Beyond The Ban: Chhaupadi Abolition And The Governance Of Menstrual Autonomy In Western Nepal, Nikita Paudel

Master in Public Policy Theses

This thesis examines how two decades of efforts to abolish chhaupadi have shaped the everyday conditions under which women and girls experience menstruation in western Nepal. Chhaupadi, commonly understood as menstrual seclusion, has been addressed through Supreme Court directives, national policy, criminal law, municipal implementation instruments, hut demolition campaigns, public health programming, and rights-based advocacy. Yet the practice has persisted, adapted, and in some cases moved into less visible spaces. Rather than treating this as a simple gap between law and practice, this thesis asks how abolition efforts themselves have become part of the regulatory regime through which menstruation is …

University Student Mental Health: Service Utilization, Equity Gaps, And Strategies To Improve Access, Richard Mutua Kilonzo

Electronic Theses and Dissertations

Student mental health and access to care are pressing concerns in higher education. This study assesses mental health outcomes and access to campus mental health services at East Tennessee State University. Survey data from the 2023–2024 Healthy Minds Study were analyzed to report the prevalence of depression, anxiety, and suicidal ideation across the student population. The study evaluates disparities in these outcomes and barriers to care across student groups, with particular attention to equity-impacted students, especially sexual and gender minority students.

Findings indicate widespread psychological distress alongside persistent barriers, including long wait times, limited-service availability, and stigma-related concerns. These barriers …

Exploring Systemic Challenges In The Western North Carolina Dental Safety Net: A Qualitative Analysis, Blaire Mirmow, Bill Milner, Nadia Laniado

Journal of Appalachian Health

Introduction: Despite statewide growth, rural communities in Western North Carolina (WNC) face persistent barriers to oral health care driven by chronic dental workforce shortages and systemic geographic disparities. Within this Appalachian region, the dental safety net serves as a vital yet strained support system, struggling with limited financial resources and a lack of provider participation that leaves many underserved populations without essential oral health services.

Purpose: This study aims to explore the experiences of individuals working within the WNC dental safety net to identify barriers and strategies required to strengthen the delivery of oral health care in high-need rural settings. …

A Mixed-Methods Research Study: Nc Health Department Directors’ Perspective On Local Impact Of Early Medicaid Expansion, Asma Warrich

MUSC Theses and Dissertations

North Carolina became the 41^st state to expand Medicaid under the Affordable Care Act. The bipartisan expansion addressed longstanding challenges; however, little is known about how Local Health Departments (LHDs) adapted to this policy change, especially in the 24 months following expansion. This study sought to fill that gap by documenting the perspectives of LHD Directors in North Carolina utilizing a ten-question REDCap survey with closed- and open-ended questions. Purposeful sampling targeted all 86 LHD Directors. Data was collected anonymously between November 2025 and January 2026. Descriptive and thematic analyses were conducted. Thirty LHD Directors completed the survey, which …

On Burden Of Diseases, Prevention, Medical Research And Health Service Delivery: Grampian Case Study, Seshadri S. Vasan, Sudarshan Anand, Miae Lee, Nicholas C. Fluck

Research outputs 2022 to 2026

Burden of diseases measured as disability-adjusted life years (DALYs) per 100,000 people can be mined from public domain data, when they are made available by population health surveillance systems. This can be analysed to allow insightful comparisons with the national average, and to understand differences in trends between the sexes, age groups, time periods, geographic regions, and sub-regions. In this illustrative case study, we have analysed the Scottish burden of disease database to understand what ailed the population of the Grampian region before the COVID-19 pandemic. We have identified that selected cancers, ischaemic heart disease, Alzheimer’s disease and other dementias …

Diabetes And Hypertension Frequencies And Trends In The Health Districts Of Sololá, Alejandro Cerón, Sophie Perfetto, Ana Textor, Sidona Alemayehu, Emilia Alvear Escobar, Adele Beard, Sarah Berson, Rachel Bryant, Jennifer Calzontzi, Rylee Castro, Eva Cress Palencia, Jake Czarnecki, Jordyn Epstein, Nikki Harris, Patience Hinojos, Max Hippisley, Erin House, Jackson Hullett, Nathan Johnson, Amelie King, Saule Lankelyte, Juan Loya, Ashley Mackenzie, Ilana Mighdoll, Molly Morrill, Maria De Jesus Ramos Jimenez, Lilly Teklemedhin, Joseph Trujillo, Lauren Verachtert, Nathan Verachtert, Violet Vreeland, Alex Welch, Jada Wright

