Community Health and Preventive Medicine Commons^™

Identifying Barriers And Place-Based Solutions To Physical Activity For Older Adults In East Tennessee, Lydia Hoskins, Jodi Southerland

Journal of Appalachian Health

Introduction: Older adults in East Tennessee (TN), the fastest growing demographic, face significant health challenges, with 44% reporting four or more chronic conditions. The state ranks 45th in physical inactivity among older adults, exacerbating chronic disease risks, fall-related injuries, and mental health issues. Urban-rural disparities in East TN further complicate efforts to promote active living, particularly for rural residents.

Purpose: This qualitative study explored socioecological barriers and solutions to increase physical activity (PA).

Methods: In April 2024, two focus group were conducted in East TN, with a total of 11 participants composed of six community partners and five older adults. …

Person-Centered Trauma-Informed Care (Pctic): A Training Needs Assessment For Home And Community-Based Services In West Virginia, Ranjita Misra, A. Brianna Sheppard, Natalie Wilson, Megan C. Govindan, Matthew Myers, Amanda Acord-Vira, Steven Wheeler, Heather Henderson, Christena Ross, Laura Cooper, Rachel A. Goff

Journal of Appalachian Health

Introduction: Person-centered, trauma-informed care (PCTIC) is a combined, holistic service model promoting the well-being and empowerment of trauma survivors.

Purpose: This study examined the PCTIC knowledge, skills, and abilities needed by West Virginia (WV) Medicaid Home and Community-Based Services (HCBS) direct service professionals (DSPs) to serve clients that may have experienced trauma.

Methods: Semi-structured interviews were conducted with diverse stakeholders (n = 32) from 19 organizations that provide HCBS services in all 55 counties. Interviews focused on identifying current training, needs and knowledge gaps, and priority areas for additional PCTIC training. ATLAS.ti software was used to manage and code. Validity …

Radon Environmental Health Literacy Among Health Council Participants In Northeast Tennessee, Kawther Al Ksir, Stacy Stanifer, Hadii M. Mamudu, Megan Quinn, Deborah L. Slawson

Journal of Appalachian Health

Introduction: Radon, a radioactive gas, poses significant health risks, including lung cancer, and is prevalent in indoor environments. Understanding radon testing behavior and Environmental Health Literacy (EHL) is crucial for individuals to take appropriate preventive measures.

Purpose: This study assessed radon-related EHL among Health Council participants in seven Northeast Tennessee (NETN) counties and examined associations between sociodemographic factors and EHL levels. Understanding radon knowledge and behaviors within this influential group is critical, as they often serve as trusted public health advocates.

Methods: A cross-sectional survey was conducted from September – November 2023 among Health Council participants across seven counties in …

Prevalence Of Screening Patients For Alcohol Use In West Virginia: A Cross-Sectional Observational Study, Bayan Abuhalimeh, Christopher Waters, R. Constance Wiener

Journal of Appalachian Health

Introduction: Consequences of alcohol consumption are well-established and compounded by physiological changes of aging (increased sensitivity; medication interactions; etc.). Alcohol screening for all ages is recommended, especially as most Americans believe moderate drinking is acceptable. Screening is important in high alcohol use regions, such as rural areas where isolation is more likely, especially for older adults. The Appalachian Region has a significant rural population of older adults. West Virginia (WV) is representative of Appalachia. It is a rural state, has many older adults, and all counties are Appalachian.

Purpose: The purpose of this cross-sectional study is to determine the likelihood …

Finding Community: A Thematic Analysis Of Resilience During The Pandemic, Myles Kwitny, Quinn Richards, Grace Digirolamo, Shannon Freedman, Sophie Wenzel

Journal of Appalachian Health

Introduction: The Covid-19 pandemic impacted those within rural Appalachian communities, particularly people with marginalized identities.

Purpose: Through interviewing 44 participants from New River Valley, an Appalachian community in Virginia, this study sought to understand how resilience impacted individuals' experiences during the pandemic.

Methods: Participants belonged to one of the following groups: African American, Hispanic, older adults, or people who use drugs. Participants were required to reside in the New River Valley and be older than 18. Each participant was interviewed either in person, by phone, or over video call. Interviews were recorded, transcribed, then thematically analyzed for themes of resilience. …

Addressing The Root Causes Of Population Health In Central Appalachian Virginia, David L. Driscoll, Kol Gold

Journal of Appalachian Health

Introduction: The Southwest Virginia Health Authority (SWVHA) recently commissioned a community health needs assessment (CHNA) to reduce the high rate of preventable health problems in Virginia’s (VA) Appalachian Region. The CHNA took place over a two-year period from 2023 – 2025.

