Community Health and Preventive Medicine Commons^™

Colorectal Cancer Screening: Implementation And Evaluation Of A Screening Algorithm In A Rural Family Practice Clinic, Mollie M. Tate, Whitney Dubas

Doctor of Nursing Practice Projects: College of Nursing

Background: Colorectal cancer (CRC) is the second leading cause of cancer-related mortality in the United States and disproportionately affects rural populations. Although more than 90% of cases occur in adults older than 50 years, increasing incidence among younger adults prompted an update to national guidelines recommending screening beginning at age 45. Rural residents face multiple barriers to colorectal cancer screening (CRCS), including limited access to care, transportation challenges, lack of insurance, and absence of standardized screening processes in primary care. These barriers contribute to lower screening rates, delayed diagnosis, and poorer outcomes. Evidence demonstrates that CRCS reduces CRC morbidity and …

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 …

Implementation Of An Adolescent Women’S Health And Wellness Education Program, Lauren Acker, Laynee Conner, Jennifer Cera

Doctor of Nursing Practice Projects: College of Nursing

Objectives: The goal of this research study was to provide scientific evidence supporting the importance and effectiveness of implementing a women’s health and wellness education course and its effect on (1) adolescent knowledge of sexual health and hygiene, (2) self-efficacy in menstrual management, and (3) self-empowerment in managing their own reproductive health.

Design: This was a mixed methods pilot study utilizing a pre/post-test single intervention efficacy trial. Quantitative and qualitative data were obtained.

Setting: The setting included two different sites including one outpatient ambulatory obstetrics/gynecology clinic and one community outreach center. Both sites were located within a midwestern metropolitan …

The Association Between Economic Outcomes And Abortion: A Scoping Review, Larisa Nicole Stephenson

Capstone Experience: Master of Public Health

Background: Abortion access is not just an issue of autonomy, but an economic issue as well. Evidence of the intersectionality of abortion health care and economics has endured due to the financial cascading effects a denial of an abortion, or the inability to access an abortion, has on one’s personal, professional, and economic upward mobility. A change in recent policies impacting access to abortion warrants an updated synthesis examining the relationships between economic outcomes and abortion access for people of reproductive age in the United States (U.S.).

Aim: This scoping review summarizes evidence pertaining to the association …

Kansas City Health Department – Childhood Lead Poisoning Prevention Program – Quality Improvement, Hanh Pham

Capstone Experience: Master of Public Health

This capstone manuscript evaluates the Kansas City Health Department's Childhood Lead Poisoning Prevention Program’s effectiveness. Through comprehensive data analysis of grant utilization, return-on-interest (ROI) and participant satisfaction evaluation, the project will provide actionable recommendations for improving sustainable long-term outcomes in lead poisoning prevention.

Evaluating Surge Capacity In The Emergency Department: A Comprehensive Literature Review On Preparedness And Response Frameworks, Tanner J. Riscoe

Capstone Experience: Master of Public Health

Medical surge capacity in emergency departments is influenced by four critical factors: staff, stuff, space, and systems. Understanding these factors and the interplay between them is critical. Emergency departments are increasingly encountering issues with overcrowding, patient boarding, and medical surge events causing interruptions in care and depleting critical resources. Coordination of medical surge is challenging during normal operations but is intensified during times of crisis. This comprehensive literature review seeks to better understand the current state of the literature surrounding surge preparedness and response in emergency departments across the United States, identify gaps in the current literature, and ultimately recommend …

Utilizing The Health Belief Model To Design A Community-Based Program To Increase Cervical Cancer Screening Rates Among 21 To 25-Year-Olds In The Omaha Metro Area, Karli Baker

Capstone Experience: Master of Public Health

The 2021 Douglas County Community Health Needs Assessment found that cervical cancer screening rates have been on a downward trend since 2011. Previous studies on cervical cancer screening interventions have examined refugee populations, and current programs in Douglas County offer assistance to uninsured women, typically aged 40 and older. However, interventions have overlooked young women aged 21 to 25 in the Omaha metro area, who exhibit the lowest cervical cancer screening rates. We will use the PRECEDE-PROCEED Model as a framework to design an educational program for young women aged 21 to 25, guided by the theoretical underpinnings of the …

