Community Health and Preventive Medicine Commons^™

Dental Clinic Deserts In The Us: Spatial Accessibility Analysis, Md Shahinoor Rahman, Jeffrey C. Blossom, Ichiro Kawachi, Renuka Tipirneni, Hawazin W. Elani

School of Public Health Faculty Publications

IMPORTANCE: Little is known about the spatial accessibility to dental clinics across the US. OBJECTIVE: To map the spatial accessibility of dental clinics nationally and to examine the characteristics of counties and US Census block groups with dental care shortage areas. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of US dental clinics in 2023 using data from the IQVIA national practitioners' database, which includes 205 762 active dentists. Data were analyzed from November 2023 to April 2024. EXPOSURES: Socioeconomic characteristics of block groups and counties including rurality, area deprivation, racial and ethnic segregation, and uninsured population. MAIN OUTCOMES AND MEASURES: Enhanced …

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. …

Fda Approves Neffy®- First Nasal Spray For Anaphylaxis, Abigail Carter, Penlope Mazivanhanga, Haylee Whyde, Rileigh Rahrig, Ashley Jacob, Anna Spalvieri, Joshua Honaker, Samantha Mccord, Andrew Roecker

Pharmacy and Wellness Review

Between 1.6 and 5.1% of the United States population have experienced anaphylaxis, a severe allergic reaction.1 Anaphylaxis occurs when someone is exposed to an allergen, most commonly foods, medications, and insect venom. Epinephrine is the first-line agent for anaphylaxis treatment, and it is critical to administer this medication immediately after the onset of anaphylactic symptoms to prevent worsening that could lead to death. Epinephrine, more commonly known as EpiPen® or Auvi-Q®, has historically only been available as an intramuscular (IM) injection. Many people are afraid, anxious, or uneducated on how to properly give someone an IM injection, causing anaphylaxis treatment …

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 …

Assistive Technology Abandonment With Veterans And Leisure Activities, Tara Lamson, Lee Ann Hoffman, Mary Greer

Fall 2024 OTD Capstone Symposium

Veterans using assistive technology (AT) often face barriers that limit their participation in meaningful leisure activities, negatively impacting their mental health and quality of life. This project aimed to address these challenges by developing an educational program focused on improving AT management, reducing abandonment, and promoting leisure engagement. A needs assessment of veterans in Abilene, TX, revealed critical issues, including barriers to leisure, limited community involvement, and gaps in AT maintenance education. The program delivered web-based and in-person resources on AT use, adaptive leisure strategies, and equipment recycling. Key outcomes included enhanced social participation, improved independence, and sustainable solutions for …

Use Of Adventure To Address Play Deprivation In Children And Teens Raised In Conflict, Kristin Salisbury, Mary Jan Greer

Fall 2024 OTD Capstone Symposium

Youth raised in conflict often experience extrinsic and intrinsic factors that contribute to play deprivation and occupational injustice. These factors are reviewed through interviews with stakeholders and participants and observed while embedded in an adventure program for foster and adopted youth and in a refugee camp for families and children. Current literature reveals underlying factors that contribute to play deprivation for these youth, including conditions resulting from trauma and developmental delays due to the absence of play engagement. The poster reviews the programmatic components necessary for addressing these factors through whole-person play-based programming. It considers using adventure-based programming to introduce …

Development Of A Health Education Intervention And Its Effectiveness In Improving Mmr Vaccination Confidence, Attitude And Uptake Among Parents Attending Public Health Clinics In Kuala Lumpur, Aida Mohd Azlan

Student Works (2020-2029)

Despite the progress made in Malaysia's vaccination programmes, measles continues to persist. Parental confidence in measles vaccines plays a pivotal role in ensuring successful immunisation. However, there is currently limited research on effective interventions to measure outcomes related to parental trust in MMR (measles, mumps, rubella) vaccination programmes in Malaysia. Hence, this study aims to determine the effectiveness of Health Education Intervention in improving MMR vaccination confidence, attitude, and uptake among parents attending Public Health Clinics in Kuala Lumpur. Methods: This multi-phase quantitative study, conducted from June 2022–March 2024, utilised the Health Belief Model to assess parental vaccine confidence and …

The Doing, Being, Becoming, And Belonging Of Intergenerational Collective Occupations, Gladys Garcia, Jazminne Orozco-Arteaga

