Public Health Commons^™

A Religious Etiology Of Genito-Pelvic Pain And Pain With Penetration, Emily L. Carlson

Theses and Graduate Projects

Pelvic pain during penetration (PPDP) has been described using various diagnostic terms, including vaginismus, dyspareunia, and vulvodynia. The most recent and comprehensive classification is Genito-pelvic pain/penetration disorder (GPPPD) which is characterized by psychological distress associated with pain during or in anticipation of vaginal penetration (DSM-5-TR; American Psychiatric Association [APA], 2022). The etiology of PPDP is multifactorial, involving a complex interplay of biological, psychological, and relational factors. Religious and cultural influences may play a significant role in shaping individuals’ experiences of sexual pain. This study investigated the etiology of PPDP in relation to the religious influences among women raised in Judeo-Christian …

Germline Structural Variations Involving The Pediatric Brain Tumor Transcriptome Include Disease-Relevant And Ancestry-Related Genes, Fengju Chen, Yiqun Zhang, Luis F Paulin, Fritz J Sedlazeck, Chad J Creighton

Faculty, Staff and Students Publications

Background: Germline Structural Variants (SVs) represent an important source of genetic diversity, in large part due to their influence on gene transcription. It is necessary to systematically catalog germline SVs and their associated impacted genes across different cohorts and tissue and cellular contexts, including pediatric brain or Central Nervous System (CNS) tumors.

Methods: We combined RNA with whole genome sequencing across 1430 pediatric brain or CNS tumor patients from the Children's Brain Tumor Network. We set out to systematically identify genes for which the proximity of germline SVs was recurrently and significantly associated with differential expression in the tumor sample …

Is Health Insurance Related To Breastfeeding Duration?, Anna De La Paz

Population Health Research Brief Series

Breastfeeding duration, which plays an important role in shaping maternal and infant health, can be influenced by insurance type. This data slice uses data from the 2022-2023 National Survey of Family Growth (NSFG) to described differences in breastfeeding duration by insurance type among females ages 15-49 in the United States. Findings show that mothers with private insurance breastfeed longer than mothers with public insurance, such as Medicaid, net of controls for maternal age, race, education, and income.

Proteogenomic Characterization Unveils Biomarkers Associated With Chemoresistance In Muscle-Invasive Bladder Cancer, Matthew V Holt, Yongchao Dou, Meggie N Young, Alexander B Saltzman, Meenakshi Anurag, Jonathan T Lei, Antrix Jain, Mei Leng, Beom-Jun Kim, Lacey E Dobrolecki, Stefanie F Faucher, Sara Savage, Chenwei Wang, Zhiao Shi, Hugo Villanueva, Karoline Kremers, Kyle D Drinnon, Patricia D Castro, Michael M Ittmann, Mehak Mehboob Khatani, Sung Han Kim, Matthew J Ellis, Bing Zhang, Anna Malovannaya, Seth P Lerner

Faculty, Staff and Students Publications

To explore potential chemoresistance mechanisms and identify therapeutic opportunities in muscle-invasive bladder cancer (MIBC), we conduct comprehensive proteogenomic characterization of 46 pre- and 14 post-treatment MIBC tumors incorporating genomics, transcriptomics, proteomics, and phosphoproteomics. Multi-omics clustering not only recapitulated established molecular subtypes but also revealed subtypes associated with chemotherapy sensitivity. Protein isoform level analysis identifies protein abundance of a short isoform of ATAD1 and RAF family proteins as biomarkers of chemosensitivity. Integration of proteomic and phosphoproteomic data reveals Wnt signaling via GSK3B-S9 phosphorylation and the JAK/STAT pathway as potential targets to overcome chemoresistance. Correlations between PD-L1 and TROP-2/NECTIN-4 indicate an additive …

Editorial: Disclosure In Sexual And Reproductive Health, Pooja Chitneni, Shan Qiao Ph.D., Simon M. Manga, Janet M. Turan

Faculty Publications

No abstract provided.

