Public Health Commons^™

Diet Quality As Assessed By The Healthy Eating Index-2020 Among Individuals Diagnosed With And Without Type 2 Diabetes, Minghao Zhou, Hairui Yu, Renee Underwood, Hongning Cai, Tung Sung Tseng, Susu Luo

School of Public Health Faculty Publications

Background: Dietary management is key to preventing and controlling type 2 diabetes mellitus (T2DM). However, few studies have examined differences in Healthy Eating Index (HEI-2020) scores and components among individuals with and without diagnosed T2DM. This study aimed to assess gender differences in HEI-2020 scores and its 13 components by T2DM status. Methods: Using National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2018, this cross-sectional study analyzed 19,464 adults. Diagnosed T2DM was identified via self-report or diabetes medication use. Diet quality was assessed using the HEI-2020, scored from 0 to 100, with a higher HEI score indicates …

Women’S Empowerment And Child Stunting In Peru: A Nationally Representative Analysis, Marisella Chumán-Sánchez, Brando Ortiz-Saavedra, Leonardo J. Uribe-Cavero, Anita P. Llamo-Vilcherrez, Joshua W. Moxey, Carlos J. Toro-Huamanchumo

Research outputs 2022 to 2026

Background: Child stunting remains a persistent public health challenge in Peru. Although women’s empowerment has been linked to improved child health, evidence on its domain-specific relationship with stunting remains limited. The objective of this study was to assess the association between women’s empowerment, across attitudes towards violence, social independence, and decision-making, and child stunting in Peru.

Methods: We conducted an analytical cross-sectional study using nationally representative data from the 2021 Demographic and Family Health Survey (ENDES), including 16,650 mother-child pairs. Analyses of women’s empowerment were conducted in a sub-sample with complete SWPER data (n = 12,696). Stunting was defined as …

Slushies Before School: Exploring How Nearby Food Outlets Impact The Eating Behaviours Of Secondary Students In Perth, Western Australia, Sharonna Mossenson, Klug, Joelie Mandzufas, Jacinta Francis, Siobhan Hickling, Lukar Thornton, Gina Trapp

Research outputs 2022 to 2026

The external school food environment, comprising food outlets and marketing near schools, shapes what young people eat. Yet little is known about how Australian adolescents perceive and navigate these environments. Focus groups were conducted with 31 school students (Years 7–12) from Perth, Western Australia, to explore their experiences of the external school food environment and its influence on their food-related behaviours. Transcripts were thematically analysed and six themes were identified. Accessibility emphasised proximity, transport links, opening hours and speed of service, with older students using outlets as social spaces. Availability of slushies, energy drinks, snacks and fast-food meal deals influenced …

My Story Is Good… It’S Not Like That For All: Uneven Access To Contraception Among Incarcerated Women In New South Wales, Australia, Helene Smith, Basil Donovan, Jocelyn Jones, Tony Butler, Paul Simpson

Research outputs 2022 to 2026

Background: Evidence indicates high levels of unmet contraceptive need among justice-involved women, linked to intersecting vulnerabilities such as housing instability, substance use, violence and poor mental health. In Australia, limited research has explored how women in prison navigate access to family planning services. This study aimed to examine the experiences of incarcerated women in New South Wales (NSW) in accessing contraception and making fertility-related decisions.

Methods: The study formed part of the Second Sexual Health and Attitudes of Australian Prisoners (SHAAP-2) study. Seventeen women aged 19–45 were recruited from two NSW correctional centres. Semi-structured qualitative interviews were conducted face-to-face or …

The Effect Of School-Based Educational Session On Knowledge, Attitudes, And Beliefs Of Cervical Cancer Among Adolescents In Mixed Day High Schools In Embu County: A Quasi-Experimental Study, Lucy W. Kivuti-Bitok, Mugo, Dorothy Mituki, Christine Marete, Irene Ngune, Jessica Wells

