HHV In Action

(2026) Reed, Rylee Anne; Howard, Laura, Philosophy

Homelessness in the United States is often regarded as either a personal shortcoming or a public nuisance, which critically obscures the central role that stigma plays in producing day to day harm for the unhoused individuals. By combining my coursework experience on stigma and moral status, together with my outreach internship alongside a local police department, I learned that the difficulties the unhoused face are not all material. They are often faced with social, institutional, and moral hardships. Labels become identities that travel through intake portals and service provider files; familiar narratives become moral judgements that justify isolation or punishment; language recasts neighbors as outsiders; and unequal power is exercised through rules, eligibility requirements and discretionary enforcement. In this paper I aim to provide a reconceptualization of stigma as it pertains to the unhoused population. This concept is centered on four components: labeling, negative stereotyping, linguistic separation, and power asymmetry. My reconceptualization of stigma as it pertains to the unhoused population will offer a clearer framework for understanding the societal mechanisms that marginalize the unhoused and will provide a foundation for more effective interventions.

(2025) Granholm, Delaney Rae; Loya, Julio, Public Health

Latinx populations in the United States experience disproportionately high rates of prediabetes and type 2 diabetes, driven by complex cultural, socioeconomic, and structural factors. This literature review examines historical and contemporary health disparities affecting Latinx communities, focusing on risk factors, barriers to healthcare access, and the effectiveness of culturally tailored diabetes prevention interventions. Building on this evidence, a quality improvement plan is proposed for the Prediabetes Education Program at Clí­nica Amistad, a free health clinic in Tucson, Arizona. Recommendations include integrating culturally relevant recipes, increasing family involvement, incorporating experiential learning activities, implementing the buddy system, and enhancing participant incentives. These interventions aim to improve program engagement, retention, and clinical outcomes, ultimately advancing health equity for low-income, uninsured Latinx individuals. An evaluation plan is outlined to assess the success of the proposed strategies.

(2025) Romano, Emma Lucia; Baliani, Patrick, Creative Writing

This thesis takes you through West Virginia history, specifically the healthcare of West Virginians. The four health issues represented are: Black Lung Disease, The Opioid Epidemic, The COVID-19 Pandemic, and Maternal Mortality. I inspect each topic by examining current treatment methods and diverse recommended preventative techniques. This thesis promotes education and guidance on health issues plaguing rural West Virginia and those outside its borders. As a West Virginian myself, I believe it is important to discuss, educate, and improve rural healthcare for the millions of Americans that rely on it. This thesis utilizes artistic media to guide the conversation in the four health topics outlined. The major parts of West Virginia's health history will be viewed by interpreting local West Virginia paintings (Ch. 1), poems (Ch. 2), photography (Ch. 3), and sculptures (Ch. 4). This project analyzes our current healthcare practices and sparks conversation on the best ways to improve outcomes for patients -- particularly rural Americans.

(2024) Lasher, Joshua Keith; Wilson, Amanda, Public Health

Introduction: Access to clean drinking water is a fundamental human right for sustaining health and well-being. However, unhoused individuals face significant barriers to accessing this essential resource, particularly in regions like Tucson, Arizona, where access to clean drinking water and public resources is limited. This study aimed to address this gap by examining the experiences of unhoused individuals regarding their access to clean drinking water in Tucson. Methods: Unhoused individuals (n=29) were surveyed between November 1st and December 13th, 2023, with the assistance of El Rio Health to oversee the surveys. This study protocol was approved by the University of Arizona Institutional Review Board. The surveys consisted of a structured questionnaire that explored various aspects of water access, including sources, challenges, seasonal variations, storage methods, and perceived difficulty accessing and storing clean drinking water. Results: Survey responses reported that convenience and grocery stores were common drinking water sources for unhoused individuals in Tucson. Denied access and financial constraints were identified as primary challenges. Seasonal variations in water availability were noted, particularly during the summer months, when water availability is more difficult to obtain reliably. Reusable containers and single-use plastics were the most prevalent storage containers, with varying cleaning practices reported. Discussion: The study's findings emphasize the urgent need to address water insecurity among unhoused populations. They emphasize the importance of equitable access to clean drinking water for promoting health and social justice. Legal implications include the need for policies mandating water provision in public spaces. Educational interventions could empower unhoused individuals with knowledge about the importance of hydration. While the study's limitations, such as sample size and potential bias, warrant consideration, its insights have broader applicability beyond Tucson, informing interventions in urban settings globally. Overall, this study serves as a catalyst for collaborative efforts to ensure equitable access to clean water and enhance the well-being of unhoused communities.

