Public Health Commons^™

Program Evaluation: Wellness For Life, Patricia Wagner

Capstone Experience: Master of Public Health

Specific Aim: The specific aim of this program evaluation is to assess the effectiveness of the employee wellness program (Wellness for Life program) at Community Hospital (CH) in McCook, Nebraska through the analysis of biometric data, personal health assessment results, and survey results.

Significance: The evaluation of this program is important to ensure CH is aiding their employees so they might lead healthy lives at a time when the health of our country is incredibly poor.

Background: CH is a small critical access hospital that employs 323 people in McCook, Nebraska. In 2013 CH decided to offer a formal employee …

Medical-Legal Partnerships: Assessment Of Mental Health & Substance Abuse Patients And Social/Legal Needs, Fung J. Liu

Capstone Experience: Master of Public Health

A medical-legal partnership (MLP) is a model which brings together health and legal services in the form of a multidisciplinary team that works to address medical and legal issues. Currently, Legal Aid of Nebraska is partnering with Bluestem Health, a local federally qualified health center (FQHC) located in Lincoln, Nebraska, to identify legal issues and provide civil legal aid services through a screening and referral process. The purpose of this capstone project was to assess the characteristics and determine the types of social/legal needs of FQHC patients referred to Legal Aid of Nebraska. Data collected was utilized to assess whether …

A Statewide Needs Assessment Of Perspectives On Training And Certification Of Community Health Workers In Nebraska, Jessica Ern

Capstone Experience: Master of Public Health

INTRODUCTION: Community Health Workers (CHWs) are a crucial growing component of the health care field in the U.S. According to the US Bureau of Statistics (2018), the CHW workforce is expected to grow 38% in the next ten years. While research has repeatedly shown the success of CHW-led programs and the financial benefits of CHWs, little work has been done to evaluate the training and certification preferences of CHWs in Nebraska. This project aimed to gather and analyze qualitative and quantitative data through an exploratory sequential mixed-methods approach to provide policy recommendations regarding the future training and potential certification of …

Surgical Care Perspectives: Exploring Barriers And Facilitators To Surgery In Rural Nebraska, Sarah Stanislav

Capstone Experience: Master of Public Health

Background: Minimally invasive surgery (MIS) is associated with less pain, faster recovery, and lower complication rates. Despite being the standard of care, it remains underutilized in rural Nebraska. Surgeon shortages and limited studies describing patient and provider factors influencing treatment gaps contribute to unnecessary complications and healthcare expenditure. Our study aimed to understand rural surgical care barriers and facilitators encountered by patients, providers, and stakeholders in Nebraska. Methods: This exploratory mixed methods study involved 17 semi-structured interviews using a snowball sampling of eligible participants affiliated with an MIS Advisory Committee. Two coders analyzed data using NVivo12. A follow-up review of …

Characteristics Of Tobacco Retailers And Proximity To Schools In A Midwest City, Sierra N. Garth

Capstone Experience: Master of Public Health

This descriptive epidemiology project provides an overview of the number, characteristics, and proximity of retailers that sell tobacco and vaping products to middle and high schools. ArcGIS was used to map the proximity of these retailers to public and private middle and high schools in Lincoln, Nebraska. Mapping the retailers and schools allowed us to explore the potential exposures to these products teens experience on a daily basis.

The Development Of A Suicide Prevention Program For American Indian Youth In Nebraskan Communities, Sara Donovan

Capstone Experience: Master of Public Health

In Nebraska and nationally, American Indian (AI) youth have higher rates of depression, suicide attempts, and suicide completions than other racial and ethnic groups. These statistics highlight the need for accessible and culturally aware behavioral health planning and support. In Nebraska, access to care by AI youth is limited by a behavioral health provider shortage and concerns of affordability, stigma, trust, cultural competence, and historical trauma. The developed culturally humble suicide prevention program for AI youth aged 19-24 to be implemented in community settings addresses an existing service gap. Strategies were developed with input from the population of focus, and …

Comprehensive Review Of Telehealth Law And Literature: Implications For Future Policy And Patients, Morgan Kristensen

