Public Health Commons^™

Considering The Historical And Systemic Context, To What Extent Are Cuban Women’S Healthcare And Reproductive Rights Affected By The Privacy And Social Influence Of Cuba Today?, Autumn Cowell

Student Research Symposium

This paper will examine how historical and systemic values continue to frame social influences thus impacting Cuban women’s healthcare and reproductive rights. If the impact of history and systems still affects social influences then Women’s Healthcare and Reproductive Rights may be compromised. This investigation will highlight the potential benefits and risks of historical and systemic values that have affected challenges or changes within Cuban culture. And how these social influences are found within the areas of prevention, intervention, and treatment. This paper hopes to outline how the Cuban government and society are sustaining the protection of Cuban women’s access to …

Improving Quality Of Life In Menopausal Women Through A Best Practice Protocol: The Use Of Hormone Therapy, Mindfulness-Based Module And Exercise, Claire Czerwonka

Evidence-Based Practice Project Reports

Menopause is a normal process of aging, but many of the symptoms negatively impact women’s day-to-day quality of life (QOL), as well as activities of daily living, physical and mental health (ACOG, 2014). Generally, systemic estrogen hormone therapy is indicated for menopause-related vasomotor symptoms, but there is no research further addressing QOL issues or lifestyle management in addition to hormone therapy. The purpose of this evidence-base practice (EBP) project was to implement a menopause protocol to address QOL issues in menopausal women with the use of hormone replacement therapy, education through an online mindfulness module, and the use of exercise. …

Impact Of Covid-19 On Opioid Misuse, Mental Health, And Substance Abuse Treatment Of Adults, David Stephen Reed

Walden Dissertations and Doctoral Studies

The purpose of this quantitative cross-year comparison of two cross-sectional studies was to examine whether there is an impact of the COVID-19 pandemic on opioid misusers seeking mental health and substance abuse treatment, taking into consideration the social, ecological, and economic factors of age, gender, poverty status, and county of residence metropolitan status. The theoretical foundations of this study are the social-ecological framework in terms of the geographic and economic impacts, and the structural and social determinants of health framework to examine the influences of economic and community on individual behaviors, to answer the research questions while controlling for the …

Humanizing Affordable Housing: A Public Health Centered Approach To Affordable Housing, Eiman Mohamed

Graduate School of Architecture & Urban Design Theses & Dissertations

This thesis focuses on exploring housing as a determinant of health; thus, the aim is to investigate the historical and current influence of housing design and city planning on occupant health and population health in metropolitan cities. The thesis will primarily examine how housing affects the health of low-income individuals. Historically and presently, this demographic has been disproportionately affected by health issues stemming from overcrowding, substandard housing design, declining neighborhood conditions, and environmental inequities. The goal is to discern the dimensions and standards for healthy housing against which designers and planners can define health outcomes. By acknowledging the factors that …

Emotion Regulation Strategies And Perceived Emotional Intelligence: The Effect Of Age., Iwanna Sepiadou

Adultspan Journal

The aim of this study was to investigate the relationship between perceived emotional intelligence and the reported use of cognitive reappraisal and expressive suppression. We also investigated the possible effects of age on the aforementioned variables. The total sample consisted of 379 people (158 men, 220 women, 1 unreported). Across participants, 273 were young (20-39 years old) and 106 were middle-aged (40-65 years old). We found statistically significant positive correlations between the dimensions of perceived emotional intelligence and the reported use of cognitive reappraisal and negative primarily correlations between the dimensions of perceived emotional intelligence and the reported use of …

Effect Of An Hpv Vaccination Multi-Level, Multi-Component Program On Hpv Vaccination Initiation And Completion In A Pediatric Clinic Network, Lara S Savas, Ross Shegog, Erica L Frost, C Mary Healy, Dale S Mantey, Sharon P Coan, L Aubree Shay, Travis A Teague, Juan J Ferreris, Sharice M Preston, Sally W Vernon

Faculty, Staff and Student Publications

Despite clear evidence of the public health benefits of the human papillomavirus (HPV) vaccine in preventing HPV-related cancers and genital warts, underutilization of HPV vaccination in the United States persists. Interventions targeting multi-level determinants of vaccination behavior are crucial for improving HPV vaccination rates. The study's purpose was to implement and evaluate the adapted Adolescent Vaccination Program (AVP), a clinic-based, multi-level, multi-component intervention aimed at increasing HPV vaccine initiation and completion rates in a five-clinic pediatric network in Bexar County, Texas. The adaptation process was guided by established frameworks and involved formative work with clinic stakeholders. The study utilized a …

