Medicine and Health Commons^™

Beyond The Cycle: How Menstruation Influences Gender Identity And Well-Being In Binary And Non-Binary Adults, Rin Nguyen

College of Education and Human Sciences: Dissertations, Theses, and Student Research

Approximately 1.8 billion people worldwide menstruate, including transgender and gender-diverse (TGD) people, yet their experiences remain underrepresented in research. Given that menstruation can affect gender alignment and psychological well-being, understanding its impact on TGD people is critical. Gender congruence, or alignment between one’s gender identity and expression, is a key factor influencing well-being, with research linking it to reduced depression and anxiety. Furthermore, emerging research on gender euphoria, the joy experienced when gender congruence is experienced, suggests it may serve as a protective factor for mental health and well-being. Gender euphoria has been associated with reduced psychological distress and increased …

Chronic Pain After Traumatic Brain Injury: Treatment Experiences And Effects On Cognition And Functioning, Rachael L. Snyder

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

Traumatic brain injury (TBI) can contribute to changes in cognitive and emotional functioning, quality of life, and psychosocial reintegration. Chronic pain is a common consequence of TBI which can uniquely impact such outcomes. Still, the exact nature of the contribution of pain on post-TBI outcomes remains unclear, and there are few existing studies exploring the treatment journey for chronic pain and injury rehabilitation through qualitative methods, specifically individual interviews with TBI survivors. This study aimed to document these narratives and to identify precisely how the experiences of TBI survivors seeking treatments, rather than the treatments themselves, impact outcomes. It also …

Resilience Of Interdependent Transportation And Healthcare Systems: A Simulation-Driven Framework Incorporating Social Equity And Facility Optimization, S. Yasaman Ahmadi

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

The overarching goal of this dissertation is to develop an integrated, simulation-driven framework to assess and enhance the resilience of interdependent transportation and healthcare systems before, during, and after natural hazards. By examining how spatial disruptions, social vulnerability, operational constraints, and infrastructure interdependencies affect access to and functionality of hospitals, this research offers a multifaceted evaluation of system performance under stress. This dissertation examines the impact of natural hazards, particularly floods, on the interdependent transportation and healthcare systems. The proposed approach combines and advances GIS-based network analysis, graph-theoretical modeling, and discrete-event simulation to evaluate system performance under different scenarios. The …

Enhancing The Eden Alternative Model With Well Standards: A Case Study Analysis, Mariah Stoner

Architecture Masters of Science Program: Theses

This thesis investigates the potential for improving the Eden Alternative Model, a person-centered approach to elder care that emphasizes creating a homelike environment and meaningful relationships, using WELL Standards, a building certification system focused on enhancing human health and well-being through improvements in environmental quality. Through a mixed-methods approach involving quantitative data analysis and qualitative case studies, this research examines how WELL Standards, which cover aspects such as air quality, water quality, lighting, and thermal comfort, can improve environmental quality and resident satisfaction within the Eden Alternative Model. This research introduces a tailored approach to elder care by combining these …

Men’S Fertility Beliefs, Intentions, And Contraceptive Use, Meagan Kunitzer

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

Despite advancements in reproductive technology, gender-inclusive approaches remain limited, and research on men’s reproductive health is scarce. Specifically, little is known about how men conceptualize reproductive health and how perspectives vary by race and social class. As such, the purpose of this study is to further the field’s understanding of men’s reproductive health, including fertility beliefs, intentions, and behaviors. Guided by the theory of conjunctural action, this study uses survey-driven narrative construction to explore how 35 men think about their reproductive health and how this varies by race and class. The main benefit of using this method is that it …

Access To And Utilization Of Dental Care Services By Older Adults In Nigeria: Barriers And Facilitators, Sunkanmi Folorunsho, Victor Ajayi, Munirat Sanmori, Medinah Suleiman, Raji Abdullateef, Abdulazeez Abdulganiyu

Department of Sociology: Faculty Publications

Aims: Nigeria’s rapidly aging population presents urgent challenges for the healthcare system, particularly in oral health, which remains an overlooked aspect of well-being. While older adults are especially vulnerable to dental issues such as tooth loss, periodontal disease, and oral pain, access to care remains limited due to systemic, economic, and cultural barriers. This qualitative study explored the lived experiences of older Nigerians in accessing and utilizing dental care, with the goal of identifying key barriers, facilitators, and policy-relevant insights.

