Public Health Commons^™

Socio-Spatial Patterns Of Suicide Mortality In The United States, Kushagra Tiwari, M. Amin Rahimian, Marie-Laure Charpignon, Philippe J. Giabbanelli, Praveen Kumar

VMASC Publications

Suicides cause more than 49,000 deaths per year in the United States, including 55% associated with the use of a firearm. Across states and counties in the US, suicide mortality exhibits substantial geographical and sociodemographic heterogeneity. However, the role of large-scale social networks in shaping this variation remains underexplored. To assess how both the risk of suicide mortality and the effect of firearm restriction policies propagate through inter-county social ties, we integrate data on county-level suicide mortality (2010–2022) and the Facebook Social Connectedness Index (SCI), a continuous measure of the strength of social ties between counties used to derive weighted …

Neighborhood Deprivation Associated With Impaired Sit-To-Stand Performance In Middle-Aged And Older Adults: A Cross-Sectional Analysis With Clinical Implications, Kenneth Harrison, Silvia Campos-Vargas, Brandon M. Peoples, Keven G. Santamaria-Guzman, David T. Redden, Michael A. Samaan, Jaimie A. Roper

Kinesiology and Health Promotion Faculty Publications

Background: Socioeconomic factors significantly influence health outcomes in older adults, yet their impact on specific aspects of mobility remains unclear. This study investigates the relationship between area-level socioeconomic disadvantage and mobility health in older adults.

Methods: We conducted a cross-sectional study of 110 community-dwelling older adults recruited and collected using voluntary response sampling at eight health fairs across rural Southeast Alabama in 2022–2024 (60 ± 16 years, 80% female). Area-level socioeconomic status was measured using the Area Deprivation Index (ADI), a validated composite measure of neighborhood disadvantage. Mobility was assessed using the Instrumented Timed Up and Go (iTUG) test and …

The Impact Of Gastric Sleeve And Roux-En-Y Gastric Bypass On Chief Cell Function And Protein Digestion In Obese Patients, Garikoitz Mikel Gainza

Honors Undergraduate Theses

Obesity has become one of the largest global health concerns of the 21^st century, correlating with numerous associated diseases. To help address the growing prevalence and burden of obesity, sleeve gastrectomy and Roux-en-Y gastric bypass have become two commonly performed surgical procedures done to promote weight loss by altering the anatomical structure of the stomach and surrounding organs of the gastrointestinal system. Although the benefits of improved metabolism linked to these surgical procedures are well studied, their impact on the physiology of gastric cells, and more specifically chief cells as they relate to protein digestion post-surgery, is yet to …

Iron Deficiency And Iron Deficiency Anemia: Inconsistent Screening Practices And Delayed Result Processing In Children 12-18 Months, Madonna J. Mahoney Marshall

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction:

Iron deficiency and iron deficiency anemia in children aged 12 to 18 months are prevalent conditions that, if not identified and treated early, are associated with adverse neurodevelopmental outcomes.

Purpose:

This quality improvement project evaluated the impact of a standardized screening and follow-up protocol on laboratory result retrieval, provider review, and caregiver follow-through in a military pediatric clinic.

Method:

A pre-post intervention design guided by the Plan-Do-Study-Act framework was implemented over 11 weeks and included staff education, standardized workflows, and caregiver outreach.

Results:

The intervention improved laboratory completion and caregiver follow-up rates; however, sustainability was limited by staffing constraints …

Barriers To Immunity: Understanding Covid-19 Vaccine Uptake In Africa, Emilia Blechschmidt

Honors Theses

This thesis examines the factors influencing COVID-19 vaccine uptake across African countries, with a focus on structural, informational, and behavioral barriers to immunization. Drawing on cross-country data, the study analyzes how access to transportation, reliable information, and healthcare resources shape vaccination rates, alongside the effect of demographics and institutional factors in shaping individual perceptions of risk and vaccine safety.

