Faculty burnout in higher education is a critical institutional crisis driven by escalating workloads, administrative demands, and systemic inequities. While existing literature extensively describes these stressors, fewer frameworks explore how faculty actively mediate these pressures. This paper utilizes Bandura’s Self-Efficacy Theory as a central analytical framework to examine the multidimensional pathways of faculty burnout and identify targeted avenues for intervention. This paper analyzes how escalating job demands systematically erode faculty members' perceived capabilities across teaching, research, and advisory roles, with particular emphasis on how these dynamics intersect with gender and racial demographics. Shifting the focus from mere description to theory-driven action, this paper evaluates how cultivating robust professional self-efficacy serves as a vital protective buffer. Ultimately, we outline actionable, solutions-oriented institutional interventions, such as structured mentoring and workload equity metrics, designed to rebuild faculty agency and foster long-term systemic well-being.
Family caregiving plays a central role in the United States' long- term services and supports system. This comprehensive overview consolidates recent data from population-based surveys, government sources, and peer-reviewed research to create a detailed profile of intergenerational and multigenerational caregiving trends projected through 2025. The report highlights the overall prevalence of caregiving, its societal and economic value, and specific roles within grandfamilies where grandparents care for their grandchildren and within the sandwich generation, which consists of adults caring for both children and aging parents. It also examines disparities faced by caregivers from diverse racial, ethnic, and LGBTQ+ backgrounds, emphasizing how these differences impact access to resources and overall caregiver well-being. The analysis further explores the economic and health consequences of caregiving, including financial burdens, increased stress, and health risks for caregivers. The evolving policy environment is another focus area, covering initiatives such as Medicaid’s home- and community-based services (HCBS), the National Family Caregiver Support Program, and the recent 2022 National Strategy to Support Family Caregivers [1]. Key findings reveal that approximately 53 million adults in the U.S. provide unpaid care, according to data from AARP and the National Alliance for Caregiving (2020), with out-of-pocket expenses averaging over $7,200 annually [2] and the economic contribution of unpaid caregiving reaching around $600 billion in 2021 [3]. Additionally, grandparents serve as primary caregivers for millions of children [4]. While caregivers are more likely to experience mental health challenges, including elevated distress, compared to non- caregivers [5]. The report concludes with evidence-informed recommendations to improve caregiving support through better financing strategies, enhanced training programs, expanded respite services, and equity-focused programs to ensure fair access and inclusivity across all caregiver populations.
Barriers exist in the United States which potentially prevent 46 million Americans from having reliable access to healthcare. While the Affordable Care Act was implemented to address this issue, as recently as 2024, it was estimated that 27.2 million eligible Americans still did not possess insurance. Access is most often limited due to being under or uninsured, but can also occur on racial/ethnic lines, socioeconomic status, and proximity to health care providers. In response to discrepancies in access to care, programs at the state and federal level have been implemented including Medicare/Medicaid and federally qualified community health centers (FQHC’s). Even when controlling for factors related to access, many people who are eligible for federal support do not utilize free healthcare provided by community health centers. Little research exists on the effects of behavior on healthcare utilization, especially between rural and urban populations. This research was conducted to determine what barriers, if any, exist which prevent under or uninsured patients from utilizing free or reduced cost clinics in rural and urban settings in Southwest Missouri. Our findings indicate that primary factors affecting utilization differ significantly between rural and urban areas. Secondary factors in care choice were related to the perception of quality. Additionally, significantly more respondents in rural areas would continue to utilize free or reduced cost facilities if given the choice compared to respondents from the urban areas. Regardless, respondents from both locations indicated their preferred care would be with a private provider. The lack of consistent providers at FQHC’s was perceived as a barrier with many respondents indicating they were discriminated against in their health care because they do not have a single primary care provider. These results may imply that access to a consistent provider and location may play a role in perceived barriers to care.
