Master of Public Health
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Item An Analysis of the Differences in Educational Attainment between TBI Severity Level, Gender, and Injury Cause(2021-08) Jordan, JustinTraumatic Brain Injury (TBI) has become increasingly prevalent in the last ten years and poses a major threat to public health. TBI continues to plague millions of individuals around the world on an annual basis (Galgano et al., 2017). The purpose of this study was to evaluate the differences in the educational attainment of TBI survivors across injury severity, gender, and cause of injury. This study examined the differences in the educational attainment across severity levels classified as mild, moderate, and severe. Second, this study examined differences in educational attainment of TBI survivors between males and females. Lastly, this study evaluated the differences between the educational attainment of TBI survivors across injury cause categories. Secondary data was utilized from the 2019 Traumatic Brain Injury Model Systems National Data and Statistical Center (TBINDSC). In this study, a One-Way ANOVA and Independent Samples t-test were used to evaluate the data and examine differences in educational attainment across gender and severity categories. It was found that there was a significant difference in educational attainment across severity levels, however, there was not a significant difference found between educational attainment and gender. Furthermore, this study found that there was a significant difference in educational attainment across injury cause categories. This shows a need for increased promotion of safety measures to avoid injuries due to risky behaviors.Item An Analysis of the Relationship Between Income, Gender, and Perception of Gun Violence in One’s Local Community(2019-04) Hinrichs, Courtney AlexandraGun violence has significant impacts on an individual’s health and well-being. In 2017, Pew Research Center conducted a national probability-based online survey titled the American Trends Panel (ATP) Wave 25. The survey targeted adults living in households in the United States (Pew Research Center, 2017). This cross-sectional research study utilized the Pew Research Center’s American Trends Panel to examine differences in local communities’ perceived problem of gun violence between genders and income levels. In this study, a Pearson Chi-Square was calculated analyzing gender and income level as variables predicting an individual’s perception on the degree of the problem of gun violence in one’s local community. It was found that perception of local community gun violence did not differ between genders. However, perception of local gun violence did significantly differ among income levels.Item Assessing Factors for Dental Decay using NHANES Survey in the United States(2022-08) Gallardo, LauraThe purpose of this research was to study the factors affecting oral health in the residents of the United States. This study examined if there were significant differences in the examination of dental decay concerning the last dental visit and age. The study analyzed secondary data National Health and Nutrition Examination Survey 2017-2018. This study examined a sample of 9,254 residents aged 1 – 80 years old. The Chi-Square Test of Independence was used to test the association among the variables of the last visit to the dentist and age. The researcher of the study found significant difference in dental decay and age, but no significant difference was found between dental decay and last visit to the dentist. However, the researcher recommends that future studies review other factors affecting oral health in regard to oral health behaviors, high sugar intake, and full integration across all levels of the health system will likely lead to optimal benefit for population health and reduction in oral health inequities.Item Assessing Risks Factors of Hispanic Adults for Type II Diabetes in Riverside County(2021-08) Marquez, EmmanuelType II diabetes is a chronic disease that overwhelmingly affects minority populations. A unique blend of social-economic factors, self-management education, lifestyles, culture, stress, and environmental factors contribute to individuals’ risk of developing type II diabetes. Individuals are at higher risk for type II diabetes if they are over the age of 40, have excess weight, and engage in low levels of physical activity (CDC, 2021). A volunteer sample of 110 Hispanic adults participated in the study and were asked to complete a two-page International Physical Activity Questionnaire (IPAQ) survey questionnaire to measure their levels of physical activity. This study aimed to examine two major risk factors for type II diabetes among Hispanic adults: BMI and physical activity. Findings from this study showed that 65.5% of males (n = 36) were overweight, and 32.2% (n = 19) of males had normal weight. Additionally, 71.6% (n = 58) of females were found to be overweight, and 25.9 % (n = 21) were normal weight. Based on the results, it is suggested that adults were not meeting the American Heart Association’s recommended 150 minutes of weekly physical activity. Public health