Community Health and Preventive Medicine Commons^™

Diet Quality As Assessed By The Healthy Eating Index-2020 Among Individuals Diagnosed With And Without Type 2 Diabetes, Minghao Zhou, Hairui Yu, Renee Underwood, Hongning Cai, Tung Sung Tseng, Susu Luo

School of Public Health Faculty Publications

Background: Dietary management is key to preventing and controlling type 2 diabetes mellitus (T2DM). However, few studies have examined differences in Healthy Eating Index (HEI-2020) scores and components among individuals with and without diagnosed T2DM. This study aimed to assess gender differences in HEI-2020 scores and its 13 components by T2DM status. Methods: Using National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2018, this cross-sectional study analyzed 19,464 adults. Diagnosed T2DM was identified via self-report or diabetes medication use. Diet quality was assessed using the HEI-2020, scored from 0 to 100, with a higher HEI score indicates …

Nourishing Births: A Program Evaluation Proposal For Community-Based Nutrition Education, Food Access, And Garden Engagement Among Black Birthing People, Naa Deedei-Vera Hammond

Master's Projects and Capstones

Black birthing people in the United States continue to experience unequal maternal health outcomes, shaped in part by racism and barriers to nutritious food, culturally relevant health education, and supportive community spaces. While prenatal nutrition education and food assistance programs can provide important resources, information alone cannot address the challenges many people face when trying to access healthy and affordable food during pregnancy. The Nourishing Births Initiative is a proposed community-based maternal health program designed to respond to these needs by bringing together prenatal nutrition education, help connecting to food resources, community gardening, and peer support for Black birthing people …

From State To Nation: A Federal Framework For Breast Cancer Primary Prevention Informed By California's Paths To Prevention, Serena Padda

Master's Projects and Capstones

The United States’ federal government should adopt a primary prevention framework for breast cancer modeled after Breast Cancer Prevention Partners’ (BCPP) Paths to Prevention: the California Breast Cancer Primary Prevention Plan. The plan focuses on systemic actions to reduce breast cancer risk through a social and racial justice lens. Breast cancer is the leading diagnosed cancer among women in the United States, with incidence rates increasing annually by 1% since 2012. Disparities persist in communities disproportionately burdened by chemical and environmental exposures, contributing to unequal and preventable risk. Current federal policy focuses primarily on secondary prevention through screenings, which does …

Rethinking Existing Extension Programming: A Foundation For Healthy Aging?, Nicholas J. Spokely, Sloane A. Montgomery, Kelsey J. Weitzel, Kristin A. Miller, Marta Novaes Oliveira, Stephen D. Ball, Breanne S. Baker

Journal of Extension

Muscle declines are becoming more prevalent in younger adults, driving the need for accessible exercise programs. The Stay Strong, Stay Healthy (SSSH) Extension program was developed for adults 60 years old or older, but for this study, we enrolled 135 participants aged less than 60 years old in rural and urban counties to assess if it could improve their muscle performance. We analyzed data with time and group comparisons using paired t-tests and 2 × 2 repeated measures ANOVAs. Younger adults significantly improved muscle performance after SSSH, and the results were similar between rural and urban counties. This study …

The Impact Of Tobacco-Free School Laws On Student And Staff Smoking Behavior, Rachana Bhatt, Peter Hinrichs

Upjohn Institute Working Papers

A number of U.S. states have enacted bans on tobacco use by students, staff, and visitors anywhere on the grounds of public elementary and secondary schools statewide. These laws are intended to reduce tobacco use, reduce exposure to secondhand smoke, reinforce anti-tobacco curricula taught in schools, and prevent children from viewing their teachers and fellow students using tobacco products. We examine the impact that the laws have on the smoking behavior of students, teachers, and other school staff by using stacked difference-in-differences estimators that exploit the time variation in adoption of the laws across states. The results presented in this …

Did Statewide School Smoking Bans Reduce Smoking Rates?, Rachana Bhatt, Peter Hinrichs

Upjohn Institute Policy and Research Briefs

No abstract provided.

Under Pressure And Underrecognized: The Role Of Social Workers And Case Managers In Screening For Social Determinants Of Health In The United States, Melissa L. Habrat, Lindsay D. Nelson, David A. Nelson

Journal of Patient-Centered Research and Reviews

Social determinants of health (SDOH) screening is increasingly embedded in clinical care, yet the work of asking, documenting, and responding to social needs often falls to social workers and nurses or professional case managers who operate under significant time, staffing, and system constraints. We conducted a narrative review to examine how SDOH influence outcomes, identify systemic and emotional barriers to effective screening, and synthesize evidence-informed strategies that support implementation. Across included sources, findings clustered into three domains: challenges in integrating screening (policy and accreditation pressure, staffing and resource constraints, EHR documentation and interoperability limits, closed-loop referral and cross-sector partnership gaps, …

Strengthening Health System-Community Partnerships To Address Pediatric Social Needs: A Qualitative Study, Joy Friedman, Melissa A. Alderfer, Kelsey Higgins, Aaron Carpenter, Jennifer Sciolla, Sarah E. Wawrzynski

