Public Health Commons^™

Strengthening Local Health Systems And Governance For Universal Health Coverage: Experiences And Lessons From The Covid-19 Pandemic Response In Quezon City, Philippines, Esperanza Anita Escano-Arias, Ramona Asuncion D.G. Abarquez, Rolando V. Cruz, Rosalie Espeleta, Madeline Mae Ong, Arianna Maever L. Amit, Veincent Christian Pepito, Vida Gomez, Manuel M. Dayrit

Ateneo School of Medicine and Public Health Publications

The COVID-19 pandemic has disrupted the Philippines's transition toward universal health coverage. However, some local government units in the country made use of the pandemic as a catalyst to strengthen their local health system, scale-up the provision of preventive and primary care services, and improve health governance to make it more prepared to face future pandemics and realize the aims of the country's new Universal Healthcare Act. This paper describes the response of the local government of Quezon City, Philippines, to COVID-19 and how it strengthened local health systems. We also discuss enablers such as partnerships, collaborations, and foresight to …

Association Between Use Of Services To Address Adverse Social Determinants Of Health And Documented Suicide Attempt Among Patients In The Veterans Health Administration, John R. Blosnich, Aerin Derussy, Joshua S. Richman, Melissa E. Dichter, Gala True, Ann Elizabeth Montgomery

School of Medicine Faculty Publications

Suicide prevention is a top priority for the US Department of Veterans Affairs (VA), and suicide is often associated with adverse social factors (e.g., financial, legal, and housing problems). The VA provides social services integrated with healthcare services, which may increase the opportunities to detect and document suicide attempt in EHR records. Using VA administrative data, we examined three cohorts of all patients from 2014 to 2018 who had housing instability (n = 659,987), justice involvement (n = 200,487), and unemployment (n = 346,556). Administrative records were used to determine ordinal indicators of receipt of VA social services (no services, …

The Impacts Of Physical (In)Activity On Endothelial Function, Joel Ernest Harden

Rehabilitation Sciences Theses & Dissertations

Exercise and physical activity are known to have beneficial effects on endothelial function and vascular health. Sedentary behavior and physical inactivity, however, have been shown to be related to poor endothelial function and vascular health. The overall purpose of this dissertation was to further elucidate the physiological links between physical (in)activity and vascular health. In the first study, 12 active, young (18-40 yr) individuals and 12 active, old (55+ yr) individuals were recruited. Participants underwent 5 days of removal of exercise, and had their endothelial function assessed via flow-mediated dilation (FMD) during their normal, habitual exercise state (EX) and during …

Lead Telecommunications Cables: A Call For Concern?, Zachary Young

Michigan Journal of Environmental & Administrative Law

From the late 1800s until the 1950s, telecommunication companies across the United States utilized lead casing to protect their telecommunication lines. As technology developed and different types of plastic coatings were created, telecommunication companies phased out the use of lead cables. However, the lead cables remain in the air and buried in the ground, even continuing to provide telephone service for some. The failure to remove these cables, most of which are not in use anymore, has generated a slew of issues for the modem-day telecommunication companies that have inherited these cables from their predecessors. As the protective casing decays, …

Revitalizing Passenger Rail: A Sustainable Solution To Environmental And Public Health Challenges In South Carolina, Benjamin Cochran

Theses and Dissertations

South Carolina, a historic leader in passenger rail, has become a heavily vehicle-dependent state. As the population rapidly grows, so does the number of vehicles, vehicle miles traveled, and vehicle emissions, including the greenhouse gas pollutants carbon dioxide (CO2), nitrous oxide (N2O), and particulate matter (PM2.5), significantly contributing to air pollution and deteriorating health and environmental outcomes. Despite this, mass transit is nonexistent for the three largest cities in South Carolina, Charleston, Columbia, and Greenville, forcing residents and travelers to drive. This study evaluates the feasibility and the environmental, public health, environmental justice, and economic implications of a passenger rail …

Tobacco Package Health Warnings About Product Manipulations: An Experimental Study Among Australian Adults Who Smoke, Emily Brennan, Claudia Gascoyne, Kimberley Dunstone, Amanda Vittiglia, Gayathri Srinivasan, Jim Thrasher Ph.D., Ma, Ms, Janet Hoek, Melanie Wakefield, Sarah Durkin

