Public Health Commons^™

Building On A Strong Foundation: Celebrating Our Past And Looking Toward The Future, Zachary K. Winkelmann

Clinical Practice in Athletic Training

No abstract

What Drives Schoolchildren's Food Choices? Insights From A Gamified Stated-Preference Choice Experiment In Tunisia, Ali Chalak, Christelle Akl, Joanne Haddad, Nehmat El Helou, Sonia Sassi, Houda Ben Gharbia, Rawan Traboulsi, Marc Haber, Jalila El Ati, Hala Ghattas Ph.D.

Faculty Publications

This paper models the drivers of schoolchildren's food choices in urban Tunisia using a gamified Stated-Preference Choice Experiment (SPCE), which includes scenario attributes (food placement, preparation, and price) and contextual factors (parental/peer modeling eating behaviors). A representative sample of 2465 schoolchildren aged 8 to 12 years in Greater Tunis participated in a SPCE, which simulates real-life food choice scenarios on a typical school day. The game includes six nodes (breakfast, recess, lunch, snack on the road to/from school, afternoon snack, dinner) in various locations (home, school, neighborhood). Each choice task includes nine items to choose from (3 beverages, 3 side-meals, …

Perceived Effectiveness Of Cigar Warnings Among Young People In The U.S., Leah M. Ranney, Rime Jebai, Michael Jetsupphasuk, Sonia A. Clark, Kristen L. Jarman, Sarah D. Kowitt, Jim Thrasher Ph.D., Ma, Ms, Adam O. Goldstein, Jennifer Cornacchione Ross

Faculty Publications

Introduction: The effectiveness of warning size and format on cigar packaging in influencing youth and young adult smoking behaviors is not well understood. This study tested these cigar warning characteristics among youth and young adults who use or are susceptible to using little cigars or cigarillos.

Methods: The study recruited 506 U.S. youth and young adults, aged 15−20 years, between April and June 2023. Participants reported ever or past 30-day use of little cigars or cigarillos or were susceptible to using little cigars or cigarillos. A 2 £ 2 between-subjects online experiment was conducted where youth and young adults were …

Exploring Capacity For Future Sustainability Of Healthy Eating Policy, Systems, And Environmental Change Strategies Previously Implemented Through Snap-Ed Programming, Carrie L. Draper, Nicholas Younginer Ph.D.

Faculty Publications

Objective

Design

Setting

Participants

Phenomenon of Interest

Analysis

Results

The Role Of Paraprofessionals In The Mental Health Structure Of India, Amy Abraham, Kimberly D. Becker, Wendy Chu

Caravel Undergraduate Research Journal

The mental health treatment gap in India is part of a growing public health crisis, with over 95% of those in need of services never receiving them. Over 197 million Indians suffer from at least one diagnosable mental health disorder, and this number continues to grow given the treatment gap. The treatment gap is a result of four major factors: lack of government support, stigma, limited treatment facilities, and dearth of professionals able to provide treatment. The current study aimed to analyze several factors of paraprofessional-led mental health interventions including setting, treatments delivered, treatment models, and client outcomes. A narrative …

Examining Biobehavioral Indicators Of Adhd In Children With Fxs, Hannah Pressler, Kayla Smith, Ramsey Coyle, Elizabeth Will, Jane E. Roberts

Caravel Undergraduate Research Journal

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention and hyperactivity/impulsivity behaviors that are inconsistent with developmental age. Children with fragile X syndrome (FXS), a genetic neurodevelopmental disorder, are often diagnosed with comorbid ADHD (53–59% of males with FXS). Despite the prevalence of ADHD in FXS, little is known about the early manifestation of ADHD. The current project aims to explore group differences in play behaviors between children with FXS and typically developing (TD) children as well as the relationship between infant play behavior and heart activity to future ADHD attention outcomes. Participants included male children with FXS and …

Predator Or Prey: The Analysis Of Gender And Race On The Perception Of Black Men As Sexual Assault Victims, Jordyn Livingston, Dr. Florencia Cornet

Caravel Undergraduate Research Journal

Men sexual assault victims have gained more attention in recent years. Despite the growing sociological literature on violence against men, previous research provides little acknowledgment of Black men sexual assault victims. In this manuscript, I analyze emerging literature in the socio-medical sciences to explore how gender and race affects the perceptions of Black men as sexual assault victims. Specifically, I utilize intersectionality as a theoretical framework to synthesize literature on blackness and masculinity in sexual assault victims to conclude that there is an intersectional point that disadvantages Black males, portraying them as sexual predators. In so doing, I provide research …

