Public Health Commons^™

Outbreak Preparedness And Response In A Globalized World: Are We Ready?, Francesca F. Norman, David Brett-Major, Chiara Sepulcri, Emmanuel Bottieau, Theresa Sepulveda, Federica Toscanini, Laura A. Nicolini, Jesse J. Waggoner, Sami Alcedo, Davidson H. Hamer, Ralph Huits, Michael Libman, Geosentinel Network, Tropnet Network, Kevin O'Laughlin

Journal Articles: Epidemiology

BACKGROUND: Recent global epidemics and pandemics have highlighted the need for adequate diagnostic capacities to respond to emerging threats. Strengthening operational capacities can lead to improved preparation; investing in emergency response infrastructure may diminish progression of outbreaks and prevent escalation.

METHODS: An email-linked survey was sent January-March-2025 to two global infectious disease surveillance networks' (GeoSentinel and TropNet) participating clinics assessing capacity for Oropouche virus (OROV) diagnostic testing. Data on testing capacity for other arboviruses was also requested.

RESULTS: Responses were obtained for 58 GeoSentinel/TropNet sites (58/104, 55.8%): 50% responding sites (29/58) had OROV diagnostic testing available at a public reference …

Delivering Safe Sleep And Breastfeeding Education To Pregnant And New Mothers Through Private Facebook Groups: Study Protocol For A 4-Armed Randomized Controlled Trial, Rebecca F. Carlin, Margaret G. Parker, Ann L. Kellams, Fern R. Hauck, Stephen Kerr, Benjamin T. Cornwell, Marc T. Kiviniemi, Nicole Geller, Katherine E. Boguszewski, Michael J. Corwin, Eve R. Colson, Rachel Y. Moon

Health, Behavior & Society Faculty Publications

Background: Annually, more than 3500 US infants die suddenly and unexpectedly. Many sudden unexpected infant deaths (SUID) are preventable with greater adherence to safe infant sleep guidelines. There are racial and economic disparities in guideline adherence and SUID rates. Education alone has proven ineffective at altering behavior for many parents, and social networks and social norms regarding infant care have been found to influence rates of unsafe sleep. Using the power of social networks to shape social norms by delivering education through moderated online social media groups provides a unique opportunity to influence these practices in large groups of parents. …

Exploring Biopsychosocial Influences On Hookup Culture And Disrupting Compulsory Behaviors In Emerging Adults: A Multidisciplinary Analysis Of A Contemporary Public Health Concern, Catherine Benjamin

Honors Theses and Capstones

Multidisciplinary analysis, including biology, psychology, and sociology, to better understand the compulsory Hookup Culture that exists as a contemporary public health concern among the age group defined as emerging adults. Sexually Transmitted Infections (STIs) diagnoses are steadily rising in the United States and disproportionately affecting college students. Early socialization and current educational resources that contribute to shame and stigma are discussed to explain how lifestyle and social conditions can act as risk factors for individual health outcomes.

Enhancing Nursing Education To Improve Care For Women Experiencing A Substance Use Disorder During Pregnancy, Sadie Caddell

Honors Theses and Capstones

Introduction: Nursing education prepares students to care for patient populations by enhancing knowledge of clinical pathophysiology and applying foundational nursing skills to tailor to the unique care requirements of each patient. When analyzing the nursing course curriculums as guides for what is included in nursing education, it is essential to consider relevant patient populations to ensure adequate representation in lectures. Inclusivity of relevant patient populations within curriculums equips students to encounter a variety of patients in a clinical setting. Perinatal substance use has prevalence in the local community of this university, with 6% of all births in New Hampshire in …

Ethical Considerations For Hospice Patients In Inpatient Settings: A Systematic Review And Thematic Analysis, Matthew D. Harry

Honors Theses and Capstones

Hospice care is intended to prioritize comfort, dignity, symptom management, and quality of life for individuals with life-limiting illness. However, when hospice-eligible patients are managed within inpatient hospital settings, significant ethical challenges frequently emerge due to the tension between comfort-focused care and the curative, intervention-driven structure of acute care medicine. This paper presents a systematic literature review and thematic analysis examining the ethical considerations surrounding hospice patients in inpatient settings, with particular attention to clinical decision-making, communication, prognostic uncertainty, moral distress among nurses, and conflicts involving patient autonomy and family wishes. A structured review of peer-reviewed literature was conducted using …

