Public Health Commons^™

Cardiac Patient Care Coordination: A Comprehensive Literature Review On Outcomes, Payton Allen

Capstone Experience: Master of Public Health

Care coordination is a vital aspect of the U.S. primary care landscape. Care Coordination is the deliberate process of managing a patient across different provider settings and services and is a vital part of chronic patient care. Most primary care providers (PCPs) today have moved to adopt some form of patient-centered care that serves as the central hub for coordinating and managing a patient's complete healthcare journey. PCPs' access to specialist records and their familiarity with their patients' long-term disease courses uniquely position them as the prime coordinators of patient care. Care coordination is becoming increasingly important in cardiac care …

Utilizing The Health Belief Model To Design A Community-Based Program To Increase Cervical Cancer Screening Rates Among 21 To 25-Year-Olds In The Omaha Metro Area, Karli Baker

Capstone Experience: Master of Public Health

The 2021 Douglas County Community Health Needs Assessment found that cervical cancer screening rates have been on a downward trend since 2011. Previous studies on cervical cancer screening interventions have examined refugee populations, and current programs in Douglas County offer assistance to uninsured women, typically aged 40 and older. However, interventions have overlooked young women aged 21 to 25 in the Omaha metro area, who exhibit the lowest cervical cancer screening rates. We will use the PRECEDE-PROCEED Model as a framework to design an educational program for young women aged 21 to 25, guided by the theoretical underpinnings of the …

A Comprehensive Literature Review Of Barriers To Hormone Therapy Utilization: Strategies For Improving Menopause Management In Women Aged 40-60, Suhan Lee

Capstone Experience: Master of Public Health

Menopause is a natural transition marked by the cessation of ovarian activity, often accompanied by vasomotor symptoms (VMS), genitourinary syndrome of menopause (GSM), and psychological changes that significantly impact women’s quality of life. Hormone therapy (HT) has been the primary treatment for managing menopausal symptoms, particularly VMS, providing substantial relief when initiated within 10 years of menopause. Despite its effectiveness, HT usage has declined dramatically over the past two decades primarily due to barriers such as stigma, safety, misinformation, provider hesitancy, financial barriers, and cultural beliefs. This comprehensive literature review explores key factors influencing HT decision-making, including the media’s role …

Breaking Barriers To Smoking Cessation: Applying The Baby & Me - Tobacco Free Program To Improve Maternal And Child Health In Omaha, Nebraska, Madison Ravens

Capstone Experience: Master of Public Health

Smoking during pregnancy remains a pressing public health concern, contributing to adverse outcomes such as preterm birth, low birth weight, and developmental complications. In Nebraska, about 10% of pregnant women continue to smoke throughout pregnancy—above the national average, highlighting a critical gap in maternal health interventions. The Baby & Me – Tobacco Free (BMTF) program provides an evidence-based solution through structured counseling, carbon monoxide (CO) monitoring, and incentive-based rewards to support smoking cessation among pregnant women. This capstone project utilized the Getting to Outcomes framework to develop a detailed implementation plan to support Tobacco Free Nebraska (TFN) in launching the …

A Comparative Analysis Of Preventable Deaths And Healthcare Accessibility: The U.S. Healthcare System Vs. Canada, The United Kingdom, And Australia, Aleya K. Byrd

Capstone Experience: Master of Public Health

The United States continues to struggle to improve healthcare performance and patient outcomes in comparison with other developed nations. This study examines access to primary care services and preventable deaths by comparing the performance of the United States, Australia, Canada, and the United Kingdom. (Blumenthal et al., 2024). A comprehensive scoping literature review method was applied to examine the health systems of three countries' public health structures to better understand the factors that may influence the US health system performance in accessing primary care services and decreasing preventable deaths. Understanding the structures that lead to the outcomes can help provide …

Barriers To Medication-Assisted Treatment For Opioid Use Disorder In Prisons And Jails In The United States: A Comprehensive Literature Review, Amy C. Smith