Faculty Publications

The tobacco industry manipulates cigarettes to provide sensory cues that mislead people who smoke. We assessed the effectiveness of health warnings (HWs) focussed on the impact of misleading product attributes, including filter ventilation, menthol, and roll-your-own tobacco, which were called Product Attribute HWs. Australian adults who smoke (n = 2544) were randomly assigned to view: control medication warnings; new Standard HWs with smoking harm images; Product Attribute HWs; or Product Attribute HWs plus a video. At baseline, participants were exposed to seven condition-specific warnings (+ video for those in the Product Attribute HWs + Video condition), then they were …

Research Priorities For Drivers Of Food Choice For Food System Transformation In South Asia: Proceedings Of A Collaborative Workshop, Christine E. Blake Ph.D., Rd, Sunny S. Kim, Edward A. Frongillo Ph.D., Purnima Menon

Faculty Publications

Agrifood systems in South Asia are highly productive, but substantial challenges including poverty, climate change, and environmental degradation complicate progress toward achieving sustainable healthy diets for all. The dynamics of food systems and the consequence of their rapid transformation for food choice behaviors that contribute to healthy and unhealthy diets are not well understood. Food choice is defined as a decision-making process through which individuals and households consider, acquire, prepare, distribute, and consume foods and beverages. Understanding drivers of food choice (DFC) is important for achieving sustainable healthy diets, but evidence is lacking. This article outlines collectively derived priorities for …

Telehealth Or In-Person Hiv Care? Qualitative Study Findings On Decision-Making From People With Hiv And Hiv Care Providers In South Carolina During The Covid-19 Pandemic, Valerie Yelverton, Salome Joelle Gass, Daniel Amoatika, Christopher Cooke, Jan Ostermann, Nabil Natafgi, Nicole L. Hair Ph.D., Bankole Olatosi Ph.D., Otis L. Owens, Shan Qiao Ph.D., Xiaoming Li Ph.D., Caroline Derrick, Sharon Weissman, Helmut Albrecht

Faculty Publications

The COVID-19 pandemic disrupted HIV care services across the United States. Telehealth was rapidly implemented to ensure HIV care continuity. Despite the evidence of unequal telehealth uptake among some people with HIV (PWH), the decision-making processes to determine who received telehealth or in-person care are under-researched. This study assessed which decision criteria and processes determined which HIV care visit type was used by PWH and HIV care providers during the COVID-19 pandemic. Qualitative in-depth interviews with 18 PWH and 10 HIV care providers from South Carolina assessed PWHs’ and HIV care providers’ decision-making criteria and processes for telehealth HIV care …

Science And Politics In Public Health Regulation, Samuel R. Bagenstos

University of Michigan Journal of Law Reform

Much of American public discourse takes for granted a distinction between science and politics. People describe and understand that distinction in contradictory ways, however. And those contradictions themselves underscore how closely entwined science and politics actually are.

Food For Thought: The Impact Of The Gut-Brain Axis On Mental Health, Emily S. Miiller

Honors Thesis

Research regarding the role of the human microbiome has grown over the years as professionals develop a better understanding of the gut-brain axis. New studies and expanding knowledge on the relationship between the nervous system and gut microbiome promote a deeper understanding of the impact of diet on mental health. Diet plays a crucial role in maintaining a healthy balance between the gut and the brain. Incorporating nutritional modulators, such as probiotics, prebiotics, and vitamins, is crucial for supporting the gut-brain axis by influencing neurotransmitter production, managing inflammation, and promoting the growth of beneficial gut bacteria. On the other hand, …

Investigating Mercury Contamination In Urban Fish: Atomic Absorption Spectroscopy And Histological Analysis For Environmental And Human Health, Indy L. Cockrill, Ross Andrew

