Public Health Commons^™

The Hazard Prediction Problem, Mary E. Helander, Brendan Smith, Sylvia Charchut, Erika Swiatowy, Calvin Nau, Gregory Cavaretta, Timothy Schuler, Adam Schunk, Héctor Ortiz-Peña

Social Science - All Scholarship

This work formulates the hazard prediction problem while addressing the research question: Can machine learning create a model to automatically recognize patterns that correspond to hazard state conditions during a mission-critical operation? Supervised learning models were trained and tested on data observed from mission simulators, which allowed for safe observation of dynamic system states and undesirable casualty events. The prediction task was formulated as a binary classification problem, producing the probability of being in a hazard state at time t and providing situational awareness of a possible imminent loss. Several modeling architectures were investigated: neural networks, logistic regression, a support …

The Impact Of Mental Healthcare Access On Community Safety, David Buchinsky, Caroline Watts

Scholarship in Medicine - All Papers

Mental health illness is a pressing American public health concern. Approximately one in five Americans is diagnosed with a mental health condition.1 While cost, location, and physician shortage play a role in one’s access to mental healthcare, research is still determining the effects of mental healthcare access on community safety. Using County Health Rankings (CHR), we analyze the changes in mental health providers between 2016 and 2022 in Alabama and Massachusetts, two states with differing rankings in access to mental healthcare and firearm legislation. We then investigate how access to mental health providers affects community safety (firearm fatalities, suicide rates, …

Insufficient Sleep In Ohio And Its Complication In Risky Behaviors, James Dai, Jackson Mitchell

Scholarship in Medicine - All Papers

Background Insufficient sleep is a major public health concern in the United States. Lack of sufficient sleep causes impaired decision making that can increase the chance of participating in risky behavior. Methods County Health Rankings data from Ohio in 2016 and 2022 were reviewed for percentage of insufficient sleep and risky behaviors. We identified excessive alcohol use, driving deaths due to alcohol, drug overdose mortality, and percentage of smokers as risky behaviors. Urban and rural counties were identified via HRSA. Results: There was a significant increase in insufficient sleep from 2016 to 2022 in Ohio. Smoking and drug overdose mortality …

Positive Correlation Of Smoking Percentage And Mentally Unhealthy Days In Ohio 2016-2022, Kevin Williams, Matt Crudele

Scholarship in Medicine - All Papers

There is substantial research regarding the negative physical side effects of smoking, such as increased risk of developing hypertension or chronic obstructive pulmonary disease. Smoking rates are substantially higher among those with a pre-existing mental illness (such as schizophrenia or generalized anxiety disorder)1. Additionally, second-hand smoke exposure among non-smokers has been attributed to an increased risk of developing symptoms of poor mental health (such as anxiety or depression)2,3. It has also been shown that smoking cessation leads to improved mental health4. However, there is limited research regarding the negative effects of smoking on mental health, especially in the state of …

The Relationship Between Being Uninsured And Having Poor Health Outcomes And Experiences In Eastern Kentucky, Danielle Adams, Amber Todd

Scholarship in Medicine - All Papers

Objective: To examine health insurance and health outcome disparities in Eastern Kentucky since Kentucky’s implementation of the Affordable Care Act. Methods: Using data from County Health Rankings and Roadmap, rates of uninsurance will be compared before and a decade after implementation of the ACA in Kentucky (2013 and 2023). In addition, prevalence of certain health outcomes in Eastern Kentucky will be compared from 2013 and 2023 and correlation established between uninsured rates and particular health outcomes for 2023. Results: Since 2013, the percentage of those uninsured in Eastern Kentucky has seen a significant decline. While there is no correlation between …

Regional Disparities In Hispanic/Latino Health Outcomes: A Comparative Analysis Of The Midwest And Top Hispanic Population States, Julian Aviles, Marcelo Hyczy Dacosta Neto

Scholarship in Medicine - All Papers

Background: Hispanic/Latino communities in the United States face significant health disparities and poorer health outcomes compared to non-Hispanic whites. While previous research has documented these inequalities at the national level, it is unclear whether certain regions exhibit more substantial disparities than others. Hypothesis/Research Question: This study aims to investigate whether counties in Midwest states with higher rates of health inequalities and unfavorable outcomes have compared to counties in the top 3 states by Hispanic/Latino population percentage. Methods: Using County Health Rankings, we examined counties in Midwest states (Ohio, South Dakota, and North Dakota) and counties within high Latino population states …