Regulating For Birth Justice, Jamille Fields Allsbrook

Lewis & Clark Law Review

Impacted persons have shared accounts of traumatic birthing experiences, and advocates have raised the alarm on the urgent need to advance birth justice. Despite this raised awareness, women and birthing people are still dying and suffering unnecessarily. Even more, systems are still structured to impede birthing choices, particularly those from marginalized communities such as Black and Indigenous women. Notably, over 80% of U.S. maternal deaths are preventable, according to federal government data. Ironically, the same laws and systems that have created, perpetuated, and tolerated birth injustices can be leveraged to move the country towards birth justice. On the national level, …

Implementation Of Standardized Screening And Patient Education Regarding Hpv Vaccination Within An Ob-Gyn Clinic, Kristina Krupa, Nicole Tenzel

North Texas GME Research Forum 2026

Background: Each year, millions of women become infected with Human Papillomavirus Virus (HPV). The HPV virus can cause multiple types of cancer including cervical, vaginal, vulvar, penile, anal, vaginal, and oropharyngeal. HPV vaccination has the potential to prevent majority of these cancers. Despite this, a large portion of the United States population remains unvaccinated. Standardizing screening protocols and patient education materials within our OBGYN clinic can help educate patients about the HPV vaccine benefits and facilitate shared decision-making regarding vaccination.

Methods: This ongoing quality improvement project was initially created as a single-phase initiative that involved implementation of a screening questionnaire …

Bpa: Effects Of The "Plastic Era", Bianca G. Pietrangeli

Student Work

Infographic review of sources of BPA and its impacts on human health with a focus on osteoporosis.

Blocking Interleukin 33 Reduces Joint, Systemic, And Lung Inflammatory Responses In The Combined Collagen-Induced Arthritis-Inhalant Endotoxin Exposure Model, Jill A. Poole, Jacob L. Larsen, Geoffrey M. Thiele, Todd A. Wyatt, Amy J. Nelson, Michael J. Duryee, Angela Gleason, Oliver W. Schanze, Aaron D. Schwab, John D. Dickinson, Deanna Mosley, Michael Lush, Han-Jun Wang, E. Suzanne Cohen, Bryant England, Ted R. Mikuls

Journal Articles: Environmental, Agricultural & Occupational Health

Therapies capable of resolving rheumatoid arthritis (RA)-associated lung disease, particularly in the setting of environmental exposures, are lacking. This study sought to determine whether blocking interleukin (IL)-33 in a murine model of RA-associated lung disease induced by combined collagen-induced arthritis (CIA) and repeated inhalant lipopolysaccharide (LPS) exposures could be advantageous. Arthritis prone male DBA/1J mice received CIA (vs saline) injections (days 1 and 21) plus intranasal LPS (100 ng) or saline daily for 4 weeks and were subsequently treated with 5 doses of anti-IL-33 (10 mg/kg) or isotype over 11 days. Anti-IL-33 therapy significantly (P < .05) mitigated several CIA+LPS-induced effects. Anti-IL-33 reduced arthritis inflammatory score by 76% and serum acute phase reactant pentraxin-2 by 70% and reversed weight loss induced by CIA+LPS coexposure. Anti-IL-33 reduced CIA+LPS-induced antimalondialdehyde acetaldehyde but not anticitrullinated autoantibodies in serum and reduced serum levels of inflammatory mediators. Lung cell infiltrates induced by coexposure, including neutrophils, activated lung macrophages, transitional monocytes-macrophages, monocytic-like cells, and dendritic cells, were reduced with anti-IL-33. Anti-IL-33 also reduced CIA+LPS-induced lung levels of chemokines involved in monocyte-macrophage recruitment and fibrotic/repair mediators collagen deposition, IL-33 expression, inflammatory CC motif chemokine receptor 2