Risks Of Depression, Anxiety, And Suicide In Partners Of Men With Prostate Cancer: A National Cohort Study, Casey Crump, Pär Stattin, James D Brooks, Jan Sundquist, Alexis C Edwards, Kristina Sundquist, Weiva Sieh

Faculty, Staff and Student Publications

BACKGROUND: A diagnosis of prostate cancer (PC) may cause psychosocial distress not only in a man but also in his intimate partner. However, long-term risks of depression, anxiety, or suicide in partners of men with PC are largely unknown.

METHODS: A national cohort study was conducted of 121 530 partners of men diagnosed with PC during 1998-2017 and 1 093 304 population-based controls in Sweden. Major depression, anxiety disorder, and suicide death were ascertained through 2018. Cox regression was used to compute hazard ratios (HRs) while adjusting for sociodemographic factors.

RESULTS: Partners of men with high-risk PC had increased risks …

Health Care Utilization And Behavior Changes After Workplace Genetic Testing At A Large Us Health Care System, Elizabeth Charnysh, Subhamoy Pal, Jonathan Reader, Wendy R. Uhlmann, Sarah Mccain, Kunal Sanghavi, Drew Blasco, Rachael Brandt, William Gregory Feero, Rebecca Ferber, Veda N. Giri, Katherine Hendy, Anya E. R. Prince, Charles Lee, J. Scott Roberts

College of Life Sciences Faculty Papers

PURPOSE: This study explored employee health behavior changes and health care utilization after workplace genetic testing (wGT). Wellness-program-associated wGT seeks to improve employee health, but the related health implications are unknown.

METHODS: Employees of a large US health care system offering wGT (cancer, heart disease, and pharmacogenomics [PGx]) were sent electronic surveys. Self-reported data from those who received test results were analyzed. Descriptive statistics characterized responses, whereas logistic regression analyses explored correlates of responses to wGT.

RESULTS: 53.9% (n = 418/776) of respondents (88.3% female, mean age = 44 years) reported receiving wGT results. 12.0% (n = 48/399) received results …

The State Of Mental Health In The Mountain West, 2023, Ayda Atici, Freddy Nie, Jesse M. Fager-Larsen, Caitlin J. Saladino, William E. Brown Jr.

Health

This fact sheet examines the state of mental health for both youth and adults and availability of mental health care in the Mountain West states of Arizona, Colorado, Nevada, New Mexico, and Utah. The data are retrieved from Mental Health America’s (MHA) 2023 report, The State of Mental Health in America.

A Study On The 2016 And 2022 Ms And Oh Populations: How Obesity Is Related To The Co-Mingling Of Median Household Income, Limited Access To Healthy Foods And Limited Access To Exercise Opportunities, Ben Schlessel, Justice Williams

Scholarship in Medicine - All Papers

Background: Obesity has plagued the United States for decades, and while the implications of obesity have drastically changed over time (from a sign of wealth to a possible implication of mal/low nutrition), its impacts on the country’s population are abrasive and costly. Objective: The aim is to address and investigate how factors such as Median Household Income (MHI), Limited Access to Healthy Food and Limited Access to Exercise interplay with and correlate to obesity. Methods: Data acquired from the County Health Rankings was analyzed using several analysis strategies (paired and unpaired T-tests, and regression plots, etc.). Only Mississippi and Ohio …

The Relationship Between Ultrarunning Status, Subjective Well-Being, And Life Satisfaction, Raquel Ramirez Hernandez

Walden Dissertations and Doctoral Studies

The COVID-19 pandemic resulted in a rise in mental health challenges across the United States. Consequently, two important well-being measures for Healthy People 2030—subjective well-being and life satisfaction—were negatively impacted. A plethora of evidence exists about the benefits of running for physical and mental health. Yet, there is no available evidence that shows the benefits of ultrarunning, subjective well-being, and life satisfaction. This quantitative cross-sectional study examined the relationship between ultrarunning status, subjective well-being, and life satisfaction among adult runners in the United States. The advanced triangle of epidemiology served as the conceptual framework. A convenience sample included 369 adult …

Improving Early Identification And Management Of Depression Symptomology Through Implementation Of Universal Depression Screening In A University Student Health Center, Jessica M. Monjaras