Purpose: This iterative, mixed-method CHNA informed the development of a new iteration of the regional Blueprint for Health Improvement and Health-Enabled Prosperity identifying and prioritizing health issues and develop strategic planning to address them in VA’s three westernmost regional health districts.

Methods: The CHNA followed a sequential mixed methods design to assess the regional health status, the contextual factors …

Align Appalachia’S Opioid-Settlement Spending With Evidence And Emerging Threats, Bradley Firchow

Journal of Appalachian Health

State and local governments across Appalachia are allocating opioid-settlement dollars over the coming years. This funding opportunity can support lasting public health infrastructure or be spent on short-term programs anchored in the opioid crisis of the past. Evidence indicates that emerging synthetic drugs such as nitazenes and xylazine are altering overdose risk patterns in ways that require urgent policy attention.

Weight Gain Among Tuberculosis Patients And Its Association With Socio-Demographic Profile And Disease-Related Characteristics In Urban And Rural Areas Of Mysuru., Sana Khader M, Smitha Malenahalli Chandrashekarappa, Anchu R Nath, Arun Gopi

Digital Journal of Clinical Medicine

Background: Tuberculosis remains a major public health burden in India, accounting for 25% of the global tuberculosis cases. Weight gain during tuberculosis treatment is a key recovery indicator influenced by sociodemographic and clinical factors. Addressing these challenges is crucial for achieving India’s Tuberculosis elimination goal by 2025.

Objectives: To assess weight gain across different phases of anti tubercular therapy among tuberculosis patients in urban and rural Mysuru, and to determine its association with sociodemographic and disease-related characteristics.

Methodology: A retrospective cross-sectional study was done using secondary data of tuberculosis patients who attended primary health care centers in …

The Association Between Pain Catastrophizing, Somatization, Psychological Distress And Low Back Pain Severity Among Academics In Malaysia, Noordiyana Izyanti Mohamad Saufi, Eva Nabiha Zamri

Makara Journal of Health Research

Background: Psychological factors may influence the severity of low back pain (LBP), especially in high-stress professions such as academia. This study aimed to identify the relationship between psychological factors and LBP severity among Malaysian public university academics.

Methods: This cross-sectional study aimed to assess the relationship between psychological factors and LBP among academics at four public universities located in the northern region of West Malaysia. A self-administered questionnaire was used to collect information on sociodemographic characteristics, work information, lifestyle factors, LBP presence and intensity, and psychological factors. Data were analyzed using ordinal logistic regression and reported in terms …

Risk Factors Of Acute Gastroenteritis And The Implementation Of Community-Based Total Sanitation In Banyuwangi, Indonesia: A Cross-Sectional Study, Citra Al Karina, Juniastuti Juniastuti, Budi Utomo, I Made Dwi Mertha Adnyana

Makara Journal of Health Research

Background: In Banyuwangi Regency, Indonesia, diarrhea remains a major health problem, even though the community-based total sanitation (CBTS) program has been implemented for ten years. This household survey study aimed to identify the risk factors of acute gastroenteritis (AGE) and to evaluate the implementation of CBTS in Banyuwangi Regency.

Methods: A cross-sectional study was conducted in Banyuwangi Regency. Characteristic data from patients with AGE were collected from the two primary healthcare working areas, followed by collecting data of their family members and CBTS in their houses. Data were obtained through interviews and direct observation. The CBTS evaluation results …

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

Reports & Documents

The Earth Care Trusted Messengers Vaccine Access Project was a two-month intervention implemented in Santa Fe, New Mexico in spring 2025 to address persistent barriers to COVID-19 and routine vaccine access among Spanish-speaking communities. Using a peer-to-peer “Trusted Messenger” model, respected community members received training in vaccine knowledge, communication strategies, and community organizing before hosting small house meetings to share accurate information, address concerns, and build trust.

A mixed-methods evaluation included pre/post/follow-up surveys, weekly house meeting questionnaires, and a final focus group. Quantitative results demonstrated substantial increases in participants’ confidence across all domains, including vaccine knowledge, communication skills, and ability …

Family Healthy Weight Program: Smart Movestm Pilot Project Evaluation Report, Camille Velarde, Theresa H. Cruz Dr., Elena Martinez

Reports & Documents

The Smart Moves™ Family Healthy Weight Program is an evidence-based, family-centered intervention designed to address childhood overweight and obesity through nutrition education, physical activity, social-emotional learning, and caregiver engagement. In spring 2025, Presbyterian Community Health piloted Smart Moves™ in a South Valley community health clinic as part of the Healthy Here initiative, with evaluation conducted by the University of New Mexico Prevention Research Center.

