Doctor of Philosophy, The Ohio State University, 2024, Educational Studies

Each year in the United States, an estimated 57.8 million adults and 7.7 million children experience mental health issues with far-reaching implications (National Alliance on Mental Illness [NAMI], 2023). Despite our increased awareness in the aftermath of the COVID-19 pandemic, which both exposed and exacerbated the problem, access to services remains severely limited for 163 million Americans living in Mental Health Professional Shortage Areas (NAMI, 2023). There is an insufficient supply of mental health providers in America, and an additional 8,251 practitioners are needed immediately to adequately meet the needs of the people (Health Resource & Services Administration [HRSA], 2023b). However, this deficit will not be resolved soon, as nearly half of mental health practitioners currently report intentions to leave their employment (Centers for Disease Control [CDC], 2023). Furthermore, resolving the shortage will require more than hiring additional mental health professionals (HRSA, 2023b). Compared to the larger workforce, mental health providers have a higher risk of experiencing detrimental occupational outcomes (Cocker & Joss, 2016; Ledoux, 2015; Ondrejkova & Halamova, 2022; Sinclair et al., 2017; Sorenson et al., 2016). Burnout, one of the occupational harms associated with the unique demands of care work, is a driving force in the provider retention problem (CDC, 2023; Hoge et al., 2007; Morse et al., 2012). Although there is a direct link between burnout and a lack of organizational support (Schaufeli & Greenglass, 2001), there is a lack of research examining systemic causal factors. Most existing studies neglect to explore links between work characteristics and employee well-being and are restricted to investigating individual traits as contributors (CDC, 2023). The present study confronts the gap in the literature through a systemic exploratory analysis. This quantitative study examined the link between workplace environments and mental health (open full item for complete abstract)

Committee: Darcy Haag Granello (Committee Chair); Paul Granello (Committee Member); Noelle Arnold (Committee Member) Subjects: Behavioral Sciences; Behaviorial Sciences; Clinical Psychology; Counseling Education; Counseling Psychology; Health Care; Health Care Management; Medical Ethics; Mental Health; Occupational Health; Occupational Psychology; Organization Theory; Organizational Behavior; Psychology; Psychotherapy; Public Health; Public Health Education; Systems Design; Therapy

Doctor of Philosophy, The Ohio State University, 2015, Public Health

Cardiovascular disease (CVD) and cancer, leading causes of morbidity and mortality in the U.S., share modifiable sources of risk. Health disparities, which are differences in the incidence, prevalence, mortality and burden of disease that should not exist, are influenced by wide-ranging social determinants of health. This research sought to address the need for improved understanding of the status and social determinants of mutual sources of CVD and cancer risk among two U.S. populations facing health disparities, Puerto Ricans living in the contiguous U.S. and residents of Appalachia, using The American Heart Association's Life's Simple 7 of Cardiovascular Health (LS7) metric and data from the Boston Puerto Rican Health Study (BPRHS) and Appalachian Community Cancer Network (ACCN). LS7 includes well-defined poor, intermediate and ideal levels of smoking, body mass index (BMI), physical activity, diet, blood pressure, total cholesterol and plasma glucose, modifiable behaviors and factors associated with CVD and cancer. The goals of this research were to: (1) quantify and compare LS7 across BPRHS and ACCN study participants and a nationally representative sample of civilian, non-institutionalized non-Hispanic whites from the National Health and Nutrition Examination Survey (NHANES), and (2) independently assess the relationship between geographic food access and LS7 healthy diet score among BPRHS and ACCN study participants. There were significant differences in the distribution of several LS7 components and overall LS7 score between BPRHS and ACCN study participants, BPRHS and NHANES participants, and ACCN study and NHANES participants. Results suggest smoking, BMI, and plasma glucose warrant further investigation among BPRHS participants and BMI and blood pressure warrant further investigation among ACCN study participants. Diet was also identified as a risk behavior for prioritization among BPRHS and ACCN study participants since <=1% of each research sample (open full item for complete abstract)

Committee: Electra Paskett (Committee Chair); Randi Foraker (Committee Member); Michelle Kaiser (Committee Member); Abigail Shoben (Committee Member) Subjects: Epidemiology; Public Health