Methods: Fifteen participants aged 50–83 years were purposively selected from urban and peri-urban areas of Ilorin, North- Central …

Impact Of The Department Of Defense Maternity Leave Policy Change On Retention And Postpartum Depression And The Air Force Postpartum Physical Fitness Policy Change On Physical Readiness Outcomes, Minette S. R. Herrick

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

Understanding the implications of health policy is paramount to support continued execution and further wide-spread distribution. The Department of Defense has made many recent family friendly policy changes in effort to improve the health and morale of the force. Two such policies were analyzed in this study. The first was the change in maternity leave, in 2016, from allotting women six weeks time off to twelve weeks time off in the postpartum period. The second was executed by the Air Force to permit postpartum women a longer duration for their required physical fitness assessment (an increase from six months to …

The Impact Of The Covid-19 Pandemic On The Well-Being Of People Incarcerated In United States Prisons, Kimberly Rivera

Department of Sociology: Dissertations, Theses, and Student Research

The COVID-19 pandemic has negatively impacted the population as a whole. However, the incarcerated population (which also experiences a variety of health disparities) has been disproportionately affected by the pandemic. Due to overcrowding, poor ventilation, and lack of resources, the incarcerated population already is at a heightened risk for negative health outcomes, made worse by the recent pandemic. To adapt to the rapidly changing conditions during the pandemic in 2020 and into 2022, new safety measures were implemented, but the unintended consequences associated with the implementation of these procedures have yet to be examined empirically. I conducted a qualitative content …

Services Provided To Aging Individuals With Intellectual Disabilities: Survey Of Speech Language Pathologists, Claire H. Gatewood

College of Education and Human Sciences: Dissertations, Theses, and Student Research

Purpose: The present study explored current speech-language pathology service provision for aging individuals with intellectual disabilities in the United States, including areas and domains of services, factors restricting service provision, and reported knowledge and confidence of individuals within the field of speech-language pathology in providing services, to identify possible gaps of service and needed improvement.

Methods: Participants (n = 272) from across the United States completed an online survey to gather descriptive information about current speech-language pathology service provision for aging individuals with intellectual disabilities. Participants were recruited through state speech-language hearing associations and universities with speech-language pathology clinics …

Unemployment And Opioid-Related Mortality Rates In U.S. Counties: Investigating Social Capital And Social Isolation–Smoking Pathways, Tse-Chuan Yang, Seulki Kim, Stephen A. Matthews

Department of Sociology: Faculty Publications

We examine two mechanisms—social capital and sociobehavior—potentially linking unemployment rates to opioid-related mortality and investigate whether the mechanisms differ geographically by the pace of the opioid crisis. Applying path analysis techniques to 2015–2017 opioid-related mortality in U.S. counties (N = 2,648), we find that (1) high unemployment rates are not directly associated with opioid-related mortality rates; (2) high unemployment rates are negatively associated with social capital, and low social capital contributes to high opioid-related mortality; (3) high unemployment rates increase social isolation and the prevalence of smoking, which is positively related to opioid-related mortality; and (4) the pathways are stronger …

Revisiting The Rainbow: Culturally Responsive Updates To A Standard Clinical Resource, Angela M. Dietsch, Richard Mocarski, Debra A. Hope, Nathan Woodruff, Miechelle Mckelvey

Department of Special Education and Communication Disorders: Faculty Publications

Purpose

Cultural responsivity is essential for efficacious and affirming clinical relationships. This may be especially important with historically marginalized clients, such as transgender and gender-diverse (TGD) people seeking behaviorally based affirming communication services. We recommend modifications to standard tools for diagnostics and training that otherwise might undermine our efforts to create an inclusive and affirming environment.

Method

Modifications to the Rainbow Passage, a standardized paragraph utilized for eliciting speech samples in clinical settings, focused on nongendered terminology and the elimination of content with religious connotations.