SPARK Symposium Presentations

Mercury contamination in aquatic ecosystems is a pressing environmental and public health concern, particularly in urban areas where industrial runoff and wastewater contribute to heavy metal accumulation. This study investigates mercury presence in fish from Richland Creek in Nashville, TN, by analyzing histological changes in liver and muscle tissues. Mercury bioaccumulates in aquatic food chains, potentially leading to physiological damage in fish and posing health risks to humans who consume contaminated seafood. While prior research has established mercury’s toxic effects, there is a need for localized studies assessing its presence in urban waterways. The hope is to find histological abnormalities …

South Dakota Department Of Health: Office Of Community Engagement Strategic Plan Fiscal Years 2025-2028, Julia E. Platt

Honors Thesis

The goal of a strategic plan is to ensure that resources are used effectively and efforts are focused where they are most required by means of direction and concentration. The South Dakota Department of Health Office of Community Engagement Strategic Plan Fiscal Years 2025-2028 contains objectives and goals aimed at maximizing the use of resource allocations and solutions to best meet the needs of the OCE and its partners. In order to create those goals and objectives, internal and external needs assessments, along with key informant interviews, were conducted and analyzed to pull data into actionable SMART objectives. Alignment with …

Associations Between B Vitamin Interactions With Polyunsaturated Fatty Acids And Cognitive Function Among Cognitively Healthy Older People As Modified By Amyloid Status And Sex, Chuliang Zhao, Karen A. Abbott, Chinedu Momoh, Geraint Price, Oliver J. K. Robinson, Sujin Kang, Celeste A. De Jager Loots

Brain and Mind Institute

Background/Objectives: Nutrients such as vitamin B12, folate (B9), and polyunsaturated fatty acids (PUFAs) may independently influence cognitive health, but their combined effects and interactions remain unclear. This study aims to investigate the effects of B12, folate, and PUFAs, including their interactions, on cognitive function in cognitively healthy older adults, considering effect modification by sex and amyloid-beta status.

Methods: A cross-sectional analysis was conducted using data from 321 participants aged 60–85 y enrolled in the UK CHARIOT–PRO SubStudy. Dietary intake was assessed using the Scottish Collaborative Group Food Frequency Questionnaire, and cognitive performance was measured via the Repeatable Battery …

The Impact Of Employer-Provided Drug/Alcohol Education On Marijuana And Alcohol Use In Young Adults., Sonia Cerrillo, Naomi Ramirez

Posters - 2025

According to the American Society of Addiction Medicine, addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences (1). People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences. The most common addictions in the United States are alcohol and marijuana (2). In the U.S., 59.277 million people twelve and older have used illegal drugs or misused prescription drugs. Out of the 138.522 million Americans who overdrink alcohol, 28.32 million have an alcohol use disorder (3).

Since alcohol and drug abuse …

V.O.T.S. Virus Outbreak Tracking System, Izak O. De La Cruz, Elias Ciudad Leon, Van Nguyen, Amy Torres, Enzo Jaques

Posters - 2025

In a post-pandemic world, the need for real-time, accessible disease tracking has never been more critical. While global COVID-19 heat maps were widely utilized during the pandemic, local virus tracking tools have since diminished, leaving a gap in public health awareness.

V.O.T.S. is an interactive application that visualizes real time disease outbreaks through an interactive heatmap, enabling users to track virus trends by county, severity, and timeframe. The system integrates public health data from trusted sources such as the CDC, empowering individuals and healthcare professionals to make informed decisions. In addition, V.O.T.S. enhances accessibility with multilingual support, symptoms assessment, and …

Cultural And Religious Perspectives On Suicide And Healing, Arielle Friedman

be Still

This essay is built off of a paper I wrote in a college global health course on culture and mental illness. I have always been fascinated by cultural interpretations of illness & believe that as a future physician, it is my responsibility to educate myself and others on the complex interplay between religious ideologies & recognition/management of biological disease in order to provide appropriate patient-centered care.

What's Missing From Value-Based Care-Accounting For The Costs And Benefits Of Quality Improvement, Donald E. Casey

College of Population Health Faculty Papers

No abstract provided.