Fall 2024 OTD Capstone Symposium

Background: Older adults have been globally recognized as a vulnerable population. Literature has indicated that intergenerational engagement can decrease social isolation for older adults, but there is a gap in understanding intergenerational co-occupational engagement and how these engagements can improve quality of life and fulfillment of self-identity. The purpose of this qualitative research study was to generate knowledge of how relationships and occupations performed with individuals from a younger generation impacted sense of well-being. Through the lens of Doing, Being, Becoming and Belonging (Wilcock, 2006), the study sought to increase understanding of this lived experience to promote intergenerational practice within …

Infant Mortality Data: Missing Pieces To Prevention In Lesotho, Jacinda Croissant

Master's Projects and Capstones

Lower-middle-income countries (LMICs) like Lesotho lack complete and quality infant mortality data. Without infant mortality data, it can be challenging to develop public health education, programming, and policies to address preventative infant deaths in specific populations (Rao et al., 2004). A literature review identified strategies to improve infant mortality data in LMICs. Through a community engagement model and digital storytelling, community members can gain awareness, begin an ongoing conversation about local public health issues, and participate in an improved data collection system. Infant mortality is often used as an indicator of health for a population; improved infant mortality data can …

Food Security And Its Impact On Hypertension In Urban Communities, Lauren M. Nobriga

Master's Projects and Capstones

The Quality Improvement Team proposed an intervention to increase enrollment in the Food Security Program, a six-month initiative that provides vouchers redeemable for fruits and vegetables. Long-term impacts of this Program include an improved food economy and enhanced patient disease management autonomy. This project aimed to increase the percentage of eligible adult medicine clinic patients enrolled in the Food Security Program by 25%, or 11 patients per month, based on the mean enrollment for the first four months of the Program (May to August) of nine patients. The intervention was based on bi-monthly performance reports, making the goal include enrolling …

Improving Food Security To Decrease Hypertension At An Urban Community Clinic, Christine S. Villalta

Master's Projects and Capstones

Diet and lifestyle changes have been proven to reduce blood pressure in patients with hypertension, and a key dietary approach aligned with this recommendation is the DASH diet, which includes consuming fruits and vegetables. Food insecurity, defined as lacking enough safe, nutritious food to maintain an active and healthy life, is a growing crisis in the United States, affecting 13.5% of U.S. households in 2023. This is especially significant for those whose chronic disease management depends on the accessibility of healthy food. An urban community clinic implemented a Food Security Program to decrease food insecurity and reduce hypertension among their …

Addressing Alcohol Use Disorder In The Outpatient Indigenous Health Clinic Setting, Kylie M. Timmerman

Doctor of Nursing Practice (DNP) Projects

Background: Alcohol use disorder disproportionately impacts American Indian and Alaska Native (AIAN) populations at higher rates of disease morbidity and mortality. In the primary care setting, few treatment resources are available to patients outside of medication-only options.

Local Problem: While the intervention site (rural Tribal Federally Qualified Health Center [FQHC]) was known to have a well-established medication-assisted treatment (MAT) program for opiate use disorder (OUD), the was a need for alcohol use disorder (AUD) resources.

Methods: A review of current evidence was conducted to explore best practices for addressing AUD in the AIAN outpatient clinic setting.

Intervention(s): A quality improvement …

Chronic Disease Screening And Detection In Vulnerable Populations, Courtney J. Seman, Hussein Hadid, Tania Jaimes, Robert Walls

Master's Projects and Capstones

This quality improvement project aims to address gaps in chronic disease screening by implementing standardized protocols for diabetes, hypertension, vision impairment, and scoliosis within the University of San Francisco (USF) Nurse-Led Clinic in Orange County. Problem: The clinic identified a lack of screening practices, which limited early detection and intervention for two specific vulnerable populations. Context: The clinic serves two high-risk groups: older adults, including formerly homeless individuals, and children in two local grade schools. These populations face significant healthcare disparities, making early detection of chronic conditions critical. Interventions: Guided by Kotter’s Change Theory, the project developed and implemented evidence-based …

Take Charge Of Your Health: Start With Your Smile, Jordan L. Lacey, Brizette O. Owusu, Sophia Gardner, Madeline Whitehead, Haeun Park, May Ligno

Nursing Leadership in Community Engagement Projects

Take Charge of Your Health: Start with Your Smile

Oral health is a fundamental component of overall health, yet it is often neglected-particularly among vulnerable populations like houseless individuals (Freitas et al., 2019). Houseless individuals face numerous barriers to accessing healthcare, with dental services being limited. This lack of access contributes to a higher prevalence of oral diseases, which if left untreated, can lead to severe complications. Poor oral health doesn’t just affect the mouth; it negatively impacts one’s overall systemic health, psychosocial well-being, and quality of life (Csikar et al., 2019).

