Public Health Commons^™

Integrating Human And Animal Health In The Stop Spillover Outbreak Scenarios, Kathleen E. Angell, He Julia Bai, Katherine C. Prager, Janetrix H. Amuguni, Felicia B. Nutter, Jonathan D. Gass Jr, David Brett-Major

Journal Articles: Epidemiology

OBJECTIVES: To generate and employ scenarios of sentinel human and animal outbreak cases in local contexts that integrate human and animal health interests and practices and facilitate outbreak risk management readiness.

METHODS: We conducted a scoping review of past outbreaks and the strengths and weaknesses of response efforts in USAID STOP Spillover program countries. This information and iterative query-and-response with country teams and local stakeholders led to curated outbreak scenarios emphasizing One Health human:animal interfaces at sub-national levels.

RESULTS: Two core scenarios were generated adapted to each of 4 countries’ pathogen priorities and workflows in Africa and Asia, anchoring on …

Schistosoma Haematobium Infection And Associated Risk Factors Among Pre-School Age Children In Gambella, Ethiopia, Tigist Mohammed, Abraham Degarege, Mulugeta Aemero, Abebe Animut, Yohannes Negash, Yirgalem Gebrehiwot, Berhanu Erko

Journal Articles: Epidemiology

Background

Method

The Alcohol Exposome, Nousha H. Sabet, Todd A. Wyatt

Journal Articles: Environmental, Agricultural & Occupational Health

Science is now in a new era of exposome research that strives to build a more all-inclusive, panoramic view in the quest for answers; this is especially true in the field of toxicology. Alcohol exposure researchers have been examining the multivariate co-exposures that may either exacerbate or initiate alcohol-related tissue/organ injuries. This manuscript presents selected key variables that represent the Alcohol Exposome. The primary variables that make up the Alcohol Exposome can include comorbidities such as cigarettes, poor diet, occupational hazards, environmental hazards, infectious agents, and aging. In addition to representing multiple factors, the Alcohol Exposome examines the various types …

Expertise Or Experience: Comparing Discussion Of Drought Between Audiences And Agencies In Nebraska, Kansas, Iowa, And Missouri, Cory L. Armstrong, Sharon E. Baldinelli, Kelly Helm Smith, Sharon J. Medcalf

Journal Articles: Epidemiology

Significant portions of the states in FEMA region 7 (Kansas, Nebraska, Missouri, and Iowa) were in drought in 2022–23. Culling data gathered from a prominent social media platform and from focus group discussions, this research examines how drought information was communicated between the public officials and the general public. Through the lens of the two-step flow of communication theory, the central research question explored the differences between public conversations about drought among individuals experiencing it and the viewpoints of experts who work on drought-related issues. Results from social media conversations were examined, along with insights from focus group discussions involving …

Priorities To Care Within The Military Health System: A Mixed Methods Study On Military Spouse Access To Care During Covid-19 On Okinawa, Elayne L. Wilson

Theses & Dissertations

Military spouses in Okinawa experienced denial of care at military treatment facilities and off base Japanese healthcare facilities during the COVID-19 pandemic. Over two years of travel restrictions further contributed to difficulties accessing healthcare while stationed on the island with their active-duty spouse. This study examined the implications of a priority-based access system through the TRICARE program implemented due to limited resources during COVID-19 and its impact on military spouses in a scarce medical resource environment. This concurrent mixed-methods research used a survey tool developed by Community First Hawaii to quantify access to healthcare and in-depth interviews to further explore …

Sparkled: Social Programming In Kids Affects Risk Of Latent Endothelial Disease, Rebecca Drakowski

Theses & Dissertations

Background: Social Health Programming (SHP) is a holistic intervention that can empower communities to address modifiable risk factors for poor cardiovascular health, including suboptimal nutrition or psychosocial stressors. SHP participation has been shown to increase dietary intake of fruits and vegetables, decrease perceived stress, and improve cardiovascular endurance. However, it is unknown how SHP participation during adolescence affects carotenoid serum levels, hair cortisol concentrations (biological marker of chronic stress), or vascular reactivity index (VRI; measure of subclinical cardiovascular health).

