Medicine and Health Commons^™

A Cross-Sectional Study Of The Predictors Of Covid-19 Vaccine Hesitancy In Pakistan, Saeed Ahmad, Muhammad Rizwan Safdar, Mufti Nadimul Quamar Ahmed

Sociology and Anthropology Student Research

Vaccine hesitancy, where individuals are reluctant to get vaccinated, is a significant issue, especially in the event of a pandemic, and poses a major concern. We explore a few predictors of vaccine hesitancy in Pakistan using a cross-sectional study. For this purpose, 562 respondents registered their responses through an online questionnaire from March 31, 2021, to May 28, 2021, during the third wave of the COVID-19 pandemic. Cronbach’s Alpha was used for Internal Consistency Reliability, while Factor Analysis was used for Construct Validity. We applied bivariate linear regression analysis for hypothesis testing. Fear of COVID-19 was higher among respondents as …

Hiv And Sti Testing Service Utilization Among Youth Experiencing Homelessness: A Multi-Method Inquiry, Alexander A. Ochs

Electronic Theses and Dissertations

Youth experiencing homelessness (YEH) face disproportionately high risk for HIV and sexually transmitted infections (STIs), yet rates of testing remain low. This dissertation examines the individual and social network level factors that influence HIV/STI testing behaviors among YEH. Guided by insights from multiple theoretical frameworks, this three-paper dissertation integrates quantitative and qualitative approaches to better understand how personal relationships and social context shape HIV/STI testing decisions in this population.

Paper 1 presents a secondary data analysis of the Homeless Youth Risk and Resilience Survey (HYRRS), which includes 1,426 YEH across seven U.S. cities. Logistic regression models identified geographic variation in …

Differential Mirna Expressions Linking Environmental Risk Factors To Triple-Negative Breast Cancer Stages At Diagnosis, Amjila Bam, Yawen Hu, Xiaocheng Wu, Meng Luo, Nubaira Rizvi, Luis Del Valle, Arnold H. Zea, Fokhrul Hossain, Denise Moore Danos, Jovanny Zabaleta, Augusto Ochoa, Lucio Miele, Edward Trapido, Qingzhao Yu

School of Public Health Faculty Publications

Background/Objectives: Triple negative breast cancer (TNBC) is an aggressive, molecularly heterogeneous subtype of breast cancer, accounting for approximately 10–15% of all cases. While reproductive and metabolic factors contribute to breast cancer development, growing concerns about environmental exposures, alongside biological and socio-cultural influences, underscore the need for targeted prevention strategies across diverse populations. Despite increasing evidence linking biological, socioeconomic, and environmental factors to TNBC outcomes, the molecular mechanisms underlying these relationships remain poorly understood. Micro-RNAs (miRNAs), which regulate gene expression and play critical roles in cancer development, have emerged as potential mediators between environmental exposures and TNBC progression. The goal of …

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 …

Factors Influencing Information And Accessibility Of Tuberculosis Prevention Services Among Nomadic Fulani And Host Communities, Nigeria, Abolaji Azeez, Kabiru Salami

Journal of Social, Behavioral, and Health Sciences

Despite efforts to curtail tuberculosis (TB) in Nigeria, the country has not yet attained the global target. This study explored the dynamics of access to information about TB control and prevention among nomadic Fulani and their host communities. We used a mixed-methods approach and multistage sampling technique to recruit 812 respondents for the survey, and we conducted 18 in-depth interviews across six local government areas. The results indicated generally low access to TB information and services, with only 2% of nomadic Fulani engaging in TB prevention activities compared to 6.7% of host community members. Yoruba respondents had significantly higher odds …

Temporal And Generational Changes In Depression Among Young American Adults, Ashley W. Kranjac, Dinko Kranjac, Valentine Chung

Sociology Faculty Articles and Research

The prevalence of depression among young American adults has risen significantly over the past two decades, but the mechanisms that underlie the population-level changes in depressive symptoms severity remain unclear. We used data from the 2005–2023 National Health and Nutrition Examination Survey (NHANES) and hierarchical age–period–cohort (HAPC) analysis to examine developmental (i.e., age), life stage (i.e., period), and generational (i.e., cohort) distribution of depressive symptoms among American adults aged 20–30 years old over an 18-year period. Our model results indicate that the probability of either mild, moderate, or severe depression increased among young adult females and males between 2005 and …