Capstone Experience: Master of Public Health

Background: The American Society for Addiction Medicine guidelines state that all FDA-approved medication for opioid use disorder should be available for all patients (CDC, 2024). Medication-assisted treatments for opioid use disorders, also known as medication for opioid use disorder (MOUD), are treatments that help diminish the physical symptoms of addiction to opioids. Currently, there are three FDA-approved medications to treat opioid use disorder: buprenorphine, methadone, and naltrexone (FDA, 2024). Despite being at an increased risk for opioid misuse and overdose, incarcerated individuals in the U.S. often do not have access to MOUD. This comprehensive literature review aimed to determine the …

Surge Scramble: An Evaluation Of Combining The Medical Response And Surge Exercise With The Centers For Disease Control And Prevention’S Pan Flu Scramble, Rebecca L. Thompson

Capstone Experience: Master of Public Health

This report analyzes how Hospital Preparedness Program funding recipients in Nebraska adapted the Center for Disease Control’s Pan Flu Scramble format to meet Medical Response and Surge Exercise (MRSE) requirements in the 2023-2024 fiscal year. By combining the MRSE and Pan Flu Scramble, the recipients created an in-person functional exercise format for the six Nebraska health care coalitions to test their respective chemical plans and the Health Care Crisis Protocol for the State of Nebraska. The report explains the design and conduct of the exercises and provides a comprehensive evaluation of the exercise design and conduct. This report will outline …

State Case Count As An Indicator Of Successful Multistate Outbreak Investigation, Lorisa M. Pennell

Capstone Experience: Master of Public Health

Background/Objectives: Shiga-Toxin producing Escherichia coli (STEC) is a contaminant found in multiple food types and causes multistate outbreaks due to the industrialization of food production. In this report I examine the differences in outbreaks categorized by the regulating agency responsible in outbreak prevention and compare outbreak case counts when organized by positive outbreak investigation and response outcomes.

Methods: STEC Multistate outbreak data was obtained from the Center for Disease Control’s National Outbreak Reporting System (NORS) for outbreaks occurring from 2006-2023. Outbreaks were organized into those regulated by either the US Food and Drug Administration (FDA) or the US Department of …

Focus Group Study Of Racial Disparities And The Effects Of Parental Marijuana Use On Youth Marijuana Use, Avina K. Mahroke

Capstone Experience: Master of Public Health

Marijuana has become one of the most used drugs in the United States. There has been an increase in use among both adults and youth during the past several years. Public health interventions are needed to address marijuana use because of its detrimental effects on youth well-being. Research shows that marijuana can lead to problems with memory, learning, attention, and even depression among youth. Furthermore, marijuana exposure in-utero can lead to developmental issues and problems with other organs such as the lungs. Youth are influenced to start using drugs, like marijuana, for numerous reasons, and parents are one of those …

Investing In Embedded Practitioners: Lessons From The Region Vii Public Health Expansion Program, Julia Quigley

Capstone Experience: Master of Public Health

Public health systems in the United States face mounting challenges, including workforce shortages, skill gaps, and increasing demands on practitioners. These issues are particularly acute in rural and Tribal communities, where systemic barriers and health disparities persist. The Region VII Public Health Expansion Program (PHES) addresses these challenges by investing in practitioners already embedded in their communities. Through fully funded public health degree programs, the PHES aims to enhance workforce retention, strengthen skills, and support the delivery of essential public health services in Missouri, Iowa, Nebraska, and Kansas. This study evaluates the program's innovative approach, which departs from traditional recruitment …

Recycling Infrastructure And Its Benefits: A Literature Review Of Economic And Community Impact, Grace Kollars

Capstone Experience: Master of Public Health

Lincoln currently relies on a recycling system with private haulers and limited recyclables collection sites. To increase recycling rates and waste diversion, this review focused on the economic benefits of implementing city-wide recycling, the costs of implementing that recycling program, and the economic effects of making no change to the recycling program. Subjects of job creation, landfill costs, and virgin materials are discussed, along with the analysis of the economic, environmental, and social costs of each recycling program scenario. By the end of this project, I have identified the best recycling program option for the City of Lincoln to implement …

