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Articles 1 - 30 of 454
Full-Text Articles in Other Public Health
An Assessment Of Accessibility And Affordability Of Inpatient Psychiatric Care In Tennessee, Kailee Havrda
An Assessment Of Accessibility And Affordability Of Inpatient Psychiatric Care In Tennessee, Kailee Havrda
Electronic Theses and Dissertations
Introduction: Access to mental health has seen changes over the past decade, but little research and attention have been given to access to inpatient psychiatric facilities. Inpatient psychiatric care is crucial for patients experiencing mental health emergencies who need immediate access to care. Gaps in spatial accessibility, affordability, and the access and assessment process were identified due to a lack of available information in the field.
Methods: Secondary data from the Tennessee Department of Health were used to assess financial accessibility through payer source charges and patient encounters, as well as through mapping of inpatient psychiatric facilities and conducting drive …
Cultural Tailoring Of Digital Nutrition Interventions: A Scoping Review Of Adaptation Strategies, Evaluation Methods, And Evidence Gaps, Wendy Liang
Master's Projects and Capstones
Background: Nutrition-related chronic diseases disproportionately affect culturally diverse populations, highlighting the need for effective and equitable interventions. Digital nutrition interventions have expanded rapidly due to their accessibility; however, the extent to which they incorporate and evaluate cultural tailoring remains unclear.
Research aim: This scoping review maps the existing evidence on culturally tailored digital nutrition interventions, describes cultural adaptation strategies used, examines methods used to evaluate cultural appropriateness, and identifies gaps for future research and public health practice.
Methods: A scoping review was conducted following the PRISMA-ScR guidelines.
Findings: Culturally tailored digital nutrition interventions generally improved participant engagement, acceptability, and dietary …
Assessing Hpv And Hpv Vaccine Awareness And Perception Amongst Undergraduate Students, Maura Hawkins
Assessing Hpv And Hpv Vaccine Awareness And Perception Amongst Undergraduate Students, Maura Hawkins
Honors Theses
Human Papillomavirus (HPV) is one of the most common sexually transmitted infections in the United States. Vaccination rates remain low among college-aged students despite an effective vaccine being available. This study investigates HPV and HPV vaccination-related knowledge, beliefs, and perceptions among undergraduate students to inform targeted intervention strategies. Participants included undergraduate students (n = 19) who attended one of three focus groups conducted in April 2025 at the University of South Alabama. Structured interview guides explored HPV knowledge, perceived risk and severity, attitudes towards vaccination, autonomy in health decision-making, trust in health information sources, and preferred educational strategies. Discussions were …
Determinants Of Corporal Punishment And Severe Physical Punishment In Egypt: A Mixed-Methods Analysis For Child Protection Policy, Marwa Moustafa Nassef
Determinants Of Corporal Punishment And Severe Physical Punishment In Egypt: A Mixed-Methods Analysis For Child Protection Policy, Marwa Moustafa Nassef
Theses and Dissertations
Corporal punishment (CP) and severe physical punishment (SPP) remain a major public health, child rights, and child protection policy concern. In Egypt, despite legislative reforms, survey-weighted analysis of the 2021 Egypt Family Health Survey (EFHS) 2021 (CAPMAS, 2022) reveals prevalence rates of 60.5% for CP and 27.4% for SPP among children aged 1–14 (author’s calculations using EFHS-2021, n=7623), yet evidence distinguishing the determinants of routine corporal punishment from escalation to severe physical punishment remains limited in low- and middle-income contexts. Guided by Bronfenbrenner’s ecological framework, this mixed-methods study identifies key drivers of CP and its escalation to SPP among Egyptian …
Extraction Of Key Themes In Online Health Discourse Using Unsupervised Learning And Large Language Models, Miranda G. Scully
Extraction Of Key Themes In Online Health Discourse Using Unsupervised Learning And Large Language Models, Miranda G. Scully
Computer Science Senior Theses
Health online discussion boards are a modern platform that allow patients to interact with each other and the healthcare system as a whole, making them valuable sources of information for clinicians seeking to better anticipate treatment experiences and barriers. This study focuses on one such community, r/suboxone, a subreddit where patients using Suboxone share their experiences and ask questions. Our analysis is motivated by previous work that proposes event-based classification systems for such posts which buckets posts from r/suboxone into one or more of five high-level labels (Access Logistics, Co-Occurring Drug Usage, Medication for Opioid Use Disorder Administration, Psychophysical Effects, …