Evidence-Based Practice Project Reports

Depression is the leading cause of disability in the United States for individuals aged 15 to 44 (Anxiety and Depression Association of America, 2023). The purpose of this evidence-based practice (EBP) project was to increase early identification of depression through implementation of universal depression screening, and to implement management strategies to decrease symptoms of depression. A two-tiered approach to universal depression screening was utilized through use of the PHQ-2 and PHQ-9 screening tools. Ten young adult patients, between the ages of 18 to 25, from a university student health center clinic in Northwest Indiana participated in this project. Participants underwent …

Boosting Self-Efficacy And Improving Practices For Smoking Prevention And Cessation Among South American Cancer Care Providers With A Web-Based Algorithm, Irene Tamí-Maury, Samuel Tundealao, Valeri Noé-Díaz, Esperanza Garcia, Vilma Diaz, Jennie Meier, Mira Dani, Tatiana Vidaurre

Faculty, Staff and Student Publications

Background: Digital technologies have positively impacted the availability and usability of clinical algorithms through the advancement in mobile health. Therefore, this study aimed to determine if a web-based algorithm designed to support the decision-making process of cancer care providers (CCPs) differentially impacted their self-reported self-efficacy and practices for providing smoking prevention and cessation services in Peru and Colombia.

Methods: A simple decision-making tree algorithm was built in REDCap using information from an extensive review of the currently available smoking prevention and cessation resources. We employed a pre-post study design with a mixed-methods approach among 53 CCPs in Peru and Colombia …

Determinants Of Mosaic Chromosomal Alteration Fitness, Yash Pershad, Taralynn Mack, Hannah Poisner, Yasminka A Jakubek, Adrienne M Stilp, Braxton D Mitchell, Joshua P Lewis, Eric Boerwinkle, Ruth J F Loos, Nathalie Chami, Zhe Wang, Kathleen Barnes, Nathan Pankratz, Myriam Fornage, Susan Redline, Bruce M Psaty, Joshua C Bis, Ali Shojaie, Edwin K Silverman, Michael H Cho, Jeong H Yun, Dawn Demeo, Daniel Levy, Andrew D Johnson, Rasika A Mathias, Margaret A Taub, Donna Arnett, Kari E North, Laura M Raffield, April P Carson, Margaret F Doyle, Stephen S Rich, Jerome I Rotter, Xiuqing Guo, Nancy J Cox, Dan M Roden, Nora Franceschini, Pinkal Desai, Alex P Reiner, Paul L Auer, Paul A Scheet, Siddhartha Jaiswal, Joshua S Weinstock, Alexander G Bick

Faculty, Staff and Student Publications

Clonal hematopoiesis (CH) is characterized by the acquisition of a somatic mutation in a hematopoietic stem cell that results in a clonal expansion. These driver mutations can be single nucleotide variants in cancer driver genes or larger structural rearrangements called mosaic chromosomal alterations (mCAs). The factors that influence the variations in mCA fitness and ultimately result in different clonal expansion rates are not well understood. We used the Passenger-Approximated Clonal Expansion Rate (PACER) method to estimate clonal expansion rate as PACER scores for 6,381 individuals in the NHLBI toPMed cohort with gain, loss, and copy-neutral loss of heterozygosity mCAs. Our …

Identification Of Potent Pan-Ephrin Receptor Kinase Inhibitors Using Dna-Encoded Chemistry Technology, Chandrashekhar Madasu, Zian Liao, Sydney E Parks, Kiran L Sharma, Kurt M Bohren, Qiuji Ye, Feng Li, Murugesan Palaniappan, Zhi Tan, Fei Yuan, Chad J Creighton, Suni Tang, Ramya P Masand, Xiaoming Guan, Damian W Young, Diana Monsivais, Martin M Matzuk

Faculty, Staff and Students Publications

EPH receptors (EPHs) are highly sought-after drug targets owing to their essential roles in maintaining appropriate cellular functions in both physiological and disease conditions. However, limited potency and specificity pose significant obstacles to the development of small-molecule inhibitors for EPHs. Here, using high-throughput DNA-encoded chemical library screenings, we developed potent and selective inhibitors of the EPH receptor kinase family. Our results also emphasize the therapeutic potential of our EPH inhibitors in cancer and endometriosis, a global health concern that causes chronic pain and often leads to infertility in women. This study showcases the robust pipeline of using DNA-encoded chemistry technology …