Research outputs 2022 to 2026

Background: School-based interventions have proven effective in enhancing knowledge and altering attitudes toward cervical cancer among adolescents. This study aimed to evaluate the effect of a school-based educational intervention on the attitudes, beliefs, and knowledge of cervical cancer among adolescents in mixed-day high schools in Embu County. Methods: This study used a single-group, repeated cross-sectional design to assess the effect of a structured health education session on cervical cancer among adolescent boys and girls in mixed-gender secondary schools. A self-administered anonymous questionnaire was administered before and immediately after the post-intervention. The education session lasted 30–45 min, and the study population …

Implementation And Effectiveness Of A Food Education Intervention To Promote Plant-Based Foods: A Partially Cluster-Randomized Controlled Trial, Henna Vepsäläinen, Satu Kinnunen, Sari Niinistö, Leena Forma, Suvi T. Itkonen, Tuuli E. Korhonen, Liisa Korkalo, Heli Kuusipalo, Jelena Meinilä, Kaija Nissinen, Susanna Raulio, Ros Sambell, Mari Åkerlund, Suvi M. Virtanen, Maijaliisa Erkkola

Research outputs 2022 to 2026

Background: Legumes can substitute for meat and are thus a particularly important food group for environmental sustainability. As the use of legumes among Finnish children is marginal, there is potential for a substantial increase in their consumption. However, food education delivered through early childhood education and care (ECEC) settings has rarely focused specifically on environmentally sustainable foods, such as legumes. This study describes the implementation and effectiveness of an ECEC-delivered food education intervention within the FoodStep study. Methods: The partially cluster-randomized FoodStep intervention aimed to increase the supply of vegetables, legumes, fruits, berries, and sustainable fish while reducing the provision …

Living Next Door To Mcdonald’S: A Qualitative Study Of Community Submissions And Resident Realities Pre- And Post Development, Roslyn Giglia, Jacinta Francis, Jana Buckle, Clare Whitton, Ros Sambell, Frith Klug, Lukar Thornton, Siobhan Hickling, Katherine Kent, Gina Trapp

Research outputs 2022 to 2026

Background: The proliferation of fast-food outlets (FFOs) in residential areas has raised growing concerns about their impact on community health, safety, and wellbeing. This qualitative study examined both pre-development community consultation submissions and post-development resident experiences surrounding the development of a McDonald’s outlet in a newly established suburb on the urban fringe of Perth, Western Australia (WA). Methods: Using a qualitative descriptive design, the study analyzed 183 community submissions lodged with the local council prior to development and conducted semi-structured interviews with 11 residents living within 300 m of the outlet after construction. Results: Content analysis revealed strong opposition, with …

Local Government Policies Restricting Unhealthy Outdoor Food Advertising In Australia: Stakeholder Perspectives Identify Political Willingness Is Key To Overcoming Barriers, Alexia Bivoltsis, Frith Klug, Jacinta Francis, Clare Whitton, Gina S.A. Trapp, Claire E. Pulker

Research outputs 2022 to 2026

Background: Unhealthy outdoor food advertising is strongly linked to poor diet, highlighting the need for policies. Western Australian (WA) local governments (LGs) can restrict advertising on their owned infrastructure through their Public Health Plans, but limited policy action has occurred. This study aimed to explore the perspectives of WA LGs and public health organizations (PHOs) on current and potential policies restricting unhealthy outdoor food advertising on LG owned infrastructure to (1) identify barriers and enablers to the policy making process, (2) assess the current level of political willingness (i.e. political want, political can and political must) and (3) inform development …

Chlorinated Drinking Water Exposure Enriches Antimicrobial Resistance Pathways In The Infant Gut Microbiome: A Randomized Trial, Kimberley Parkin, Claus T. Christophersen, Valerie Verhasselt, Debra J. Palmer, Matthew N. Cooper, Susan L. Prescott, Desiree Silva, David Martino

Research outputs 2022 to 2026

Background: Water chlorination is essential for controlling harmful microbes in drinking water; however, the antimicrobial effects of chlorine-based disinfectants present in tap water may influence early-life gut microbial ecology.

Objective: To investigate the functional and compositional impact of chlorinated drinking water on the gut microbiome of infants.