Methods: Adolescent girls and young adult women (12–29-year-old) were enrolled in this observational cohort study. Serum, hair, and saliva samples were …

A Comprehensive Usability And Economic Analysis Of Heat-Related Wearable Technologies: Applications To Occupational Health, Ryan T. Cannady

Theses & Dissertations

The purpose of this research was to analyze the usability and economic considerations of real-time wearable technologies that are implemented in occupational settings to assess risk of heat stress and heat strain. The study population included current agriculture workers and Department of Energy (DOE), Environmental Management (EM) contractors. We employed a mixed-methods approach to comprehensively analyze the usability and economic considerations of heat-related technologies. Specifically, our approach assessed three distinct aspects the applications of these technologies in occupational settings to comprehensively address our research objective: (1) worker perceptions of heat-related wearable technologies, (2) field-based assessment of these heat-related wearable technologies, …

Bio-Preparedness In A Global Context: Multi-Site International Study Investigating Global Health Security Challenges In Egypt, Oman, And The United States, Rima M. Al Balushi

Theses & Dissertations

The COVID-19 pandemic exposed myriad vulnerabilities globally within public health systems, from inadequate bio-risk management in laboratories to overwhelming utilization of hospital resources and disparities in vaccine access and uptake. The Global Health Security Index (GHSI), which critically evaluates health security domains including health systems and risk environments, reports serious weaknesses in global health security. This dissertation aims to investigate critical aspects of global health security domains by examining factors impacting biosafety and biosecurity capacities in laboratories in Egypt, healthcare resource utilization in hospitals in Oman relating to acute respiratory infections (ARI), and COVID-19 vaccine uptake in the United States. …

A Replication Study — Suicidal Thoughts And Behaviors Among High School Students — Youth Risk Behavior Survey, United States, 2021, Mallory Hays

Capstone Experience: Master of Public Health

Suicidal thoughts and behaviors among adolescents are critical public health concerns in the United States, with suicide being the third leading cause of death among high school-aged youths (14-18 years). This study replicates and extends the findings of the 2021 Youth Risk Behavior Survey (YRBS) conducted by Gaylor et al., which analyzed data from 13,677 students in 2019 and 17,232 students in 2021. The original study revealed alarming increases in suicidal ideation and behaviors, particularly among female students, and highlighted disparities across demographic groups. Using raw YRBS datasets, this replication involved a pure replication of the original findings, followed by …

Promoting Adolescent Mental And Physical Health: Initiatives Focused On Connecting Public Health And Social Services To The Health Sector In Nebraska, Theresa Nguyen

Capstone Experience: Master of Public Health

This capstone focuses on the second recommendation of improving access to comprehensive, coordinated health services from the National Academies of Sciences, Engineering, and Medicine report The Promise of Adolescence: Realizing Opportunity for All Youth (2019). This proposal uses secondary data from the research project, Moving Evidence-Based Recommendations to Practice to Strengthen the Health Care System in Nebraska. Key stakeholders (n=28) were interviewed from the health care, public health, social services, and policy sectors. Each subject was asked to participate in a semi-structured interview by a trained interviewer. The interview was 1 hour long and conducted via phone call or Zoom. …

The Association Between Systolic Blood Pressure And Coronary Heart Disease In The Framingham Heart Study: A Long-Term Prospective Cohort Study, Alexandrea M. Welch

Capstone Experience: Master of Public Health

Coronary heart disease (CHD) is a leading cause of morbidity and mortality worldwide, with systolic blood pressure (SBP) as a critical risk factor. This study utilized data from the Framingham Heart Study to assess the association between SBP and CHD among participants. Univariate, bivariate, and multivariable logistic regression was used to explore this association as well as the association with other key covariates. We found a significant positive association between elevated SBP and the risk of CHD (adjusted OR: 1.69, 95% CI: 1.41-2.01, p < 0.0001). Age, sex, current blood pressure medication use, and body mass index (BMI) were significantly associated with CHD. Our findings support the need for blood pressure management to prevent cardiac events and reduce CHD burden.

Closing Gaps To Address Lifespan Health: Considerations For Developing A Preconception Healthcare Training For Community Health Workers, Jaclyn R. Vancamp

Capstone Experience: Master of Public Health

Community health workers (CHWs) are frontline public health workers who are embedded in their own communities and as linkages to care, decreasing health disparities for underserved individuals. The goal of this capstone project was to identify Michigan CHWs' knowledge gaps in the area of preconception healthcare. Through administering a training needs assessment to a sample of community health workers, the goal was to characterize knowledge gaps and make recommendations about what type of training would be most useful to them. The results of this needs assessment showed that the general state of self-reported knowledge about preconcept health among Michigan community …

Dietary And Physical Activity Behaviors In 2021 And Changes From 2019 To 2021 Among High School Students: A Replication Study, Jamila Nasir

Capstone Experience: Master of Public Health

Shannon L. Michael et al. conducted the study “Dietary and Physical Activity Behaviors in 2021 and Changes from 2019 to 2021 Among High School Students” to compare the prevalences of specific dietary and exercise behaviors among high-school students between 2019 and 2021, in order to examine how the COVID-19 pandemic affected these behaviors and to identify disparities in these effects.