(2023) Lee, Brian; Oberman, Hester, Religious Studies

Poor mental health symptoms are increasingly correlated with a history of traumatic life events. Thus, clinical practitioners have been turning away from the traditional western medical model, and adopting more holistic, trauma-informed practices that provide targeted and efficient mental health services to their clients. One such therapeutic model was coined by psychiatrist Dr. Bruce Perry, whose Neurosequential Model of Therapeutics (NMT) posits that the brain develops in a bottom-up, use-dependent modality. Dr. Perry’s NMT describes how traumatic experiences can halt regular neurological development. Many traumatic experiences result from a singular aversive event; however, some trauma can arise from extended exposure to an aversive environment. Where these singular traumatic events can result in Post Traumatic Stress Disorder (PTSD), these prolonged forms of trauma can result in Complex Post Traumatic Stress Disorder (C-PTSD) (Franco, 2021). Religious trauma is a form of C-PTSD which results from exposure to a religious community that has negatively affected the individual’s wellbeing. By placing the concept of religious trauma within the existing NMT, we can better understand how adverse religious experiences influence brain development. Finally, the clinical implications of this juxtaposition of religious trauma and neurological development will be explored to provide practicing clinicians a reference for how to better support individuals struggling with the lasting effects of religious trauma.

(2023) Nava, Bianca; Wilson, Amanda- Public Health

Unsheltered individuals are sometimes asked to leave restroom facilities or are not permitted to enter due to their status as being unsheltered. With this, many unsheltered individuals are forced to urinate, defecate, or engage in other hygiene practices outdoors. They may also lack access to necessary hygiene toiletries or wait to urinate or defecate until they are able to gain access to a facility. These challenges can lead to health issues, such as urinary tract infections (UTIs), diarrhea, rashes, etc. The purpose of this study was to understand how lack of access to basic hygiene facilities is related to experienced health effects by unsheltered individuals. A verbal survey in English and research protocol was formulated and subsequently approved by the University of Arizona Institutional Review Board to explore the relationship between hygiene and being unsheltered. Each week, the primary researcher went out with the homeless outreach team from El Rio, a trusted organization in the unsheltered community, to verbally consent and recruit participants. Thirty consenting unsheltered adults ranging in ages from twenty-nine to sixty-eight participated. Results of the survey revealed that access to water was the most considerable hygiene barrier, followed by access to soap, concerns for privacy, and concerns for safety. Approximately 37% of participants experienced a UTI at least once since becoming unsheltered and 30% experienced a yeast infection at least once, with female participants having a higher occurrence rate than male participants. In addition, 63% of participants experienced a rash at least once and 57% of participants experienced diarrhea at least once. However, 67% of participants did not seek medical care for their health-related issues. The lack of utilization of medical resources shows a disconnect between health care providers and unsheltered individuals, which demonstrates the need for more socially competent care.

(2023) Reines, Jayne; Oberman, Hester, Religious Studies

Through her own experiences with death and religion, Reines explores the value of developing a personal perspective on the role of religious belief in end-of-life spaces for personal and professional growth. Reevaluating the oaths physicians make to patients, especially the Hippocratic Oath, is an important step toward self-determining your scope of care as a physician. By learning concepts and skills from the humanities early on in medical education, we can evaluate the promises we are making to our patients and the realistic impact we can have on their health experiences during and at the end of life. Courses offered in the Health and Human Values minor and the Public and Applied Humanities at the University of Arizona challenge pre-health students to evaluate current healthcare systems and consider the complexity of the concept of health. Reflecting on religious pluralism in the United States, Reines will explore community resources available to healthcare providers for improving end-of-life care as it relates to personal religious beliefs. Reines submitted the following paper to a student essay competition at the Conference on Medicine and Religion and was invited to present her work at the Ohio State University in Columbus, Ohio during March 2023. Presentation slides from Reines’ conference presentation have been attached at the end of this document.