Design: The waTer qUality and Microbiome Study (TUMS) was an Australian-based double-blinded, randomised controlled trial. Six-month-old infants (n = 197) received either de-chlorinated drinking water via benchtop filtration (treatment, n = 99), or regular chlorinated water (control, n = 98) for twelve months. Tap water and stool samples were collected at baseline and …

Impact Of School Nurse Education On Factors Influencing Hpv Vaccine Communication With Parents, Diane Santa Maria, Erika Thompson, Sanghamitra M Misra, Paula M Cuccaro

Faculty, Staff and Student Publications

Human papillomavirus (HPV) can cause six cancer types but can be prevented with timely vaccination in early adolescence. However, despite the wide availability of the HPV vaccine, uptake remains suboptimal among US adolescents. School nurses are invaluable resources to students and their families regarding adolescent immunization needs. As part of the All for Them vaccination program, we assessed the impact of the continued nurse education (CNE) intervention on school nurses’ HPV vaccine communication with parents. Seventy-two school nurses and nurse administrators in Texas participated in the study. Using a single-arm study design, we measured participants’ potential barriers to and self-efficacy …

Preventive Behaviors Associated With Fall Incidence Among Older Adults Living In Rural Communities Of Thailand: A Cross-Sectional Study, Rujira Nonsa-Ard, Sirapat Khodseewong, Kasama Wongprachum, Chaiwut Bourneow, Ploypailin Aneknan, Sumattana Glangkarn, Davina Porock

Research outputs 2022 to 2026

Background: The escalating population of older adults poses a significant challenge, particularly in lower-middle-income countries like Thailand. Falls represent a critical public health concern in this demographic. This study aimed to identify risk factors influencing fall occurrence in older adults within a specific rural community context, where the majority of participants remain engaged in farm work.

Methods: A cross-sectional study design was utilized, involving 1,256 participants recruited by the multistage random sampling approach. Data were collected via a questionnaire that included: demographic information, the Thai version of the Barthel Activities of Daily Living (ADL), the Thai Fall Risk Assessment Tool …

Progression Of Non-Radiographic To Radiographic Axial Spondyloarthritis: A Risk Model Based On A Chinese Cohort Study, Rui Ying Deng, Xiaojia Xu, Jian Hua Peng, Feng Cai Shen, Yao Gong, Dan Min Wang, Hong Jin Liang, Shu Xin Huang, Zhao Peng Chen, Wen Long Wu, Ze Xin Zheng, Ling Lin, Zhi Duo Hou

Research outputs 2022 to 2026

Objectives: To evaluate the progression from non-radiographic axial spondyloarthritis (nr-axSpA) to radiographic axial spondyloarthritis (r-axSpA) in a Chinese cohort, identify associated risk factors in both clinical and imaging arms, and enable risk stratification based on these factors. Methods: Overall, 572 patients with nr-axSpA were enrolled with a median follow-up of 5 years. Cox proportional hazard regression analyses were conducted to identify potential risk factors associated with the progression from nr-axSpA to r-axSpA in both clinical and imaging arms. A risk-scoring system was then developed by assigning each independent predictor a weight based on its regression coefficient. Patients were subsequently categorized …

A Dynamic Framework Of Professional Identity Formation In Trainees For Low-Resource Settings: A Qualitative Study, Yilin Chen, Peixin Lin, Hengshun Du, Jiaxin Wu, Xuanhua Zheng, Mi Yao, Kai Lin

Research outputs 2022 to 2026

Background: Professional Identity Formation (PIF) is a dynamic and context-dependent socialisation process; while existing research identifies various influencing factors, there is a paucity of cohesive frameworks that capture the stage-related internalisation of identity elements within practice. This gap is particularly salient in low-resource settings, such as China’s Rural-Streamed Medical Education Programme (RMEP), where substantial turnover and tenuous professional identity among trainees present significant challenges. Drawing upon the Ring Theory of Personhood (RToP) as a theoretical lens, this study aims to construct a dynamic framework for understanding PIF among RMEP trainees, thereby offering insights to enhance PIF for healthcare professionals in …

Paternal Age And Offspring Bone Health And Body Composition At 20 Years: Findings From The Raine Study, Mia A. Percival, Kun Zhu, John P. Walsh, Marc Sim, Kara B. Anderson, Julie A. Pasco, Natalie K. Hyde

Research outputs 2022 to 2026

Aims: There is growing evidence supporting paternal contributions to child health. Previous findings from the Vitamin D In Pregnancy study suggest that advanced paternal age is associated with a range of poorer bone measures for offspring at age 11 years. Whether these associations are evident when peak bone mass is attained remains unknown. This study aimed to investigate associations between paternal age and offspring bone health and body composition at age 20 years.

