Master of Public Health

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    Examining the Relationship Between Loneliness and Mental Health
    (2022-08) Garcia, Briana
    In the United States (U.S.) in 2019, 51.5 million or nearly one in five U.S. adults were estimated to live with a mental illness. Mental health among college students is a growing concern as it can pose a major threat to public health (WHO, 2021). Nearly half of college-aged people in the United States have a mental condition. The purpose of this study was to explore the relationship of loneliness and mental health among university students, the drivers of loneliness such as educational status and one’s sex, and the association of psychological or mental services among college students. This cross sectional study used secondary data from the fall 2019 American College Health Association National College Assessment III (ACHA-NCHA III). A Chi-square test of independence was used to evaluate the relationship between mental health status and educational status and loneliness. Also examined was the association between the mental health status and sex. Lastly, the difference between utilization of psychological or mental health services between sex was evaluated using a Chi-square test. A significant relationship was found, X^2(1, N= 3697)= 10.117, p = .001) between educational status and mental health status as well as between loneliness and mental health status, (X^2(1) = 375.767, p =.001). A significant association was found, (X^2(1) = 15.926, p = .001) between mental health status and sex. A significant difference was found (X^2(1) = 117.016, p = .001) suggesting a difference between the use of psychological or mental health services and sex.
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    Evaluation of the Keepin' it REAL Drug Prevention Program
    (2022-08) Bernal, Nancy Guadalupe
    Alcohol, 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.
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    The Contributing Factors to Anxiety and Depression Among the Chinese International Students During COVID-19
    (2022-05) Yun, Fang
    Introduction: 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.
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    Measuring the Impact of the COVID-19 Pandemic and the Public Health Pandemic Response Activities on the Local PH Workforce
    (2022-08) Urbina, Suzanna Maria
    Currently, in the United States, the number of confirmed cases of COVID-19 exceeded 87 million and one million deaths in 2022 (World Health Organization, 2022). The pandemic has been an incredibly hectic time for the public health (PH) workforce. While there has been worldwide recognition of the efforts of PH workers in ensuring that the morbidity and mortality associated with COVID-19 reduced, there has not been enough recognition and acknowledgement about the impact of COVID-19 and COVID-19 response activities on the well-being of PH workers. The current study was a cross-sectional analysis measuring the impact of COVID-19 and the PH pandemic response activities on 372 local PH workforce. The study examined if there was a significant level of burnout, comfortability, job burnout, reduced attrition, and stress due to COVID-19 and COVID response activities. In this study, most of the employees reported a higher level of burnout following the COVID-19 pandemic compared to prior to the pandemic. In addition, the study showed that non-supervisory employees were twice as likely as their supervisors to report a negative economic impact from COVID-19. As a result, COVID-19 and COVID-19 response negatively affected local PH workers. Collectively, the study revealed how the pandemic indirectly and directly impacted the wellness and personal lives of the PH workers.
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    Examining the Relationship Between Age of Death, Race/Ethnicity and Education Among COVID-19 Related Deaths in Riverside County, California
    (2022-08) Shi, Hongyu
    Since the COVID-19 outbreak in late 2019, it has spread to states in the United States. COVID-19 became the third leading cause of death in the United States in just two years. The data used in this study were obtained from the RUHS-PH using a dataset that included all deaths caused by COVID-19 among Riverside County, California residents from March 2020 to December 2021. one-way ANOVA was used to determine whether there was a relationship between race/ethnicity and age at death. In addition, a multiple regression was used to determine the degree of prediction of age at death by race/ethnicity and education level. It turned out that Whites had the oldest age at death, and American Indian/Alaskan Natives had the earlier age at death. Furthermore, Race was the strongest predictor of age at death compared to education. Compared with all independent variables, the analysis found that Hispanics had the largest effect on age at death. And age at death was not statistically different for those without college degrees compared to those with a college degree.
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    Sedentary Status Among California Adolescents and Its Impact on BMI
    (2022-08) Shen, Yiqing
    Adolescent obesity is a serious health problem in the United States that occurs when teens weigh more than a healthy weight for their height. Adolescent obesity may be caused by prolonged sedentary time. There may also be racial/ethnic differences in sedentary time among adolescents. School environment and community demographics based on school type may also be triggers for obesity in adolescents. The purpose of this study was to determine the relationship between sedentary time and body mass index (BMI) in adolescents and describe adolescent sedentary time by race/ethnicity and school type. The data used in this study were extracted from the California Health Interview Survey (CHIS)-Adolescent 2020, which was conducted between September 2019 and November 2020 by randomly selected households in California. A simple linear regression, a one-way ANOVA, and independent t-test were used to analyze the data. The findings showed that sedentary time during weekend among California adolescents has a limited impact on obesity. However, racial/ethnic differences were in sedentary time among adolescents, but school type was not a significant predictor of obesity.
