Public Health Commons^™

Degree Assortativity And Estimation Of Degree Distribution In A Contact Network Of People Who Inject Drugs, Peter Geissert

Dissertations and Theses

This dissertation analyzes data from a respondent driven sampling (RDS) study of people who inject drugs in Portland, OR.  The objective was to assess assumptions for the use of weighted estimators to estimate a population physical contact (syringe sharing) network degree distribution.

Visualization of degree distribution for social and physical networks, Kolmogorov-Smirnov tests of difference, and kernel tests of equivalence were used for comparison of distributions. Spearman's rho and GAM non-parametric regression models were used to test for association and assess non-monotonic relationship. The validity of Markov chain assumptions for RDS was assessed using a transition matrix, Markov chain graphs, …

(Re)Claiming Homeplace: Dance As Embodied Resistance & Healing For Health & Spatial Justice, Preeya G. Kannan

University Honors Theses

This thesis argues that dance functions as both an upstream public health intervention and a form of radical spatial resistance; creating healing, agency, and belonging among historically marginalized communities. Drawing on bell hooks' concept of homeplace, Jasbir Puar's assemblage theory, Nancy Krieger's eco-social theory, and Katherine McKittrick's Black geographies, I position the body as both an ecological and political landscape shaped by histories of colonialism, racial capitalism, displacement, and resilience.

Through this community-based participatory research study, Homeplace, I explore dance as a form of social prescription that centers liberation rather than pathology. Movement is often reduced in public health discourse …

Testing Potential Correlations Between Childhood Lead Exposure And Authoritarianism In Adulthood, Kragen Anderson

University Honors Theses

A significant body of research links lead exposure during childhood to negative effects ranging from increased impulsivity to societal level effects such as an increased likelihood of committing violent crime in adulthood. Due to exposure vectors such as lead water pipes, lead solder, lead based paints, and leaded gasoline there was significant lead exposure during childhood for large portions of the American population. This paper tested and found a statistically significant association between average population level lead exposure in childhood and likelihood of voting for candidate Trump later in life.

Healthcare Access Challenges Among Asian Americans, Phyo Theingi

University Honors Theses

Asian Americans are the fastest growing racial ethnic group in the U.S. According to the 2023 U.S. Census Bureau population estimate, Asian Americans account for 25.2 million (or 7.4%) of the nation's population. Asian Americans are not a monolith and represent a diversity of rich histories, cultures, languages and ethnicities. According to research conducted by the Pew Research Center, most Asian Americans face discrimination of some kind, including being treated as a foreigner in the U.S and being stereotyped as a model minority. They also experience health care access barriers. Research found that Asian Americans face barriers related to language …

Aid As Leverage: How Humanitarian Assistance Shapes The Health Power Dynamics In Eastern Democratic Republic Of Congo, Emmanuella K. Mbuyu

University Honors Theses

This paper examines humanitarian aid in the Eastern Democratic Republic of Congo, where it serves as both relief and a force reshaping local power dynamics within ongoing conflict. Humanitarian organizations provide essential services in contexts of state collapse, but aid delivery is deeply embedded in systems of coercion, negotiation, and external influence. Drawing on critical humanitarianism and the aid economy, this study analyzes how humanitarian access is negotiated, how donor priorities shape definitions of need, and how temporary interventions create dependency and instability. The paper explores how humanitarian action can reinforce alternative structures of authority, particularly in weak or absent …

Understanding Moral Injury In Emergency Department Clinicians: Predictors, Outcomes, And Evidence Gaps, Rose Doering Lightspeed

University Honors Theses

Moral injury (MI) is an emerging construct for understanding clinician distress in high-acuity healthcare settings, yet its application to Emergency Department (ED) clinicians remains limited. MI refers to psychological distress resulting from exposure to, or participation in, situations that conflict with deeply held moral or ethical standards, often due to systemic or organizational constraints. Although prior research has examined MI in heterogeneous healthcare samples, the ED remains underexamined despite its unique combination of high patient acuity, throughput pressure, and resource limitations.

