Public Health Commons^™

The Power Of An Effective Safety Culture, Justin B. Negley

Capstone Experience: Master of Public Health

Workplace injuries and illnesses have continued to decrease significantly through increased regulations, awareness, and technological advances. These enhancements are not enough to continue to drive these rates lower. A robust safety culture within an organization is required to truly affect change that will continue to diminish the occurrence of injuries and illnesses within the workplace. This project seeks to define the key aspects and elements that are fundamental to a culture of safety as a top priority amongst competing demands. The foundations of a robust safety culture were identified through a systematic literature review, a site comparison example of safety …

Exploring The Mental Health Experience Of Perinatal Military Spouses Based In Sigonella, Italy, Lyndsey Dannenberg

Capstone Experience: Master of Public Health

The perinatal period can have a profound impact on the mental health of women, their infants, and their families, especially when it comes to depression and anxiety disorders. This study aims to delve into the experiences of perinatal mental health among military spouses stationed overseas, on Naval Air Station Sigonella, Italy, and contribute to the limited research on active-duty military spouses and their perinatal mental health while stationed overseas. The research uses a qualitative phenomenological approach, seeking to provide valuable insights into the lived experiences of military spouses and their perinatal mental health. Risk factors associated with perinatal mental illness …

Nutrition Needs Assessment For A Produce Prescription Program In The Pediatric Dental Setting, Zachary Houser

Capstone Experience: Master of Public Health

More than half of young people in the U.S. aged 2-19 have a poor-quality diet, including low fruit and vegetable (FV) intake (Liu et al., 2020). Poor nutrition increases health risks, including chronic diseases such as dental caries and obesity, low-income households experience higher rates of poor nutrition and subsequent health burdens (AAPD, 2022b). Produce prescriptions (PPR) are a type of financial incentive program that can improve FV intake among low-income populations (Ridberg et al., 2019). PPR programs are often conducted in a primary medical setting (Little et al., 2022); however, no literature describes PPR programs conducted in a dental …

Environmental Exposure Effects To Humans And Trends Of Harmful Algal Blooms In Nebraska, Ericka Sanders

Capstone Experience: Master of Public Health

Harmful algae blooms (HAB) are becoming more of a human health concern. Humans are exposed to harmful algae blooms from freshwater bodies used for recreational activities. The presence of harmful algae blooms has been increasing across the United States. Aerosol, dermal, and ingestion routes of exposure are ways humans can develop an illness when around a HAB. Environmental exposure to humans above 8 ppb per liter of surface water can cause mild to severe symptoms and, in rare cases, may be fatal. Exposure can be acute or chronic. The Nebraska Department of Environment and Energy (NDEE) has implemented a monitoring …

Antibiotic Prescribing Patterns In The Emergency Department, Maddison Mcconnaughhay

Capstone Experience: Master of Public Health

Purpose: Antibiotic resistance is a major public health problem in the United States, resulting in significant morbidity and mortality (CDC, 2019). This study seeks to understand how antibiotic use for dental problems may contribute to antibiotic resistance and adverse drug reactions while only temporarily relieving the underlying oral health condition. Previous research suggests differences in prescribing patterns for pain management by provider type, but little is known about antibiotic prescribing patterns, especially for diverse groups of pediatric patients (Chua, et al., 2019). This study aims to characterize antibiotic prescribing patterns in a midwestern children's hospital emergency department for non-traumatic dental …

Body Mass Index And Acute And Chronic Work-Related Injuries; A Random Sample Analysis Of Occupational Health Clinic Records, Nicole M. Lundy

Capstone Experience: Master of Public Health

Workplace injuries are detrimental because they impact the productivity and wellbeing of workers. The ultimate goal is to minimize job-related injuries due to workplace exposure. This study examines the relationship between body mass index (BMI), age, gender, and injury patterns. Data was collected through a chart review of patients from an occupational medicine health clinic in Grand Rapids, Michigan from January 2022 through December 2022.