Capstone Experience: Master of Public Health

PURPOSE: The purpose of this Capstone is to determine whether telehealth is effective at producing positive health outcomes, and what the current status of state telehealth law is in the United States and how can the law be changed to improve the implementation and use of telehealth services. METHODS: A literature review of PubMed was used to find articles relating to telehealth and its effectiveness. A law review of each state’s telehealth and telemedicine laws was conducted using Westlaw. RESULTS: The literature review uncovered that telehealth has the potential to produce positive health outcomes for a variety of conditions and …

Equivalency Testing For Two Formulations Of A Clinical Laboratory Control Material, Jessica M. Hart

Capstone Experience: Master of Public Health

Clinical laboratory control materials are an integral part of legally-mandated and highly regulated quality control protocols in all clinical laboratories. These controls ensure accurate performance of the laboratory testing and instrumentation used to produce medical test results for millions of patients. It is of clinical and public health interest to ensure the diagnostic test results which affect so many people are regulated by the most accurate and precise controls.

Formulation changes in control materials have the potential to impact laboratory quality control. In this study, data from two formulations of a hematology control were compared to assess equivalency of the …

An Assessment Of Occupational Heat Stress In A Central Utility Plant, Abdoulaye Abdoulaziz

Capstone Experience: Master of Public Health

Global climate change has been declared a threat to human health, which includes occupational safety issues. As temperatures continue to increase, heat stress and heat-related illness are occupational safety issues that need to be better understood. Assessments of workplace heat exposures are key to implement appropriate health and safety interventions. This study attempted to assess whether workers’ perception of work environment temperature in a Central Utility Plant was associated with heat-stress prevention behaviors. Therefore, we used a questionnaire to collect Central Utility Plant employees’ demographic characteristics, data regarding their perceived work environment temperatures, and their behaviors related to preventing heat-related …

Planning A Culturally And Linguistically Appropriate Obesity Intervention For Hispanic/Latino Children Living In Rural Nebraska, Ada V. Luna

Capstone Experience: Master of Public Health

Childhood obesity is a public health concern in the U.S; however, for the Hispanic/Latino community these concerns have grown to epic proportions. In Nebraska, the rate of childhood obesity is 25.1%; among Hispanic / Latinos students, the obesity rate is 30.9%. Unfortunately, specific Nebraska obesity rates by race and ethnicity are limited among rural communities, and programs that can effectively address this problem in the Hispanic / Latino community are limited or non-existent. Consequently, disparities between urban and rural communities exist. The purpose of this capstone project is to design a culturally and linguistically oriented intervention to address childhood obesity …

Prevalence Of Intimate Partner Violence Among The Maternal-Fetal Medicine Population, Sarah K. Larsen

Capstone Experience: Master of Public Health

Intimate partner violence (IPV) is increasingly understood as an important public health issue. It is well understood that intimate partner violence has many negative effects on its survivors ranging from physical to mental health conditions. The population of people who experience intimate partner violence and population of pregnant women are both vulnerable populations. Examining the two populations together demands a trauma-informed approach and an understanding of the intricacies of both pregnancy and intimate partner violence. While IPV has been studied among the pregnant population, intimate partner violence as it relates to the maternal fetal medicine (MFM) or high-risk pregnancy population …

The Wellbeing Partners’ Use Of The School Health Index To Identify Needs In Omaha Public Schools: A Process Evaluation, Sophia A. Quintero

Capstone Experience: Master of Public Health

The School Health Index tool from the Center for Disease Control and Prevention has been a useful tool to identify needs and areas of improvement for schools. This tool is most effective when used in collaboration with school staff and assistance from an outside facilitator. The purpose of this evaluation was to determine the administration efficiency of the School Health Index in select schools throughout the Omaha Public School (OPS) district by The Wellbeing Partners. A process evaluation was conducted to: 1) assess the relationship between the schools’ wellness champions at five Omaha Public School (OPS) elementary schools and The …

Closing The Loop: Pilot Evaluation Of Referral Navigator At Oneworld Community Health Centers, Oliver Ramirez-Gutierrez

Capstone Experience: Master of Public Health

Background. Low-income persons are subject to barriers to accessing health care and the additional complexity of the referral process, specifically for those receiving assistance from indigent care programs, contributes to those barriers. The requirements for patients receiving social assistance from indigent care programs leads to increased waiting time to be seen by specialists and contributes to health disparities.

