Other Public Health Commons^™

From Vision To Impact: Strategic Planning For The South Health District, Jason D. Butler Jr

College of Graduate Studies: Theses & Dissertations

This study presents a community health assessment and strategic planning process for the South Health District (SHD), a rural, multi-county public health district.  Using a mixed-methods approach, quantitative surveys and qualitative data from County Nurse Managers, County Boards of Health, and internal staff were integrated with secondary sources to identify community health priorities and organizational gaps.  Broad stakeholder engagement through surveys, SWOT workshops, and town-hall meetings ensured credibility and contextual relevance.

Findings revealed challenges in behavioral health, substance abuse, chronic disease, access to preventive services, transportation, workforce capacity, communication, and infrastructure.  Four strategic issues—Communication, Workforce Development and Retention, Purpose-Driven District, …

Advancing Interoperability Through Governance And Sustainability: A Qualitative Comparative Case Study Of State Health Information Exchanges In The United States, Karterria Finkley

College of Graduate Studies: Theses & Dissertations

This study presents a comprehensive comparative analysis of state-level Health Information Exchanges (HIEs) across all 50 U.S. states and the District of Columbia, examining how governance structures, consent frameworks, funding models, and technical infrastructure influence interoperability maturity, sustainability, and adoption. Guided by Systems Theory and Donabedian’s Structure Process Outcome framework, the research employs a mixed-methods comparative case design integrating systematic documentary review, qualitative thematic analysis, and a policy-anchored analytic scoring methodology. Structural and policy characteristics were operationalized through standardized ordinal (1-5) metrics and aggregated into composite indices representing governance capacity, consent inclusivity, financial sustainability, and technical readiness. This approach enabled …

Exploring The Impact Of Adverse Childhood Experiences On Preventive Healthcare Utilization In Rural Georgia, Ryan R. Traylor

College of Graduate Studies: Theses & Dissertations

This study examines the relationship between Adverse Childhood Experiences (ACEs) and preventive healthcare use among adults in Georgia, specifically within rural populations facing structural barriers. Using 2023 Georgia Behavioral Risk Factor Surveillance System (BRFSS) data, the research analyzes associations between ACE exposure, rural residence, and preventive care outcomes, including physical exams and flu vaccinations. Guided by an intersectionally adapted version of Andersen’s Behavioral Model of Health Services Use, the study evaluates how predisposing factors, enabling resources, and perceived barriers relate to healthcare engagement. Logistic regression analyses assess the correlation of ACE exposure, cost barriers, provider access, and sociodemographics with preventive …

Assessing And Advancing Pandemic Emergency Preparedness In New York City's Hospitals: A Strategic Management Toolkit Integrating Policy Analysis, Risk Assessment, And Stakeholder Insight, Irrem Jamal

College of Graduate Studies: Theses & Dissertations

This dissertation examines pandemic emergency preparedness in New York City hospitals, which were severely strained during COVID-19, revealing critical gaps between documented plans and operational readiness. Using a multimethod approach combining a survey of 20 stakeholders across city hospitals, semi-structured interviews, and document analysis of policy frameworks and after-action reports, the study identifies a persistent "documentation-execution paradox": while 80% of respondents confirmed clear pandemic plans, only 45% expressed confidence in staffing adequacy, 55% in surge planning realism, and just 45% confirmed regular drills. Qualitative analysis revealed workforce as the single greatest yet most underinvested vulnerability, supply chain fragility rooted in …

Exploring The Impact: Eating Disorder Treatment And Mortality In The United States, Brittany Tolbert

College of Graduate Studies: Theses & Dissertations

This study explores adolescent eating disorder trends in the United States between 1999-2013, identifies national eating disorder mortality trends, and analyzes data for in-patient adolescent hospital admissions. Additionally, this study uses public-facing data for residential eating disorder treatment centers to explore issues related to insurance coverage, gender inclusivity, and evidence-informed treatment practices. The findings will highlight gaps in data collection and policy, support advocacy, and contribute to the research into eating disorder prevalence, prevention, treatment outcomes, and economic impact, leading to greater visibility to promote change.