Navigating Trust: The Impact Of Social Media Influencers On Gen Z Health Behaviors, Abigail Stelling
Navigating Trust: The Impact Of Social Media Influencers On Gen Z Health Behaviors, Abigail Stelling
Honors Thesis
Social media plays a defining role in the daily lives of Gen Z, influencing how people communicate, access information, and make decisions. More than a form of entertainment, social media is a powerful source that shapes identity, perceptions, and behaviors. As the first generation to grow up fully immersed in a digital world, Gen Z is uniquely impacted by the content and interactions that occur on social media platforms. Within this digital landscape, social media influencers have emerged as powerful figures. These individuals use large online platforms to promote lifestyles, products, and behaviors. Influencers often have the ability to shape …
Tiktok And The Brain: Neuropsychological Correlates Of Short-Form Video Consumption, Caty Enders
Tiktok And The Brain: Neuropsychological Correlates Of Short-Form Video Consumption, Caty Enders
Psychology ETDs
Short-form video platforms like TikTok have quickly become the fastest growing segment of social media, thanks to powerful algorithms serving up personalized content driven by large quantities of user data. This study investigates the neuropsychological correlates of digital media use, with a particular focus on TikTok and smartphone screen time among young adults. Combining correlational analyses and an experimental design (n = 49; n = 44 included in final sample), we examined the relationship between digital media use and cognitive and emotional functioning across multiple domains. Objective measures of digital media consumption (daily average screen time and time on TikTok) …
“There Was Nothing Left To Give”: Experiences Of Compassion Fatigue Among Former In-Patient Psychiatric Clinicians, Katie Ladner
“There Was Nothing Left To Give”: Experiences Of Compassion Fatigue Among Former In-Patient Psychiatric Clinicians, Katie Ladner
Counseling and Psychology Dissertations
Compassion Fatigue (CF) is a state of emotional and physical exhaustion resulting from prolonged exposure to stressful or traumatic experiences, specifically among healthcare workers, and it negatively impacts their ability to provide care to their patients and perform their jobs effectively (Singh et al., 2020). The purpose of this qualitative study is to explore the lived experiences of compassion fatigue in mental health clinicians who previously worked in in-patient psychiatric hospitals and their subsequent resignations. This phenomenological research explored participants' understanding and descriptions of their CF experiences in their roles within psychiatric hospitals and how CF contributed to their leaving …
Care Without Barriers: Dei And Cultural Competency In Athletic Training Education Programs, Sydney Hotz
Care Without Barriers: Dei And Cultural Competency In Athletic Training Education Programs, Sydney Hotz
Graduate Theses, Dissertations, and Capstones
In the field of athletic training, cultural competency is a topic that is highly under-researched. Athletic trainers (ATs) are healthcare professionals who provide care in a variety of settings, including secondary schools, where their patient population often includes student-athletes experiencing adverse social determinants of health and barriers to healthcare access. Only since 2022 has the governing body of athletic training education mandated that programs include cultural competency and DEI education in their programs, and to this day does not require programs to report adherence and methods of implementation. A quantitative, cross-sectional analysis was conducted to assess the relationship between cultural …
Quantifying Black Carbon Concentrations In Georgia And Analyzing Associated Public Health Risks, Khloe R. Osborne
Quantifying Black Carbon Concentrations In Georgia And Analyzing Associated Public Health Risks, Khloe R. Osborne
Honors Theses
Quantifying Black Carbon Concentrations in Georgia and Analyzing Associated Public Health Risks
One of the most daunting challenges of the industrial world is air pollution. Within this broad spectrum, there is an inhalable particle group named PM2.5, which contains black carbon. Black carbon has evidence that supports the generation and worsening of adverse health impacts, which may include birth complications, cognitive deficits in children, pulmonary aggravation, asthma, cardiovascular issues, neurological degenerative patterns, and cancer risk. This is especially seen in vulnerable populations, like children, elderly, and those who already suffer from weakened health, many of which reside in the southern …
The Legacy Of Lead: Lead Exposure's Harmful Effects And Its Concentration In Poc Communities, Layla Sophronia Barber
The Legacy Of Lead: Lead Exposure's Harmful Effects And Its Concentration In Poc Communities, Layla Sophronia Barber
Student Theses 2015-Present