Performance Outcomes Of Critical Access Hospitals: A Resource Dependence Theory Evaluation Of Change Of Ownership Versus Independence, Colette Christina Martin

Theses, Dissertations and Capstones

Critical Access Hospitals (CAHs) play a vital role in sustaining healthcare access in rural communities, yet many face persistent financial and operational constraints. A change in hospital ownership is frequently seen as a strategy to sustain these hospitals, improve access to capital, supplement administrative infrastructure, and leverage system-level expertise. However, empirical evidence regarding the effectiveness of acquisition for CAHs remains limited and mixed. Guided by Resource Dependence Theory (RDT) and the Balanced Scorecard framework, this study examines whether ownership change is associated with differences in financial performance, utilization, staffing, and quality outcomes among CAHs.

Using Medicare Cost Reports, the American …

Community Benefit Spending Decisions At Virginia’S Nonprofit Hospitals, Zelda Hinkle

School of Professional and Continuing Studies Nonprofit Studies Capstone Projects

Nonprofit hospitals play a unique role in the healthcare system: in exchange for tax- exempt status, they are expected to provide “community benefits,” such as charity care, health programs, and community investments. While this spending represents a major opportunity to improve population health and address disparities, stakeholders debate how expectations should be set, measured, and regulated to ensure mission adherence while maintaining nonprofit autonomy. This study explores how community benefit spending allocation is actually determined, leveraging interviews with decision-makers at large nonprofit hospital systems in Virginia. Findings consider the role of factors such as Community Health Needs Assessments and strategic …

Feeding Missoula: Food Insecurity In Rural Children And Youth, Chani Brammer, Braelee Cheeks, Jordin Holland, Rayne Mccollough, Laurel Palmer, Therese Solomon

Undergraduate Theses, Professional Papers, and Capstone Artifacts

In Montana, approximately one in seven children live in a food-insecure household, with rural Montanans in particular facing significant barriers. Existing needs-based food assistance programs, such as SNAP and WIC, have structural weaknesses: SNAP benefits are often not sufficient to last through the month, and those eligible for these programs face a confusing application process, shame and stigma, and logistical hurdles, such as limited transportation.

“Feeding Missoula” began with an evaluation of how current food assistance programs met or failed to meet the needs of rural youth. Our methodology integrated a comprehensive review of existing literature and structured interviews with …

Viral Misunderstandings: Reddit Posts And The Covid-19 Infodemic, Julia C. Knutson

Scripps Senior Theses

Information epidemics or “infodemics” became the center of misinformation conversations, due to a global increase in information spread surrounding the COVID-19 pandemic. While many academic scholars and institutions, such as the World Health Organization (WHO) attribute the cause of infodemics to anti-science attitudes and the public’s lack of scientific literacy, scholars in Science, Technology, and Society argue that analyzing misinformation within these isolated bounds limits our understanding of its underlying social and historical contexts. Using the COVID-19 pandemic as a case study for misinformation analysis reveals a gap in our current understanding of how people who resonate with or spread …

Increasing Oral-Gut Axis Health Literacy In Underserved Communities With Community-Involved, Pantry-Accessible Nutrition Education: A Conceptual Framework And Program, Audrey Kho, Yinon Gankin, Polina Pine

Chemistry: Faculty Publications and Other Works

In metropolitan U.S. areas, health inequities caused by socioeconomic disparity continue to influence oral health, nutritional status, and the risk of chronic diseases. Diets heavy in added sugars and poor in fiber and vital micronutrients are especially harmful to the oral–gut axis, which connects diet, microbial balance, inflammation, and systemic and neurological health. Due to institutional hurdles to health literacy, limited access to preventive health education, and food poverty, these eating habits are more common among low-income individuals. Only 36% of low-income parents in Chicago report being in good health, compared to 75% of parents with better incomes, underscoring the …

Risk Of Gestational Diabetes By Aerobic And Resistance Exercise During The First And Second Trimesters, Takaki Tanamoto, George Saade, Leryn J. Reynolds, Tetsuya Kawakita

Department of Obstetrics & Gynecology Faculty Publications

Objective

While some studies have shown that exercise reduces the incidence of gestational diabetes mellitus (GDM), there is limited evidence on whether aerobic or resistance exercise is more beneficial. This study aimed to examine the rate of GDM according to the type of exercise during early pregnancy.