This was an exploratory study with no population sample control group. Variables investigated were body mass index, gender, age, and type of injury sustained. The injuries were classified by body part into head, back, lower …

Evaluating The Utility Of Hospital Full-Scale Exercises In Veteran Health Administration's Emergency Departments, Brian Barhorst

Capstone Experience: Master of Public Health

The Department of Veterans Affairs' (VA) Veterans Health Administration (VHA) serves nine million veterans annually. Preparing for and responding to emergencies locally and nationally remains one of its critical missions. While VA policy requires the Homeland Security Exercise and Evaluation Program (HSEEP) methodology to conduct national-level exercises, local medical facility exercises mandated by The Joint Commission do not hold the same requirement. This evaluation assesses the effectiveness of hospital-based exercises within the Veterans Health Administration in preparing VA Emergency Departments (EDs) and Urgent Care Centers (UCCs) for local disasters by querying ED/UCC Medical and Nursing Directors about their experiences with …

Nurse Initiated Standing Orders: A Process Improvement At An Emergency Department In Interior Alaska, Justin D. Melberg

Capstone Experience: Master of Public Health

Emergency Departments (EDs) are a valuable and limited public health resource. In addition to treating acute medical emergencies, EDs bridge the gaps in urgent care and primary care accessibility, operating twenty-four hours a day, seven days a week, providing care regardless of an individual’s ability to pay. EDs across the country operate at or above capacity regularly, and overcrowding is projected to increase due to decreased facilities and available inpatient beds. Innovative measures are necessary to increase patient throughput and decrease length of stay while maintaining quality care. Nurse initiated standing orders, also known as nurse driven protocols, standing orders, …

Geospatial Distribution Of Pharmacist Diabetes Management Within A Patient Centered Medical Home Model In Omaha, Nebraska, Anthony Donovan

Capstone Experience: Master of Public Health

Patients with uncontrolled diabetes, defined as a hemoglobin A1c value greater than 9%, are at an increased risk of diabetes progression. Primary care is often the first point of contact where patients with uncontrolled diabetes are identified and treated. Pharmacists are utilized in diabetes medication management of patients with uncontrolled diabetes as one component of primary care multidisciplinary models of care. This descriptive project describes the geospatial distribution of patients with uncontrolled diabetes from a single institution in the Omaha, Nebraska area who were exposed to pharmacists within a Patient Centered Medical Home (PCMH) model of care compared to those …

Evaluating Lack Of Access To Secondary Prevention-Based Healthcare Services Between Racial/Ethnic Groups In The United States: A Logistic Regression Analysis Using 2022 Brfss Cross-Sectional Data, Samuel Ortiz Severiano

Capstone Experience: Master of Public Health

Objective: To determine whether racial/ethnic minorities have reduced access to preventive healthcare services in the United States, with participation in routine checkups serving as the metric for access. Methods: Performing logistic regression analysis comparing the length of time since the last routine checkup between different racial/ethnic groups in the study population. Those who haven’t had a routine checkup in at least 12 months served as the comparison group. Results: Black populations were 66% less likely to not have access to preventive care compared to White populations, while Asian, American Indian/Alaskan Native, and Native Hawaiian/Pacific Islander populations were 8.5% more likely …

Associations Between Self-Reported Cognitive Decline And Chronic Diseases: A Cross-Sectional Analysis Of Behavioral Risk Factor Surveillance System (Brfss) 2022, Hailey Child

Capstone Experience: Master of Public Health

Objective: This study seeks to capture how self-reports measure cognitive decline. The association between chronic conditions and cognition with age consideration in individuals aged 45 and older is investigated.

Methods: Univariate analysis generates frequencies and weighted percentages of 2022 BRFSS data. Chi-square tests and polytomous regressions generate odds ratios for bivariate analyses. A weighted multiple logistic regression model stratified by age group analyzes self-reported cognitive decline.

Results: Respondents ages 45 to 54 with three or more chronic diseases have the highest odds (OR = 6.81; 95% CI = 4.42, 10.48) of cognitive decline. Respondents 75 and older …

The Relationship Between Self-Reported Mental Health And Body Mass Index Among Adults In The United States Using The 2021 Behavioral Risk Factor Surveillance System (Brfss), Madhur Pandey

Capstone Experience: Master of Public Health

Objective

This study investigated the link between frequent mental distress (FMD) and body mass index (BMI) in 2021 among U.S. adults, while considering sociodemographic and lifestyle factors.

Methods

Using 2021 Behavioral Risk Factor Surveillance System (BRFSS) data, we analyzed the association between BMI as the dependent variable and FMD as the independent variable, considering the sociodemographic factors and lifestyle variables. Logistic regression models were applied.

Results

In our sample, 30.7% had a normal BMI, while 69.3% were outside the normal range. Of these, 85.1% reported infrequent mental distress, whereas 14.9% reported FMD. Those with FMD were more likely to have …

Examining The Relationship Between Adverse Childhood Experiences And Covid-19 Vaccine Status Using 2022 Brfss Data: A Cross-Sectional Study, Cristhian A. Chau-Valdivia

Capstone Experience: Master of Public Health

Abstract:

Objective.To determine the association between adverse childhood experiences (ACEs) scores with COVID-19 vaccination outcomes before and after adjusting for demographic variables.

