Public Health Commons^™

Out From Under: Stories Of Endometriosis, Prisca Edwards

Theses and Dissertations

Six individuals. One diagnosis. In Out From Under, people living with endometriosis gather for an art-centered workshop. Through collage and conversation, they transform isolating medical experiences into paths of connection and collective healing.

Endometriosis affects approximately one in ten women of reproductive age, yet diagnosis is often delayed by nearly a decade. During this time, many suffer from debilitating symptoms without adequate care or accessible treatment. Out From Under explores the lived experience of endometriosis through the lens of socially engaged documentary filmmaking. Participants share their medical histories, emotions, and frustrations in a structured yet open environment designed for intimacy, …

Implementing And Evaluating An Ai-Powered Visual Decision Support System To Improve Antibiotic Usage Among Physicians With A Built-In Early Warning System, Akua Sekyiwaa Osei-Nkwantabisa

Theses and Dissertations

The widespread misuse and excessive prescription of antibiotics have played a pivotal role in the emergence and proliferation of antibiotic-resistant bacteria, posing a critical global public health crisis. Addressing this challenge necessitates innovative solutions that enhance antimicrobial stewardship. This study presents the development and implementation of a visual decision support system designed to monitor and optimize antibiotic usage among healthcare providers. The proposed system integrates advanced machine learning algorithms with real-time data analytics to provide a dynamic, evidence-based decision support tool. Specifically, a neural network model was developed after evaluating multiple machine learning approaches, including Random Forest, Logistic Regression and …

From Pregnancy To Postpartum: A Longitudinal Analysis Of Maternal Depressive Symptoms And Hemoglobin Concentration In Uttar Pradesh, India, Abdullah Nurus Salam Khan

Theses and Dissertations

Background: Perinatal depression and maternal anemia impact maternal health, pregnancy outcomes, and infant growth in low- and middle-income countries. This study examines the prevalence and risk factors of these conditions during pregnancy and postpartum in rural Uttar Pradesh, India. Methods: A prospective cohort study was conducted among 475 pregnant women recruited during early pregnancy (≤20 weeks gestation) and followed through late pregnancy (≥27 weeks) and postpartum (< 42 days of childbirth). The outcome variables were, i) depressive symptoms, assessed using the Edinburgh Postnatal Depression Scale (EPDS), and ii) hemoglobin concentrations, measured using HemoCue Hb 301 analyzer from capillary blood. Multivariable linear regression examined associations of the outcome variables with sociodemographic, obstetric, nutritional, interpersonal, and perinatal factors. Path analysis evaluated direct and indirect paths influencing postpartum hemoglobin. Results: Prevalence of probable depression (EPDS score≥13) peaked in early pregnancy (24%) and declined in late pregnancy (17%) and postpartum (4%). Mean hemoglobin declined from early (10.5 g/dL) to late pregnancy (9.7 g/dL), and partially recovering in postpartum (10.4 g/dL). Household food insecurity was associated with higher depressive symptoms during pregnancy and postpartum (early pregnancy:β=2.61, p=0.011; late pregnancy:β=2.84, p< 0.001; postpartum:β=1.40, p=0.023). Psychological intimate partner violence was associated with greater depressive symptoms in early pregnancy (β=3.19, p=0.001). Receiving more antenatal visits was associated with decrease in depressive symptoms in late pregnancy (β=-0.46, p=0.001) and hemoglobin at postpartum (β=-0.11, p=0.070). Consumption of more food groups was associated with increase in depressive symptoms (β=0.63, p=0.004) and hemoglobin in late pregnancy (β=0.10, p=0.026). Iron folic acid (IFA) consumption was associated with increase in hemoglobin in late pregnancy (β=0.01, p< 0.001) and postpartum (β=0.004, p=0.031). Experiencing postpartum health complications was associated with increase in depressive symptoms (β=0.41, p=0.013) and decrease in hemoglobin concentrations (β=-0.18, p=0.036). Antenatal hemoglobin concentrations mediated the associations of IFA supplementation and dietary diversity with postpartum concentrations. Conclusion: Perinatal depression was associated with socioeconomic vulnerabilities, food insecurity, and intimate partner violence, while hemoglobin concentrations were associated with maternal nutrition and perinatal care. Integrating mental health services and comprehensive nutrition interventions into antenatal and postpartum care can improve psychological and physical well-being of mothers during and after pregnancy.