Anthropology: Undergraduate Student Scholarship

This report was prepared by the students, Graduate Teaching Assistants, and instructor of “The Social Determination of Health” class taught in the fall of 2025 at the University of Denver. The report was prepared for Dr. Luis Pablo Méndez, of the Vice Ministry of Health Regulation, Surveillance and Control, of the Ministry of Public Health and Social Assistance of Guatemala. The work used the following guiding question: How can available data about service production can be used to inform the planning process for the implementation of the Global Hearts Initiative’s HEARTS technical package in the Distrito de Redes Integradas de …

Band-Aids And Backroads: Surviving Rural Healthcare In South-Central Mississippi, Cambry L. Craft

Honors Theses

Health is more than the absence of disease—it is the product of opportunity, trust, and access. Yet for millions living in rural areas of the United States, equitable healthcare remains out of reach. This thesis seeks to amplify the voices of rural residents in Mississippi and uncover how their experiences, beliefs, and cultural values shape their perception of their local hospital and the care that is provided there. This qualitative research study examines the experiences and opinions of a rural community in south-central Mississippi regarding their local hospital, as well as their perceptions of the most effective approach to prevent …

Author Reply: Investment Case For Mental Health, Cyprian Mostert

Population Health, East Africa

No abstract provided.

Influences And Implications Of Medical Mistrust On Healthcare Behaviors In A Low Health Outcomes County In The State Of New Jersey, Dale Johnson, Adeena Javed, Nathaniel J Byrnes, Anne C Jones, Kristin N Bertsch

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Medical mistrust is an ongoing concern in the United States, with patient confidence in both individual practitioners and institutions decreasing sharply in recent years. Atlantic County, New Jersey has some of the worst health outcomes in the state and is below the national average. This study sought to investigate medical mistrust by recruiting participants to complete a survey and/or health screening at 12 food pantry distribution events throughout Atlantic County (N = 124). The mean score for the Medical Mistrust Index was 19.06 (SD = 5.6) for participants who reported receiving the annual influenza vaccine and 16.05 (SD = 4.7) …

Knowledge, Attitudes, And Practices Regarding Antimicrobial Resistance And Antimicrobial Stewardship Among Healthcare Workers In Outpatient Medical Centers In Kenya: A Qualitative Study, Mary Kaniu, Wahu Gitakah, Rupali Jain, Ann Munyare, Rodney Adam, Aliza Monroe Wise

Paediatrics and Child Health, East Africa

Objective: Antimicrobial resistance (AMR) is a major global health threat with a projected 10 million deaths globally by 2050. Antimicrobial stewardship (AMS) programs are coordinated efforts involving doctors, nurses, pharmacists, and other healthcare providers. Understanding knowledge, attitudes, and practices of health providers is pivotal for implementing strategies to curb the spread of AMR. The aim of this study was to evaluate knowledge, attitudes, and practices surrounding AMR and AMS among healthcare workers in Kenya.

Design: A qualitative study using in-depth semi-structured interviews

Setting: 12 private outpatient clinics in Kenya.

Participants: Healthcare workers including administrators and clinicians. …

Assessing Middle Eastern American Attitudes Towards Substance Use Disorders, Hazem Alata, Hussein Bazzi, Saleh Al-Juburi, Angie Achkar, Liam Browning, Nicole Oska, Adam Chaban, Arash Javanbakht

Medical Student Research Symposium

Assessing Middle Eastern American Attitudes Towards Substance Use Disorders

Introduction:

Substance use disorders (SUD) among Middle Eastern and North African (MENA) populations remain largely understudied, despite evidence of high prevalence rates and lower rates of treatment engagement. Unique cultural conceptualizations and beliefs surrounding substance use disorders may perpetuate stigma, further contributing to disparities in access to and utilization of treatment services. This study aims to explore the attitudes and perspectives of individuals from MENA communities regarding substance use disorders, with the goal of identifying and addressing barriers to treatment.

Methods:

An anonymous bilingual Qualtrics survey was administered, gathering responses from …

Birth Defect Trends Within Texas Public Health Region 11, 2000-2019: An Analysis Of Texas Department Of State Health Services Public Data, Jonathan M. Hebert, Miguel A. Lopez, Padmanabhan Rengasamy

Research Colloquium

Background: South Texas is a medically underserved area with pockets of low socioeconomic status and poor access to healthcare, including prenatal care. This paper aims to monitor the changes in prevalence for cardiac, circulatory, gastrointestinal, genitourinary, and neural tube birth defects in this region in the last two decades to monitor the effectiveness of current public health efforts.