The Association Between Economic Outcomes And Abortion: A Scoping Review, Larisa Nicole Stephenson

Capstone Experience: Master of Public Health

Background: Abortion access is not just an issue of autonomy, but an economic issue as well. Evidence of the intersectionality of abortion health care and economics has endured due to the financial cascading effects a denial of an abortion, or the inability to access an abortion, has on one’s personal, professional, and economic upward mobility. A change in recent policies impacting access to abortion warrants an updated synthesis examining the relationships between economic outcomes and abortion access for people of reproductive age in the United States (U.S.).

Aim: This scoping review summarizes evidence pertaining to the association …

Transgender And Gender-Diverse Health Care Access And Availability Of Care According To Resident Leaders In The Mahoning County, Ohio, Robin A. Perry

Capstone Experience: Master of Public Health

BACKGROUND: Transgender and gender diverse health is significantly under attack in the United States and there is a continued need to further research to identify ways to increase their access to both inclusive care as well as gender affirming care. The purpose of this study was to explore barriers and supportive factors that professionals and community leaders perceive surrounding the availability and accessibility of inclusive and gender affirming care for transgender and gender diverse people in Mahoning County, Ohio.

METHODS: Key informant interviews were conducted with professionals and community leaders who could be considered “facilitators” helping transgender and gender diverse …

Improving Oral Hygiene Practices In A Long-Term Care Setting For Individuals With Advanced Dementia: A Quality Improvement Initiative, Rachel L. Mcinerney

Capstone Experience: Master of Public Health

This quality improvement project utilized the Plan-Do-Study-Act framework to enhance oral hygiene practices in a long-term care setting for individuals with advanced dementia. Advanced dementia often leads to significant oral health challenges due to the individuals’ inability to communicate needs or independently manage oral care. Poor oral hygiene results in pain, systemic infections, and reduced quality of life. The project aimed to identify and address barriers to effective oral care delivery by focusing on organizational factors such as leadership, training, and caregiver support. This capstone paper provides insights into the quality improvement initiative’s aims, background, and methodology, while emphasizing its …

Active Shooter And Radiological Contamination Full-Scale Exercise, Elise M. Lowe

Capstone Experience: Master of Public Health

Planning and conducting exercises in rural settings highlights the unique features and challenges of emergency preparedness in rural America. Exercise designers must employ creative solutions to plan for player/controller contingencies, limited resources, and patient management across large geographical areas. This paper outlines the process by which a full-scale mass casualty exercise was conducted in a small Wyoming town. It analyzes some of the major problems encountered in rural exercise development and the solutions employed. The focus is on the success and failures of the exercise design based on direct observation/participation, hotwash forms, the after-action review, and direct feedback from participants. …

Kansas City Health Department – Childhood Lead Poisoning Prevention Program – Quality Improvement, Hanh Pham

Capstone Experience: Master of Public Health

This capstone manuscript evaluates the Kansas City Health Department's Childhood Lead Poisoning Prevention Program’s effectiveness. Through comprehensive data analysis of grant utilization, return-on-interest (ROI) and participant satisfaction evaluation, the project will provide actionable recommendations for improving sustainable long-term outcomes in lead poisoning prevention.