The findings emphasize that the broader strength and preparedness of national health systems strongly influence vaccine uptake. Countries that demonstrated higher coverage of routine childhood immunizations, such as polio and hepatitis B, also tended to perform better in COVID-19 uptake efficiency …

Caregiver Training: Improving Social Determinants Of Health, Patient Safety, Empowerment Through Improving Elder Care Education And Skills, Kathleen Thimsen

Nursing Faculty Research

Caregiver training (CaGi TRaining) is a time-tested intervention aimed at improving safety in elders living and aging in place in the community. While elder abuse and maltreatment was the intial purpose of the project, with over 3500 Caregivers graduated from this program since 2009, the course has addresses social determinants of health, and improved workforce pipelines by providing stable employment, improved self-efficacy, and confidence demonstrated by self-reports at graduation and in follow up surveys. Previously learners without a high school diploma retruned to school to obtain a GED (40%), with an additional return to school for bacalaureate and degrees (27%) …

Hallucinogen Use Among Parents Of Children In The United States: Associations With Mental Health And Substance Use, Maggie K. Richardson

Theses and Dissertations--Educational, School, and Counseling Psychology

Hallucinogen use has reemerged in the United States amid expanding clinical research and shifting social and policy contexts. However, population-based evidence remains limited regarding hallucinogen use among adults living with children and its relationship with mental health impairment severity in caregiving environments. Therefore, this study’s objective was to examine associations between past-year hallucinogen use and past-year mental health impairment among U.S. adults, and to test whether associations differ by parental status and number of children in the household. A secondary aim examined correlates of co-occurring substance use among those reporting hallucinogen use.

Data were drawn from the 2023 National Survey …

One-Stop-Shop (Oss): Community Health Nursing: (For Undergraduate Nurses), Sarmad Muhammad Soomar

Books

No abstract provided.

Facilitating Shared Reading Exposure To Promote Health Outcomes In A Rural Pediatric Primary Care Clinic, Meredith L. Longino

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of this scholarly project was to address a gap in early literacy promotion for rural children by incorporating the Reach Out and Read program. This program bolsters foundational literacy by providing a book and anticipatory guidance at every well-child visit from birth through age 5. This project was expected to decrease no-show well-child attendance rates and improve provider morale.

Background

The project was implemented in an established rural pediatric primary care clinic in Northeast Texas. 

Methodology

Process implementation was measured through books distributed and EHR documentation of the intervention. Process objectives were measured by no-show rates for …

Improving Parental Self-Efficacy And Stress Management Among Parenting Youth Experiencing Homelessness: Development And Implementation Of A Standardized Group Parenting Curriculum At An Urban Homeless Shelter, Liam Jerez

Doctor of Nursing Practice Final Project Abstract

Purpose

This quality improvement (QI) project developed and implemented an evidence-informed group parenting curriculum, The Parenting Hub: Mindful Moments (TPHMM), at an urban youth shelter, aiming to increase parental self-efficacy by 20% and decrease parental stress by 20% among homeless parenting youth.

Background

Nearly half (49%) of 18–24-year-olds in families experiencing homelessness are parents, often facing low parenting confidence, limited support, and high stress. The project site, serving up to 150 youths, with a fluctuating number of young parents, lacked a standardized parenting curriculum.

Methodology

This pre-/post-test QI pilot used the Model for Improvement; Plan-Do-Study-Act cycles refined delivery in the …

Improving The Continuity Of Care For Opioid Use Disorder: Investigating Fentanyl Overdose Outcomes And Pharmacy-Level Buprenorphine Access, Lyn Yuen Choo

Graduate Theses, Dissertations, and Problem Reports (ETD)