Unregulated drug distribution and informal healthcare in Nigeria pose severe medication-related risks, driven by a lack of professional oversight and the proliferation of counterfeit medicines. This study identified the determinants of adverse health outcomes through a cross-sectional survey of 663 participants across 15 Nigerian states. Using multivariate logistic regression, we found that uncertainty regarding a licensed pharmacist's presence was the strongest predictor of adverse outcomes (AOR = 18.891; 95% CI: 7.876-45.310), followed by the confirmed absence of a pharmacist (AOR = 13.280; 95% CI: 4.674-37.730). Failing to consult a physician (AOR = 4.877; 95% CI: 2.477–9.599) and sourcing drugs from unlicensed stores (AOR = 2.544; 95% CI: 1.443-4.484) also significantly increased complication risks. Notably, avoiding informal nurse services was highly protective (AOR = 0.015; 95% CI: 0.004-0.055). These findings highlight that a deficit in professional oversight is a primary driver of pharmaceutical harm in Nigeria. Urgent policy interventions are required to strengthen regulatory enforcement, improve access to qualified professionals, and bolster national pharmacovigilance.
Insufficient exercise and obesity remain significant public health concerns. Identity theory and self-efficacy theory provide frameworks for understanding health behavior, suggesting that athletic identity and perceived physical ability influence exercise participation. Community running events offer practical opportunities for identity development and efficacy enhancement, yet their psychological and behavioral impacts remain underexplored. This study examined changes in athletic identity and perceived physical ability associated with participation in a trail running event and explored relationships among these constructs and self-reported health behaviors. Participants in a trail race completed surveys assessing athletic identity, perceived physical ability, and health behaviors pre-event and post-event. Significant increases were observed for athletic identity and perceived physical ability, but not for health behaviors. Athletic identity was found to predict self-reported health behaviors. These findings suggest that participatory sports events such as running races function as interventions for strengthening psychological constructs associated with sustained physical activity engagement. Considering public and non-profit investment in community running events, results provide insights into using these events as important public health tools.
Public health interventions can change epidemic trajectories and, critically, can also increase the chance that an outbreak dies out early. We developed a quantitative framework to estimate the probability of epidemic extinction under different strengths of non-pharmaceutical interventions implemented in two subpopulations (low-risk and high-risk). The approach extends a standard compartmental model by incorporating random transmission events and evaluating disease extinction probabilities under alternative intervention scenarios.We applied the framework to COVID-19 incidence data from Brazil (Johns Hopkins University). Under fitted baseline parameters, the basic reproduction number was approximately R0 = 1.4, indicating that deterministic models would predict sustained epidemic growth. Despite R0> 1, the stochastic framework yields substantial extinction probabilities that can be increased through timely interventions. When the outbreak was seeded by one infectious individual in the high-risk group, the estimated extinction probability under baseline intervention levels was 67.22%. A 40% proportional increase in low-risk interventions (holding high-risk interventions at baseline) increased extinction to 74.93%, whereas the same proportional increase applied only to high-risk interventions increased extinction modestly to 68.43%. Increasing interventions in both groups by 40% yielded a similar extinction probability (75.13%), highlighting that broad population-level measures can achieve near-maximal gains relative to dual targeting at the same scale.Overall, these results indicate that early, population-wide non-pharmaceutical interventions, particularly those improving compliance or reducing transmission in the larger low-risk group, can meaningfully increase the likelihood of epidemic control even when R0 > 1.
This naturalistic case study used Chickering and Reisser’s Theory of Student Identity Development to explore the impact of participation in collegiate women’s basketball on female student-athletes’ health, well-being, and academic development. This study followed one National Collegiate Athletic Association (NCAA) Division I women’s basketball program throughout an entire season. Data was collected through observations, semi-structured interviews, and document analysis to understand the lived experiences of student-athletes and coaches. Findings discovered five themes: effective communication, emotional challenges, demands of student-athletes, support systems, and motivation mindset. Results showed that participation in collegiate athletics supports student development, including competence, autonomy, and purpose, while also facing challenges with limited time, mental health, and identity development outside of their sport. Strong support systems and open communication with coaches were crucial in helping these student-athletes face these challenges to maintain academic and personal growth. Overall, this study shows the importance of a holistic approach within collegiate athletic programs to improve student-athlete development, well being, and overall success.
