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2025

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Full-Text Articles in Public Health

Psychological Impacts In Exercise Riders And Professional Jockeys Following Injury, Kelley M. Renner Jan 2025

Psychological Impacts In Exercise Riders And Professional Jockeys Following Injury, Kelley M. Renner

Theses and Dissertations--Kinesiology and Health Promotion

One of the most well-known equestrian sports, horse racing, is not only a cornerstone of Kentucky’s economy, but also a vital part of its culture, with professional jockeys playing an essential role in the local communities and traditions that define the state. Despite its popularity and financial impact, mental health challenges within the sport have continually been shrouded in silence and ignored in research (Ball et al., 2007). Equally concerning is the high injury prevalence, and psychological impact of these injuries (e.g., psychological distress, depression, anxiety, loss of identity, and self-esteem (King et al., 2022; Losty et al., 2019; McConn-Palfreyman …


Proximity And Density Of Tobacco Retail Locations To Kentucky Schools And The Relationship To Youth Perceptions Of Harm And Susceptibility To E-Cigarette Use, Hannah Cardona Jan 2025

Proximity And Density Of Tobacco Retail Locations To Kentucky Schools And The Relationship To Youth Perceptions Of Harm And Susceptibility To E-Cigarette Use, Hannah Cardona

Theses and Dissertations--Kinesiology and Health Promotion

Purpose: To explore the potential relationship between tobacco retailer proximity/density around Kentucky elementary, middle, and high schools, and students’ perceptions, perceived norms, susceptibility to, and use of e-cigarettes. Design: A mixed-methods analysis of youth’s self-reported survey results and geographical data. Setting: 106 Kentucky elementary, middle, and high schools which participated in #iCANendthetrend’s tobacco education program between September 2023 and May 2024. Subjects: Convenience sample of students from Ky schools (N = 7,823) Measures: Items assessing e-cigarette use, susceptibility, perceptions, and perceived norms. Analysis: ANOVA tests used to compare responses of elementary, middle, and high school students. Chi-squared tests were used …


Pathogen Surveillance Of Viruses And Antimicrobial Resistance Through Wastewater Based Epidemiology, William Strike Jan 2025

Pathogen Surveillance Of Viruses And Antimicrobial Resistance Through Wastewater Based Epidemiology, William Strike

Theses and Dissertations--Biomedical Engineering

Pandemic surveillance is a cornerstone in public health safety, as it enables identification of pathogens circulating within a community before they become widespread outbreaks. Wastewater based epidemiology has blossomed in recent years due to its success in the SARS-CoV-2 pandemic, but this form of public health surveillance has a global equity problem. A large majority of the wastewater-based surveillance work has been done in large metropolitan cities with access to advanced testing infrastructure, which poses a challenge as we consider where pandemics have historically emerged. Therefore, there is a need to identify, adapt, and develop workflows to meet the needs …


Understanding The Impact Of The Medicaid Expansion On Hospital Length Of Stay And Emergency Department Use In Kentucky, Cameron Bushling Jan 2025

Understanding The Impact Of The Medicaid Expansion On Hospital Length Of Stay And Emergency Department Use In Kentucky, Cameron Bushling

Theses and Dissertations--Epidemiology and Biostatistics

Three related analyses were performed to try to understand the immediate effects of Medicaid expansion on hospital systems in Kentucky. Medicaid expansion led to a large, sudden increase in the number of individuals eligible for various health care needs. This sudden increase in demand for health services lead to initial hypotheses regarding hospitals’ ability to handle this demand. The first analysis examined hospital average length of stay (LOS) using a linear mixed-effects model. Length of stay was modeled longitudinally between 2013 and 2015 to determine if significant changes in the slope of LOS could be detected after expansion (2014). Separate …


Changes In Cancer Diagnosis And Survival In The United States During The Covid-19 Pandemic, Justin T. Burus Jan 2025

Changes In Cancer Diagnosis And Survival In The United States During The Covid-19 Pandemic, Justin T. Burus

Theses and Dissertations--Epidemiology and Biostatistics

The COVID-19 Pandemic led to global societal disruptions as political leaders and public health authorities attempted to control the spread of the newly discovered SARS- CoV-2 virus. While these measures were designed to lessen morbidity and mortality from a novel pathogen, their impact was also felt in many other, often unintended ways. The purpose of this dissertation is to use cancer surveillance research methods to examine the association between COVID-19 Pandemic-related disruptions and changes in the normal diagnosis and care of cancer in the United States.