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    Psychological Distress among Women in the Workforce Post COVID-19 Pandemic
    (2022-08) Santiago, Michelle Joanna
    The novel coronavirus (COVID-19) can impact an individual's mental health, and the COVID-19 pandemic conditions increased the rates of depression and anxiety. During the pandemic, individuals faced adverse psychological effects, including worrying about contracting the virus and adjusting to the stay-at-home mandates. Former studies showed that women tend to have higher reported levels of depression, anxiety, and psychological distress. The objectives of this study were to determine if there were statistically significant differences in self-reporting psychological distress, emotions interfering with work performance, social life impairment, and self-reported depression related to gender and psychological distress. A cross-sectional study using secondary data from the 2020 California Health Interview Survey (CHIS) was performed. An independent samples t-test and chi-square test of independence were performed. Independent samples t-tests showed that there was a statistically significant difference in self-reported serious psychological distress between men (m = 3.33) and women (m = 4.24) (t = -5.474, p = .035) and a statistically significant difference in depression between men (m = 4.69) and women (m = 4.61) (t = 2.507, p = .012). A chi-square test of independence found no statistically significant association between gender and emotions interfering with work performance (X2(1) = .568, p = .451), and no association was found between gender and social life impairment amongst those experiencing psychological distress (X2(1) = 2.336, p = .126).
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    Evaluating Public Health Workforce Satisfaction in San Bernardino County
    (2022-08) Ramirez, Jennifer
    Over 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.
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    Positive Mental Well-Being Analysis: Effects of Gender, Age, and Physical Activity
    (2022-08) Ordonez, Genesis
    A paramount approach to understanding mental health in communities is via a positive lens that focuses on the absence of a mental illness and steers away from the common, negative aspects of diagnoses and symptoms. Three elements of positive mental health consist of psychological, emotional, and social well-being. Depression is a prevalent mental illness in all cultures and age groups worldwide, and adolescents are a vulnerable age group for experiencing depressive episodes. Physical activity can have numerous targeted effects on individual health, well-being, and mental health. This descriptive cross-sectional study aimed to explore differences in self-reported mental well-being across different age and gender categories and the relationship between moderate physical activity and mental well-being. A sample of 167 participants ages 13 and older were recruited at community-based events to complete an anonymous self-administered online survey in English or Spanish. Qualtrics was used to disseminate the survey and collect responses. The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) was used to measure positive mental well-being because it consists of only positively worded items and measures mental well-being. The International Physical Activity Questionnaire (IPAQ) was also used to measure participants’ physical activity levels. Results showed that full WEMWBS scores did not differ across age, gender, or physical activity categories. Upon exploring individual elements of the study, significance was demonstrated across categories.
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    Examining Race and Socioeconomic Status as Predictors of Cervical Cancer Screening and Human Papillomavirus Vaccination in Women
    (2022-08) Ochoa, Marlene Elizabeth
    More than 4,000 women die from cervical cancer annually, even though 93% of cervical cancers are preventable with HPV screenings and vaccinations (Centers for Disease Control and Prevention [CDC], 2020). In 2012, women ages 21 to 65 in the United States reported they had not been screened for cervical cancer (CDC, 2020). This study aimed to examine the relationships of between ethnicity/race, income, education, HPV screening, and HPV vaccine uptake of cervical cancer. The 2020 Behavioral Risk Factor Surveillance System (BRFSS) data were used to determine if there was a significant relationship between sociodemographic factors, specifically race, ethnicity, household income, and education, with disparities in HPV screenings and vaccines among women. A cross-sectional research design was utilized. The study revealed a significant relationship between HPV screening across race/ethnicity categories, income level, and education. The findings showed a significant relationship between HPV screening across race/ethnicity categories (H (5) = 43.846, p <.001), within income levels (X2(1) =12.077, p <.001), and for educational attainment (X2(1) = 52.220, p < .001). There also was a significant relationship between HPV vaccination across race/ethnicity categories (H (5) = 36.367, p <.0010), income level (X2(1) = 2.145, p >.143), and education (X2(1) = 14.490, p <.001). The findings from this study are beneficial in identifying the disparities among women residing in underserved communities for cervical cancer screenings and acquiring the HPV vaccination series. This study demonstrates that race/ethnicity, income, and education may be factors that make a woman more susceptible to cervical cancer. Therefore, health educators must be conscious of a community's cultural background and its impacts when addressing the disparities in HPV vaccine uptake and cervical cancer screenings. It is vital for public health and healthcare professionals to implement more efforts to promote HPV screening and HPV vaccination at the state and national levels to decrease cervical cancer incidence.