Barriers To Seeking Medical Care And Their Effects Among Fat Patients With A Fat Liberation Praxis In The United States, Christina Seiko Cook

College of Graduate Studies: Theses & Dissertations

Weight stigma and weight bias have significant effects on the health of individuals (Alberga et al., 2019; Pearl, 2018; Puhl & Heuer, 2010; Schwartz et al., 2003; Udo et al., 2016). These biases can show up in the form of fatphobia or anti-fat bias. Physicians who hold anti-fat bias can affect their relationship with their patients, leading to poorer health outcomes and worse patient experiences for larger-bodied and fat people (Phelan et al., 2015). The purpose of this study is to contribute to the current literature regarding the positive and negative experiences of fat patients with a fat liberation praxis …

Exploring The Impact Of Covid-19 And The Role Of The Church On African Americans’ Mental Well-Being In South Georgia, Adrian D. Lewis

College of Graduate Studies: Theses & Dissertations

The emergence of COVID-19 in 2020 disrupted the social dynamics of communities in the United States. Furthermore, public health mandates led to closures that changed how populations access faith. Historically, African Americans have utilized the church to cope with societal stressors. This study will explore the history of church utilization in the African American community, assess how COVID-19 public health mandates led to church closures for the first time in recent history and impacted this marginalized population, and provide a qualitative perspective on the quality of life during the closures and what changed after the closures for African Americans in …

Evaluation Of The Navy Shipshape Program At A Large Navy Military Treatment Facility: A Comprehensive Swot Analysis Approach, Nia Nur Maye

College of Graduate Studies: Theses & Dissertations

The increasing problem of obesity among Navy service members (SMs) is a public health concern that impacts operational readiness and health risks. To combat obesity, the Navy has an official weight management initiative called ShipShape. This project aimed to conduct a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis of ShipShape at a large Military Treatment Facility (MTF) in Portsmouth, Virginia. This program evaluation aimed to identify the internal and external factors that influenced the program's effectiveness to propose suggestions for improvement. Using quantitative and qualitative methods, the evaluation focused on conducting a paired t-test to analyze changes in Body Mass …

Sheprep: Examining The Influence Of The Messaging And The Messenger Associated With Prep Uptake Among African American Women, Christian C. Spears

College of Graduate Studies: Theses & Dissertations

African American Women (AAW) make up less than 15% of the female population in the United States but account for over 50% of new HIV diagnoses among females. This largely preventable health disparity can be mitigated by advocating and prescribing Pre-exposure Prophylaxis (PrEP), a preventive HIV medication, to persons at risk. Despite advances in medication options, there are less than 13% of Black people who could benefit from having been prescribed PrEP, and limited research and promotion on the effectiveness of PrEP for AAW. The “ShePrEP Study” aimed to assess awareness, perceptions, and receptivity toward PrEP among AAW. This study …

Exploring Relationship Among Programmatic Expertise, Work Engagement, And Turnover Intentions Across Different Generation Cohorts In State And Local Governmental Public Health Agencies, Stephanie L. Irvin

College of Graduate Studies: Theses & Dissertations

This study examined the relationship among public health programmatic competencies, work engagement, and turnover intentions among state and local public health workers. It also explored the moderating role of generational cohorts in these relationships. It employed a quantitative secondary data analysis using the 2021 PHWINS survey, a collaboration between the de Beaumont Foundation and The Association of State and Territorial Health Officials. The study's principal findings shed light on critical relationships within the public health workforce: Firstly, an increase in programmatic expertise among public health professionals is linked to increased work engagement, particularly notable within the Millennial cohort. Secondly, a …

Addressing Breast Health Disparities Among Recent, Established African-Born Immigrant Women And Second-Generation Americans In Prince George County, Maryland, Omolola Okunromade

College of Graduate Studies: Theses & Dissertations

Background: Breast health disparities and underutilization of screening methods are major concerns in the United States (US), particularly affecting Black women who experience lower survival rates and advanced diagnoses. Despite the rapid growth of the African-born immigrant population, breast health among this group in the US is notably under-examined. This study aims to investigate the breast health knowledge and practices of first-generation African-born immigrants and second-generation immigrant women of African descent, aiming to understand the distinctive attributes of this group and the impact of acculturation on this public health issue.

