Transportation And Healthcare Systems: A Simulation-Driven Framework Incorporating Social Equity And Facility Optimization, S. Yasaman Ahmadi

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

The overarching goal of this dissertation is to develop an integrated, simulation-driven framework to assess and enhance the resilience of interdependent transportation and healthcare systems before, during, and after natural hazards. By examining how spatial disruptions, social vulnerability, operational constraints, and infrastructure interdependencies affect access to and functionality of hospitals, this research offers a multifaceted evaluation of system performance under stress. This dissertation examines the impact of natural hazards, particularly floods, on the interdependent transportation and healthcare systems. The proposed approach combines and advances GIS-based network analysis, graph-theoretical modeling, and discrete-event simulation to evaluate system performance under different scenarios. The …

The Associations Of Childhood Adversities And Mental Disorders With Suicidal Thoughts And Behaviors - Results From The World Mental Health International College Student Initiative, Philippe Mortier, Xue Yang, Yasmin Altwaijri, Jacob Holdcraft, Nancy Sampson, Yesica Albor, Ahmad Alhadi, Jordi Alonso, Nouf Al-Saud, Lukoye Atwoli

Internal Medicine, East Africa

Objective: To investigate the associations of demographic variables, childhood adversities (CAs), and mental disorders (MDx) with onset, transition, and persistence of suicidal thoughts and behaviors (STB) among first-year university students.

Method: Poisson regression models within a discrete-time survival framework were constructed using web-based self-report survey data from 72,288 incoming university students across 18 countries (response rate=20.9%; median age=19 years, 57.9% female, 1.4% transgender, 21.0% non-heterosexual). These models examined the associations of four demographic variables, five CAs, and eight MDx with STB outcomes.

Results: Lifetime prevalence of suicidal ideation, plans, and attempts was 47.0%, 26.0%, and 9.6%, respectively; 12-month estimates were …

Supporting Autistic Students' Mental Wellness: A Community Readiness Model Approach, Cady Walker

Capstone Experience: Master of Public Health

Autism spectrum disorder or difference (ASD) is a lifelong neurodevelopmental disability, usually identified during childhood. However, many adults miss the opportunity for diagnosis during childhood due to previous misunderstandings about autism presentation, camouflaging behaviors, and misdiagnoses. While current diagnostic tools for assessing autism in children are more robust, similar measures are lacking for adults who were not diagnosed in childhood. This gap poses risks for poor mental health outcomes among adults who missed a timely ASD diagnosis, which can be especially challenging for autistic college students. Although some higher education institutions offer support programs for autistic students, most do not, …

Inequality And Covid Risk At School: Racial Disparities In Indoor Density, Vaccination Rates, And Consequences For Absenteeism, Michael C. Quinn, Michah W. Rothbart, Amy Ellen Schwartz, Brian Elbel

Center for Policy Research

During the COVID pandemic, schools were widely believed to be a venue that facilitated disease transmission. While some worried Black and Hispanic students would disproportionately face greater risk of COVID exposure at school (school COVID risk) – given well-documented racially disparate school environments and resources – little empirical evidence exists documenting or refuting potential disparities in school COVID risk. This paper begins to fill this gap by examining racial disparities in the school environments that contribute to COVID risk at school—specifically, vaccination rates and classroom space per pupil (indoor density) - in New York City elementary schools. We then document …

Temporal And Generational Changes In Depression Among Young American Adults, Ashley W. Kranjac, Dinko Kranjac, Valentine Chung

Sociology Faculty Articles and Research

The prevalence of depression among young American adults has risen significantly over the past two decades, but the mechanisms that underlie the population-level changes in depressive symptoms severity remain unclear. We used data from the 2005–2023 National Health and Nutrition Examination Survey (NHANES) and hierarchical age–period–cohort (HAPC) analysis to examine developmental (i.e., age), life stage (i.e., period), and generational (i.e., cohort) distribution of depressive symptoms among American adults aged 20–30 years old over an 18-year period. Our model results indicate that the probability of either mild, moderate, or severe depression increased among young adult females and males between 2005 and …

A Cancer Education Needs Assessment: Informing Middle-Aged Female Patients About The Relationships Between Obesity And Women’S Health Concerns In The Reproductive System, Breast, And Endometrial Health, Batul Mirza

MUSC Theses and Dissertations

Obesity significantly impacts women’s health, particularly among middle-aged women, by increasing the risk of hormone-sensitive cancers such as breast, endometrial, and reproductive system cancers. This study examines the educational needs of this demographic group regarding obesity-related cancer risks and explores effective intervention strategies. Obesity-induced mechanisms – hormonal imbalances, chronic inflammation, and insulin resistance – drive cancer susceptibility, emphasizing the need for targeted health education. The study employs a qualitative design, which includes interviews with subject matter experts (SMEs) and surveys of middle-aged women. The goal is to assess awareness, perceived barriers, and preferred learning methods. Findings suggest that with many …

