Doctor of Philosophy, The Ohio State University, 2022, Public Health

Asian-Americans and Native Hawaiian/Other Pacific Islanders (NHOPIs) experience health and healthcare disparities compared to their white counterparts. In both communities, which are often jointly described as Asian-American Pacific Islanders (AAPIs), college students represent a vulnerable subpopulation in regard to mental health outcomes and healthcare. Unfortunately, relatively little is known about the mental health outcomes and experiences of Asian-American and NHOPI undergraduate students. This dissertation sought to evaluate how race, gender, and the intersection of the two affect the mental health outcomes and lived experiences of Asian-American and NHOPI undergraduate students. Three separate, but interconnected, studies using both qualitative and quantitative methods were completed. First, a secondary data analysis of the Healthy Minds dataset (2018-2019) provided a characterization of depression, anxiety, and psychological well-being outcomes for Asian-American and NHOPI undergraduate students across the United States. Second, a qualitative semi-structured interview study was conducted among Asian-American undergraduate students; this allowed me to explore and analyze their lived experiences of filial piety and how it intersected with mental health, race, gender, and other macro-level factors. Finally, a cross-sectional quantitative survey of Asian-American and white undergraduate students was launched. This survey was developed using survey input from research experts in public health, survey methodology, and/or Asian-American health and input from focus groups with Asian-American undergraduates. The survey collected information on filial piety and mental health to determine how race, gender, and the intersection of the two impacted filial piety, depression, anxiety, and psychological well-being. This research had three main conclusions. First, the mental health outcomes of AAPI undergraduate students are heterogenous. Differences between Asian-Amer (open full item for complete abstract)

Committee: Mira Katz (Advisor); Daniel Strunk (Committee Member); Paul Reiter (Committee Member); Rebecca Andridge (Committee Member) Subjects: Asian American Studies; Gender; Health; Health Care; Minority and Ethnic Groups; Psychology; Public Health

Ed.D., Antioch University, 2025, Education

The persistent health disparities faced by Black, Indigenous, and People of Color (BIPOC) in the United States are deeply rooted in systemic racism embedded within medical education and clinical practice. Historical acceptance of racial supremacy in the United States has shaped both the foundations and continued practices of medical education, leading to entrenched biases that affect healthcare delivery and patient outcomes. This dissertation critically examines the intersection of race, education, and health by analyzing how historical and contemporary understandings of race and ethnicity shape medical curricula, healthcare practices, and patient care. Through the integration of Critical Race Theory (CRT), Social Cognitive Theory (SCT), and ScT, this study deconstructs racialized knowledge systems in medicine and examines their impact on health equity. CRT provides a lens to analyze how systemic racism is embedded within medical education and practice, illuminating the ways racial bias is institutionalized and perpetuated in healthcare structures. SCT contributes by exploring how individuals internalize societal norms and beliefs, which influence the attitudes and behaviors of both medical practitioners and patients. Finally, ScT emphasizes the role of social networks and relationships, highlighting how disparities in access to healthcare resources and support systems affect health outcomes in marginalized communities. Together, these theories offer a comprehensive framework for understanding the layered and interconnected influences of race, education, and healthcare, guiding the study's aim to challenge and dismantle biased practices within medical training and clinical care. Chapters I and II introduce the research problem and establish a comprehensive foundation, outlining key theoretical frameworks—CRT, SCT, and ScT—while exploring the historical roots of racialized practices in medicine, including the legacy of unethical experimentation and the Flexner Report (open full item for complete abstract)

Committee: Tony Kashani Ph.D. (Committee Chair); Cristy Sugarman Ph.D. (Committee Member); Lauren Mitchell Ph.D. (Committee Member) Subjects: African Americans; American History; Black History; Black Studies; Cultural Anthropology; Education History; Education Policy; Educational Evaluation; Educational Leadership; Educational Theory; Ethics; Evolution and Development; Health; Health Care; Health Education; Health Sciences; Higher Education; Higher Education Administration; Medical Ethics; Medicine; Organization Theory; Organizational Behavior; Public Administration; Public Health; Public Health Education; School Administration; Science Education; Secondary Education; Social Research; Social Structure

MS, University of Cincinnati, 2023, Medicine: Clinical and Translational Research

Objective: We assessed for inequities in continuity of care, using the Usual Provider Continuity Index (UPC – the proportion of visits with the provider the patient saw most frequently out of all visits), in a set of large pediatric academic clinics. Methods: We conducted a retrospective cohort study. Patients 12-24 months seen at 3 pediatric academic primary care clinics for any visit October 1-31, 2021 were included. We then reviewed continuity for these patients in the preceding 12 months. Outcomes included each patient's UPC for all visits, and a modified UPC for well child checks only (UPC Well). Covariates included race, ethnicity, insurance, clinic site, age, sex, care management, or seeing a social worker. We evaluated for differences in outcomes using bivariate analyses and multivariable regression models. Results: Our cohort included 356 patients (74% Black, 5% Hispanic, 85% Medicaid, 52% female, median age 15.8 months). The median UPC was 0.33 and median UPC Well was 0.40. Black patients had significantly lower median values for UPC (0.33 Black vs 0.40 non-Black, p<0.0001) and UPC Well (0.33 Black vs 0.50 non-Black, p<0.0001). There were similar inequities in continuity rates by insurance and clinic site. In multivariable models, clinic site was the only variable significantly associated with continuity. Conclusions: Clinic sites serving higher percentages of Black patients had lower rates of continuity. We believe structural racism contributes to these inequities. This analytic approach can be used to inform family-engaged, co-produced improvements in clinic processes, and to address structural factors influencing likelihood of continuity.

Committee: Patrick Ryan Ph.D. (Committee Chair); Shelley Ehrlich M.D. (Committee Member); Andrew Beck M.D. (Committee Member) Subjects: Medicine

MS, University of Cincinnati, 2020, Medicine: Genetic Counseling

The disability and genetics communities have a long and complex history, beginning with the modern eugenics movement and continuing as genetic technology improves the ability to prenatally screen for and diagnose genetic conditions. Genetic counselors, who are key players in the genetics field and who often interface with individuals with disabilities, play a seemingly contradictory role in their interactions with patients. Genetic counselors provide information about disabling genetic conditions and offer opportunities for avoidance of these conditions in a prenatal setting, while simultaneously advocating for individuals with disabilities in pediatric and adult contexts. This study aimed to fill a gap in the literature surrounding genetic counselors' explicit attitudes on disability, as well as their views on nondirective counseling in the context of disability, awareness of health inequities faced by those with a disability, and endorsement of disability models. By investigating these questions, this study sought to provide a better understanding of the views of genetic counselors and to determine how these views are related to non-directiveness in the delivery of care. This study also aimed to help determine whether there is a need to increase awareness and education around the lived experience of individuals with a disability. Genetic counselors belonging to the National Society of Genetic Counselors were sent an electronic survey consisting of multiple parts, the final being the Attitudes Toward Disabled Persons scale to assess explicit attitudes. Analysis of responses revealed that genetic counselors largely adhere to a nondirective approach in a prenatal setting regardless of disability status of the patient or the scenario of interest. Areas for improvement exist regarding genetic counselors' awareness of inequity and discrimination regarding disability. Genetic counselors in our study endorse all assessed models of disability and have relatively positive a (open full item for complete abstract)

Committee: Carrie Atzinger M.S. C.G.C. (Committee Chair); Kara Ayers Ph.D. (Committee Member); Hua He M.S. (Committee Member) Subjects: Genetics