Study design

We analyzed data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b), a prospective cohort of individuals enrolled during the first and second trimesters. We excluded participants with pregestational diabetes or delivery < 20 weeks. The primary exposure was either aerobic or resistance exercises in the first or second trimester. For each trimester, the metabolic equivalent of task hours per week (MET-h/week) was calculated for each exercise. Participants were grouped as follows: "Aerobic exercise" (≥7.5 MET-h/week from aerobic exercises), "Resistance exercise" (≥2 times/week from resistance exercises), "Both types of exercise" (≥7.5 MET-h/week from aerobic exercise and ≥2 times/week from resistance exercises), and "Insufficient exercise" (≤7.5 MET-h/week from aerobic exercise and ≤2 times/week from resistance exercises). Our primary outcome was GDM. Adjusted relative risks (aRRs) with 95% confidence intervals (95% CIs) were calculated using modified Poisson regression, adjusting for potential confounders.

Results

In both the first and second trimesters, analyses included 9049 individuals. In the first trimester, individuals who performed …

The Utilization Of Uv-C Devices To Improve Cleaning And Disinfection In The Operating Room For Reduction Of Infection Rates: An Integrative Research Review (Irr), Kathrina Joyce L. Manalo

Covenant Nurses Week 2026

No abstract provided.

Bridging The Language Gap: The Impact Of In-Person Versus Remote Interpreter Services On Medication Adherence And Patient Safety In Adult Spanish-Speaking Patients, Ashley E. Alarcon Martinez, Jocelyn N. Lopez Maradiaga

Nursing | Senior Theses

Background: Significant health inequities are caused by language barriers between patients and health care staff, resulting in miscommunication among adult Hispanic patients with low English proficiency, reducing medication adherence, impairing patient safety, and raising the possibility of medical errors. To address this issue, interpreter services, both in-person and remote translation, have been introduced in healthcare settings to enhance communication. Objective: The purpose of this study is to investigate the differences in patient safety and medication adherence between in-person and remote translation services for adult Hispanic individuals with limited English proficiency in healthcare settings. Methods: The proposed research involves five local …

Health Disparities In Cardiovascular Care: The Impact Of Diabetes Education And Post-Discharge Interventions For African American Adults At Risk For And After Myocardial Infarction, Trinity L. Billingsley

Nursing | Senior Theses

Background: Cardiovascular disease is the leading cause of death in the United States, affecting African American adults at higher rates compared to other racial and ethnic groups. Diabetes as a comorbidity is one of the risk factors of experiencing a myocardial infarction, remaining one of the leading causes of death among individuals with diabetes. Objective: To examine the effectiveness of structured diabetes education tailored to African American adults who are at risk for and after a myocardial infarction. Additionally assessing the complications of a myocardial infarction, the outcomes associated with structured education will be compared to the outcomes of …

Health Insurance As A Mediator Of Neighborhood Deprivation And Pediatric Cancer Survival: An Analysis Of State Cancer Registry Data, Emma Hymel, Cheng Zheng, Jenna Allison, Kendra L. Ratnapradipa, Edward S. Peters, Sarah H. Nash, Mei-Chin Hsieh, Shinobu Watanabe-Galloway

Journal Articles: Epidemiology

INTRODUCTION: To develop interventions to reduce neighborhood-level disparities in pediatric cancer outcomes, it is necessary to understand their underlying mechanisms. It has been suggested that individual-level health insurance is a mediator of neighborhood deprivation and pediatric cancer survival.

METHODS: This study was a population-based longitudinal study of children with cancer from 2000 to 2020 in the Iowa Cancer Registry and Louisiana Tumor Registry. Neighborhood deprivation was measured using the Area Deprivation Index. Log-binomial regression models were used to identify predictors of health insurance status at diagnosis. Cox regression models were used to assess the association between health insurance status at …

Vitamin D Status During Pregnancy Modulates The Effect Of Pre-Pregnancy Obesity On Gestational Diabetes Mellitus Risk: A Birth Cohort Study, Ali H. Ziyab, Abdullah Al-Taiar, Reem Al-Sabah, Majeda S. Hammoud, Saeed Akhtar

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Objective:

To determine whether gestational vitamin D status modulates the effect of pre-pregnancy obesity on gestational diabetes mellitus (GDM) risk while stratifying by maternal age.