This thesis examines the disproportionate burden of lead exposure carried by low income, POC communities. The systemic nature of this problem is a symptom of a longstanding legacy of environmental injustice in the United States. Decades of federal neglect are reflected in the higher statistics of lead exposure and poisoning in predominantly black communities. While it is understood that lead exposure poses a serious threat to physical health and early cognitive development, there is a discouraging lack of urgency to remove the toxin from non-wealthy communities. The material covered by this thesis aims to identify and correct the discriminatory social …
Examining The Rural Workforce: Comparing Admissions Strategies And Training Pathways In U.S. Medical And Dental Education, Charolyn A. Harris
Examining The Rural Workforce: Comparing Admissions Strategies And Training Pathways In U.S. Medical And Dental Education, Charolyn A. Harris
Honors Theses
Access to healthcare in rural and underserved communities remains a significant challenge in the United States, particularly in dental care, where workforce shortages are more pronounced. This study examines how medical and dental education programs develop rural healthcare providers, focusing on admissions strategies and training pathways. Using a structured scoping review and secondary data analysis, this research compares how each field incorporates known predictors of rural practice, such as rural background and training experiences, into workforce pipeline development. Findings indicate that while both medical and dental education recognize rural background as a strong predictor of rural practice, medical education more …
Developing A Comprehensive Resource Guide For Caregivers Within The Area Agency On Aging, Aiden R. Murphy
Developing A Comprehensive Resource Guide For Caregivers Within The Area Agency On Aging, Aiden R. Murphy
Public Health Capstone Projects
This project developed a new universal caregiver resource guide for caregivers within the Area Agency on Aging, in order to improve resource navigation and workflow efficiency. Resources were collected, verified, and organized into a new, streamlined guide via the ARIA chatbot, covering multiple needs. Caregiver resources were collected and verified by the capstone student and mentor, Michael Kroeker, and organized into a centralized knowledge base within the ARIA chatbot. A mixed methods evaluation was conducted utilizing a 5-point Likert scale with three quantitative questions and one open-ended qualitative question. The data was given to the SeniorLine staff, who wanted to …
Descriptive Analysis: Effects Of Insufficient Sleep Among College Students Ages 18-22, Divine Ighalo
Descriptive Analysis: Effects Of Insufficient Sleep Among College Students Ages 18-22, Divine Ighalo
Honors Theses
Background: Not getting enough sleep is common among college students and is often linked to habits such as screen time, caffeine intake, stress, and irregular routines. This study examined how these lifestyle factors are associated with insufficient sleep among college students ages 18-22 and how poor sleep affects their overall wellbeing. Methods: This study used a cross-sectional survey design and collected data through an anonymous 25 question online Qualtrics questionnaire. This was completed by 150 participants. The survey was designed to be completed in about 5-7 minutes. It included a mix of multiplechoice questions, frequency-based responses and select all that …
Assessing The Needs Of Public Health Professionals In The Inland Empire, Esteban Silva-Garcia
Assessing The Needs Of Public Health Professionals In The Inland Empire, Esteban Silva-Garcia
Electronic Theses, Projects, and Dissertations
An effective public health system relies on the need for highly trained professionals with degrees or certifications within the field of public health. As public health continues to evolve, professionals are required to improve and evolve with the pace of technology and knowledge advancements. This project focuses on reviewing literature on the current ongoing needs of public health professionals and providing them with resources that are available at low to no cost. It surveys the needs of public health professionals in the Inland Empire and the solutions created by organizations and federal agencies to support professional development for current and …
Charity Pharmacies: An Integrative Overview Of Operations: A Continuing Education Program For Pharmacists, Stella Bertram
Charity Pharmacies: An Integrative Overview Of Operations: A Continuing Education Program For Pharmacists, Stella Bertram
Honors Theses
PROGRAM DESCRIPTION
The goal of this activity is to educate pharmacists about Charity Pharmacies by creating an integrative overview of their purpose, laws and regulations, processes and procedures, eligibility, and opportunities for involvement. This course will ensure pharmacists are competent in the operations involved in volunteering or working within a charitable pharmacy.
Additionally, the information provided supports pharmacists in understanding their roles as well as roles of volunteers. They will understand the importance of their role in the community and the depth of their service within Charity Pharmacies.