This study examines two decades of nationally recognized healthcare organizations in the United States that earned the nation’s highest awards for performance excellence in healthcare delivery between 2005 and 2025. Using a structured qualitative document analysis design, the review synthesized publicly available award documentation, government reports, and peer-reviewed healthcare management literature to identify recurring organizational processes and measurable results associated with high-performing, community-engaged health systems. Data were extracted using a standardized abstraction template capturing organizational context, strategic management practices, community citizenship initiatives, and reported performance outcomes. A directed content analysis approach was used to code evidence into thematic domains aligned with performance excellence constructs and population health orientation, followed by cross-case synthesis to compare patterns across organizations and time periods. Findings indicate that honorees consistently aligned mission, strategy, and operations with community engagement and measurable quality and safety goals. Across cases, organizations extended impact beyond hospital walls through community benefit investment, social determinants of health initiatives, workforce pipeline development, and cross-sector partnerships, with reported improvements in clinical outcomes, patient experience, workforce engagement, and financial sustainability. Results suggest that high-performing systems operationalize community citizenship as a strategic capability supported by integrated management systems and continuous measurement, offering transferable lessons for health systems seeking to strengthen population health alignment and organizational performance.
Obesity remains a major public health concern in the United States, with disproportionately high prevalence in low socioeconomic status communities. Chicago communities experience elevated rates of both economic hardship and obesity. The present study used a cross-sectional ecological design to examine the relationship between socioeconomic hardship and adult obesity rates in Chicago, and evaluated physical inactivity as a mediator. Using publicly available data from the Chicago Health Atlas, analyses were conducted across 75 Chicago community areas (N = 75). Community-level hardship was operationalized using the Chicago Hardship Index, obesity was measured as the percentage of adults with a body mass index of 30 or greater, and physical inactivity was defined as the percentage of adults reporting no physical activity in the past month. Bivariate correlations and a mediation model were tested using Hayes’ PROCESS Macro. Results indicated that hardship was positively associated with obesity and physical inactivity. Physical inactivity significantly mediated the relationship between hardship and obesity, accounting for a substantial proportion of the association while retaining a significant direct effect. Correlational analyses revealed higher obesity rates amongst Black residents and females. Findings suggest that unmet basic needs in economically disadvantaged communities may impede engagement in health-promoting behaviors such as physical activity. These results highlight the importance of addressing structural and environmental barriers to physical activity when designing obesity prevention strategies. Policy and community-level interventions that target economic hardship and promote accessible opportunities for physical activity may be critical for reducing obesity-related health disparities in urban populations.
Regression analysis is a fundamental statistical technique widely applied in preventive healthcare research to identify risk factors, predict health outcomes, and inform targeted interventions. This in-depth review examines the pivotal role of various regression approaches—linear, logistic, Cox proportional hazards, quantile, linear mixed-effects, multilevel, and Poisson regression—within medical-focused preventive research. The review highlights regression analysis as a powerful tool for analyzing multiple variables simultaneously, quantifying relationships numerically, and minimizing confounding effects to improve the precision of health outcome predictions. It also outlines the advantages of each type of regression and their suitability for different data structures and clinical questions, ranging from simple associations to complex hierarchical and longitudinal analyses. Despite its strengths, regression analysis has limitations, including the need to validate assumptions, issues with multicollinearity and over fitting, challenges with small sample sizes, difficulties in interpreting causality, handling non linear relationships, outliers, missing data, and the complexity of interpreting results. Identifying and managing these challenges is essential for generating valid and actionable findings. In conclusion, the proper use of regression analysis is a critical component of evidence-based preventive strategies, enabling healthcare providers to proactively address health threats and improve both patient and population health outcomes.