Progress Toward A Vaccine For Extraintestinal Pathogenic Coli (Expec) Ii: Efficacy Of A Toxin-Autotransporter Dual Antigen Approach, Yikun Xing, Justin R Clark, James D Chang, Jacob J Zulk, Dylan M Chirman, Felipe-Andres Piedra, Ellen E Vaughan, Haroldo J Hernandez Santos, Kathryn A Patras, Anthony W Maresso

Faculty, Staff and Students Publications

Extraintestinal pathogenic Escherichia coli (ExPEC) is a leading cause of worldwide morbidity and mortality, the top cause of antimicrobial-resistant (AMR) infections, and the most frequent cause of life-threatening sepsis and urinary tract infections (UTI) in adults. The development of an effective and universal vaccine is complicated by this pathogen’s pan-genome, its ability to mix and match virulence factors and AMR genes via horizontal gene transfer, an inability to decipher commensal from pathogens, and its intimate association and co-evolution with mammals. Using a pan virulome analysis of >20,000 sequenced E. coli strains, we identified the secreted cytolysin α-hemolysin (HlyA) as a …

Researching Covid To Enhance Recovery (Recover) Pediatric Study Protocol: Rationale, Objectives And Design, Rachel S. Gross, Tanayott Thaweethai, Erika B. Rosenzweig, James Chan, Lori B. Chibnik, Mine S. Cicek, Amy J. Elliott, Valerie J. Flaherman, Andrea S. Foulkes, Margot Gage Witvliet, Richard Gallagher, Maria Laura Gennaro, Terry L. Jernigan, Elizabeth W. Karlson, Stuart D. Katz, Patricia A. Kinser, Lawrence C. Kleinman, Michelle F. Lamendola-Essel, Joshua D. Milner, Sindhu Mohandas, Praveen C. Mudumbi, Jane W. Newburger, Kyung E. Rhee, Amy L. Salisbury, Jessica N. Snowden, Cheryl R. Stein, Melissa S. Stockwell, Kelan G. Tantisira, Tamara Bradford, Et Al

School of Medicine Faculty Publications

Importance The prevalence, pathophysiology, and long-term outcomes of COVID-19 (post-acute sequelae of SARS-CoV-2 [PASC] or “Long COVID”) in children and young adults remain unknown. Studies must address the urgent need to define PASC, its mechanisms, and potential treatment targets in children and young adults. Observations We describe the protocol for the Pediatric Observational Cohort Study of the NIH’s REsearching COVID to Enhance Recovery (RECOVER) Initiative. RECOVER-Pediatrics is an observational meta-cohort study of caregiver-child pairs (birth through 17 years) and young adults (18 through 25 years), recruited from more than 100 sites across the US. This report focuses on two of …

Psychometric Evaluation Of A Perceived Barriers To Medication Adherence Instrument And Association Between Perceived Barriers And Patient Characteristics, Lynn Andreae

All ETDs from UAB

Medication adherence is an important component of diabetes management, yet nonadherence is common and has substantial patient and economic costs. In order to achieve meaningful improvements in medication adherence, clinicians and researchers need good ways of both identifying those at risk of nonadherence and ascertaining the specific reasons driving nonadherence in those patients. Current options for self-reported medication adherence are limited in their vulnerability to response bias, which may lead to overestimation of adherence. A measure that assesses perceived barriers to medication adherence may be a useful alternative, as it may identify patients at risk of nonadherence while reducing socially …

The Relationships Among Economic Support And Hypertension And Diabetes Among The Adult Jamaican Population, Andrea Wolfe

Walden Dissertations and Doctoral Studies

A significant number of adult Jamaicans have been diagnosed with diabetes and hypertension, and individual socioeconomic status (SES) has been linked to these health outcomes. SES included income, education and employment. Income may directly influence health; however, some individual’s income may not be sufficient to cover all financial obligations and income support may be necessary. Local or overseas family members may significantly augment an individual’s income and financial situation that could affect health outcomes. This quantitative cross-sectional study was used to examine whether there were relationships between health outcomes (hypertension and diabetes) and economic support (governmental and familial). The Jamaica …