(2023) Smith, Cassandra; Roth, Louise - Sociology

This study analyzes the effectiveness of El Rio Health Reproductive Health Access Project’s (RHAP’s) peer-led sexual health education workshops for youth called Pizza Protection Parties. Youth ages 14-24 in Tucson, Arizona attended a Pizza Protection Party at a Youth Reengagement Center with Goodwill Industries of Southern Arizona and then participated in a focus group to share their perspectives about the workshop. This study gained youth insight from pre-test and post-test knowledge surveys, an online survey after the workshop, observation notes, and focus group responses. Youth participants viewed the Pizza Protection Party and peer-led education as a useful experience to learn about sexual health topics and resources available in their community. Participants obtained new sexual health knowledge as reflected by focus group responses and the knowledge surveys. Youth also provided suggestions for how to improve the Pizza Protection Party with more in-depth sexual health information as well as changes to make the workshop more inclusive and engaging. RHAP can utilize these perspectives to improve the effectiveness and quality of Pizza Protection Parties as peer-led sexual health education for youth.

(2023) Weissert Danielle; Roth, Louise - Sociology

Menstrual equity is a critical global health issue that affects billions of people around the world. Menstrual equity is a term used to define the systemic issues that affect the ability to adequately access menstrual products, washing facilities, waste management, and any other menstrual hygiene tools and education. Current estimates show that a quarter of college students that menstruate struggle with adequately accessing menstrual products at any point during the year, which can affect a student’s ability to regularly attend class. Due to the understood and assumed need for action to promote menstrual equity on the University of Arizona campus, a survey of undergraduate students was created, conducted, and analyzed to provide evidence to advocate for more free menstrual products on campus. Based on the survey results, 86.24% of respondents reported that adding more locations with free menstrual products on the University of Arizona campus would increase their ability to access menstrual products. In addition, respondents agreed that the University can do a better job at providing free menstrual products on campus. On top of needing an increase in free menstrual products on campus, there also needs to be an increase in knowledge of existing resources, as 76.6% of respondents reported not knowing about any on-campus resources. Overall, there needs to be an increase in education of current resources and increase in available resources to move towards menstrual equity at the University of Arizona.

(2020) Cannon, Marisa; Baliani, Patrick

Complementary and Alternative Medicine (CAM), are therapies that can aid in the symptoms and emotional distress associated with breast cancer. The integrative health of the patient is explored through the following question - “How might CAM therapies, specifically yoga, massage therapy and Chinese medicine, collectively contribute to the psychology of healing in breast cancer patients?”. Breast cancer patients and survivors have constant emotional distress and physical problems with their diagnosis and subsequent treatment (Kacel et al. 2019). Yoga and meditation have been shown to have anti-depressive effects (Rao 2019), decrease IL-6 and salivary cortisol levels (Lengacher et al. 2019), and provide the ability to enhance acceptance of emotions (Henderson et al. 2012). Chinese Medicine has varying effects on breast cancer treatments symptoms such as: alleviating hot flushes and insomnia, reduce the risk of endometrial cancer induced by tamoxifen, and improve bone loss (Wang et al. 2019). Massage therapy techniques are helpful in aiding the physical toll of cancer. Swedish massage therapy (SMT) showed clinically significant relief of cancer related fatigue (CRF) (Kinkead 2017) and Classical massage may decrease the side effects of chemotherapy induced peripheral neuropathy from paclitaxel (Izgu et al. 2019). Through these CAM therapies, by treating the patient as a whole and being dedicated to their health in an all-encompassing approach, patients can achieve their new-found definition of health throughout their cancer journey.

(2020) Carter, Savannah; Cutshaw, Christina- Public Health

Mass media, specifically television, has provided information and influenced perceptions of audiences on the topic of mental illness. Aims: To explore the extent that the popular dramatic television programs: 13 Reasons Why and Atypical, use stigmatizing or non-stigmatizing language about mental health conditions portrayed by the main character, the representation of mental health treatment, and how stigma is reflected in these portrayals. Methods: The author conducted a qualitative content analysis of four episodes of each show. Results: The depictions of mental illness through stigmatizing language, context, and plot were found to emphasize both public and self-stigma in each show. There were both positive and negative examples of treatment in each show with a more positive impression in Atypical than in 13 Reasons Why. Conclusion: Stigmatizing language continues to be used in popular shows that portray teen characters with a mental illness with mixed representation of treatment. Concerns include how teen audiences interpret the language and its contributions to stigma about mental health.