Qualitative Insights Into Drug Use Safety Strategies And Social Support Among Sexual Minority Women Who Inject Drugs In Baltimore, Maryland, Jennifer L. Glick, Leanne Zhang, Aimee Huang, Megan Nguyen, Danielle German

School of Public Health Faculty Publications

Background: Sexual minority women (SMW) experience higher rates of substance use relative to heterosexual women in the U.S. but remain an under-studied population. SMW who inject drugs (SMWWID) navigate an unpredictable drug market and may experience complex relationships within their social spheres. We explore cisgender SMWWID’s strategies to maintain safety while injecting drugs, and the influence of their social support systems on those strategies. Methods: We conducted N = 16 phone-based, semi-structured, in-depth interviews with SMWWID in Baltimore, Maryland between June-October 2021. The interviews explored participants’ sexual orientation and gender identities, social networks and support systems, drug use behaviors and …

Co-Design Of A Program For Medical Students’ Experiential Learning In Community-Engaged Research, Daenique H. A. Jengelley, Tess D. Weathers, Dustin O. Lynch, Morgan E. Ness, Luis Garcia, Gina E. Claxton, J. Dennis Fortenberry, Tamara S. Hannon

Journal of Community Engagement and Higher Education

Medical education may lack experiential training on authentic community engagement (CE). Employing a human-centered design approach with medical faculty and students to identify goals, opportunities, needs, and barriers to implementing CE research, we developed an Experiential Community Engagement Learning Series (EXCELS) pilot program. EXCELS supported both our community partners and medical students as a platform from which to learn from each other. EXCELS can be accomplished virtually, incorporated in medical training, and disseminated broadly.

Positively Impacting Traffic Safety Culture For Indigenous Youth: A Heritage-Focused Approach, Jacob Steven Pehrson, Ahmed Abdel-Rahim, Logan Prescott

Journal of Community Engagement and Higher Education

This paper presents the development of heritage-focused outreach materials with the objectives of positively impacting traffic safety culture for Indigenous youth to reduce the number and severity of traffic crashes impacting these communities. The approach presented in this paper includes involving local community leaders in traffic safety education and incorporating culturally based material in outreach education. This could empower Tribal communities to preserve their cultural identities while acquiring the expertise needed to promote traffic safety.

Sociodemographic Influences On Substance Use In Psychosis In An African Cohort, Megan L. Campbell, Raymond Odokonyero, Dickens Akena, Melkam Alemayehu, Lukoye Atwoli, Lori B. Chibnik, Bizu Gelaye, Stella Gichuru, Symon M. Kariuki, Karestan C. Koenen

Internal Medicine, East Africa

Background: Substance use is common among individuals with psychotic disorders, but limited research exists on the variations in substance use across countries in Africa. This study aims to investigate the frequency of alcohol, tobacco, cannabis, and khat consumption in individuals with bipolar disorder (BD) and schizophrenia (SCZ) across four African countries: South Africa, Ethiopia, Kenya, and Uganda.

Methods: We utilized data from the Neuropsychiatric Genetics of African Populations-Psychosis project, a large case-control study which will soon have genetic data on over 42,000 participants, half with psychosis. Information on substance use was collected using the Alcohol, Smoking and Substance Involvement Screening …

Inadequate Healthcare For Women In The United States, Grace Loveless

Journal of Nonprofit Innovation

Barriers to adequate healthcare for women stem from a lack of research on their specific health needs, gender-based biases in healthcare, and harmful societal norms. One key aspect highlighting these disparities is the menstrual cycle—a topic unique to women. Menstrual health, defined as a state of complete physical, mental, and social well-being, illustrates the urgent need for greater focus on reproductive health. Despite its significance, the dialogue and knowledge about reproductive health remain limited; an issue which is exacerbated by societal attitudes of secrecy and shame. These attitudes create barriers that hinder many women in the United States from accessing …

A Call For Change: Supporting Children With Tourette Syndrome, Matt Reall

Journal of Nonprofit Innovation

Tourette Syndrome affects 1 in 100 U.S. children but remains widely misunderstood due to stigma, delayed diagnosis, and media misrepresentation. This neurological disorder is characterized by involuntary tics and often co-occurs with ADHD, anxiety, and sleep disorders. Children with Tourette Syndrome face disproportionate challenges in social, academic, and emotional settings—despite having average or above-average intelligence. One-third engage in self-harm, and suicide rates are four times the national average. Peer-education programs like the Tourette Association of America’s Youth Ambassador initiative have shown promise in reducing stigma, but unequal access and weak institutional support limit their impact. This paper calls for early …