Adolescent Sleep Health, Mental Health, And Cardiovascular Disease Risk In Adulthood, Prince Nii Ossah Addo

Theses and Dissertations

Background: Insufficient sleep and poor sleep quality are major public health issues among adolescents in the United States (U.S.). Mental health and substance use challenges are also common among adolescents, particularly those with sleep problems. Although exposures in adolescence have been evidenced to significantly impact future health, little is known about how adolescent sleep health, mental health, and substance use influence future cardiovascular disease (CVD) risk. We, therefore, examined the association between sleep health in adolescence and CVD risk in adulthood and assessed whether the association is mediated by depressive symptoms and substance use in adolescents. Further, we explored the …

Revitalizing Passenger Rail: A Sustainable Solution To Environmental And Public Health Challenges In South Carolina, Benjamin Cochran

Theses and Dissertations

South Carolina, a historic leader in passenger rail, has become a heavily vehicle-dependent state. As the population rapidly grows, so does the number of vehicles, vehicle miles traveled, and vehicle emissions, including the greenhouse gas pollutants carbon dioxide (CO2), nitrous oxide (N2O), and particulate matter (PM2.5), significantly contributing to air pollution and deteriorating health and environmental outcomes. Despite this, mass transit is nonexistent for the three largest cities in South Carolina, Charleston, Columbia, and Greenville, forcing residents and travelers to drive. This study evaluates the feasibility and the environmental, public health, environmental justice, and economic implications of a passenger rail …

Understanding The Factors Influencing Movement Behaviors Among Dog Owners, Katherine Eileen Devivo

Theses and Dissertations

This dissertation investigates two key objectives: 1) to understand influences of physical activity among dog owners, and 2) to determine if there were differences in objectively measured physical activity levels and/or affect at times when dog owners are with their dogs compared to times when they are not with their dogs. To address the first objective, a qualitative study was conducted with 20 dog owners using semi-structured interviews, constant comparative methodology, grounded theory, and open coding. The findings revealed several key barriers to physical activity and dog walking such as physical health, seasons/weather, time/schedules, and dog specific limitations. Key facilitators …

Associations Between Cardiovascular Disease And Utilization Of Dental Preventive And Periodontic Services, Amirhossein Fakhre Yaseri

Theses and Dissertations

Cardiovascular disease (CVD), including coronary artery disease, heart failure, myocardial infarction, and stroke, remains a leading cause of global mortality, with approximately 20.5 million deaths in 2021. Despite advancements in medical science, CVD prevalence continues to rise, underscoring the need for preventive approaches and increased awareness. CVD is closely associated with oral diseases, and poor oral health is linked to worse cardiovascular outcomes. This study investigates the association between CVD and the utilization of dental preventive and periodontal services using data from the Dental Experience and Research Exchange (DERE) database, which aggregates clinical data from dental practices across the U.S. …

Evaluating Dry Air Personnel Decontamination Of Methyl Salicylate As A Chemical Agent Surrogate In Extreme Cold Environments To Reduce Airborne Risks Using A Manikin, Lance E. Campbell

Theses and Dissertations

This research investigated a mobile air shower as an alternative to water washing for personnel chemical decontamination in Arctic environments, where traditional methods like disrobing and rinsing are impractical. Interest in Arctic operations has grown with recent U.S. military focus on strategic advancements by Russia and China, yet research on air shower effectiveness for chemical decontamination remains limited. This study examined whether a commercial off-the-shelf air shower could effectively decontaminate methyl salicylate (MES), a surrogate for chemical warfare blister agents, from a manikin outfitted in military cold-weather gear. Researchers used a ppbRAE 3000 photo-ionization detector to measure MES concentrations following …