Methods: Data from the Raine study, a multigenerational cohort, were used. Among 1183 offspring with total body DXA data (Norland XR-36 densitometer) at the 20-year follow up, …

Perspective: Improving Social Connection And Inclusion Through Equitable Digital Health Solutions, Dominika Kwasnicka, Jaimon Kelly, Eleanor Quested, Loretta Baldassar, Suzanne Robinson, Richard Sinnott, Paul O’Halloran, Anne Tiedemann, Paul Flatau, Rajna Ogrin, Jane Farmer, Abby C. King

Research outputs 2022 to 2026

In this Perspective, we address the critical intersection of digital health, social connection, and health equity. Taking an interdisciplinary and complex adaptive systems perspective, we highlight evidence-based digital solutions to improve social connection and inclusion and, consequently, health outcomes. We describe actionable strategies for ensuring that digital health innovations benefit all, highlighting how user-centered design can address diverse needs, particularly for structurally disadvantaged populations.

Temptation At The School Fence: A Qualitative Exploration Of The Impact Of External Food Outlets On The School Community, Sharonna Mossenson, Klug, Jacinta Francis, Siobhan Hickling, Lukar Thornton, Gina Trapp

Research outputs 2022 to 2026

Retail food outlets are commonly located in close proximity to schools, providing students with opportunities to purchase and consume food enroute to or from school. These outlets are typically unhealthy and disproportionately clustered near schools, and this trend has been increasing over time. While quantitative studies have established associations between school food environments and adolescent dietary behaviours, little is known about how school personnel perceive and experience their impacts. This qualitative study explored perspectives of school personnel (n = 9) from a secondary school in Perth, Western Australia, located 150 m from two retail food precincts (areas with a high …

Project Inspire, Daphney R. Portis

Inspire Brochures

Project Inspire is USA Health’s semester-long injury prevention program that offers education, exposure and mentorship to justice-involved youth. Since 2017, this collaboration between USA Health and James T. Strickland Youth Center has engaged justice-involved teens with the five-pillar curriculum, which includes: traumainformed care training and confidence building, educational and professional development, financial literacy, entrepreneurship, and intensive mentorship. The goal is to reduce the rates of violence by equipping and empowering youth to overcome obstacles and barriers they may face in order to build a brighter future. There are currently three sites with more opening across several states.

Age- And Period-Stratified Associations Between Ambient Fungal Spore Exposure And Asthma Healthcare Utilization In The San Juan Metropolitan Area, Puerto Rico, 2018–2021, Benjamín Bolaños-Rosero, Claudia I. Pereira Moreira, Catalina S. Robles-Rivera, Félix E. Rivera-Mariani

College of Arts and Sciences Faculty Publications & Presentations

Puerto Ricans experience among the highest asthma morbidity in the United States, and ambient fungal spores are abundant tropical aeroallergens. This ecological time-series study asked whether associations between ambient fungal spores and recorded asthma healthcare utilization in the San Juan Metropolitan Area, Puerto Rico (2018–2021), were stable across two contextual eras (post-Hurricane María recovery, 2018–2019; the COVID-19 pandemic, 2020–2021) and across age groups. Daily Burkard spore counts were linked to 168,578 asthma encounters. Encounter volume (negative binomial rate ratios, RR) and the ED/inpatient encounter fraction (logistic odds ratios, OR) were modeled per 10,000 spores·m−3 using weekly means and 3- and …

Network Analysis Of Chronic Disease Diagnosis Co-Documentation In Insurance Claims Among Older Arkansans, Mohsen Bazargan, Mohammadreza Rezaei, Ehsan Yaghmaei, Meredith Adkins, Panteha Rezaiean, Koustav Ganguly, James Abbas, Cyril Rakovski

Mathematics, Physics, and Computer Science Faculty Articles and Research

Background

Multimorbidity among older adults presents growing clinical and economic challenges, particularly in medically underserved states such as Arkansas. However, it remains unclear whether chronic conditions documented in routine healthcare encounters exhibit structured patterns of diagnosis co-documentation or primarily reflect incidental co-documentation. Understanding these patterns may inform future studies of multimorbidity and healthcare utilization.