A Cancer Education Needs Assessment: Informing Middle-Aged Female Patients About The Relationships Between Obesity And Women’S Health Concerns In The Reproductive System, Breast, And Endometrial Health, Batul Mirza

MUSC Theses and Dissertations

Obesity significantly impacts women’s health, particularly among middle-aged women, by increasing the risk of hormone-sensitive cancers such as breast, endometrial, and reproductive system cancers. This study examines the educational needs of this demographic group regarding obesity-related cancer risks and explores effective intervention strategies. Obesity-induced mechanisms – hormonal imbalances, chronic inflammation, and insulin resistance – drive cancer susceptibility, emphasizing the need for targeted health education. The study employs a qualitative design, which includes interviews with subject matter experts (SMEs) and surveys of middle-aged women. The goal is to assess awareness, perceived barriers, and preferred learning methods. Findings suggest that with many …

Breaking The Odds: A Gendered Analysis Of Women And Gambling Behaviors, Rowland Edet

UNLV Gaming Research & Review Journal

Gambling is increasingly recognized as a complex public health issue with wide-ranging implications for individuals, families, and communities. While traditionally male-dominated, recent shifts reveal a growing participation among women, facilitated by gender-specific gambling products, targeted marketing, and evolving societal norms. This paper critically examines the prevalence, motivations, and harms associated with gambling among women, drawing on theoretical perspectives such as social capital theory, cultural geography, and gender role theory. By synthesizing existing literature, this review highlights distinct gendered patterns in gambling behaviors, including the use of gambling as a coping mechanism for stress, isolation, and caregiving burdens, and the role …

The Landscape Of Malignant Transition: Unraveling Cancer Cell-Of-Origin And Heterogeneous Tissue Microenvironment, Ruihan Luo, Jiajia Liu, Tiangang Wang, Weiling Zhao, Yanfei Wang, Jianguo Wen, Hongyu Wang, Shanli Ding, Xiaobo Zhou

Faculty, Staff and Student Publications

Understanding disease progression and sophisticated tumor ecosystems is imperative for investigating tumorigenesis mechanisms and developing novel prevention strategies. Here, we dissected heterogeneous microenvironments during malignant transitions by leveraging data from 1396 samples spanning 13 major tissues. Within transitional stem-like subpopulations highly enriched in precancers and cancers, we identified 30 recurring cellular states strongly linked to malignancy, including hypoxia and epithelial senescence, revealing a high degree of plasticity in epithelial stem cells. By characterizing dynamics in stem-cell crosstalk with the microenvironment along the pseudotime axis, we found differential roles of ANXA1 at different stages of tumor development. In precancerous stages, reduced …

A Call For Change: Supporting Children With Tourette Syndrome, Matt Reall

Journal of Nonprofit Innovation

Tourette Syndrome affects 1 in 100 U.S. children but remains widely misunderstood due to stigma, delayed diagnosis, and media misrepresentation. This neurological disorder is characterized by involuntary tics and often co-occurs with ADHD, anxiety, and sleep disorders. Children with Tourette Syndrome face disproportionate challenges in social, academic, and emotional settings—despite having average or above-average intelligence. One-third engage in self-harm, and suicide rates are four times the national average. Peer-education programs like the Tourette Association of America’s Youth Ambassador initiative have shown promise in reducing stigma, but unequal access and weak institutional support limit their impact. This paper calls for early …

U.S. Young Adults’ Family-Building Intentions In The Event Of Infertility And Knowledge Of Associated Costs, Jean Marie Place, John Horowitz, Minh Nguyen, Maya Guinn, Brennan Peterson

Marriage and Family Therapy Faculty Articles and Research

Introduction: Infertility affects approximately 8.5% of married women in the United States, yet there is limited understanding of how young adults anticipate and prepare for potential barriers to biological parenthood. As reproductive planning increasingly intersects with social, medical, and financial considerations, it is important to examine how emerging adults perceive and approach family-building options. This study aims to explore college students' intentions regarding childbearing, their openness to non-traditional family-building methods, and their awareness of the associated financial costs.