Opioid overdose (OD) deaths remain a leading cause of injury-related death in the United States (US) and approximately 76,516 drug OD deaths were predicted in the past year prior to April 2025. While previous research has focused on fatal opioid ODs, less is known about outcomes following non-fatal opioid ODs (NFOO) involving fentanyl. Patients who experienced a fentanyl OD may develop significant morbidity and inpatient mortality due to fentanyl’s high potency, rapid onset of action, and decreased response to naloxone. Research efforts to improve continuity of care for opioid use disorder (OUD) are highly needed to ensure appropriate follow-up care …

Adolescent Girls’ Experiences Of Digital Dating Abuse Through Social Media: A Scoping Review, Kiara E. Rodriguez

Social Work Theses

Teen dating violence (TDV) is a prevalent adverse childhood experience with lasting psychological and behavioral consequences. As adolescents increasingly engage with social media, with 95% of teens aged 13-17 reporting using it, digital spaces have become a significant context in which dating abuse can occur. Digital dating abuse (DDA) refers to patterns of abusive behaviors that are directed toward a dating partner through digital technologies, including social media and mobile phones. Despite the growing role of social media in adolescent relationships, research on how adolescent girls experience DDA in these contexts remains limited. The central question for this scoping review …

Exposition Professionnelle Aux Agents D'Infections Nosocomiales En Milieux De Soins : Mieux Comprendre Et Contrôler La Voie De Propagation Par Aérosols, Caroline Duchaine, Yves Longtin, Marc Veillette, Adriana Larotta, Bianka Paquet Bolduc

États de la question, rapports d’expertise et revues de littérature

Ce projet, mené dans le contexte de la pandémie de COVID-19, visait à mieux comprendre les risques liés à la présence de virus et de bactéries dans l’air des milieux de soins et à identifier les meilleures façons de protéger le personnel de la santé. Ce projet s’est articulé autour de trois grands volets de recherche complémentaires, menés en milieux réels et en laboratoire. Le premier volet visait à documenter la présence de virus comme le SARS-CoV-2 (responsable de la COVID-19), l’influenza ou le norovirus dans l’air d’hôpitaux et de centres de soins de longue durée. Des prélèvements dans les …

Établissement De L'Équivalence De La Méthode Irsst 381 Pour La Mesure De L'Exposition Professionnelle Aux Fumées D'Asphalte En Conformité Avec La Nouvelle Valeur D'Exposition Admissible, Simon Aubin, Ousmane Bangoura, Corina Tue

États de la question, rapports d’expertise et revues de littérature

Depuis quelques décennies, la valeur d’exposition admissible consiste en une valeur d’exposition moyenne pondérée (VEMP) des fumées d’asphalte est de 5 mg/m³, prélevée en fraction « particules totales », pour laquelle une mesure gravimétrique non spécifique est préconisée. (Règlement sur la santé et la sécurité du travail) Une nouvelle VEMP entre en vigueur en mars 2026 avec la valeur et l’expression suivante : 1,5 mg/m³ [particules et vapeur exprimée en fraction soluble dans le benzène ou son équivalent] prélevé en fraction « particules totales » (Pt). La méthode préconisée pour soutenir cette VEMP est la …

Les Répercussions Des Changements Climatiques Sur La Sst : État Des Lieux Et Pistes D'Action, Sophie De Serres, Alain Marchand

États de la question, rapports d’expertise et revues de littérature

Cet état des lieux expose les répercussions multidimensionnelles des changements climatiques (CC) sur la santé et la sécurité du travail (SST), en se concentrant sur les contextes nord-américain et européen. L'augmentation de la température moyenne mondiale, qui atteint désormais +1,2 °C par rapport à l'ère préindustrielle, transforme les conditions de travail et exacerbe les dangers professionnels existants. Le stress thermique induit par la chaleur excessive provoque des pathologies allant de l'épuisement au coup de chaleur mortel, tout en dégradant la vigilance et en augmentant le risque de blessures traumatiques. Au-delà des atteintes physiques, les CC aggravent les risques psychosociaux, engendrant …