Beyond The Numbers: Supporting Young Adults With Diabetes In The Transition To Adulthood, Alexis Salkovick
Beyond The Numbers: Supporting Young Adults With Diabetes In The Transition To Adulthood, Alexis Salkovick
Honors Projects
This project focuses on the transition to adulthood for young people with diabetes, a chronic medical condition. Both Type 1 and Type 2 diabetes are included. The main research focus is two-part: first examining this transition including barriers to health care, changes in lifestyle, and mental health, and then creating a new, innovative tool to support young adults with diabetes. An independent literature review was conducted to investigate diabetes management, barriers to health care, how transitioning to adulthood impacts diabetes care, and the importance of patient support systems. Then, a board game was developed with the dual purpose of educating …
Health Data And Policy Related To Methamphetamine-Use Suicide In Mississippi, Mary C. Drane
Health Data And Policy Related To Methamphetamine-Use Suicide In Mississippi, Mary C. Drane
Honors Theses
The purpose of this research is to investigate how methamphetamine use in Mississippi, especially in its rural areas, intersects with public health, policy, and suicide outcomes in the state. Mississippi's methamphetamine crisis has evolved significantly, shifting from locally produced drugs to cartel-supplied crystal methamphetamine, while state and federal policies have struggled to keep pace with the scale and complexity of the problem. Using a convergent parallel mixed-methods design, this research analyzed CDC Wonder multiple causes of death data and SAMHSA Treatment Episode Data Set Admissions (TEDS-A) data from 2018 to 2024 alongside four qualitative key informant interviews with stakeholders across …
Investigating Social Justice Implications Of Glyphosate Residues In Human Urine, Ananya Malhotra
Investigating Social Justice Implications Of Glyphosate Residues In Human Urine, Ananya Malhotra
Electronic Theses, Projects, and Dissertations
Background: Glyphosate, the nominal active ingredient in professional-grade Roundup weed and grass killer, is the most extensively used herbicide globally and in the United States (U.S. Environmental Protection Agency, 2020). An increasing level of concern has surfaced regarding its health consequences, particularly because of contamination of our food supplies. Recent research indicates distressing levels of detection of glyphosate in human blood and urine samples, revealing many instances of frequent human exposure (Conrad et al., 2017; Zhang et al., 2020).Most of the research about exposure is focused on agricultural workers or individuals living in close vicinity to agricultural lands. Few …
Investigating Tau Pathology In The Retina And Anterior Segment Structures Of The Eye In A 3-Nitropropionic Acid–Induced Tauopathy Mouse Model, Mohamed Sayed Ahmed Abdel-Kader Qasem
Investigating Tau Pathology In The Retina And Anterior Segment Structures Of The Eye In A 3-Nitropropionic Acid–Induced Tauopathy Mouse Model, Mohamed Sayed Ahmed Abdel-Kader Qasem
Theses and Dissertations
Background and Objectives: Alzheimer's disease, the most prevalent neurodegenerative disorder in older adults, is characterized by accumulation of hyperphosphorylated tau and amyloid-beta (Aβ) plaques in the central nervous system. Given the retina's shared embryological origin with the brain, its direct neural connectivity via the optic nerve, and similarities in vasculature and age-related degeneration patterns, retinal pathology may serve as an early, non-invasive biomarker for Alzheimer's disease. This study employed 3-nitropropionic acid (3NP) as a pathway-specific tauopathy model driven by mitochondrial dysfunction. The study particularly aimed to investigate whether retinal and corneal tau pathology reflects underlying tau-related neurodegeneration triggered by …
Prephiral Bacterial Infectious Agent Triggers Neuroinflammatory Responses And Neurobehavioral Impairment In Wild-Type Mice, Hadeer Atalah
Prephiral Bacterial Infectious Agent Triggers Neuroinflammatory Responses And Neurobehavioral Impairment In Wild-Type Mice, Hadeer Atalah
Theses and Dissertations
Neurodegenerative diseases, including Alzheimer's and Parkinson's, present an increasing global challenge, with chronic neuroinflammation identified as a principal factor alongside genetic, environmental, and infectious influences (Boyd et al., 2022). Epidemiological data associate bacterial infections with a 40% heightened risk of Parkinson's disease; however, the mechanisms—especially the direct connection between peripheral sepsis and the silent onset of central nervous system pathology absent acute meningitis—are inadequately investigated (Smeyne et al., 2021), particularly concerning common pathogens like Klebsiella pneumoniae in high-burden areas such as Egyptian ICUs, where it constitutes 30% of cases (Alkompoz et al., 2023). This study filled the gap by creating …
Investigating The Risk Factors Affecting The Control Of Diabetes And Hypertension In The Refugees Living In Egypt, Noura Seada
Investigating The Risk Factors Affecting The Control Of Diabetes And Hypertension In The Refugees Living In Egypt, Noura Seada
Theses and Dissertations
Introduction: Non-Communicable Diseases (NCDs) account for 74% of global deaths, with high prevalence of Diabetes and Hypertension worldwide. Egypt hosts over 1 million registered refugees and asylum seekers, often lacking inclusion in social protection or insurance schemes. This study aimed to assess the factors affecting the control of Type 2 Diabetes (T2D) and Hypertension (HTN) among Syrian and Sudanese refugees in Egypt, focusing on healthcare access, sociodemographic characteristics, lifestyle, and health behaviours.
