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Exploring the Association between Childhood Anxiety and Stressful Urban Life Events
Get PDFObjective: Research indicates that children who live in underserved urban environments are more likely to experience behavioral problems, such as social withdrawal, school adjustment problems, and self-reported delinquency (e.g., King, Huang, & Dewan, 2022). Studies have shown that for adolescents who later develop anxiety and depression, the neighborhood during childhood development could be a factor (Lee et al., 2018). Environmental conditions such as a higher risk of exposure to violence, limited community resources, and undergoing a significant life change in childhood can result in greater risk for psychological distress, including anxiety (King, Huang, & Dewan, 2022). The purpose of this study was to examine the association between childhood anxiety and stressful life events in a sample of youth and their families living in an urban, low-income area.
Methods: Children ages 5-12 (N = 79) and their primary caregivers (N = 79) were recruited from high-poverty, urban zip codes in Richmond, Virginia. The study was IRB-approved and conducted in a research building near the Virginia Commonwealth University campus. Child anxiety symptoms were measured via parent reports using the Multidimensional Anxiety Scale for Children scale (March et al., 1997; Wood et al,., 2002). Children reported their exposure to stressors including at the community level (e.g., exposure to violence) and within the family (e.g., death) via the Stressful Urban Life Events Scale (Attar et al., 1994; Tolan et al., 1988). Linear regression was used to assess the association between stressful urban life events and child anxiety. Control variables included child gender and age.
Results: Stressful urban life events were positively associated with child anxiety ( = .249, p = .027), controlling for child age and gender.
Conclusions: Results indicate that children who live in urban, high-poverty zip codes in Richmond did not have an increased likelihood of having anxiety, parents reported. Understanding aspects of community and contextual stress that impact child mental health may provide insight into interventions seeking to promote resilience in youth exposed to early adversity. However, data for this study are cross-sectional and cannot show the direction of effects. Future research should employ longitudinal designs and use both parent and child reports to investigate the role of urban stressors in child psychological health.https://scholarscompass.vcu.edu/uresposters/1478/thumbnail.jp
The Built Environment and the Systemic Agenda
Get PDFThe built environment in the United States, characterized in large part by suburban sprawl and car-dependent infrastructure, has significant negative impacts on public health, economic mobility, and environmental sustainability. This paper examines the consequences of car-centric development, highlighting its role in exacerbating social and economic inequalities, increasing traffic-related fatalities, and contributing to climate change through excessive carbon emissions. The analysis reveals that a majority of Americans feel forced into car ownership due to inadequate alternative transportation options, leading to financial strain and adverse health outcomes, including obesity and air pollution-related diseases. The historical roots of these development patterns are traced to mid-20th-century policies that prioritized suburban expansion and highway construction, often reinforcing racial and economic segregation. The study underscores the urgency of introducing a restructuring of the North American built environment into the systemic political agenda and advocating for focus on all levels of government on policies to improve the economic, environmental, and medical sustainability of our urban areas.https://scholarscompass.vcu.edu/uresposters/1481/thumbnail.jp
Social anxiety: What role do orthodontists and pediatric dentists play in this nation-wide epidemic?
No full textObjective: The purpose of this study was to explore orthodontists’, pediatric dentists’, and general dentists’ knowledge of social anxiety disorder (SAD), its presentation, prevalence, and the perceived role of dental professionals in this nationwide epidemic.
Methods: An original survey was distributed to orthodontists and pediatric dentists across the country using the American Association of Orthodontists (AAO) and American Academy of Pediatric Dentistry (AAPD) for mailing information. Questionnaires were distributed either physically or digitally, with proportional representation from each state. Differences between the AAPD and AAO respondents were assessed with chi-squared or Fisher’s exact tests. Agreement in the responses was assessed with McNemar’s chi-squared test. Differences in agreement ratings were compared between groups with nonparametric Wilcoxon rank-sum tests. Significance level was set at 0.05.
Results: The survey was distributed to 2000 orthodontists and 8126 members of the AAPD with an overall response rate of: 4.4% (5.9% for orthodontists, 4% for AAPD members). Forty-one percent of the AAPD respondents reported that they perceive greater than 10% of their youth patients have SAD compared to twenty-eight percent of the AAO respondents (P = 0.0045). Similarly, Sixty-one percent of the AAPD respondents reported they perceive that greater than 10% of the U.S. youth have SAD compared to forty-four percent of the AAO respondents (P = 0.0174). Respondents were significantly more likely to perceive that the US prevalence of SAD was higher than the prevalence rates in their own practice. Pediatric dental providers felt more comfortable recognizing the signs and symptoms of SAD than orthodontists (P = 0.0001). Pediatric dental providers reported that when they do recognize signs of SAD in their patients, they have a better understanding of what to do next than orthodontists do (P = 0.0002).