Metaplastic Regeneration In The Mouse Stomach Requires A Reactive Oxygen Species Pathway, Zhi-Feng Miao, Jing-Xu Sun, Xuan-Zhang Huang, Shi Bai, Min-Jiao Pang, Jia-Yi Li, Han-Yu Chen, Qi-Yue Tong, Shi-Yu Ye, Xin-Yu Wang, Xiao-Hai Hu, Jing-Ying Li, Jin-Wei Zou, Wen Xu, Jun-Hao Yang, Xi Lu, Jason C Mills, Zhen-Ning Wang

Faculty, Staff and Students Publications

In pyloric metaplasia, mature gastric chief cells reprogram via an evolutionarily conserved process termed paligenosis to re-enter the cell cycle and become spasmolytic polypeptide-expressing metaplasia (SPEM) cells. Here, we use single-cell RNA sequencing (scRNA-seq) following injury to the murine stomach to analyze mechanisms governing paligenosis at high resolution. Injury causes induced reactive oxygen species (ROS) with coordinated changes in mitochondrial activity and cellular metabolism, requiring the transcriptional mitochondrial regulator Ppargc1a (Pgc1α) and ROS regulator Nf2el2 (Nrf2). Loss of the ROS and mitochondrial control in Ppargc1a-/- mice causes the death of paligenotic cells through ferroptosis. Blocking the cystine transporter SLC7A11(xCT), which …

Interprofessional Curriculum Delivery: Experience Of A Primary Care Education Program, Jessica A Davila, Nancy D Harada, Kathryn Wirtz Rugen, Stuart C Gilman, Shubhada Sansgiry

Faculty, Staff and Students Publications

Few post-graduate training programs offer a comprehensive curriculum that includes structured clinical experiences to teach interprofessional care. To address this need, the United States Department of Veterans Affairs, Office of Academic Affiliations funded the Centers of Excellence in Primary Care Education (CoEPCE) from 2011-2019 to provide interprofessional curricula for health profession trainees (HPTs), including physician residents, nurse practitioner residents, pharmacy residents, and psychology residents. We examined changes over time in curricular domains, system impacts, and program practices based on HPT survey data and the qualitative evaluation of narrative feedback. An annual survey was administered to participants. Indirect standardized ratios were …

A Multi-Modal Intervention To Decrease Hpv Vaccine Hesitancy And Increase Uptake In Young Adult Women, Rylee Cartales

Evidence-Based Practice Project Reports

Human Papillomavirus (HPV) is the leading cause of cervical cancer worldwide and the most common sexually transmitted disease, yet hesitancy towards the HPV vaccine remains high and uptake of the HPV vaccine remains remarkably low (CDC, 2021b). The purpose of this evidence-based practice (EBP) project was to determine if the implementation of a multimodal intervention including a motivational interview, strong provider recommendation, and educational materials will decrease HPV vaccine hesitancy and consequentially increase uptake of the vaccine. Eleven young adult women ages 18-26 from a rural outpatient Obstetrics and Gynecology (OBGYN) clinic in Indiana participated in this project. After agreeing …

Successful Application Of Craniosacral Therapy In A Case Of Acute Ptosis Following A Covid-19 Infection., Efterpi Rompoti

Journal of Transformative Touch

This case study offers a unique insight on the effectiveness of CranioSacral therapy (CST) in a 49 year old woman experiencing an acute stage of a viral infection (Covid-19) causing a partial left Oculomotor nerve palsy. A CST glial/Cerebrospinal Fluid (CSF) specific protocol was utilised over 2 consecutive days. The patient recovered fully after 5 days. The results of this particular case can open up the possibility of utilising CST more widely in treating cranial nerve palsies following a viral infection to support the healing process and the functional restoration.

The Relationship Between Sun Protective Behavior, Health Beliefs, Attitudes, And Norms Of Sun Exposure Among College Athletes, Avery B. Snyder

Honors Theses

The purpose of this study was to access the relationship between sun protective behavior, health beliefs, attitudes, and norms of sun exposure among college athletes. An electronic survey was provided to student athletes for about two weeks in October of 2023. Prior to student participation the Institutional Review Board approved the protocol and data collection. The survey was sent to the students by the athletic director through an app called Teamworks that connects to all the athletes at Coastal Carolina. The majority of students who took the survey reported they did not wear sunscreen in past games/practices. Of those who …

From Survivors To Care Providers: A Multi-Dimensional Study On Physical Activity In Cancer Care, Gaurav Kumar