This review synthesizes literature on MI among healthcare workers with a focus on ED clinicians, drawing on Industrial-Organizational psychology …

The Gut Microbiome, The Gut-Brain Axis, And College Student Well-Being, Idi Mckay

University Honors Theses

This literature review examines how diet, stress, environmental exposure, and food accessibility may influence college students' mental health and academic performance through the gut microbiome and the Gut-Brain Axis (GBA). Current microbiome research often focuses on early childhood development, clinical disease populations, or older adults, while overlooking college-age students who experience significant social, environmental, and biological transitions. College students frequently face food insecurity, irregular eating patterns, chronic stress, inconsistent sleep schedules, and reduced access to nutrient-dense foods, all of which may influence microbial diversity and overall gut health.

This thesis explores how modern campus environments and lifestyle factors may contribute …

How Do Us States Define Person-Centered And Family-Involved Care In Assisted Living Regulations, Paula Carder, Lindsey Smith, Jennifer N. Bunker, Cassandra L. Hua, Erh-Chi Hsu, Isabelle Boun, Olivia M. Ainsworth, Kali S. Thomas, Eric Jutkowitz

Institute on Aging Publications

Introduction: A large share of assisted living (AL) residents have a diagnosis of dementia or cognitive impairment, and these individuals can benefit from person-centered care and family-involved care. This study examines whether and how states’ AL licenses address these topics.MethodsThis research analyzed a national database of 249 unique licensing requirements that govern 35,602 ALs in all states and associated regulations, including those that govern memory care (MC) services. We reviewed each regulation for the presence of person-centered or family involved care and then used content analysis of license requirements with at least one relevant policy to identify key categories and …

Social Determinants As A Predictor For Heart Disease Mortality: Oregon Regional Study, Jewel Jones

University Honors Theses

The study examined the association between selected social determinants of health and heart disease mortality across geographic regions in Oregon. Using a regional analysis design, county-level population and mortality data were grouped into nine geographic regions to evaluate patterns of cardiovascular disease burden across the state. Social determinant variables were obtained from publicly available U.S. Census Bureau datasets and included poverty, crowding among households, single-parent households, lack of broadband internet subscription, housing cost burden, high school diploma attainment, and unemployment.

Heart disease mortality counts per 100,000 population were derived from official birth and death certificate records. Statistical analyses were conducted …

Geographic And Systemic Disparities In Maternal Health: A Systems Analysis Of Prenatal Care Access Across Rural Oregon, Cecelia Petrik

University Honors Theses

Objectives: In Oregon, 51% of hospitals providing labor and delivery services are located in rural areas. Consolidation of these hospitals and provider shortages has created severe geographic and systemic disparities in maternal healthcare. This thesis explores how geographic isolation and inadequate prenatal care access contribute to widening disparities in severe maternal morbidity (SMM) and mortality across Oregon's rural and frontier counties.

Methods: This study utilizes data from the Oregon Health Authority (OHA) Center for Health Statistics (2024) and analyzes spatial correlations across all 36 Oregon counties. A bivariate choropleth map was constructed to examine the structural intersection between health infrastructure …

Moving Beyond Traditional Cost Containment For Glp-1 Coverage Within Oregon's Proposed Universal Health Plan, Manoj Rajesh

University Honors Theses

In 2022, Oregon voters passed Measure 111, constitutionally mandating access to affordable health care. As the Universal Health Plan Governance Board (UHPGB) designs the state's proposed single-payer system, it faces an unprecedented financial vulnerability: the clinical demand for GLP-1 receptor agonists. These high-cost, indefinite-use medications for obesity and metabolic syndrome threaten to overwhelm fixed public budgets. Historically, both the Oregon Health Plan's Medicaid framework and commercial private insurers have relied on static cost-containment models—categorical exclusions, step therapy, and aggressive utilization management—that achieve short-term fiscal solvency at the expense of comprehensive preventative care. This thesis argues that to fulfill the mandate …

Navigating Homelessness And Housing Accessibility: An Ethnography Of Guests At Operation Nightwatch, Chase Kawika Patton