Retrospective Cohort Study Of Pure Tone Audiometry Hearing Changes Associated With Ototoxic Metals And Solvents, Continuous Noise And Impulse Noise Exposures At Robins Air Force Base From 2001-2019, Ronald Diaz Cataldo Ramos

Theses and Dissertations

Utilizing DOEHRS-IH and DOEHRS-HC, a retrospective epidemiological study was performed on Robins AFB personnel to investigate relative risks of hearing loss associated with exposures to continuous noise, impulse noise, and ototoxic metals and solvents. An analysis of variance identified age, frequency octave, era and exposure type as influencers of hearing threshold shifts. Risk ratios showed higher risk of hearing loss for exposures to continuous noise + impulse noise + ototoxic metals as well as continuous noise + impulse noise at low frequencies (500Hz and 1,000Hz), and lesser risk for exposures to continuous noise + impulse noise and continuous noise + …

Air-Based Chemical Patient Decontamination Methodologies For Arctic Regions Using Methly Salicylate As A Chemical Agent Surrogate On A Litter-Bound Manikin, Marcus D. Shadd

Theses and Dissertations

This study evaluated a mobile air shower for patient decontamination without disrobing or rinsing, an alternative for Arctic conditions where water is scarce. A manikin in extreme cold weather gear was exposed to 10 µL of methyl salicylate (MeS), a sulfur mustard surrogate, and placed in a horizontal chamber on a military litter. Airborne MeS was measured using a ppbRAE 3000 detector to assess inhalation risk for the patient and decontamination team. Three methods were tested: an air-knife system, paper towels, and no decontamination, with 10 trials each (30 total). ANOVA analysis showed significant reductions in airborne MeS with air-knife …

Personal Decontamination Of Copper Oxide Powder As A Radiological Surrogate On Ambulatory Patients In Arctic Environments: Assessing Residual Airborne Risks After Air Shower Or Vacuum Decontamination Of A Manikin, Quinn G. Pelichoff

Theses and Dissertations

This study assessed air-based decontamination methods for treating patients exposed to dry radiological contamination while minimizing reaerosolization during disrobing, particularly in extreme cold environments. A full-size manikin,  simulating an able-bodied Airman, was dressed in military-issue extreme cold weather gear and coated with 28 grams of Copper Oxide. The manikin underwent one of three treatments: HEPA vacuuming, a mobile personal air shower, or no treatment (control). After treatment, researchers removed the uniform and used optical particle counters to measure airborne dust concentrations that could pose risks during disrobing. Each method was tested ten times (30 trials total). Statistical analyses (ANOVA, Tukey’s …

Cervical Cancer Screening And Hpv Vaccine Intentions: An Egyptian Population Assessment Through University Channels, Rita Hany Ebeid

Theses and Dissertations

Background: Cervical cancer remains a significant global health burden, disproportionately affecting low- and middle-income countries. While HPV vaccination and cervical cancer screening programs have shown promise in reducing incidence and mortality, access to these interventions remains limited in Egypt. The purpose of this study was to analyze female and male beliefs, knowledge of, and perceptions related to cervical cancer screening and HPV vaccination, and how these factors influence women and men’s intentions to respectively undergo or promote these behaviors in Egypt. This study also aimed to develop recommendations for more effective cervical cancer prevention measures that promote greater uptake among …

1 Studying The Determinants Of Successful Aging: Diet, Lifestyle, And Social Relations In Egypt, Fayrouz Shaltout

Theses and Dissertations

Abstract

Background

The global population is aging rapidly, with projections indicating that by 2050, one in six people will be over the age of 65. In Egypt, the aging population, particularly those aged 60 and above, is expected to grow significantly, posing a growing public health concern. Unhealthful diets (that are associated with overweight and obesity), are one of the main reasons associated with non-communicable diseases (e.g., diabetes and cardiovascular diseases) are major risk factors for poor aging outcomes. Despite this, there is limited research on the specific determinants of successful aging (SA) in Egypt, especially among individuals aged 50 …

Menstrual Poverty In Egypt: Padding The Way To Period Equity, Sara Hesham Nasr

Theses and Dissertations

With approximately 800 million women menstruating daily worldwide, a significant portion of this demographic experiences barriers to accessing sanitary products. In Egypt, despite having around third of the population in reproductive age and menstruating monthly, an economic turmoil in 2017 opted the government to label menstrual products as luxury items and the prices have increased since then.