Department of Pediatrics Faculty Papers

IntroductionStructural and social conditions influence pediatric health outcomes. Successful implementation of social needs screening and referral programs depends on community-based organizations (CBOs) to provide resources that address health-related social needs (HRSN). We explored current practices and perspectives of health care workers and CBO representatives on improving health system-CBO partnerships.MethodsParticipants were purposively recruited from a variety of health care settings involved in HRSN screening and CBOs delivering resources in the community. Participants completed semi-structured interviews. Qualitative thematic analysis was used to summarize data.ResultsTen key informants participated (six health care workers and four CBO representatives). Four themes were identified: 1) mismatches in …

Cost Analysis Of Integrated Genderaffirming And Sexual Health Services For Transgender Women In Thailand: Evidence From The Tangerine Clinic, Braprut Sawatwipachai, Kunncadah Anuwong, Nittaya Phanuphak, Rena Janamnuaysook, Kritima Samitpol, Sujin Nitadpakorn

The Thai Journal of Pharmaceutical Sciences

Background: Transgender women experience a disproportionate burden of human immunodeficiency virus (HIV) globally and in Thailand. Integrating gender-affirming care into sexual health services may improve uptake of HIV and sexually transmitted infections (STIs) testing, treatment, and prevention. Cost data are essential to inform program planning and policy decisions regarding inclusion of such services within Thailand’s Universal Health Coverage (UHC) system.
Objectives: To estimate the full and unit costs of trans-led, integrated gender-affirming and sexual health services along the HIV care cascade.
Methods: Costs of Tangerine Clinic services in 2021 were assessed from the provider perspective, using standard and activity-based costing …

Precision Approaches Improve Community Health, Roger A. Rennekamp, David Buys

Journal of Extension

Recent advances in data science provide Extension practitioners with access to data sorted by zip code, census tract, or neighborhood. Such hyper-local data now allows Extension personnel to assess community needs and assets at a more granular level and focus their work on the people and communities of greatest need. In this article, we introduce an approach we refer to as precision public health. Using such a precision approach to community assessment and, ultimately, programming can save money, increase the likelihood of producing measurable results, and create more manageable workloads for county-based Extension personnel.

State-Level Implementation Of Health And Safety Policies In Mississippi Secondary Schools, Heather L. Shirley, Valerie J. Moody

Internet Journal of Allied Health Sciences and Practice

Background: State-level investigations of health and safety policy implementation in secondary school athletics highlight ongoing challenges in ensuring student-athlete safety that aligns with evidence-based best practices. Purpose: The purpose of this study was to examine current state-level implementation of health and safety policies in Mississippi secondary schools from the perspective of athletics/activities directors, athletic trainers, and other school administrators. Methods: In May 2025, a 26-item web-based questionnaire was distributed to 226 athletic directors and 114 athletic trainers across Mississippi secondary schools. The survey assessed participant demographics, access to healthcare resources, emergency action planning (EAP), required coaches’ health and safety training, …

Gene-Environment Interactions In Cardiovascular Aging: Volunteering, Polygenic Risk, And Biomarker Change In European And African Ancestry Populations, Seoyoun Kim, Byeongju Ryu, Erin Ware, Koichiro Shiba, Cal J. Halvorsen

Brown School Faculty Publications

Volunteering has been associated with better cardiovascular health, but whether this association varies by genetic susceptibility to cardiovascular disease remains unclear. This study examined associations between volunteering and cardiovascular biomarkers, assessed associations between biomarker-specific polygenic scores (PGSs) and these outcomes, and tested whether polygenic risk moderated volunteering–biomarker associations among U.S. adults aged 51 years and older.

Piloting The Strong Bodies Strength Training Program In Utah, Gabriela Murza, Jenna Dyckman, Cris Meier, Emma Parkhurst, Sadie Wilde, Christina Pay, Naomi Brower, Cindy Nelson

Outcomes and Impact Quarterly

Muscle and bone loss occurs as we age, impacting health and independence. We evaluated a pilot 12-week strength training program for older adults in Utah. Participants showed improved fitness metrics and increased confidence. Results demonstrate the program’s effectiveness and public value in expanding access to evidence-based exercise that supports healthy aging.