Sparkled: Social Programming In Kids Affects Risk Of Latent Endothelial Disease, Rebecca Drakowski

Theses & Dissertations

Background: Social Health Programming (SHP) is a holistic intervention that can empower communities to address modifiable risk factors for poor cardiovascular health, including suboptimal nutrition or psychosocial stressors. SHP participation has been shown to increase dietary intake of fruits and vegetables, decrease perceived stress, and improve cardiovascular endurance. However, it is unknown how SHP participation during adolescence affects carotenoid serum levels, hair cortisol concentrations (biological marker of chronic stress), or vascular reactivity index (VRI; measure of subclinical cardiovascular health).

Methods: Adolescent girls and young adult women (12–29-year-old) were enrolled in this observational cohort study. Serum, hair, and saliva samples were …

Bio-Preparedness In A Global Context: Multi-Site International Study Investigating Global Health Security Challenges In Egypt, Oman, And The United States, Rima M. Al Balushi

Theses & Dissertations

The COVID-19 pandemic exposed myriad vulnerabilities globally within public health systems, from inadequate bio-risk management in laboratories to overwhelming utilization of hospital resources and disparities in vaccine access and uptake. The Global Health Security Index (GHSI), which critically evaluates health security domains including health systems and risk environments, reports serious weaknesses in global health security. This dissertation aims to investigate critical aspects of global health security domains by examining factors impacting biosafety and biosecurity capacities in laboratories in Egypt, healthcare resource utilization in hospitals in Oman relating to acute respiratory infections (ARI), and COVID-19 vaccine uptake in the United States. …

Cardiovascular Disease Risk Reduction Program For Hispanics In The Us Midwest: A Culturally Adapted Intervention, Armando De Alba

Theses & Dissertations

Cardiovascular disease (CVD) represents the second leading cause of death in Nebraska (NE), accounting for approximately one in every five deaths. In the state, there are marked ethnic and rural-urban disparities in the prevalence of chronic diseases and resultant deaths. For instance, while the rates in NE of coronary heart disease and myocardial infarction between 2001 and 2010 decreased among non-Hispanic Whites, the rates for Hispanics almost tripled. There is little evidence of CVD risk factor reduction strategies being implemented in Midwestern areas and Hispanic populations.

One promising approach for reducing CVD risk involves health education and lifestyle modification programs …

From Survivors To Care Providers: A Multi-Dimensional Study On Physical Activity In Cancer Care, Gaurav Kumar

Theses & Dissertations

As the population of cancer survivors grows, understanding the dynamics of physical activity (PA) engagement is critical due to its potential benefits in reducing adverse health outcomes and mortality associated with cancer. Despite known benefits, both adherence to and promotion of PA among cancer survivors face significant challenges. This comprehensive study examines PA levels, barriers, facilitators, and perceptions among cancer survivors and oncology care providers over a ten-year period. The objectives are to assess adherence levels to PA among cancer survivors, explore the perceived barriers and facilitators to PA engagement from the survivors' perspectives, and understand the barriers, facilitators, and …

Evaluation Of Community Healthcare Workers Of Faith-Based Workers In Northern Omaha, Ashley Piwkiewicz

Capstone Experience: Master of Public Health

The University of Nebraska Medical Center (UNMC) developed a training and certificate program for Community Health Workers (CHWs) in faith-based organizations in Northern Omaha. Each recruited trainee developed an experimental program they implemented in their faith-based community. This research study aims to explore and analyze the implementation of these programs in the community, the effects that these programs have on the community, and the extent to which the goals of the CHWs' implemented programs were met.

To achieve this, data was collected through a 41-question survey administered via REDCap to 12 CHW trainees. Descriptive statistics of this data were analyzed …

Examining The Impact Of Racial And Ethnic Disparities In Colorectal Cancer Screening Compliance In The United States And The Potential Of Targeted Interventions., Jessica Ware

Capstone Experience: Master of Public Health

Objectives:

Examine Colorectal cancer (CRC) screening compliance among racial and ethnic groups in the United States (US) based on the US Preventive Services Task Force (USPSTF) recommendations.

Identify targeted interventions to promote screening compliance, early diagnosis, and CRC survivorship.