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    Exploring Air Quality, Race, and Asthma in Californian Residents
    (2022-08) Morgan, Rachel
    Objective: Air pollution is the most significant environmental cause of disease and premature death; it is estimated to be responsible for approximately 6.5 million deaths worldwide and a wide range of diseases (National Institute of Environmental Health Sciences, 2022). This research considers air pollution in relation to asthma and exposure compared with existing literature. This study was conducted to understand the epidemiology and etiology of asthma disparities in children and air pollution across California and to highlight existing literature and policies to aid in addressing inequalities. Methods: Data sets from the National Survey of Children’s Health and CalEnviroScreen 4.0 were analyzed to determine if there is an association between a child’s race/ethnicity or income (as measured by income being sufficient to afford essentials) and developing asthma. The study also endeavored to determine if there was a significant association between air quality and socioeconomic status (SES) across census tracts within California and if San Bernardino County has varying levels of asthma associated with air pollution based on census tract. Summary: This study revealed a significant relationship between self-reported asthma rates and income categories, as well as a significant relationship between socioeconomic status and exposure to air pollution across California census tracts. African American children whose parents reported an inability to afford essentials based on their current income were the most likely to develop asthma. Lower-income individuals were more exposed to air pollution across California census tracts, and there is no correlation between pollution burden and asthma rates across census tracts within San Bernardino County.
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    Public Health Employees' Perceived Stress during the COVID-19 Pandemic and Their Levels of Physical Activity
    (2022-12) Mendoza, Mayra Alejandra
    The COVID-19 pandemic exacerbated the stress levels of public health employees in local and state public health departments. This study aimed to evaluate whether the perceived stress levels differed between the stages of readiness for change for physical activity and stress management techniques among public health workers. Secondly, this study assessed whether stress levels differed depending on their role in the department and race/ethnicity. The study sample included 101 public health employees from local public health departments in Southern California. Participants completed a survey that included the Perceived Stress Scale (PSS), demographic questions, and other questions about their engagement in physical activity and stress reduction activities. There was no significant difference among the stages of readiness for change for physical activity. The results showed a significant difference in the perceived stress scores between the stages of readiness for change for stress management techniques. Participants in the maintenance stage of readiness for stress management techniques showed significantly lower mean PSS-10 scores (M = 18.46, sd = 4.11) than in the other stages of readiness. Mean perceived stress scores were significantly different between entry-level employees (M = 20.80, sd = 4.65) and managers/directors (M = 18.00, sd = 3.25). Finally, perceived stress scores were significantly higher among employees who identified as Black, Indigenous, or Person of Color (BIPOC) (M = 21.46, sd = 4.37) compared to White/Caucasian employees (M = 18.97, sd = 4.01). This thesis provides recommendations for implementing holistic multi-dimensional interventions for public health employees to improve their well-being.
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    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 Dipesh
    The 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.
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    Health Literacy Surrounding Anal Cancer Among Women and the Need for Policy Changes in Preventive Health Screenings
    (2022-08) Jovanov, Adriana
    When examining health literacy across ethnicities and communities, ethnic minority groups are known to be at a higher risk of being below the average health literacy threshold, and limited health literacy has been linked to poor health status and higher mortality rates (Giurca et al., 2018). This study examined health literacy surrounding anal cancer and HPV related preventative health screening behaviors. More specifically, the aim of the study was to bring awareness to low levels of anal cancer related health literacy for women and the need for policy changes regarding preventive health screenings. The following research questions were explored: (1) What are the common themes and/or beliefs when asked about anal cancer, HPV, and preventive screening? and (2) What are the common themes and beliefs surrounding the severity and susceptibility of contracting anal cancer?. This study utilized a cross-sectional design to survey 26 individuals regarding their knowledge level and perspectives regarding anal cancer and HPV related severity and susceptibility. The student researcher developed and administered an 8-question survey de novo. The survey included open-ended questions constructed based on an application of the Health Belief Model (HBM) elements of perceived susceptibility and perceived severity to anal cancer health literacy. This study employed thematic analysis and grounded theory to explore critical themes and construct a model to explain health literacy regarding anal cancer and intention to participate in preventive screenings. The fundamental attitudes and themes about health literacy related to anal cancer and the intention to participate in preventative screenings were elicited using a qualitative descriptive technique. The student researcher utilized the coded data to create open categories, axial codes, and finally selective codes based on higher level themes based on (1) knowledge and (2) perceived risk, both severity and susceptibility. A model for classifying responses, including knowledge levels and perceived severity, and perceived susceptibility, was created. While the axial and selective codes were created by grouping the themes discovered through open coding, application of the core constructs of the health belief model informed the creation of the groups into the evidence-based selective code categories of risk and knowledge. The results from this study may be used to inform practitioners, providers, and policymakers in developing interventions addressing low health literacy rates surrounding anal cancer in support of creating a standardized health screening procedure.