This replication of the study focuses on exercise behaviors. The study data, drawn from the CDC’s YRBS in 2019 and 2021, had been selected using a three-stage cluster sampling method in which the clusters in the third stage were selected …

Association Between Cigarette Smoking And Angina Pectoris Among Middle-Aged Adults: Findings From The Framingham Cohort Study, Lauren M. Hron

Capstone Experience: Master of Public Health

Objectives: This study investigates the relationship between current cigarette smoking at baseline and the occurrence of angina pectoris during follow-up among middle-aged adults (30-70 years), adjusting for age, sex, BMI, diabetes status, education, and number of cigarettes smoked per day.

Methods: Using the Framingham Heart Study cohort (N=4,434), logistic regression analyses were performed. A backward selection approach identified confounders and explored effect modification.

Results: Angina prevalence was 16.4%, with higher odds observed in males, older individuals, and those with obesity or diabetes. Smoking status showed a non-significant association with angina in multivariable models (aOR:0.86, 95% CI: 0.73-1.01). However, age and …

Cybersecurity Vulnerabilities And Considerations In U.S. Healthcare Facilities: A Scoping Review, Rebecca J. Campbell

Capstone Experience: Master of Public Health

Robust cybersecurity measures are essential for business continuity of U.S. healthcare institutions which is to maintain care standards for all patients. Hackers seek to disrupt healthcare delivery for financial and political means, to disrupt services in retaliation, or simply for malicious intent (Wasserman & Wasserman, 2022). The COVID-19 pandemic further accelerated innovation and digitization in healthcare, including wearable and implanted medical devices, telehealth care delivery options, artificial intelligence, and cloud-based data management (Kioskli, Fotis, & Mouratidis, 2021). This progress in innovation continues today but also brings new vulnerabilities and challenges to stay ahead of cybersecurity threats.

Given that cyberattacks have …

Knowledge, Attitudes, And Behaviors Regarding Water Quality, Nitrate Contamination, And Related Health Issues Among Nebraska Healthcare Professionals, Jessenia Hincapie

Capstone Experience: Master of Public Health

Background: Nitrate contamination in drinking water is a public health concern, particularly in agricultural regions. Healthcare professionals often address water quality issues but may lack sufficient knowledge regarding the health effects of nitrate contamination. This study evaluates whether Nebraska healthcare professionals' knowledge and attitudes about nitrate contamination predict their behaviors in addressing this issue.

Methods: A survey was administered to healthcare professionals across Nebraska to assess their knowledge, attitudes, and behaviors regarding nitrate contamination in drinking water. A total of 462 respondents participated. Generalized linear regression analysis was employed to assess the impact of knowledge and attitudes regarding nitrate contamination …

Understanding And Mitigating The Potential Effects Of Postpartum Depression On Fathers And Male Support Persons, Rachel Norton-Turk

Capstone Experience: Master of Public Health

Background. During the postpartum period, best practices dictate that medical professionals screen new mothers or birthing persons for anxiety and depression and direct them to the appropriate resources and services they may need. This qualitative study explored the steps being taken to identify depression and anxiety concerns in male support partners during the postpartum period and to understand what resources are being brought to their attention if depression and anxiety are identified. Methods. A convenience sample of male support persons participated in semi-structured, one-on-one interviews either in-person or over Zoom between September and October 2024. Interviews were recorded, transcribed, …

Investigating The Association Of Total Cholesterol Level And Odds Of Angina In Women Over 40: A Cohort Study Using Data From The Framingham Heart Study, Katelyn Mitchell

Capstone Experience: Master of Public Health

Objective To investigate the association between total cholesterol level and the odds of experiencing angina in women over the age of 40.

Methods This retrospective cohort study was conducted using a subset of the cohort from the Framingham Heart Study to create a multivariable logistic regression model for analysis. Out of the 4,434 participants in the Framingham cohort, 2,148 participants were women over the age of 40 and included in this study.

Results Of the participants who experienced angina (n=308) in this study, 62% had high cholesterol at the baseline. After controlling for age, women with high cholesterol had 2.03 …

A Cohort Study Examining The Risk Of Smoking On The Likelihood Of Developing Angina Among Women Under Age 65, Sarah Ward

Capstone Experience: Master of Public Health

Objective:

To determine if current smoking status is a risk factor for angina among women under the age of 65.