Evaluating The Role Of Stress, Self-Perceptions Of Health, And Self-Efficacy On Physical Activity Over Time: Results From Project Drive, Ashlynn Riley, Allison Sweeney, Dawn K. Wilson

Caravel Undergraduate Research Journal

Most Americans are not meeting the recommended levels of physical activity. In underserved communities, these inequities are even greater, with African American women being less likely to engage in physical activity and being at greater risk for chronic disease relative to non-minority women. This study seeks to further understand the factors that support or undermine engagement in physical activity among African American women. Specifically, the present study evaluates the impact of stress, self-perceptions of health, and self-efficacy on physical activity engagement in a 10-week physical activity intervention program for African American women. Participants (N = 33) completed measures of …

Use Of Period- Or Fertility-Tracking Technologies Pre- And Post-Dobbs, Emily Neiman, Marta Bornstein Phd, Mph, Abigail Norris Turner, Megan L. Kavanaugh, Maria F. Gallo

Faculty Publications

Objectives

Study design

Health Insurance Literacy Among College Students At The University Of South Carolina, Emma J. Smith, Lorie Donelle Phd, Rn, Fcan, Robin Dawson

Caroliniana Undergraduate Research Journal

Purpose: This study aims to investigate the health insurance literacy skills of graduate college students and undergraduate college students.

Methods: A cross-sectional research design incorporated a 20-item questionnaire to examine college students’ knowledge of common health insurance terms and definitions, as well as their perceived understanding of health insurance. Descriptive analyses were conducted of participant demographics, health insurance literacy scores were summarized, and common health insurance policies were tested through a readability checker.

Results: The majority of students were between the ages of 18-25 and undergraduate students. More than half of the participants were female, and more …

Psychosocial Mediators Of A Physical Activity And Dietary Intervention In Pregnant Women With Overweight Or Obesity, Meghan Baruth, Sarah Wilcox, Jihong Liu, Rebecca Schlaff

Faculty Publications

Background

Mediation analyses provide insight into both ‘pieces’ of the mediation chain; they allow us to look into the ‘black box’ that is behavior change. They allow researchers to better understand the ‘how’ of an intervention’s effects and/or the ‘why’ behind why an intervention worked or did not work. The lack of publications in pregnant populations highlights the need for additional studies to be conducted and published. The purpose of this study is to examine the psychosocial mediators of physical activity and dietary outcomes in a sample of pregnant women with overweight or obesity participating in the Health in Pregnancy …

Single State Agency Licensure Requirements For Substance Use Disorder Treatment Programs In The United States: Results Of A National Survey, Brooks Yelton Ma, Lmsw, Melissa A. Westlake, Amanda J. Abraham, Colleen M. Grogan, Olivia Hinds, Christina M. Andrews

Faculty Publications

Background

Substance use disorder (SUD) remains a critical public health crisis in the United States, with high prevalence and overdose mortality rates. Despite the availability of effective treatments, including medications that significantly reduce overdose risk, fewer than 20% of Americans with active SUD receive treatment annually. Single State Agencies (SSAs), which oversee federal funding and regulate SUD treatment programs, hold significant authority to impose licensure and reporting requirements intended to promote treatment quality.

Methods

This study presents findings from a national survey of SSAs across 50 states and the District of Columbia (94% response rate) conducted between 2020 and 2021, …

Factors Associated With Lapses In Care Among People Living With Hiv In South Carolina, Xueying Yang Ph.D., Fanghui Shi, Shujie Chen, Gavi Samuel, Bankole Olatosi Ph.D., Sharon Weissman, Xiaoming Li Ph.D., Jiajia Zhang Ph.D.

Faculty Publications

Utilizing statewide electronic health records (EHR) data, this study aims to assess the factors determining the occurrence of lapses in HIV care among people with HIV (PWH) in South Carolina (SC). All adult (≥ 18 years old) PWH who were diagnosed with HIV between 2006 and 2018 with at least two HIV care encounters and at least 1-year follow-up record were included in the analysis. The outcome, a lapse in care, was defined as a repeated measure of HIV care encounter that occurs over a year following the previous visit. Generalized Estimation Equation models were employed. The study cohort had …

Implementation And Costs Of A Food Insecurity Resource Navigation Program For Primary Care Patients With Diabetes And Hypertension In South Carolina, Deeksha Gupta, Darin Thomas, Stella Coker Watson Self Ph.D., Ms, Edward A. Frongillo Jr. Ph.D., Alain H. Litwin, Joseph A. Ewing, Lynnette Ramos-Gonzalez, Lynnette Ramos-Gonzalez

Faculty Publications

Objective

To examine food insecurity resource navigation program costs and how navigation intensity relates to clinical outcomes, healthcare costs, and quality of life (QOL) for diabetes and/or hypertension patients.