A Case Study In Prospective Program Evaluation, Sarai Rosemary Combs

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Evaluation is a helpful tool in public health to provide transparency about community interventions and programs. The following is a prospective evaluation of a case study, looking at a recently designed program by the Lexington-Fayette County Health Department, as a capstone project for the Health Management and Policy concentration of the Masters in Public Health program of the College of Public Health. The health department developed a series of online training modules to increase knowledge of Methicillin-resistant staphylococcus aureus (MRSA) and other similar organism outbreaks and how to respond to these outbreaks. The program targets were Fayette County Public School …

Characteristics Of Congenital Syphilis Cases In Kentucky 2019-2023, Ines Roy

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Abstract:

Background: The incidence of congenital syphilis (CS) has increased both in the United States (US) and globally and remains a public health concern. In Kentucky alone, there has been a significant increase in CS cases, from 9 cases in 2019 to 27 cases in 2023. CS is a preventable disease, but testing and immediate treatment are critical to prevent its spread. We have limited knowledge regarding Kentucky’s characteristics and behavioral factors that may be associated with this rise. The goal of this study is to identify characteristics and potential risk factors that contribute to the rise of CS in …

The Distribution Of Cp-Cre Cases From 2013-2020 In The Commonwealth Of Kentucky, Hannah Hiscox

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Multidrug-resistant organisms (MDROs), particularly Carbapenem-Resistant Enterobacterales (CRE), pose a significant threat to public health due to their resistance to multiple antibiotics, including carbapenems. CRE infections, especially those producing carbapenemases (CP-CRE), are associated with high morbidity and mortality rates, making them a growing concern in healthcare settings. Despite the prevalence of CRE infections in the United States, limited data exist on the incidence and distribution of CP-CRE infections in specific regions, such as the Appalachian counties of Kentucky.

This study aimed to investigate the cumulative incidence and distribution of CP-CRE cases in Appalachian and non-Appalachian counties of Kentucky, as well as …

A Case Study In Program Evaluation, Iantha Wright

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The framework for program evaluation is a systematic way of improving and accounting for public health actions by providing practical, feasible, ethical, and accurate information. As a practical, non-prescriptive tool, it guides public health professionals through the essential steps in program evaluation. The framework uses the six steps to understand how to improve and conduct assessments effectively. Additionally, it emphasizes integrating stakeholders and using ongoing evaluation strategies to plan effective interventions, improve existing programs, and demonstrate the efficient use of resources.

Demographic And Behavioral Characteristics Of People Who Help Others Inject Drugs: A Study Of People Who Inject Drugs In Appalachia Kentucky, Ryli Hockensmith

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Aim: This study aims to understand the demographic and behavioral characteristics of people who inject drugs (PWID) who assist others with injection, hereafter “injection assistors,” and assess the characteristics of injection assistors compared to PWID who do not assist others with injection in Appalachian Kentucky.

Methods: A cross sectional secondary data analysis of data collected from 433 PWID enrolled in the ongoing Kentucky Outreach Service (KyOSK) was performed. Logistic regression analyses were performed to compare injection assistors to those who do not assist others on demographic, behavioral, service usage, and harm reduction characteristics.

Results: In total, 128 (29%) PWID reported …

Mail-Based Or Home Delivery Services: Preferences Among People Who Inject Drugs In Appalachian Kentucky, Su Su Zin

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Aim: To explore acceptability of delivery-based syringe services program (SSP) among people who inject drug (PWID) in Eastern Kentucky and compare those who wanted to participate in delivery-based SSP to those who did not.

Methods: This was a cross-sectional analysis of data from PWID who injected drugs to get high in the past 30 days (n=246) collected during the baseline assessment administered to the Gateway2Health cohort. Chi-square tests, t-tests, univariate and multivariable logistic regressions were calculated between independent variables and the outcome variable (likelihood of participating in a delivery-based SSP).

Results: 52.9% of PWID reported being likely to participate in …

Human Papilloma Virus Type 16 Seroprevalence Among Men Living With Hiv, Ashley Duff

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objectives: Individuals living with HIV are at a higher risk for developing human papillomavirus-driven oropharyngeal cancer (HPV-OPC). There are no methods for early detection; however, HPV16 E6 antibodies have been identified as a promising early marker. The objective of this study was to evaluate seroprevalence and predictors of HPV16 E6 seropositivity among men living with HIV.