Dissertations and Theses

In 2025, over 7,000 individuals in Portland, Oregon experiencing unsheltered homelessness are without access to shelter or transitional housing. In this resource gap Operation Nightwatch (ON) provides material support for people experiencing homelessness (PEH) in the University District neighborhood of downtown Portland. This study focused on the experiences of chronically homeless guests of Nightwatch as they navigated homelessness and housing access. The study relied on semi-structured interviews with staff and guests and on-site participant observation to determine the availability of support to access housing in a system governed by Coordinated Access and the Housing First model. Primary research took place …

Medicaid Funding And Health-Related Social Needs: A Policy Analysis, Passion Ilea

Dissertations and Theses

The U.S. has disproportionately high health care spending compared to other high-income nations and comparatively poor health outcomes. The Centers for Medicare and Medicaid Services (CMS) have recently increased emphasis on addressing Medicaid member social needs. CMS believes addressing health-related social needs (HRSN) may reduce costs and improve health outcomes for Medicaid members. CMS has begun to test theories regarding the impact of member HRSN on health care by designing federal mechanisms to address HRSN, such as in lieu of services and settings-funded services, and by encouraging state Medicaid programs to develop their own approaches, such as Flexible Services. Information …

Understanding The U.S. Maternal Healthcare System At The Intersection Of Asian American Birth Outcomes And The Model Minority Stereotype: A Literature Review, Sophia Hevel

University Honors Theses

This thesis aims to explore the maternal healthcare system in the United States as it pertains to Asian American birthing people, the ways in which their racial, ethnic, and cultural identities are interacted with within the U.S. Healthcare system, and subsequently the detrimental effects of the medical system's devaluation of culturally specific birthing and postpartum practices have on Asian American birthing experiences. This will be accomplished through an exploration of the United States' maternal healthcare system, or rather, its crisis; how Asian Americans navigate a system that has not been structured to support their specific needs; and lastly, a discussion …

Applying The One Health Approach To Study The Policy And Institutional Determinants To Control And Prevent Zoonoses In A Low-Resource Setting, Lisset Dumet, Erin S. Kenzie, Veronika Merino, Vanessa Cruz, Ruth Atto, Percy Vilchez, Seth O'Neal, Julia Goodman

OHSU-PSU School of Public Health Faculty Publications and Presentations

Zoonoses - diseases transmitted between animals and people - disproportionally affect low-resource countries (LRCs). The complex nature of zoonoses adds substantial barriers to implementing multisectoral policies to address them. Research on the policy process could help illuminate the significant factors influencing policy change among the complex systems involved in managing zoonoses. We applied the One Health (OH) approach to describe the policy process among the systems involved in preventing and controlling zoonoses in Peru. The study's purpose is to (1) describe the priority-making process and the driving or limiting factors, (2) describe the process for selecting policy solutions and (3) …

Honoring Childhood Agency In Developmental Research: Best Practices, Applications, And Insights, Amanda N. Howery, Olivia J. Lashley, Hanna R. Wright, Julia L. Williams, Olivia K. Nomura, Eline Lenne, Elizabeth K. Wood, Hanna C. Gustafsson, Elinor L. Sullivan

School of Social Work Faculty Publications and Presentations

Pediatric research requires caregivers to provide informed consent on behalf of their children. While not a formal requirement for children under the age of seven, it is important to involve child participants in the assent and decision-making processes in developmentally appropriate ways. This is especially important in longitudinal research, where the extent to which a developing child understands study tasks evolves over time. Although there is consensus that assent procedures are important and necessary, limited resources synthesizing strategies for pediatric researchers to encourage positive and respectful research experiences for young children exist. We describe methods used in an ongoing longitudinal …

The Answer To Perimenstrual Distress Is Not Automatically Prescription: Review Of Allopathic And Integrative Approaches To Mental Health Care For Pms & Pmdd Symptoms, Grace Oja

University Honors Theses

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) affect a notable percentage of people who menstruate. PMS/PMDD have a wide range of symptoms that negatively impact mental well-being and quality of life. This review is the culmination of a database search to review current allopathic treatments for PMS/PMDD, which often include oral contraceptives and antidepressants, and explore evidence-based methods for integrative and alternative treatments to address some of the limitations of standard allopathic care, including limitations on which symptoms they address and side effects. This paper aims to examine how integrative medicine may expand existing treatments for PMS and PMDD …

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 …

How Do Montessori-Based Activities Affect Behaviors For Older People With Dementia: A Literature Review, Isabel Quigley

University Honors Theses

Objectives: This literature review is meant to analyze the development on the research on Montessori-based activities for adults with dementia.