Motivational interviewing (MI) is an evidence based communication method used by public health professionals to promote health behavior change. Traditionally, MI instructors used in person pedagogical methods for training learners, but geographical disparities necessitated the development of distance learning, and the SARS‐CoV‐2 pandemic further motivated a shift to online, virtual pedagogical methods. This study evaluated the feasibility and acceptability of online synchronous versus in person pedagogical methods for MI instruction among public health professionals.Forty professionals were randomly assigned to an online synchronous or in-person MI training group. Both groups received 14 hours of training from the same instructor using an identical curriculum. A mixed-method evaluation approach was used to measure the learning and acceptability of the training. Attrition following randomization led to participant dropout. Participants (n=16) submitted a recorded MI session for evaluation by trained MI coders using the Motivational Interviewing Treatment Integrity 4.2.1 (MITI 4.2.1) instrument were included in the analysis to determine MI skill and spirit competence. Pre- and post-training surveys were used to evaluate training preferences and satisfaction.MITI 4.2.1 global rating scores did not differ significantly between the two training modalities. The only behavioral count that differed was "giving information," which was statistically higher in the online group. Overall satisfaction was significantly greater among the in-person training group. Participants also expressed a stronger preference for in-person MI training. Several participants dropped out of the study, especially among the participants assigned to the online group, which impacted the robustness of the results.Maintaining fidelity is crucial when delivering evidence-based training. While online synchronous and in-person MI training pedagogy produced similar MITI 4.2.1 outcomes, participants were more satisfied with and preferred the in-person pedagogical approach. These findings support the feasibility of using synchronous online MI training methods to produce acceptable training outcomes for geographically remote participants.
Background: The multi-year consequences of Long COVID remain incompletely characterized, particularly with respect to healthcare utilization and economic burden.Methods: We conducted a prospective longitudinal analysis of 4,038 respondents from the Medical Expenditure Panel Survey (MEPS) Panel 24 (year 2019–2022). Participants were classified into three groups: Long COVID (symptoms ≥3 months), COVID-recovered, and no COVID. Hierarchical linear models were used to estimate four-year trajectories of perceived health, psychological distress (K6 scale), and inflation-adjusted healthcare expenditures, adjusting for age, sex, race/ethnicity, insurance status, baseline self-rated health, and comorbidity burden.Results: After full adjustment, COVID-19 status was not independently associated with perceived health or psychological distress over time, and no evidence of differential symptom progression was observed between the groups. In contrast, healthcare expenditures diverged significantly by COVID status. Individuals with Long COVID experienced a substantially faster rate of spending growth compared with COVID-recovered and No-COVID respondents, confirmed by a strong time-by-group interaction (p < 0.0001), independent of baseline health and sociodemographic factors.Conclusions: In this nationally representative cohort, baseline health status explained most variation in long-term health and psychological outcomes following COVID-19 infection, whereas Long COVID was independently associated with escalating healthcare costs. These findings suggest that, in this cohort, the dominant long-term sequela of Long COVID is economic rather than symptomatic, with important implications for healthcare financing, disability policy, and post-acute care planning.
Background: Public health systems in the United States are confronting escalating and interrelated challenges—including chronic disease, addiction, interpersonal violence, social fragmentation, political polarization, and declining trust in institutions—that increasingly strain existing governance and organizational models. These challenges are commonly addressed as discrete problems, reflecting mechanistic and reductionist approaches that fail to account for the cumulative effects of stress and adversity across the lifespan and across social systems.Problem Framing: More than twenty-five years of research on Adverse Childhood Experiences (ACEs) demonstrates that early adversity is a major determinant of population morbidity, mortality, and social dysfunction. Despite this evidence, trauma and chronic stress remain insufficiently integrated into public health strategy, organizational practice, and policy design.Framework: This article introduces CREATING P.R.E.S.E.N.C.E., a trauma-informed, values-based framework for trauma-responsive and trauma-resilient public health systems. Drawing on trauma science, complex adaptive systems theory, organizational psychology, and public health ethics, the framework conceptualizes organizations as living systems—described here as biocracies—whose capacity for alignment, learning, and ethical action is profoundly shaped by stress and trauma.Contribution and Implications: P.R.E.S.E.N.C.E. operationalizes the Science of Suffering into eight interrelated domains that support emotional regulation, shared responsibility, and adaptive capacity. The framework is offered as both a practical method of governance and a conceptual foundation for addressing preventable suffering at the population level.