The first two studies of this dissertation analyzed reductions in cancer diagnoses in the …


Enhancing Public Health Surveillance: Development And Validation Of Machine Learning Models For Suspected Opioid Overdose Detection In Emergency Medical Services Data, Peter J. Rock Jan 2025

Enhancing Public Health Surveillance: Development And Validation Of Machine Learning Models For Suspected Opioid Overdose Detection In Emergency Medical Services Data, Peter J. Rock

Theses and Dissertations--Clinical and Translational Science

The ongoing opioid overdose crisis in the United States requires timely and accurate surveillance systems to inform public health responses. Traditional public health surveillance methods rely on hospital discharge data and death certificates, which suffer from significant reporting delays and miss cases where patients refuse hospital transportation. Emergency Medical Services (EMS) data presents a promising alternative with advantages in timeliness and case ascertainment but lacks validated definitions for suspected opioid overdose (SOO).

This dissertation addresses this critical gap through the development, validation, and fairness assessment of machine learning models with natural language processing (ML-NLP) for identifying SOOs in EMS data. …


Assessing The Effectiveness Of A Modified Cook Together Eat Together Program On Food Resource Management Behaviors In A Rural Setting, Johanna K. Poysti Jan 2025

Assessing The Effectiveness Of A Modified Cook Together Eat Together Program On Food Resource Management Behaviors In A Rural Setting, Johanna K. Poysti

Theses and Dissertations--Nutrition and Food Systems

This study evaluated the effectiveness of a modified, hybrid Cook Together, Eat Together (CTET) program on food resource management behaviors in a rural setting. A six-week intervention combining virtual and in-person sessions aimed to improve health behaviors, food resource management skills, and self-efficacy. Although most behavioral changes were not statistically significant, participants reported increased confidence in cooking healthy meals on a budget. Positive qualitative feedback from focus group discussions indicated program feasibility and engagement. Strengths and limitations of the study were discussed as well as recommendations for future research were given.


Researching Dementia Indicators Among Rural Populations, Justin S. Yount Jan 2025

Researching Dementia Indicators Among Rural Populations, Justin S. Yount

Theses and Dissertations--Community & Leadership Development

The study explored potential dementia indicators and risk factors among older adults residing in rural areas who are actively engaged in farming operations. Data was collected in three components a questionnaire, an audiogram test, and a memory impairment screening. 104 people responded to the questionnaire, 133 participants took the audiogram test, and 94 participated in the memory impairment screening. The findings revealed that 80.9% of participants showed no sign of cognitive impairment while 19.1% showed signs of possible impairment. Participants reported moderate levels of physical and social activity, but common risk factors such as elevated BMI, diabetes, hearing loss, and …


Supports For Mental Well-Being Valued By Healthcare Workers: Qualitative Analysis Of Data From A Canadian Cohort Of Healthcare Workers During The Covid-19 Pandemic, Shannon Marie Ruzycki, Anil Adisesh, Quentin Durand-Moreau, France Labrèche, Tanis Zadunayski, Erica Stroud, Nicola Cherry Jan 2025

Supports For Mental Well-Being Valued By Healthcare Workers: Qualitative Analysis Of Data From A Canadian Cohort Of Healthcare Workers During The Covid-19 Pandemic, Shannon Marie Ruzycki, Anil Adisesh, Quentin Durand-Moreau, France Labrèche, Tanis Zadunayski, Erica Stroud, Nicola Cherry

Études primaires

A prospective cohort of 4964 HCWs from four Canadian provinces was established early in the COVID-19 pandemic. Participants were invited to comment about workplace mental health supports at three time points. We performed a thematic content analysis of responses from 1738 participants using the Social Support Behaviour Code framework to categorize barriers to support as informational, tangible, emotional, social, or expressing esteem. Themes were synthesized into suggestions for healthcare organizations to prepare for future crises. Formal and informal peer support, workplace mental health supports, and one-on-one counseling were most often mentioned as valued. Analysis suggested that workplace social networks as …


The Incidence Of Postmenopausal Breast Cancer In Relation To Occupational Exposure To Textile Fibers And Dusts In Montreal, Canada, 2008-2011, Maymouna Myriam Ka, France Labrèche, Mark S. Goldberg, Vikki Ho Jan 2025

The Incidence Of Postmenopausal Breast Cancer In Relation To Occupational Exposure To Textile Fibers And Dusts In Montreal, Canada, 2008-2011, Maymouna Myriam Ka, France Labrèche, Mark S. Goldberg, Vikki Ho

Études primaires

Objective To estimate the associations between occupational exposure to textile fibers/dusts, and incidence of postmenopausal invasive breast cancer.