Methods: This cross-sectional study utilized 165,878 selected participant responses from the 2022 Behavioral Risk Factor Surveillance System. We modeled and investigated CRC screening compliance based on the USPSTF recommendations as inclusion criteria between racial/ethnic groups in the US while adjusting for covariates using a weighted stepwise logistic regression.

Results: With covariates adjustment, Hispanics (POR 1.16 95%CI 1.04-1.29), Asian …

Community Health Assessment Collaboration: Implementing A Joint Assessment Between A Healthcare System And A Local Health Department, Briar L. Deen

Dissertations: Doctor of Public Health

Non-profit hospitals and local health departments (LHDs) often complete community health assessments (CHAs) to help understand the needs of their community and develop implementation strategies to address the community needs. Hospitals and LHDs in the same community often develop separate CHAs with similar results leading to overlap in work and funds. This project aimed to address this issue in the Dallas-Fort Worth Metroplex by convening one local health department, Denton County Public Health, and one non-profit healthcare system, Texas Health Resources, to leverage resources from each other to build a joint CHA. The Mobilizing for Action through Planning and Partnerships …

Examining The Relationship Between Deafness And Mental Health Status: An Analysis Of The Behavioral Risk Factor Surveillance System (Brfss) 2022, Brianna Stroud-Williams

Capstone Experience: Master of Public Health

Objective: The objective of the research is to examine the association between mental health status as measured by number of mentally healthy days in the past month and deafness and binge drinking.

Methods: The Behavioral Risk Factor Surveillance System (BRFSS) study was conducted via telephone survey in 50 states, including the District of Columbia and US territories. The sample size is 402,156 participants. Univariate, bivariate, and multivariate regressions, odds ratio, and 95% confidence interval were used to measure the data.

Results: Deaf respondents have 1.56 times the odds of having poor mental health than those who are not deaf. (95% …

Identifying Barriers To Healthcare Access And Utilization Experienced By Lgbtq+ Adults With Chronic Diseases Through The Lens Of The Social Ecological Model, Devin Mottier

Capstone Experience: Master of Public Health

The purpose of this literature review is to comprehensively examine and synthesize existing research on present barriers to health access and utilization that contribute to the disparities in chronic disease prevalence within the adult LGBTQ+ population. In the context of this review, the social-ecological model (SEM) was used to describe the nuanced and multifaceted nature of healthcare access and utilization. This literature review was based upon the following question: ‘Using the social-ecological model, what are the barriers to health access and utilization that contribute to high rates of chronic disease in LGBTQ+ adults?’ Outcome measures of interest included the following …

Improving Intimate Partner Violence Screening In A Women’S Health Practice Through Implementation Of An Evidence-Based Screening Tool, Jasmine Weber

Doctor of Nursing Practice Projects: College of Nursing

The purpose of this quality improvement project was to implement intimate partner violence screening in an outpatient women’s health clinic with no prior screening process in place. Current recommendations are to screen all reproductive age women for intimate partner violence 6 . During a three-month period 170 patients out of 260 eligible patients were screened using the HARK screening tool, 7 of those patients screened positive and were offered referrals to social work. While universal IPV screening was not achieved, a screening rate of 64% is a remarkable improvement from an apparent absence of screening prior to project implementation.

Inequality In Opportunities And Outcomes: Indicators To Inform Data-Driven Community Systems For Youth Physical Activity, Ann Essay

Theses & Dissertations

Indicators illuminating whole-of-community and setting system physical activity (PA) outcomes and drivers are needed to inform population health improvement efforts. This multi-study dissertation examines inequalities in PA resources, opportunities, and outcomes and the factors influencing inequalities across multiple temporal and geospatial scales (e.g., community, setting). First, a scoping review examined community-level variability in PA resource and opportunity availability by community sociodemographic characteristics (e.g., race). Across 46 included studies, 41 unique indicators characterizing community PA systems were identified, and 29.8% of relationships assessed indicated greater resource/opportunity availability in communities of higher socioeconomic status or lower minority population prevalence. The indicators synthesized …

A Community-Based Participatory Research Approach To Addressing Pediatric Asthma Disparities In Douglas County, Nebraska, Aislinn Rookwood