Results

The recommended edits to the Rainbow Passage maintain similar length, cadence, and phonetic balance …

Living Alone During Old Age And The Risk Of Dementia: Assessing The Cumulative Risk Of Living Alone, Benjamin A. Shaw, Tse-Chuan Yang, Seulki Kim

Department of Sociology: Faculty Publications

Objectives: This study examines the association between living alone during old age and dementia. Whereas most previous studies on this topic utilize measures of living alone status that were obtained at a single point in time, we compare this typical approach to one that measures long-term exposure to living alone among older adults and assesses whether dementia is more likely to occur within individuals with more accumulated time living alone. Methods: Data come from the Health and Retirement Study, with a follow-up period of 2000–2018. A total of 18,171 older adults were followed during this period, resulting in 78,490 person-waves …

Social Vulnerability And The Prevalence Of Opioid Use Disorder Among Older Medicare Beneficiaries In U.S. Counties, Tse-Chuan Yang, Seulki Kim, Stephen A. Matthews, Carla Shoff

Department of Sociology: Faculty Publications

Objectives: Recent research has investigated the factors associated with the prevalence of opioid use disorder (OUD) among older adults (65+), which has rapidly increased in the past decade. However, little is known about the relationship between social vulnerability and the prevalence of OUD, and even less about whether the correlates of the prevalence of OUD vary across the social vulnerability spectrum. This study aims to fill these gaps. Methods: We assemble a county-level data set in the contiguous United States (U.S.) by merging 2021 Medicare claims with the CDC’s social vulnerability index and other covariates. Using the total number of …

Active Consideration Of Health And Nutritional Quality Of Food Choices, Christopher R. Gustafson

Cornhusker Economics

Everyone can be positively influenced by effective interventions promoting healthier food choices. A handful of recent papers have documented positive impacts on dietary quality resulting from interventions that remind people to consider health through prompt messages or subtle priming in supermarkets and in controlled, online experiments. These studies have focused on the impact of reminders on nutritional quality rather than explaining how reminders work. An exception, Arslain, Gustafson, and Rose (2021), collected data on multiple elements of individuals' choice processes to trace the impact of reminders on decisions, showing that reminder messages led people to consider a healthier set of …

County Social Isolation And Opioid Use Disorder Among Older Adults: A Longitudinal Analysis Of Medicare Data, 2013–2018, Tse-Chuan Yang, Carla Shoff, Seulki Kim, Benjamin A. Shaw

Department of Sociology: Faculty Publications

This study aims to fill three knowledge gaps: (1) unclear role of ecological factors in shaping older adults’ risk of opioid use disorder (OUD), (2) a lack of longitudinal perspective in OUD research among older adults, and (3) underexplored racial/ethnic differences in the determinants of OUD in older populations. This study estimates the effects of county-level social isolation, concentrated disadvantage, and income inequality on older adults’ risk of OUD using longitudinal data analysis. We merged the 2013–2018 Medicare population (aged 65+) data to the American Community Survey 5-year county-level estimates to create a person-year dataset (N = 47,291,217 person-years) and …

Nebraska Youth Tobacco Survey 2022, Bureau Of Sociological Research

Nebraska Student Health and Risk Prevention Surveillance System (SHARP)

No abstract provided.

Rural Parent's Experiences Of Stress And Resilience During The Covid-19 Pandemic And School Closure, Emily Wilson, Jungwon Eum, Yuenjung Joo, Martinique A. Sealy, Jentry Stoneman Barrett, Gwen C. Nugent, Joan M. Carraher, Angela G. Hinrichs

Department of Child, Youth, and Family Studies: Faculty Publications

The COVID-19 pandemic has generated social and economic disruptions, resulting in cascading effects on the health and well- being of global citizens. However, little research has focused on how COVID-19 has affected rural regions, despite rurality being a critical factor for understanding community impact and response to the pandemic. The purpose of this phenomenological study was to explore the experiences of rural Nebraskan parents with young children during the COVID-19 pandemic and school shutdown, and the strategies they used to support their families during that time. We conducted individual and group interviews with 22 white, non-Hispanic mothers living in rural …

Social Isolation, Residential Stability, And Opioid Use Disorder Among Older Medicare Beneficiaries: Metropolitan And Non-Metropolitan County Comparison, Tse-Chuan Yang, Carla Shoff, Seulki Kim

Department of Sociology: Faculty Publications

Research has shown that the prevalence of opioid use disorder (OUD) may rise substantially as society ages, but this issue receives the least attention in the literature. To address this gap, this study utilizes county-level data from multiple data sources (1) to investigate whether social isolation is associated with OUD prevalence among older Medicare beneficiaries, (2) to examine whether and how residential stability moderates the association between social isolation and OUD prevalence in US counties, and (3) to determine if there are any differences in these associations between metropolitan and nonmetropolitan counties. The results show that social isolation is a …

