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Effectiveness of Text-Only E-Cigarette Warnings
Get PDFA single text-only e-cigarette warning about nicotine addiction is required by the US Food and Drug Administration in the US, yet little is known about whether health harms warnings are more effective than the required nicotine addiction warning. To assess the effectiveness of text-only e-cigarette warnings on message processing, risk belief, and behavioral intention outcomes, as well as the impact of health harm warnings and the required nicotine addiction warning or similar addiction warnings. A comprehensive search was conducted using PubMed, Embase, Scopus, PsycINFO, and Business Source Premier from inception through February 2024. Review articles were also examined for potential studies. Experimental studies that randomized participants to view nicotine addiction or health harms e-cigarette warnings were included. Studies had to report 1 or more message processing, risk perception, or behavioral intention outcomes. Using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines, 2 independent coders (Y.J. and J.S.) screened and coded all studies. Effect sizes characterizing overall warning effects and health harm vs addiction warning effects were calculated using the standardized mean difference (d). Effect sizes were pooled using random-effects models and tested for heterogeneity using the Q statistic and I2. Effect sizes with their 95% CIs, as well as prediction intervals, are reported. The outcomes were attention, negative affect, and effects perceptions (message processing); addiction, risk, and relative risk beliefs (risk perceptions); and intentions to vape and intentions to quit vaping (behavioral intentions). Across 24 studies with 22 549 participants (mean [SD] age, 27.91 [6.36] years; 53.9% female), e-cigarette text-only warnings were associated with improvement of most outcomes. Compared to control, e-cigarette warnings were associated with greater attention (d, 0.52; 95% CI, 0.33-0.70), negative affect (d, 0.65; 95% CI, 0.49-0.81), and effects perceptions (d, 0.95; 95% CI, 0.69-1.21), as well as increased addiction beliefs (d, 0.24; 95% CI, 0.05-0.42) and risk beliefs (d, 0.26; 95% CI, 0.16-0.36) but not relative risk beliefs (d, 0.00; 95% CI, −0.11 to 0.12). E-cigarette warnings also were associated with reduced intentions to vape (d, −0.14; 95% CI, −0.27 to −0.01) and increased intentions to quit vaping (d, 0.34; 95% CI, 0.09-0.58). Health harm warnings outperformed nicotine addiction warnings on many outcomes. Compared to addiction warnings, health harm warnings were associated with more negative affect (d, 0.44; 95% CI, 0.32-0.52), attention (d, 0.37; 95% CI, 0.26-0.49), and effects perceptions (d, 0.36; 95% CI, 0.23-0.49), as well as increased risk beliefs (d, 0.07; 95% CI, 0.00-0.13) and intentions to quit vaping (d, 0.17; 95% CI, 0.06-0.27). There were no differences in addiction beliefs, relative risk beliefs, or intentions to vape for health harms vs addiction warnings. In this meta-analysis of experimental studies, text-only e-cigarette warnings were associated with increased beliefs about the harm and addictiveness of e-cigarettes without creating the misperception that e-cigarettes are more harmful than cigarettes. Warnings were also associated with reduced intentions to vape and increased intentions to quit vaping. These findings support adding health harms to e-cigarette warnings and have important implications for warning policy
What do Applicants Need for Federal Grant Applications?
Get PDFWhat do grant applicants need for federal grant applications? Increasing professionalization within the transportation space has increased the complexity of USDOT discretionary grant applications. The application process itself is very complicated with specific details and requirements that applicants must adjust to in order to get funding. Before being considered for funding, potential grantees must submit several documents detailing every component of their proposed project and must go through eligibility requirements before it is passed along for evaluation. All of this complexity can hinder many applicants from obtaining funding for their projects and forces them to redo and reapply for these grants during the next grant cycle. This project will analyze and examine what applicants really need for the grant process and can inform ways to simplify the process in order to relieve some of the burden placed on applicants. This analysis will delve into discretionary grant programs from the FHWA, FRA, and FTA and will include an analysis of their similarities and differences along with pros and cons of application materials for both the Federal and applicant sides to conclude what is really necessary and helpful for a successful grant application.Master of City and Regional Plannin
Meeting Mothers Where They Are: Proposal to Implement Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Employees at the Pediatric and Obstetric Clinics at the Martin Luther King Jr Healthcare Center
Get PDFBlack mothers and infants face disproportionately high rates of food insecurity, adverse birth outcomes, and systemic barriers to maternal resources. Historical discrimination and inadequate access have fostered deep distrust in government programs, contributing to lower WIC enrollment among eligible Black mothers.
In Southern Los Angeles County, increasing WIC participation is critical to improving maternal and infant health. Implementing targeted WIC outreach in pediatric and obstetric clinics at the Martin Luther King Jr. Healthcare Center (MLKHC) presents an opportunity to address these disparities through culturally competent approaches that foster trust and accessibility.