Objective

To characterize statewide, sex-stratified patterns of claim-level diagnosis co-documentation among Arkansas adults aged ≥ 65 years using administrative claims data.

Methods

We analyzed 2024 IQVIA administrative claims for Arkansas residents aged ≥ 65 years (1408,707 claims from 35,253 unique patients). Analyses were conducted at the …

Measuring And Understanding Geographic Inequities In Physician Distribution In The Philippines: A Multi-Method Study Protocol, Veincent Christian F. Pepito, Ryan Gabriel C. Molen, Julius R. Migriño Jr, Theo Prudencio Juhani Z. Capeding, Anne Rose D. Payumo, Hazel Ivy M. Jeremias, Karl R. Ubial, William C. Tiu, Manuel M. Dayrit

ASMPH Center for Research and Innovation (ACRI)

INTRODUCTION: The Philippines faces physician shortages, exacerbated by their propensity to practise in urban centres. Despite government placement programmes, recruitment and retention of physicians in many areas throughout the country remain difficult. This study aims to: (1) describe the distribution of general physicians and board-certified specialist physicians and (2) identify the individual, work environment, local environment, national environment and international environment factors that may influence physicians to establish their practice in areas with below-optimal physician-to-population ratios in the Philippines. METHODS AND ANALYSIS: To describe the distribution of general physicians and board-certified specialist physicians, we will map Philippine Health Insurance Corporation …

Prevalence And Correlates Of Digital Burnout Among Liberty University Students: A Cross-Sectional Study, Shaira Neupane

Masters Theses

Background: Digital burnout, characterized by chronic psychological and physiological fatigue from persistent digital engagement, is an emerging public health concern among university students. It is conceptually related to but distinct from academic burnout, and few U.S. studies have examined both constructs together using validated instruments.

Objective: To describe digital burnout among Liberty University students, identify its sociodemographic and behavioral correlates, assess its relationship with academic burnout, and evaluate student awareness of campus digital-wellness resources.

Methods: This cross-sectional study surveyed 336 Liberty University students during Summer 2026 using the Digital Burnout Scale (DBS) and the Academic Burnout Scale (ABS). Hierarchical linear …

Advancing Patient-Centred Ai With Adaptive Machine Learning, Dimitrios Kalogeropoulos, Paul Barach, Andrea Downing, Stefaan Verhulst, Maryam Lustberg

College of Population Health Faculty Papers

Healthcare services and data ecosystems remain fragmented, inequitable and misaligned with patient, clinician and public health needs. Three pathways to patient-centred Artificial Intelligence (AI) have emerged to address this: data collaboration, Whole System Approaches and digital inclusion. Each has advanced the field. However, none delivers the continuous, participatory and outcome-grounded learning that equitable AI demands. The populations whose data drives AI learning must also be the populations who benefit from it. This principle has not been structurally embedded in any existing pathway. This narrative review defines a framework for operationalising Adaptive Machine Learning (AML) as a fourth, integrative pathway to …

Health Insurance And Moud: Predicting Oud Treatment Success, Amy S. White, Jennifer I. Manuel

Publications and Research

Background

Opioid use disorder (OUD) is a chronic condition with low rates of treatment success; use of medication for OUD (MOUD) is inconsistent across treatment settings. The purpose of this study was to examine the independent and interactive associations of MOUD and health insurance status with successful treatment completion across residential and outpatient treatment settings.