Methods

This retrospective study included patients receiving resource navigation (July 12, 2021-December 31, 2022 with twelve-month follow-up) across three primary care practices in South Carolina's largest health system. Participants were 18+ years old (from electronic medical records/Epic), had food insecurity (from Hunger Vital Sign™), and diabetes and/or hypertension (from Epic registries). Matched controls came from food insecurity screening-only practices. Patients in each group (n= 219) had diabetes (9.13%), hypertension …

The Role Of Community Health Workers In Rural South Carolina, Sarah W. Haselden

Senior Theses

This paper aims to explore the role of Community Health Workers (CHWs) in rural South Carolina through a literature review as well as the data supplied from the Community Health Alignment Initiative (CHAI) and Community Health Workers Changing Outcomes in SC (CCOSC). Through reviewing the collection of materials and data, the effectiveness of CHWs can be studied. Community Health Workers (CHWs) provide a unique aspect to primary care within communities through their aid in prevention of health conditions. CCOSC and CHAI collected data throughout South Carolina to determine the needs of communities and how CHWs can work to address those …

Antibiotics And You: A Comprehensive Guide, Brady Haas

Senior Theses

Antibiotic resistance is a rapidly emerging issue within public health. As resistance grows, the effectiveness of traditional antibiotic therapies diminishes while risk of treatment grows. Alongside novel therapies, public knowledge is a strong combatant of the resistance-related risks of antibiotic usage. Through a comprehensive review of current literature, this work serves as an accessible guide to the mechanisms of antibiotics, bacterial resistance, and the challenges related to current antibiotic usage. Additionally, the ability of current policy and emerging novel treatments, such as nanoparticles and bacteriophage therapy, to fight antibiotic resistance is evaluated. This analysis highlights the importance of improving public …

Informed Consent In Childbirth: A Global Scoping Review Of Episiotomy Practices And The Gaps In U.S. Perinatal Care, Rachel Gulczinski

Senior Theses

Informed consent is a fundamental ethical and legal component of preoperative and perinatal care and forms the foundation of trust between patients and healthcare providers. Despite this, current evidence suggests that many childbirth interventions, including episiotomies, are often performed without explicit patient consent. Episiotomy remains one of the most commonly cited interventions associated with non-consented care and obstetric violence. Therefore, this global scoping review aimed to evaluate whether informed consent is obtained for episiotomy procedures during childbirth, understand documented experiences of disrespect and unnecessary procedures, and identify differences between international and U.S. practices. This thesis followed the PRISMA Scoping Review …

Eating Disorder Prevention And Early Intervention In U.S. Higher Education – A Comparative Benchmarking Study, Jake R. Arcement

Senior Theses

Eating disorders (EDs), including anorexia nervosa, have the highest mortality rate of any psychiatric illness, yet remain underrecognized relative to their severity and treatment burden. Because the period of peak onset aligns with the college years, institutions of higher education are uniquely positioned to play an important role in prevention, early identification, and referral to specialized care. However, limited research has examined how colleges and universities structure ED prevention and treatment resources. This thesis applies a comparative benchmarking framework to assess current institutional practices across U.S. colleges and universities. A national survey of student health and counseling centers examined staffing, …

Knowledgable Births: Advancing Informed Consent In Maternal Healthcare, Ella A. Forrester

Senior Theses

Background:

Informed consent is both a legal requirement and an ethical cornerstone of healthcare, ensuring that patients understand and voluntarily agree to medical treatments. However, evidence suggests that the informed consent process is often inadequately implemented in maternal healthcare settings, particularly during childbirth. While giving birth, women retain full decision-making capacity but are not consistently provided with sufficient information or support to exercise this right. Contributing factors include ineffective patient–provider communication, limited health literacy, and insufficient access to culturally responsive educational resources.

Methods:

This study aimed to address gaps in accessible prenatal education by developing an online resource platform, Know …

A Comparative Analysis Of Group Care: Trust, Professional Identity, And Health System Structure In The United Kingdom And The Netherlands, Samantha J. Kohlmann

Senior Theses

Group prenatal care (Group Care) has been associated with improved maternal experiences and select clinical outcomes, yet less is understood about how it functions within high-resource health systems and what mechanisms underlie its impact. This study examines how Group Care is implemented in the United Kingdom and the Netherlands, with particular attention to professional roles, relational dynamics, and health system context.