interventions are needed to encourage individuals to increase their level of physical activity and lower their risk for type II diabetes.Item Assessment of Public Health Core Competencies to COVID-19 Contact Tracers(2021-08) Hombs, Danielle R.Public health agencies rapidly hired contact tracers to mitigate the spread of COVID-19 without time to properly recruit or prepare staff. This research investigated the skill levels of those contact tracers based on public health core competencies. This study utilized a retrospective pre- and post-survey to capture responses from COVID-19 contact tracers employed at a local health jurisdiction in Southern California. A paired samples t-test was completed on the public health core competency means to determine if the contact tracers’ understanding of public health core competencies changed after working in this role. Results determined a significant improvement in the understanding of public health core competencies from the pre- to post-survey. An analysis of variance (ANOVA) was completed to determine if public health core competency scores were impacted by specific job tasks a contact tracer may have and revealed no significant core competency difference based on job task. Lastly, an independent samples t-test was performed to determine if contact tracers with formal public health academic training scored higher in public health core competency pretests than those without public health academic training. Results determined individuals with formal public health academic training scored significantly higher in half of the core competency groupings compared to individuals without public health academic training. These results may help stakeholders understand public health workforce recruitment and training practices and encourage other public health agencies to prioritize creating a robust workforce.Item The Association of Vaccination Status and Race/Ethnicity on Post-COVID Conditions in Riverside, California(2022-08) Buckner, Madison CandiceCOVID-19 is a significant illness and has affected society in many ways. Research has been conducted on COVID-19 on factors associated with and how to prevent and mitigate outbreaks. However, post-COVID conditions have prompted a new challenge concerning the virus. Scientific knowledge is limited in understanding what may influence the occurrence and the frequency of post-COVID conditions. The primary purpose of this study was to examine potential associations between case characteristics and the development of post-COVID conditions using local public health post-COVID surveillance system data. The study explored the relationship between race/ethnicity, vaccination status, and post-COVID conditions. A sample of 12,656 males and females from Riverside County, California, was used. Using a cross-sectional design, participants answered questions through a phone interview about demographics, symptoms, history of medical care, COVID-19 vaccination, history of hospitalization care, level of function, and comorbidities. The independent variable was race/ethnicity and vaccination status, and the dependent variable was post-COVID conditions. A Chi-square test of independence was used to answer the research questions. The results of the study indicated there is no significant relationship between race/ethnicity and post-COVID conditions. Also, there is a significant relationship between vaccination status and post-COVID conditions.Item ATOD Use During the COVID-19 Pandemic Among Adolescents(2021-08) Kaupiko, Kiana R.The COVID-19 pandemic created several changes to the daily lives of adolescents, including, but not limited, to altering the risk factors associated with alcohol, tobacco, and other drug (ATOD) use. The purpose of this study was to examine any changes in the frequency of ATOD use and perceptions of ease of availability of ATOD. Additionally, this study investigated if there was a correlation between the stress of COVID-19 and ATOD use and if adolescents who saw ATOD use on social media or online were more likely to use themselves. Secondary data from a longitudinal study that was collected in the spring of 2020 and fall of 2020 was utilized for this study. A random sample of students in grades 7th through 12th were recruited from their public schools throughout Riverside County, California. In spring 2020, participants completed a paper and pencil survey, and in fall 2020, they completed an online survey. Results indicated that that there was no change in ATOD use or perceptions of ease of access to ATOD from spring 2020 (pre-COVID-19) to fall 2020 (in-COVID-19). No correlation was found between stress during the COVID-19 pandemic and adolescent ATOD use. This study did find that adolescents who reported seeing their friends use ATOD through social media or other online contexts were more likely to use ATOD. The results of this study suggested that future research should examine the role of social upheaval, social media use, and peer affiliation needs related to adolescent ATOD use.Item A Comparison of Advance Care Directive Attitudes and Completion Rates Amongst Medicaid Population in Inland Empire Pre and Post-COVID-19 Pandemic(2020-12) Manley, Ethel