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Associations Of the Medicaid Expansion Policy with Racial/Ethnic Disparities in Breast Cancer Screening and Treatment
No full textBackground and Aim. This dissertation examines Medicaid expansion’s effect on breast cancer (BC) screening and treatment disparities in two Medicaid-expanding states (MES) that passed Medicaid expansion (New Jersey and Vermont) relative to two non-expansion states (NES) (Georgia and Wisconsin). It then compares the association of Medicaid expansion to other states that did not undertake this policy on various subgroups, such as minorities by race and ethnicity, income, and age groups. Black women still bear significant BC disparities due to untimely screenings, treatments, and deaths. Therefore, it is critical to investigate how socioeconomic status influences racial/ethnic disparity gaps, given that BC cases continue to rise in America (American Cancer Society, 2022d).Methods. This study provides reliable comparisons across states for healthcare professionals and policymakers, revealing how Medicaid expansion relates to various racial/ethnic subgroups receiving BC care. Thus, the analysis will differentiate these states by matching covariates in all four states that affect BC screening and treatment rates, including educational level, employment status, household income, and healthcare coverage. Thus, the association of Medicaid expansion with other potential influences will be more valid and accurate. 2012 and 2020 Behavioral Risk Factor Surveillance System (BRFSS) compares two MES and two NES. Last, the study applies a modified Andersen Framework Model to conceptualize associations of Medicaid expansion with BC screening and treatment across racial/ethnic groups. Results. The Intervention states show that Medicaid expansion, as a policy by itself, had comparable odds of receiving mammography screenings for both Black and women of other races relative to White women (OR = 0.67, 95% (CI): 0.45–1.01, p \u3c .0552); (OR = 1.13, 95% (CI): 0.77–1.66, p = .5430). Therefore, mammography screenings did not change for all races of women after Medicaid expansion took effect. However, Medicaid expansion had an overall positive impact on BC treatments. Relative to White women, Black women had about eight times higher odds of receiving BC treatments (OR = 8.07, 95% (CI): 1.12–58.36, p = .0386), whereas women of other races had comparable odds of receiving BC treatments (OR = 0.45, 95% (CI): 0.09–2.25, p \u3c .3289). Conclusion. The results indicate no support for Hypothesis 1 (H1) and Hypothesis 2 (H2) since Medicaid expansion did not improve mammography screenings for both Black and other races of women relative to White women. As a result, both Black and other races of women had comparable odds of mammography screening receipt in the past 12 months relative to White women, and the findings do not support (H1) and (H2). However, when looking at the Interaction between Race and Medicaid expansion, Medicaid expansion had a significant influence on BC treatments for Black women. Still, women of other races had comparable odds of receiving BC treatments, and Hypothesis 3 (H3) and Hypothesis 4 (H4) are partially supported
Mimbres Social Organization at The Micro-Scale: Households at The ELK Ridge Site, Southwestern New Mexico
No full textAs a component of the ongoing work with the Elk Ridge research project, this thesis utilizes data acquired from previous excavations of the Elk Ridge site and from previous research in the Mimbres Mogollon region to examine how vernacular architecture reflects social organization at the scale of the household. Following Wilk and Rathje (1982) this approach views the household as a fundamental social and economic unit of past societies. Household is defined here as a group occupying a bounded residential space sharing in domestic activities and decision-making responsibilities (Roth 2012:137, Kramer 1982:637, Blanton 1994:5). Previous works within the Mimbres Mogollon region suggests interconnected rooms, those with doorways between them, and the spatial organization of rooms evidence that households were organized into kin based residential units (Shafer 1982). Household units are defined through patterns observed in the use of spatially bounded architecture of the site and household activities are reconstructed through an examination of interior features and artifact assemblages. Rooms are viewed as walled activity areas which both physically control access and metaphorically reinforce social relationships of individuals interacting with them (Rapoport 1969). The identification of certain modes of activity at the organizational level of the household produces a model starting from the smallest activity group and working outward allowing for investigation of variability between identified household units. This thesis attempts to identify households, explore their development over time and examine variability between them
Hot Spring Associated Infectious Diseases in the Great Basin and Southwest
No full textLike all bodies of freshwater, natural hot springs can harbor pathogenic microorganisms that carry the threat of infectious disease. The unique chemistry, increased temperature, and popularity for bathing may alter the risk profile of hot springs compared to other natural bodies of water. Despite this risk, the role of hot springs as a reservoir for infectious diseases remains understudied, particularly within the context of regional public health. Nevada and the Great Basin/Southwest have increasingly promoted hot springs for the purposes of tourism, and they share a strong link to the cultural heritage of the region. The unknown risk profile and the promotion of hot spring bathing could have unintended consequences for public health outcomes in the region and prompted this pilot study. This mixed-methods review investigated hot spring bathing hygiene within the Great Basin region and Southwest by examining hot spring site development, known pathogens, and disease outbreak response. Data for indicator bacteria for known hot spring bathing sites were gathered from public records, peer-reviewed articles, and local and federal water quality surveys which were evaluated against site development. Statistical analysis showed that most indicator bacteria declined