One of the problems faced by breast cancer patients is fear and can be defined as the fear or worry that the disease will recur in the same or another organ. This affects the quality of life. This work aims to validate the 8-item Cancer Worry Scale (CWS) and to establish a cut off score for high fear of cancer recurrence. Methodology: Two hundred and fifty female cancer survivors were invited to participate in the study, of which 134 (53.6%) returned the questionnaires. This study was conducted at the Oncology Clinic of the Clinical Hospital Center of the University of Niš. Of these, 116 women completed the (CWS) in full, which was necessary for analysis. Responses on the scale are assessed using a 4-point Likert type scale. Responses are “rarely”, “sometimes”, “often” and “almost always”. The score on the scale ranges from 8 to 32. Results: In this study, we use an 8-item scale. The Worry Scale (CWS) assesses worry about cancer and its recurrence and the effects of these worries on daily life in those with a history of cancer. The cut-off score of the CVS was set at 13, and a score of 13 and below was defined as low fear, and a score of 14 and above as high fear. As the score increases, the level of fear of cancer increases, and the Cronbach's alpha coefficient was calculated as 0.713, so the instrument is quite reliable. As a result of this factor analysis conducted to determine the validity of the Breast Cancer Worry Scale, it was found that the factor loading values were between 0.61 and 0.87. Conclusions: After breast cancer surgery, a serious problem that significantly impairs the quality of life of patients is the fear of cancer recurrence. This scale (CWS) is a reliable and valid questionnaire for assessing fear of recurrence in breast cancer survivors, allowing us to provide adequate care to survivors.
Alcohol use and abuse has consistently been an issue for people of all ages and walks of life. These behaviors are increasingly worrisome in the college student population. Many things factor into this complex issue. So many students are experiencing freedom from their parents for the first time, many already have established drinking behaviors, some are dealing with mental health issues, and then they all enter an environment that encourages alcohol use, often leading to abuse. Whites’ binge drinking was statistically greater compared to African Americans and Non-White / Non-African Americans.Methods: A sample of college students from 4 universities were administered the Youth Risk Behavior Survey. Descriptive statistics and Dunn-Bonferroni Post-hos tests were performed.Results: When examining drinking and binge drinking behaviors, statistical significance was found between Freshmen and Sophomores (p=0.03) and between Freshmen and Juniors (p=0.042). Also, significance was found between White vs. African American students (p=0.001) and White vs. non-White or African American students (p=0.001). The purpose of this study was to examine the alcohol use and binge drinking behaviors of college students.
The high prevalence of chronic noncommunicable diseases (NCDs) among older adults in Brazil presents substantial challenges to medication adherence—an essential component for ensuring therapeutic effectiveness. Adherence is influenced by a range of factors, including socioeconomic status, cultural beliefs, cognitive decline, and health conditions, all of which demand close attention from professionals in Primary Health Care (PHC). Objective: To analyze the challenges faced by PHC professionals in addressing low medication adherence among older adults with NCDs in a municipality within the Metropolitan Region of Belo Horizonte, Minas Gerais. Methods: This action research was conducted in two stages. The first involved a descriptive phase using an electronic questionnaire distributed to professionals from 38 Basic Health Units (UBS), focusing on their perceptions of medication adherence and their interest in participating in focus groups. The second phase involved conducting two focus group sessions with both care and management professionals. The study adhered to the Standards for Reporting Qualitative Research (SRQR), and the data were analyzed using thematic content analysis, following Bardin’s methodological framework. Results: A total of 131 professionals responded to the questionnaire, the majority being women (87%), aged 40–49 years, with 71.8% affiliated with the Family Health Strategy. Only 15.3% had received specific training in older adult health. Eight professionals participated in the focus group discussions. The primary challenges identified included lack of family support (33.6%), low levels of education (23.7%), complexity of therapeutic regimens (9.9%), limited access to medications (6.9%), and forgetfulness (6.9%). Additional barriers reported were popular beliefs, socioeconomic vulnerability, side effects, self-medication, dementia, and alcohol use. Most professionals attributed non-adherence to a combination of intentional and unintentional causes, such as perceived “cure” due to asymptomatic conditions, cognitive impairment, and shortcomings in comprehensive PHC care. Conclusions: Medication adherence among older adults with NCDs is a multifactorial issue influenced by both social determinants of health and intrinsic aspects of aging. The lack of family support, low education levels, and regimen complexity emerged as central barriers. Strengthening the professional–patient relationship, providing specific training on older adult health, and implementing intersectoral strategies are essential measures to improve clinical outcomes within the scope of Primary Health Care.