Methods: Interviews were conducted among First Generation African immigrants and …

What Could Go Wrong? Patient And Hospital Characteristics Associated With Pediatric Quality Of Inpatient Care And Pediatric Adverse Events, Michael H. Samawi

College of Graduate Studies: Theses & Dissertations

This study aims to analyze associations between hospital and patient characteristics with pediatric adverse events (PAE) in the inpatient hospital setting, utilizing the framework of pediatric quality indicators (PDIs) from the Agency for Healthcare Research and Quality (AHRQ) indicators. Three PDIs were identified and utilized for this purpose: NQI 03 Neonatal Blood Stream Infection, PDI 09 Postoperative Respiratory Failure, and PDI 10 Postoperative Sepsis. The data used for the study is based on an analysis of discharge data from the Healthcare Cost and Utilization Project (HCUP) Kid’s Inpatient Databases (KID) for the year 2019. The findings contribute to the growing …

Using The Cipp Model Of Evaluation On A Health Disparities Curriculum Delivered To Medical Residents In 12 Residency Programs, Gauri K. Shevatekar

College of Graduate Studies: Theses & Dissertations

Background: Although the Accreditation Council for Graduate Medical Education (ACGME) has provided educational directives on health disparities education during residency program for the medical residents, there is paucity of curricula focused on disparities education within the graduate medical education.

Objective: The purpose of this study was to evaluate a Health Disparities Curriculum (HDC) that was delivered to twelve residency programs at a College of Medicine.

Methodology: The study employed a cross-sectional study design. Stufflebeam’s Context-Input-Process-Product (CIPP) model was utilized as theoretical framework to assess whether the curriculum achieved its stated goals and objectives, the teaching and learning processes, and the …

Factors Associated With Intention To Disclose Concussive Symptoms In Active Duty Soldiers, Carly Beck

College of Graduate Studies: Theses & Dissertations

Background: Concussion disclosure is a heavily researched topic, and while previous literature has explored predictors of concussion disclosure in numerous populations, research within the active duty Soldier population is limited. This study further explored predictors of concussion disclosure to a medical professional or leadership in the active duty Solider population through the lens of the Theory of Planned Behavior. Methods: A cross-sectional electronic survey was distributed to 181 active duty Soldiers. Descriptive statistics were used to report frequency of high intention to disclose concussive symptoms among demographics, and a multivariate regression model was used to assess significant predictors of intention …

Becoming A Public Health Professional: Millennials’ Perspective On Organizational Assimilation And Professional Identity, Tony K. Winters

College of Graduate Studies: Theses & Dissertations

ABSTRACT

Public health must confront the ongoing challenge of workforce transitions and the impending exodus of existing employees. The millennial generation rises as an option to fill this workforce gap. Using the Socialization Resource Theory as a framework and qualitative data from in-depth interviews with 27 millennial professionals from federal, state, local, and non-governmental public health agencies, this study describes (a) the organizational assimilation (OA) process for millennial public health professionals, (b) explores the impact of OA on professional identity, and (c) describes how the OA process may impact the retention of public health professionals.

The results from this study …

"Who's The Man?" Examining The Relationships Between Black Masculinity, Perceived Social Support, And Sexual Behavior In Black Male College Students, James Thomas

College of Graduate Studies: Theses & Dissertations

Introduction: Sexual health disparities in college-aged Black men remains a critical public health issue. Black men are likely to have an earlier sexual debut, acquire sexually transmitted infections (STIs) and HIV at higher rates, and enter fatherhood at earlier ages than their White counterparts. Previous research has identified masculinity and perceived social support as predictors of sexual risk behavior for men in the U.S. However, when exploring masculinity’s influence on sexual behavior, studies that are culturally sensitive to Black men’s experiences and perspectives on manhood are few. The purpose of this study was to explore the relationship between Black masculinity, …

Identifying Strategies To Increase The Recruitment And Retention Of Minority Males In The Public Health Workforce: A Two-State Comparative Case Study Approach, Melicent R. Miller

College of Graduate Studies: Theses & Dissertations

Non-White males have higher rates of morbidity and mortality from chronic health conditions as compared to Whites. An essential element for achieving success in eliminating health disparities is to increase the presence of racial/ethnic minorities (i.e., people of color) within public health careers. One of the most important competencies for a public health professional is the ability to work in culturally and racially diverse populations. Yet, individuals are significantly more likely to receive their care and experience greater satisfaction from providers that are of the same racial or ethnic background. The racial/ethnic composition of the health professions workforce continues to …

