Public Health Commons^™

A Landscape Analysis Of Rapid Evidence Curation During The 2022 Sudan Virus Disease Outbreak In Uganda, Jemimah J. Wachap

Capstone Experience: Master of Public Health

Uganda's 2022 Sudan Virus Disease (SVD) outbreak emphasized the need for rapid and effective evidence curation in public health emergencies. This analysis examines evidence curation practices during the SVD response, identifying challenges and assessing the timeliness and effectiveness of strategies in low-resource settings. While global responses to previous outbreaks, like COVID-19, have advanced evidence synthesis, the SVD outbreak revealed infrastructure and data integration gaps. The study aims to map the evidence curation landscape, focusing on models and tools, such as data-sharing platforms, mobile Polymerase Chain Reaction (PCR) labs, and Integrated Management Systems (IMS). It will also address gaps in surveillance, …

Evaluating The Nebraska Medical Center's Repatriation Of Inter-Hospital Transfers, Natalie Crump

Capstone Experience: Master of Public Health

Background: Bed capacity challenges at large academic medical centers delay the transfer of rural patients, negatively impacting their safety and quality of care. Repatriating inter-hospital transfer (IHT) patients to referral facilities upon completing specialized care can improve tertiary hospital bed capacity and community hospital financial sustainability.

Objectives: This project aims to identify the barriers and facilitators to successful IHT repatriation and the process and outcome variables influenced by the Nebraska Medical Center’s reverse transfer program.

Study Design: A retrospective observational cohort study was conducted to identify barriers and facilitators of NM’s IHT repatriation program.

Methods: Descriptive and comparative analyses of …

A Research Report: What Are The Challenges That Refugee Women Experience When Seeking Healthcare Related To Pregnancy In The United States?, Manuela Krieger-Adi

Capstone Experience: Master of Public Health

Background

Refugees in the United States, including African refugee women, face many challenges in seeking healthcare after moving to the United States to resettle. It is urgent and essential to look into some of the health challenges the refugee community faces here in Omaha, Nebraska, that prevent them from seeking healthcare, especially when pregnant. This Capstone research project aims to focus on African refugee women, specifically in Omaha, Nebraska, and the challenges they face seeking healthcare related to pregnancy.

Methods

This research report involved five in-depth interviews conducted over Zoom. The target population was refugee mothers who had given …

Assessing The Association Between Total Cholesterol And Hospitalized Myocardial Infarction In Women Ages 32-70: An Analysis Of The Framingham Heart Study, Jolene L. Stapleton Duree

Capstone Experience: Master of Public Health

Objective

Heart disease is the leading cause of death in women that may go undiagnosed due to unexpected symptoms. The purpose of this analysis was to assess the effect of total cholesterol on the odds of hospitalized myocardial infarction (MI).

Methods

This analysis used a sample of 2,445 women from the Framingham Heart Study, an observational prospective cohort study. The exposure was total cholesterol, and the outcome was hospitalized MI. Logistic regression was used to estimate crude and adjusted odds ratios (OR). The adjusted models controlled for age, blood pressure, and diabetes. Effect modification by diabetes status was evaluated in …

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 …

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 …

Reducing Greenhouse Gases Through Food Waste Reduction: A Literature Review Of Programs And Behavior Change, Schafer Flowerday

Capstone Experience: Master of Public Health

Anthropogenic greenhouse gas (GHG) emissions significantly contribute to climate change. Methane is a potent GHG emitted in landfills as organic material breaks down. Food waste is the single most common item disposed of in Lincoln’s Bluff Road Landfill (LTU, 2022). As such, food waste disposal in the landfill is a preventable issue that could dramatically reduce GHG emissions in Lincoln. This project seeks to determine what barriers and motivations exist for reducing food waste at a consumer level. A literature review was conducted to find what behavior change campaigns and interventions have taken place nationwide to encourage residential food waste …

A Process Evaluation Plan For The Nebraska Fetal Infant Mortality Review (Fimr) Program, Mamello Makhele

Capstone Experience: Master of Public Health

The United States (U.S.) has made substantial progress in reducing fetal and infant mortality, but high rates of infant mortality persist, particularly within minority populations. In Douglas County, Nebraska, racial disparities in infant mortality rates remain a significant issue. In 2019, the infant mortality rate among African American mothers was 14.2 infant deaths per 1,000 live births, compared to 5.7 infant deaths per 1,000 live births among Caucasian mothers.

To reduce fetal and infant mortality in the U.S., the Centers for Disease Control and Prevention along with the Human Resources and Services Administration, fund the Fetal and Infant Mortality Review …

Current Status Of Colorectal Cancer Screening Among Adults With And Without Cognitive Disabilities In The United States, 2022, Elma Vasconcelos

Capstone Experience: Master of Public Health

Objective: Evaluate the prevalence of non-compliance with colorectal cancer screening guidelines among US adults aged 45-75, comparing individuals with cognitive disabilities to those without.