Methods

A population-based case-control study conducted in Montreal (2008 − 2011) identified hospital cases (N = 695) and population controls (N = 608) from the electoral list. Occupational hygienists examined participants’ occupations and tasks, and attributed exposures to several textile fibers. For all tumors and according to biomolecular subtypes, odds ratios (OR) and 95% confidence intervals (95%CI) were estimated using logistic regression models with different exposure indices, adjusting for potential confounders.

Results

Ever exposure to cotton dust was associated with an increased …


Vocational Training And Occupational Health: An Ergonomics Approach To Gender And Disabilities For Social Sustainability, Myriam Bérubé, Céline Chatigny, Marie Laberge Jan 2025

Vocational Training And Occupational Health: An Ergonomics Approach To Gender And Disabilities For Social Sustainability, Myriam Bérubé, Céline Chatigny, Marie Laberge

Études primaires

The Work-Oriented Training Path (WOTP) in Quebec, Canada, is a dual vocational training program that offers students with learning difficulties supervised traineeships. Teachers play a pivotal role in managing students' occupational health and safety (OHS), yet must do so under tight time constraints, limited institutional guidance and highly diverse student profiles. Building on an activity-centered ergonomics and capabilities framework, this multiple-case study explores how gender, disabilities, and work determinants shape OHS management within the WOTP, emphasizing their implications for social sustainability. Twenty-seven semi-structured interviews were conducted with 15 WOTP teachers; 497 narrated anecdotes, which are units of speech when teachers' …


Characterization Of Airborne Bacterial Diversity In Conventional Hen Houses, Enriched Colonies And Aviaries, And Link Between Possible Bioaerosol Sources, M.-W. St-Germain, M. Veillette, V. Létourneau, A. D. Larios Martínez, S. Godbout, M. Boulianne, C. Duchaine Jan 2025

Characterization Of Airborne Bacterial Diversity In Conventional Hen Houses, Enriched Colonies And Aviaries, And Link Between Possible Bioaerosol Sources, M.-W. St-Germain, M. Veillette, V. Létourneau, A. D. Larios Martínez, S. Godbout, M. Boulianne, C. Duchaine

Études primaires

Background

Canada’s transition toward alternative housing systems for laying hens may have an impact on bioaerosol content and concentrations in those environments. This project aimed to characterize the airborne bacterial diversity in six conventional hen houses, six enriched colonies and six aviaries. The bacterial diversity found in bioaerosols was also compared to the diversity found in feces or litter samples from each corresponding housing type to investigate similarities between possible bioaerosol sources and bioaerosols.

Results

Specific richness (Sobs) and CHAO1 indexes were higher in air samples from conventional hen houses and enriched colonies, compared to their corresponding fecal …


Occupational Exposure To Combustion By-Products And Breast Cancer Risk In Postmenopausal Women, Kahlila Paul-Cole, France Labrèche, Mark S. Goldberg, Sydney Westra, Vikki Ho Jan 2025

Occupational Exposure To Combustion By-Products And Breast Cancer Risk In Postmenopausal Women, Kahlila Paul-Cole, France Labrèche, Mark S. Goldberg, Sydney Westra, Vikki Ho

Études primaires

Objective

To estimate the association between lifetime occupational exposure to select combustion by-products and postmenopausal breast cancer (BC) risk.

Materials and Methods

Data from a population-based case-control study among postmenopausal women residing in Montréal, Quebec were used. Cases included 661 women aged between 47 and 75 yr, diagnosed with incident malignant BC between 2008 and 2011. Controls comprised 587 women randomly selected from the Quebec Electoral List, frequency-matched to cases by 5-year age groups. Information on risk factors and lifetime occupational histories was collected by interview. Two industrial hygienists used job histories to assign exposure to 293 agents, including 6 …


Editors’ State Of The Journal, Nancy E. Krusen, Stacy Smallfield, M Nicole Martino Jan 2025

Editors’ State Of The Journal, Nancy E. Krusen, Stacy Smallfield, M Nicole Martino

Translational Science in Occupation

No abstract provided.