Specialist in Education (Ed.S.), University of Dayton, 2024, School Psychology

This thesis investigates the relationship between the presence of Gay-Straight Alliances (GSAs) and school staff attitudes toward and knowledge of LGBTQ+ students and issues. Drawing upon existing literature highlighting the significance of social supports for LGBTQ+ populations in educational settings, this study focuses on the attitudes and knowledge of LGBTQ+ rights and risk factors held by school staff in high schools with and without GSAs. A quantitative survey design was employed, utilizing adapted measures from existing research tools to assess school staff attitudes and knowledge regarding LGBTQ+ student populations. Results revealed no significant differences in knowledge or attitudes between schools with and without GSAs. These findings suggest that while GSAs provide vital support for LGBTQ+ students, additional strategies beyond their presence alone may be necessary to enhance school staff knowledge and attitudes, emphasizing the importance of comprehensive LGBTQ+ inclusivity initiatives within educational settings.

Committee: Susan Davies (Committee Chair) Subjects: Counseling Psychology; Educational Psychology; Glbt Studies; Psychology; School Counseling

Doctor of Philosophy, Case Western Reserve University, 2024, Social Welfare

Each year in the United States, approximately 15.5 million children are exposed to intimate partner violence (IPV), and 7.1 million children fall victim to child maltreatment, in their homes. Not only are these childhood violence exposures serious concerns alone, but they often co-occur, with child maltreatment happening in approximately 30-60% of households where IPV is taking place. Among several of their deleterious outcomes, both violence exposures have been linked with adolescent dating violence (ADV). However, despite the significance of these issues, several gaps exist in the literature, including inconsistent measurement IPV exposure and ADV research, with varying results specific to ADV perpetration, limited child maltreatment and ADV studies, and no existing studies assessing the impact of IPV exposure and child maltreatment co-occurrence on ADV. These limitations are exacerbated by a lack of theoretically grounded studies, particularly examining mechanisms explaining the relations between childhood IPV exposure, child maltreatment, and ADV. To address these gaps, this dissertation comprises three distinct yet connected studies within the fields of childhood IPV exposure, child maltreatment, and ADV. In studies one and two, theoretically driven conceptual models were tested using moderated mediation structural equation modeling with data from the National Survey of Teen Relationships and Intimate Violence (STRiV) to identify potential points of prevention and intervention in the relations between childhood IPV exposure, child maltreatment, co-occurrence of both, and ADV perpetration. In study three, a systematic review and evaluation of existing measurement approaches in the field of IPV exposure and ADV was conducted, resulting in recommendations for the field moving forward. In studies one and two, one theoretically driven, potential point of intervention was identified: youth mental health quality. Study three identified several recommendations for the (open full item for complete abstract)

Committee: Laura Voith (Committee Chair); Christopher Burant (Committee Member); Marjorie Edguer (Committee Member); Megan Holmes (Committee Member) Subjects: Social Work

Doctor of Philosophy in Health Sciences, Youngstown State University, 2023, Department of Health Professions

Manual Therapy (MT) is a heterogenous, non-pharmacological analgesic treatment approach utilized by healthcare practitioners to manage pain. The utility of MT has been well established; however, developments within the field of MT question how patients should be selected, and by what mechanism(s) MT is providing analgesia. Patient-centered care models emphasize the need to use tailored treatment directed at patients who are most likely to respond. Historically, MT models have utilized clinical exam findings and biomechanics to guide treatment in a ‘patient centered' way, recent literature has suggested biomechanical and technique factors to be less important than previously understood. This prompts a shift towards patient-level factors dictating treatment. Pain phenotyping may use patient characteristics to subgroup individuals in an attempt to identify those who are likely to respond to an intervention. The purpose of this dissertation was to establish the concept of pain phenotyping as a step towards patient centered care within Orthopedic Manual Therapy. The concept of pain phenotyping was introduced across several platforms (digital and print). A scoping review was completed to investigate how patient specific phenotypic variables interact with MT treatment effect. An international Delphi study was completed investigating necessary changes within MT training paradigms based on this progressive knowledge. The results of the studies produced within this dissertation support manual therapies transition from a biomedical model to a patient centered biopsychosocial model for application. Pain phenotyping in orthopaedic manual therapy has enormous potential to improve patient -centered care models. This dissertation framed the concept of pain phenotyping across three different subgrouping methods in several ways and took several steps towards a better understanding of how this concept should influence orthopedic manual therapy clinical practice and research.