Theses & Dissertations

As the population of cancer survivors grows, understanding the dynamics of physical activity (PA) engagement is critical due to its potential benefits in reducing adverse health outcomes and mortality associated with cancer. Despite known benefits, both adherence to and promotion of PA among cancer survivors face significant challenges. This comprehensive study examines PA levels, barriers, facilitators, and perceptions among cancer survivors and oncology care providers over a ten-year period. The objectives are to assess adherence levels to PA among cancer survivors, explore the perceived barriers and facilitators to PA engagement from the survivors' perspectives, and understand the barriers, facilitators, and …

Phase 0 Feasibility And Design Of Mobile Health Applications For Use In Rural Settings, Aubree C. Honcoop

Theses & Dissertations

Background. Mobile Health (mHealth) interventions, when meant to serve as decision support, require an in-depth investigation of current workflows and decisional needs to ensure future usability and acceptability. Rural groups were prioritized due to their limited healthcare access, and therefore, their increased need for interventions like mHealth apps that address health disparities.

Objective. To assess the decisional needs of parents/caregivers and/or Healthcare Providers (HCPs) in rural areas regarding emergencies with children with medical complexity (CMC, Project 1), COVID-19 vaccination (Project 2), and HPV and COVID-19 vaccination (Project 3).

Methods. Parents and HCPs were approached through various methods for participation, primarily …

Bridging The Information Divide: Leveraging The Learning Health System To Understand Rural-Urban Health Disparities In The Covid-19 Era, Alfred J. Anzalone

Theses & Dissertations

The examination of healthcare disparities, which the COVID-19 pandemic exacerbated, revealed a pronounced divide between rural and urban settings. This divide particularly underscored the challenges of integrating rural healthcare into the Learning Health System (LHS) and utilizing real-world data (RWD) in response to a public health emergency. Our investigation expanded the growing body of literature on the rural mortality penalty, encompassing the period following the COVID-19 pandemic. By employing an LHS-enabled centralized platform of RWD, we assessed the impact of rurality on adverse COVID-19 outcomes (Aim 1), focusing on inpatient adverse events and the effectiveness of treatments and vaccinations across …

Mental Health Among Collegiate Athletes, Stella Elise Fairbanks

Honors Thesis

Mental health has become increasingly more linked with athletics, especially collegiate athletics. There has been an increase in public acknowledgment of the presence of mental health in sports, specifically, more athletes are speaking about their mental health struggles as well as more research is being conducted in order to gain a greater understanding of the relationship between mental health and athletics. This literature review discusses athletes’ personal experiences of their mental health struggles, the presence of stigma associated with mental health and athletics, and the results of the recent NCAA, National Collegiate Athletic Association, research. This thesis aims to uncover …

Heavy Metals In Afforested Mangrove Sediment From The World's Largest Delta: Distributional Mapping, Contamination Status, Risk Assessment And Source Tracing, Md Saifur Rahman, Moshiur Rahman, Yeasmin N Jolly, Md Kamal Hossain, Sanjida Afrin Semme, Bilal Ahamad Paray, Takaomi Arai, Jimmy Yu, M Belal Hossain

Faculty, Staff and Student Publications

This study aims to assess seasonal and spatial variations, contamination status, ecological risks, and metal sources (Ni, Pb, Cr, Cu, Mn, and Zn) in human-afforested mangrove sediments in a deltaic region. Five sampling locations were sampled during dry and wet seasons. Heavy metal concentrations followed the order: Mn > Zn > Ni > Cr > Cu > Pb. Metal loads, except Cu and Pb, were higher during the dry season, aligning with national and international recommendations. Sediment quality guidelines, contamination factor, geoaccumulation index, enrichment factors, and pollution load index indicated uncontaminated sediment in both seasons. Potential ecological risk assessment showed low risk conditions in all …

Cardiovascular Disease Risk Reduction Program For Hispanics In The Us Midwest: A Culturally Adapted Intervention, Armando De Alba

Theses & Dissertations

Cardiovascular disease (CVD) represents the second leading cause of death in Nebraska (NE), accounting for approximately one in every five deaths. In the state, there are marked ethnic and rural-urban disparities in the prevalence of chronic diseases and resultant deaths. For instance, while the rates in NE of coronary heart disease and myocardial infarction between 2001 and 2010 decreased among non-Hispanic Whites, the rates for Hispanics almost tripled. There is little evidence of CVD risk factor reduction strategies being implemented in Midwestern areas and Hispanic populations.

One promising approach for reducing CVD risk involves health education and lifestyle modification programs …