The current study aimed to investigate menstrual poverty in Egypt, focusing on the economic and social challenges faced by women during menstruation. Key objectives include assessing the financial challenges related to menstruation, exploring existing policies aimed at alleviating these challenges, and proposing evidence-based …

The Role Of Social Support In Protecting Against Perinatal Depression Among Egyptian Women, Radwa Raafat Abdelshafi

Theses and Dissertations

Perinatal Depression (PND) is a global public health issue affecting many women as they transition to motherhood, and carrying detrimental consequences for both mothers and infants. Research in low and middle-income countries shows higher PND prevalence rates than in high-income and Western countries. In addition, social support has been shown to strongly protect or reduce the impact of PND. This study aimed to address a gap in research on PND in Egypt, and to build an understanding of the social support ecological system of new mothers. A survey was conducted with 81 first-time middle-class mothers living in Greater Cairo between …

Determinants Of Physicians' Brain Drain In Egypt, Mennatallah Elbeheiry

Theses and Dissertations

Egypt is enduring a significant shortage of physicians, despite the annual graduation of approximately 10,000 medical students from its 27 medical schools. In 2016, the physician density was alarmingly low, with only one doctor per 12,285 people. This shortage is exacerbated by a physicians’ brain drain, as Egypt is a leading exporter of physicians to countries like the United Kingdom and Australia. As of 2020, the Egyptian Medical Syndicate reported 212,835 registered physicians, yet 56 percent of them work abroad, and only about 62,000 are actively employed in public hospitals, serving a population of over 110 million. The government’s efforts …

Customized Feminine Hygiene Wash Containing Postbiotics From Lactobacillus Spp. To Treat Urinary Tract Infections (Uti), Veena G. Nair

Theses and Dissertations

Probiotics, which support host health by maintaining normal microbial flora, offer a promising approach for preventing recurrent infections. To evaluate the prophylactic potential of vaginal probiotics against urinary tract infections (UTIs), we conducted a study on 54 healthy South Indian women aged 18–40 who visited the Obstetrics and Gynaecology outpatient clinic at Trichy SRM Medical College and Research Centre between June and July 2022. Vaginal swabs were collected following ethical guidelines, and commensal microbiota were isolated for probiotic characterization, with the broader objective of developing a customized feminine hygiene wash enriched with vaginal postbiotics.

Lactobacilli cell-free supernatant (CFS) demonstrated potent …

Perinatal Policy Disparities And Their Impact On Maternal, Paternal, And Child Health, D'Ashanae Y. Pippens

Theses and Dissertations

This systematic review synthesized evidence on perinatal policy framework to evaluate their public health significance and impact on family outcomes. Following Preferred Reporting Items for Systematic Reviews Meta-Analyses (PRISMA) methodology, peer-reviewed literature, policy documents, and corporate data from 2015-2025 were reviewed across national, state, and global levels. The analysis revealed seven thematic domains, (1) policy design and duration, (2) wage replacement, (3) insurance continuity, (4) workplace breastfeeding accommodations, (5) parental leave, (6) equity in access, and (7) policy enforcement. Evidence shows that integrated and inclusive policies particularly those in Sweden, Germany, and progressive U.S. states (NY and CA), yield substantial …

An Evaluation Of Frank Brown's Free Market, Leigh Ann Mccormick

Theses and Dissertations

Background: This study aimed to conduct an in-depth evaluation of Frank Brown Hall, Free-Market (Food Pantry), within the grant timeframe from January to April 2024. The central objective was to examine the distinct resource demands of students limited to selecting three items each day. By employing careful observation, effective communication, and active listening, we successfully obtained essential student feedback that enhanced our understanding of their needs and preferences, improving the support provided during that semester. Methods: Throughout the grant, data were systematically classified according to the chosen items, the students’ academic majors, and the cumulative number of visits to the …