P.The passage of the Patient Self Determination Act in 1990 gave patients the legal right to express their wishes for future medical care and end of life treatment wishes. Yet, despite the benefits of executing an advance directive, most people do not have one executed. Few studies have been done that focus on the Medicaid population and their attitudes about completing an advance directive during a pandemic. This study aimed to determine if the COVID-19 pandemic is enough to influence attitudes and readiness in the Medicaid population about advance directives. A cross-sectional study was conducted using a modified version of Porter Novelli’s HealthStyles end of life items and the four-item version of Measuring Advance Care Planning: Optimizing the Advance Care Planning Engagement Survey to obtain information about exposure to health information, health promotion, and communication about advance directives. The population sample consisted of 63 adult Medicaid recipients, 13 males and 49 females living in San Bernardino and Riverside counties in California. A paired samples t-test and a one-way analysis of variance (ANOVA) were performed. Based on these results, the COVID-19 pandemic was not a large enough motivator to influence advance directive completion in the Medicaid population.Item The Contributing Factors to Anxiety and Depression Among the Chinese International Students During COVID-19(2022-05) Yun, FangIntroduction: The Coronavirus Disease 2019 (COVID-19) outbreak erupted worldwide in 2019, and COVID-related psychological impacts have become a pervasive issue. However, its impacts are unclear on overlooked and yet sizeable groups such as international students in the U.S. This study examined factors significantly correlated with Chinese international students’ anxiety and depression during COVID-19. Method: A cross-sectional research design was conducted in this study. A survey sample of 100 Chinese international students from three postsecondary institutions was collected to analyze their mental health status during COVID-19. Results: There is a statistically significant association found between anxiety and financial difficulty (β = 0.22, t = 2.14, p = 0.04). Remote learning (β = -1.01, t = -2.34, p = 0.02), social support (β = -0.60, t = -2.50, p = 0.01), and financial difficulty (β = 0.21, t = 2.16, p = 0.03) significantly predict depression. There was no significant difference in anxiety or depression between Chinese international students studying in the U.S. and those studying remotely in China. Discussion: The study results indicated that increased social support and remote learning satisfaction could help international students reduce depression, and reducing financial difficulties could decrease both anxiety and depression. Future studies should explore the causal link between these factors and mental health.Item Determinants of Depressive Symptomology among College Students(2019-08) Navarro, Olivia JamileRates of depression among college students is on the rise across the United States, and the consequences are dire. This study aimed to determine if various lifestyle choices protected or put college students at-risk for developing depressive symptomology. This study examined the effect of four potential determinants and depressive symptomology: spirituality, social media use, residential status (on- or off-campus), and employment status among undergraduate college students. This study was conducted at a private Christian university and included 220 participants who completed a paper-based survey. A cross-sectional design from a convenience sample was used. Results of this study found a statistically significant association between fewer depressive symptomologies and “feeling deep inner peace or harmony.” There was also an association found between depressive symptomology and social media use. There were no significant findings for depression and residential status or employment status.Item Determinants of Type II Diabetes among Native Americans in the United States: An Analysis of the 2015 Behavioral Risk Factor Surveillance(2020-05) Snowball, Kandis DevenThe purpose of this study is to examine the relationship between type II diabetes and mental health status, alcohol/tobacco use, sleep disorders, and healthcare coverage within the Native American population. The aim of this study is to answer these questions: (1) Is mental health status, sleep disorders, tobacco use and alcohol abuse significantly associated with self-reported type II diabetes in the Native American Population? (2) Is health care coverage significantly associated with self-reported type II diabetes in the Native American Population? METHOD: using data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS). After reviewing the 2015 questionnaire, 6-questions were classified as dependent variables and were examined to determine if there was a significant relationship with self-reported type two diabetes in the Native American population (measured using BRFSS question-7). The design was a cross-sectional design using secondary data. RESULTS: no significant relationship between the variables sleep or energy and having type-II diabetes. There