Committee: Chad Cook PhD (Committee Chair); Kenneth Learman PhD (Committee Member); David Griswold PhD (Committee Member) Subjects: Physical Therapy

PHD, Kent State University, 2022, College of Public Health

Background: Type 2 diabetes, known as non-insulin-dependent diabetes, has increased among the adult population in Saudi Arabia. Diabetes affects 18.3% of Saudi individuals, and about $7 billion (13.9% of the total health care budget) is utilized for all diabetes patients. The problem affects people of all ages, and college students often fail to follow the recommended diabetes prevention behaviors, increasing their risk of T2DM. Evidence shows that people's health behaviors are influenced by their health beliefs and other personal and environmental factors. From a prevention viewpoint, a few studies have explored the association between health beliefs and people's behaviors; however, those studies were on patients with T2DM. The association of environmental factors on physical activity and dietary behaviors among Saudi college students in the United States was not previously assessed. Therefore, using the Health Beliefs Model, this study examines the association between college students' health beliefs, other risk factors, and their physical activity and dietary behavior. Method: A cross-sectional survey was conducted through social media targeting Saudi international students living in the United States. Descriptive analysis was utilized to identify participant characteristics and describe the frequencies of physical activity and healthy diet per week. Logistic regression analysis examined the association between multiple factors and health behaviors. Results: Among the 410 participants, overweight and obese participants represented 32.4% and 14.6%, respectively. Participants with T2DM family history were 57.2%, and 22% were current smokers. The majority of participants reported moderate levels of stress (93.9%), and 61% had a lack of T2DM knowledge. Most participants did not feel susceptible to T2DM and did not feel it was serious; however, most (56.5%) believed in the benefits of engaging in healthy behaviors. About 59.5% had low levels of perceived susceptibilit (open full item for complete abstract)

Committee: Jeffrey Hallam Dr. (Committee Chair); Kele Ding Dr. (Committee Member); Peggy Stephens Dr. (Committee Member); Eric Jefferis Dr. (Committee Member) Subjects: Health; Health Sciences; Public Health

PhD, University of Cincinnati, 2022, Nursing: Nursing - Doctoral Program

Background: Firefighter fatalities from heart attacks or sudden cardiac deaths (SCD) are the number one cause of on-duty firefighter deaths. With more than 1.1 million firefighters working in the United States, lack of routine monitoring of firefighters engaged in strenuous activities could result in the delayed early detection of cardiopulmonary compromise that warrants further medical evaluation. It is imperative for occupational health professionals and firefighter leadership to develop practical and cost-effective strategies facilitating early detection of cardiopulmonary distress in on-duty firefighters. Performing research during firefighting activities may lead to identifying effective real-time monitoring strategies leading to early detection and application of early interventions reducing or eliminating on-duty firefighter deaths due to cardiopulmonary issues. Aim: The aim of this dissertation research is to advance knowledge about using practical approaches, such as exploring exertion perception and monitoring vital signs variability, as surveillance techniques to assess for early signs of cardiopulmonary stress while firefighters are on-duty. Methods: For this manuscript-based dissertation, three interrelated manuscripts were completed. Manuscript one was a systematic review of existing literature to explore the relationship of Borg rating of perceived exertion (RPE)® scale and heart rate in firefighters. Two data-based manuscripts were constructed on data gathered during an exploratory, descriptive study conducted with 19 firefighter participants. Using an observational repeated measures design, four time points of data were collected from each participant under the two conditions (firefighter fire house activities and live-burn training activities). Manuscript two was an exploration of vital sign variability within and between the two conditions. Manuscript three was an exploration of vital sign variability in relationship to cardi (open full item for complete abstract)

Committee: Carolyn Smith Ph.D. (Committee Member); Amit Bhattacharya Ph.D. (Committee Member); Susan Reutman Ph.D. (Committee Member); Joshua Lambert Ph.D. (Committee Member); William Jetter Ph.D. (Committee Member) Subjects: Occupational Safety

Doctor of Philosophy, The Ohio State University, 2022, Human Ecology: Human Development and Family Science