Conclusions: Comparison of the responses regarding the US prevalence and the practitioner’s own practice, revealed that the respondents were significantly more likely to purport that the US prevalence was higher than their own practice. Pediatric dental providers indicated a greater level of comfort than orthodontists about recognition of SAD as well as the next steps to take after recognition. Both groups valued the importance for the dental profession to recognize the signs of SAD
Unpacking the Study Abroad Experience: Exploring How the Perceptions and Awareness of Faculty, Staff, Advisors and Students Shape Study Abroad Participation at Virginia Commonwealth University
Get PDFThe study abroad experience, often credited with providing an inclusive learning opportunity, has the transformative potential to expand students\u27 worldviews, enrich their academic experiences, and foster cross-cultural understanding. This study examines the Global Education Office (GEO) at Virginia Commonwealth University (VCU) and its efforts to increase institutional support, student awareness, and engagement with study abroad programs. The study explores barriers to participation and perceptions of value through secondary analysis of GEO’s post-program student surveys and primary data from a faculty, staff, and academic advisor survey. Guided by Wigfield’s Expectancy-Value Theory and Perry’s Theory of Intellectual and Ethical Development, the research investigates how motivation, institutional messaging, and developmental growth influence students’ decisions to pursue study abroad.
This collaborative effort ensures that the study abroad experience achieves its intended educational and cultural outcomes, supported by the VCU Strategic Plan, Quest 2028
Beyond the Bulk: Cell-type Specific Resolution of Epigenomic and Transcriptomic Disease Signatures
No full textUnderstanding how molecular changes contribute to human health and disease requires analytical approaches capable of resolving the cellular heterogeneity of complex tissues. Traditional bulk RNA and DNA methylation analyses average molecular signals across all cell-types in a sample, obscuring important cell-type specific variation. This dissertation applies and refines cell-type specific methodologies, statistical deconvolution of bulk data and single-nucleus RNA sequencing (snRNA-seq), to identify epigenomic and transcriptomic changes in both developmental and psychiatric contexts.
The included studies span four investigations. First, cell-type specific methylome-wide association studies (MWAS) of neonatal blood were used to dissect common and unique DNA methylation patterns associated with early-life health risks. Second, novel analyses revealed that maternal obstetric pain relief, including laughing gas and pudendal block, is associated with distinct neonatal methylation changes in specific immune cell-types. Third, transcriptomic fine-mapping of bipolar disorder GWAS loci identified 20 validated genes across 13 cell-types, linking genetic risk to functional gene expression changes in the human brain. Finally, by integrating bulk and snRNA-seq data, this dissertation demonstrates that transcriptional brain aging is accelerated in psychiatric disorders and varies by cell-type, with excitatory neurons showing the largest increases.
Methodological innovations include combining down-sampling and weighted regression for transcriptomic aging clocks, and integrating factor analysis with deconvolution to improve clinical phenotype interpretation. Taken together, this work highlights the importance of cellular resolution in molecular biology and offers tools and insights that improve both mechanistic understanding and translational potential. By identifying cell-type specific molecular signatures, this research provides a more nuanced view of disease risk, developmental programming, and biological aging, laying the groundwork for more precise diagnostic and therapeutic strategies
Assessing the Impact of New Medical Learners on Healthcare Processes and Outcomes: A Study of U.S. Hospitals
No full textScreening for social needs in hospitals is an effective strategy to measure and address health disparities and improve quality. Social determinants of health (SDOH), the non-medical factors that influence health outcomes such as education and socioeconomic status, are increasingly incorporated into U.S. medical education. Academic medical centers and teaching hospitals may be particularly well-positioned to lead in SDOH-responsive care and achieve outcomes from those efforts.
This study examines whether hospitals affiliated with medical schools or those that sponsor graduate medical education (GME) programs are more likely to screen all patients for SDOH. Among hospitals that universally screen patients, the study explores whether causal inference may be drawn from the presence of new medical learners and hospitals’ reported success in driving improvements in individual and community-level healthcare outcomes based on their SDOH efforts.
The study uses a cross-sectional design analyzing data drawn from the 2023 American Hospital Association (AHA) Annual Survey. The sample consisted of all general medical and surgical hospitals in the U.S. that responded to the 2023 AHA Survey other than federal facilities (n = 4301). Propensity score matching followed by weighted logistic regression models were used to assess whether academic affiliation or the presence of full-time residents predicted universal screening. We then assessed the relationship between resident presence and four healthcare outcomes: 1) better patient health, 2) decreased utilization, 3) decreased costs, and 4) improved community health in hospitals that screen all patients for social needs (n = 1367).