Addressing Barriers To Preventive Healthcare Access Through Community Outreach In Underserved Populations, Deneisha Sparks

Theses and Dissertations

Access to preventive healthcare is a significant public health challenge, particularly for underserved populations in Muscogee County, Georgia. This project addresses systemic barriers such as transportation, limited health education, and economic constraints, which contribute to health disparities and reliance on emergency room services. Guided by the Social Determinants of Health (SDOH) framework and the Health Belief Model (HBM), the project aims to enhance access to preventive care, improve health literacy and identify barriers to healthcare access.

This program evaluation report examined a community-based initiative that utilized a mobile health unit to improve access to preventive healthcare in underserved areas of …

Flavorful Foes: Assessing Students’ Perceptions Of Processed And Fast Food And Its Health Implications., Soumi Roy Banerjee

Theses and Dissertations

High fast-food consumption is a common public health concern due to its link to a number of non-communicable diseases and mental health, but increased consumption of processed food, rapid urbanization, and changing lifestyles have led to a shift in dietary patterns. People are consuming more foods high in energy fats and free sugars. This mixed methods study was conducted at a college campus in Georgia, to assess knowledge and understanding of the students between the ages of 18 and 22 years about highly processed Fast Food, and its effects on health. Forty student participants were chosen through convenience sampling and …

Why A Healthy Diet Is Important For Women's Health, Halley Doster

Theses and Dissertations

Nutrition plays a critical role in women’s reproductive health, yet many women face barriers to maintaining a balanced diet. This study aimed to examine the relationship between nutritional intake and reproductive health outcomes among women of reproductive age, as well as to assess their knowledge and challenges related to healthy eating. Using a cross-sectional survey design, data were collected from 50 women at a community health center and analyzed using SPSS to generate descriptive statistics and explore patterns through chi-square and regression analyses. Findings revealed that most participants had moderate to low fruit and vegetable intake, and fewer than half …

Attacking Diabetes One Day At A Time, Kyla Duncan

Theses and Dissertations

The "Attacking Diabetes One Day at a Time" initiative targets the growing concern of public health, type 2 diabetes, among under-reserved communities. This comprehensive care program emphasizes the importance of prevention through education, improving lifestyles, and access to care. Based on insights from the Self-Care Management Theory, this initiative seeks to provide individuals with sound, culturally tailored strategies that reduce disease risk and help them manage healthy lifestyles. Major components include educational workshops, and resource navigation. The success of this program, from community engagement through evaluation on a phased implementation plan, is guaranteed. The expected outcomes of this work will …

Prevalence Of Hypertension Among Low-Income Individuals In Muscogee County Columbus, Georgia, Amelia K. Fallah

Theses and Dissertations

This study investigates the prevalence and predictors of elevated blood pressure (BP) among 409 low-income adults in Muscogee County, Columbus, Georgia—a population disproportionately burdened by hypertension. The findings reveal that elevated BP is significantly more prevalent among African Americans (71.4%) compared to non-African Americans (27.1%), highlighting the role of racial disparities influenced by systemic inequities, healthcare access, and chronic stress. Gender differences were modest, with females exhibiting a slightly higher prevalence (77.9%) than males (76.7%), potentially due to age-related hormonal changes post-menopause. Older adults (50+ years) represented most of the sample and showed significantly higher hypertension rates, consistent with established …

Mental Health Trends Among African American High School Students, Alexis Heard

Theses and Dissertations

Adolescent mental health is a major public health issue in the U.S., with African American high school students facing a rapidly worsening crisis. While all youth show increasing rates of depression, anxiety, and suicidality, African American adolescents are at greater risk due to systemic racism, socioeconomic inequality, community violence, and limited access to culturally responsive care. Few national studies have examined mental health trends among this group. This study (1) examines 2011–2021 trends in persistent sadness/hopelessness, suicidal ideation, suicide planning, and suicide attempts among African American high school students; (2) explores gender differences; and (3) compares these patterns to national …