Assessing The Impact Of Atrazine And Paraquat On Parkinson’S Disease Prevalence In Rural Nebraska Counties, Alex Egbuchiem

Capstone Experience: Master of Public Health

This study examines the association between exposure to the herbicides atrazine and paraquat and the prevalence of Parkinson’s Disease (PD) in various counties of Nebraska. PD is a neurodegenerative disorder that impacts rural agricultural regions in Nebraska, where pesticide application is prevalent. Through a thorough analysis of data sourced from the Nebraska PD Registry, environmental monitoring databases, and pesticide usage, this research aims to establish a correlation between the concentrations of atrazine and paraquat in both groundwater and surface water and the incidence of PD within this region. The study will employ statistical techniques to evaluate this association while accounting …

Integrated Primary Care And Mental Health In Rural Communities: A Comprehensive Literature Review To Understand Barriers, Zinab Alaskar

Capstone Experience: Master of Public Health

This comprehensive literature review capstone project identifies structural barriers to integrating primary care and mental health services in rural areas. It examined reliable literature and validated research articles to determine challenges and barriers to the adoption and expansion of integrating primary care and mental health services in rural communities. The hypothesis of this work is that the issues of workforce shortages, financial constraints, technological limitations, and stigma in a society limits the development and viability of integrated healthcare models. These structural limitations must be addressed to address issues related to access to health care, costs and patient well-being. As it …

Enhancing Safety In Healthcare Construction: A Comprehensive Training Program On Managing Construction Dust, Melissa Nalath

Capstone Experience: Master of Public Health

In healthcare settings, construction activity poses significant risks due to the formation and release of construction dust containing allergens, pathogens, and toxic substances. This culminating project will develop a comprehensive training course for contractors to mitigate these risks while ensuring the safety of patients, employees, and construction workers. The training programs will raise awareness of the health risks associated with construction dust and educate contractors on proper dust handling techniques and ensure compliance with relevant regulations. Key elements such as containment, ventilation, and proper personal protective equipment (PPE) use will be emphasized. The program will also underscore the potential for …

Examining The Association Between Diabetes And Hypertension Among Women 40 Years And Older Using The Framingham Study, Stefanie F. Starinsky

Capstone Experience: Master of Public Health

Objectives: To investigate the association between diabetes and hypertension over 24 years using the Framingham Heart Study in women 40 or older.

Methods: The study utilized a subset of data from the Framingham Study (initiated in 1948), a longitudinal prospective cohort study, which followed participants for 24 years. The exposure was diabetes, while hypertension was the outcome. Women aged 40 years or older who had no missing data on diabetes or hypertension were included (N=2,187). Logistic regression was used to estimate unadjusted and adjusted odds ratios (OR) and 95% confidence intervals (CI). Adjusted models controlled for body mass index, smoking, …

The State Of Abortion Training In Medical School And Family Medicine Residency Curricula: A Scoping Literature Review, Eric James Reece

Capstone Experience: Master of Public Health

This project aims to assess how abortion education has been integrated into medical training over the past decade, with a particular focus on understanding its current state in medical schools and family medicine residencies, including those offering specialized programs affiliated with RHEDI (Reproductive Health Education in Family Medicine) and TEACH (Training in Early Abortion for Comprehensive Healthcare). Given the ever-evolving legal landscape following the June 4^th, 2022 Supreme Court case of Dobbs v. Jackson Women’s Health Organization, this review explores how both federal- and state-level legal restrictions impact access to abortion training and attempts to identify gaps …

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

Capstone Experience: Master of Public Health

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

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

Capstone Experience: Master of Public Health

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

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

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

Methods: Descriptive and comparative analyses of …

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

Capstone Experience: Master of Public Health

Background

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

Methods

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

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

Capstone Experience: Master of Public Health

Objective

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

Methods

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

Improving Nutrition Outcomes Through Enhanced Allocative Efficiency Of Investments In 24 High Risk Counties In Kenya: An Optima Nutrition Modelling Study, Morris Ogero, Nick Scott, Veronica Kirogo, Anthony Ngugi

Population Health, East Africa

Introduction ;Undernutrition remains a significant global challenge, severely impacting children’s development and growth. To address this, the Sustainable Development Goals target a substantial reduction in stunting and wasting by 2025. Achieving these goals requires scaling up evidence-based nutritional interventions; however, limited budgets pose challenges in funding all necessary programs. To assist policymakers in making informed decisions, the World Bank developed the Optima Nutrition Modelling tool, which optimizes the allocation of nutrition investments. Kenya, with its high prevalence of stunting, was the focus of this study. Using the Optima Nutrition model, we aimed to (1) assess the impact of scaling up …