Methods. Data were from 2022 Behavioral Risk Factor Surveillance System (BRFSS) surveys regarding 13 categories of ACEs, COVID-19 vaccination, and demographic variables. Data was weight adjusted for survey respondent data. This complex design combined the core and optional modules. Participants who received at least one dose of the COVID-19 vaccine were categorized as vaccinated. The sample size is 12,514.

Results. Participants who were female (OR=1.35, 95% CI: [1.19,1.52]), greater than or equal to 65 years old (OR=4.76, 95% …

A Cross-Sectional Analysis Of Adverse Childhood Experience Exposure On Cancer Diagnosis Utilizing The 2022 Behavioral Risk Factor Surveillance Survey Data, Emma Zipperer

Capstone Experience: Master of Public Health

Objective: To determine the association between Adverse Childhood Experiences (ACEs) and cancer diagnosis based on ACE exposure levels.

Methods: We utilized data collected in the 2022 Behavioral Risk Factor Surveillance System (BRFSS) survey. The study population (n=54,148) was restricted to states that reported on the optional model of experiencing ACEs and those who responded about cancer diagnosis. A univariate analysis, bivariate analysis and a multivariate logistic regression were performed. Odds of cancer diagnosis among those with differing ACE exposure levels were calculated.

Results: High ACE exposure had 20% higher odds of cancer diagnosis when compared to low ACE exposure. White, …

Mental Health Perceptions Among Us Veterans And Non-Veterans: 2022 Behavioral Risk Factor Surveillance System, Nicole Frederickson

Capstone Experience: Master of Public Health

Objective. To determine the association between veteran status and perceived mental health in US adults.

Methods. 2022 Behavioral Risk Factor Surveillance System cross-sectional telephone survey data were used. Analyses were adjusted for confounding sociodemographic and health-related characteristics. Weighted multinomial logistic regression was used to determine the association between veteran status and reporting 0, 1-13, or 14+ poor mental health days.

Results. A total of 430,653 individuals were included in this analysis. Veteran status was associated with decreased odds of reporting 1-13 poor mental health days than nonveterans (OR=0.81; 95% CI 0.77, 0.86) but greater odds of reporting 14+ poor mental …

Adverse Childhood Experiences As Individual Predictors Of Subjective Cognitive Decline: Analyzing The 2022 Behavioral Risk Factor Surveillance System, Ruthie Schmitt

Capstone Experience: Master of Public Health

Objectives. This study explored the association of Adverse Childhood Experiences (ACEs) and Subjective Cognitive Decline (SCD). This study aimed to determine within the United States which ACEs have a stronger association with SCD after 45 years of age by analyzing all 13 ACEs individually with SCD.

Methods. Data were obtained from the 2022 BRFSS. An analytic sample of 42,509 adults over 45 years of age from seven states was analyzed using binary and multivariate logistic regression. The outcome variable investigated in this study was SCD, and the explanatory variables were 13 ACEs.

Results. Of the respondents, 10.4% reported experiencing SCD …

Associations Between Long Covid And Healthcare Access: A Cross-Sectional Analysis Of The Behavioral Risk Factor Surveillance System (Brfss) 2022, Tiffany Elliott

Capstone Experience: Master of Public Health

Objective. To evaluate the association of healthcare access with Long COVID and clinical and sociodemographic factors.

Methods. Data were from the CDC's 2022 Behavioral Risk Factor Surveillance System (BRFSS) surveys regarding four measures of healthcare access and Long COVID. There were 25,549 respondents who reported Long COVID and 95,830 respondents who did not report Long COIVD.

Results. 25,549 (22.0%) of respondents reported Long COVID. Significant associations were found in respondents with public health insurance and delayed medical care due to cost. Those with chronic health conditions were more likely to report Long COVID. Women, certain racial/ethnic groups, …

Association Between Frequent Mental Distress And Insurance Status Using The 2022 Brfss, Christina Clayson

Capstone Experience: Master of Public Health

Objectives

Determine if there is a direct relationship between frequent mental distress and health insurance coverage.

Methods

Data from the 2022 BRFSS was used to calculate adjusted percentages. Crude odds ratios for both mental distress and insurance coverage. Multivariate analysis calculated crude and adjusted odds ratios for frequent mental distress by insurance coverage with income as a covariate.