The Presence of Medical Residents increased the likelihood of universal screening by 17%. Among hospitals that screen all patients, those with medical residents were associated with a greater likelihood of reporting Better Patient Health Outcomes (+12%), Decreased Utilization of Healthcare Services (+12%), and Decreased Costs of Health Care (+17%). Medical School Affiliation and Association of American Medical Colleges Membership were not associated with significant results. The Presence of Medical Residents was not significantly associated with Improved Community Health Care Status.
Study results highlight the potentially transformative role of graduate medical education in shaping hospital practices and improving healthcare outcomes both clinically and financially. Through demonstrated associations between the presence of medical residents and both the adoption of universal screening and reports of improved patient health outcomes, decreased utilization, and decreased costs, this research provides evidence for increased support of graduate medical education. Increased funding for and creation of additional GME slots would be the most effective means of support.
These benefits are particularly important for hospitals in underserved areas where impending physician shortages will be felt most acutely through diminished access and growing health disparities. Embedding new medical learners will ease the rapidly increasing shift toward value-based and whole-patient centered care for hospitals that welcome medical residents as integral members of their clinical teams while also improving outcomes and decreasing costs.
Future research should explore longitudinal data to draw greater causal inference and/or incorporate qualitative interviews with clinicians, administrators, and patients to better understand the mechanism(s) underlying these results
The Trauma-to-Prison Pipeline: A Multi-Level Theoretical Framework Exploring the Intersection of Inequality, Trauma, and Exclusionary Discipline
Get PDFThe school-to-prison pipeline (STPP) is a widely recognized and extensively studied metaphor used to describe the process by which school discipline policies increase the risk of juvenile justice system involvement, particularly among historically marginalized populations. While it has been instrumental in shaping educational policy, the STPP framework has not evolved to account for the critical impact of trauma on learning and behavioral outcomes. Furthermore, it overlooks the role of systemic inequality that increases trauma exposure and produces concentric patterns of marginalization.
Drawing on research across the fields of education, public health, sociology, and criminal justice, this study proposes a theoretical framework for an expanded model of the STPP, often referred to as the trauma-to-prison pipeline (TTPP). Using data from the Minnesota Student Survey, this dissertation examines the intersection of adverse childhood experiences (ACEs), school behavior and discipline practices, and the structural conditions that increase both the risk of trauma exposure and incarceration. Findings support the assertion that systemic inequality is associated with an increased risk of trauma exposure—which is linked to negative learning and behavioral outcomes—and exclusionary discipline, particularly among students of color.
This work emphasizes the need to replace reactive, punitive discipline models with trauma-responsive, preventive approaches that proactively address the root causes of student behavior. The TTPP framework provides a lens through which educators, researchers, and policymakers can better understand the cyclical forces that contribute to youth criminalization. It envisions an equity-centered education system where schools act as stop valves, interrupting the flow of youth into the justice system rather than propelling them toward it
Investigating Neuroepigenetic Mechanisms of Behavior
No full textExperiences represent a powerful influence on an individual and their behaviors. Different life experiences can lead to long term changes in both brain physiology and behavioral phenotypes (Rosenzweig & Bennett, 1996). Indeed, early life experiences have been well-documented to affect an individual through the duration of their life across multiple species (Kundakovic & Champagne, 2015). Yet, the neurobiological mechanisms through which experiences can drive beneficial versus maladaptive behavioral changes are incompletely understood.
It is common to examine the biological origins of behavior through the synapse. Neurons communicate through the release of neurotransmitters to activate receptors on the post-synaptic neuron, and this signal is terminated by neurotransmitter reuptake through transporter proteins on the pre-synaptic neuron. Seminal work by Donald Hebb posited that experience driven alterations to these synaptic machinery can lead to the development and strengthening of neural circuits, providing an anatomic model of learning and memory (Brown, 2020). This framework remains relevant today, and many of our current therapeutic strategies to treat neuropsychiatric syndromes build on this synaptic model by modulating neurotransmission in the brain (Braslow & Marder, 2019).
More recently, growing evidence suggests that the synapse is an incomplete explanation for how experiences influence behaviors. Rather, behavioral change reflects a series of processes ranging from intracellular molecular mechanisms to widespread neural circuitry integrating throughout the brain (Langille & Brown, 2018). It is therefore important to study behavioral adaptations to experience not only at the synapse, but also downstream of the synapse and through the lens of the cell body and nucleus.