(2020) Chadha, Abhimanyu; Braitberg, Victor

At my time at the University of Arizona, I had the privilege of being a part of the Health and Human Values minor cohort. This minor is a unique health humanities minor offered by the Honors College. Through this minor, I have found that my empathy in the context of health and medicine has grown. This was something I grew curious about and researched other health humanities programs to see what they had found on the impact of their program on their students’ empathy. I found that health humanities programs may hold the key to increasing empathy in undergraduate pre-medical students striving to be healthcare professionals in a world where physician burnout is on the rise. I discuss my experience in the introductory course and internship course in the minor, how the courses succeed in increasing empathy and how my empathy grew from the unique challenges and coursework presented by this minor.

(2020) Compton, Kelsey; Barraza, Leila

This project aims to discuss the history of needle exchange programs in the United States, as well as to document and understand knowledge, awareness, and perceptions of the legality and success of needle exchange programs in Arizona. A survey was distributed between January and February 2020 to students of various fields of study attending the University of Arizona. This survey asked questions regarding students’ knowledge, understanding, and opinions of needle exchange programs, as well as knowledge and perceptions of their legality and effects. Several factors including age and field of study were shown to influence knowledge and support of the programs. Overall, respondents had positive attitudes of needle exchange programs but had fewer positive responses when asked to imagine the programs operating near their property. The results showed a lack of awareness and support of the legal status of NEPs in Arizona despite an understanding of the positive effects of the programs.

(2020) Cox, Alexandra; Coppola, Crista

Dogs are widely recognized as “Man’s Best Friend” and have become one of the most popular pets in the US. Their success as a companion relies heavily on their unique ability to develop a close bond with humans and their innate desire to interact with them. A major contributing factor to this special bond is the emotional welfare of both parties. To date, traditional dog training has focused on ​what​ a dog is trained to do but more modern methods also focus on ​how​ this is accomplished. This thesis was a community project that provided no-cost, modern dog training classes to UArizona students, faculty and staff. The focus of the project was to explore the effect dog training has on improving the human-canine bond. Training classes were provided during both the Fall and Spring semesters. The Fall semester training focused on basic obedience and behavior management skills, while Spring semester focused on beginner level tricks. In total, 13 owner-dog dyads participated in training classes. Both training semesters presented many opportunities to explain common misconceptions regarding dog behavior, explain the species-specific requirements of companion dogs and assist owners in teaching their dog new behaviors that ultimately enhance the bond shared between the human-canine dyads. A post-class survey was given to participants to further look at the effect of training on the human-canine bond.

(2020) Huynh, Victoria; Armin, Julie

This thesis consists of a scoping literature review, followed by a project proposal, regarding the topic of liver cancer prevention behavior in the Vietnamese American (VA) population. Despite past interventions, the VA population continues to experience health disparities in liver cancer such that their incidence and mortality rates are significantly greater than those found in non-Hispanic Whites, as well as any other Asian ethnicities. A contribution of this paper is to aid in the disaggregation of Asian American health data, since within the past few decades, there has been a constant underrepresentation of certain ethnic groups. This research recognizes the heterogeneity of the Asian American population and hopes to reduce the health disparities faced by the local VA community. The literature review was chosen to identify and organize data trends related to hepatitis screening/vaccination, address areas needing further research, and inform the project proposal for a community- and clinic-based program to improve screening rates in VA. Methods of this review consisted of utilizing various online databases, and using a systematic approach in article selection. It is important to note that the following project proposal is entirely hypothetical in its details of research methodology and community partner collaboration, but nonetheless contains information to inform future development of VA cancer screening interventions.