According to the American Society of Metabolic and Bariatric Surgery (ASMBS) clinical practice guidelines, all patients seeking bariatric surgery are required to have a preoperative psychological evaluation. The purpose of the psychological evaluation is to assess current and untreated mental health diagnoses, disordered eating, substance use and psychosocial history prior to surgery (Mechanick et al., 2020). However, there is no clear guidance on how these areas should be assessed within the evaluation. These guidelines also do not provide guidance on how providers should assess family/relational contexts that may also influence the patients' ability to modify and maintain health behaviors. This is critical information that is needed to establish consistency of the preoperative psychological evaluation process between centers to ensure equity for bariatric patients in the evaluation process between centers. This current dissertation presents the results of three studies which investigated associations between psychological evaluation pass/delay rates, demographics, current diagnoses (mental health, disordered eating, substance use), postoperative outcomes, impairment/no impairment on that piloted relational screener, and whether a patient completed the behavioral health consultation once screening as impaired. It also explored the preliminary feasibility of piloting a brief relational screener alongside the standard psychological evaluation and referral pathways. The first study provides evidence about which mental health, disordered eating, and substance use diagnoses associate with patient pass and delay rates from the bariatric surgery preoperative psychological evaluation. It also investigated reasons, recommendations, and referrals for delay and denial after the postoperative psychological evaluation. Significant associations between pass/delay rates and demographics, current mental health treatment, and having a current mental health, disordered (open full item for complete abstract)

Committee: Keeley Pratt (Advisor); Natasha Slesnick (Committee Member); Ashleigh Pona (Committee Member); Brian Focht (Committee Member); Lorraine Wallace (Committee Member) Subjects: Health Sciences; Psychotherapy; Social Psychology

Master of Science, The Ohio State University, 2021, Psychology

Body mass index (BMI) is a risk factor for Alzheimer's disease (AD) although the relationship is complex. Obesity in midlife is associated with increased risk for AD, whereas evidence supports both higher and lower BMI increasing risk for AD in late life. This study examined the influence of individual differences in genetic risk for AD to further clarify the relationship between late-life BMI and conversion to AD. Participants included 54 individuals categorized as cognitively normal or as having mild cognitive impairment at baseline who converted to AD within 24 months and 54 matched controls from the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort. BMI was measured at baseline. Genetic risk for AD was assessed via genome-wide polygenic risk scores. Conditional logistic regression models were run to determine if BMI and polygenic risk predicted conversion to AD. Results showed an interaction between BMI and polygenic risk, such that individuals with lower BMI and higher polygenic risk were more likely to convert to AD relative to individuals with higher BMI. These results remained significant after adjusting for cerebrospinal fluid biomarkers of AD as well as for depressive symptomology. Moreover, an interaction between BMI and APOE ε4, the single strongest genetic risk factor for AD, did not predict conversion to AD. Furthermore, sex-stratified analyses revealed the interaction between BMI and polygenic risk only remained significant in males. These results show that higher genetic risk in the context of lower BMI predicts conversion to AD in the next 24 months, particularly among males. These findings suggest that genetic risk for AD in the context of low BMI may serve as a prodromal risk factor for future conversion to AD.

Committee: Jasmeet Hayes PhD (Advisor); Scott Hayes PhD (Committee Member); Charles Emery PhD (Committee Member) Subjects: Psychology

PHD, Kent State University, 2020, College of Nursing

Between 18.5% and 21% of patients hospitalized for heart failure (HF) are readmitted within 30 days, representing a significant burden to the U.S. healthcare system. Readmission within 30-days has been considered an issue of poor quality of care by CMS, but for patients it may indicate the worsening of the disease process or difficulty managing their HF and other comorbidities. Further, disparities are known to exist for HF and HF hospital readmission for patients living in highly disadvantaged neighborhoods. Multidisciplinary interventions that account for care across health care settings, as well as the upstream factors that impact health overall, are needed to improve outcomes. The purpose of this study was to examine the relationship between early provider follow-up, nursing care coordination/transition management (CCTM) intensity, and 30-day hospital readmission in a population of older adults with HF, and to determine if an interaction exists with neighborhood disadvantage. The study was a retrospective, correlational design utilizing existing data. Inclusion criteria were age ≥ 65 years, hospitalization for heart failure, and discharge to the home setting. In the primary study, population-level data were obtained based on the geocoded addresses of record from the index admissions. All other data were obtained from medical records and billing databases. Logistic regression and moderated mediation analysis were used to describe the relationships between the study variables. A direct relationship between early provider follow-up within 14 days and decreased 30-day readmission was identified, but no indirect relationship through CCTM intensity. Further, neighborhood disadvantage did not moderate the direct effect of early provider follow-up on 30-day readmission. The relationship between early provider follow-up and CCTM intensity was significant and moderated by neighborhood disadvantage. Patients who had an early provider follow-up and lived in areas (open full item for complete abstract)