Methods:

A subset of participants from the Framingham Heart Studywere used to complete a cohort study. The analyses evaluated population means and characteristics, followed by bivariate and multivariable logistic regression, to determine the association of smoking and other key factors with angina.

Results:

Smoking status had a significant association to angina(OR 0.67, 95% CI: 0.52, 0.86, p-value= 0.0015). Age as a categorical variable had a significant relationship with angina (OR 0.97, 95% CI: 0.617, 1.520, p-value=

Conclusions:

Smoking had a …

Beryllium Work Area And Tank Waste, Angelica Zarate

Capstone Experience: Master of Public Health

My capstone was conducted at the Hanford site in Richland, Washington. It was once a location that produced weapons-grade plutonium, but now its mission is to clean up the radioactive waste that was left behind. My project focused on beryllium and how much is present in the 56 million gallons of waste that needs to be disposed of. I evaluated the OSHA regulations for beryllium work areas, medical surveillance, and beryllium exposure's environmental and health implications. The purpose was to determine if the concentrations present meet the requirements to continue to be considered a beryllium work area.

Comparative Study Of Coronary Heart Disease Incidence In Smokers Vs. Non Smokers: A Longitudinal Cohort Analysis From The Framingham Heart Study, Mona Melvin Periera

Capstone Experience: Master of Public Health

Objective: To evaluate the association between smoking and coronary heart disease (CHD) incidence while adjusting for potential confounding factors, including age, education level, systolic blood pressure, BMI, serum cholesterol, and diabetes, using data from the Framingham Heart Study.

Methods: A cohort of 4,434 participants aged 32–70 years, free of CHD at baseline, was analyzed. Smoking status (current vs. non-current smokers) was the primary exposure, and CHD incidence was the outcome. Adjustments were made for confounders using multivariable logistic regression models. Unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.

Results: CHD was diagnosed in 27.96% of …

The Role Of Serum Total Cholesterol In Coronary Heart Disease: A Prospective Cohort Analysis From The Framingham Heart Study, Sanish Maharjan

Capstone Experience: Master of Public Health

Objective: To investigate the association between serum total cholesterol and coronary heart disease (CHD), accounting for key risk factors in adults aged 32–70 years.

Methods: We analyzed data from 4,382 participants of the Framingham Heart Study, a prospective cohort study with 24 years of follow-up. Multivariable logistic regression was used to assess the relationship between serum cholesterol and CHD, adjusting for age, sex, smoking status, systolic blood pressure, BMI, diabetes, and heart rate.

Results: Individuals with high (aOR = 1.87; 95% CI = 1.52 - 2.32; p<.0001) and borderline high (aOR = 1.40; 95% CI = 1.13 - 1.75; p = 0.0024) cholesterol levels have significantly higher odds of developing CHD than those with normal cholesterol. Older (aOR=1.03; 95% CI=1.03–1.05), male (aOR=2.16; 95% CI=1.86–2.51), current smokers (aOR=1.20; 95% CI=1.03–1.39), hypertensive (aOR=1.88; 95% CI=1.55–2.26), obese (aOR=3.03; 95% CI=1.24–7.43), and diabetic individuals (aOR=2.41; 95% CI=1.63–3.56), had significantly higher CHD risk.

Conclusions: Elevated serum cholesterol significantly increases CHD risk, emphasizing …

55-Word Stories: Insight Into Healthcare, Nancy E. Krusen

Translational Science in Occupation

Narrative medicine and health humanities focus on arts, ethics, and clinical practice. Many health education programs incorporate creative activities to facilitate learner self-awareness and insight. We include them to address programmatic themes of professional growth and translational science.

Association Between Agrichemical Mixtures And Pediatric Health Outcomes: Evidence From A Nebraska Population-Based Surveillance, Jabeen Taiba

Theses & Dissertations

Human exposure to environmental contaminants is associated with various pediatric health outcomes. Agrichemicals are a significant environmental risk factor for childhood cancers and congenital anomalies, and reduced exposure could improve pediatric health outcomes. Previous studies in Nebraska have explored the association between single pollutants and pediatric cancers and birth defects. However, it is important to estimate the overall effect of the agrichemical mixture on these pediatric health outcomes. In addition to environmental risk factors, several social vulnerability factors also contribute to increased agrichemical exposure and show disparities in pediatric cancers and birth defects. The objectives of this dissertation are to …

Telehealth For Healthy Aging: A Multi-Level, Multi-Methods Approach, Vaibhavi Mone