The Power Of Podcasting In Knowledge Translation For Occupational Therapy, Matthew C. Brandenburg Jan 2025

The Power Of Podcasting In Knowledge Translation For Occupational Therapy, Matthew C. Brandenburg

Translational Science in Occupation

No abstract provided.


Value Of Case Studies For Translating Evidence In Occupational Therapy: A New 3-Dimensional Model, George S. Tomlin, Bonnie Riley, Aimee Piller, Jessica Mchugh Conlin, Ashlea D. Cardin, Katrina M. Serwe, Deborah A. Dougherty Jan 2025

Value Of Case Studies For Translating Evidence In Occupational Therapy: A New 3-Dimensional Model, George S. Tomlin, Bonnie Riley, Aimee Piller, Jessica Mchugh Conlin, Ashlea D. Cardin, Katrina M. Serwe, Deborah A. Dougherty

Translational Science in Occupation

Importance: Occupational therapy (OT) practitioners often address complex occupational performance needs of diverse consumers. Professional reasoning, theory, and trial and error interventions can be demonstrated in case studies. Case studies are usually relegated to the lowest level in evidence hierarchies. Yet they have a long tradition in health care literature, and may particularly document the holism, inclusivity, uniqueness, and complexity of OT practice.

Objective: To determine how case studies make a distinct contribution to professional knowledge, using a new model for categorizing them.

Evidence Review: 103 case studies published in AJOT from 1990-2023 were rated by the authors “1” or …


Gazing In The Mirror: Reflecting On Student Perspectives In Work-Integrated Learning In Healthcare Education, Cassidy P. Johnson, Simone C. Regnier, Leah M. Stade Otd, Mhptt, Otr/L Jan 2025

Gazing In The Mirror: Reflecting On Student Perspectives In Work-Integrated Learning In Healthcare Education, Cassidy P. Johnson, Simone C. Regnier, Leah M. Stade Otd, Mhptt, Otr/L

Translational Science in Occupation

Abstract: Student engagement is typically woven into the curriculum of healthcare education through hands-on experiences, lectures, discussions, active learning, and lab components. This engagement is critical to developing student confidence, efficacy, and esteem in important skills that will serve them as they enter their profession. In our doctoral program, we are allowed additional engagement opportunities, including belonging to a research project with professionals. Upon reflection, our experience on an interprofessional research team has helped to translate our classroom knowledge to research and professional practice skills.

Plain-Language Summary: This paper is a reflection on the value of adding work skills beyond …


Retrospective Chart Review Of The Acute Care Psychosocial Evaluation Process For Females Diagnosed With Breast Cancer, Kimberly Conrad, Lou Jensen, Shelley Ashcroft, Antoine Bailliard, Vanessa D. Jewell Jan 2025

Retrospective Chart Review Of The Acute Care Psychosocial Evaluation Process For Females Diagnosed With Breast Cancer, Kimberly Conrad, Lou Jensen, Shelley Ashcroft, Antoine Bailliard, Vanessa D. Jewell

Translational Science in Occupation

Background: A breast cancer diagnosis can significantly impact an individual’s quality of life. This retrospective chart review explored the occupational therapy evaluation process with female patients in an inpatient acute care hospital with a breast cancer diagnosis.

Methods: This descriptive retrospective chart review analyzed 134 occupational therapy evaluations of female patients with breast cancer admitted to a southeastern US academic medical center. Data were extracted and categorized using the Occupational Therapy Practice Framework.

Results: The most frequently administered assessments were non-standardized and the AM-PAC "6-Clicks." Documented short-term goals primarily focused on self-care (56.6%), gross motor skills (24.7%), and instrumental activities …


Perceptions And Barriers Of Vestibular Rehabilitation Among Occupational Therapy Practitioners, Rebecca Callais Jan 2025

Perceptions And Barriers Of Vestibular Rehabilitation Among Occupational Therapy Practitioners, Rebecca Callais

Translational Science in Occupation

Background: Vestibular dysfunction affects 15-20% of adults annually, often impacting daily activities and quality of life (Neuhauser, 2016). While occupational therapists and occupational therapy assistants (OTs/OTAs) can address functional limitations caused by vestibular disorders, their role in vestibular rehabilitation (VR) is under-studied.