Committee: Dana Hansen PhD (Committee Chair); Lisa Onesko DNP (Committee Member); Amy Petrinec PhD (Committee Member); Lynette Phillips PhD (Committee Member); Hallam Jeffrey PhD (Other) Subjects: Health Care; Health Sciences; Nursing

PhD, University of Cincinnati, 2019, Medicine: Industrial Hygiene (Environmental Health)

The goal of the exposure assessment process is to accurately define the exposure distribution for workers over a certain period of time in order to identify the resulting potential risk to employees' health or well-being. The main objectives of this research were to investigate the effect of local environmental factors on occupational exposure with the consideration of different contaminants and to determine the impact of these factors on the performance of different direct reading instruments. Overall, this dissertation consists of three studies (A-C). In study A, the current occupational health risk assessment methodologies that have been developed to assess human health risks in the petroleum refining industry are outlined and compared. Three general categories of health risk assessment methods that have routine use in the petroleum sector include process safety management, quantitative exposure and risk assessment management tools, and qualitative risk ranking tools. Published health assessment methods for oil and gas, and, chemical industries lack transparency, often have unclear validation, and the majority of the available methods are too complicated and time intensive for routine scenario assessment use. In study B, four micro-environmental factors, wind speed and direction, distance to the emission source, and worker posture were investigated in a laboratory simulation. Methane was used in a simulated setting of an oil refinery maintenance task involving replacing a blind in a 4-inch line. Gas concentration was measured at the breathing zone (BZ) with the Gas-Rover. This simulation study suggests that the local environmental factors have a significant effect on the level of gas concentration at the worker BZ. Air blowing from the side direction reduced average concentrations by the most significant percentage (96%) compared to the baseline, followed by the front direction (68%) then the swirled air movement by (63%) reduction level. Air blowing fr (open full item for complete abstract)

Committee: Kermit Davis Ph.D. (Committee Chair); Susan Arnold Ph.D. (Committee Member); Thomas Lentz Ph.D. (Committee Member); Michael Maier Ph.D. (Committee Member); Marepalli Rao Ph.D. (Committee Member) Subjects: Occupational Safety

Master of Science, The Ohio State University, 2019, Industrial and Systems Engineering

This study used a qualitative approach to attempt to provide further insight into the causal mechanisms for the previous findings of investigations which have documented a higher prevalence of musculoskeletal symptoms and/or disorders in women surgeons when compared to their male colleagues. One-on-one in-depth interviews were conducted with twelve women surgeons practicing in a range of surgical subspecialties, with a wide range of years of experience. Surgeons described the factors of their work system which resulted in awkward postures, requirements for high levels of manual force, exertions while maintaining static postures, as well as operating while physiologically strained due to minimal opportunities to eat or hydrate, combined with insufficient periods for physical recovery. These factors included manual patient handling, suboptimal task height related to operating room tables, deficiencies in instrument design related to their hand size and strength capacity, and a culture of surgery which does not advance the general well-being of surgeons. Many of the issues raised in these interviews can be addressed through application of known human factors engineering design principles, leading to an operating room environment that

Committee: Carolyn Sommerich (Advisor); Steven Lavender (Committee Member) Subjects: Design; Engineering; Health; Health Care; Health Care Management; Health Sciences; Medicine; Womens Studies

Master of Science, The Ohio State University, 2017, Allied Medicine

Objective: Patient physiological monitoring creates a large number of alarms, most of which are false. High numbers of false alarms inhibit discrimination between true and false alarms leading to the neglect of future alarms, both false and true, risking slower identification and reaction to hazardous conditions. This study introduces several methods, especially novel visualizations, to discern how alarms are temporally distributed, and how alarms coalesce as sets of alarms. Methods: Retrospective evaluation of data extracted from a hospital-system-wide middleware alarm escalation software database containing million of alarms over a time period of 16 to 18 months. Multiple comparison of means is employed as well as several visualizations including, box-and-whisker plots, periodograms, and a novel Gantt-inspired visualization in combination with a histogram. Results: Multiple comparison of means finds statistically significant differences between alarms occuring on an hourly, daily, and shift-wise basis. Box-and-whisker visualization of alarms by hour over a week reveals visual signatures of alarm occurence varying on a unit-by-unit basis. Periodograms reveal multiple periodicities in alarm occurrence varying on a unit-by-unit basis. Study of simultaneous alarms uncovers quantizations such as the highest numbers of alarms occuring by unit (6 to 10 simultaneous alarms). Gantt-style visualization of simultaneous alarm occurences uncovers interesting alarm signatures such as threshold hovering of alarms, appearing as a visual stutter, or the redundancy of certain alarms (e.g. bradycardia and low heart rate) which occur in parallel.Long-term, there is a large percentage of time that at least one alarm is sounding on a unit (18.1% to 62.2%). Conclusions: Retrospective evaluation of a middleware alarm escalation software database in combination with novel visualization provides a valuable heuristic tool.