As nursing students engaged in a Community Health …

Review Of Epidemiology, Prevention And Management Of Blood-Borne Viruses Experienced By Aboriginal And Torres Strait Islander Peoples, Katiska Davis, Eliza Lock, Laura Thum, Gemma Crawford, Roanna Lobo, Odette Aung Thein, Shane Kavanagh, Jonathan Hallett

Journal of the Australian Indigenous HealthInfoNet

This review examines the epidemiology, prevention, and management of blood-borne viruses (BBVs) experienced by Aboriginal and Torres Strait Islander peoples in Australia with a focus on hepatitis B, hepatitis C, and HIV. The review highlights the disproportionate burden of BBVs among Aboriginal and Torres Strait Islander peoples in Australia, influenced by historical, social, and cultural factors stemming from colonisation. Key findings include higher prevalence rates of hepatitis B and C compared to non-Indigenous Australians, with some progress in reducing new infections through vaccination and treatment programs. However, significant gaps remain in screening, linkage to care, and treatment uptake. The review …

Impact Of Pathogenic E. Coli In Drinking Water On The Well-Being Of Children, Aysha Khatoon

CBER Conference

Despite global advancements, unsafe drinking water is a major cause of illness, ranked as the eighth highest worldwide (Forouzanfar et al., 2015). Studies indicate that even improved water sources, can harbour faecal contamination (Shaheed et al., 2014; Bain et al., 2014b). Globally, 1.8 billion people rely on drinking water contaminated with faecal matter (Bain et al., 2014a), with pathogenic E. coli being a primary concern. In Pakistan, the situation is dire. About 25 million people, particularly children, suffer due to open defecation, leading to 53,000 child deaths annually from diarrhoea (UNICEF, 2021). Pathogenic E. coli is a significant contributor to …

Machine Learning Approaches For Predicting Dental Caries In Permanent Molars Of Children And Adolescents Using Nhanes 2011-16 Data, Pritam Deb, Christina Scherrer Phd, Lin Li Phd

Symposium of Student Scholars

Dental caries remains a prevalent chronic disease among children, significantly affecting their quality of life, educational outcomes, and school attendance. Between 2011 and 2016, caries affected 17.4% of children aged 6-11 and 56.8% of adolescents aged 12-19, with higher incidences among non-Hispanic Black and Mexican American youth, and those from lower-income families. This study aims to develop a robust machine learning model to predict the presence of decayed, missing, or filled permanent molars (DMFT) in children and adolescents using demographic, dietary, and oral health examination data from the National Health and Nutrition Examination Survey (NHANES) for the years 2011 to …

Prepared To Protect: Improving Cardiac Emergency Response In Youth Club Sports, Melissa Garcia

Nursing | Student Research Posters

Sudden cardiac arrest (SCA) is a medical emergency where the heart unexpectedly stops beating due to an electrical malfunction. A person experiencing a cardiac arrest collapses, loses consciousness, and ceases breathing (American Heart Association, 2022).

Exercise offers numerous benefits to the cardiovascular system and a person’s overall health. However, there are incidents of sports-related cardiac arrest in apparently healthy athletes, including children and young adults. Athletes may be exposed to dehydration, adrenic surges, electrolyte imbalances, acid/base disturbances, and trauma which increases their risk of experiencing a cardiac event (Wasfy et al., 2016).

Sudden cardiac arrest is the leading cause of …

Review Of The Diagnosis, Pathophysiology, And Treatment Of Naegleria Fowleri-Induced Primary Amoebic Meningoencephalitis, Terrance Zhang

MCB Articles

Naegleria fowleri is a thermophilic, ubiquitous, free-living amoeba, but is also known as the “brain-eating” amoeba. This is the etiological agent of a rare and fulminant waterborne disease known as Primary Amoebic Meningoencephalitis (PAM) that is acutely fatal in 90-99% of reported cases. Those who come into contact with infested waters are at risk of introducing the amoeba into their upper nasal canal, whence the trophozoite form is known to migrate along the olfactory nerve, through the cribriform plate, and enter the central nervous system. Although the exact pathogenesis of N. fowleri is not known, studies have demonstrated contact-dependent and …

Determining An Optimal Case Definition Using Mid-Upper Arm Circumference With Or Without Weight For Age To Identify Childhood Wasting In The Philippines, Lyle Daryll Dimaano Casas, Jhanna Uy, Eldridge Ferrer, Charmaine Duante, Paluku Bahwere, Rene Gerard Galera, Alice Nkoroi, Behzad Noubary, Mueni Mutunga, Sanele Nkomani, Roland Kupka, Valerie Gilbert Ulep