Introduction: Baby Boomers are the largest generation to enter senior age (65+) in history due to the advancement in medicine to increase life expectancy. Dementia is a neurocognitive disease that affects parts of the brain related to memory and signs typically surface around 65 years old. Dementia is not considered healthy aging. Montessori-based activities have been recently developed as an intervention to encourage a feeling of accomplishment and success for adults with dementia.

Methods: Two electronic databases …

How Different Forms Of Exercise Affect Bone Mineral Density In Postmenopausal Women, Jonathan Mccanless

University Honors Theses

This paper analyzed 20 studies to understand how bone health in postmenopausal women is impacted by different forms of exercise. The primary aspect of bone health examined in this paper is bone mineral density (BMD). Resistance and impact training demonstrated clear signs of maintenance and increases in BMD, particularly in the lumbar spine and femoral neck. Aquatic exercise demonstrated mixed results in positively impacting BMD in a significant way, but it’s worth noting that there were still some signs of increased BMD. Impact exercise on its own can maintain BMD, and these effects can be seen in total hip BMD. …

One Health Integration To Control And Prevent Zoonoses: Application Of Organizational Theory Literature, Lisset M. Dumet Poma, Sherril Gelmon, Julia M. Goodman, Seth E. O’Neal

Hatfield Graduate Journal of Public Affairs

Zoonoses are infectious diseases transmitted between animals and people that disproportionately affect low- and middle-income countries (LMICs). The One Health (OH) approach aims to integrate systems, incentivizing collaboration among animal, human, and environmental systems to address zoonoses and improve health. Innovative solutions for effectively and sustainably achieving systems integration are needed. Organizational theories can facilitate the study of the context of OH implementation, applying comprehensive approaches that recognize the interconnections among organisms, the environment, and social systems, including the diverse entities needing integration (e.g., policy, community, public organizations). This narrative review examines organization and systems literature to provide recommendations for …

Adolescent Preventive Care Outcomes Before And After Covid-19 Onset: What Is The Role Of Telehealth?, Sarah Hayden Knipper

Dissertations and Theses

Adolescents are a developmentally distinctive population with unique primary health care needs; they comprise about 10% of Oregon's population and more than half are covered by the Oregon Health Plan (OHP). This dissertation investigated significant declines in preventive care utilization (well visits and HPV immunizations) among adolescents enrolled in OHP during the COVID-19 pandemic and the relationship between the decline in utilization and the rise in telehealth availability. The study focused specifically on the role of race/ethnicity, geography, and access to health systems in mitigating or exacerbating decreases in preventive care. A mixed methods approach was employed to understand not …

Exploring Muslim American Attitudes Toward Genetic Testing: Perceptions, Barriers, And Ethical Considerations, Hannah Mahmoud

University Honors Theses

This thesis explores perceptions and attitudes toward genetic testing within the Muslim American community, a group often underrepresented in genomic research and public health discourse. Using a community-distributed digital survey, data was collected from 50 self-identified Muslim Americans on their familiarity with genetic testing, reproductive and ethical considerations, and the influence of religious factors. While only 18% had undergone genetic testing themselves, many were familiar through family or friends, and most expressed cautious interest—especially when results could influence future family planning. Education level, age, and religious values shaped both comfort and understanding.