Changes In Self-Reported Excessive Daytime Sleepiness Are Associated With 5-Year All-Cause Mortality Risk Among Veterans, Katherine G Bay, Arash Maghsoudi, Amin Ramezani, Drew A Helmer, Amir Sharafkhaneh, Javad Razjouyan

Faculty, Staff and Students Publications

Excessive daytime sleepiness (EDS) is linked to adverse clinical outcomes. This study evaluated changes in a validated tool to assess EDS, the Epworth Sleepiness Scale (ESS) and mortality risk. This retrospective cohort study included Veterans receiving sleep-related services in the Department of Veterans Affairs (VA) from October 4, 1999 to August 18, 2018, with two qualifying ESS measures. ESS values were extracted from patient notes using a validated natural language processing (NLP) pipeline (96% accuracy). ESS scores were categorised as Normal (0-10) or Abnormal (11-24). Patients were grouped based on ESS changes: Normal-Normal, Normal-Abnormal, Abnormal-Abnormal and Abnormal-Normal. Cox proportional hazards …

Causes Of Symptoms And Symptom Persistence In Long Covid And Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Anthony L Komaroff, Robert Dantzer

Faculty, Staff and Student Publications

Debilitating symptoms for many years can follow acute COVID-19 ("long COVID"), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and various post-acute infection syndromes (PAISs). Together, long COVID and ME/CFS affect 60-400 million individuals, globally. Many similar underlying biological abnormalities have been identified in both conditions including autoantibodies against neural targets, endothelial dysfunction, acquired mitochondrial dysfunction, and a pro-inflammatory gut microbiome. Each of these abnormalities may directly cause some of the symptoms. In addition, the symptoms also may be caused by ancient, evolutionarily conserved symptomatic and metabolic responses to vital threats-sickness behavior and torpor-responses mediated by specific, recently discovered neural circuits. These neural …

Promising Practices To Address Healthcare Needs Voiced By Local Native Americans, Noelle Taylor, Mykin R. Higbee, Raiden Gaul

Transforming Communities

Purpose

To examine barriers and facilitators to nursing education among Native Americans and identify evidence-based strategies to increase the number of Native American nurses working in their local communities to address health disparities.

Background

Native Americans experience significantly higher rates of chronic illnesses such as diabetes and heart disease, and lower life expectancies. Only 4% of registered nurses identify as Native American, with no growth despite increased funding for diversity in nursing education. This underrepresentation contributes to culturally insensitive care and persistent healthcare inequities stemming from historical marginalization and trauma.

Methods

A comprehensive literature review was conducted using CINAHL, PubMed, …

Understanding Loss To Follow-Up: The Role Of Social Determinants Of Health In Infants Referred After A Positive Newborn Screening – A Quantitative Analysis, Betsy Graham-Moeller Graham-Moeller

Walden Dissertations and Doctoral Studies

Newborn screening (NBS) is a vital U.S. public health initiative that identifies medical conditions shortly after birth. Patients with positive screenings are referred for medical follow-up or evaluation. However, many patients do not receive the recommended long-term follow-up, posing concerns for healthcare providers and public health professionals working to ensure timely treatment and care continuity. Based on the Social Determinants of Health framework, this quantitative, retrospective cohort study aimed to examine demographic and clinical factors associated with follow-up adherence among 691 infants identified through NBS in Colorado and Wyoming. The purpose of the study was to determine whether race, ethnicity, …

Mechano-Signal Transduction Pathways Of The Diaphragmatic Muscle And Role Of Cytoskeleton, Junaith S Mohamed, Patricia S Pardo, Aladin M Boriek

Faculty, Staff and Students Publications

Mechanotransduction, also referred to as mechano-signal transduction, is a biophysical process wherein cells perceive and respond to mechanical stimuli by converting them into biochemical signals that initiate specific cellular responses. This mechanism is fundamental to the development and growth, and proper functioning of mechanically active tissues, such as the diaphragm-a respiratory muscle vital for breathing in mammals. In vivo, the diaphragm is subjected to transdiaphragmatic pressure, and therefore, its muscle fibers are subjected to mechanical forces not only in the direction of the muscle fibers but also in the direction transverse to the fibers. Previous research conducted in our laboratory …