Theses & Dissertations

Pediatric asthma is the leading chronic disease among children in the United States, and the incidence of pediatric asthma is increasing every year. Nebraska has an asthma prevalence comparable to the United States average; however, the state has significant disparities by county, race, and geographic location, with prevalence rates much higher than the national average. Douglas County is a hot spot for increased pediatric asthma rates, with further differences in rates by race and geographic location within the county. The University of Nebraska Medical Center, in partnership with Healthy Housing Omaha and the Nebraska Asthma Coalition, collaborated to conduct this …

Spotlight On Mental Health On A Healthcare Campus: An Assessment Of Psychological Trauma Awareness, Training, And Treatment In The University Of Nebraska Medical Center College Of Public Health Community, Jenny E. Mueller

Capstone Experience: Master of Public Health

Background: Psychological trauma has been recognized as a public health concern of epidemic proportions globally. Public health community awareness of and education in trauma is likely to be integral to preparing future public health professionals to work effectively and safely in the field. Currently, the extent of trauma awareness, training, and treatment on the University of Nebraska Medical Center College of Public Health (UNMC COPH) campus is not known.

Aims: The aims of this project are to investigate and assess the level of psychological trauma awareness, training, and treatment on the UNMC COPH campus; and to provide recommendations for actions …

Associations Between Self-Reported Cognitive Decline And Chronic Diseases: A Cross-Sectional Analysis Of Behavioral Risk Factor Surveillance System (Brfss) 2022, Hailey Child

Capstone Experience: Master of Public Health

Objective: This study seeks to capture how self-reports measure cognitive decline. The association between chronic conditions and cognition with age consideration in individuals aged 45 and older is investigated.

Methods: Univariate analysis generates frequencies and weighted percentages of 2022 BRFSS data. Chi-square tests and polytomous regressions generate odds ratios for bivariate analyses. A weighted multiple logistic regression model stratified by age group analyzes self-reported cognitive decline.

Results: Respondents ages 45 to 54 with three or more chronic diseases have the highest odds (OR = 6.81; 95% CI = 4.42, 10.48) of cognitive decline. Respondents 75 and older …

Strategies To Encourage Recall And Prevent Relapse After Full Mouth Rehabilitation Under General Anesthesia In Children, Claire Koukol

Capstone Experience: Master of Public Health

Background: Dental caries are preventable. Dentists utilize many prevention strategies in the office and provide at-home education to families. However, once a child develops Early Childhood Caries (ECC), especially in more severe cases, they may need general anesthesia (GA) to complete treatment. While this is an effective way to achieve full mouth dental rehabilitation (FMDR), this burdens the healthcare systems and families and does not come without risk to the patient. Patients with high caries experience remain at high risk of caries relapse after FMDR under GA, sometimes necessitating additional FMDR under GA. While there has been a significant amount …

To Screen Or Not To Screen: Prostate Cancer In Liver Transplant Candidates, Patrick Twohig, Jared Schober, Timothy Mccashland, Thoetchai Peeraphatdit

Graduate Medical Education Research Journal

Prostate cancer screening is a controversial topic in the general population and is even more contested among liver transplant candidates. Not only should transplant programs be concerned about the risk of false positive screening results but also the competing risks of death and the diagnostic and therapeutic effects of true prostate cancer, which often does not cause significant morbidity or mortality in organ transplant recipients. Our letter highlights a best-practices approach to prostate cancer screening in transplant candidates using available research and consensus guidelines.

An Exploration Of Policies, Equity, And Emerging Threats To The Traffic Safety Environment In The U.S., Sachi Verma

Theses & Dissertations

Road traffic crashes are among one of the leading causes of death around the globe. Additionally, it also causes long-term physical disabilities, mental trauma, and financial pressure. By implementing road safety guidelines such as speed limits, drug and alcohol checkpoints, restraints, and penalties, motor vehicle crashes can be reduced. Road traffic crash survival primarily depends on emergency medical service's timely triaging. Rapid triaging and reduced response times can help road traffic crash morbidities and mortalities. However, several factors can be responsible for EMS delays in responding to a fatal crash. This dissertation aims to observe multiple factors related to EMS …

Early Childhood Nutrition Education Implementation Evaluation And Planning: Learn, Grow, Eat & Go!, Alyssa L. Wessling