Methods: A cross-sectional survey was administered to undergraduate students (mean age = 20) at a Midwestern public university. Most participants had not …

Gender Differences In Regretted Consensual Sexual Experiences And Problematic Alcohol Use Among First-Year College Students, Shannon Shen, Soyoung Kwon, Sukho Lee

Journal of Social, Behavioral, and Health Sciences

Regretted sexual behaviors and alcohol use often occur in tandem for college students; however, few studies have examined their interrelationships or the variance across gender. This study tested gender differences in how regretting a consensual sexual experience is related to college students’ alcohol use. One hundred and forty first-year students (63% women, 69% Hispanic) surveyed in 2018 and 2019 reported their sexual behavior and alcohol use (following the Rutgers Alcohol Problem Index [RAPI]). Twenty-one percent of men and 16% of women reported a regretted sexual encounter. Interaction effects from regression models revealed that men with sexual regret had a significantly …

Medical Debt In The Mountain West, 2022, Kian Parikh, Lara Karaalp, Otoniel Ramos, Caitlin J. Saladino, William E. Brown Jr.

Health

This fact sheet presents 2022 data on the prevalence of medical debt in the five Mountain West states of Arizona, Colorado, Nevada, New Mexico and Utah. The Urban Institute report, “The Changing Medical Debt Landscape in the United States” includes data on medical debt estimates, hospital market concentration, as well as estimates of uninsured individuals, disabled adults, average household incomes, and racial compositions at the state and county level for the 50 states and Washington, DC. This fact sheet focuses on state-level differences on the prevalence of medical debt, as well as differences in the percentages of uninsured individuals and …

The Rhetoric Of Responsibilization: A Rhetorical Analysis Of Pre-Exposure Prophylaxis Campaigns For Hiv Prevention, Catherine M. Pabalate

Kentucky Undergraduate Journal for the Health Humanities

Responsibilization refers to the process by which patients are made accountable for their health and wellbeing, which is determined by their habits and behaviors. Though responsibilization affords greater agency to patients, it can also result in anxiety and guilt when the patient appears "deviant" or "noncompliant." Because sexual behavior is attributed to the causality of HIV/AIDS, patients’ sexual patterns and choices are included within their medical decision-making. This rhetorical analysis focuses on pharmaceutical campaigns and commercials for pre-exposure prophylaxis (PrEP), which were released between 2012 and 2024 and are targeted towards patients at-risk for HIV/AIDS. Findings suggest that specific rhetorical …

The Effect Of Birthweight And Gestational Age On Cognitive Function In Midlife: The Bogalusa Heart Study, Eunsun Gill, David J Libon, Soo Jung Kang, Ileana De Anda-Duran, Lydia A Bazzano, Wei Chen, Camilo Fernandez-Alonso, Emily W Harville

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Although the relationships between birthweight, gestational age (GA), and cognitive function (CF) before midlife have been demonstrated, the relationships after midlife and potential racial disparities remain inconclusive. This study examined the association between birthweight, GA, and midlife CF stratified by race.

METHOD: 1,032 subjects from the Bogalusa Heart Study (67% Whites, 33% Blacks, mean age 48.1 ± 5.3 years) were studied. Cognition was assessed with tests measuring verbal episodic memory, working memory, attention, graphomotor information processing speed, and global CF. Each test was standardized by sex and age, then averaged. The global CF was computed by averaging all cognitive …

Trends In The Demographic And Well-Being Indicators Of The Singapore Life Panel Over The Past 9 Years, From 2016-2024, Rachel Wen Yi Ngu, Yi Wen Tan, Yue Qing Chew, Hanif Mohamed Yacob, Yan Er Tan

ROSA Research Briefs

The Singapore Life Panel® (SLP) has been tracking demographic and well-being indicators among older adults in Singapore for nearly a decade. This research brief presents the longitudinal trends observed in the SLP over a nine-year period (2016-2024), with the aim of identifying key shifts in these indicators and drawing attention to salient issues facing Singapore’s ageing population. The findings reveal notable demographic and well-being developments with significant implications for policy domains such as ageing-in-place, employment, and health. We highlight the following prominent trends: (i) a growing proportion of older adults living alone, accompanied by a steady decline in average household …

Tobacco, Alcohol, And Poverty In Lao Pdr Based On National Survey Analysis, Robert M. Semakula

Loma Linda University Electronic Theses, Dissertations & Projects

Tobacco and alcohol use are among the most prevalent and harmful addictive behaviors globally, including in the Lao People’s Democratic Republic (Lao PDR). In Southeast Asia and the Western Pacific, substance use patterns are shaped by cultural, social, economic, policyrelated, and environmental factors. This study aimed to: (1) explore associations between different patterns of alcohol and tobacco use among men and women in Lao PDR, and (2) investigate the effect of poverty on the relationship between alcohol and tobacco use. We conducted a secondary analysis of the 2013 Lao National Adult Tobacco Survey (N = 9,706), a nationally representative sample …