Committee: Emily Patterson (Advisor); Laurie Rinehart-Thompson (Committee Member); Michael Rayo F (Committee Member) Subjects: Engineering; Health Care; Health Sciences; Information Science; Information Systems; Medicine

Master of Science, The Ohio State University, 2016, Dentistry

There is growing interest in the social factors that influence healthcare seeking behaviors, especially in the pediatric population. The purpose of this study was to compare parental stress, parenting style, and social risk factors of patients presenting for dental caries related emergencies versus hygiene controls in a hospital dental clinic setting. Subjects presented to the dental clinic at Nationwide Children's Hospital as a new patient for either a dental caries related emergency or hygiene visit. Seventy-seven qualifying primary caregivers, 46 in the emergency group and 31 in the hygiene group, were administered 3 questionnaires: a demographic survey determining the patient's number of social risk factors for poor health outcomes, the Parental Stress Index Short Form Fourth Edition (PSI4-SF), and the Parenting Styles and Dimensions Questionnaire (PSDQ). This study found that emergency patients were significantly less likely to be African American or Hispanic, were significantly more likely to have self -reported poor caregiver mental health, and were significantly older. Hygiene visits were more frequent among Medicaid patients and male patients but these differences were not statistically significant. After controlling for race, age, and defensive responding, higher stress in the parent distress domain and total stress domain of the PSI4-SF were associated with greater odds of the patient being from the emergency group. Low caregiver mental health and high parenting stress seem to be predictors of emergency dental care seeking behavior. Future studies should study the relationship between interventions to improve caregiver mental health and parenting stress and the improvement in the oral health of the child.

Committee: Ashok Kumar DDS, MS (Advisor); Dennis McTigue DDS, MS (Committee Member); Daniel Coury MD (Committee Member); Paul Casamassimo DDS, MS (Committee Member); Homa Amini DDS, MS, MPH (Committee Member) Subjects: Dentistry

Master of Science, The Ohio State University, 2016, Dentistry

Purpose: To characterize a child population seeking emergency dental care at the largest urban children's hospital's dental clinic and determine social determinants of health associated with emergency care seeking behaviors. Methods: 418 parents of children seeking emergency dental care at the Nationwide Children's Hospital Dental Clinic (NCHDC) completed a two-part survey. Part 1 asked 22 questions regarding patient and parent demographics, social risk factors, prior utilization of the dental and medical health care system, parent-identified chief complaint, thorough pain history, and past dental history. In part 2, dentists noted diagnosis, whether patient had sought care elsewhere for chief complaint, and information regarding necessary treatment and follow-up care. Additional patient demographics, in depth medical history and information related to previous care seeking behaviors were drawn from the electronic health record. Results: Of 418 patients completing the survey, most respondents were Caucasian 227(54%) or African American 161(39%), with the majority residing in Franklin County 288(71%). At assessment, 243(59%) of patients presented with caries pain, and 74(18%) presented with dental trauma. 237(57%) patients required treatment, with extraction being the most common. 234(56%) of patients were in pain, and nearly half (49%) had been in pain for 7 days or more. Almost half of patients (44%) had a dental visit within the last 6 months, and nearly one third of patients (30%) were seen elsewhere before presenting to NCHDC for this emergency visit. 226(54%) patients have only ever sought care at NCHDC on an emergency basis, with 47(11%) having their first dental visit at the time of emergency visit. 301(77%) families were considered low income, earning less than $40,000 annually which is approximately 200% of the federal poverty level. 227(67%) children lived in single parent homes, and only 90(22%) parents reported having a bachelor's degree. Only 259(63 (open full item for complete abstract)

Committee: Ashok Kumar DDS, MS (Advisor); Paul Casamassimo DDS, MS (Committee Member); Homa Amini DDS, MPH (Committee Member); Catherine Flaitz DDS, MS (Committee Member); Jeffrey Hoffman MD (Committee Member) Subjects: Dentistry; Public Health