Methods:2,334 men aged 40+ living with HIV with blood specimens banked within the Tennessee Center for AIDS Research (TN-CFAR) biorepository were evaluated using HPV multiplex serology. Seroprevalence of HPV16 antibodies was calculated for all HPV16 proteins analyzed (L1, E1, E2, E4, E6, E7). …

A Case Study In Program Evaluation, Sierra L. Williams

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The Lexington-Fayette County Health Department (LFCHD) developed an education program targeted toward infectious disease outbreaks. The program ensures timely reporting and action during an infectious disease outbreak within the Fayette County Public Schools (FCPS) system. I have been tasked with evaluating the program and its implementation of training modules through pre and post-surveys to determine if the program is significantly increasing the overall knowledge of program participants and make recommendations for how program aspects can be improved.

Program Evaluation Case Study, Grace Mullikin

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Program evaluation case study utilizing Center for Disease Control and Prevention's Case Evaluation Framework.

Rethinking Health Law Architecture, Ani B. Satz

Faculty Articles

Neither the individualistic regulatory health paradigm nor the vulnerable populations approach of public health can provide the legal structure necessary to address the most pressing problems in health care today. These approaches fail to address conflicts between individuals and populations as well as challenges to qualifying for care and are in inherent conflict with each other, sometimes within the same statute. As health concerns become more global, it is necessary to move past a vulnerable populations approach to a broader population approach that respects individual choice but does not sacrifice community health for liberty interests.

The Influence Of Hospital Service Quality On National Health Insurance Patients’ Perceived Value, Satisfaction, And Revisit Intention Across Gender And Age Group In Outpatient Setting In Indonesia: A Mixed Method Study, Alvera Noviyani

Chulalongkorn University Theses and Dissertations (Chula ETD)

Background: Recent literature on healthcare quality shows the important of patient-centred design, hence more contextualized and patient-perspective research is needed to assess service quality. Hence, this study aimed to analyse and explain the relationship between patient satisfaction, perceive value, and revisit intention of Indonesian National Health Insurance patients via service quality in outpatient department in national central public hospital setting. Methods: A mixed-methods approach was employed, combining quantitative analysis through Structural Equation Modelling (SEM) and qualitative data obtained from patient interviews. The SEM results assessed the direct and indirect effects of service quality on perceived value, satisfaction, and revisit intention. …

Factors Associated With Rabies-Related Behaviors Among Myanmar Migrant Workers In Bangkok Metropolitan Area, Thailand., Amornsit Chavanayarn

Chulalongkorn University Theses and Dissertations (Chula ETD)

Rabies is a fatal but preventable viral disease that continues to be a public health concern in Thailand, particularly among vulnerable populations such as migrant workers. Myanmar migrant workers, who often reside in high-risk environments with limited access to healthcare and information, may face increased risk of rabies exposure due to animal bites and inadequate knowledge of prevention measures. This study aimed to determine the proportion of potential rabies exposure and assess the levels of knowledge, attitudes, and practices (KAP) regarding rabies among Myanmar migrant workers in the Bangkok Metropolitan Area. It also examined associations between socio-demographic factors and KAP …

Knowledge, Attitude, Utilization Frequency, And Reutilization Of Telehealth Centers For Maternal Care Services Among Pregnant Women And Mothers In Pakistan: A Cross-Sectional Study, Yamna Ghaffar

Chulalongkorn University Theses and Dissertations (Chula ETD)

Background: Maternal health in rural Pakistan, especially in Balochistan, faces challenges due to limited access to skilled care and health inequalities. Telehealth offers a promising solution by providing remote antenatal, delivery, and postnatal services. Global and local evidence, including the BRDF Telehealth Center, shows its potential to improve outcomes and bridge service gaps, despite ongoing digital access challenges. The study objective was to evaluate the knowledge, attitudes, and reutilization of the BRDF Telehealth Center in Gandawah among pregnant women and mothers. Methods: A cross-sectional study was conducted at the Balochistan Research and Development Foundation (BRDF) Telehealth Center in Gandawa, Balochistan, …

The Association Between Mental Health, Fear Of Missing Out, And Sleep Quality Among University Students In The Sichuan Chongqing Region, China: A Cross Sectional Study, Yuncheng Jia

Chulalongkorn University Theses and Dissertations (Chula ETD)