Objective: This study explored the competence and confidence of occupational therapy practitioners (OTP) in VR and identified barriers to implementation.

Methods: A cross-sectional survey was distributed to 532 OTP in the Gulf South region, with 79 responses received. The survey included questions on VR training, techniques used, barriers of implementation in practice, and educational supports. Quantitative data were …


Integration Of The Science Of Team Science (Scits) With Applied Healthcare Frameworks: Interprofessional Education Through A University-Based Head Injury Clinic, Part I: Theory, Emily Balog, Susan Paparella, Natalia Noce, Stephanie Hubbell, Kelly Pena Jan 2025

Integration Of The Science Of Team Science (Scits) With Applied Healthcare Frameworks: Interprofessional Education Through A University-Based Head Injury Clinic, Part I: Theory, Emily Balog, Susan Paparella, Natalia Noce, Stephanie Hubbell, Kelly Pena

Translational Science in Occupation

Background: Wicked problems in healthcare, such as the complex health condition of head injury, demand interprofessional collaboration that transcends traditional disciplinary boundaries. These complex clinical challenges call for theoretical frameworks that integrate both disciplinary expertise and interdisciplinary processes.

Definitions and Concepts: Grounded in Repko and Szostak’s (2017) framework of interdisciplinary studies, this paper integrates the Science of Team Science (SciTS), the Interprofessional Education Collaborative (IPEC) competencies, and TeamSTEPPS® to construct a novel heuristic that informs the design of an interprofessional education (IPE) and practice model.

Relationships Between Concepts: We align SciTS’ four phases with IPEC and TeamSTEPPS® to enhance team-based …


Évolution Des Troubles Mentaux Liés Au Travail Au Québec Entre 2012 Et 2021, Jaunathan Bilodeau, Martin Lebeau, Marc-Antoine Busque, Alain Marchand Jan 2025

Évolution Des Troubles Mentaux Liés Au Travail Au Québec Entre 2012 Et 2021, Jaunathan Bilodeau, Martin Lebeau, Marc-Antoine Busque, Alain Marchand

Études primaires

Introduction : Plusieurs pays ont connu une augmentation du nombre de troubles mentaux acceptés au cours des dernières années, mais les variations possibles de cette évolution dans la main-d’œuvre demeurent à explorer.

But de l’étude : Cette étude examine la distribution dans le temps des troubles mentaux acceptés selon la profession, le secteur industriel, le sexe et l’âge au Québec.

Résultats : Les taux d’incidence des troubles mentaux et leur évolution varient selon la profession et le secteur industriel. Alors que le taux est généralement plus élevé dans les professions mixtes et le secteur tertiaire, l’augmentation de ces taux s’observe …


The Importance Of Supply Chain Management In Improving Maternal, Newborn, And Child Health, Tamah Kamlem, Katie M. Mercer Jan 2025

The Importance Of Supply Chain Management In Improving Maternal, Newborn, And Child Health, Tamah Kamlem, Katie M. Mercer

Eagles Talking About the Public’s Health

No abstract provided.


The Important Role Of Health State Departments In The Surveillance And Control Of Tick-Borne Diseases, Seun Abiola, Marina Eremeeva Jan 2025

The Important Role Of Health State Departments In The Surveillance And Control Of Tick-Borne Diseases, Seun Abiola, Marina Eremeeva

Eagles Talking About the Public’s Health

No abstract provided.


An Emerging Obstacle To Childhood Obesity Control And Prevention, Queeneth C. Edwards, Jian Zhang Jan 2025

An Emerging Obstacle To Childhood Obesity Control And Prevention, Queeneth C. Edwards, Jian Zhang

Eagles Talking About the Public’s Health

The rise of telehealth has created both opportunities and challenges as healthcare providers seek to balance the convenience of telemedicine with the need for effective and comprehensive care.1-3 This commentary highlights the implications of telehealth for addressing pediatric obesity, a pressing public health issue.