Aim. Through a partnership with OneWorld Community Health Centers this project seeks to understand the efficacy of the implementation of a “referral navigator” at OneWorld and make recommendations to enhance the process. The proposed navigator is aimed to decrease the waiting time …

The Effect Of Childhood Farm Exposure On Adult Respiratory Symptoms And Proinflammatory Cytokine Responsiveness In Agricultural Workers, Jacob C. Grothe

Capstone Experience: Master of Public Health

Introduction: Studies have shown that the farm exposes workers and family members to countless microorganisms such as, gram-negative bacteria that possess endotoxins, which have been demonstrated to contribute to lung disease, such as asthma, in exposed workers. Results of studies of children show conflicting results regarding the development of asthma or asthma-like symptoms in response to farm exposures. European children show a “protective effect” against atopy and asthma during adolescence, while North American children show a higher prevalence of asthma or asthma-like symptoms. Also, whether this protective effect carries into adulthood is unclear. Some studies show a low prevalence of …

Effect Of Cigarette Smoking On Cd4 Count And Viral Load Among Hiv Patients Attending Treatment At Nebraska Medicine, Chacha Josiah Mwita

Capstone Experience: Master of Public Health

Background

Smoking is known to have a negative impact on both morbidity and mortality in people living with HIV (PLHIV). However, there is inconsistent information about the role of smoking on markers of HIV disease progression (CD4 count and HIV viral load). This study examined the effects of cigarette smoking on markers of HIV disease progression among PLHIV at Nebraska Medicine.

Methods

A retrospective cohort study was conducted utilizing electronic health information of 604 PLHIV who attended treatment at Nebraska Medicine between 2012 and 2020. Multiple linear regression was used to model the effects of smoking on the mean change …

The Association Of Demographic And Clinical Characteristics And Self-Reported Sleep Duration Among Patients With Prediabetes, Priyanka Chaudhary

Capstone Experience: Master of Public Health

Background: Sleep has been recognized as a critical component of healthy development and overall health. However, sleep duration has emerged as an important lifestyle factor that influences endocrine function and glucose metabolism. There remains a dearth of research to assess sleep duration among patients with prediabetes.

Objective: To evaluate the association between socio-demographic and clinical characteristics and self-reported sleep duration among patients with prediabetes.

Methods: Baseline data (n=599) was used from a diabetes prevention trial. A chi-square test was used to assess the differences between the groups of sleep duration for the categorical, whereas the t-test was used for the …

A Review Of The Characteristics Of Super-Utilizers And Evidence-Based Approaches To Reduce Healthcare Utilization, Suswara Mandala Rayabandla

Capstone Experience: Master of Public Health

A significant fraction of health care resources in the United States of America is utilized by a comparatively small number of people. An examination of the attributes and patterns and associated evidence-based interventions for such high-utilizing patients might aid clinicians to improve interventions to address the distinctive needs of these patients, decrease their risks for numerous hospitalizations, and contribute to reducing the costs. This study aims at exploring the existing literature on the characteristics of super-utilizers and interventions to reduce avoidable use of health care among this population. The method used for this research is a comprehensive literature review. Search …

Age-Adjusted Incidence Rates And Time Trends Of Non-Hodgkin Lymphoma By Subtype, 2000-2015, Daitrang Le

Capstone Experience: Master of Public Health

Background: Non-Hodgkin lymphomas (NHL) are a group of diverse and complex cancers of the lymphocytes. More than 60 subtypes have been identified based on certain characteristics of the cancer cell. The objectives of this study were to: 1) determine NHL age-adjusted incidence rates from 2000 to 2015 in the U.S. by age, sex, and race/ethnicity; 2) to examine age-adjusted subtype-specific NHL incidence rates by age, sex, and race/ethnicity; 3) to determine if there was significant time trend in age-adjusted NHL incidence rate from 2000-2015 in the U.S by age, sex, and race/ethnicity.; 4) and to examine time trend in age-adjusted …

Association Between Gastroduodenal Ulcer And Age Of Diagnosis Of Head And Neck, Gastroduodenal And Pancreatic Cancer, Rukevwe Madusor

Capstone Experience: Master of Public Health

Background: Cancer is the second leading cause of death in the United States and remains a major public health problem worldwide. Epidemiological studies have demonstrated that insulin like growth factor-1 (IGF-1) is linked to ulcers and most cancers. Although studies have investigated the role of IGF1 in ulcer healing and cancer pathogenesis, the link between ulcer and cancer remains unclear. Hence, we assessed the relationship between ulcers and cancers.