Exploring The Web And Language Accessibility Of Medical Tourism Providers’ Websites: Implications For Online Marketing And Patient Recruitment Practices, Alicia Mason, Elizabeth Spencer, Kristen Livingston, Treyton Meyers

Faculty Submissions

Background: Web accessibility as an attribute of the digital presence of organizations has been studied across domains and contexts. Our study aims to add to existing lines of research inquiry by examining the web and language accessibility of medical tourism provider (MTP) websites commonly used to market and promote international medical tourism treatments and services globally.

Objective: This study aims to (1) systematically analyze the web and language accessibility of MTP online health messages and (2) discuss challenges and implications for medical tourists’ user experiences when seeking health information online.

Method: We conducted an exploratory quantitative content analysis of web …

Revisions To The Safety Assurance Factors For Electronic Health Record Resilience (Safer) Guides To Update National Recommendations For Safe Use Of Electronic Health Records, Dean F Sittig, Trisha Flanagan, Patricia Sengstack, Rosann T Cholankeril, Sara Ehsan, Amanda Heidemann, Daniel R Murphy, Hojjat Salmasian, Jason S Adelman, Hardeep Singh

Faculty, Staff and Student Publications

The Safety Assurance Factors for Electronic Health Record (EHR) Resilience (SAFER) Guides provide recommendations to healthcare organizations for conducting proactive self-assessments of the safety and effectiveness of their EHR implementation and use. Originally released in 2014, they were last updated in 2016. In 2022, the Centers for Medicare and Medicaid Services required their annual attestation by US hospitals.

Objectives: This case study describes how SAFER Guide recommendations were updated to align with current evidence and clinical practice.

Materials and methods: Over nine months, a multidisciplinary team updated SAFER Guides through literature reviews, iterative feedback, and online meetings.

Results: We reduced …

Dental Disparities: An Analysis Of Dental Caries Risk Factors Promoting Disparities Between Rural And Urban Communities In Nebraska, Nick Lounsbery

Honors Program: Senior Projects (Public)

The prevalence of dental caries in the United States remains a public health concern, as it is one of the most common chronic conditions across people of all ages. Research shows that preventative measures including brushing, fluoridated water, and regular checkups are effective strategies to mitigate tooth decay. However, there appears to be a divide between rural and urban populations, as the presence of dental cavities is significantly greater in remote areas in the State of Nebraska. Research methods used in this analysis included analyzing accredited academic literature to illustrate how cavities form from a biochemical perspective. Research methods also …

The Epidemiology Of Sports And Recreation Related Toe Fractures In The United States, Dogerno Norceide, Gabriel I. Onor, Oluwatomi Akingbola, William Justice, Nana F. Amponsah, Abimbola Okulaja, Ifeanyichukwu Onor, Michael Okoronkwo, Chibuikem Nwizu, David Pedowitz

School of Medicine Faculty Publications

BACKGROUND: Fractures of the toes are among the most frequently diagnosed lower extremity fractures. In sports, toe fractures may present after diverse mechanisms of injury, varying severity, and varying implications for management. This study aimed to discern trends in toe fractures presenting to US emergency departments (EDs) particularly in association with sports and recreational activities. An additional aim of the study was to identify if rates of toe fracture presentation significantly decreased during the year 2020 at the height of the COVID-19 pandemic. METHODS: We queried the National Electronic Injury Surveillance System (NEISS) database to identify toe fractures presented to …

Soluble Cd13 Is A Potential Mediator Of Neutrophil-Induced Thrombogenic Inflammation In Sars-Cov-2 Infection, Pei-Suen Tsou, Ramadan A. Ali, Chenyang Lu, Gautam Sule, Carmelo Carmona-Rivera, Serena Lucotti, Yuzo Ikari, Qi Wu, Phillip L. Campbell, Mikel Gurrea-Rubio, Kohei Maeda, Sharon E. Fox, William D. Brodie, Megan N. Mattichak, Caroline Foster, Ajay Tambralli, Srilakshmi Yalavarthi, M Asif Amin, Katarina Kmetova, Bruna Mazetto Fonseca, Emily Chong, Yu Zuo, Michael D. Maile, Luisa Imberti, Arnaldo Caruso, Francesca Caccuri, Virginia Quaresima, Alessandra Sottini, Douglas B. Kuhns, Et Al