Examining Spatial Inequality In Covid-19 Positivity Rates Across New York City Zip Codes, Tse-Chuan Yang, Seulki Kim, Yunhan Zhao, Seung-Won Emily Choi

Department of Sociology: Faculty Publications

We aim to understand the spatial inequality in Coronavirus disease 2019 (COVID-19) positivity rates across New York City (NYC) ZIP codes. Applying Bayesian spatial negative binomial models to a ZIP-code level dataset (N = 177) as of May 31st, 2020, we find that (1) the racial/ethnic minority groups are associated with COVID-19 positivity rates; (2) the percentages of remote workers are negatively associated with positivity rates, whereas older population and household size show a positive association; and (3) while ZIP codes in the Bronx and Queens have higher COVID-19 positivity rates, the strongest spatial effects are clustered in Brooklyn and …

A Person-Centered Care Model’S Effectiveness For Older Adults With Dementia: A Systematic Review And Meta-Analysis, Karen Goeschel

Honors Program: Senior Projects (Public)

I evaluated the effectiveness of person-centered care interventions for older adults with dementia. Quality of life and agitation levels were used as primary outcomes for the effectiveness of the intervention. Electronic databases were searched for studies which satisfied the inclusion principles and did not satisfy exclusion principles. Cluster-randomized trials and non-randomized control trials which compared person-centered care approaches to usual care were included. I performed two random-effects meta-analyses. Six studies with 1,384 patients were included. For older adults with dementia, person-centered care had no significant impact on quality-of-life improvement (SMD = -0.116, p = 0.206) or agitation reduction (SMD = …

Nebraska Risk And Protective Factor Student Survey Results For 2021. Profile Report: State Of Nebraska, Bureau Of Sociological Research

Nebraska Student Health and Risk Prevention Surveillance System (SHARP)

No abstract provided.

The Ideology Of Baby-Mama Phenomenon: Assessing Knowledge And Perceptions Among Young People From Educational Institutions, Opeyemi S. Adeojo, Daniel Egerson, Gabriel Mewiya, Rowland Edet

Department of Sociology: Faculty Publications

This study investigated the knowledge and perception of the ideology of baby-mama concept among the youths. Particularly, this paper assessed the knowledge of the concept of baby mama among youths and also their opinion on the acceptability of this style of family structure. The study employed a qualitative approach through an in-depth interview research method. Forty respondents between the ages of 16 and 40 years were selected across three educational institutions in Oyo state, south-west Nigeria. The participants of the study voluntarily agreed to participate in the research and everything said during the course of the interview was transcribed and …

Rural/Urban Differences In The Predictors Of Opioid Prescribing Rates Among Medicare Part D Beneficiaries 65 Years Of Age And Older, Carla Shoff, Tse-Chuan Yang, Seulki Kim

Department of Sociology: Faculty Publications

Purpose: While research has been done comparing rural/urban differences in opioid prescribing to the disabled Medicare Part D population, research on opioid prescribing among the aged Medicare Part D population is lacking. This study aims to fill this gap by exploring the predictors of opioid prescribing to aged Medicare Part D beneficiaries and investigating whether these predictors vary across rural and urban areas. Methods: This is an analysis of ZIP Codes in the continental United States (18,126 ZIP Codes) utilizing 2017 data from Centers for Medicare & Medicaid Services. The analytic approach includes aspatial descriptive analysis, exploratory spatial analysis with …

Face Masking Violations, Policing, And Covid-19 Death Rates: A Spatial Analysis In New York City Zip Codes, Tse-Chuan Yang, Seulki Kim, Stephen A. Matthews

Department of Sociology: Faculty Publications

The use of face masks during a pandemic and compliance with state and local mandates has been a divisive issue in the United States. We document variation in face masking violation rates involving police enforcement in New York City and examine the association between police-enforced face masking violations and COVID-19-related death rates. We assemble a Zone Improvement Plan (ZIP) code–level data set from the New York City Open Data, Department of Health, and the American Community Survey (2014–2018). We use maps to demonstrate the spatial patterning of police-enforced face masking violation rates and COVID-19-related death rates. Using a Bayesian spatial …

Attitudes About Paid Parental Leave: Cross-National Comparisons And The Significance Of Gendered Expectations, Family Strains, And Extant Leave Offerings, Chris Knoester, Qi Li, Richard J. Petts