Bullying As A Public Health Crisis: Linking Aces To Long-Term Health Consequences, Doreen Ugwu, Dziyana Nazaruk Jan 2025

Bullying As A Public Health Crisis: Linking Aces To Long-Term Health Consequences, Doreen Ugwu, Dziyana Nazaruk

Eagles Talking About the Public’s Health

No abstract provided.


Leveling The Playing Field: The Critical Role Of Ada Compliance In Graduate Education, Victoria Davis, Katie M. Mercer, Amber J. Culpepper Jan 2025

Leveling The Playing Field: The Critical Role Of Ada Compliance In Graduate Education, Victoria Davis, Katie M. Mercer, Amber J. Culpepper

Eagles Talking About the Public’s Health

No abstract provided.


An Epidemiological Study Of Finger, Hand, And Wrist Injuries In The Department Of Air Force And Us Workers, Melody Kay Gwilliam Jan 2025

An Epidemiological Study Of Finger, Hand, And Wrist Injuries In The Department Of Air Force And Us Workers, Melody Kay Gwilliam

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

An Epidemiological Study of Finger, Hand, and Wrist Injuries in the Department of Air Force and US workers

Melody Gwilliam

Background and Objectives: Fingers, hands, and wrists (FHW) are the leading injured body parts in work-related injuries in the United States (U.S.) and in the U.S. Department of the Air Force (DAF). There has been limited research on risk factors for FHW injuries. Workers across all industries are at risk for these injuries. The objectives of these studies are to 1) describe and compare FHW injuries among enlisted, officer, and civilian U.S. Department of the Air Force (DAF) …


Evaluating A Public Health Program Using The Cdc Framework: A Case Study Approach, Brooke A. Poe Jan 2025

Evaluating A Public Health Program Using The Cdc Framework: A Case Study Approach, Brooke A. Poe

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

In Bourbon County, Kentucky, where rural health challenges and chronic disease burdens persist, a coalition of public health partners set out to improve population-level physical activity through an innovative, community-centered initiative. The Bourbon County Physical Activity Program emerged through collaboration between the Bourbon County Health Department, the University of Kentucky College of Public Health, and UK HealthCare. Together, these partners designed a six-month intervention that combined discounted YMCA memberships, partnerships with employers, a physical activity tracking app with behavioral incentives, and community-wide events to promote accessible and sustained engagement.

Guided by the CDC’s framework for program evaluation in public health, …


Influence Of Perceived Health Provider Communication, Diabetes Duration And Age At Diagnosis With Confidence In Diabetes Self-Care, Courtney L. Ortz, Meredith S. Duncan, Oluwatosin Leshi, William B. Burrows, Brittany L. Smalls Jan 2025

Influence Of Perceived Health Provider Communication, Diabetes Duration And Age At Diagnosis With Confidence In Diabetes Self-Care, Courtney L. Ortz, Meredith S. Duncan, Oluwatosin Leshi, William B. Burrows, Brittany L. Smalls

Family and Community Medicine Faculty Publications

Introduction: Several factors influence individuals’ confidence to perform diabetes-related self-care activities, including perceived patient-provider communication, diabetes duration and age at diagnosis. It has been well-documented that patient-provider communication is essential when managing chronic diseases such as diabetes; however, the impact of this communication with diabetes duration and age at diabetes diagnosis on confidence in performing self-care behaviors is obscure.

Research design and methods: We utilized data from the 2021 Household Component of the Medical Expenditure Survey among participants 18 years or older who had completed the Diabetes Care Survey. Ordinal logistic regression models were utilized to assess the association between …


Empowering Reproductive Health & Access To Enhance College Student Well-Being: A Mixed Methods Community Engaged Proposal, Allison Maladore Jan 2025

Empowering Reproductive Health & Access To Enhance College Student Well-Being: A Mixed Methods Community Engaged Proposal, Allison Maladore

CGU Theses & Dissertations

This study is a proposal developed in response to the need for the expansion of reproductive health services in institutions of higher education. College-age young adults in the age group of 18 to 24 are particularly vulnerable to unintended pregnancies, sexually transmitted infections, and participate in risky behaviors such as alcohol usage and illicit drug consumption which can increase the likelihood of unsafe sexual behaviors. Reproductive healthcare access is linked to academic success, improved health outcomes, and holistic well-being. The proposal utilizes a community-engaged socioecological approach to create a roadmap and implementation plan to expand reproductive services and access to …