The pilot, adapted from a 12-lesson curriculum to 8 core lessons plus orientation and celebration, included bilingual instruction, cooking in a teaching kitchen, and family-based incentives. Evaluation methods combined quantitative and qualitative data, including pre/post BMI …

Enhancing Cataract Surgery Outcomes: Optimal Use Of Pre- And Post-Operative Eye Drops, Keith Skolnick M.D., Anu Valiaveedu

Mako: NSU Undergraduate Student Journal

Many preoperative and postoperative cataract patients struggle with comprehending the use of prescription medication as directed. Language barriers and low health literacy levels are major factors contributing to improper use of prescriptions. To increase patients comprehension, the Fort Lauderdale Eye Institute employed an educational intervention consisting of a live presentation and an instructional video. Results found that 44% of patients were hesitant to ask questions to clinical staff, 32% felt overwhelmed, and nearly 70% lacked confidence in using their prescribed eye drops. Following the intervention, 91% of patients reported increased confidence in their medications, and most indicated that the video …

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.

Bridging Evidence With Community: Five Routes To Diabetes Prevention In Latino Adults, Ann M. Maliackal

Doctor of Nursing Practice Final Project Abstract

Bridging Evidence with Community: Five Routes to Diabetes Prevention in Latino Adults

Background: This project used the Eightfold Path policy analysis approach to identify and recommend an evidence-based diabetes prevention program (DPP) for Latino adults in the Rio Grande Valley (RGV). The aim was to reduce diabetes prevalence by selecting an intervention that is culturally appropriate and effective for this population.

Methodology: The Eightfold Path policy analysis approach guided this project. A comprehensive literature review identified diabetes prevention programs (DPPs) tailored for Latino adults, and the Critical Appraisal Skills Programme (CASP) was used to assess study quality. Five DPPs were …

Holistic Approach To Managing Grade 3 Vaginismus: An Obg Physiotherapy Perspective, Nagma Khan

Internet Journal of Allied Health Sciences and Practice

Background: Vaginismus is a condition characterized by involuntary pelvic floor muscle contractions, which can make vaginal penetration painful or impossible. This disorder has both physical and psychological components, often leading to significant emotional distress, anxiety, and relationship difficulties. Effective management requires a holistic, multidisciplinary approach, combining physical therapy with psychological support. This case report examines the treatment of a 29-year-old woman with grade 3 vaginismus, highlighting the role of Obstetrics & Gynaecology (OBG) physiotherapy in improving both physical symptoms and emotional well-being.

Case Presentation: A 29-year-old female presented with grade 3 vaginismus, with a history of severe pelvic floor tension …

Eco-Emotions And Climate Activism In Adolescents, Julianna Sahoo

Master's Projects and Capstones

Background. Youth are especially vulnerable to climate change, both physically and psychologically. Combatting climate change will require a coordinated, global effort. Understanding the motivations and emotions behind climate activism is essential to coordinate efforts to combat climate change.

Methods. This research uses survey data collected from first and second year undergraduates (n=521) at a private, urban university in California in the Fall of 2022. Youth were surveyed on emotions related to climate change, activism, compassion, eco-anxiety, and well-being.

Results. Experiencing positive emotions had a stronger relationship with environmental activism compared to negative emotions.

Conclusion. Results suggest climate change communications should …

A Comprehensive Evidence-Based Educational Initiative For Improving Hand Hygiene, Lyanna L. Chan

Master's Projects and Capstones

Abstract

Problem: Healthcare-associated infections (HAIs) are a persistent concern in assisted living facilities, often resulting from inconsistent hand hygiene practices. Although national guidelines exist, adherence remains suboptimal, especially where staff training and compliance monitoring are limited.

Context: This project took place in a 53-bed assisted living facility without a formal system to track or reinforce hand hygiene. The aim was to improve staff knowledge and promote infection prevention through education.

Interventions: A Clinical Nurse Leader (CNL) led an evidence-based hand hygiene education program. The intervention included interactive training, visual reminders, personal sanitizers, and leadership support during clinical huddles.