EdD, University of Cincinnati, 2016, Education, Criminal Justice, and Human Services: Counselor Education

Postnatal depression (PND) impacts an estimated 13% of women of childbearing age. PND impacts the mother's offspring evidenced by increased risk of developmental delays, alcohol dependence, anxiety, and depression. Many investigators have examined the individual risk factors associated with PND but only a few studies outside of the U.S. have delved into the maternal neighborhood characteristics for PND. The aim of this study was to investigate the association between postnatal depression potential and structural neighborhood characteristics among at-risk women in a home visitation program in Hamilton County, Ohio. The archival data sources - eECS (individual level) and U.S. 2010 census tract (neighborhood level) were utilized for this study. The sample included 295 mothers enrolled in a home visitation program between 2006 and 2011 who were at risk for developing PND, observed as three-month Edinburgh Postnatal Depression Scale (EPDS) scores ≥ 10. After a principal component analysis of the structural characteristics, two components were maintained: Social Disadvantage and Stability. These two components were the neighborhood predicators analyzed in a generalized estimating equation (GEE) method using clustered standard errors. Stability was negatively associated with PND potential. Social Disadvantage was not found to be statistically significantly associated with PND potential. The findings suggest that women in home visitation programs who have high EPDS scores and live in unstable neighborhoods are at special risk of developing PND. This finding is significant in that it is possible for the counseling profession to intervene with at-risk women not only at the individual level, through differing therapeutic approaches (individual to group), but also at the neighborhood level (e.g., advocating for policy to increase stability).

Committee: Mei Tang Ph.D. (Committee Chair); George Richardson Ph.D. (Committee Member); Christopher Swoboda Ph.D. (Committee Member) Subjects: Counseling Psychology

MS, University of Cincinnati, 2016, Education, Criminal Justice, and Human Services: Health Education

Background: Research indicates that a better understanding of the relationship between the health status of communities and weight status and physical activity level among Latinos would be beneficial in developing culturally appropriate health education programs for this community. Purpose: This study assessed the relationship between perceived neighborhood health and current weight status and physical activity levels among Latinos in the Greater Cincinnati Metropolitan Area. Further, it aimed to assess the extent to which weight status and physical activity levels differed based on healthy community factors. Methods: A secondary data analysis was conducted based on the 2013 Greater Cincinnati Community Health Status Survey (CHSS). A total of 251 randomly sampled Latino participants were interviewed by telephone. The CHSS included self-reported items that assessed four main concepts: general health status and access, weight status, physical activity, perceived neighborhood health and community factors. Results: Results indicated that the majority (63%) of Latino participants reported unhealthy weight status and nearly one-third self-reported no physical activity within the past month. 29.2% rated the healthiness of the region as `fair' or `poor' and 16.1% rated their own living facilities as `fair' or `poor'. Over 30% of participants reported a lack of walkable communities and between 18% and 24% reported not feeling secure, or as if they could not obtain help or depend on their communities. Non-overweight and non-obese Latino participants reported healthier community factors in comparison to their counterparts. Participants who engaged in physical activity scored higher than those who reported being physically inactive. Discussion: Study findings should be considered when creating health education programs that address these health indicators in the local Latino community.

Committee: Liliana Guyler Ph.D. (Committee Chair); Ashley Merianos Ph.D. (Committee Member) Subjects: Health Education

Doctor of Philosophy, The Ohio State University, 2015, Nursing

More than 400,000 premature deaths per year occur due to preventable harm in U.S. hospitals, costing over $20 billion per year in healthcare expenses, lost worker productivity, and disability. Conceptual frameworks, such as the Generic Reference Model, contribute to a greater understanding of patient safety because they explain the context of patient harm. The healthcare context, including organizational factors such as strong safety culture and human factors like teamwork, may improve patient outcomes. Patient outcomes, such as adverse events, are more readily detected using instruments such as the Institute for Healthcare Improvement (IHI) Global Trigger Tool (GTT), which may detect up to ten times more adverse events than existing methods. The GTT uses keywords or triggers to guide chart reviews. Currently, relationships between safety culture and teamwork and adverse event detection using trigger-tools remain underexplored. The purpose of this study was to explore relationships between organizational and human factors with adverse events that result in patient harm detected using a modified trigger-tool methodology. The descriptive, cross-sectional design used the Safety Attitudes Questionnaire (SAQ) to measure interprofessional staff perceptions of safety culture using safety climate and teamwork climate subscales, and a retrospective, modified IHI GTT chart review methodology to measure patient outcomes at the unit level. The convenience sample was comprised of 32 nursing units/departments from one 750+-bed Midwestern U.S. regional acute care hospital that employed over 1000 nurses. Safety and teamwork climate percentage agreement averages were 75.61% and 70.07%, respectively. Medical surgical units reported the strongest safety climate whereas critical care units reported the strongest teamwork. An average of 69 adverse events occurred per 1,000 patient days, 21.83 adverse events per 100 admissions, and approximately 20% of admissions experienced a (open full item for complete abstract)