The Silent Epidemic: Equipment Maintenance Failures And Patient Outcomes In Ghana's Healthcare System, Ramseyer Adekorang Asamoah, Celene Dzreke, Evans Dzreke, David Kanzin

Health & Biomedical Sciences Faculty Publications

Broken tools indicate a broken system. This new study reveals how medical equipment failures destroy Ghana's public hospitals, turning life-saving technologies into silent murderers that disproportionately affect rural areas. Moving beyond technical diagnostics, we study the cascading systemic failures, chronic underfunding, critical staff shortages, and fragmented supply chains that leave 40% of vital equipment, such as ventilators, MRI scanners, and dialysis machines, inoperable at any given time. We quantify the devastating human toll through rigorous mixed-methods analysis of equipment downtime records across ten regional hospitals (2018-2023) and profound narratives from 50 frontline stakeholders, doctors forced to improvise without working incubators, …

Old Vs New Local Ancestry Inference In Hchs/Sol: A Comparative Study, Xueying Chen, Hao Wang, Iris Broce, Anders Dale, Bing Yu, Laura Y Zhou, Xihao Li, Maria Argos, Martha L Daviglus, Jianwen Cai, Nora Franceschini, Tamar Sofer

Faculty, Staff and Student Publications

Hispanic/Latino populations are admixed, with genetic contributions from multiple ancestral populations. To uncover genetic associations in these populations, researchers often turn to admixture mapping, which relies on inferred counts of "local" ancestry, i.e. the source ancestral population at a locus. Local ancestries are inferred using external reference panels that represent ancestral populations, making the choice of inference method and reference panel critical. This study used a dataset of Hispanic/Latino individuals from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) to evaluate how updates in local ancestry inference (LAI) affect results, specifically, the 'old' LAI performed using a popular inference method …

A Feasibility Study To Mitigate Arsenic Exposure In Well Water In Oregon, Christine Lucas-Woodruff, Veronic L. Irvin, Laura Nielsen, Meghan Megowan, Lilly Anderson, Julia Pavlosek, Molly Kile

Journal of Extension

Approximately 13 million households in the United States rely on private wells for their drinking water. It is the homeowner’s responsibility to manage the quality of water in their private wells. There are many toxic contaminants that can be present private wells that can negatively impact health. Extension Agents are well positioned to assist homeowners in understanding how to manage toxics in private wells. This study demonstrated the feasibility that motivational education provided by an Extension Agent’ trained in motivational interviewing techniques is able to help homeowners with private wells mitigate their exposure to arsenic by adopting appropriate water treatment.

Beyond The Bruise: Understanding Injury Risk Factors Among Livestock Workers In Cattle Feedyards And Animal Handling Farms And Ranches, Rishad Ahmed

Theses & Dissertations

Cattle feeding and livestock production are central to U.S. agriculture and represent some of the most hazardous occupational environments. Workers in feedyards and on cattle farms and ranches face elevated risks of injury due to physically demanding labor, frequent animal handling, and exposure to environmental and ergonomic hazards. Many feedyard workers are Hispanic/Latino immigrants who may experience additional barriers related to language, healthcare access, and job security. Similarly, injury risks among cattle producers are compounded by seasonal workload fluctuations, limited rest opportunities, and psychosocial stressors. Beyond individual impacts, agricultural injuries also pose a substantial economic burden. Recent estimates indicate that …

The Association Of Adult Medicaid Beneficiaries’ Characteristics And Their Experience During The Covid-19 Pandemic, Frank R. Tortorella

Dissertations and Theses (Open Access)

Background: The COVID-19 pandemic disrupted the United States’ safety net program, Medicaid, for low-income individuals affecting access to care, increasing enrollment, and requiring new approaches to care delivery. The literature shows that beneficiaries’ personal characteristics influence their healthcare experience. This study investigated the association between Medicaid beneficiary characteristics and experience with their Medicaid health plan, examined if COVID-19 negatively impacted experience, and tested if COVID-19 moderated the relationship between beneficiary characteristics and experience.