More Than Hormones: Psychological Consequences Of The Medicalized Menopausal Experience, Haley Derrickson

University Honors Theses

Menopause, a transitional period that roughly half the population may experience, has a high degree of variability in onset and intensity of symptoms, one of which is depression. It is also a period in which the lives of those transitioning are highly medicalized. This literature review investigates how medicalization has increased since the term was created, and how it impacts perimenopause, menopause, and mental health.

Navigating Crisis: A Qualitative Exploration Of Parents' Journeys With Suicidal Adolescents In Australian Emergency Departments, Demee Rheinberger, Lauren Mcgillivray, Fiona Shand, Sally Ann Pollard, Susanne Oliver Armstrong, Julia Lessing, Katherine Boydell

The Qualitative Report

Rates of emergency department (ED) presentations for suicide crisis (thoughts, feelings, plans and behaviours) in adolescents are increasing. Parents play a key role in supporting adolescents during and after the ED presentation, however little is known about parental experiences in the ED. Interviews with 20 parents from across Australia were undertaken to help understand this experience. A reflexive thematic analysis was conducted, resulting in three themes which explore the impact of the suicide crisis and ED presentation on the parents’ sense of identity. First, parents’ identity was threatened as they were faced with the juxtaposition between the role of protector …

Creating Family Flow By Participating In The Reflective Practice Of Exercise With Family Members, Julianne M. Sylva

Critical and Creative Thinking Capstones Collection

This synthesis project explores how families can use shared exercise and reflective practice to cultivate lifelong learning habits and deepen family connection. Anchored in the fields of critical and creative thinking, the work integrates concepts of metacognition, flow, and personal mastery to examine how structured, intentional routines can foster both individual growth and relational attunement. The author documents a series of weekly exercise sessions undertaken with her co-parent and child at a local training facility. Drawing from theories of action research, reflective practice (Schön, Brookfield), and flow (Csikszentmihalyi), the project combines personal observation, scholarly frameworks, and course-based learning to construct …

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) …

Exploring The Experience Of Embodiment Of Diverse Leaders, Susan Lynn Flaming Yeats

Dissertations

The experience of embodiment is a complex phenomenon that spans a range of feelings: a sense of connection to one's physical body, a sense of capability to accomplish certain physical acts, an attunement to self-care behaviors, a connection to desire, and inhabiting the body as a subjective site (Piran, 2016). This can be a complicated experience for leaders who hold multiple intersecting identities (Hill et al., 2016). As new medical therapies promise radical weight loss possibilities, the experience of embodiment has taken on a new layer of complexity (Giorgis, 2024). For fat leaders who are also women of color, sexual …

From Oversight To Insight: Enhancing Vte Prophylaxis Through System-Level Improvements, Nehar Damle, Jessica Cobb, Jordan Feingold, Yunisse Gonzalez, Lamya Jaigirdar, Sheraz Qamar, Claire Ketchem

Health Equity and Quality Improvement (HEQI) Summit

Background

- Hospitalized patients – particularly those with prior venous thromboembolism (VTE), reduced mobility, severe sepsis, and operative procedures - are at significantly elevated risk for recurrent VTE events^1-4

- Although clinical evidence supports use of pharmacologic VTE prophylaxis in highrisk patients, gaps in delivery remain common (highlighted below):

• Miscommunication between managing teams
• Unclear documentation
• Lack of standardized peri-procedural protocols
• Challenges in care coordination

- Missed or delayed VTE prophylaxis represents a frequent and preventable threat to inpatient safety

- We present a near miss event involving a hospitalized patient with severe sepsis and history of pulmonary embolism within …

Utility Of Community Partnership And Sustainable Street Outreach, Daniel Lee, Hannah Klinghoffer, Mallika Kodavatiganti, Luke Benedict, Kelsey Van Housen, Ashley Wetzel, Lele Yang, Alisha Agarwal, Shane Nieves, Charlotte Harris, Jessica Lely, Vinh Dang, Ivel Morales, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• 14,088 individuals experience homelessness (IEH) across the state of Pennsylvania, with over 50% concentrated in Pittsburgh and Philadelphia¹
• In late 2021, only 4 medical school programs existed that conducted street outreach to support individuals experiencing homelessness in Pennsylvania before the pandemic.² None existed at the undergraduate level.
• Street outreach has been linked to increased motivation of IEH to seek services by removing stigma via positive, nonjudgmental relationships.^3,4