Socioeconomic Influences On Doula Access And Perceived Care Quality Among Black Women Experiencing Severe Maternal Morbidity, Deborah Esene

2026 Spring Honors Capstones Projects

Black women experience disproportionately high rates of maternal morbidity and mortality, making it essential to examine access to and the perceived impact of doula support. This study examines whether socioeconomic status influences access to and the perceived benefits of doula support among Black women who experienced severe maternal morbidity (SMM). Researchers surveyed Black women ages 18-49 who had a live birth within the past two years and experienced SMM. Participants were recruited and completed an online survey in late 2020. Key variables included income, education, doula use, and perceived quality of prenatal, intrapartum, and postpartum care. Among 188 participants, 12.2% …

From Reactionary To Anticipatory Integrated Action: Novel Environmental Health Surveillance For Mass Gatherings, Benjamin J. Ryan, Michael Donahoo, Danielle Esler, Paul Barach, Benjamin Coghlan, Shelby Garner, Laura M. Langan, John Piispanen, Bryan W. Brooks

College of Population Health Faculty Papers

Advances in AI-driven analytics, human-in-the loop techniques, and wastewater monitoring provide the foundation needed to shift from reactive to anticipatory actions for mass gatherings. Traditional surveillance systems focus on clinical and laboratory-based notification pathways, which often result in tardy actions being implemented. Thus, traditional surveillance is becoming outdated. Mass gatherings pose heightened public health risks and hazards, including trauma; injury and substance misuse; deliberate poisoning; and infectious diseases such as food and waterborne illnesses, sexually transmitted infections, and respiratory diseases. There is also a heightened concern due to reduced vaccination coverage. As a result, future international events such as the …

Clinical Subtypes Of Co-Morbid Insomnia And Obstructive Sleep Apnea (Comisa): Results Of A Cluster Analysis, Yuan Shi, Xujun Feng, Fengyi Hao, Yuru Nie, Yihui Zhang, Zhaohua Chen, Siqi Guan, Larry D. Sanford, Michael V. Vitiello, Xiangdong Tang

Department of Pathology & Anatomy Faculty Publications

Background

Variations in the bidirectional relationship between obstructive sleep apnea (OSA) and insomnia in co-morbid insomnia and OSA (COMISA) may form distinct subtypes of COMISA, which have not been previously characterized. This study aims to identify and characterize subtypes of COMISA.

Methods

From a community-recruited COMISA cohort 256 individuals who met diagnosis for COMISA were used to identify subtypes using a two-step clustering methodology. Demographics and multidimension clinical characteristics were collected and compared among obtained subtypes. Logistic models were used to evaluate whether these subtypes were associated with cardiometabolic and mental disorders. A clinical cohort of 1816 COMISA patients was …

Developing Curcumin Analogues For Treating Breast Cancer, Tulasi Laxmi Nutalapati

Theses, Dissertations and Capstones

Breast cancer is still one of the most common types of cancer and one of the most common causes of cancer-related deaths in women around the world. Despite significant advances in early detection and treatment strategies, drug resistance, systemic toxicity, and poor outcomes in aggressive subtypes continue to limit the overall effectiveness of cancer therapy. Natural compounds have become promising anticancer agents because they can target many different things and are not very toxic. Curcumin has shown promise as an anticancer drug, but it cannot be used in the clinic because it does not absorb well, breaks down quickly, and …

Effectiveness Of Occupational Therapy-Inspired Educational Sessions For Mothers Accessing Women, Infants, And Children (Wic) Services, Samantha Annette Merew

Graduate Theses, Dissertations, and Problem Reports (ETD)