Living Heritage, Resilience And Ethically Informed Infrastructures In Malawi, Martha B. Lerski, Frank Puluputu Mwale

Publications and Research

Rooted in a rural community’s needs, this paper explores how historically, and ethically informed infrastructures can support community engagement towards identification, documentation, and dissemination of local, traditional, and indigenous knowledge relating to climate change. The paper examines climate adaptation and sustainability issues through the lenses of community organizing and Library & Information Science best practices. It draws on a growing body of literature identifying a role for expanded epistemological and subject discipline perspectives. While the impacts of climate on material culture are increasingly recognized, intangible, and biocultural heritage have not received as much attention. Living heritage traditions and knowledge systems …

Increasing Community Members' Engagement In Cancer Research: The Making Research Clear Program, Rebecca J. Melillo, Christiane J. El Khoury, Joshua Blanding-Godbolt, Q. Greene, Karen M. Bussard, Amy Leader

Kimmel Cancer Center Faculty Papers

BACKGROUND: Despite the importance of engaging community members in research, multiple barriers from the perspective of the investigator and community member exist. The Making Research CLEAR (Community Learning and Experience about Research) Program aims to bridge the gap between research conducted at an NCI-designated cancer center and the community.

METHODS: Community members and a cancer center investigator were paired for a 6-month immersive research experience. Community members had at least one research experience per month with their investigator, while also attending cancer center activities such as Institutional Review Board (IRB) meetings, research lectures, protocol review meetings, and community outreach events. …

The Social Standing Versus The Mind Standing Of Older Adults In Egypt: Cross-Sectional Analysis Of The Relationship Between Social Capital And Cognitive Functions, Shaza H. Shinaishen Dr

Theses and Dissertations

Introduction: Egypt's population, much like that of other countries, is expected to age considerably over the course of the coming decades. Although biological and socioeconomic predictors of cognitive function have been studied widely, personal level social capital remains unexplored, especially in LMICs.

Purpose: This study primarily investigates the relationship between individual social capital and cognitive functioning among older adults aged 65 years and older in Egypt using the structural and cognitive components of social capital, including group membership, civic engagements, and caregiving roles.

Methods: A cross-sectional survey on 363 older individuals in different geographical and demographic segments of Egypt using …

Beyond The Genome: The Racialized Exposome, Flourishing, And Stress Biology In African Americans, A Non-Exhaustive Review, Enye Washington

University Honors Theses

Racial health disparities remain an enduring challenge in the United States, disproportionately impacting African American communities through higher rates of chronic disease and premature mortality. This non-exhaustive literature explores how the racialized exposome - a term denoting the totality of social, environmental, and structural stressors rooted in systemic racism - biologically embeds itself via stress-responsive pathways. Specifically, it examines the interaction between racial stress, flourishing, and key biological markers, including allostatic load and telomere length, considering the gut-brain axis. The review highlights robust evidence that chronic exposure to racial discrimination and structural adversity contributes to multisystem dysregulation and accelerated cellular …

Urban-Rural Divide In Inequality’S Impact On Substance Abuse, Jonathan E. Flores

Undergraduate Theses, Capstones, and Recitals

This thesis focuses on investigating the relationship between income inequality, measured through the Gini coefficient, and drug addiction, proxied through substance-related mortality. Specifically, this thesis focuses on how these dynamics vary across rural and urban counties in the United States, using population size as a proxy. County-level data from 2016 to 2020 were collected through both the CDC and the Census Bureau and subsequently analyzed using Stata, with crude death rates from drug and alcohol causes serving as a function of the Gini coefficient, labor force participation, racial composition, and other socioeconomic indicators. Through a quadratic version of the model, …

Enhancing Mental Health Through Mind-Body Exercises In Sedentary Students: A Systematic Review With An Indonesian Perspective, Izmi Alya Khairunnisa, Aditya Denny Pratama

Jurnal Sosial Humaniora Terapan

Sedentary Behavior (SB) among students is associated with increased risks of depression, anxiety, stress, and weakened immune function. According to the WHO, SB contributes to approximately two million deaths each year. This systematic literature review aims to evaluate the effectiveness of mind-body exercises in improving mental health outcomes—specifically stress reduction, anxiety management, and emotional regulation—among students with sedentary lifestyles. Using the PRISMA framework, 2,201 articles were identified from databases including Scopus, PubMed, and ProQuest, with six studies meeting the inclusion criteria. The review found that mind-body exercises such as yoga, tai chi, and pilates significantly reduce stress and anxiety, enhance …

The Effect Of Birthweight And Gestational Age On Cognitive Function In Midlife: The Bogalusa Heart Study, Eunsun Gill, David J Libon, Soo Jung Kang, Ileana De Anda-Duran, Lydia A Bazzano, Wei Chen, Camilo Fernandez-Alonso, Emily W Harville

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Although the relationships between birthweight, gestational age (GA), and cognitive function (CF) before midlife have been demonstrated, the relationships after midlife and potential racial disparities remain inconclusive. This study examined the association between birthweight, GA, and midlife CF stratified by race.