I employed a qualitative, comparative design and conducted four semi-structured interviews with midwife researchers involved in Group Care implementation in both countries. Data were analyzed thematically, with attention to cross-context similarities and differences.

Findings indicate that Group Care operates …

The Blurred Boundaries Of Care: A Qualitative Analysis Of Nurse-Doula Role Conflict, Curisa Mae Tucker Phd, Rn, Maria Mcclam, Kelly Russin Dnp, Rnc-Ob, Chse, Nansi Boghossian, Rachel Gulczinski, Lauren Workman

Faculty Publications

Introduction:

Methods:

Association Between The Dietary Index For Gut Microbiota (Di-Gm) And Colorectal Cancer In The Plco Cohort, Bezawit E. Kase, Angela D. Liese Ph.D., Jiajia Zhang Ph.D., Elizabeth Angela Murphy, Susan E. Steck Phd, Mph, Rd

Faculty Publications

Objectives: The study aimed to examine the association between a dietary index for gut microbiota (DI-GM) and the risk of incident colorectal cancer (CRC). Clarifying the role of diet-induced alterations in the composition and function of gut microbiota on the development of CRC can contribute to prevention efforts. Methods: Participants from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening trial enrolled in the intervention arm and who completed baseline assessments were included in the analysis (n = 55,685). The DI-GM is a literature-derived index used to score diet quality in terms of maintaining healthy gut microbiota. A time-dependent Cox model …

Association Between The Dietary Index For Gut Microbiota (Di-Gm) And Colorectal Cancer In The Plco Cohort, Bezawit E. Kase, Angela D. Liese, Jiajia Zhang, Elizabeth Angela Murphy, Susan E. Steck

Faculty Publications

Objectives: The study aimed to examine the association between a dietary index for gut microbiota (DI-GM) and the risk of incident colorectal cancer (CRC). Clarifying the role of diet-induced alterations in the composition and function of gut microbiota on the development of CRC can contribute to prevention efforts. Methods: Participants from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening trial enrolled in the intervention arm and who completed baseline assessments were included in the analysis (n = 55,685). The DI-GM is a literature-derived index used to score diet quality in terms of maintaining healthy gut microbiota. A time-dependent Cox model …

Dyadic Internalized Stigma, Resilience, And Psychological Distress Among People With Hiv And Their Family Members: An Actor-Partner Interdependence Mediation Model Analysis, Fanghui Shi, Xueying Yang, Shan Qiao Ph.D., Cheuk Chi Tam Ph.D., M.S., M.A., Shuaifeng Liu, Yuejiao Zhou, Xiaoming Li Ph.D.

Faculty Publications

Despite robust evidence showing the mediation role of psychological resilience in the impacts of HIV-related stigma on psychological distress, most studies were conducted from an intrapersonal perspective. Limited studies have examined the dyadic effects of HIV-related stigma and resilience on psychological distress for people with HIV (PWH) and their family members. This study aimed to explore the actor-partner effect and the mediation role of resilience in the relationship between internalized stigma and psychological distress among PWH and family members dyads. Between October 2023 and December 2023, a total of 800 PWH-family member dyads were recruited from two urban cities and …

A Livelihood Intervention Improved Nutritional, Mental Health And Sexual Health Outcomes Among Hiv-Affected Adolescents In Western Kenya: Results From The Shamba Maisha Randomised Controlled Trial, Sheri D. Weiser, Lila Aziz Sheira, Pauline Wekesa, Jennifer Monroe Zakaras, Edward A. Frongillo Jr. Ph.D., Elly Weke, Jason M. Nagata, Amy A. Conroy, Marguerita Lightfoot, Torsten B. Neilands, Lisa M. Butler, Elizabeth A. Bukusi, Craig R. Cohen, Maricianah Atieno Onono

Faculty Publications

Introduction Interventions that address household-level factors, including food insecurity (FI) and poverty, may reduce HIV risk and improve sexual and reproductive health (SRH) among adolescent girls and young women (AGYW).