Modeling Vaccination Strategies And Intervention Impacts On Infectious Disease Dynamics, Elizabeth B. Amona

Theses and Dissertations

This dissertation explores how mathematical and statistical modeling can inform vaccination strategies and evaluate the impact of interventions during infectious disease outbreaks. Motivated by the challenges observed during the COVID-19 pandemic, the research integrates compartmental modeling, Bayesian inference, and agent-based simulation to assess policy effectiveness and disease control across varying contexts. The first study develops a SEIRDV model that incorporates government interventions and vaccination rollout to examine COVID-19 dynamics in Qatar. A Bayesian approach is used to estimate parameters and compute time-varying transmission rates. The model captures shifts in transmission following policy changes and quantifies the reduction in deaths attributable …

Examining Healthcare Access Disparities: Social Determinants And Patient Experiences At Valley Healthcare, Mikaila Larmond

Theses and Dissertations

Persistent disparities in healthcare access continued to affect low-income, rural, and underserved populations across the United States. This capstone project explored these disparities within Valley HealthCare, a regional provider in Columbus, Georgia, by examining how social determinants such as income, education, geography, and transportation shaped healthcare engagement among adult patients. A mixed-methods case study design was used to analyze survey data, patient satisfaction feedback, and organizational reports from a sample of 80 adult patients between January and March 2025.

The results showed that patients residing in lower-income or geographically isolated areas reported significantly higher rates of missed appointments. Individuals with …

Place, Culture, And Care: A Socioecological Examination Of Type 2 Diabetes Among Hispanics In The U.S., Danielle Montoya

Theses and Dissertations

Introduction: Type 2 diabetes (T2D) disproportionately affects U.S. Hispanic populations. This dissertation examined whether structural determinants fundamentally drive T2D disparities among Hispanics, with attention to within-group racial heterogeneity.

Methods: Three studies utilized nationally representative data. Study 1 examined neighborhood segregation and ethnic enclave residence associations with T2D using restricted NHANES data (2011-2018, n=5,056). Study 2 investigated acculturation and T2D associations using restricted NHANES data (2011-2018, n=4,540). Study 3 analyzed patient-provider racial/ethnic concordance and adequate diabetes care using MEPS data (2008-2021, n=17,138).

Results: Structural factors demonstrated primacy across all studies. Neighborhood segregation (aOR=1.17, p>0.05) and ethnic enclave residence showed no …

Financial Health Literacy Of Community-Dwelling Older Adults: A Qualitative Research Study, Kimberly Davis

Theses and Dissertations

Background: Financial health literacy (FHL) is an emerging concept with unique application to older adults. Multiple complexities converge in older age that create increased financial vulnerability (e.g., retirement, chronic disease). However, low financial and health literacy are common in older adults, impacting their ability to self-manage. The AWV’s focus on prevention offers an opportunity to incorporate a proactive approach to financial-related assessment. This study will explore the perceived value of assessing FHL in primary care settings and the financial-related barriers and facilitators to implementing the personalized prevention plan.

Methods: The conceptual framework was guided by the Individual and Family Self-Management …

Birthing While Black: The Color Of Care And Black Women’S Lived Experiences Giving Birth In The United States, Portia Cowlings

Theses and Dissertations

Black women in the United States face disproportionate maternal health outcomes during pregnancy, childbirth, and postpartum compared to other racial and ethnic groups. Despite advancements in healthcare, the United States continues to report the highest maternal mortality rates among high-income developed nations, with Black women experiencing rates up to three times higher than their White counterparts. This phenomenological study explores the lived experiences of Black women in the United States to understand how they navigate the continuum of maternal healthcare, from preconception through postpartum. Guided by the social determinants of health (SDOH) theoretical framework, childbirth was examined through four interconnected …