Visiting Medical Student Stipends In The Us | An Analysis Of Equity Within Physiatry, Ashley Otto, Do, Mbs, Jeffrey Gray, Md, Summer Nestorowicz, Md, Adrian Oppong, Md, Ms, Oluseye Raymond, Md, Andrew Walrond, Md, Alexis Tingan, Md, Marisa Moreta, Do

Health Equity and Quality Improvement (HEQI) Summit

Introduction & Aims

Health inequities are ubiquitous throughout medicine especially pertaining to accessibility, affordability, and availability. These challenges disproportionately affect minorities- both patients and providers alike [3,4]. Patient outcomes have been shown to improve when treated by physicians of similar backgrounds [3,4,7]. The journey to improve outcomes begins with pre-residency rotations; medical students who can complete audition rotations have an increased opportunity to matriculate into said residency program. Physical Medicine & Rehabilitation (PM&R), like many specialties, is disproportionately represented by men and Caucasians [1,5, 8] with the greatest drop in URM representation occurring between applicants and residents [Escalon]. This project …

The Effect Of Targeted Outreach To Improve Cpap Adherence In Patients With Socioeconomic Disparities, Henry Ideker, Md, Ethan Zheng, Ba, Stephen White, Md, Ritu Grewal, Md

Health Equity and Quality Improvement (HEQI) Summit

Introduction

• Continuous positive airway pressure (CPAP) is first line treatment for obstructive sleep apnea (OSA) in adults given its high efficacy; however, it is limited by poor patient compliance
• Socioeconomic disparities are known to be associated with significantly worse health outcomes and adherence to therapy¹
• Area deprivation index (ADI) is a validated tool that highlights populations with high socioeconomic disparities on a neighborhood level.² Prior research in our department in 2022 demonstrated significantly worse CPAP adherence in OSA patients with higher ADI scores.³
• Initial CPAP use has been shown to predict long-term adherence, and strategies to maximize …

Framing The Future: A Community Health Analysis Of The Pee Dee Region, Stephen Borders, Jean Anton, Rian Fontaine, Donielle Phillips, Treyton Ringer, Jessica Robinson, Caitlin Thompkins

Public Health

This report presents a comprehensive, data-driven analysis of community health across South Carolina’s Pee Dee region, encompassing Florence, Darlington, Chesterfield, Marlboro, Marion, and Dillon Counties. Using tract-level data from CDC PLACES, the U.S. Census, and the National Provider Identifier registry, it assesses chronic health conditions, health behaviors, and social determinants of health. The analysis incorporates the South Carolina Healthy Communities Index (SCHCI) and a Suitability Analysis to identify the region’s most disadvantaged communities. The findings highlight persistent disparities, particularly in rural counties, where high rates of poverty, chronic disease, and unmet basic needs intersect with limited access to care. Despite …

Planning And Facilitating Hybrid Meetings To Support Relationality During Coalition Building, Luettamae Lawrence, Maureen Boyle, Moira Ross

Utah Conference on Community Engagement

Hybrid events where communities are connected through both in person and online spaces have simultaneously grown in popularity and gotten a bad reputation. While hybrid events have been around for decades, they gained significant traction with the onset of the COVID-19 pandemic to increase accessibility for attendees to accommodate diverse needs. Although hybrid events can be beneficial to many, they are not simple to execute. With the increase in hybrid events has come frustration with the low quality interactions between in person and online attendees leading to isolation, technology challenges, and low productivity. We argue the positive affordances of hybrid …

Integrating Positive Psychology And Spirituality To Foster Meaning And Well-Being In Older Adults, Crystal Morris

Adultspan Journal

This perspective article explores the integration of positive psychology interventions (PPIs) and spirituality in therapy to foster meaning and well-being in older adults. It highlights exercises such as the positive introduction, positive legacy, character strengths, mindfulness, mindful-based yoga, and a manifestation prayer journaling. The interventions presented are tools to support older adults that may experience depression, difficult life transitions, and the search for renewed meaning. Therapists who integrate PPIs and spirituality into therapy can promote a holistic, non-pathological approach to treatment.