Underfunded And Undervalued: Community-Based Health Promotion Practitioners’ Experiences Of Western Australia’S Prevention Sector, Ruth M. Wallace, Leesa N. Costello, Elizabeth J. Cook

Research outputs 2022 to 2026

Prevention is a central policy focus of contemporary health promotion, offering cost-effective strategies to reduce disease burden and improve population well-being. Despite this, Australia allocates a small proportion of its health budget to prevention, with funding models characterized by short-term cycles and competitive tendering. While the consequences for public health are well documented, the impact on the health promotion workforce remains underexplored. Workforce health and stability are critical for program delivery, ethical practice, continuity of relationships with communities, and the capacity to sustain long-term prevention efforts. This qualitative study examined the experience of 19 community-based health promotion practitioners in Western …

Gallbladder Ascariasis Presenting As Acalculous Biliary Colic, Carmen A. Urbina, Luigi G. Cubeddu, Luigi X. Cubeddu

HCA Healthcare Journal of Medicine

We detail a case of gallbladder ascariasis, presenting as an acute episode of acalculous biliary colic, nausea, bloating, an unremarkable abdominal ultrasound, and negative helminth and protozoa stool smears. A follow-up ultrasound provided unexpected images consistent with gallbladder infection by Ascaris lumbricoides. Repeat ultrasonography performed 10 days after anthelmintic therapy showed no live worms and 2 newly appearing echogenic areas suggestive of gallbladder calculi that were confirmed following elective cholecystectomy. The case course highlights key clinical, diagnostic, and management considerations in gallbladder ascariasis and underscores the value of repeated ultrasonographic evaluation in affected patients.

Determinants Of Multimorbidity Among Stroke Patients For Epidemiological Management In Indonesia's Agro-Coastal Communities, Krish Naufal Anugrah Robby, Isa Ma'rufi, Farida Wahyu Ningtyias, Latifatul Izzah, Nurjazuli Nurjazuli, Suhartono Suhartono, Muchlis Achsan Udji Sofro, Ida Srisurani Wiji Astuti, Olivia Listiowati Prawoto, Dedek Sutinbuk, Taufik Kurrohman, Elhoussin Ouassou

Kesmas

Multimorbidity remains a major public health challenge among stroke patients, particularly in agro-coastal communities characterized by socioeconomic vulnerability, limited healthcare access, and lifestyle changes. This study aimed to analyze the determinants of multimorbidity among stroke patients in agro-coastal communities. A quantitative observational analytical design was employed, involving 45 stroke patients selected through total sampling in Jember District, Indonesia. Data were collected through structured interviews, anthropometric measurements, and secondary health records. The model included biological, socioeconomic, healthcare access, and lifestyle as exogenous variables, with multimorbidity as the endogenous variable. Data were analyzed using PLS-SEM, including evaluation of measurement and structural models …

Beyond The Binary: Strengthening Nursing Students’ Proficiency Of Equitable Health Promotion, Martha K. Findley

Theses

Background: Sexual and gender diverse (SGD) populations continue to experience significant health inequities, yet prelicensure nursing curricula often lack structured, evidence‑based training to prepare students for equitable care.

Purpose: This study evaluated whether a targeted, transgender‑focused simulation could improve nursing students’ clinical knowledge and preparedness for providing equitable health promotion to SGD populations.

Methods: A pre‑/post‑intervention design was used with senior‑level nursing students who completed a transgender patient simulation emphasizing communication, assessment, and equitable health promotion. Students completed a validated survey measuring knowledge and preparedness in caring for SGD patients.

Results: Significant improvements across most survey items demonstrated that the …

Post-Pandemic Telebehavioral Health: Sustaining And Regulating Remote Mental Health Care As A Core Modality, Weiqiao Dong

Dartmouth College Master’s Theses

The United States continues to face a persistent mental health crisis after the COVID-19 pandemic, raising a policy question about the long-term role and regulation of telebehavioral health as a core modality of care. This thesis examines that question through a case study of New York State, an early center of the pandemic and a leader in telehealth policy reform.

Guided by the Health Policy Triangle framework, this thesis integrates longitudinal data from all 62 New York counties for 2010-2025 with a 2025 cross-sectional dataset covering 61 counties. Seventeen standardized indicators are organized into four dimensions: geographic, economic, demographic, and …

Artificial Intelligence-Assisted Retinal Imaging For Chronic Disease Detection, Prediction, And Screening, Shivani Gandhi

Master's Projects and Capstones

A retinal image may reveal more than eye disease; it may also show early signs of chronic illness elsewhere in the body. Diabetes, hypertension, cardiovascular disease, and chronic kidney disease can develop before symptoms become noticeable, making earlier detection an important public health goal. Advances in artificial intelligence have created new possibilities for using retinal images to identify patterns linked to these conditions. This scoping review examined how Artificial Intelligence -assisted retinal imaging has been used for chronic disease detection, prediction, and screening, along with the practical and health-equity factors that may influence its use.

To map the current evidence, …

Preventive Interventions Targeting Social Determinants Of Health: Implications For Healthcare Utilization And Cost, Audrey Wrinkle

NEXUS: The Liberty Journal of Interdisciplinary Studies

Preventive interventions targeting social determinants of health could reduce avoidable healthcare utilization and positively impact long-term cost outcomes within healthcare systems. Evidence indicates that financial and social barriers to preventive care lead to delayed treatment and increased use of high-cost healthcare services in the long term. Preventive interventions focusing on upstream social factors, like home-based care and digital health programs, could improve patient outcomes and reduce avoidable service utilization. Also, incorporating social needs data into policy creation could promote better allocation of healthcare resources. This research highlights the role of prevention-focused strategies in promoting cost-effective, sustainable healthcare delivery.