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    The impact of breakfast intake on BMI in high school teenagers in California
    (2022-08) Herrera, Arlene Navarro
    Skipping breakfast is an unhealthy eating habit that commonly occurs in teenagers and has become a public health concern for the youth population in the state of California. The literature indicates a relationship between skipping breakfast and overweight/obesity, which may result from unhealthy dietary behavior and skipping other meals. This study aimed to assess the impact of skipping breakfast and breakfast eating frequency (low, moderate, and high breakfast intake) on body mass index. We hypothesized that skipping breakfast will result in higher BMI and higher consumption of sugar-sweetened beverages (SSB), while high breakfast intake will lower BMI. An independent samples t-test was used to compare the mean BMI between breakfast-skippers and breakfast eaters. Further, the breakfast eaters were categorized into low, moderate, and high breakfast intake groups to assess the impact of breakfast frequency on BMI. A one-way ANOVA was used to determine the differences in BMI between breakfast-skippers and the above breakfast intake categories. Similar analyses were performed in males, females, and in different ethnic/race groups using the split file function in SPSS. A significant difference was observed between the mean BMI of breakfast eaters and skippers (p = 0.005). The frequency of breakfast intake impacted BMI. High school teenagers who did not eat breakfast had a higher BMI (p = <0.001) compared to teenagers who had high breakfast consumption (5-7 days breakfast intake). Specifically, only the high breakfast intake group (p = <0.001) had a significantly lower BMI, but not those who had low (1-2 days breakfast intake) (p = 1.00), or moderate (3-4 days breakfast intake) (p=0.868) compared to breakfast skippers. A similar trend was observed in females, males, non-Hispanic, and black African Americans when our dataset was split by gender and ethnicity. In summary, this study shows that skipping breakfast has a negative impact on high school teenagers’ BMI. The study also revealed the importance of eating breakfast almost daily (5-7 days) to improve body weight; therefore, effective strategies to promote the daily consumption of breakfast are warranted to combat obesity in high school teens in California.
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    Assessing Factors for Dental Decay using NHANES Survey in the United States
    (2022-08) Gallardo, Laura
    The 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.
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    The Relationship between Sleep and Racial-Ethnic Demographics as Protective Factors against Cognitive Decline
    (2022-08) Espinoza, Esteban
    Despite nearly four decades of advocacy and month-long awareness campaigns, Alzheimer's disease (AD) continues to slowly deteriorate the minds of millions of Americans (James et al., 2022). Although genetics accounts for two-thirds of the risk of developing AD, behavioral factors may pose a greater risk (Silva et al., 2019). Certain racial-ethnic groups produce AD preventative proteins in much higher concentrations, whereas others are born into healthier environments (Qin et al., 2021). Behavioral practices such as sleep may reduce AD incidence. Sleep is crucial to the central nervous system and has been linked to halting the progression of many neurodegenerative diseases (Borges et al., 2019). When researching whether self-reported sleep quality was predictive of cognitive decline, sleep was found to be a significant independent predictor of cognitive decline (X2(2) = 677.012, p < 0.001). Similarly, a significant relationship was found (X2(7) =68.20, p < 0.001) between cognitive decline and one’s self-reported race/ethnicity. Additional research can highlight the exact association between each racial-ethnic group and cognitive decline. Further analysis is required to understand the complex role of sleep on cognition and AD incidence.
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    The Effect of Education Level and Income Level on the Diagnosis of Stroke in Mississippi
    (2022-08) Chen, Liang
    Mississippi 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.
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    The Association of Vaccination Status and Race/Ethnicity on Post-COVID Conditions in Riverside, California
    (2022-08) Buckner, Madison Candice
    COVID-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.