Methods: The research sample was 76,976 adult Medicaid beneficiaries who voluntarily completed the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS) health plan surveys in 2018 …

Earth Care Trusted Messengers: Vaccine Access Project, Camille Velarde, Theresa H. Cruz

Reports & Documents

Spanish-speaking communities in New Mexico continue to face persistent barriers to vaccine access, confidence, and culturally relevant health information. The Earth Care Trusted Messengers Vaccine Access Project was implemented in Santa Fe to address these inequities using a peer-to-peer, community-rooted model. Trusted Messengers, respected community members, participated in a full-day training covering vaccine science, misinformation, communication strategies, and resource navigation, and subsequently facilitated small “house meetings” to engage peers in open conversations about vaccines. A mixed-methods evaluation assessed changes in confidence, knowledge, and community connectedness using pre-/post-/follow-up surveys, weekly implementation logs, and a final focus group. Quantitative findings showed large …

Sox2 Regulates Foregut Squamous Epithelial Homeostasis And Is Lost During Barrett’S Esophagus Development, Ramon U Jin, Yuanwei Xu, T Mamie Lih, Yang-Zhe Huang, Toni M Nittolo, Blake E Sells, Olivia M Dres, Jean S Wang, Qing K Li, Hui Zhang, Jason C Mills

Faculty, Staff and Students Publications

Esophageal adenocarcinoma is increasingly prevalent and is thought to arise from Barrett's esophagus (BE), a metaplastic condition in which chronic acid and bile reflux transforms the esophageal squamous epithelium into a gastric-intestinal glandular mucosa. The molecular determinants driving this metaplasia are poorly understood. We developed a human BE organoid biobank that recapitulates BE's molecular heterogeneity. Bulk and single-cell transcriptomics, supported by patient tissue analysis, revealed that BE differentiation reflects a balance between SOX2 (foregut/esophageal) and CDX2 (hindgut/intestinal) transcription factors. Using squamous-specific inducible Sox2-KO (Krt5CreER/+ Sox2Δ/Δ ROSA26tdTomato/+) mice, we observed increased basal proliferation, reduced squamous differentiation, and expanded metaplastic glands at …

More Than A Feeling: A Mixed-Methods Examination Of Transgender Community Connectedness And Associations With Suicidality, Erin Rook

UNLV Theses, Dissertations, Professional Papers, and Capstones

Transgender adults experience significantly higher rates of suicidal ideation than the general population. A sense of transgender community connectedness (STCC) may reduce this risk, but predictors of STCC and its association with suicidal ideation are understudied. This cross-sectional mixed methods study examined STCC and past-year suicidal ideation in relation to dimensions of transgender community connectedness (TCC) at each level of the Social Ecological Model using data from a U.S. survey of transgender adults (n = 126). About half (52.4%) felt connected to the transgender community, and 27.0% reported past-year suicidal ideation. Hierarchical logistic regression models for both outcomes showed good …

Factors Associated With Discrimination-Related Distress Among Sexual And Gender Minority Individuals: A Predictive Analysis, Emylia Terry

UNLV Theses, Dissertations, Professional Papers, and Capstones

Sexual and gender minority (SGM) individuals face disparate rates of mental health outcomes, such as psychological distress, which contributes to suicidality. This may be attributable to minority stress, which posits that health inequities impacting this community are driven by increased exposure to stigma- and discrimination-related stressors. The negative physical and psychological health impacts of psychological distress and discrimination are well-documented in the literature. Structural stigma – in the form of harmful anti-LGBTQIA+ laws and policies – is associated with increased suicidality. However, little is known about factors associated with perceived discrimination occurrences and discrimination-related distress. First, a systematic review was …

Hot Spring Associated Infectious Diseases In The Great Basin And Southwest, Matthew Bentz

UNLV Theses, Dissertations, Professional Papers, and Capstones

Like all bodies of freshwater, natural hot springs can harbor pathogenic microorganisms that carry the threat of infectious disease. The unique chemistry, increased temperature, and popularity for bathing may alter the risk profile of hot springs compared to other natural bodies of water. Despite this risk, the role of hot springs as a reservoir for infectious diseases remains understudied, particularly within the context of regional public health. Nevada and the Great Basin/Southwest have increasingly promoted hot springs for the purposes of tourism, and they share a strong link to the cultural heritage of the region. The unknown risk profile and …