This doctoral capstone project examined the effectiveness of occupational therapy (OT)-inspired group and one-on-one educational sessions designed to support the emotional, mental, and social well-being of pregnant and postpartum mothers accessing Women, Infants, and Children (WIC) services in Onslow County, North Carolina. Grounded in the Model of Human Occupation and Cognitive Behavioral Frame of Reference, the program aimed to address gaps in holistic maternal health support, particularly among low-income and at-risk populations. Eight structured group sessions and five one-on-one sessions were developed, implemented, and evaluated, focusing on topics such as stress management, emotional regulation, self-care, role transition, and self-advocacy. A …

Hardin Health Link: A Community-Integrated Paramedicine (Cip) Program In Hardin County, Kentucky, Samantha Jones

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

Rural and mixed rural–urban communities face persistent disparities in access to timely emergency medical services (EMS), contributing to preventable morbidity and mortality from time-sensitive conditions such as cardiovascular disease, stroke, and injury. Hardin County, Kentucky, reflects these challenges due to its geographically dispersed population, high burden of chronic disease, and variability in EMS response times. This capstone proposes Hardin Health Link, a Community-Integrated Paramedicine (CIP) program designed to expand the traditional role of EMS providers through in-home health assessments, chronic disease monitoring, post-discharge follow-up, medication reconciliation, and connection to clinical and social services.

Guided by an evidence-informed framework, the program …

Stronger Starts: Advancing Maternal And Infant Health In Breathitt County, Kentucky, Madisyn Smith

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

Maternal and infant health outcomes remain significantly poorer in rural Appalachian communities, where structural and socioeconomic barriers limit access to timely and comprehensive care. Kentucky reports elevated rates of preterm birth and infant mortality, with counties such as Breathitt County facing challenges including limited obstetric services, transportation barriers, and high poverty rates. These factors contribute to delayed prenatal care, fragmented services, and increased risk of adverse outcomes.

The Stronger Starts Initiative is an evidence-informed public health program designed to improve maternal and infant health outcomes through a coordinated, multi-level approach. The program integrates nurse-led home visiting, telehealth obstetric consultations, community-based …

Rapid Response To Recovery: Expand Integrated, Technology-Enabled Crisis Care, Madison Chandler

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

Behavioral health challenges in rural communities continue to place significant strain on healthcare systems, particularly through repeated reliance on emergency departments for crisis care. Nelson County, Kentucky, reflects this pattern, with higher reported rates of poor mental health and limited access to behavioral health providers. This paper proposes the Beacon Behavioral Health Response Program, a community-based, multidisciplinary crisis intervention model designed to improve access to timely care and strengthen continuity of support. The program combines mobile crisis response—delivered by a licensed clinical social worker and a peer support specialist—with a technology-enabled component using the Luma AI-supported mental health platform. Together, …

Promoting Maternal And Infant Health In Franklin County, Ky: A Community-Based Physical Activity And Education Intervention, Subin Kim

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

Maternal and infant health outcomes are key indicators of population health, yet persistent disparities exist in rural communities across the United States. In Kentucky, Franklin County reflects this pattern, with concerning maternal and infant health indicators despite relatively favorable socioeconomic conditions. Identified challenges include elevated rates of poor physical and mental health days, high drug overdose mortality, provider shortages, and ongoing reproductive health concerns such as tobacco use during pregnancy and increased infant mortality associated with elevated maternal body mass index.

To address these gaps, a three-pronged, community-based prenatal and postpartum physical activity and education program is proposed. The program …

A Program To Increase Prenatal And Postnatal Care Access In A Rural Kentucky County, Alyssa Thomas

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

Prenatal and postpartum health care access is necessary for positive pregnancy and postpartum outcomes. Many rural areas in the United States are facing maternity care deserts, where there are no obstetric services available in their county. Maternity care deserts typically have higher rates in maternal mortality, low-birth weight, and pre-term births. Fleming County, Kentucky is a small rural community with a population of about 15,000 that is a maternity care desert. To improve prenatal and postpartum care access in this county, this program will use a mobile health clinic and community health workers (CHWs). The mobile health clinic will operate …

Momentum For Healthy Births-Hardin County, Ky, Brittany R. Jackson

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

Maternal and infant health disparities in Hardin County, Kentucky, reflect persistent gaps in timely access to care, particularly among rural and underserved populations. Structural barriers, including transportation limitations and unmet social needs, contribute to delayed prenatal care initiation and low postpartum follow-up, increasing the risk of adverse outcomes. This capstone project proposes the MOMentum (Maternal Outreach and Monitoring for Mothers) Program, an integrated care model designed to strengthen access, improve care coordination, and enhance continuity across the prenatal and postpartum period.