Health Sciences Faculty Publications

In resource-limited areas, where accurate weight-for-height Z-scores are hard to obtain, Mid-Upper Arm Circumference (MUAC) is a simple tool to identify wasted children. MUAC alone, however, may miss identification of many wasted children, leading to untimely intervention and potentially death. Our study aimed to identify the best-performing case definition to detect wasting by Weight-for-Height z-scores (WHZ) in Filipino children aged 6-59 months. We analyzed the 2018-2019 Expanded National Nutrition Survey to assess the diagnostic performance of MUAC cutoffs and a case definition combining MUAC and weight-for-age z-score (WAZ) in identifying moderate and severe wasting compared to the WHZ criterion. The …

An Innovative Community‐Led Education And Recruitment Program To Increase Clinical Research Participation Among Black Americans, Bahar Niknejad, Ethlyn Mcqueen Gibson, Travonia Brown-Hughes, Katie Mcdonough, Ebony Andrews, Deborah Hudson, Hamid Okhravi

Glennan Center for Geriatrics and Gerontology Faculty Publications

Background: Previous studies attest to a lack of awareness about Alzheimer’s Disease (AD) and limited participation of Black Americans in AD clinical trials. The AHEAD Study is a multicenter trial focused on preventing AD by evaluating the effectiveness and safety of Lecanemab in individuals with preclinical AD. The study aims to recruit at least 15% from underrepresented populations, including Black Americans. To achieve this goal, our study site utilizes a community-based participatory research (CBPR) approach and developed a Community Education and Recruitment Program (CERP) designed to increase the participation of Black individuals in the AHEAD Study.

Method: In a collaborative …

Understanding And Intervening In Children's Tick Risk Perceptions And Protective Behaviors: A Grounded Theory, Ariel Dawdy

Department of Entomology: Dissertations, Theses, and Student Research

Children, ages 8 years and younger, are at a particularly high risk of contracting a tick-borne disease. This is partially due to the misconceptions spread about tick protective behavior and a poor understanding of how antibiotic treatment can help. Because most communities and families believe that tick control is the individual’s responsibility, looking at the interaction between ticks and human children is essential to understanding the individual’s motivations to protect themselves. To help alleviate the number of individuals contracting tick-borne diseases, misconceptions must be addressed, intervention programs implemented, and a behavioral change must occur. This study used a qualitative research …

Obesity: Influencing Behavioral Consumption Through Meal Kit Distribution, Alejandro Hernandez

Capstone Projects and Master's Theses

Founded in 2002, Everyone’s Harvest is a grassroots nonprofit dedicated to providing access to healthy, affordable fruits and vegetables through certified farmers markets and community food programs. Its key initiatives—Fresh Rx, Market Match, Edible Education and Farms Together —focus on alleviating nutrition insecurity and combating diet-related health conditions by providing vulnerable populations the resources to purchase, or receive, fresh produce and gain nutritional knowledge. This study explores a new intervention: the distribution of farmers' market meal kits as a complementary strategy to the current Edible Education program. These meal kits, which feature seasonally available produce and pre-measured ingredients, aim to …

Opioid Knowledge And Experiences In Nebraska College Students, Natalie Holding

Theses/Capstones/Creative Projects

This study investigated opioid-related knowledge and experiences among 83 Nebraska college students, with an emphasis on awareness, perceived risks, and educational needs regarding opioids and the overdose-reversing drug, naloxone. For participants who have used opioids outside of a doctor’s orders, questions were asked regarding motivations, comorbidities, coping mechanisms, and treatment experiences. Data were collected via an anonymous survey featuring closed- and open-ended questions. Results showed that 41% of participants reported feeling moderately knowledgeable about opioid risks, while 34% felt only slightly knowledgeable. Although 80.7% of participants were aware of naloxone, most were uncertain either about (22.9%) or did not know …

Cuisine As A Compass: Exploring The Therapeutic Benefits Of Community, Cooking, And More Within The Lgbtqia+ Population, Sera Shevchenko, Karen Park Otd, Otr/L, Bcp, Susan Macdermott Otd, Otr/L

Fall 2024 OTD Capstone Symposium

Background: The LGBTQIA+ population experiences unique barriers to occupation and well being. Anti-LGBTQ legislation encroaches on inclusive and affirming care affecting occupational access. Limited occupational participation and additional exhaustive adaptive strategies to engage in occupations safely have an emotional cost. This research study explores how food or mealtime occupations such as cooking, eating, and hosting can support LGBTQIA+ well-being. This research was made possible by LGBTQIA+ participants that are experts of their lived experience.