Nevada Hpv Vaccine Completion Time And Adherence Among 9-14-Year-Olds From 2017-2023, Emily Sandoval

UNLV Theses, Dissertations, Professional Papers, and Capstones

The HPV (Human Papillomavirus) is one of the most common sexually transmitted infections, in the United States. Since its development in 1991, the HPV vaccine has been proven to be highly effective against the infection (Centers for Disease Control and Prevention [CDC], 2024). In order for an individual to receive optimal protection, the CDC has given guidelines dependent on age. It is important to understand changes in HPV vaccine completion for future public health immunization campaigns and objectives. To analyze how HPV completion and adherence has changed from 2017-2023 among the 9-14-year-old population, a retrospective cohort study was conducted utilizing …

Symptom Clusters And Their Association With Health-Related Quality Of Life In Pediatric Cancer Survivors After Treatment Completion, Krishtee Napit

Theses & Dissertations

A critical area of cancer research, symptom management, has evolved from focusing on individual symptoms to recognizing the complexity of co-occurring symptoms, commonly referred to as symptom clusters. However, most studies on pediatric cancer symptom clusters have focused primarily on the treatment phase or long-term survivorship, overlooking the early post-treatment period. This dissertation examines the prevalence of multiple symptoms and symptom clusters in pediatric cancer survivors post-treatment; factors associated with the total number of symptoms and symptom clusters; and the association of the total number of symptoms and symptom clusters with health-related quality of life (HRQoL). We developed and tested …

Analyzing Food Access: An Investigation Of Food Insecurity Amongst Latinos In Rural Nebraska, Natalia Santos

Theses & Dissertations

Background: Food insecurity is a public health issue in the United States, with disproportionately higher rates among Latino/Hispanic households. Rural communities face unique geographical, socioeconomic, and systemic barriers that often exacerbate food access disparities. Despite the growing Latino population in rural areas, particularly in Midwestern states like Nebraska, there remains a critical gap in comprehensive research that integrates both objective and subjective understandings of their food environments. Understanding these multifaceted influences is crucial for developing effective, culturally sensitive interventions.

Problem Statement: This dissertation aims to answer the central question: How does food access and food insecurity manifest amongst Latinos in …

Patterns Of Ophthalmology-Related Interfacility Transfers To The Emergency Department By Temporal Trends, Laura E. Ramirez, Michael Waxman, Denis R. Pauze, Edward J. Wladis

Journal of Academic Ophthalmology

Background: Interfacility transfer patients are associated with inferior outcomes, higher costs, and emergency department (ED) overcrowding. Previous studies have analyzed the general trends influencing interfacility transfers, but the patterns affecting ophthalmology-related transfer rates remain unclear. The purpose of this study was to identify and quantify the patterns of interfacility ophthalmology-specific transfers to the ED by temporal trends and to determine the type of ophthalmic services required by the transferred population.

Methods: All patients transferred to the ED of a single level 1 trauma center because of ophthalmology-related complaints from 2016 to 2023 were analyzed retrospectively. Transfer and nontransfer …

A Qualitative Analysis Of The Lived Experience Of Active-Duty Servicewomen Receiving Perinatal Care Within The Military Health System., Caitlin Russell, Emily Balog, Anne Teitelman, Rosemary Polomano

Rowan-Virtua School of Osteopathic Medicine Departmental Research

OBJECTIVES: We explored the lived experiences of active-duty servicewomen (ADSW) accessing and receiving care during the perinatal period (from discovery of pregnancy to 1 year postpartum) within the Military Health System.

STUDY DESIGN: Using qualitative methods, we conducted semi-structured interviews between September 2022 and February 2023 with 23 ADSW participants who were pregnant or within their first year postpartum. Data were analyzed using inductive coding and thematic analysis techniques.