Theses & Dissertations

Telehealth, rapidly adopted during the pandemic, has shown its usefulness and limitations, yet was not designed with older adults in mind. This dissertation encompasses three interconnected studies exploring telehealth utilization for Medicare Annual Wellness Visits (AWVs) among older adults, provider perspectives on telehealth AWVs, and the impact of teleconferencing on primary care providers' knowledge and confidence in geriatric care. The objectives are to determine patient characteristics using telehealth AWV (study 1), understand provider perspectives on telehealth AWV (study 2), and evaluate the effectiveness of geriatrics education through telehealth (study 3). Study 1 investigates the changes in AWV utilization among 18,405 …

The Dissemination And Implementation Of N95 Fit Testing Capacities For Nebraska Long-Term Care Facilities: A Mixed-Methods Analysis Using The Re-Aim Framework, Anthony Blake

Theses & Dissertations

Background: Ensuring the proper fit of N95 respirators used by healthcare workers in long-term care facilities (LTCF) is essential for their safety. The Nebraska Department of Health and Human Services launched a LTCF strike team project (STP) in the summer of 2022, focused on increasing the number of staff trained in infection control and building internal capacity for LTCFs to fit test their employees. This study describes the N95 fit-testing initiative for Nebraska LTCFs.

Methods: Staff from all 19 local health departments (LHD) received “train-the-trainer” training to prepare LTCF staff to perform qualitative fit testing. LTCF administrators were requested to …

Not Ready: The Need For A Training Standard In Healthcare Emergency Preparedness, Patrina White

Dissertations: Doctor of Public Health

Background: Disasters, both natural and human-induced, are increasing. Disasters impact public health and safety in many ways including disruption of healthcare. Emergency preparedness mitigates disaster impacts. Training improves preparedness however no training standard exists. Purpose: This study aimed to explore the current state of U.S. healthcare preparedness and the impact of training on preparedness; determine the best strategies to improve healthcare emergency preparedness training; propose a standard for training in healthcare emergency preparedness; and identify barriers to adopting a standard for training in healthcare emergency preparedness including strategies to overcome identified barriers. Methods: A comprehensive literature review, …

Effect Of Insufficient Sleep On Activity Limitation: Results From The Brfss 2022 Survey, Jonathan Meyer

Capstone Experience: Master of Public Health

Objective: To determine whether insufficient sleep (less than 7 hours per night) is associated with activity limitation (14 days or more of poor mental or physical health interfering with everyday activities) in Behavioral Risk Factor Surveillance System (BRFSS) survey data from 2022. Methods: BRFSS is a nationally representative cross-sectional survey of non-incarcerated US adults. The exposure of interest was insufficient sleep, and the outcome of interest was activity limitation. Other demographic variables used in a final weighted adjusted analysis include age >65 years, race/ethnicity, gender, marital status, income, and total physical inactivity. Results: The weighted prevalence of insufficient sleep for …

Ensuring Safe Mri Examinations And Earlier Detection Of Recurrent Cancer: A Scoping Review To Identify Breast Tissue Expanders That Are Safe For High-Risk Breast Cancer Survivors, Kristin E. Westmore

Capstone Experience: Master of Public Health

Purpose

This capstone project aims to conduct a scoping review to identify breast tissue expanders that are safe for high-risk breast cancer survivors, ensuring safe magnetic resonance (MR) examinations. The goal is safe MR examinations for early detection of recurrent cancer, post-operative evaluation, monitoring, and reducing preventable morbidity and mortality.

Background

The MR safety of manufacturers' tissue expanders is defined according to the United States Food and Drug Administration (FDA) guidelines and regulations as MR Conditional or MR Unsafe. Before 2023, there was a safety concern about using tissue expanders containing a magnetic port during the first stage of breast …

Exploration Of Canine T. Cruzi Seroprevalence As A Trigger For Enhanced Human Chagas Surveillance, Brittany N. Hocking

Capstone Experience: Master of Public Health

Background: Chagas disease, caused by the parasite Trypanosoma cruzi, is endemic in many Latin American countries and now the southern United States. An increasing number of Chagas cases in the U.S. have occurred because of autochthonous transmission and enzootic cycles involving infected wildlife and domestic animals, like canines.

Objective: This study aimed to explore canine seroprevalence as a trigger for enhanced human Chagas surveillance by describing detected U.S. T. cruzi from human and canine testing data, creating maps to explore geographic areas with potential high yield for T. cruzi surveillance via animal testing, and developing a SWOT analysis for …