Perceptions Of Local Board Of Health Effectiveness In Georgia, Amber Erickson

College of Graduate Studies: Theses & Dissertations

Objective: The purpose of this study is to examine the perceptions of the local board of health chairpersons in Georgia on their engagement in six governance functions and examining the challenges faced and facilitators perceived by local boards of health in performing the governance functions properly. Methods: For this descriptive mixed method study design, a survey was administered to all local board of health chairpersons and key informant interviews were conducted with a small selection of board of health chairpersons. Descriptive statistics were produced for recoded survey data variables and themes from qualitative data collected through the surveys and interviews …

An Exploration Of Depression In African American Adults With Sickle Cell Disease: Symptoms, Coping Strategies And The Potential Benefits Of Religiosity, Delores P. Quasie-Woode

College of Graduate Studies: Theses & Dissertations

Depressive symptoms in adults with Sickle Cell Disease (SCD) often go unrecognized and untreated. SCD is one of the most common inherited hemoglobin disorders in the United States, affecting 1 in 365 African Americans. Individuals with SCD and co-morbid Depression lead to high hospitalization rates and healthcare utilization. The objective of this study is to explore depressive symptoms and preferred coping strategies among African American Adults with SCD. Furthermore, the aim is to explore the acceptability of religiosity among those who self-identify as religious.

Interviews were conducted with 30 African American adults, recruited during their hematology appointment at the Center …

Assessing Public Health Workforce Informatics Competencies: A Study Of Three Health Departments In Metro Atlanta, Olatanwa Adewale

College of Graduate Studies: Theses & Dissertations

Background: There is a need for the public health workforce to be current and versatile in technology usage. Public health leveraging technology usage in service delivery has the potential to improve efficiency and bring it to the forefront in the provision of healthcare services. The purpose of this study was to assess public health workforce informatics competencies in select Atlanta health districts and determine the correlates of public health informatics proficiency.

Methods: A 10-item instrument adapted from the recommendations of a Working Group document by the Centers for Disease Control and Prevention and the 2015 Informatics Capacity and …

Assessing Hotel Employee Knowledge On Risk Factors And Risk Management Procedures For Microbial Contamination Of Hotel Water Distribution Systems, Brandon Leftwich

College of Graduate Studies: Theses & Dissertations

Background: Compromised hotel water supply lines by neglect or by physical and structural damage can lead to exposure of harmful pathogens to guests and staff. To reduce the risk of having contaminated water in a hotel plumbing system, some facilities may incorporate a water safety plan (WSP). WSPs are not mandatory for hotels in many US states, including the state of Georgia. As such, many hotel personnel are uninformed of WSPs and the precautions to take if their hotel water system is compromised. The purpose of this study was to identify hotel personnel’s knowledge and practices of WSPs through a …

Exploring The Factors Associated With Social Media Use In Local Health Departments, Suzanne Lamarca Madden

College of Graduate Studies: Theses & Dissertations

Background: The health system in the United States is rapidly advancing, including newer technologies, newer ways of delivering essential public health services and population health. Approximately 70% of the public uses social media as a communication tool, which makes it an ideal platform for dissemination of information. Local health departments (LHDs) are accountable for assuring ten essential public health services, including informing, educating, and empowering people about health issues. Previous research showed less than 70% of LHDs are adequately performing this essential service. The purpose of this study was to examine what factors impact the use of social media by …

Examining Factors Associated With Minority Turnover Intention In State And Local Public Health Organizations: The Relationship Among Diversity Climate, Career Growth Perception, Job & Organizational Satisfaction And Turnover Intention., Ashley Kennedy Mitchell

College of Graduate Studies: Theses & Dissertations

Research shows that a diverse workforce can increase workplace satisfaction, organizational performance, and retention (Konrad, 2006; Choi, 2013; McKay et al., 2007). There is a need to understand governmental public health workforce turnover to ensure the retention of public health minority workers, the capitalization on diversity benefits, and the services needed to provide for a more diverse population. This study aimed to assess the impact of the workforce environment, particularly employee perceptions of the diversity climate, individual career growth, and job and organizational satisfaction, on minority state and local health worker turnover intention. Data were analyzed from the 2017 The …

Let Me Upgrade You: Common Measures In Public Health Accreditation Action Plans, Gurleen K. Roberts

College of Graduate Studies: Theses & Dissertations

Objectives: The purpose of this study is to understand the success rates for health departments pursuing and achieving accreditation in version 1.0 and 1.5 of the Public Health Accreditation Board (PHAB) standards and measures. During the accreditation process, health departments that present performance gaps are asked to complete an Action Plan to specify how they plan to improve to meet the desired conformity. This study will highlight specific measures that are often included in Action Plans so that health departments pursuing accreditation can be better prepared to address these common pitfalls.