Methods: Public data on 20 birth defects from the Texas Department of State Health Services were obtained for decades 2000-2010 and 2010-2019 in Texas Public Health Region 11 and the remaining regions of Texas. Prevalences and odds ratios for all birth defects …

The Next Phase Of Public Health: Innovations From The Private Sector To Build Health Equity, Collaborations, And Resilience, Susan Garfield, Amy S. White, Frances Garfield, Rick B. Siegrist, Natasha Eslami

Publications and Research

The Covid-19 pandemic highlighted foundational challenges in managing the public's health and the persistent health inequities in our communities. Within the private sector, companies witnessed how adverse health events impact the economy at large, their employees, and their customers. As a result, many companies have begun to see that they have a critical role in improving the long-term well-being of the communities in which they work and how health equity can build resilience. This recognition has driven many to action. Either on their own or in collaboration with established public health players, companies are deploying private sector points of view …

Changing The Playbook For Immigrant Health, Cheryl Bettigole, Patricia C. Henwood, Sage Myers, Maura Sammon

Department of Emergency Medicine Faculty Papers

Philadelphia’s response to welcoming Afghan evacuees during the COVID-19 pandemic suggests the need for a new approach to immigrant health care.

Wound Care For Unhoused Youth, Diana Altman, Monse Villasenor, Grace Fry, Maddy Johnson, Matthew Messenger

Nursing Leadership in Community Engagement Projects

Wound Care For Unhoused Youth

Introduction

We partnered with a non-profit organization designed to serve the unhoused youth, ages 18-25, who have a day program as well as an overnight shelter. They have 30 beds and reserve 20 of those beds for individuals who are “residents,” who commit to staying for several nights and work towards finding more permanent options. The other 10 beds are for individuals to use for a single night, but these are not always guaranteed, you must sign up to save a spot. The day program has various activities ranging from painting to resume workshops and …

Neighborhood Condition Prevalence Rates Correlate With Covid-19 Mortality In Milwaukee County, Wisconsin, George L. Morris Iii

Journal of Patient-Centered Research and Reviews

Purpose: We sought to determine if census tract-level (ie, neighborhood) COVID-19 death rates in Milwaukee County correlated with the census tract-level condition prevalence rates (CPRs) for individual COVID-19 mortality risk.

Methods: This study used Milwaukee County-reported COVID-19 death rates per 100,000 lives for the 296 census tracts within the county to perform a linear regression with individual COVID-19 mortality risk CPR, mean age, racial composition of census tract (by percentage of non-White residents), and poverty (by percentage within census tract), followed by multiple regression with all 7 CPRs as well as the 7 CPRs combined with the additional demographic variables. …

A Global Perspective Of Advanced Practice Nursing Research: A Review Of Systematic Reviews Protocol, Kelley Kilpatrick, Isabelle Savard, Li-Anne Audet, Abby Kra-Friedman, Reneé Atallah, Mira Jabbour, Wentao Zhou, Kathy Wheeler, Elissa Ladd, Deborah C. Gray, Colette Henderson, Lori A. Spies, Heather Mcgrath, Melanie Rogers

Ellmer School of Nursing Faculty Publications

Introduction

In 2020, the World Health Organization called for the expansion and greater recognition of all nursing roles, including advanced practice nurses (APNs), to better meet patient care needs. As defined by the International Council of Nurses (ICN), the two most common APN roles include nurse practitioners (NPs) and clinical nurse specialists (CNSs). They help ensure care to communities as well as patients and families with acute, chronic or complex conditions. Moreover, APNs support providers to deliver high quality care and improve access to services. Currently, there is much variability in the use of advanced practice nursing roles globally. A …

Decision-Making Processes For Essential Packages Of Health Services: Experience From Six Countries, Rob Baltussen, Omar Mwalim, Karl Blanchet, Manuel Carballo, Getachew Teshome Eregata, Alemayehu Hailu, Maryam Huda, Mohamed Jama, Kjell Arne Johansson, Teri Reynolds

Community Health Sciences

Many countries around the world strive for universal health coverage, and an essential packages of health services (EPHS) is a central policy instrument for countries to achieve this. It defines the coverage of services that are made available, as well as the proportion of the costs that are covered from different financial schemes and who can receive these services. This paper reports on the development of an analytical framework on the decision-making process of EPHS revision, and the review of practices of six countries (Afghanistan, Ethiopia, Pakistan, Somalia, Sudan and Zanzibar-Tanzania).The analytical framework distinguishes the practical organization, fairness and institutionalization …