Design:

Birth cohort.

Setting:

A major maternity hospital in Kuwait.

Participants:

Pregnant women in their second/third trimester of gestation were enrolled. Pre-pregnancy body mass index (BMI, kg/m²) was categorized as under/normal weight (< 25.0), overweight (25.0 to < 30.0), and obesity (≥30.0). Gestational 25-hydroxyvitamin D concentrations were categorized as deficiency (< 50 nmol/L) or insufficiency/sufficiency (≥50 nmol/L). GDM status was ascertained according to international guidelines. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated using logistic regression.

Results:

Data from 957 pregnant women were analyzed, with GDM affecting 166 (17.4%) pregnancies. Pre-pregnancy obesity and gestational vitamin D deficiency was ascertained in 275 (28.7%) and 533 (55.7%) pregnant women, respectively. The association between pre-pregnancy obesity and GDM risk differed according …

Investigating The Relationship Between Drug Overdose Deaths, Excessive Alcohol Drinking, And Adult Smoking In Urban And Rural Ohio Counties In 2025, Sumin Byoun, Anne Griffin

Scholarship in Medicine - All Papers

Deaths from drug overdoses have been increasing each year. Ohio ranks among states with the highest number of drug overdose deaths per year. There is a gap in the literature regarding discussions of how excessive alcohol drinking and cigarette smoking rates may predict drug overdose death rates in a community. First, this study investigates differences in excessive drinking, adult smoking, and drug overdose deaths between urban and rural counties in Ohio. Second, this study explores whether excessive drinking and smoking behaviors can predict drug overdose death rates in urban and rural Ohio counties. Data exclusive to Ohio counties was obtained …

Understanding The Impacts Of Food Insecurity On Education Outcomes In Ohio, Maria El Biri, Sreya Tummalapalli

Scholarship in Medicine - All Papers

Background: Food insecurity has been a growing concern in the United States, and prior research has shown how food insecurity in youth can correspond to negative psychosocial outcomes. Additionally, there are known disparities with access to food based on living in rural or urban counties. Objective: The goal of this study was to determine how differences in food security can impact youth educational outcomes in Ohio. Methods: Data from County Health Rankings & Roadmaps were obtained on variables such as access to healthy foods, food insecurity, high school graduation rates, average grade performance, and percentage of the population living in …

Infant Mortality In Ohio, Isabella Bacon, Alexis Jackson

Scholarship in Medicine - All Papers

Introduction: Infant mortality continues to occur at alarming rates that differ among various groups and states. Despite this, there has been a lack of intersectional examination of risk- and protective-factors. Methods: We examine how smoking status, education level, primary care to population ratio, teen birth rates, and urban vs rural status impact infant mortality rates in Ohio, Kentucky, Michigan, and Indiana using County Health Rankings data. Results: Ohio was shown to have no significant difference between urban and rural infant mortality rates; however,  risk-and-protective factors did differ. In urban counties, high school completion, teen birth rates, and primary care ratios …

Long-Lasting Impact Of Public Health Dentistry, Michal Herman Dds, Facd

Journal of the American College of Dentists

This article reflects on the enduring impact of public health dentistry through the author’s 25-year professional journey serving underserved and marginalized communities. It examines persistent barriers to equitable oral health care, including workforce shortages, inadequate insurance coverage, racial disparities, and limited access in rural and low-income populations. Drawing on experiences in nonprofit and community dentistry, the article highlights the importance of mentorship, advocacy, leadership, and community engagement in addressing oral health inequities. It argues that public health dentistry represents a form of professional altruism grounded in service and social responsibility, and calls on dental professionals to expand access, support workforce …

Maternal Healthcare In The United States: An Exploration Of The Organizational And Political Determinants Of Maternal Healthcare Quality And Outcomes, Tamaya S. Browder