was a significant relationship between the variables: alcohol, reported being a current/former smoker, and mental health concerns (including stress, depression and problems with emotions) and having type-II diabetes. Also, the results found that having health care coverage was significantly associated with participants that reported having type-II diabetes. CONCLUSION: Findings from this study are beneficial in understanding the Native American/Alaska Native population and type II diabetes relationships.Item Eating Behaviors and Physical Activity among Registered Nurses in Riverside County(2020-11) De Leon, MelissaNurses are critical to the United States healthcare system, as there are more than 3.8 million registered nurses. Supporting the well-being of nurses is fundamental since they are frequently in contact with patients and work daily to improve the health of patients. The purpose of this study was to determine if there was a relationship between health habits and working as an RN within Riverside County, California. A total of 174 participants completed the Nurses’ Health Survey consisting of 24 questions. Participants were asked demographic questions that included gender, age, ethnic background, height, weight, hospital affiliation, and work setting. A weak positive correlation was found between the number of years of employment as an RN and BMI (rho (148) = .203, p = .014), indicating a significant relationship between the two variables. No significant relationship was found between perceived stress level and fast food consumption (X2 (1) = .068, p = .79). No significant relationship was found between the amount of vigorous physical activity and shift work among RNs working in Riverside County (X2 (1) = .000, p = .99. The results of these findings have public health implications for implementing health-promoting activities for nurses.Item The Effect of Education Level and Income Level on the Diagnosis of Stroke in Mississippi(2022-08) Chen, LiangMississippi has one of the nation's highest heart attack and stroke mortality rates (Mississippi Department of Health, 2019). Mississippi's educational opportunity and education levels are below the national average (Center, E. W. R. 2021). Meanwhile, Mississippi continues to have one of the nation's highest rates of poverty and income inequality (Nave & Nave, 2017). However, few studies have investigated the relationship between stroke diagnosis, income, and education level in the Mississippi population. This study aimed to examine the association between self-reported stroke diagnoses and education and income levels in the Mississippi population aged 18 years and older. This study used a questionnaire from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) as a survey tool to collect and analyze participants' secondary data information on stroke diagnosis, education level, and income level. Both research questions passed the chi-square test of independence to determine the relationship between variables. The findings showed that education and income levels were significantly associated with self-reported stroke diagnoses in Mississippi people 18 years of age and older.Item The Effect of Food Insecurity on Fruit/Vegetable Consumption and Body Mass Among Low Income and Minority Adults(2022-08) Barahona, JackieFood insecurity is a public health concern across the United States. It is rooted in poverty and can have long-lasting health consequences on communities (U.S. Agency for International Development, 2021). In 2020, California’s food insecurity rate was 20%, demonstrating that one-fifth of the state’s residents lack access to healthy, nutritious foods (California Association of Food Banks, 2020). This study aimed to examine the effect of food insecurity, specifically cutting, or skipping meals, on variables such as fruit/vegetable consumption and body mass index (BMI) in low income, minority adults, using the 2020 California Health Interview Survey (CHIS) data. The results showed a significant relationship between cutting or skipping meals and fruit consumption (t (-2.81) = 2381, p = .005). There was also a significant relationship between cutting or skipping meals and BMI (t (3.525) = 2381, p < 0.001). The findings from this study suggest health educators and community agencies should promote food assistance programs in minority communities. Furthermore, interventions need to be tailored to promote healthy eating to different cultures. Public health professionals must advocate for programs that support access to healthy food in underserved communities.Item The Effects of Multiple Chronic Conditions and Alzheimer’s Disease on the Activities of Daily Living of the Geriatric Population within Residential Care Communities(2022-08) Kothari, Ashish DipeshThe geriatric population is one of the fastest-growing subsets in the United States. They are prone to developing multiple chronic conditions, which impacts their ability to complete activities of daily living (ADLs). As the geriatric population continues to grow and live longer, many seniors seek out long-term care facilities, such as residential care communities (RCCs), to assist them in performing ADLs and