Department of Sociology: Faculty Publications

Using data on paid parental leave preferences from 35,488 adults situated within 26 different OECD countries, and multilevel modeling, this study examines public opinions about the provision of paid parental leave, some government funding of leave offerings, and preferred lengths of leave offerings. We consider how attitudes may be similar or different across social contexts and then focus upon the extent to which gender, gendered parenting role attitudes, family strains, and country-level institutionalized leave offerings are associated with leave preferences. The findings indicate that the vast majority of respondents are in favor of rather widespread and generous paid parental leave …

Spatial Non‑Stationarity In Opioid Prescribing Rates: Evidence From Older Medicare Part D Beneficiaries, Seulki Kim, Carla Shoff, Tse-Chuan Yang

Department of Sociology: Faculty Publications

Previous research that examined spatial patterns of opioid prescribing rates and factors associated with them has mainly relied on a global modeling perspective, overlooking the potential spatial non-stationarity embedded in these associations. In this study, we investigate whether there are spatially non-stationary associations between opioid prescribing rates and key characteristics of older Medicare Part D beneficiaries and their prescribers using several data sources from the Centers for Medicare and Medicaid Services. All measures are aggregated to the ZIP code level, and a total sample size of 18,126 ZIP codes is included in the analyses. Our descriptive results from geographically weighted …

Knowledge Of Breast Cancer And Screening Methods Among Rural Women In Southwest Nigeria, Rowland Edet, Oluwayimika Ekundina

Department of Sociology: Faculty Publications

The objective of this study was to assess the awareness of rural women on breast cancer and its screening methods in Southwest Nigeria. Descriptive cross-sectional survey design with the aid of a semi-structured questionnaire was used to generate data among 422 rural women in selected communities in Egbeda local government area of Ibadan. The qualitative data was generated through in-depth interviews among rural women and key informant interviews among health workers in the communities. The study revealed that only 63.7% were aware of breast cancer screening methods compared to 31.6% who were not aware. The commonly known screening method among …

Variability In The Analysis Of A Single Neuroimaging Dataset By Many Teams, Rotem Botvinik-Nezer, Tom Schonberg, Russell A. Poldrack, Zachary J. Cole, Matthew R. Johnson, Phui Cheng Lim, Evan N. Linz, Douglas H. Schultz, Joshua E. Zosky, Narps Management Team, Jean M. Vettel, More Than 100 Other Co-Authors

Department of Psychology: Faculty Publications

Data analysis workflows in many scientific domains have become increasingly complex and flexible. To assess the impact of this flexibility on functional magnetic resonance imaging (fMRI) results, the same dataset was independently analyzed by 70 teams, testing nine ex-ante hypotheses. The flexibility of analytic approaches is exemplified by the fact that no two teams chose identical workflows to analyze the data. This flexibility resulted in sizeable variation in hypothesis test results, even for teams whose statistical maps were highly correlated at intermediate stages of their analysis pipeline. Variation in reported results was related to several aspects of analysis methodology. Importantly, …

Rural-Urban Differences In Roles And Support For Community Health Workers In The Midwest, Kate E. Trout, Virginia Chaidez, Angela L. Palmer-Wackerly

Department of Nutrition and Health Sciences: Faculty Publications

The Patient Protection and Affordable Care Act supports the integration of community health workers (CHWs) into the health care workforce, but little is known about integration and current roles of CHWs among employers in community settings. This analysis of 97 employers described the roles of CHWs in Nebraska and found significant differences between CHWs practicing in rural and urban areas in organization types employing CHWs, funding sources, and minority populations served. The findings suggest that the utility of CHWs is widely recognized among employers, but deliberate support will be needed to better define the roles of CHWs to meet the …

How Relevant Is The Hippocratic Oath In Guiding Physicians' Views On Physician-Assisted Suicide, Megan Neal

Honors Program: Senior Projects (Public)

The Hippocratic Oath is an ancient vow that most doctors, especially within the last century in the United States, take upon their graduation from medical school. The importance of this oath, however, is up for debate as medical advances and cultural beliefs in the rights of the patient evolve. The Hippocratic Oath has been adapted many times over the past few centuries to reflect the beliefs of the period, but the original Oath still survives. One of the most recent movements in the medicine has been the legalization of physician-assisted suicide (PAS) in select states. Using a qualitative, thematic approach, …