Methods: This study is a non-experimental, secondary …

Public Health Workforce Perceived Impact Of Emerging Issues In Public Health, Kristie C. Waterfield

College of Graduate Studies: Theses & Dissertations

Background: In an era where public health has been viewed as a global, multi-disciplinary field, the public health workforce has remained united to unfailingly holding fast to the mission of protecting, promoting, and improving the health of the public. However, the practice of public health is consistently evolving, and the workforce is continually facing a mirage of challenges. In order to overcome these challenges, practitioners need to be up-to-date on the necessary knowledge and skills to effectively deliver the core public health services.

Purpose: The purpose of this research was to explore the perceived impact of emerging trends in public …

Prevention Of Violence Against Children: A Systems Readiness Assessment In Côte D’Ivoire, Marie-Kaye Soletchi Seya-Sery

College of Graduate Studies: Theses & Dissertations

Violence against children (VAC) is a global problem with significant consequences. Recognizing the need to better understand the problem of VAC in Côte d’Ivoire (CI), the government of CI recently completed a survey on violence against children. The recent data will support an evidence-based national action plan for the prevention of VAC. Research shows that initiatives tackling specific problems will only be as successful as the community’s readiness to take action. This study applied the community readiness model to assess the readiness of the multisectoral task force (MSTF) to implement the national action plan in CI. Eight MSTF participants’ interview …

Characteristics Associated With Local Health Departments’ Completion Of Community Health Assessment, Community Health Improvement Plan, And Strategic Planning, Abraham Deng Ater

College of Graduate Studies: Theses & Dissertations

Local health departments engage in community health assessment, community health improvement plan, strategic planning to systematically monitor health, identify risk factors, and to set strategic priorities to improve population health outcomes. Successful completion of these three processes within the last five years is also paramount as they are required for accreditation by the Public Health Accreditation Board. The main purpose of this study was to analyze characteristics of local health departments that are associated with completion of community health assessment, community health improvement plan, strategic planning, and accreditation processes. This cross-sectional study drew data from the 2016 NACCHO profile of …

Factors Associated With Continuous Improvement By Local Boards Of Health, Tran Nguyen

College of Graduate Studies: Theses & Dissertations

Background: The continuous improvement as applied to a local board of health (LBoH) is one of the six governance functions and focuses on activities that target LBoH’s self-improvement and improvement of local health department (LHD) it governs.

Purpose: The purpose of this study was to determine the engagement level of LBoHs in continuous improvement efforts and to identify factors associated with this function. The goal was to provide insights that will inspire LBoHs to improve their continuous improvement governance function for better practices, and in turn, enhance the performance of local health departments (LHDs) for which the LBoHs serve as …

Application Of The Misclassification Simulation Extrapolation (Mc-Simex) Procedure To Log-Logistic Accelerated Failure Time (Aft) Models In Survival Analysis, Varadan Sevilimedu

College of Graduate Studies: Theses & Dissertations

Survival analysis is the study of time to event outcomes. Accelerated Failure Time models (AFT) serve as a useful tool in survival analysis to study the time of occurrence of an event and its relation to the covariates of interest. The accuracy of estimation of parameters in a model depends upon the correct measurement of covariates. Considering that perfect measurement of covariates is highly unlikely, it is imperative that the performance of the existing bias-correction methods be analyzed in AFT models. However, certain areas of bias-correction in AFT models still remain unexplored. One of these unexplored areas, is a situation …

Evaluation Of Tattoo Artists' Perceptions Of Tattoo Regulations In The United States, Jessica L.C. Sapp

College of Graduate Studies: Theses & Dissertations

Background: With the increasing popularity in recent years, tattoos are no longer considered taboo but rather becoming a mainstream mode of self-expression so the inherent risks associated with tattooing could have a greater impact on the public’s health.

Objective: The study aims to gain an understanding and describe the perceptions and opinions of tattoo artists regarding tattoo regulations in the United States.

Methods: Data were collected through an online survey using a descriptive, survey research design. Survey responses were used from 1,315 study participants.

Results: There were 5 health policy related items evaluated: 1) tattoo artists should be licensed, 2) …