Methods: This mixed methods research used both qualitative and quantitative methods to gather data on the significance of food-based occupations, culture, mental health, and identity in …

Volunteering For Medically Underserved Children: Clinic With A Heart–Back-To-School Clinics, Isabella Marie Kerby Kessinger

Honors Program: Senior Projects (Public)

Medically underserved children, often from low-income families or areas with limited healthcare resources, face significant barriers in accessing essential medical services and represent a fundamental challenge to equity and social justice. School physicals and back-to-school clinics play a crucial role in addressing these healthcare needs, serving as a gateway to educational and extracurricular opportunities.

Clinic With a Heart (CWH), a non-profit medical and dental clinic in Lincoln, Nebraska, serves as a model for addressing healthcare disparities. In 2023, CWH provided 3,109 visits to 1,846 unique patients, with 83% lacking health insurance and 63% having household incomes below $16,000 annually. The …

Service Provider Perceptions Of Systems Serving Individuals Experiencing Homelessness: A Needs Assessment And Strategic Plan In Johnson City, Tn, Opal Frye-Clark

Electronic Theses and Dissertations

This Integrated Learning Experience (ILE) investigates service providers' perceptions of Johnson City, Tennessee's homelessness services, aiming to inform a city-wide strategic plan for reduction. Employing a mixed-methods approach, the study gathered qualitative data through in-depth interviews with service providers in 2022 and quantitative data via a 2024 survey. The research focused on those directly involved in serving or significantly influencing the lives of individuals experiencing homelessness (IEH). Three key aims guided the investigation: (1) To analyze provider perspectives to identify community assets, opportunities, barriers, and unmet needs, informing a comprehensive needs assessment; (2) To refine these findings through SWOT analysis …

Whole-Of-School Physical Activity Promotion: Findings From Elementary Schools In The United States, Derek W Craig, Christopher D Pfledderer, Natalia I Heredia, Kevin Lanza, Kempson Onadeko, Andjelka Pavlovic, Jizyah Injil, Laura F Defina, Timothy J Walker

Faculty, Staff and Student Publications

INTRODUCTION: Schools can support students' participation in physical activity by offering opportunities consistent with a Whole-of-School (WOS) approach; however, the extent to which physical activity opportunities are provided and how school-level characteristics associate with their use remains unclear. This study examined how elementary schools' use a WOS approach to promote physical activity, as well as associations between school-level characteristics and physical activity opportunities provided.

METHODS: Survey data was collected from 162 elementary schools participating in the NFL PLAY 60 FitnessGram Project during the 2022-2023 school year. A WOS index (ranging from 0 to 12) was created from responses by school …

Water Fluoridation: The Evidence Behind The Risk Of Fluoride Use, Margherita Fontana D.D.S., Ph.D., Carlos González-Cabezas D.D.S., M.S.D., Ph.D., Livia Tenuta D.D.S., M.Sc., Ph.D.

The Journal of the Michigan Dental Association

The debate surrounding fluoride use for caries control has intensified due to recent events, including a National Toxicology Program (NTP) report and a court ruling mandating EPA action on fluoride levels in tap water.

Despite concerns about fluoride's potential neurodevelopmental impact at high concentrations, current evidence shows no adverse effects at the recommended levels of 0.7 ppm in U.S. community water fluoridation programs. While studies in regions with endemic fluorosis suggest an association between high fluoride exposure and lower IQ, methodological limitations undermine causal conclusions.

Global and U.S. health authorities, including the WHO and ADA, reaffirm the safety and efficacy …

Comprehensive Community Medicine, Alexander Walther

Capstone Projects and Master's Theses

Comprehensive Community Medicine (CCM) is a theoretical framework designed to address the complex needs of individuals with dual diagnoses of mental illness and substance use disorders (SUDs). Dual diagnosis is highly prevalent, particularly among populations experiencing homelessness, and is associated with poorer health outcomes and increased healthcare service utilization. Structural inequities, including a fractured healthcare system, exacerbate the challenges faced by this vulnerable group. Research indicates that effective care for dually diagnosed individuals requires a layered approach addressing clinical, systemic, legal, and housing barriers.

The development of CCM has been informed by interviews with local stakeholders, including County EMS board …