Evaluation will assess the impact of clinic-based outreach on WIC participation, food security, and continuation of government assistance. By identifying barriers and outreach strategies, this aims to develop sustainable interventions that bridge racial and economic gaps in maternal nutrition programs. Findings will inform recommendations to enhance WIC accessibility and ensure more Black mothers and infants receive essential nutritional support.Master of Public Healt
Carrboro Farmers’ Market UNC Capstone Final Report
Get PDFBridging academic learning with community partnership, a group of public health graduate students spearheaded an experiential Capstone project to support the local Carrboro food system. Belle Duguid, Paddy Qiu, Madison Robertson, and Gaby Sandor are second-year Master of Public Health students in the Health Behavior and Health Equity concentrations at the University of North Carolina at Chapel Hill (UNC). As a core element of the program, students complete a year-long Capstone project where they partner with a local organization to address real-world public health challenges and build community (Landfried, 2025). The student team was paired with the Carrboro Farmers’ Market (CFM), to fulfill their Capstone requirement. CFM has maintained a longstanding relationship with UNC since their origin, as the Market was organized by the Agricultural Marketing Project and a UNC Public Health Graduate Student in the late 1970s (Mission & History, n.d.). As a continuation of their partnership, CFM requested a Capstone group to help develop a strategic plan that will guide future development of the Market. As tasked by their preceptor and manager of CFM, Maggie Funkhouser, the student team coordinated research with Market vendors and customers to identify challenges and opportunities for growth at CFM to support future leadership decision-making.
The student team produced six deliverables to gather a wide variety of insights and produce data-driven recommendations for CFM leadership: 1) a literature review (see page 5); 2) a qualitative summary report (see page 16); 3) a quantitative summary report (see page 26); 4) an infographic (see page 41); 5) a final presentation (see page 42); and 6) a final report (this document). Students conducted the literature review from September to October 2024 to keep the CFM staff and Board of Directors up to date on the best practices and developments in farmers markets across the U.S. and to inform key topics to explore in the two subsequent deliverables. Students then conducted interviews and focus groups, and distributed an open-ended survey to CFM Members in December 2024 to assess current Market experiences, goals for business growth, and recommendations for CFM, summarizing findings in a qualitative summary report. To include the customer perspective, the student team distributed surveys among CFM customers in February 2025 to examine customer demographics, motivations for shopping at CFM, and their alignment with CFM values. The results were collected and analyzed in a comprehensive quantitative summary report. To summarize key points from the first three deliverables, students developed an infographic, outlining their research methods, major findings, and next steps that leadership could apply to address identified challenges. Students then created and facilitated a presentation to CFM Board Members in April 2025, highlighting key findings and recommendations from the four previous deliverables. The final deliverable is this final report, which was created in April 2025 to thoroughly outline the methods and findings of each Capstone deliverable.Master of Public Healt
Telehealth Payment Parity and Outpatient Service Utilization: Evidence from Privately Insured Workers
Get PDFIntroduction Telehealth was catalyzed by the COVID-19 pandemic and has become a new norm in healthcare. In response to the pandemic, some states passed telehealth payment parity legislation, mandating equal payment rates for telehealth and in-person services. We evaluated the relationship between telehealth payment parity and health service utilization, focusing on insured workers in commercial insurance plans. Method Using the Merative Commercial Claims and Encounters database from 2019 to 2021, we leverage variation in the timing of policy changes across states using a Difference-in-Difference approach. Results Payment parity was significantly associated with increased telehealth visits and total outpatient visits, but without a notable rise in in-person visits. Furthermore, payment parity was pronounced in increasing telehealth utilization within self-funded large employer plans, while not significantly associated with telehealth visits among fully insured small employer plans. Conclusion Our findings underscore the important role of the payment parity in increasing telehealth service utilization by incentivizing providers. Future policies should support the sustainable integration of telehealth services, shifting from solely focusing on equal payment rates to adopting value-based reimbursement models that improve equitable healthcare access for all employees in commercial insurance
CENTRAL AMYGDALA TO LATERAL HYPOTHALAMUS NPY1R SIGNALING MODULATES BINGE-LIKE ETHANOL CONSUMPTION IN A SEX-DEPENDENT MANNER