Measures: Pre- …

Evaluating What Works: A Comparison Of Five Diabetes Prevention Programs For Latino Children, Ruchi Patel

Doctor of Nursing Practice Final Project Abstract

Background: Children in the Rio Grande Valley (RGV) are at increased risk of diabetes due to limited access to effective, culturally appropriate prevention programs. Existing programs are often time-intensive, require transportation, and lack cultural relevance, reducing participation and impacting outcomes. This project aimed to evaluate diabetes prevention programs (DPPs) in the literature and identify five that may benefit children in the RGV by reducing diabetes risk.

Methodology: The Eightfold Path policy analysis approach guided this project. A literature review identified DPPs for children, and the Critical Appraisal Skills Programme (CASP) was used to assess study quality. Limitations included difficulty finding …

Reentry For Formerly Incarcerated Individuals: A Focus On Workforce Reentry And Recidivism In Appalachia, Margaret E. Francisco

Electronic Theses and Dissertations

Formerly incarcerated individuals face challenges to successful reentry, a critical component of reducing recidivism and improving public health outcomes. These challenges are particularly acute in rural Appalachia, where structural disadvantages such as limited economic opportunities, healthcare access, and public transportation intersect with stigma and systemic barriers related to prior incarceration. This dissertation addresses these gaps through a mixed-methods examination of reentry and recidivism, grounded in public health frameworks and focused on the unique context of rural Appalachia.

This work includes three studies. First, a PRISMA-guided systematic review synthesized qualitative research on barriers and facilitators to employment following incarceration. Findings highlighted …

Shifting From Crisis To Prevention: Community-Generated Materials From The Core Sipp Listening Sessions (Version 1), Camille Velarde, Mahtab Soleimani, Yvonnie Baik, Theresa Cruz

Reports & Documents

The Core State Injury Prevention Program (CORE SIPP) in New Mexico sought to understand how communities can prevent injury and violence before crisis occurs. In 2025, the University of New Mexico Prevention Research Center, in partnership with the New Mexico Department of Health, listened to service providers, advocates, and community leaders working with youth and families across the state. Participants described overlapping challenges, including poverty, unsafe housing, limited mental health care, transportation gaps, and a lack of safe spaces for young people, and emphasized that real prevention must start early and address families’ basic needs. From these sessions, community members …

Living In Fear: Be Empathetic (Life)-Tool Kit, Desiree A. Díaz, Heather Peralta, Samantha Stephenson, Danny Hernandez, Geraldine Luzincourt, Syretta Spears, Ann Marie Parker, Trysten Altamirano

Nursing Handouts, Tools, and Other Documents

Open source materials to immerse learners in rural and public health experiences are needed to ensure the new work force is equipped to care for a variety of people in differing circumstances. Public health remains a vital yet underemphasized component within healthcare education, specifically nursing education. This often limits opportunities for students to develop the skills necessary to become strong advocates for equity and systemic change. A

This project emerged from a commitment to provide experiential opportunities replicating the communities we serve. A Empathy Walk and LIFE Clinic (Díaz et al., 2025) was created as a strategy designed to engage …

Public Understanding Of And Engagement With Community Health Workers And Promotores De Salud: Findings From Two National Surveys, Elizabeth A. Rohan, Julie S. Townsend, Andrea Torres, Hope L. Thompson, Dawn M. Holman, Avid Reza, Felicia Solomon Tharpe, Erin Caple, Ashley Wennerstrom

School of Public Health Faculty Publications

INTRODUCTION: Community health workers (CHWs) can improve health by helping people navigate health care services and systems and connecting them to community services that address nonmedical factors such as food insecurity, housing, and transportation. While CHWs have long been part of the US public health system, there are no data, to our knowledge, on the public's familiarity and interactions with CHWs. METHODS: We analyzed data from the 2022 Porter Novelli FallStyles and Estilos surveys, online market research surveys of the general public delivered in English (FallStyles) or primarily Spanish (Estilos). Each survey asked the same 4 questions on familiarity and …

State-Level Immigrant Policies And Diabetes Prevalence In Latino And Asian American Groups: A Weighted Multilevel Analysis, Md Towfiqul Alam, Jennifer Toller Erausquin, Erica Payton, Elizabeth Vásquez, Sandra Echeverria

Faculty Scholarship

Introduction: Growing literature has shown that immigrant-related policies influence population health by limiting or enhancing immigrants’ rights. However, less is known about the role of state-level immigrant policies shaping chronic health conditions such as type 2 diabetes (T2DM). This cross-sectional study examined the association between state-level immigrant policies (both criminalising and inclusive) and prevalence of T2DM among individuals of Latin American and Asian American origin.