Results

Individuals reporting frequent mental distress had lower income, less education, and were younger. Individuals without health insurance were more likely to be younger, Hispanic, and not have graduated high school. There was no significant association between frequent mental distress and not …

Assessing How Children Modify The Impact Of Having Health Insurance On Smoking Status Using The 2021 Behavioral Risk Factor Surveillance System Survey, Zak Lippert

Capstone Experience: Master of Public Health

Objective: To understand if children living in the home modify the relationship between health insurance and smoking.

Methods: This analysis used the 2021 Behavioral Risk Factor Surveillance System Survey. The outcome was being a current smoker with health insurance as the exposure. The analysis was stratified by children to determine if children changed how having health insurance impacted smoking. The odds ratios for each stratum were compared to determine if children was a modifying factor.

Results: Children had a modifying effect on health insurance. For someone with children, if they had insurance, their odds of smoking were 0.91 (95% CI: …

Examining The Impact Of Adverse Childhood Experiences (Aces) On Breast And Colorectal Cancer Screening Behaviors In Adulthood, Meagan A. Kraft

Capstone Experience: Master of Public Health

Objective: To investigate the relationship between adverse childhood experiences (ACEs) and screening for breast and colorectal cancer in adulthood.

Methods: This cross-sectional study utilized nationwide survey data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS). Data regarding ACEs and compliance with breast and colorectal cancer screening guidelines were analyzed from 12 states. Weighted logistic regression models were used to assess the relationship between ACEs and breast cancer screening compliance in a population of 18,369 women, and colorectal cancer screening compliance in a population of 30,884 men and women. Screening compliance among those with a high ACE score was compared …

Relationship Of Adverse Childhood Experiences And Depression Using The 2022 Behavioral Risk Factor Surveillance System Data In 12 States, Ivy Sovine

Capstone Experience: Master of Public Health

Objective: To determine if reporting adverse childhood experiences (ACE) is linked to depression in adults, taking into consideration the influence of sociodemographic factors.

Methods: A secondary analysis was performed using the cross-sectional 2022 Behavioral Risk Factor Surveillance System (BRFSS) survey data. Twelve states included the optional ACE module, respondents who did not answer the questions about depression, education, or at least one ACE question were excluded from the analysis. The study population included 59,860 respondents. We examined the relationship between depression and ACE by using weighted univariate analysis, bivariate models, and logistic regressions.

Results: Among the respondents, 21% (12,112) reported …

Ordinal Logistic Regression Analysis Of The Frequency Of Marijuana Use Among Adult Informal Caregivers In 20 U.S. States, Behavioral Risk Factor Surveillance System (Brfss) 2021, Athena Plichta

Capstone Experience: Master of Public Health

Objectives. To examine the association between frequency of marijuana use among informal caregivers of persons with dementia (PWD) and other health conditions compared to non-caregivers in 20 U.S. states.

Methods. We used complex survey data from the optional modules Caregiver and Marijuana Use of the 2021 BRFSS survey. Univariate and bivariate analyses were performed to determine the frequency and distribution of sample population characteristics and calculate crude relationships. Ordinal logistic regression modelled the relationship between the three-level outcome and covariates.

Results. Frequency of marijuana use and caregiver status were not associated. There was no difference in increased use among individuals …

Certified Midwives: An Exploration Of Their Impact On Maternal Health Outcomes – A Comprehensive Literature Review, Heather Hollister

Capstone Experience: Master of Public Health

Maternal health outcomes in the United States have been consistently worse than other high-income countries, with a disproportionate impact on women of color. Midwives have long played an important role in maternal health worldwide. The literature review examines the evidence for midwives as key contributors to improving maternal health outcomes. The paper reviews the existing literature on midwifery, including the impact on maternal health, labor and delivery outcomes, and patient satisfaction. Electronic searches were conducted through Cochrane Library, CINAHL, Medline and Embase. Articles were screened according to inclusion and exclusion criteria including that they must be a randomized study; participants …

A Policy Evaluation For California’S Care Act And The Application Of The Social Determinants Of Health, Adelina Mercedes Lang

Capstone Experience: Master of Public Health

In 2022, California passed a legislative bill, SB 1338: the Community Assistance, Recovery, and Empowerment (CARE) Act, which created a new statewide procedure for treating mentally ill homeless adults diagnosed with psychotic disorders through a court-ordered CARE plan. SB 1338 intends to alleviate the mental health and homeless crisis. This capstone project provides an early assessment of SB 1338 using a modified formative policy evaluation methodology, including a scoping literature review and applying a policy assessment using the CDC's Policy Evaluation Framework. A stakeholder survey was also applied to gather stakeholders' perspectives on SB 1338. The literature review supported the …