Methods This cluster randomised controlled trial in Kenya assessed AGYW living in households of adults enrolled in Shamba Maisha (SM). SM was a multisectoral agricultural livelihood intervention designed to improve HIV health. At the trial end, we used linear and logistic regressions to compare differences between the intervention and control arms in FI, and mental health among AGYW-caregiver pairs and SRH outcomes among the AGYW, accounting for clusters with robust …

What Factors Influence Health Professions Trainees’ Preferences For Employment In Rural Appalachia? A Qualitative Study To Inform The Design Of A Discrete Choice Experiment, Chris Gillette, Jan Ostermann Ph.D., Aylin A. Aguillar, Sarah O'Neal, Chris Everett, Dawn Caviness, Esita Patel, Laiton Steele, Dawn Goel, Quazi Minhaz Tabassum

Faculty Publications

Optimizing the geographic allocation of health care providers has the potential to improve health care access and health outcomes for rural populations. To inform the design of a discrete choice experiment (DCE) survey to elicit health professions trainees' preferences for rural practice, this formative research aimed to: (1) elicit factors that influence job selection among health profession trainees, including medical residents physician assistant (PA) and nurse practitioner (NP) students, (2) identify how these trainees evaluate trade-offs for rural job placement and (3) inform attribute selection for inclusion into a future DCE to identify health professions trainees’ preferences for rural practice. …

Predictors Of Employment Attrition In Lebanon During Multifaceted Crises: The Role Of Chronic Diseases – A National Cross-Sectional Study, Myriam Dagher, Ali Abboud, Ghada E. Saad, Rita Itani, Rindala Fayyad, Hala Ghattas Ph.D., Stephen J. Mccall, Jocelyn Dejong, Malak Ghezzawi, Nisreen Salti, Sasha Fahme, Serena Canaan

Faculty Publications

The COVID-19 pandemic and Lebanon’s ongoing economic crisis exacerbated existing workforce and health disparities. This study explored the predictors of employment attrition during Lebanon’s concurrent crises and examined the association between chronic conditions and employment attrition. This cross-sectional study recruited adults aged 19–64 years residing in Lebanon through random digit dialing (January – July 2024). Data collected included socio-demographics, household characteristics, employment history and characteristics, and self-reported chronic conditions. The outcome was loss of paid employment (employment attrition) during the crises. Predictors were identified through a Least Absolute Shrinkage and Selection Operator (LASSO) regression, and model discrimination and calibration were …

Dietary Inflammatory Index And Objective Disease Activity In Ibd: No Association Found, Rúbia Moresi Vianna De Oliveira, Ana Carolina Junqueira Vasques, Stefhani Andrioli Romero, Nitin Shivappa Mbbs, Mph, Ph.D., Michael David Wirth, James Hébert Scd, Glaucia Fernanda Soares Ruppert Reis, Cristiane Kibune Nagasako

Faculty Publications

Background

Inflammatory Bowel Disease (IBD) involves genetic and environmental factors, but the relationship between disease activity, adiposity, and diet remains unclear.

Objective

To investigate the association between endoscopic/radiological activity of IBD, body adiposity, and the Dietary Inflammatory Index with or without adjustment for energy density (E-DII or DII).

Method

An observational, cross-sectional study was carried out. Endoscopic activity was defined by an endoscopic Mayo score >2, Crohn’s Disease Endoscopic Index of Severity (CDEIS) > 5, and/or the presence of a deep ulcer in any intestinal segment. Body adiposity was estimated using the body mass index, waist circumference, and waist-hip ratio (WHR). …

Circulating Levels Of Insulin-Like Growth Factor I (Igf-I) And Risk Of Multiple Myeloma: An Observational And Mendelian Randomisation Study, Yolanda Benavente, Sara Hermosa, Nikos Papadimitriou, Alyssa I. Clay-Gilmour Ph.D., Elizabeth E. Brown, Jonathan N. Hofmann, Nathaniel Rothman, Qin Lan, Sonja I. Berndt, Demetrius Albanes, Mark Purdue, Mitchell J. Machiela, Stephen J. Chanock, Parveen Bhatti, Wendy Cozen, Aaron Norman, Susan L. Slager, James R. Cerhan, Vincent Rajkumar, Et. Al.

Faculty Publications

No abstract provided.

Social Network Determinants Of Cigarette Forgoing And Quit-Related Conversations In A 15-Day Ecological Momentary Assessment Study In Mexico And The Us, Lizeth Cruz-Jiménez, Kevin A. Carson, Jim Thrasher Ph.D., Ma, Ms, Katia Gallegos-Carrillo, Dèsirée Vidaña-Pérez, Diego F. Leal

Faculty Publications

Introduction

Methods