Insights Into Cancer Awareness And Health Practices In Rural Kenya: A Cross-Sectional Study Of Esophageal, Breast, Prostate, Cervical, And Colorectal Cancers, Rosebella Iseme-Ondiek, Joseph Abuodha, Anthony Ngugi, Mansoor Saleh, Innocent Abayo

Population Health, East Africa

PURPOSE; In sub-Saharan Africa (SSA), there has been an epidemiologic transition from infectious diseases to noncommunicable diseases, including a projected doubling in incidence of cancer. Understanding the underlying factors driving this surge is crucial for designing effective strategies to mitigate the cancer burden. This study focuses on assessing knowledge, attitudes, screening practices, and health behaviors related to five most prevalent cancers in SSA: prostate, breast, cervical, esophageal, and colorectal—among a predominantly rural coastal population in Kenya.

MATERIALS AND METHODS ;We used a cross-sectional study design targeting 1,500 adult respondents randomly selected from an existing community health and demographic surveillance system. …

Educational Leadership In A Vuca World: The Crisis Management Experiences Of Rural School Superintendents, Lucas J. Grossnicklaus

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

The job of both urban and rural superintendents is challenging, but it is the rural school superintendency that comes with unique challenges that aren’t always faced by their urban and suburban counterparts. The COVID-19 Pandemic brought about a number of crises for school superintendents such as school closures, mask mandates, and navigating positions taken by governors, teachers unions, and school boards. While concerns about school closures and mask mandates has dissipated, conflict within school districts has only seemed to grow since the pandemic.

This multi-case study explored the lived experience of rural superintendents in the Midwest who have experienced a …

T2-Weighted Imaging Of Rectal Cancer Using A 3d Fast Spin Echo Sequence With And Without Deep Learning Reconstruction: A Reader Study, Dan Nguyen, Sarah Palmquist, Ken-Pin Hwang, Jingfei Ma, Usama Salem, Jia Sun, Xinzeng Wang, Jong Bum Son, Randy Ernst, Peng Wei, Harmeet Kaur, Nir Stanietzky

Faculty, Staff and Student Publications

Purpose: To compare image quality and clinical utility of a T2-weighted (T2W) 3-dimensional (3D) fast spin echo (FSE) sequence using deep learning reconstruction (DLR) versus conventional reconstruction for rectal magnetic resonance imaging (MRI).

Methods: The study included 50 patients with rectal cancer who underwent rectal MRI consecutively between July 7, 2020 and January 20, 2021 using a T2W 3D FSE sequence with DLR and conventional reconstruction. Three radiologists reviewed the two sets of images, scoring overall SNR, motion artifacts, and overall image quality on a 3-point scale and indicating clinical preference for DLR or conventional reconstruction based on those three …

Dose Prediction Via Deep Learning To Enhance Treatment Planning Of Lung Radiotherapy Including Simultaneous Integrated Boost Techniques, Wenhua Cao, Mary Gronberg, Stephen Bilton, Hana Baroudi, Skylar Gay, Christopher Peeler, Zhongxing Liao, Thomas J Whitaker, Karen Hoffman, Laurence E Court

Faculty, Staff and Student Publications

Background: Recent studies have shown deep learning techniques are able to predict three-dimensional (3D) dose distributions of radiotherapy treatment plans. However, their use in dose prediction for treatments with varied prescription doses including simultaneous integrated boost (SIB), that is, using multiple prescription doses within the same plan, and benefit in improving plan quality should be validated.

Purpose: To investigate the feasibility and potential benefit of using deep learning to predict dose distribution of volumetric modulated arc therapy (VMAT) including SIB techniques and improve treatment planning for patients with lung cancer.

Methods: The dose prediction model was trained with 93 retrospective …