The program combines a Community Health Worker (CHW)-led navigation model with enhanced postpartum care supported by telehealth services and …

Improving Prenatal And Postpartum Care Gaps In Breathitt County, Megan Deaton

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

Maternal and infant health remain a major public health issue across the United States, particularly in rural communities. Barriers such as shortages of obstetric providers, transportation challenges, and limited access to prenatal and postpartum care contribute to delayed care, low follow-up rates, and an increased risk of poor outcomes, including preterm birth and low birth weight. In response, the proposed Maternal and Infant Health Program aims to address gaps in care access through a home visiting model that provides in-home support, maternal health education, care coordination, and referrals to healthcare services, with a direct focus on Breathitt County. Expected outcomes …

Implementation Of A Reminder/Recall Messaging Program In Kentucky, Laura Schwarz

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

Childhood vaccination remains a critical public health priority, yet measles, mumps, and rubella (MMR) vaccination rates in several rural Kentucky counties fall below the 95% threshold required for herd immunity. Recent declines in coverage, compounded by socioeconomic disparities and barriers to healthcare access, place children at increased risk for vaccine-preventable diseases and outbreaks. This capstone project proposes the implementation of an evidence-based reminder/recall (R/R) text messaging intervention utilizing the Kentucky Immunization Registry (KYIR) to improve timely MMR vaccination among children aged 4–6 years before kindergarten entry.

The proposed program targets thirteen Kentucky counties with vaccination rates below 70% and documented …

Strengthening Rural Mental Health Crisis Response: Integrating Broadband Telehealth Care Across Counties Served By Kentucky River District Health Department, Mary K. Mcnabb

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

Rural communities in Eastern Kentucky face persistent barriers to timely and effective mental health crisis care, including provider shortages, transportation challenges, and limited broadband infrastructure. Counties served by the Kentucky River Health Department Wolfe, Lee, Owsley, Perry, Knott, Leslie, and Letcher experience disproportionately high behavioral health needs while relying on shared regional resources. The Broadband-Enabled Rural Crisis Stabilization Initiative (BERCSI) is a proposed public health program designed to strengthen rural mental health crisis response through integrated, technology-enabled care. Grounded in evidence-based practices, including tele-mental health and crisis stabilization models, BERCSI leverages broadband expansion to facilitate rapid assessment, coordinated care, and …

Increasing Hpv Vaccination Among Early Adolescents Using A Game-Based Digital Intervention: A Randomized Controlled Trial, Angela Chia-Chen Chen, Lihong Ou, Elizabeth Reifsnider, Kimberly Arcoleo, Ashish Amresh, Michael Todd

Ellmer School of Nursing Faculty Publications

Background/Objectives: Human papillomavirus (HPV) vaccination coverage among adolescents remains below public health targets despite strong evidence of vaccine effectiveness in preventing HPV-related cancers. Digital interventions (e.g., serious games) may improve HPV vaccine uptake, but evidence for effects on vaccination behavior remains limited. Methods: This secondary analysis of a randomized controlled trial evaluated a co-designed, game-based digital intervention to increase HPV vaccine initiation among unvaccinated youth aged 11-14 years and their parents. The sample included 64 parent-adolescent dyads (33 intervention and 31 usual care dyads). The primary outcome was HPV vaccine initiation at 2-month follow-up. Results: A significantly greater proportion of …