Methods: This study consists of a sample of 180 cancer patients obtain by convenience sampling who were seen at Nebraska Medicine and were enrolled in the integrated cancer repository for cancer …

Examining Racial & Ethnic Disparities In The Reach Of The Medicare Shared Savings Program, Lindsey Arneson

Capstone Experience: Master of Public Health

It is important to understand the quality of health care for racial and ethnic minorities covered under the largest U.S. government-run insurance program, Medicare, because the demographics of the U.S. are becoming older and more diverse. A new value-based program under Medicare is the Shared Savings Program (MSSP), which creates incentives to improve care quality and health outcomes for Medicare beneficiaries with a specific focus on increasing the provision of preventive care services. This capstone project aims to understand the representation of racial/ethnic minority Medicare beneficiaries, namely African Americans/Blacks and Hispanics/Latinxs, that receive care from providers or facilities (i.e., Accountable …

Assessment Of Particulate Matter Levels In Homes With Children, Ali Al Rabou

Capstone Experience: Master of Public Health

Children’s exposure to particulate matter (PM) is of great interest because it can cause adverse health effects, including asthma, and decreased lung function. The purpose of this study was to determine the levels of PM in low socio-economic status homes in Omaha, Nebraska. Between October 2018 and September 2019, we collected ambient air PM samples from 30 homes, of which 70% had at least one asthmatic child. Samples were collected at 2 feet and 4 feet to represent the breathing zones of toddlers and older children, respectively. We also asked the study participants questions related to indoor air quality (IAQ). …

Influence Of Health Habits On The Success Of The Community Response Program, Hannah Harrington

Capstone Experience: Master of Public Health

The goal of this project is to determine how specific health habits can affect success of the Community Response (CR) program. Community Response is a program that brings government, non-profit and faith-based organizations together in one community to share resources, identify challenges and create solutions with the goal of strengthening the protective factors that help families raise happy, healthy children (Lift Up Sarpy County, 2018). Health habits include habits centered around everyday life including protective factors such as maintaining support systems, financial stability, and other ways to strengthen families, eliminate risk, and keep children out of the child welfare system. …

The Association Between Melanoma And Exposure To Arsenic Among U.S. Adults Using The National Health And Nutrition Examination Survey (Nhanes) From 2003 To 2016, Ahmed Bedaiwi

Capstone Experience: Master of Public Health

Background: Melanoma is a deadly skin cancer at late stages, and its incidence has been increasing significantly over the last ten years in the United States. Chronic exposure to arsenic has been associated in many studies as a risk factor for non-melanoma skin cancer, notably squamous cell carcinoma. However, current knowledge is limited regarding melanoma and long-term arsenic exposure.

Methods: We conducted a cross-sectional study using the 2003-2016 cycles of the National Health and Nutrition Examination Survey (NHANES), to investigate the association between arsenic exposure and self-reported melanoma and non-melanoma skin cancer diagnoses. Univariate and multivariate logistic regressions were conducted. …

Evaluating Occupational Hazards And Personal Protective Equipment Use On Farms In Kyrgyzstan, Christopher Tougeron, Chandran Achutan, Kenesh Dzhusupov, Lorena Baccaglini

Capstone Experience: Master of Public Health

Objectives – The purpose of this study was to identify occupational hazards and personal protective equipment use on farms operating in Kyrgyzstan.

Methods – We recruited 20 farmers in Kyrgyzstan. They completed a questionnaire and responded to interview questions to determine their occupational hazards, personal protective equipment use, and work-related injuries. We measured noise levels using the National Institute for Occupational Safety and Health sound level meter application for Apple iOS.

Results – Most farmers reported knowing how and when to use personal protective equipment, however 95 percent had not received training on how to use them. Observation of farmers …

Trends Of Endometrial Cancer Among Adult Women In The United States, Fnu Kanishka

Capstone Experience: Master of Public Health

Background: Endometrial cancer also referred to as uterine corpus cancer is the fourth most common cancer diagnosed among US women. It is also one of the few cancers in the US that has an increasing incidence and mortality rate. This study examined the overall and race specific age-adjusted incidence rate as well as incidence-based mortality rate of endometrial cancer in the United States from 1975-2016.

