Date of Award

8-2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Applied Health Research and Evaluation

Committee Chair/Advisor

Rennert Lior

Committee Member

Moonseong Heo

Committee Member

Witrick Brian

Committee Member

Amanda Stover

Abstract

ABSTRACT

Background

The opioid crisis remains a critical public health challenge in the United States. Mobile Health Clinics (MHCs) have emerged as a promising solution to bridge healthcare access gaps for these vulnerable populations, particularly for PWID and individuals with OUD in underserved and rural communities. Despite their potential, geographic disparities in MHC access and knowledge gaps in opioid overdose management and related diseases, including Hepatitis C Virus (HCV), remain significant barriers to care. This dissertation addresses three key dimensions of healthcare delivery for PWID, OUD populations, and college students: (1) barriers to MHC utilization for HCV screening and treatment among PWID and individuals with OUD, (2) spatial disparities in MHC access across geographic regions, and (3) knowledge, competence, and barriers in opioid overdose management among college students.

Methods

The study utilized a mixed-methods approach across three manuscripts:

  • Manuscript 1 examined individual and community-level barriers influencing MHC utilization for HCV screening and treatment among PWID and individuals with OUD, using negative binomial and logistic regression models to identify key predictors.
  • Manuscript 2 explored geographic disparities in MHC access among PWID/OUD populations, employing Geographic Information Systems (GIS) for spatial analysis to identify travel burdens and service hotspots.
  • Manuscript 3 assessed knowledge, competence, and barriers in opioid overdose management among college students using the Opioid Overdose Knowledge Scale (OOKS) and Opioid Overdose Attitudes Scale (OOAS), complemented by thematic analysis of qualitative responses.

Results

Findings from Manuscript 1 revealed that uninsured PWID/OUD populations are significantly more likely to utilize MHC services for HCV screening, with community-level poverty and rurality further predicting utilization. Manuscript 2 highlighted substantial spatial disparities, with PWID/OUD populations traveling greater distances for MHC access, indicating the need for spatially informed deployment strategies. Manuscript 3 identified critical gaps in overdose preparedness among college students, with naloxone training emerging as the strongest predictor of competence and readiness to act during an overdose.

Conclusion

This dissertation demonstrates the importance of MHC optimization, spatially informed deployment, and overdose preparedness in enhancing healthcare access for vulnerable populations. Policy recommendations include expanding MHC services to underserved areas, leveraging GIS for route optimization, and integrating naloxone training into campus health programs. Addressing these dimensions through data-driven public health strategies is essential to mitigating the opioid crisis and improving health outcomes for PWID, OUD populations, and college communities.

Author ORCID Identifier

0000-0001-6463-4094

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