Background: Sleep quality is a critical determinant of health, with poor sleep linked to adverse physical and mental outcomes. Among university students, excessive screen time, social media engagement, and psychological factors like Fear of Missing Out (FoMO) exacerbate sleep disturbances. Despite growing recognition of FoMO’s role in mental health challenges, its direct relationship with sleep quality remains understudied. This study aim to investigates the associations between mental health, FoMO, and sleep quality among university students in China’s Sichuan-Chongqing region, a population highly immersed in digital culture. And provide insight on how sleep quality is shifting in digital era.Methods: A cross-sectional …

Strengthening Deep Learning Model In Forecasting Of Covid-19 Epidemics In Selected Countries, Warapree Tangseefa

Chulalongkorn University Theses and Dissertations (Chula ETD)

Accurate forecasting of COVID-19 case dynamics is essential for facilitating robust public health strategies and interventions is critical for effective public health planning and response. This study introduced novel deep learning models that integrate autocorrelation (ACF) and partial autocorrelation (PACF) into LSTM and GRU networks to improve forecasts of cumulative confirmed, recovered, and death cases. Six variants—ACF/PACF-enhanced LSTM and GRU models—were compared with standard LSTM, GRU, and ARIMA across eleven countries during non-vaccination, vaccination, and entire study period. The results show that integrating ACF and/or PACF features notably enhances forecasting accuracy. ACF-PACF-GRU outperformed baseline models in predicting confirmed and death …

Abortion Knowledge And Attitudes Among Undergraduate Students In Bangkok, Thailand Post-Legislative Reform, Thanapond Sukonthachart

Chulalongkorn University Theses and Dissertations (Chula ETD)

Background: Following Thailand's 2021 legislative reforms to expand legal abortion access, informational barriers remain a challenge. Teachers, a key source of reproductive health information, influence youth abortion decisions. However, safe abortion is not formally included in the training of future educators. Method(s): A quantitative, cross-sectional study was conducted in Bangkok among undergraduate students enrolled in degree programs leading to a teaching qualification at 19 tertiary institutions. Data were collected using a self-administered online questionnaire and analyzed using descriptive statistics, Chi-square tests of association, and multiple linear regression. Result(s): Among 401 respondents, the distribution of knowledge among participants varied: 36.7% exhibited …

Experience Of Gender-Based Violence (Gbv) And Gbv Prevention During Disaster Among Women And Gender Diverse People In Japan: A Mixed Methods Study, Iino Sae

Chulalongkorn University Theses and Dissertations (Chula ETD)

Gender-based violence (GBV) remains a critical concern during disasters, yet preventive engagement is limited. This mixed-methods study examined GBV prevention among disaster-affected women and gender-diverse individuals in Ishikawa Prefecture, Japan, using a survey (n=424) and in-depth interviews (n=5). Despite high GBV knowledge (63.9%) and positive attitudes (51.7%), only 23.6% engaged in preventive practices. Key quantitative findings show that evacuation experience (OR=1.793, p=0.016) increased engagement, while prior IPV/GBV experience (OR=0.145, p=0.003) and suburban residence (OR=0.631, p=0.044) were associated with lower engagement. Knowledge (OR=1.383, p=0.184) and attitude (OR=1.336, p=0.213) did not significantly predict preventive actions. Qualitative findings revealed that participants had limited …

Effect Of Web-Based Tools On Knowledge And Performance Among Community Nurses On Diabetes Control At Primary Health Care Level In Myanmar: A Cost-Effective Analysis And Quasi Experimental Study, Kyi Thar

Chulalongkorn University Theses and Dissertations (Chula ETD)

Background: Along with rising prevalence, diabetes has emerged as a global public health problem which triggers economic burden, especially among developing countries. Optimizing knowledge and performance of health care workers at primary health care (PHC) level is pivotal for the success of diabetes control programs. Web-based diabetes tools are one of the innovative solutions to improve knowledge and performance among health care providers. However, evidence-based intervention study indicating the effect of web-based tools on diabetes among community nurses has not been conducted in Myanmar before. Objective: This study aimed to demonstrate the integrated effects of web-based diabetes knowledge and diabetes …

Reproductive Health Problems And Factors Associated With Services Used Among Japanese Female Expatriates In Bangkok, Ayaka Nakashima

Chulalongkorn University Theses and Dissertations (Chula ETD)