Methods: Surveillance, Epidemiology, and End Results (SEER) 1975-2016 data were used. Overall and race specific age-adjusted incidence rate, incidence-based mortality rates and 95% confidence intervals were calculated Trend graphs were created, annual average percent change …

Organizational Culture Change In The United States Government And Its Application In State And Local Public Health Agencies: A Literature Review, Katherine Barrow

Capstone Experience: Master of Public Health

State and local health agencies play a critical role in the assessment and assurance of public health in the United States. Their authority to shape the structure and delivery of health services makes organizational culture change imperative for the improvement of government services and ultimately, the health of the public. A systematic literature review using SCOPUS, PsycINFO, Business Source, and Academic Search Premier was conducted to 1) analyze organizational culture change efforts in United States federal, state, and local government settings and 2) make recommendations on how to implement organizational culture change initiatives in state and local health agencies. Of …

Developing A Training Program For Omaha Metro Area Sexual Assault Nurse Examiners Caring For Individuals With Developmental Disabilities, Emily Blanchard

Capstone Experience: Master of Public Health

Individuals with developmental disabilities experience many barriers to healthcare and are at a substantially higher risk for sexual assault and trauma. There is a need for more inclusive and collaborative healthcare policies, practices, and education to guide healthcare providers during their encounters with individuals with developmental disabilities as patients, especially during forensic examinations following sexual assault and trauma. In the Omaha metro area, physical therapists at the Munroe-Meyer institute provide clinical services in a transdisciplinary program that refer victims of sexual violence to local health systems’ Sexual Health Nurse Examiners (SANEs).

There is an existing service gap for individuals with …

Evaluation Of Relationship Between Lead-Dust Loading, Lead-Dust Concentration, And Total Dust Loading Metrics Across Multiple Data Sets, Charles Bevington

Capstone Experience: Master of Public Health

Lead-dust monitoring studies report values as either lead-dust loadings µg/ft² or as lead-dust concentrations µg/g. It is rare for studies to report both metrics. When only lead-dust loading values are present, professionals require an approach to estimate lead-dust concentration values. A literature search identified five studies that contained raw data for both lead-dust loading and lead-dust concentration. An additional thirty-two studies had summary-statistics available for both lead-dust loading and lead-dust concentration. Studies with raw-data were used to develop an empirically-based loading to concentration statistical relationship. Raw data sets were critically evaluated to determine whether elimination or …

Using Syndromic Surveillance To Assess The Impact Of Environmental Factors On Asthma- And Copd- Related Ed Visits In Douglas County, Nebraska, Sandra Gonzalez-Ramirez, Anne Mardis O'Keefe, Tricia D. Levan, Lynette Smith

Capstone Experience: Master of Public Health

Background: Asthma and chronic obstructive pulmonary disease (COPD) are chronic diseases associated with health disparities in Douglas County, Nebraska and in the United States. Currently there is a lack of information describing the impact of environmental factors in Nebraska on the burden of emergency department (ED) visits or hospitalizations related to these chronic respiratory (CR) diseases. The aim of this study was to determine if there is an association between the numbers of seasonal viral respiratory (SVR)- related ED visits, outdoor air pollutants, aeroallergens, or meteorological factors on the number of CR- related ED visits in Douglas County, Nebraska.

Methods: …

Association Of Copy Number Variations With Chronic Hepatitis B In Chinese Population, Fang Niu

Capstone Experience: Master of Public Health

With one third of the Hepatitis B virus (HBV) infection population of the world, chronic Hepatitis B (CHB) has become a top burden in China. CHB is a lifelong infection with HBV which can cause serious health problems, like cirrhosis, liver cancer or even death. HBV infection is known to result in various clinical conditions, including asymptomatic HBV carriers to chronic hepatitis and primary hepatocellular carcinoma. Several studies have shown that host genetic susceptibility could be an important factor that determines these various outcomes of HBV infection. Many Single Nucleotide Polymorphisms (SNPs) and Copy Number Variations (CNVs) have been associated …