Assessing The Role Of Distance To Level I Trauma Units On Atv Rollovers, Tractor Rollovers, And Machinery Entanglement Outcomes, Andrew K. Schissel

Capstone Experience: Master of Public Health

All-Terrain Vehicle (ATV) rollovers, tractor rollovers, and machinery entanglements cause traumatic injuries to agricultural workers. Response time of first responders combined with travel to trauma units can take a significant amount of time in rural areas, potentially leading to an increased risk of fatal outcomes for those involved in these incidents. The aim of this study is to determine if distance to a level I trauma unit is a factor in the outcomes of these incidents. ATV rollovers, tractor rollovers, and machinery entanglement injuries and fatalities, collected from a 7-state Midwestern region were entered into a GIS system along with …

A Literature Review Of The Psychosocial Impacts On Livestock Producers And Veterinary Responders Involved With Depopulation During And After An Animal Health Emergency, Beth Galles

Capstone Experience: Master of Public Health

A vital aspect of an animal health emergency in the United States is removing and disposing of diseased and healthy animals through depopulation. It is frequently required to prevent the spread of diseases that affect human health or economic stability. Production animals are eventually slaughtered, but this does not negate the human-animal bond felt between these animals and their caretakers. There is increasing recognition that participation in depopulation may be a traumatic event requiring care for the individuals involved, including livestock producers and veterinarians. Despite this, limited resources are available for these individuals when an animal health emergency occurs. This …

Occupational Exposures Associated With Thyroid Cancer In The Thyroid Tumor And Cancer Collaborative Registry In The Integrated Cancer Center Repository For Cancer Research, James Buckley

Capstone Experience: Master of Public Health

Thyroid cancer is one of the fastest growing cancers in the United States, with the rate of new cases increasing from 5.2 per 100,000 in 1985 to 13.8 per 100,000 in 2019, with a peak of 14.5 per 100,000 in 2015. Increased thyroid cancer incidence is associated with certain occupations, including healthcare and agriculture. Most existing literature on occupational exposures and thyroid cancer evaluate their association in terms of occupation type and thyroid cancer, rather than specific occupational exposures and thyroid cancer. This study sought to utilize the wide range of occupational exposure data in the Integrated Cancer Center Repository …

Evaluating Nebraska’S State Health Assessment (Sha) And State Health Improvement Plan (Ship) Methodology To Inform The Redesign Evaluation Plan, Austin J. Osborn

Capstone Experience: Master of Public Health

The Division of Public Health (DPH) within the Nebraska Department of Health and Human Services (DHHS) is redesigning its State Health Assessment (SHA) and State Health Improvement Plan (SHIP) procedures. This study aimed to support the Nebraska DPH SHA/SHIP redesign evaluation plan by determining the local health department (LHD) health priority determination processes, Tribal and LHDs’ (T/LHD) CHA/CHIP methodology, and if any differences exist between rural & urban and small, medium, and large jurisdictional size health departments in Nebraska. The results show that most health departments utilize the MAPP process to conduct their CHA/CHIP, one tribal entity utilizes a different …

Influence Of Sexual Orientation On Sexual Risk Behaviors Among High School Students – United States, 2023, Carley J. Cortez

Capstone Experience: Master of Public Health

The Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Asexual, and other (LGBTQIA+) community participate in higher sexual health risk behaviors that lead to outcomes such as sexually transmitted infections and unwanted pregnancies than their heterosexual peers. Youth and adolescent LGBTQIA+ populations also experience this increased sexual health risk which will increase the risk for negative health outcomes as adults. The 2019 Youth Behavioral Risk Survey dataset was used to assess the association between sexual orientation on specific sexual health risk behaviors such as total number of sexual partners, history of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) testing, and …

Rural-Urban Differences In The Age-Adjusted Pediatric Cancer Mortality In The United States (2000-2020), Reitumetse A. Setai

Capstone Experience: Master of Public Health

In the United States (U.S.), 5-year survival for pediatric cancers improved from 58% in 1975 to 85% in 2017. However, pediatric cancer remains the second leading cause of death in children between 0 – 14 years. Despite the growing body of pediatric cancer research, there is limited knowledge of the urban and rural disparities of pediatric cancer mortality. This study examined: 1) the differences in the U.S. pediatric cancer mortality rates between rural and urban residents during 2016-2020 by demographic characteristics (age group, sex, race/ethnicity, and income) and cancer types and 2) the trend of pediatric cancer mortality in the …