Reproductive health (RH) refers to a state of complete physical, mental, and social well-being in all aspects of reproductive system. Strengthening health system’s capacity, particularly through improving health service utilization (HSU), is key to enhancing RH outcomes. Despite services availability, access RH care remains limited. Evidence on RH service utilization (RHSU) among Japanese female expatriates is scarce, especially through the lens of Andersen’s Behavioral Model of Health Service Use (BMSU). This study is aimed to find factors associated with RHSU for dysmenorrhea, premenstrual syndrome (PMS), menopausal symptoms, and contraceptive use among Japanese female expatriates in Bangkok, using BMSU framework. A …

Factors Associated With Adolescent Pregnancy In Mpigi District, Uganda: A Community-Based Cross-Sectional Study, Kyoko Hoshino

Chulalongkorn University Theses and Dissertations (Chula ETD)

Adolescent pregnancy is a significant public health and social challenge, with around 90% of these pregnancies occurring in low-and middle-income countries. This study aims to determine the prevalence of adolescent pregnancy and its associated factors among older adolescents in Mpigi district, Uganda. A community-based cross-sectional study was conducted from September to October 2024 among adolescent girls aged 15 to 19 years in Mpigi district, Uganda. Participants were selected using a multistage sampling approach from 12 villages within the district. The data was collected using an interviewer-administered structured questionnaire, assisted by four data collectors. Descriptive statistics were employed to determine the …

Title: Factors Associated With Attitude Towards Safer-Sex Negotiation And Women Empowerment Among Married Women: An Analysis Of 2017-2018 Bangladesh Demographic And Health Survey, Maliha Nawrin

Chulalongkorn University Theses and Dissertations (Chula ETD)

Background:Women's capacity to negotiate safer sexual practices within marriage significantly influences their sexual autonomy and reproductive health outcomes. Despite progressive public health interventions, structural gender inequalities and entrenched cultural norms continue to constrain Bangladeshi women’s empowerment and their negotiation of safer-sex practices. Identifying factors associated with positive attitudes toward safer-sex negotiation is crucial for informing interventions aimed at enhancing women’s reproductive autonomy and promoting gender equity in Bangladesh.Objectives:This study aimed to evaluate the proportion of married women in Bangladesh who exhibit positive attitudes towards safer-sex negotiation, assess socio-demographic characteristics and women's empowerment levels, and examine the associations between these factors …

A Structural Equation Model (Sem) For Early Screening Of Cholangiocarcinoma (Cca) Among Thai Population In Northeast Thailand, Jetnapis Rayubkul

Chulalongkorn University Theses and Dissertations (Chula ETD)

Cholangiocarcinoma (CCA) presents the highest cancer burden in Northeast Thailand, with global-leading incidence rates of 71.3 per 100,000 in males. Despite the launch of the Cholangiocarcinoma Screening and Care Program (CASCAP) in 2013 across 20 provinces, the complex interrelations among demographic, behavioral, and clinical factors influencing early detection remain unclear. This study employed Structural Equation Modeling (SEM) and logistic regression to examine determinants of early CCA screening outcomes and develop evidence-based risk stratification strategies. A cross-sectional analysis was conducted using secondary data from 471,689 individuals aged ≥40 years enrolled in CASCAP between 2014–2019 (Total raw data 1,247,568 individuals). Eight domains …

Physical And Psychosocial Factors Related To Firefighter Musculoskeletal Disorders, Jennifer Ellen Tinsley Kubala

Theses and Dissertations--Rehabilitation Sciences

Career firefighters must perform physically and psychologically challenging duties in unpredictable and dangerous conditions. Previous investigations have found that firefighters suffer nearly 4 times the recorded musculoskeletal disorders (MSD) and workplace injuries compared to private and public sector workers, and take approximately 1.5 days longer to return to normal work. Thus, the burden of firefighter MSD experiences has been a growing area of exploration. The few investigations that have concurrently examined physical and psychosocial consequences experienced by firefighters have found a positive relationship between increased occupational stress reports and MSD experiences. However, these investigations, as well as those that individually …

The Role Of Social Determinants Of Health On Patient Recovery After Critical Illness, Lindsey E. Fresenko

Theses and Dissertations--Rehabilitation Sciences

Patients who survive critical illness have a prolonged recovery which impacts their quality of life and outcomes. The sudden life changes from being critically ill may create or exacerbate social factors or needs also known as social determinants of health. Patients’ SDOH are defined as the environments in which we live, work and play that impact health outcomes. Patients’ SDOH impact their life in early recovery from changes in previous roles to their need for increased financial, physical and emotional support. During this early recovery, patients are often recommended to participate in rehabilitation to improve their physical function. Although, accessing …