Capstone Experience: Master of Public Health

The obesity rate among American children aged two to five years old is 12.7% (Centers for Disease Control, 2022), indicating a need for health interventions at this critical life stage. Nebraska Extension’s Nutrition Education Program has identified a need for direct education materials to reach Nebraskans in early childhood. Learn, Grow, Eat & Go! Early Childhood was identified as an appropriate curriculum to be tested in an early childhood intervention pilot. Learn, Grow, Eat & Go! Early Childhood is a newly developed program built upon the foundation of teaching children about healthful foods and physical activity through gardening. An early …

Longitudinal Trends In Body Mass Index And Risk Of Obesity Among Blue Cross & Blue Shield Of Nebraska Insured Sample Population During 2017-2022, Devi Venkata Naga Akshay Dwarabandam

Capstone Experience: Master of Public Health

Objective: To estimate and compare the longitudinal trends in the crude prevalence of obesity in the Blue Cross and Blue Shield of Nebraska (BCBSNE) sample of the adult population with the Behavioral Risk Factor Surveillance System (BRFSS) of Nebraska during the pre-pandemic period (2017-2019) and COVID-19 pandemic period (2020-2022) using standardization methods.

Background: Studying the obesity disease burden in a commercial insurance company's administrative claims data can provide critical insights that can inform policy, practice, and interventions aimed at improving health outcomes, managing costs, and reducing the burden of obesity at the population level.

Methods: This study utilized a cohort …

A Twin Study Of Genetic Heritage And Environmental Influences On Tobacco Susceptibility And Initiation On Early Age, Yadi Liu

Capstone Experience: Master of Public Health

Purpose: Tobacco product susceptibility is defined as the interest a person has to start smoking. Tobacco product initiation refers to whether a person has ever used tobacco products. We aim to understand and explain how genetic and environmental factors affect tobacco products' susceptibility and initiation in children. Methods: The classical twin model estimates three sources of variance: additive genetic (A), shared environmental (C), and unique environments (E). Each source of variance is latent and is calculated from the similarity in the correlations of twin pairs on a phenotype. The magnitude of difference in the correlation of a particular …

Planning A Multiple Myeloma Needs Assessment For Omaha Nebraska, Judith Ngozi Obodougo

Capstone Experience: Master of Public Health

Literature Review

Worldwide, approximately 176,404 people had Multiple Myeloma in 2020, which caused about 117,077 deaths in the same period. Multiple Myeloma is a rare type of blood cancer currently considered a curable malignancy.

Objectives

This public health capstone aims to create a plan for a community needs assessment for multiple Myeloma in Omaha, Nebraska.

Methods

This capstone project modified the Centers for Disease Control and Prevention (CDC) community needs assessment guidelines to create a Multiple Myeloma needs assessment plan for Omaha, Nebraska.

Results

All seven steps outlined in the CDC community needs assessment planning steps were relevant. Omaha, Nebraska, …

Depression And Parenting: A Mixed Method Analysis Of Some Protective Factors For Depression Among African American Fathers Using A Community-Based Participatory Research Approach, Tatiana Tchouankam

Theses & Dissertations

In the United States (US), African American (AA) men often face oppression, discrimination, negative interactions with the justice system, and significant economic, neighborhood, and social hardships over their life course. These challenges increase the risk of chronic exposure to stressful events with negative mental health outcomes, such as depression. Most of the research on parenting and parental depression has focused on mothers based on the premise that women are more often primary caregivers for their children, especially during early childhood. However, a growing number of fathers take on childcare responsibilities. Despite dealing with different life stressors and negative circumstances, AA …

Program Planning On Social Determinants Of Health For Rural Nebraska, Maria H. Cantu Hines

Capstone Experience: Master of Public Health

Social determinants of health (SDOH) are non-health factors that impact health in both direct and indirect ways. Research into SDOH and their effects has been extensive in recent years and has been further documented by the COVID-19 pandemic. Despite the wealth of the literature on the SDOH, awareness of these important factors is not prevalent among community residents. Rural communities are as subject to the impact of SDOH just as their urban counterparts and experience additional complexities related to geography and topography.

This capstone project aims to raise awareness, provide education, and assist with tools and resources, to empower rural …