as hot spring site development increased. Data for specific pathogens demonstrated general conformity to broader trends in hot springs associated infectious diseases, with a handful of regional outliers, such as Vibrio cholerae and red spider mites. Examination of outbreak responses showed that the most common response was posting warnings and/or guidance at the site itself or online. Remediation techniques, when applied, often consisted of draining or flushing the site to rid it of pathogen colonization. A major impediment to furthering hot spring hygiene seems to be that overlapping authorities and interests of various agencies can create gaps of responsibility and result in unchecked incidents. Final recommendations include increased signage at sites and development of other novel low-cost hygienic infrastructure along with increasing the mandate of environmental agencies to monitor and remediate hot springs in addition to other bodies of water
The Impact of Business-Consumer and Consumer-Consumer Interaction Via Social Media Posts on Consumer Behavioral Intentions
No full textSocial media posts have evolved into a powerful tool for consumers to explore and evaluate products, services, and businesses due to the increased accessibility of the Internet and rapidly developing real-time, mobile digital technologies. Based on stimulus-organism-response (SOR) theory, involvement theory, and benign violation theory, this study examines how interactions between food and beverage businesses, customers, and commenters via social media posts about negative online reviews influence the attitudes and purchase intentions of observers.Two major studies with eight scenarios in total were designed and conducted. The negative reviews were classified into two categories: unreasonable negative reviews and negative reviews that included comparisons with the business\u27s competitor. Both studies implemented a 2 (social media post creator: pro-business vs. anti-business) x 2 (social media post commenter: pro-business vs. anti-business) between-subjects design. In Study 1, 643 individuals, and in Study 2, 640 individuals were randomly distributed and assigned to each scenario, where food and beverage businesses responded to negative online reviews with aggressive humor, including other consumers\u27 comments on social media posts. Both studies constructed structural equation models to analyze the results. Findings showed that consumer-inferred negative motives of the businesses behind aggressive humor and their appreciation of humor positively influence their attitudes toward the business, in turn serving as a significant determinant of their purchase intentions. Specifically, while attitudes toward social media posts did not directly impact purchase behavior, attitudes toward the business consistently were found to mediate the relationship between consumers’ impression of the business\u27s response to negative online reviews and purchase intention, suggesting a more complex consumer decision-making process from a theoretical perspective. This study supported the application of SOR theory, expanded involvement theory, and benign violation theory by demonstrating that consumers could promote businesses that employ aggressive humor aimed at individuals who have posted negative reviews. Furthermore, the study revealed that increased customer involvement with social media content could correspond to more cognitive processes, which may lead to a more unfavorable perception of the associated business if customers perceive it as potentially harmful to them. The research also provided practical recommendations for hospitality businesses on how to address negative online reviews strategically with an understanding of consumers\u27 perceptions of humor and inferred negative intentions to effectively defend the business and attract consumers simultaneously
Factors Associated with Discrimination-Related Distress Among Sexual and Gender Minority Individuals: A Predictive Analysis
No full textSexual and gender minority (SGM) individuals face disparate rates of mental health outcomes, such as psychological distress, which contributes to suicidality. This may be attributable to minority stress, which posits that health inequities impacting this community are driven by increased exposure to stigma- and discrimination-related stressors. The negative physical and psychological health impacts of psychological distress and discrimination are well-documented in the literature. Structural stigma – in the form of harmful anti-LGBTQIA+ laws and policies – is associated with increased suicidality. However, little is known about factors associated with perceived discrimination occurrences and discrimination-related distress. First, a systematic review was conducted to understand the usage of the Daily Heterosexist Experiences Questionnaire as a dependent variable given its usage in our study to measure the outcomes of perceived discrimination occurrences and discrimination-related distress. This yielded a final sample size of ten eligible articles included for data extraction and quality assessment. This review informed the present study, which was a cross-sectional, web-based survey of 1,033 SGM participants in the United States. Using the DHEQ to measure perceived discrimination occurrences and related distress, this study was grounded within the social-ecological model, which considers the multifaceted interactions between individual, relationship, community, and societal factors on health outcomes. This study evaluated various psychosocial variables as potential predictors of, and protectors against, experiencing perceived discrimination occurrences and related distress. A multiple hierarchical regression analysis identified models that explained approximately 22.30% and 82.90% of the variance in experiencing perceived discrimination occurrences (Adjusted R² = .223, F(25, 671) = 7.694, p \u3c .001) and discrimination-related distress (Adjusted R² = .829, F(26, 670) = 130.987, p \u3c .001), respectively. Additionally, this study applied an intersectional analysis to examine factors associated with experiencing perceived discrimination occurrences and discrimination-related distress at the intersections of SGM identity, being an individual from a racial or ethnic minority background, and having a diagnosed disability. A multiple hierarchical regression analysis identified models that explained approximately 14.30% and 14.60% of the variance in experiencing perceived discrimination occurrences (Adjusted R² = .143, F(15, 691) = 8.829, p \u3c .001) and discrimination-related distress (Adjusted R² = .146, F(15, 691) = 7.873, p \u3c .001), respectively. Significant factors associated with experiencing discrimination occurrences and discrimination-related distress emerged, with trends observed across each of the four models. Impacts of harmful rhetoric, the role of laws and policies, and areas for intervention are critical points of focus to reduce discrimination and related distress within the SGM community