regaining independence. This research study examines how multiple chronic conditions impact the number of ADLs an RCC resident needs help with and the required level of assistance. Additionally, this study examines how Alzheimer’s Disease (AD) impacts how many ADLs a resident needs help performing and to what degree because AD is a neurodegenerative condition that impacts cognitive function. Data collected in 2018 by the Centers for Disease Control and Prevention (CDC) and the National Post-Acute and Long-Term Care Study (NPALS) was used. The six ADLs reviewed in this study were bathing, dressing, eating, toileting, transferring, and walking. A significant, weak positive correlation was found between the number of chronic conditions a resident has and the total number of ADLs by using a Spearman’s Correlation test (rho(800) = 0.176, p <0.001). An independent samples t-test found significant results showcasing that resident with AD (M ADLs = 4.115, SD = 1.9546) needed help with one additional ADL than residents without AD (M ADLs = 3.032, SD = 1.993) (t(800) = 7.638, p <0.001). Lastly, the final six questions used a Chi-Square Test of Independence to see if the level of assistance required to complete an ADL was dependent or independent of an AD diagnosis. A Bonferroni correction post hoc test supported the significant findings that the level of ADL assistance is dependent on an AD diagnosis. Overall, this study provides an insightful look into how multiple chronic conditions and AD can impact geriatric independence and their ability to complete activities of daily living in residential care communities. These findings can help support future healthcare policies to ensure all members of the geriatric population have the resources and support they need to live a better quality of life despite the limitations caused by having multiple chronic conditions.Item Evaluating Public Health Workforce Satisfaction in San Bernardino County(2022-08) Ramirez, JenniferOver the years, public health departments state and local, as well as other public health agencies, have faced challenges with their workforce. Workplace satisfaction is influenced by factors such as supervisor-subordinate relationships, the opportunity for growth and advancement, and skill development, which directly affect attrition rates. The purpose of this study was to examine the difference in job-related satisfaction for employees in a supervisory and non-supervisory position using an independent samples t-test. An independent samples t-test was also used to evaluate the differences in employees, who do and do not have an intention to leave in the next year, and their average levels of self-reported satisfaction with their job, program, department, supervisor, and job security. A cross-sectional design was utilized to analyze the data gathered in 2021, from a California local jurisdiction public health department. The results demonstrated that there was no significant difference in job satisfaction between individuals working in supervisory and non-supervisory roles. Conversely, a statistically significant difference was found among all five categories of satisfaction, based on the employee's intention to leave or not leave work at the public health department within the next year. As such, further research should aim at developing and improving trainings to support current and future public health professionals.Item Evaluating the Difficulty in Finding Health Insurance Coverage and the Frequency of Hospital Emergency Visits Amongst Adults Living in California(2021-08) Alvillar, KevinThe United States spends roughly $3.8 trillion yearly on health care services, yet Americans bear the highest chronic disease burden compared to other high-income countries (Centers for Medicare and Medicaid Services [CMS], 2020). The poor healthcare system structure is affecting many Americans’ health, which is resulting in roughly $4.4 billion in unnecessary and preventable hospitalizations (Agency for Healthcare Research and Quality [AHRQ], 2018; Tikkanen & Abrams, 2020). Previous research examined the differences between educational attainment and understanding health insurance literacy and utilization; the affect of the Affordable Care Act (ACA) on health insurance coverage affordability; and insurance status and the frequency of emergency room visits. This study aimed to evaluate the differences between Californians' difficulty in finding health insurance and their frequency of self-reported emergency room visits in the last 12 months across socioeconomic (SES) categories as measured by federal poverty level. This research study utilized a cross-sectional approach and data from 2019 California Health Interview Survey. The sample size was 1,000 adults living in California, 442 males and 558 females. A Spearman’s correlational analysis and a one-way ANOVA were used to analyze the two research questions. This study revealed that there is no significant relationship between poverty level categories and difficulty in finding health insurance. The findings indicated that there is a significant difference between poverty levels categories and self-reported emergency room frequency. Further