METHOD: 1,032 subjects from the Bogalusa Heart Study (67% Whites, 33% Blacks, mean age 48.1 ± 5.3 years) were studied. Cognition was assessed with tests measuring verbal episodic memory, working memory, attention, graphomotor information processing speed, and global CF. Each test was standardized by sex and age, then averaged. The global CF was computed by averaging all cognitive …

Prevalence And Associated Factors Of Mental And Substance Use Problems Among Adults In Kenya: A Community-Based Cross-Sectional Study, Patrick Nzivo Mwangala, Anita Kerubo, Millicent Makandi, Rachel Odhiambo, Amina Abubakar

Institute for Human Development, East Africa

Data on the burden and determinants of mental and substance use problems among women in urban and rural informal settlements in Kenya is sparse, thus limiting preventive and treatment efforts in these areas. To bridge the gap, we (a) determined the prevalence of depressive, anxiety and post-traumatic stress disorder (PTSD) symptoms and alcohol and drug use problems among women compared to their spouses and (b) examined the correlates of these outcomes. Data collection for this cross-sectional survey was conducted in 2022 in Mombasa, Kwale and Nairobi counties in Kenya. A total of 1528 adults (1048 women) took part. The 9-Item …

Down Syndrome In Africa: Challenges, Opportunities, And Future Directions, Eimear Mcglinchey, Salina Tewolde, Amanda He, Juan Fortea, Lingani Mbakile-Mahlanza, Ayda Tefera, Emmanuel Epenge, Jason Hassenstab, Rachel Maina, Zul Merali

Brain and Mind Institute

INTRODUCTION: As life expectancy improves for people with Down syndrome (DS) in Africa, the risk of developing DS-associated Alzheimer’s disease (DSAD) will rise. There is a pressing need to plan for this emerging challenge, particularly in the context of existing health and social disparities.

METHODS: This work emerged from a pan-African collaboration, including discussions at the Brain Ageing and Dementia in Low- and Middle-Income Countries conference held in Nairobi in 2024, where stakeholders identified regional priorities for DS and dementia care.

RESULTS: Limited epidemiological, cognitive, biomarker data, delayed diagnoses, and gaps in specialized services may impact access …

Ecological Grief Among Farmers And Pastoralists In Ethiopia And Kenya, Syed Shabab Wahid, Christine Musyimi, Benjamin Oestericher, Linda Khakali, Lauren Carruth, Emily Mendenhall, Edna Bosire

Brain and Mind Institute

Climate change is a major cause of mental distress worldwide. In many ways, climate change has become a chronic disaster, while in other ways each acute event can accumulate and present challenges within and between communities. A growing body of evidence indicates that a changing climate can precipitate a cluster of negative affective states scholars call “ecological grief.” Ecological grief reflects psychological responses to climate changes and destruction of nature, species, culturally significant or sacred spaces. Until now, ecological grief has been conceptualized as a psychological response connected primarily to the destruction of the natural environment, and has not fully …

Tobacco, Alcohol, And Poverty In Lao Pdr Based On National Survey Analysis, Robert M. Semakula

Loma Linda University Electronic Theses, Dissertations & Projects

Tobacco and alcohol use are among the most prevalent and harmful addictive behaviors globally, including in the Lao People’s Democratic Republic (Lao PDR). In Southeast Asia and the Western Pacific, substance use patterns are shaped by cultural, social, economic, policyrelated, and environmental factors. This study aimed to: (1) explore associations between different patterns of alcohol and tobacco use among men and women in Lao PDR, and (2) investigate the effect of poverty on the relationship between alcohol and tobacco use. We conducted a secondary analysis of the 2013 Lao National Adult Tobacco Survey (N = 9,706), a nationally representative sample …

The Gender Effects Of Covid: Evidence From Equity Analysts, Frank Weikai Li, Baolian Wang

Research Collection Lee Kong Chian School Of Business

We use COVID-19 and sell-side analysts as an experiment to study the effects of gender on labor productivity. We find that the forecast accuracy of female analysts declined more than that of male analysts, especially when schools were closed and among analysts who were more likely to have young children, were inexperienced, were busier, or lived in southern states of the US. Relative to male analysts, females also reduced their forecast timeliness and resorted to more heuristic forecasts but did not reduce coverage or updating frequency. Relative to pre pandemic, female analysts’ careers were more negatively affected than male analysts’. …