Dr. Tricia Bertram Gallant
No full texthttps://oasis.library.unlv.edu/aiclassroom_images/1000/thumbnail.jp
Nevada\u27s Healthcare and Education Workforce Pipelines
No full textWith ongoing workforce shortages in K-12 education, healthcare, and mental and behavioral health—occupations central to the HEAL (health, education, administration, and literacy) economy—this brief utilizes the Nevada P-20 to Workforce Research Data System (NPWR) and data from the U.S. Bureau of Labor Statistics to explore the current and projected landscape for these workforces in Nevada. Examining the demographic characteristics of those participating in focused career and technical education training and those earning relevant postsecondary credentials illuminates gender disparities in Nevada’s healthcare and education workforce pipelines. After reviewing the current state of these workforces and assessing the available NPWR data, we offer policy recommendations to improve Nevada’s education, healthcare, and mental and behavioral health workforce pipelines both now and in the future
Diaper Insecurity in Nevada and the Mountain West, 2024
No full textThis fact sheet presents data on diaper insecurity in the Mountain West states of Arizona, Colorado, Nevada, New Mexico, and Utah. It also presents data on the diaper gaps faced by fifteen Nevada counties: Carson City, Churchill, Clark, Douglas, Elko, Humboldt, Lander, Lincoln, Lyon, Mineral, Nye, Pershing, Storey, Washoe, and White Pine. Esmeralda County and Eureka County are not included due to a lack of data. The 2025 Urban Institute report, “Mapping Diaper Insecurity in the US,” highlights 2024 data on diaper insecurity across all 50 U.S. states and the District of Columbia
Performance Optimization-Focused Family Behavior Therapy to Address Verbal and Physical Aggression in an Adolescent Diagnosed with Bipolar I Disorder: A Case Report
No full textBipolar disorder is a chronic and debilitating condition characterized by fluctuations in mood that significantly interfere with day-to-day functioning. While symptom onset typically occurs in early adulthood, manifestations can occur at an earlier developmental stage. Early intervention has been shown to be effective in decreasing long-term negative outcomes and decreasing symptom severity in serious mental illness (SMI) populations, and as such, early intervention treatment programs may have particular benefits for individuals who are early in the course of bipolar disorder. However, there is little information regarding the effectiveness of these programs. This thesis reports a case of an adolescent client, Blake, diagnosed with bipolar I disorder, in accordance with the Diagnostic and Statistical Manual Fifth Edition, Text Revision (DSM-5-TR), who will participate in an evidence-supported novel intervention, Performance Optimization-Focused Family Behavior Therapy (POFFBT), within the context of a Coordinated Specialty Care-Early Treatment Program (CSC ETP) designed to treat early bipolar disorder. Blake completed a comprehensive standardized test battery designed to establish diagnostic criteria, evaluate presenting symptoms, and assess cognition. He attended weekly therapeutic appointments in an evidence-based CSC ETP that provided services over 13.5 months. CSC ETP services were provided by an interdisciplinary treatment team and included medication management, psychotherapy, education and employment support, peer support, case management, and family education. Standardized assessments to determine improvements in symptoms and functioning were conducted on a regularly scheduled basis (weekly, monthly, quarterly). Outcomes presented are decreased aggression, indicated by routine assessments and reports from Blake’s family, and increased cognition. This longitudinal analysis provides support for the use of the POFFBT within the context of a CSC ETP to optimize various aspects of the adolescent’s functioning
Becoming a Researcher: A Critical Multiphase Mixed Methods Study of Identity and Efficacy Among Graduate Students of Color
No full textGraduate student research participation and engagement are crucial as they are expected to complete research assignments, successfully finish a thesis/dissertation as a prerequisite for graduation, and engage in research dissemination. Unfortunately, literature on how students develop a researcher’s identity and self-efficacy is scarce. For diverse students, there may be a disconnect between their research interests and intents and the expectations of academia. In addition, there may be a cultural mismatch between students’ cultures and those of the research community. This multiphase critical mixed methods research (CMMR) study uses critical inquiry and reflexivity throughout the research process to (a) explore how diverse students define and conceptualize researcher identity (RI); (b) use participants’ insights to inform the development of a comprehensive graduate RI (C-GRIS) instrument; and (c) to examine the relationship between RI and research self-efficacy. Findings reveal that RI is a multidimensional construct of belonging, interest, recognition, performance and competence, positionality, and impact & societal change. Qualitative narratives provide context to the paradoxical negative significant relationship between research interest and research self-efficacy. Understanding these relationships can have significant implications that can lead to greater research productivity, a more robust academic community, and equitable educational outcomes that lead to student achievement and success both in their graduate programs and postgraduation