research studies should focus on how the American Rescue Plan alleviated the nation’s uninsured gap and whether this improved the health outcomes across poverty level categories.Item An Evaluation of the Differences in HPV Vaccination Status and Providers Recommendation between Genders and Maternal Educational Levels(2020-08) Martinez Luna, DulceHuman Papillomavirus (HPV) vaccination rates have remained low among adolescents in the United States over the last decade, persevering as a public health concern. The purpose of this study was to evaluate differences in HPV vaccination status and provider recommendation between genders and maternal educational levels. First, this study addressed if there were differences in HPV vaccination status between female and male adolescents 13-17 years of age. Secondly, this study sought to determine if there were differences in HPV vaccination status based on adolescents’ mothers’ educational levels (mothers of high vs. low educational levels). The study further examined the difference in provider HPV vaccine recommendations to adolescents based on adolescents’ mothers’ educational levels. Lastly, the study explored if there were differences in the likelihood of teens receiving the HPV vaccine in the next 12 months based on the adolescents’ mothers’ educational levels. This study employed a cross-sectional design using data from the 2018 National Immunization Survey-Teen (NIS-Teen). Chi-square tests of independence and an independent samples t-test were used to analyze the four research questions. The findings of this study determined a significant difference in HPV vaccination status between genders (p = .002). This study also identified a significant difference in provider recommendations between high and low maternal educational levels (p = .001). However, no difference was found in the likelihood of teens receiving the HPV vaccine in the next 12 months between adolescents whose mothers had high or low educational levels. Further research is needed to better understand reasons for lack of provider HPV recommendations.Item An Evaluation of the Differences in Self-Reported Serious Psychological Distress, Race, Income, and Insurance Status(2019-08) Holguin, Michelle JosephineMental health is an on-going public health concern that has become a more prominent issue over the last several years. While suicide rates continue to rise, many individuals still do not receive mental health treatment. Further, a large population of adults with mental health disorders do not receive treatment for their condition despite overall increases in treatment rates in the past 20 years (Walker, Cummings, Hockenberry, & Druss, 2015). The purpose of this study was to evaluate the occurrence of serious psychological distress across race categories and income levels as well as the rate of insurance coverage for mental health needs across race categories for those who have reported mental health problems within the last year. Research has shown that individuals from different ethnicities may have different barriers in accessing health services. This study employed a cross-sectional design utilizing data from the 2017 California Health Interview Survey (CHIS). One-way ANOVA tests were used to evaluate separately differences in serious psychological distress across race categories and income levels. A Kruskal Wallis H test was used to evaluate differences in mental health insurance coverage across ethnicity categories. The findings of this study determined a significant difference in serious psychological distress across ethnicity categories (p < .01). A significant difference was also found in serious psychological distress across income levels (p < .01). However, no difference in insurance coverage was found across ethnicity categories.Item Evaluation of the Keepin' it REAL Drug Prevention Program(2022-08) Bernal, Nancy GuadalupeAlcohol, tobacco, and other drug (ATOD) use among adolescents is a severe public health problem in the United States. ATOD prevention programs have been implemented in schools to reduce the adverse health and social consequences of youth ATOD use. This study examined the effectiveness of the keepin’ it REAL (kiR) drug prevention program among 118 adolescents from two different high schools in Southern California. A quasi-experimental design was utilized to determine the impact of the program on adolescents’ ATOD use behaviors. It was hypothesized that students who received the kiR program would report a decrease in ATOD use behaviors and an increase in intention to abstain from ATOD use, intention to avoid ATOD use, intention to use ATOD resistance skills, and self-efficacy to refuse ATOD offers compared to students who did not receive the kiR program. A series of two-way repeated-measures ANOVAs were used to examine changes in outcome variables between the treatment and comparison groups. Results indicate that there was no effect of the kiR program on any of the outcome variables of interest. Future research is warranted to examine the impact of kiR on ATOD use behaviors and whether health educators should continue to use the kiR program to reduce ATOD use among adolescents in high school.