School of Medicine Faculty Publications

The soluble variant of the ectopeptidase CD13 (sCD13), released from the cell surface by matrix metalloproteinase 14 (MMP14), is a potent pro-inflammatory mediator, displaying chemotactic, angiogenic, and arthritogenic properties through bradykinin receptor B1 (B1R). We revealed a link between sCD13 and amplified neutrophil-mediated inflammatory responses in SARS-CoV-2 infection. sCD13 was markedly elevated in patients with COVID-19 and correlated with disease severity and variants, ethnicity, inflammation markers, and neutrophil extracellular trap formation (NETosis). Neutrophils treated with sCD13 showed heightened NETosis and chemotaxis, which were inhibited by sCD13 receptor blockade. Meanwhile sCD13 did not induce platelet aggregation. Single-cell analysis of COVID-19 lungs …

Preferences And Willingness For Starting Daily, On-Demand, And Long-Acting Injectable Hiv Pre-Exposure Prophylaxis Among Transfeminine Persons In The Us, 2022-2023, Duygu Islek, Travis Sanchez, Stefan Baral, Carolyn Brown, Joanna A. Caldwell, Jennifer L. Glick, Danielle Friedman Nestadt, Jeb Jones, Iaah L. Lucas, Supriya Sarkar, Annemiek De Ruiter, Patrick S. Sullivan, Mariah Valentine-Graves, Savannah Winter, Vani Vannappagari

School of Public Health Faculty Publications

Background There remains limited information concerning US transfeminine persons preferences across varying PrEP options. We examined PrEP option willingness, preferences, and associated factors among a US nationwide sample of transfeminine persons. Methods Sexually active transfeminine persons age 15 + were recruited online between June 2022-October 2023 through social media advertisements. Transfeminine persons not diagnosed with HIV were asked about willingness to initiate, and ranked preference, of three PrEP options- daily oral (DO), on-demand, and long-acting injectable (LA-PrEP). Log-binomial models were used to examine PrEP modality willingness and associated sociodemographic and behavioral characteristics. Results Among 2657 transfeminine persons not currently using …

Physiotherapy In Community-Based Rehabilitation In Middle And Low-Income Countries: A Scoping Review, Er D. Petil Jr., Napoleon R. Caballero

Philippine Journal of Physical Therapy

Introduction: Community-based rehabilitation (CBR) is a widely recognized approach to address the rehabilitation needs of individuals with disabilities in low- and middle-income countries (LMICs). Physical therapy (PT) plays a crucial role within CBR programs. This study aimed to synthesize the current state of literature regarding the integration of PT in CBR programs in LMICs across Asia, Africa, and Latin America, examining key characteristics, reported outcomes, and challenges to implementation.

Methods: A comprehensive review of literature was conducted, focusing on studies published in the past decade. Data were extracted and synthesized in matrix format to compare and contrast findings across the …

Hbv Transmission Knowledge Among Korean-American Chronic Hepatitis B Patients In The United States, Giyoung Lee, Hee-Soon Juon, Eunji Kim, Katherine C Smith, Hie-Won Hann, Mimi Chang, Ann C. Klassen

Division of Gastroenterology and Hepatology Faculty Papers

Chronic hepatitis B (CHB) is a condition that disproportionately affects Asian Americans in the United States. Knowledge of transmission is crucial for CHB patients to practice prevention methods to limit the spread of the hepatitis B virus (HBV), but also live their lives free from unwarranted fears or restrictions. Among Asian CHB patients, several misperceptions about HBV transmission have been identified. This analysis aims to assess the current state of HBV knowledge among a cohort of Korean-American CHB patients. This mixed-methods study includes 363 respondents who completed a survey in either Korean (N = 298) or English (N = 65) …