Typically, following binding of a neurotransmitter to its receptor, a signal transduction cascade will transmit the stimulus through effector proteins within the neuron to transcription factors within the nucleus. In response to transcription factor activity, mRNA molecules are produced and exported to the cell body, where they are translated into proteins and trafficked to their destinations. In this manner, a stimulus can be processed and result in a net change to neuronal physiology through nucleus-dependent mechanisms. Indeed, early investigations towards nuclear mechanisms driving behavioral adaptations to environmental stimuli have elucidated several transcriptional and epigenetic mechanisms underlying both drug seeking behaviors and stress-induced behavioral maladaptations (Tsankova et al., 2007; D. M. Walker & Nestler, 2018; Lorsch et al., 2019a; Teague et al., 2023).
The contents of this dissertation aim to use synthetic biology and bioinformatics tools to examine the molecular mechanisms underlying the origins of maladaptive behaviors. We examined transcriptional changes driving a sex-specific capacity to choose to self-administer food and forego seeking drugs (Chapter 2). We investigated a chromatin biology mechanism involving a linker histone protein correlated with susceptibility to develop behavioral maladaptations to stress experience utilizing a synthetic overexpression vector in an attempt to artificially induce susceptibility to stress (Chapter 3). Finally, we utilized synthetic transcription factors to discover a transposable element-associated cis-regulatory mechanism necessary to maintain appropriate social behaviors (Chapter 4 and Chapter 5). By improving our understanding of the neuroepigenetic and molecular mechanisms driving behavioral maladaptations, we aim to identify behaviorally significant pathways and transcriptional process that represent potential targets to investigate as novel treatment strategies for neuropsychiatric syndromes
Enhancing Clinical Trial Matching in Molecular Diagnostics: Using Natural Language Processing and Clustering Approaches in Hematological Malignancies
No full textClinical trial matching is a critical component of personalized medicine, particularly in the management of hematologic malignancies. At Virginia Commonwealth University (VCU) Health, the Molecular Diagnostics (MDX) Lab produces somatic variant reports and recommends clinical trials based on the presence of clinically significant mutations. However, the current manual trial recommendation process is time-intensive and lacks scalability.
This study introduces a computational framework to streamline and standardize clinical trial matching using natural language processing (NLP) and unsupervised clustering. Trial brief descriptions were analyzed to extract frequent terms, and trials were grouped based on term similarity using joint dimensionality reduction and clustering. Simultaneously, genomic profiles of patients were clustered based on variant data to identify groups with shared molecular features. Iterative Factor Clustering of Binary Variables (i-FCB) was used for both trial and patient clustering, with cluster quality evaluated using the Calinski-Harabasz index and Jaccard distance for stability.
The resulting framework organized 184 clinical trials into 10 clusters based on frequent trial terms, and 257 patients into 3 clusters based on shared genomic features, explaining 73.95% and 91.14% of variance, respectively. These data-driven clusters form the foundation for improving trial-patient matching in the Molecular Diagnostics (MDX) Lab. This study demonstrates the feasibility of scalable, computational clinical trial matching in hematologic oncology and represents the first such integration into the MDX Lab workflow. Future iterations may support faster enrollment and better alignment of patients with molecularly appropriate trials. Additionally, the NLP-derived Document-Term Matrix (DTM) offers a lookup table to streamline term search within previously recommended trials and identify patterns in past trial assignments
Knowledge and Practice of Pediatric Dentists Regarding the Management of Oral Piercings in Adolescents
No full textPurpose: This study aimed to assess pediatric dentists’ comfort and confidence providing educational information to patients and caregivers regarding oral piercings.
Methods: An electronic questionnaire was emailed on three occasions to nearly 6,700 American Academy of Pediatric Dentistry (AAPD) member pediatric dentists. The survey focused on knowledge of oral piercings, related state laws, and comfort in starting the conversation with 12-17 year old adolescent patients and their guardians.
Results: Nearly 90% self-reported encountering patients with oral piercings. Although not significant, this increased with years in practice from 83% with \u3c 5 years to 93% with 20+ years (P=.0932). Only 5% identified as “not familiar” with adverse effects of oral piercings. Respondents indicated their knowledge was gained most often in residency (61%) and through experience (52%). Only 31% agreed or strongly agreed that the amount of education in dental school was sufficient for becoming competent providing oral piercing related information. Awareness of the AAPD policy on intraoral/perioral piercings was not significantly associated with knowledge of state laws (P\u3c .0001), with 60% of respondents reporting awareness of the policy, but no knowledge of state laws. Self-reported experience with patients with piercings was not significantly associated with knowledge of state laws (P=.1554) or AAPD Policy (P=.9991). Ninety percent agreed or strongly agreed that it’s within their responsibilities as a pediatric dentist to educate patients on potential adverse effects.
Conclusion: Pediatric dentists are highly likely to encounter patients with oral/perioral piercings and consider themselves responsible for educating patients and guardians on potential risks