Get PDFAlcohol use disorder is characterized by maladaptive patterns of alcohol consumption, with emerging evidence suggesting that neuropeptide Y (NPY) signaling through Y1 and Y2 receptors (Y1R and Y2R) within the central amygdala (CeA) plays a critical role in modulating ethanol intake. This dissertation investigates the neural mechanisms underlying binge-like ethanol drinking, focusing on the involvement of Y1R+ CeA to lateral hypothalamus (LH) projections, dynamic interactions between Y1R and Y2R within the CeA, and the impact of chronic ethanol exposure on Y1R protein expression. Chapter 1 demonstrates that chemogenetic inhibition of Y1R+ CeA-LH projections selectively reduced binge-like ethanol drinking in male mice without affecting female mice. Chapter 2 expands on these findings by examining the dynamic interactions between Y1R and Y2R expression in the CeA and their relationship to ethanol intake. Administration of a transient intra-CeA Y1R agonist failed to influence ethanol consumption in either sex. However, chronic NPY overexpression via a viral vector revealed behavioral effects and predictive relationships between receptor mRNA expression and intake patterns. Chapter 3 investigates how a history of extended binge drinking influences Y1R protein expression in the CeA. Although no significant differences were found in Y1R/NeuN colocalization across sex and treatment groups, correlational analyses revealed that Y1R expression varied with individual ethanol consumption. Additionally, Y1R+ tracing data identified a subset of Y1R+ neurons projecting to the LH, potentially contributing to the modulation of binge-like ethanol intake, consistent with findings from Chapter 1. Collectively, these results support a model wherein Y1R signaling within the CeA regulates ethanol consumption through circuit-specific mechanisms and broader neuroadaptive changes influenced by sex and individual drinking patterns. This research advances our understanding of the neurobiological mechanisms underlying binge-like ethanol intake and highlights the complex, sex-dependent roles of NPY-Y1R and Y2R signaling in the CeA.Doctor of Philosoph
The role of structural and interpersonal discrimination in Latina mother and child immune pathways
Get PDFDiscrimination not only shapes the lives of those who experience it directly but may also leave lasting biological imprints across generations. The central hypothesis of this dissertation is that exposure to structural and interpersonal discrimination is associated with immune dysregulation (e.g., inflammation) and socioemotional outcomes in mothers and their children during sensitive developmental periods —pregnancy and early childhood.The research presented in Chapters 2 and 3 focuses on foreign-born immigrant Latina mother-child dyads (N=92) residing in North Carolina. Chapter 2 presents a mixed-methods analysis of the role of sociopolitical context (structural and interpersonal discrimination) in the emotional well-being of both mothers and their children. The study in Chapter 3 examines whether mothers’ experiences of discrimination are related to their children’s immune dysregulation through epigenetic and transcriptional mechanisms. Finally, Chapter 4 consists of a secondary data analysis (N=150), shifting the focus from foreign-born immigrant mothers and their young children to the subsequent generation — US-raised Latina mothers and their children in utero. Research in this chapter explores the role of discrimination and trauma symptoms in inflammation during pregnancy, a period of heightened immune malleability with potential consequences for the developing fetus.Mothers’ experiences of discrimination were linked to socioemotional outcomes in their children, with county-level sociopolitical context playing a critical role (Chapter 2). On a biological level, mothers’ discrimination experiences were associated with elevated pro-inflammatory gene expression (IL-8 and IL-1β mRNA) in their children — with far-reaching implications for lifelong well-being (Chapter 3). Finally, US-raised Latina mothers exhibited elevated levels of inflammatory proteins, perceived more interpersonal discrimination, and reported more traumatic avoidance symptoms compared to mothers who migrated from Latin America as adults (Chapter 4). Based on a two-mediator sequential model, discrimination and traumatic avoidance symptoms sequentially mediated the relationship between growing up in the US and the higher levels of maternal inflammation.Overall, this dissertation underscores how exposure to discrimination, situated within broader sociopolitical contexts, reverberate through generations. By focusing on the intersection of structural and interpersonal discrimination, maternal mental health, and child outcomes, these findings highlight the need to create environments that foster safety, inclusion, and opportunity for immigrant families.Doctor of Philosoph
Psychometric Evaluation of the Tinnitus Severity Short Form Measure in Veterans and Civilians
Get PDFTinnitus is the perception of sound that cannot be attributed to an external source, which can be distressing. Although there are several existing measures of tinnitus distress, these measures are long and difficult to score. The Tinnitus Severity Short Form (TS-SF) was developed to be a brief, pragmatic measure of tinnitus distress. Further confirming the factor structure of this measure and testing for invariance in important populations, such as veterans and civilians, will support the use of this measure in practice. Participants (N = 277) completed the TS-SF. A subset of participants (n = 129) were veterans. A confirmatory factor analysis demonstrated acceptable relative fit indices for a bifactor model. The TS-SF demonstrated measurement invariance at the configural, metric, scalar, and residual levels. This study provides evidence that the TS-SF is a useful, brief measure of tinnitus distress that may be used to connect individuals to appropriate treatments.Master of Art