Background: 35 years after the IOM report, The Future of Public Health (1988) [1], multiple authors [2,3] have reflected on key lessons in considering what needs to be achieved to build a robust public health system that improves health for all. A central theme is the renewed emphasis on the role of evidence-based policy. A prior study clearly evidenced the importance of policy to achieving better health outcomes [4]. How better health outcomes are influenced by policy within high and low-income states, however, remains elusive.Purpose: The purpose of this study is to assess the validity of state economic indicators as predictors of well-established state health outcomes.Methods: To assess relationships between a state’s economic status and health outcomes, we developed a ranking methodology relying on a matrix of three state economic variables: income inequality, percent of the population in poverty, and median household income. To assess validity of these measures, we calculated a composite Z-score to assess the impact on health outcomes. We ran correlations comparing the twenty-five highest and lowest Economic Index states on each of the health outcomes. Standardized mortality rates are calculated providing additional insight.Results: Findings evidenced that state economic variables correlated highly with five of the six health outcomes. For each indicator, states with higher (better) Economic Index scores had better health outcomes (other than age-adjusted prevalence of any disability). The question of “What if we were equal?” asked in earlier research focused on race and health [5] also has relevance in terms of socioeconomic status on health.
This paper focuses on the interplay between behavioral risk factors, social and demographic indicators, age, and restricted access to health care education and services. According to the 2020 Sexually Transmitted Disease Surveillance Report by the Centers for Disease Control and Prevention (CDC), sexually transmitted infections (STIs) and sexually transmitted diseases (STDs) remain among the most pressing global health challenges.The compilation of these data points juxtaposed the age of higher infection (youth ages 14 - 24) focuses on sexual health services and education as a priority for student wellness [1]. In previous writing, Williams’[2] research suggests that successful aspects of sexual health education for today’s students should include: required wellness programming, well-rounded topics that are on the continuum of wellness (to include sexual health education), current in delivery and information, and culturally competent messaging. As more first generation students enter higher education institutions, prioritizing sexual health services and education within broader wellness programs for college students will enhance lifelong outcomes.
Recent trends in U.S. public opinion regarding COVID-19 vaccination reveal an evolving landscape of vaccine acceptance, hesitancy, and booster uptake. Drawing on the latest national surveys and peer-reviewed studies, the analysis integrates four key communication theories—Uses and Gratifications, Diffusion Theory, Spiral of Silence, and Situational Theory—to interpret how media use, information diffusion, social pressures, and situational factors influence vaccine attitudes and behaviors. Current data highlight persistent demographic and regional disparities, the impact of misinformation, and the importance of trust in public health institutions. The effectiveness and safety profiles of the latest COVID-19 boosters are compared to earlier vaccines, demonstrating the ongoing need for targeted outreach and adaptive communication strategies. Regional case studies and a set of future recommendations illustrate how tailored messaging and community partnerships can address persistent gaps and support equitable vaccine uptake across diverse U.S. populations.
Endocrine-disrupting chemicals (EDCs) are pervasive in consumer products, including plastics and personal care items. Phthalates, as a major subclass of EDCs, are especially concerning due to their widespread use and potential for adverse health effects. This paper examines the impacts of phthalates and other EDCs on developmental, reproductive, and neurological health. Epidemiological evidence is reviewed, highlighting heightened risks for vulnerable populations such as women and children. The analysis explores regulatory responses and public advocacy efforts, identifying both successes and ongoing challenges in minimizing exposure. Economic implications and the historical context of regulation are discussed, underscoring the complex interplay between public health, industry interests, and policy. The paper concludes by emphasizing the critical role of public advocacy in driving regulatory change and promoting safer alternatives. Recommendations are provided for future research, policy development, and community engagement to reduce risks associated with EDCs.