A key theme was the desire for culturally …

Forecasting Influenza Rates Using Machine Learning: A Study Of Chatgpt's Predictive Accuracy, Sara Saleh

University Honors Theses

This study evaluates ChatGPT's ability to forecast influenza rates, such as the number of flu cases, hospitalizations, and death during peak season periods using CDC data, and comparing forecasts against actual results to calculate statistical accuracy and consistency. Influenza forecasting is essential for public health planning, but traditional methods may not always provide timely or accurate predictions. In this research study, ChatGPT was utilized to predict the influenza rates for the following week based on the previous week's data obtained from the FluView surveillance system. The predicted rates were compared to the actual influenza rates to assess the model's overall …

Assessing The Challenges Latin Immigrant Populations Face In Accessing Healthcare And Proposing Solutions To Improve Accessibility, Melina Khiabani

University Honors Theses

Access to healthcare is considered a basic human right, yet many Hispanic and Latin immigrant populations in the United States, especially those living in rural areas, face significant barriers that prevent them from receiving the care they need. These barriers include language differences, cultural misunderstandings, financial hardship, fear of legal consequences, and geographic isolation. This literature review explores the challenges that Hispanic/Latin immigrants aged 19-25 in rural areas encounter when trying to access healthcare, particularly preventative services.

Drawing from a wide range of existing research, this thesis identifies how policy restrictions, social determinants of health, and systemic discrimination contribute to …

Structure Vs Agency: The Intersectionality Of Race, Mental Health, And Homelessness, Jayley Martin

University Honors Theses

This project investigates the intersectionality between race, mental health, and homelessness, emphasizing the dynamic interplay between structural factors and individual characteristics. Through an integrative literature review, the research addresses the question of how race, mental health, and homelessness are interconnected. The findings suggest a distinct relationship between untreated mental illness and an increased risk of homelessness, particularly among marginalized racial groups. In addition, some mental illnesses, such as anxiety and depression, have a higher incidence among those who face conflict due to racial discrimination. Structural components such as systemic racism in social services and healthcare practices significantly impact access to …

A Comprehensive Literature Review Of Gender Differences In Perception And Response To Stress, Zoe M. Shankland

University Honors Theses

It is well established that psychological stress, whether acute, chronic, or recurring, creates an imbalance in the body’s ability to regulate itself, leading to the potential for long-term disease. This paper looks at the possibility that women (anyone who identifies as a woman) experience more general mental stress than men (anyone who identifies as a man) due to women experiencing unique stressors under a patriarchal society. Men and women live different lives in modern society due to differing societal expectations and biological processes for women (menstruation, pregnancy, menopause). These extra feelings of stress may be tied to traditional gender roles …

Digesting The Details: How Cooking Shapes The Microbiome And Influences Obesity, Tracy Lieu

University Honors Theses

Obesity is a growing global health concern linked to chronic diseases and changes in the gut microbiome. While diet is known to affect gut microbes, less attention has been given to how food processing methods, such as heating, fermentation, and cold processing, change food in ways that influence the gut microbiome and health. This thesis reviews research on how different cooking and preparation techniques affect the availability of nutrients for microbial fermentation and the resulting effects on microbial diversity and metabolism. The findings show that fermentation and cold processing are the most supportive of gut health. These methods help preserve …

Access To Healthcare For Rural Transgender Adults In The United States, Devon Smith

University Honors Theses

Urban and rural healthcare differ significantly in the amount of facilities, providers and kinds of specialty care that are offered in each environment. The United States is split into urban and rural counties in any given region, and based on those population sizes, are the allocation of healthcare resources for residents. In rural areas in the U.S., transgender adults lack access to gender-affirming care and encounter a lack of gender-affirming care providers due to workforce shortages, discrimination, and a lack of cultural competency. To determine if these residents lacked access to care compared with their urban counterparts, I performed a …

Activity Levels Among Older Adults In A Life Plan Community, Emily D. Winters

OHSU-PSU School of Public Health Annual Conference

This study aimed to analyze resident's knowledge of the health and wellness programs available to them in their facility. It explored activity levels, preferred activity methods, and health and wellness program utilization among older adults residing in a life-plan community. A total of 166 survey respondents, aged 65 and older, were included in the analysis. Data were collected using a self-administered questionnaire designed to assess physical activity patterns, preferences for activity types, and engagement with the facility’s health and wellness offerings. Open-ended questions were assessed qualitatively through thematic analysis to find common themes within data. Results indicated that the most …