Methods: This study employed a cross-sectional design using a self-administered questionnaire and BMI measurement. Data were collected from 246 refugees diagnosed with type T2D and/or HTN in the …
Child Maltreatment Risk Identification In Complex Caregiving Environments: A Public Health Review Of Split-Custody And Multi-Household Family Contexts, Makenzie Lee
Theses and Dissertations
Child maltreatment remains a significant public health concern with lifelong consequences for children's health, development, and well-being. As children's caregiving environments become increasingly diverse through split-custody arrangements, blended families, kinship care, and other multi-household contexts, recognizing and assessing child safety concerns may become more complex. Although these family structures are not inherently associated with maltreatment, the distribution of caregiving responsibilities and information across multiple households may complicate child maltreatment risk identification.
This capstone presents a scoping review of peer-reviewed literature examining child maltreatment risk identification within complex caregiving environments. The review synthesized evidence related to caregiving environments, caregiver relationships, child …
Exploring The Impact Of Adverse Childhood Experiences On Preventive Healthcare Utilization In Rural Georgia, Ryan R. Traylor
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 …
The Impact Of Gastric Sleeve And Roux-En-Y Gastric Bypass On Chief Cell Function And Protein Digestion In Obese Patients, Garikoitz Mikel Gainza
The Impact Of Gastric Sleeve And Roux-En-Y Gastric Bypass On Chief Cell Function And Protein Digestion In Obese Patients, Garikoitz Mikel Gainza
Honors Undergraduate Theses
Obesity has become one of the largest global health concerns of the 21st century, correlating with numerous associated diseases. To help address the growing prevalence and burden of obesity, sleeve gastrectomy and Roux-en-Y gastric bypass have become two commonly performed surgical procedures done to promote weight loss by altering the anatomical structure of the stomach and surrounding organs of the gastrointestinal system. Although the benefits of improved metabolism linked to these surgical procedures are well studied, their impact on the physiology of gastric cells, and more specifically chief cells as they relate to protein digestion post-surgery, is yet to …
Iron Deficiency And Iron Deficiency Anemia: Inconsistent Screening Practices And Delayed Result Processing In Children 12-18 Months, Madonna J. Mahoney Marshall
Iron Deficiency And Iron Deficiency Anemia: Inconsistent Screening Practices And Delayed Result Processing In Children 12-18 Months, Madonna J. Mahoney Marshall
Doctor of Nursing Practice (DNP) Scholarly Projects - Archive
Introduction:
Iron deficiency and iron deficiency anemia in children aged 12 to 18 months are prevalent conditions that, if not identified and treated early, are associated with adverse neurodevelopmental outcomes.
Purpose:
This quality improvement project evaluated the impact of a standardized screening and follow-up protocol on laboratory result retrieval, provider review, and caregiver follow-through in a military pediatric clinic.
Method:
A pre-post intervention design guided by the Plan-Do-Study-Act framework was implemented over 11 weeks and included staff education, standardized workflows, and caregiver outreach.
Results:
The intervention improved laboratory completion and caregiver follow-up rates; however, sustainability was limited by staffing constraints …
Identifying And Prioritizing Essential Healthcare Services For A Private Start-Up Healthcare Hub In Laxmipasha, Bangladesh, Ferdous Ara Mostofa
Identifying And Prioritizing Essential Healthcare Services For A Private Start-Up Healthcare Hub In Laxmipasha, Bangladesh, Ferdous Ara Mostofa
Dissertations
This quantitative study identifies and prioritizes essential healthcare services for developing a private start-up healthcare hub in Laxmipasha, Bangladesh, a rural community with significant gaps in healthcare access. Using secondary data from national and international sources, the research analyzed disease burden, population characteristics, and service availability to determine the most urgent health priorities. A structured, evidence-based framework was used to evaluate services based on mortality and morbidity, service gaps, and potential health impact. The findings indicate that Maternal and Child Health (MCH), Non-Communicable Disease (NCD) management, and infectious disease control represent the most critical priorities for initial implementation. The study …
Advancing Interoperability Through Governance And Sustainability: A Qualitative Comparative Case Study Of State Health Information Exchanges In The United States, Karterria Finkley
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 …
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 …
From Vision To Impact: Strategic Planning For The South Health District, Jason D. Butler Jr
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, …