Methods: This study utilized data from the 2022 Behavioral Risk Factor Surveillance System survey, which uses weighted and complex survey sampling methodologies. Participants under 45 were excluded, resulting in a study sample of 220,879. Univariate, bivariate, and multivariable logistic regression analyses were conducted to assess the prevalence odds ratio of colorectal cancer screening among individuals with and without cognitive disabilities.

Results: Those with cognitive disabilities had 1.07 (95% CI: 0.99-1.15) times the odds of not adhering …

Emergency Sheltering And Autism, Rrose Lamay

Capstone Experience: Master of Public Health

While research is abundant on the individual topics of caring for vulnerable populations in a disaster, Autism Spectrum Disorder. There is little guidance available that ties these together and deals directly with the emergency sheltering of minors on the autism spectrum. The information gap extends to preparedness for caregivers of children on the spectrum, shelter workers, and community members. This vulnerable population is known to have specific needs during disasters when mass sheltering is needed. These needs could be addressed by the development of a comprehensive literature review, a survey, and a coinciding guide. The literature review discusses preexisting academic …

A Literature Review Of Societal Obesity And Its Impact On United States Military Recruitment, Megan Thibodeaux

Capstone Experience: Master of Public Health

In recent decades, obesity rates have increased in the United States, raising significant health and societal concerns, especially in terms of military readiness. The ever-rising rates of weight-related health obstacles present a critical national security issue as it impacts the effectiveness of recruitment. This literature review aims to analyze how obesity impacts military recruitment and readiness to serve while utilizing the socio-ecological model to help determine gaps in evidence. Data was drawn from Embase, PubMed, and PsychInfo. Inclusion criteria consisted of academic journals and reports from government and non-profit organizations written in English. They focused only on the United States …

Incentive-Based And Media Literacy-Informed Approaches To Improve Vaping Cessation Among Young Adults: A Pilot Study Protocol, Troy B. Puga Jr

Capstone Experience: Master of Public Health

Introduction: Youth and young adult vaping is rapidly rising within the United States, and is approaching epidemic levels. Vaping has been marketed as a safe alternative to smoking, however, there has been clear negative health effects of vaping. Modern day vaping interventions targeting this population remain limited. With the rapid rise of vaping and the negative health effects, tested interventions are needed. This protocol research paper defines the background and methodology behind the registered clinical trial entitled Incentive-based and media literacy-informed approaches to improve vaping cessation among young adult: a pilot study protocol.

Methods: This protocol research paper will describe …

Impact Of Medicaid Redetermination On Underserved Populations In Region 7 States: A Review, Brianna Parr

Capstone Experience: Master of Public Health

When the COVID-19 Public Health Emergency ended in May of 2023, Medicaid began the process of redetermination across the states and returned to its original eligibility rules. Because of this, the healthcare status of many Americans was affected, resulting in the loss of healthcare coverage for millions of people. Of those who have lost coverage, children make up almost half of the total. This paper assesses the negative effects of Medicaid redetermination on children and other underserved populations in communities across the four states in Region 7 (Nebraska, Iowa, Missouri, and Kansas) and identifies programs that these states can implement …

How To Evacuate When Disaster Strikes: A Literature Review Of Hospital Evacuations, Grant Orr

Capstone Experience: Master of Public Health

Hospitals are an essential component of any community’s infrastructure, and due to the nature of their services they are vulnerable when a disaster strikes. If a disaster is severe enough to warrant a hospital evacuation, both hospital and community leaders must decide how to proceed with the resources at their disposal. Organizations such as the World Health Organization, the United Nations, and the United States Department of Health and Human Services offer general guidance, but specifics as to how a hospital should proceed with an evacuation are left to individual hospital leaders and emergency management teams. This capstone project will …

Physician Burnout In The United States: A Systematic Review Of Organizational And Systemic Approaches And Their Efficacies, 2014-2024, Nicole Butler

Capstone Experience: Master of Public Health

Physician burnout represents a critical public and clinical health concern in the United States. It compromises patient care and physician safety. Approaches to solve the issue are pervasive, with limited indication of effectiveness. Due to the essential job functions of physicians, the practice of medicine is inherently stressful. However, the introduction of new, more complex stressors, including those exacerbated by the COVID-19 pandemic, and the increase in chronic healthcare conditions have made burnout an unfortunate staple of physician life, with an estimated prevalence of up to 60%. Burnout involves three factors: emotional stress, depersonalization, and reduced job satisfaction. The consequences …