College of Graduate Studies: Theses & Dissertations

Despite having an advanced U.S. healthcare system, childbirth remains risky in the US, especially for socially vulnerable populations. Medicaid covers a large portion of births and is equipped to implement large-scale interventions to improve maternity care and patient outcomes. Two studies were conducted to (a) examine the relationship between organizational factors in U.S. hospitals and adverse clinical outcomes among Medicaid-insured maternity patients, and (b) analyze state-level Medicaid bundled payment models for maternity care. Guided by the Donabedian Quality of Care Model, Study One used logistic regression on data from the 2018-2020 National Inpatient Sample to explore how hospital organizational factors …

Primary Care Access And Preventable Hospitalizations: A Multi-Variable Analysis Of Medicare Populations In California (2022–2025), Mariam Shenouda, Suchetha Shashi

Scholarship in Medicine - All Papers

Background: Based on prior literature, limited access to primary care has been linked to higher preventable hospitalization rate. Particularly, rural communities often face physician shortages, contributing to disparities in health outcomes. Objective: To understand the relationship between primary care access and preventable hospitalization rates among medicare populations in California. Methods: The data was gathered from County Health Rankings & Roadmaps for 56 California counties, excluding Sierra and Alpine. This study used unpaired t-tests to determine the difference in the PCP ratio and preventable hospitalization rate between rural and urban counties in California in 2025. A paired t-test was performed to …

Factors Affecting Percentage Of Low Birth Weight In Ohio, Maureen Schmid, Mira Krishnan

Scholarship in Medicine - All Papers

A multitude of environmental factors correlate to negative outcomes on maternal and fetal health such as low birth weight. While studies reveal that housing quality, air pollution, and stress contribute to negative birth outcomes, it is unclear which housing factors have the greatest impact and how rural, suburban, and urban settings in the U.S. differ. The objective of this study was to delve into how environmental factors such as housing quality and community type impact low birth weight in Ohio. This study used publicly available data from County Health Rankings and Roadmaps to examine how different housing conditions correlate to …

Exploring Demographic Factors Relating To Low Birth Weight In Rural Vs Urban Ohio, Meghan Curran, Jessica Terrell

Scholarship in Medicine - All Papers

Although medical advancements have improved the outcomes for infants born with low birth weight (LBW), these interventions are very expensive and low birth weight still was attributed to 16.1% of infant deaths in the United States in 20201. By understanding the factors that influence the incidence of low birth weight in the United States, preventative measures can be implemented to reduce the need for costly interventions and enhance infant health outcomes. In this study, we focused on 38 counties in Ohio that had either 75% or greater rural regions or 30% or less rural regions. Additionally, we focused on four …

When Climate Change Forces Flight: Legal Duties In The Age Of Retreat, Mark P. Nevitt

Faculty Articles

In the face of climate-driven disasters, government officials and individuals alike must decide whether to invest in climate-exposed areas or retreat. This Article analyzes emerging legal and policy issues associated with both climate retreat (when the government relocates people and infrastructure away from climate-exposed areas) and abandonment (when individuals leave climate-exposed areas, following natural disasters or otherwise). I argue that government-driven climate retreat must consider four overlapping legal duties, raising novel questions in an era of climate destabilization. First, does the government have an affirmative duty to rescue its citizens, and is this duty transformed by the government’s role in …

What Is The Evolving Role Of Nurses In Telehealth As Future Healthcare Professionals?, Emma G. Lowry

Honors College Theses

Telehealth has evolved into an essential component of healthcare delivery in today's world, something that occurred alongside the COVID-19 pandemic. As healthcare professionals, nurses must be adequately prepared and equipped to use the tools for telehealth. This paper examines the evolving role of nurses in telehealth by assessing undergraduate nursing students’ and practicing nurses’ knowledge, attitudes, and perceived competencies. Data will be collected through a Qualtrics survey utilizing the Awareness, Knowledge, Attitude, and Skills (AKAS) Scale for Telemedicine, supplemented by interviews with telehealth practitioners to provide qualitative context. It is expected that variations in proficiency and attitudes, from previous biased …