Frequency Of Variants In Mendelian Alzheimer’S Disease Genes Within The Alzheimer’S Disease Sequencing Project, Dongyu Wang, Alexandra Scalici, Yanbing Wang, Honghuang Lin, Achilleas Pitsillides, Nancy Heard-Costa, Carlos Cruchaga, Ellen Ziegemeier, Joshua C Bis, Myriam Fornage, Eric Boerwinkle, Philip L De Jager, Ellen Wijsman, Josée Dupuis, Alan E Renton, Sudha Seshadri, Alison M Goate, Alzheimer's Disease Neuroimaging Initiative (Adni), The Alzheimer's Disease Sequencing Project, Anita L Destefano, Gina M Peloso

Faculty, Staff and Student Publications

Background:

Prior studies examined variants within presenilin-2 (PSEN2), presenilin-1 (PSEN1), and amyloid precursor protein (APP) genes. However, previously-reported clinically-relevant variants and other predicted damaging missense (DM) variants have not been characterized in a newer release of the Alzheimer’s Disease Sequencing Project (ADSP).

Objective:

To characterize previously-reported clinically-relevant variants and DM variants in PSEN2, PSEN1, APP within the participants from the ADSP.

Methods:

We identified rare variants (MAF< 1%) in PSEN2, PSEN1, and APP in 14,641 individuals with whole genome sequencing and 16,849 individuals with whole exome sequencing available (Ntotal = 31,490). We additionally curated …

Adolescent Sleep Health, Mental Health, And Cardiovascular Disease Risk In Adulthood, Prince Nii Ossah Addo

Theses and Dissertations

Background: Insufficient sleep and poor sleep quality are major public health issues among adolescents in the United States (U.S.). Mental health and substance use challenges are also common among adolescents, particularly those with sleep problems. Although exposures in adolescence have been evidenced to significantly impact future health, little is known about how adolescent sleep health, mental health, and substance use influence future cardiovascular disease (CVD) risk. We, therefore, examined the association between sleep health in adolescence and CVD risk in adulthood and assessed whether the association is mediated by depressive symptoms and substance use in adolescents. Further, we explored the …

Advancing Pandemic Response: Integrated Strategies For Testing, Prediction, And Bias Mitigation, Tianshu Gu

Theses and Dissertations (ETD)

The COVID-19 pandemic, along with prior outbreaks such as SARS and Ebola, has revealed critical gaps in global pandemic preparedness, emphasizing the need for integrated approaches to infectious disease management. This dissertation addresses three key areas of pandemic response: developing scalable screening strategies, constructing reliable predictive models, and mitigating demographic biases in artificial intelligence (AI) models used for healthcare decision-making.

The first study introduces a global screening strategy designed to optimize resource use and increase testing capacity, particularly in low- and middle-income countries (LMICs) where resources are limited. This study leverages pooled testing methods, where multiple samples are combined into …

The Impact Of Hyperglycemia On Post-Reperfusion Outcomes In Patients With Hyperacute Ischemic Stroke, Nicole Schumacher

Theses and Dissertations (ETD)

Stroke is a major contributor to disability in the United States, with ischemic stroke accounting for approximately 87% of all cases. The use of approved reperfusion therapies, including intravenous thrombolysis with tissue plasminogen activator (tPA) and mechanical thrombectomy, has significantly improved functional outcomes for ischemic stroke patients. However, hyperglycemia at the time of hospital arrival is associated with worse outcomes, including increased infarct growth, higher rates of disability, and elevated mortality. Despite this, current stroke guidelines neither exclude hyperglycemic patients from receiving reperfusion therapy nor recommend glucose management during the hyperacute phase of care. While recent studies suggest that mild …

The Lived Experience Of Acute Stroke Advanced Practice Registered Nurses (Aprn) Working In Expanded Roles: A Mixed Methods Study, Terri-Ellen Kiernan

Theses and Dissertations (ETD)

Introduction. Nurse practitioners have made credible gains through the six decades since inception to cover the growing need for outpatient family care. Nurse practitioners are now working in all aspects of medicine by continuing to fill gaps with healthcare needs that persist due to physician shortages. Stroke neurology is a medical specialty plagued by a shortage of physician specialists in hospital acute care which can limit acute stroke diagnosis and treatment capabilities. Stroke nurse practitioners (SNP) are vascular neurology trained specialists who fill relatively new hospital roles to assume traditionally physician-based responsibilities in an expanded role. This study aims to …