Method: We included adults aged 18+years sampled in the 2014–2018 behavioral risk factor surveillance system (BRFSS) (n=201 824), a survey design that allows the calculation of state-level estimates. Using existing policy measures, states …

Ageing And Occupational Medicine In Indonesia: A Timely Integration For An Inclusive Workforce, Iqbal Mochtar

Occupational and Environmental Medicine Journal of Indonesia

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Increasing Colorectal Cancer Screening Rates For Patients Without Insurance, Andrea F. Day

Doctor of Nursing Practice Projects

Background: Colorectal cancer is a leading cause of cancer-related death in the United States (U.S.), ranking as second most prevalent overall. Despite many initiatives, screening rates remain low, especially among clinic patients without insurance. The lack of an evidence-based screening protocol exacerbates these issues and increases the risk of advanced cancer and death. Initial data showed that 0% of patients were screened according to recommended guidelines.

Purpose: The project implemented a standard screening protocol to increase colorectal cancer screening rates in a rural Alabama free clinic for patients ages 45-64 lacking insurance.

Project Design: This quality improvement …

Utilizing Text Messaging To Increase Annual Mammogram Screening Compliance, Lacey B. Santa Cruz

Doctor of Nursing Practice Projects

Background: Routine mammography can lessen breast cancer deaths, but many patients do not follow the current screening guidelines. Limited access to mammography and insufficient awareness lead to missed screening appointments.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to improve annual mammogram adherence among women aged 40-74 by implementing an electronic medical record (EMR)-based text reminder system.

Project Design: Secondary patient data was collected from a privately owned, rural family practice clinic. Using the Mobilize-Assess-Plan-Implement-Track (MAP-IT) quality improvement framework, the project implemented a text message reminder intervention through the EMR. Eligible patients received a text reminder …

Scoring System For Screening Fitness To Work For Offshore And Onshore Remote Area Worker, Kasyunnil Kamal

Occupational and Environmental Medicine Journal of Indonesia

Background: About 10-15% of medical examinations of workers at upstream oil and gas companies are not conducted properly. In some cases, workers die at worksites. Many doctors carrying out the assessment lack the competency to assess occupational risks. In this study, we developed a scoring system for ‘fitness for work’ assessment, which can be used by trained doctors.

Methods: Diagnostic testing was done with comparing the results of the determination screening fitness for work using a scoring system with the determine fitness for work results by Occupational Medicine Specialist as a gold standard in the same group. The entire 607 …

The Effect Of Blue Light Filter Lens Glasses On The Occurrence Of Asthenopia Symptoms In Visual Display Terminal Users, Arif Hening Mustikaningrum, Dewi Sumaryani Soemarko, Indah Suci Widyahening

Occupational and Environmental Medicine Journal of Indonesia

The widespread use of Visual Display Terminals (VDTs) is associated with visual and musculoskeletal complaints, particularly Asthenopia, which may reduce productivity. A 32-year-old female financial worker presented with eye discomfort, including sore eyes, blurred vision, dizziness, and twitching on her left temple, particularly during extended computer use. The symptoms were relieved with rest. Most VDTs now use Light Emitting Diodes, which emit more blue light than LCDs and may cause eye fatigue and disrupt sleep. Currently, blue light filter lenses are available in the market, however, further study of existing scientific publications is necessary to ensure the effectiveness of blue …

Determinan Perilaku Minum Tablet Tambah Darah Pada Remaja Putri Menurut Health Belief Model: Studi Kualitatif, Tuti Surtimanah, Irfan Nafis Sjamsuddin

Perilaku dan Promosi Kesehatan: Indonesian Journal of Health Promotion and Behavior

Background. In 2018, 48.9% of adolescent girls in Indonesia were diagnosed with anemia. Knowledge about the definition, symptoms, and prevention of anemia, including the correct use of Iron Supplement Tablets (IST), is essential in the prevention of anemia. A deeper understanding of these behaviors is necessary to formulate effective educational messages. The Health Belief Model (HBM) is often used to explore and understand preventive behaviors.

Aim. To explore the determinants and practices of IST consumption among adolescent girls.

Method. This descriptive qualitative study used a phenomenological approach. Participants were selected purposively from adolescent girls. Data were collected through in-depth interviews, …