Exploring Stakeholders' Experiences And Perceptions Regarding Barriers To Effective Surveillance Of Communicable Diseases In A Rural District Of Pakistan: A Qualitative Study, Imran Naeem Abbasi, Sameen Siddiqi, Mmna Rehana Sididiqui, Rumina Hasan

Community Health Sciences

Objective: To explore the experiences and perceptions of health system stakeholders of a rural district of Sindh, Pakistan regarding the barriers to effective surveillance of communicable diseases.
Design: This qualitative descriptive exploratory design comprised in-depth interviews. Both inductive and deductive thematic analysis was applied to identify key themes from the data.
Settings: The study was conducted in public sector healthcare facilities and the district health office of the rural district of Thatta, in Sindh province, Pakistan.
Participants: Fifteen healthcare managers and healthcare providers working in the eight public sector primary and secondary healthcare facilities were interviewed using an open-ended in-depth …

Governing Cross-Sector Collaboratives: Evaluation Observations From The California Accountable Communities Of Health Initiative (Cachi), Center For Outcomes Research And Education, Desert Vista Consulting, Agd Consulting

Articles, Abstracts, and Reports

No abstract provided.

Emerging Lessons From The Covid-19 Pandemic About The Decisive Competencies Needed For The Public Health Workforce: A Qualitative Study, Osnat Bashkin, Robert Otok, Lore Leighton, Kasia Czabanowska, Paul Barach, Nadav Davidovitch, Keren Dopelt, Mariusz Duplaga, Leah Okenwa Emegwa, Fiona Macleod, Yehuda Neumark, Maya Peled Raz, Theodore Tulchinsky, Zohar Mor

College of Population Health Faculty Papers

The global COVID-19 crisis exposed the critical need for a highly qualified public health workforce. This qualitative research aimed to examine public health workforce competencies needed to face COVID-19 challenges and identify the gaps between training programs and the competency demands of real-world disasters and pandemics. Through a sample of thirty-one participant qualitative interviews, we examined the perspectives of diverse stakeholders from lead public health organizations in Israel. Grounded Theory was used to analyze the data. Six themes emerged from the content analysis: public health workforce's low professional status and the uncertain future of the public health workforce; links between …

Overview Of Transition Care Clinics And Patient No-Shows, Manul Awasthi

Electronic Theses and Dissertations

Introduction

Transition care clinics (TCCs) have proven to be effective in meeting the time-sensitive needs of patients in the post-discharge period and ensuring smooth transitions of patients from hospital to home. These clinics have led to lower readmissions, lower emergency department visits, cost savings, and lower rates of other adverse events following discharge. However, TCCs, including the East Tennessee State University Family Medicine (ETSU-FM) TCC have been facing high rates of patient no-shows.

Aim

The aim of this dissertation is to identify the different components and outcomes of TCC based on the literature. We further aim to analyze the TCC …

Healthcare Safety-Net In The United States: Patient Satisfaction Across Rural And Urban Hospitals, Vivian Ho

Senior Theses

Objective. To examine rurality and other hospital characteristics associated with patient satisfaction across hospitals in the United States.

Data. Nationwide hospital data from the 2019 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and the 2020 Centers for Medicare & Medicaid Services (CMS) Provider of Services (POS) file.

Study Design. Hospital ZIP-codes were categorized into urban, rural micropolitan, or small/isolated rural based on Rural-Urban Commuting Area (RUCA) codes. Patient satisfaction measures from the HCAHPS survey were linked to the CMS POS data for hospital characteristics, yielding 2,357 urban, 749 rural micropolitan, and 1,343 small/isolated rural hospitals. ANOVA and …

“Pandemias Políticas: The Effects Of Political And Social Instability On Infectious Disease Epidemiology In Latin America"”, Sarah H. Noonan

Senior Theses

This paper seeks to analyze the relationship between political and social unrest and conflict and infectious disease epidemiology in Latin America. An analysis of published literature regarding epidemiological, biomedical, political, and historical content was conducted to highlight potential connections between infectious disease epidemics and sociopolitical conflict in the region. Specific analyses of Smallpox, Venezuelan Equine Encephalitis, Chagas disease, Cholera, Dengue, and COVID-19 were conducted, in an effort to uncover potential causations and context of epidemics of these conditions. Results of this analysis depict a necessity for further research into public health and disease control mechanisms during times of conflict and …

The 2025 Michigan State Oral Health Plan, Ellen Sugrue Hyman Jd

The Journal of the Michigan Dental Association

This feature article explores the 2025 Michigan State Oral Health Plan (SOHP), a comprehensive initiative developed by the Michigan Oral Health Coalition (MOHC) and a statewide coalition, including the Michigan Dental Association (MDA). With a focus on enhancing oral health for all Michigan residents, the SOHP prioritizes addressing economic and racial disparities. The plan, guided by three key goals—Increasing Awareness and Education, Dental-Health Integration, and Access and Infrastructure—aims to improve oral health outcomes. The article discusses the plan's development process, key findings highlighting existing disparities, workforce challenges, and the strategic implementation of the SOHP through collaborative efforts and workgroups.