(2020) Marine, Emily; Plemons, Eric

Medical crowdfunding has been rapidly growing in popularity over the past decade. As the opioid epidemic and other drug use disorders grip the United States, many medical crowdfunding campaigns have emerged that attempt to elicit donations to pay for drug addiction-related services and treatment. In this study, I examine twenty-seven American medical crowdfunding campaigns that seek to pay for drug addiction treatment to investigate how stigma surrounding drug addiction and the nature of medical crowdfunding's platform influence campaigner's narratives. I contend that instead of directly arguing against stigma, the campaigners in my study employ specific narrative strategies to prove that each addict is primarily worthy of overcoming any stigma associated with drug addiction, and secondarily worthy of monetary donations. These narrative choices include proving that the addict is ready for and will truly benefit from treatment, shifting blame for the addiction off of the addict themselves, and emphasizing the positive social effects that will result from the addict becoming sober.

(2020) Owens, Caleb; Oberman, Hester

This paper addresses the physiological and psychological effects of caregiving. It provides a detailed analysis of the current understanding of these effects and the phenomena known as caregiver burden. Caregiving, while rewarding, can have a variety of negative impacts on the physical and mental health of the caregiver if it is not controlled. Using this knowledge, the researcher explores the state of caregivers in Southern Arizona. By using data collected from surveys and well as personal interviews from caregivers, the author investigates the health and experiences of caregivers in this region. The responses collected in this research found that caregivers in Southern Arizona were not exempt from the effects of caregiver burden, which will be outlined in the literature review segment of this paper. As the literature suggests, they report feelings of stress, both physically and mentally. Additionally, the interview portion of this thesis revealed the difficulties that some individuals have in simply gaining approval for caregiving services. Accessibility of care hours is an issue of policy that should be addressed but will not be the focus of this paper. Fortunately, the effects of caregiver burden are not absolute. They can be limited through stress management and addressing the needs of caregivers. By providing the necessary education and resources to caregivers about the effects of caregiving, they will be able to combat the impact of caregiver burden and maintain their health and, in extension, the health of those they care for.

(2020) Querrey, Corinne; Oberman, Hester

Over 80% of the United States patient population identifies as either spiritual, religious, or both. ​​While not everyone actively practices the belief system they identify with, faith is nevertheless an important element in a person's life and often a critical component in health-related decision-making. Recent literature suggests questioning the spiritual needs of the patient allows clinicians to understand patients from a more holistic lens, thus fostering a higher level of empathy, compassion, and patient-centered care. Some doctors still feel unprepared to talk about faith in the clinical setting, and other doctors express reasons for seldom addressing faith, including time constraints, discomfort, and maintaining boundaries. This paper reviews multiple spiritual assessment models, which have been developed to use as guides for physicians when addressing patient spirituality. Appropriate forms of spiritual care on behalf of physicians are represented by the Five Senses of Compassionate Care and the FICA and HOPE spiritual assessment tools, in order to establish and maintain healthy doctor-patient relationships and meet holistic needs of the patient. Discussions on the relation between spirituality and medicine, tools to conduct an assessment conscientiously and respectfully, and physician perspectives are all steps in the right direction towards improved whole-person healthcare.This thesis will review the relevant literature as well as use preliminary data collected in accordance with the University of Arizona IRB standards, to explore the value of integrating spirituality in medicine and how to do so effectively. The doctors in this study were surveyed on the importance of addressing patient spirituality, and interviews were conducted to gather additional perspectives. It was hypothesized that physicians at Alvernon Family Medicine Clinic would be willing to discuss spirituality with their patients. It was concluded that the majority of physicians are open to conducting spiritual assessments if they are provided training on how to do so.

(2020) Radeztsky, Erin; Oberman, Hester

Medical students and physicians consistently suffer from elevated levels of depression, suicide, and burnout. Prior research shows that medical students experience a significant increase in rates of stress and depression as they continue their medical education. In addition, medical students report that they do not seek treatment for their mental health concerns or are afraid to admit that they are struggling. This thesis examines this phenomenon by addressing how medical education institutions may influence the well-being of future healthcare professionals. An overview of literature containing factors leading to depression and suicide in medical students is discussed and current interventions arepresented and evaluated. Personal narrative is used to provide context to the experiences of depression and anxiety. Addressing medical student well-being must be collective effort from past, future, and current students, faculty, and professionals. By building cohesive and supportive learning environments through institutional and curricular changes, medical schools can help to equip their students with the tools to address their own needs so that they may effectively care for others.