Methods

We conducted multilevel random-effects logistic regression analyses of the 2022 Treatment Episode Dataset–Discharge (TEDS-D) to estimate associations among MOUD receipt, insurance status (Medicaid, Medicare, private insurance, uninsured), and treatment completion. Models adjusted for demographic and clinical characteristics and stratified by treatment setting. The sample …

The Impact Of Tobacco-Free School Laws On Student And Staff Smoking Behavior, Rachana Bhatt, Peter Hinrichs

Upjohn Institute Working Papers

A number of U.S. states have enacted bans on tobacco use by students, staff, and visitors anywhere on the grounds of public elementary and secondary schools statewide. These laws are intended to reduce tobacco use, reduce exposure to secondhand smoke, reinforce anti-tobacco curricula taught in schools, and prevent children from viewing their teachers and fellow students using tobacco products. We examine the impact that the laws have on the smoking behavior of students, teachers, and other school staff by using stacked difference-in-differences estimators that exploit the time variation in adoption of the laws across states. The results presented in this …

Did Statewide School Smoking Bans Reduce Smoking Rates?, Rachana Bhatt, Peter Hinrichs

Upjohn Institute Policy and Research Briefs

No abstract provided.

Bemotrizinol And The Modernization Of Us Sunscreen Regulation, Umayr R. Shaikh, Christopher G. Richter, Leela K. Raj, Afrin Mirza, Harold William Higgins, Jane M. Grant-Kels

SKMC Student Presentations and Publications

No abstract provided.

Recommendations From Health Research For Children And Adolescents Living In The Kimberley Region Of Western Australia: A Scoping Review, Lisa Cannon, Elizabeth J. Elliott, Andrew Dossetor, Tracey W. Tsang, Md Irteja Islam, Alexandra L. Martiniuk, Habiba Naanai, Tuguy Esgin, Emily Carter, Lauren J. Rice

Research outputs 2022 to 2026

Background: Aboriginal leaders in Western Australia’s Kimberley region have voiced concern that research conducted on their lands is not being adequately used to inform meaningful change. Objective: This scoping review, grounded in an Aboriginal-academic partnership, identifies the child and adolescent health-related research conducted in the region and summarises the authors’ recommendations for knowledge translation. Methods: Drawing on PRISMA-ScR guidelines, we conducted a comprehensive search of multiple databases for publications between January 1967 and June 2025, focusing on children aged ≤ 18 years. Data extraction was conducted using Covidence, and publications were categorised based on the International Classification of Diseases (11th …

Hidden Patterns: Revealing The Noise Exposure Habits Of College Musicians Throughout The Year, Maya Vallejo

Holster Scholar Projects

College musicians face elevated risk for noise-induced hearing loss (NIHL) due to extensive rehearsal, headphone use, and performance activity, yet most objective sound-exposure studies rely on personal dosimeters that capture only brief windows (1–3 weeks) during the academic year, and overlook headphone-specific exposure. This study leveraged historical Apple Watch and AirPods sound data from participants in the ongoing AMI study (Skoe lab, University of Connecticut) to compare environmental and headphone noise exposure between academic-year and academic-break periods in college-age lifelong, former, and non-musicians. Sound levels (dBA) were calculated using duration-weighted, log-power averaging to account for the logarithmic nature of decibels. …

Improving Assessment And Documentation Adherence In An Age-Friendly Health System With A Focus On "What Matters", Thelma I. Arzu

Doctor of Nursing Practice Final Project Abstract

Purpose

To improve adherence in assessing and documenting “What Matters” (WM) using a standardized assessment and documentation process.

Background

The project was implemented within a large Age-Friendly Health System (AFHS) in Houston, Texas, comprised of a geriatric outpatient clinic and a House Call program. Although the 4Ms of AFHS were regularly documented in the outpatient setting, there was limited documentation in the House Call Program.

Methodology

A standardized process was established with clinician stakeholders to assess and document WM using simplified assessment criteria, the electronic medical record (EMR) 4Ms documentation phrase, and a designated location for the 4Ms phrase in …

Pharmacy Access Is Out Of Reach For One In Six South Carolinians, Bryan L. Love Pharm.D., Tessa J. Hastings Phd, Abby Davies

CORE Research Briefs

A cross-sectional geospatial analysis mapped active South Carolina community pharmacies and used 2020 Census tract data to estimate the population residing within and beyond five-mile pharmacy service areas. About one in six South Carolinians lives more than five miles from an active community pharmacy, with limited access disproportionately affecting rural communities.