Inclusive, Supportive And Dignified Maternity Care (Sdmc)-Development And Feasibility Assessment Of An Intervention Package For Public Health Systems: A Study Protocol, Bilal Iqbal Avan, Waqas Hameed, Bushra Khan, Muhammad Asim, Sarah Saleem, Sameen Siddiqi

Community Health Sciences

Introduction: Mistreatment, discrimination, and poor psycho-social support during childbirth at health facilities are common in lower- and middle-income countries. Despite a policy directive from the World Health Organisation (WHO), no operational model exists that effectively demonstrates incorporation of these guidelines in routine facility-based maternity services. This early-phase implementation research aims to develop, implement, and test the feasibility of a service-delivery strategy to promote the culture of supportive and dignified maternity care (SDMC) at public health facilities.
Methods: Guided by human-centred design approach, the implementation of this study will be divided into two phases: development of intervention, and implementing and testing …

Impact Of The Covid-19 Pandemic On Loneliness And Social Isolation: A Multi-Country Study, Roger O’Sullivan, Annette Burns, Gerard Leavey, Iracema Leroi, Vanessa Burholt, James Lubben, Julianne Holt-Lunstad, Christina Victor, Brian Lawlor, Mireya Vilar-Compte, Carla M. Perissinotto, Mark A. Tully, Mary Pat Sullivan, Michael Rosato, Joanna Mchugh Power, Elisa Tiilikainen, Thomas R. Prohaska

Department of Public Health Scholarship and Creative Works

The COVID-19 global pandemic and subsequent public health social measures have challenged our social and economic life, with increasing concerns around potentially rising levels of social isolation and loneliness. This paper is based on cross-sectional online survey data (available in 10 languages, from 2 June to 16 November 2020) with 20,398 respondents from 101 different countries. It aims to help increase our understanding of the global risk factors that are associated with social isolation and loneliness, irrespective of culture or country, to support evidence-based policy, services and public health interventions. We found the prevalence of severe loneliness was 21% during …

Conflicts Of Interest: An Invisible Force Shaping Health Systems And Policies, Afifah Rahman-Shepherd, Priya Balasubramaniam, Meenakshi Gautham, Eleanor Hutchinson, Freddy E. Kitutu, Robert Marten, Mishal S. Khan

Community Health Sciences

No abstract provided.

Prevalence And Determinants Of Inappropriate Antibiotic Dispensing At Private Drug Retail Outlets In Urban And Rural Areas Of Indonesia: A Mixed Methods Study, Luh Putu Lila Wulandari, Mishal Khan, Marco Liverani, Astri Ferdiana, Yusuf Ari Mashuri, Ari Probandari, Tri Wibawa, Neha Batura, Gill Schierhout, John Kaldor

Department of Pathology and Laboratory Medicine

Introduction: The aim of this mixed-method study was to determine the extent and determinants of inappropriate dispensing of antibiotics by licensed private drug retail outlets in Indonesia.
Methods: Standardised patients (SPs) made a total of 495 visits to 166 drug outlets (community pharmacies and drug stores) between July and August 2019. The SPs presented three clinical cases to drug outlet staff: parent of a child at home with diarrhoea; an adult with presumptive tuberculosis (TB); and an adult with upper respiratory tract infection (URTI). The primary outcome was the dispensing of an antibiotic without prescription, with or without the client …

Voices From The Field: A Qualitative Study Of The Challenges And Promising Practices Of Rural Public Health In Addressing Hiv And Hepatitis C, Martha Elbaum Williamson Mpa, Karen B. Pearson Mlis, Ms, Amanda R. Burgess Mppm, Jennifer D. Lenardson Mhs, Erika C. Ziller Phd

Population Health

Rural areas of the United States may be vulnerable to an HIV or hepatitis C (HCV) outbreak among persons who inject drugs. Researchers at the University of Southern Maine’s Rural Health Research Center examined the capacity of rural public health systems to prepare for, identify, control, and respond to an HIV or HCV outbreak. Through semi-structured interviews with 36 state and local public health professionals from six rural states, we sought to understand the challenges related to HIV, HCV, and serving rural persons who inject drugs and to identify strategies to address those challenges. Challenges limiting the public health capacity …