(2020) Sherwood, Austin; Plemons, Eric

Transgender people endure unique struggles compared to their cis gendered heterosexual counterparts in American society. In addition to high levels of anxiety and depression and an increased likelihood to experience violence, trans people have significantly higher smoking rates. Used as a coping mechanism, smoking puts trans people at risk for adverse health outcomes. Additionally, when done concurrently with gender-affirming care, these harmful effects may compound to create even worse health disparities. For these reasons, there is a need for a trans-specific smoking cessation intervention to specifically help trans people quit smoking. There are currently no American trans-specific smoking cessation interventions in the literature. Therefore, this thesis provides a list of best-practice recommendations to guide the design of such an intervention.

(2020) Valenzuela, Allie; Myadar, Orhon

Refugees in the United States present a unique set of circumstances for their medical providers. This paper will overview the complex process for admission to the United States and the unresolved trauma that many refugees experience. It will discuss the barriers to achieving adequate healthcare experiences for refugees: language, health literacy, transportation, gender issues, provider cultural competency, and communication about trauma. These barriers confound each other and create a multidimensional challenge for refugee patients in the U.S. For this reason, this paper also explores current recommendations for providers. Finally, I will argue that employing the ideas in “The Danger of a Single Story​”​ and ​Narrative Medicine​ will have positive impacts on the way refugee patients experience U.S. healthcare.

(2019) Jordan, Gianna Marche Del Casino, Vincent

The issue of homelessness is an increasing problem in the United States, with the number of people experiencing homelessness increasing in the past two years. Historically, deinstitutionalization in the 1970s along with welfare reform in the 1990s had a drastic impact of the number of people experiencing homelessness. With the belief that the individual was responsible for their condition, homeless outreach focused on addressing individual behaviors such as substance abuse and mental illness as the reason a person was experiencing homelessness. This belief ignored any structural factors such as politics, the economy, gendered issues, and race as aspects that could contribute to someone experiencing homelessness. With a shift from a behavioralist view to a structuralist view, a Housing First program emerged as an alternative to the treatment first method. The Housing First Programs provide someone experiencing homelessness with housing immediately and does not require them to abstain from substances or access mental health treatment. By giving someone housing, the ability to make choices in their life, and reducing the harm they may encounter a Housing First program would reduce the high rates of morbidity and mortality in women experiencing homelessness.

(2019) Rabinowitz, Aaron Samuel; Braitberg, Victor

As of 2019, over 130 community paramedicine (CP) programs exist internationally. These are the goals that community paramedicine seeks to achieve: prevent hospital readmissions, reduce frequent EMS (emergency medical service) and ED (emergency department) user’s reliance on emergency services, provide alternative and more appropriate destinations for patient care, and chronic disease management by increasing patient access to primary care services. There is no way of assessing if these common goals are being met because programs today use a diversity of different strategies, techniques, and measurements when providing care. This reflects different electronic interfaces, different patient referral forms, different program evolution patterns, and different program strategies. For example, the use of an urban or rural community paramedicine model, or the use of one software in favor of another. The consequences of these different strategies include: failure to legitimize CP as an emerging type of healthcare, failure to optimally control program costs, failure to develop a language for communication that is understood by all community paramedics, failure to make data comparable between different programs, and failure to advance the outlined goals of CP. Drawing on the sociology of standards, this thesis proves that terminological and procedural standards can address these problems by creating a common language for communication and clinical practice guidelines for all community paramedics. Without the creation of such standards, the above consequences will not be remedied. Community paramedicine programs will have the ability to overcome the consequences I have listed through the creation and implementation of these standards.

(2019) Rowlison, Gabrielle Marie; Glisky, Elizabeth

This project aimed to address social isolation, decreased morale, and negative perceptions of healthcare in older adult communities such as assisted and independent living facilities by introducing intergenerational interactions as an intervention. This intervention, which took place in Spring 2019, was a component of a course taught by Elizabeth Glisky, PhD of the Department of Psychology. The students of the class visited an assigned elder at three different sites in Tucson, and spent some time interacting with their elders and learning about their lives. The college students then created “Life Story” booklets for the adults with whom they interacted. Questionnaires addressing the older adults’ psychological well-being, level of depressive symptoms, and perception of care they receive from their primary care provider were administered before and after the intervention. There were marginally significant improvements in overall psychological well-being and in the subcategory of autonomy. There were no changes in depression or perceptions of care. Although the main goal of this study was to improve older adults’ perceptions of their relationship with their primary care provider by increasing comfort in interacting with younger adults, we were unable to observe such changes. Possible reasons for this null finding are suggested in the discussion.