RESULTS: Participants reported bureaucratic hurdles and long wait times for accessing care, too little choice in providers, and inadequate coordination between civilian and military care providers. Those who experienced perinatal complications …

Culturally Responsive Occupational Therapy Treatment Guide For African-American And Hispanic People With Eating Disorders, Desere N. Cooper

Student Capstone Papers

This capstone project addressed the critical need for a culturally responsive approach to occupational therapy in the treatment of African-American and Hispanic with eating disorders (EDs) in the United States. Although EDs impair physical, cognitive, and psychosocial functioning, these communities often encounter systemic barriers such as cultural stigma, food insecurity, and inadequate assessment tools rooted in Eurocentric norms—that contribute to underdiagnosis, limited access to care, and poorer outcomes. The central issue addressed was the absence of clear, culturally relevant guidance for occupational therapy practitioners working with these underserved populations. The project was informed by a comprehensive literature review and synthesis …

An Evidence-Based Intervention To Increase Trypanosoma Cruzi, A Neglected Parasitic Infection, Diagnosis In Rural And Moderate-Size-City Us Clinics, M K. Lynn, Hunter M. Boehme, Jeffrey Hall, Patrick Kent, Alain H. Litwin, Quang H. Pham, Melissa Nolan Ph.D., Mph, Prisma Chagas Team

Faculty Publications

Background

Chagas disease is a chronic, insidious parasitic infection (Trypanosoma cruzi) that slowly develops to irreversible organomegaly over several decades. The disease is traditionally acquired in endemic Latin American countries during childhood; < 1% of foreign-born adult residents in the United States have been diagnosed or treated with this potentially fatal disease. Low physician knowledge is a primary factor leading to misdiagnosis.

Methods

Starting in April 2022, a 4-part T cruzi clinical education intervention began, which included (i) 2 grand rounds presentations to >100 internal medicine providers; (ii) implementation of a “clinical Chagas champions program” incorporating 14 key clinical staff at varying departments and administrative levels educated on their specific role related to T cruzi screening, diagnosis confirmation, clinical management, and medical billing; ( …

Exploring The Association Between Smartphone-Based Place Visitation Data And Neighborhood-Level Coronary Heart Disease In The United States, Temitope Akinboyewa, Zhenlong Li, Huan Ning, M. Naser Lessani, Louisa M. Holmes, Shan Qiao Ph.D.

Faculty Publications

Coronary Heart Disease (CHD) is the leading cause of death in the United States, affecting over 20.5 million adults. Previous studies link health behaviors – such as dietary behavior, physical activity, smoking, and alcohol consumption – to CHD risk. These studies typically use surveys and interviews, which, despite their benefits, are resource-intensive and limited by small sample sizes. Using large-scale national level anonymized smartphone-based location data, our study examines whether health behaviors that are proxy measured by place visitation are associated with CHD prevalence across US census tracts. This study utilized data from multiple sources, including demographic and socioeconomic characteristics, …

Disentangling The Effect Of Criminal Legal System Involvement On Mental Health In The United States, Pui Ying Chan

Dissertations and Theses

BACKGROUND: Interactions with the criminal legal system (CLS), such as through arrest or incarceration, are relatively common in the United States (US) and are increasingly recognized as social risk factors for poor mental health. Previous studies have reported a positive association between CLS involvement and poor mental health, with some theoretical frameworks, including the ecosocial theory and the stress process paradigm, supporting a plausible causal relationship. However, prior research has significant limitations in providing casual evidence given possible reverse causation in cross-sectional studies and insufficient consideration for the dynamics between CLS exposures, mental health status, and related confounders over time …

Beyond Smoking: A Geospatial Investigation Of Factors Associated With Lung And Bronchus Cancer Risk In Pennsylvania, Tesla D. Dubois, Daniel Wiese, Kevin A. Henry, Shannon M. Lynch

Kimmel Cancer Center Faculty Papers

INTRODUCTION: While smoking is the leading cause of lung and bronchus cancer (LBC), additional exposures have been implicated and may explain the rise in LBC among never-smokers. To better understand the spatial distribution of LBC incidence and associated risk factors, this study aims to identify geographic areas with significantly elevated incidence rates in Pennsylvania and investigate the potential underlying risk factors.

METHODS: Using cancer registry data aggregated to the census tract level, spatial scan statistics were applied to detect areas of higher-than-expected LBC incidence across the state. Associations were then tested between census tract inclusion in a high-incidence area and …