ANTIBIOTIC TREATMENT FAILURE OF STAPHYLOCOCCUS AUREUS IN DIABETIC SKIN AND SOFT TISSUE INFECTIONS
Get PDFABSTRACTJohn Christopher ShookAntibiotic treatment failure of Staphylococcus aureus in diabetic skin and soft tissue infections(Under the direction of Dr. Brian Conlon Ph.D.) Staphylococcus aureus can infect nearly every tissue site within the human body. It evades the immune system, cause severe tissue damage, and is recalcitrant to antibiotic treatment making it a major public health threat. S. aureus is an opportunistic pathogen, colonizing roughly one-third of the population and is a leading cause of bacteremia, infective endocarditis, osteomyelitis, pleuropulmonary infections, implanted device infections, and skin and soft tissue infections. In 2019, it was associated with over one million deaths globally. Additionally, S. aureus infections are especially prevalent in people with systemic chronic conditions such as conditions like diabetes, which is estimated to affect over one billion people by 2050. Diabetes mellitus is a chronic disease characterized by elevated blood glucose and immunosuppression. Unfortunately, approximately eight million adults in the United States that are unaware they have diabetes. S. aureus thrives on glucose, utilizing it to maximize its virulence factor production, leading to more severe infections. These infections are difficult to treat, often leading to amputation because of antibiotic treatment failure. Antibiotic treatment failure is mainly caused by antibiotic resistance and antibiotic tolerance. Antibiotic resistance is genetically heritable that leads to the deactivation of antibiotics, reduction/prevention of the antibiotic from binding to its target, or decreased concentration of the antibiotic within the cell. There have been S. aureus isolates characterized with resistance to every known class of antibiotic. Antibiotic tolerance is the ability to tolerate lethal levels of antibiotics typically through metabolic quiescence. Decreased ATP levels are directly linked to increased tolerance to antibiotic treatment. These tolerant cells can outlast the duration of antibiotic treatment to reestablish infection, leading to chronic long-term infections. Additionally, bacterially produced products contribute to antibiotic treatment failure, namely biofilm production. Here, I describe mechanisms driving antibiotic treatment failure in diabetic skin and soft tissue infections. Chapter 1 provides background on diabetes and S. aureus pathogenicity. Chapter 2 examines how S. aureus evolves antibiotic resistance in diabetic infections, and Chapter 3 explores the mechanisms driving antibiotic tolerance to vancomycin in diabetic SSTIs. This research underscores the importance of studying diabetic infections to improve antibiotic treatment as diabetes prevalence increases.Doctor of Philosoph
THE IMPLEMENTATION OF HPV MANDATES FOR SCHOOL ENTRY IN RHODE ISLAND AND HAWAII AND THE IMPACT ON HPV VACCINE COVERAGE AMONG ADOLESCENTS
Get PDFABSTRACTAlyssa Schatz: The Implementation of HPV Mandates for School Entry in Rhode Island and Hawaii and the Impact on HPV Vaccine Coverage Among Adolescents(Under the direction of Lisa Spees) Human Papillomavirus (HPV) is the most common sexually transmitted infection and has been linked to six known cancer types including cervical, anal, oropharyngeal, penile, vaginal, and vulvar. Annually, an estimated 37,800 cases of all cancers in the US are estimated to be caused by HPV, and HPV vaccination is estimated to prevent up to 90% of HPV related cancers. HPV vaccination is well established as effective at reducing HPV incidence and transmission. Despite demonstrated efficacy and largely mild associated side-effects, rates of uptake of the HPV vaccine in the US lag well behind other childhood immunizations.In an effort to improve HPV vaccine coverage, a handful of jurisdictions enacted HPV vaccine requirements for middle school entry from 2008 to 2020. However, it is unclear how effective these policies have been to date. Additionally, while implementation supports are established as playing a role in policy effectiveness, it is unknown what implementation supports have been used in states with HPV vaccination school-entry requirements.This study explored the implementation supports used by Rhode Island (RI) and Hawaii (HI), two states that have enacted and implemented HPV immunization requirements for school entry over the last decade. The study sought to identify and understand promising practices that could improve uptake of the HPV vaccine among adolescents nationally. The study gathered data through a literature review, secondary data analysis of HPV vaccination rates in RI and HI, a qualitative document review, and key informant interviews (KIIs) with individuals involved in or impacted by the implementation of these policies. The study concluded that the school-entry policies in HI and RI were effective in improving HPV vaccination uptake, particularly for females. However, key informants (KIs) attributed this success in part to the state having existing high rates of vaccine acceptance. The study also found that these states used robust implementation support strategies in their policy rollout and identifies the most promising practices as identified by KIs and supported by the existing literature. This study concluded that HPV vaccination requirements for school entry may be a useful intervention for some states with existing high rates of vaccine acceptance and offers insights into promising practices for states seeking to improve their HPV vaccination coverage.Doctor of Public Healt