(2019) Ryan, CJ; Lamoreaux, Janelle

Homelessness is an epidemic in the United States, where over half a million people find themselves without housing nightly. This is especially concerning when considering those who are forced to bring in the next generation into an unstable home environment – those who find themselves in the unique situation of experiencing homelessness and pregnancy simultaneously. Children born to mothers who were homeless during pregnancy are at a higher risk for intergenerational poverty, homelessness, victimization, substance abuse, and chronic illness – many of which stem from the lasting health effects from disproportionately high rates of fetal birth defects, underdevelopment, and low birth weight in these babies. When the health of the mother and their child in gestation are understood as interconnected, we can focus on factors which contribute to the holistic picture of the mother’s health – and consequently their infant’s health. This involves a close look at the socioeconomic and environmental factors which contribute to the prevalence of poor birth outcomes in the unique population of homeless, pregnant women. With understanding the intersecting factors which shape their overall picture of health, the model of shelters as a novel intervention can then serve as a treatment which may address many of these concerns in a long term, effective, and comprehensive way. This intervention seeks to understand and eradicate the underlying socioeconomic burdens which underscore the prevalence of adverse birth outcomes among this population in the first place.

(2018) Silverton, Ellen Michelle; Selberg, Scott

This thesis looks at how living situations can affect loneliness in older adults. Research shows that social isolation and activity involvement were two main factors in determining loneliness. Many adult children take in their older adult parent in part so they will not feel lonely. This is referred to as a familial intergenerational living arrangement. This living arrangement does decrease loneliness levels in older adults, but it can create issues with autonomy and dignity. Non-familial intergenerational living situations, however, are able to deal with these factors effectively, since the older and younger generations have more privacy. Elder cohousing communities, where the houses are very close together, also decrease loneliness while maintain autonomy and dignity since there are so many opportunities for involvement and interaction. I argue that by combining these two types of living situations to create a new living arrangement of non-familial intergenerational cohousing communities, loneliness can be combatted while also creating an environment where intergenerational exchange can flourish.

(2018) De Castro, Francis Miguel; Braitberg, Victor

This thesis examines the health system of the United States Department of Veterans Affairs in order to understand how its institutional structure affects physician’s clinical decisions regarding patients suffering from opioid use disorder. It provides a summary of the literature on the Veterans Affairs (VA) healthcare system to analyze how institutional structures of the VA such as the organization, financing, physician reimbursement models, and health-related research done by the VA shape the behaviors and decision-making of physicians. The question of how the VA’s institutional structure impacts individual clinical behaviors and decisions is both multi-faceted and poorly understood. This thesis offers suggestions for future research that integrate approaches focusing on determinants of health, cultural competence, and the institutional structures of the VA system in order to understand the factors that are shaping how treatment decisions are made in a clinical setting and their impact on veterans.

(2018)  Karcher, Christiana Barbara; Selberg, Scott

This thesis explores attitudes toward complementary therapies, attitudes which may adversely affect the integration of creative therapies into traditional medical practice for chronic pain management. Through multiple forms of research, a distinct pattern becomes prevalent: attitudes are specific to each stakeholder's role in experiencing, managing, or responding to pain. In turn, they end up shaping stakeholder perspective on efficacy, feasibility, or worth, and as such they carry the potential of becoming impediments to creative pain management, particularly when they are adverse. More discussion between stakeholders would perhaps bring about a better understanding and reception of complementary therapies. A diverse yet representative panel discussion provides opportunity for community insight towards complementary therapies, whilst reducing barriers brought up by attitude, by essentially allowing for open communication and the reevaluation of preconceptions. Such an event was hosted; it included 3 unique panelists and attracted an audience of 51 people. Discussion focused on complementary therapy as seen by each panelist, along with its potential for being integrated further into medicine within the community. It was generally successful, indicating that small efforts of cooperation among stakeholders have the potential to positively influence attitudes toward complementary therapy for pain management.