Committee: Pamela Salsberry Ph.D., RN (Advisor); Laura Szalacha Ph.D. (Committee Member); Emily Patterson Ph.D. (Committee Member); Esther Chipps Ph.D., RN (Committee Member) Subjects: Health Care; Nursing

Master of Science (MS), Bowling Green State University, 2015, Communication Disorders/Speech-Language Pathology

Sudden infant death syndrome (SIDS) is defined as an unexplained death in an infant's first year of life. Risk factors for SIDS include maternal smoking, sex, and infant sleep positioning, among others. The current study analyzed dysphonations in the cries of 32 infants 24-66 hours after birth. Dysphonations are acoustic characteristics of cries and include frequency shift (FS), harmonic doubling (HD), biphonation (BP), and noise (N). An interaction effect was found, male infants whose mothers smoked during pregnancy (maternal smoking status) had a significantly lower percent of dysphonations than male infants whose mothers did not smoke during pregnancy (no maternal smoking status). No significant main effects were found for the factors maternal smoking status, sex, infant positioning, or partition. In addition, the types of dysphonations were consistently distributed across groups with noise being the most commonly occurring dysphonation followed by harmonic doubling, frequency shift and then biphonation. It is hypothesized that differences in number and type of dysphonations may either be an effect of differences in infant arousal and/or developmental differences. A lower number of dysphonations seen in male infants with mothers who smoked during pregnancy may suggest a lowered arousal state, which may be associated with the occurrence of SIDS.

Committee: Alexander Goberman Dr. (Advisor); Ronald Scherer Dr. (Committee Member); John Folkins Dr. (Committee Member) Subjects: Acoustics; Communication; Gender; Health; Speech Therapy

Master of Science in Pharmaceutical Science (MSP), University of Toledo, 2013, College of Pharmacy

Medication non-adherence is commonly seen among patients with cardiovascular disease. However, failure to fill prescriptions, a type of medication non-adherence, is rarely studied among these patients. Failure to fill prescriptions, also known as primary medication non-adherence (PMN), can lead to progression of disease condition and adverse outcomes which can ultimately increase healthcare costs. Therefore, it is important for patients, especially who are newly diagnosed with cardiovascular disease to fill their prescriptions. The incidence of cardiovascular disease is higher in elderly population. Hence, elderly population is susceptible to PMN, but little is known about the extent of PMN for this population and its impact on health service utilization. Recent healthcare reform emphasizes on giving high quality care to elderly patients with chronic conditions such as cardiovascular disease. Since medication adherence is a quality measure for healthcare service received by this population, efforts should be made in identifying ways to improve PMN. Hence, the objective of this study is to measure the rate of PMN, assess reasons and factors that are associated with PMN and compare health service utilization behavior between adherent and non-adherent Medicare covered elderly population with newly diagnosed cardiovascular disease. This was a cross-sectional cohort study of Medicare beneficiaries with newly diagnosed cardiovascular disease using Medicare Current beneficiaries Survey (MCBS) files from 2002 to 2006. Andersen's model of health service utilization was used as a theoretical framework to define factors that may be associated with PMN. Seven thousand five hundred and forty-two Medicare beneficiaries were newly diagnosed with cardiovascular disease from years 2002 to 2006. Out of these, 334 patients did not fill prescriptions which represented 4.43% of the cohort under study. Female gender (OR 0.682, 95% CI 0.522-0.890), lower patient satisfaction score on ov (open full item for complete abstract)

Committee: Varun Vaidya PhD (Committee Chair); Sharrel Pinto PhD (Committee Member); Aliaksandr Amialchuk PhD (Committee Member) Subjects: Health Care; Pharmacy Sciences; Social Research