Zachary Giano

• Doctor of Philosophy
• University of Colorado

Purpose: The study sought to identify differences in use of elective induction of labor (IOL) post-ARRIVE trial, by race and ethnicity, and contributions of multilevel contextual factors to induction use. Background: Racial disparities in birth outcomes have been attributed to community and provider (ie, multilevel contextual) factors. The varie...

Objective Functional seizures (FS) are a highly debilitating symptom of functional neurological disorder (FND). FS requires a multi-disciplinary approach to treatment because the patient’s initial presentation is to neurology, emergency medicine, or primary care and treatment consists of psychotherapy. People with FS commonly experience severe chil...

Introduction This study conducted a comparative analysis between two large data repositories, the All of Us (AoU) medical data and BigMouth dental data repositories. Methods The comparison analysis includes variables related to behavioral and systemic health, health literacy, and overall health status across race, ethnicity, and gender. The analyt...

Objectives: This study examines sexual orientation/gender identity (SOGI) data collection in older adults from the UCHealth systems electronic health record. Methods: Data of older adults aged 55 and older were analyzed between January 2019 and December 2022. Prevalence of SOGI documentation based on four new SOGI-related questions were analyzed...

Violence across Latin America is an increasingly important factor influencing migration to the US. A particular form of violence that is experienced by many Latinx migrants is extortion. This research analyzes the extortion experiences of Latinx immigrant adults arriving at the US southern border and the impact these experiences have on mental heal...

With increasing violence, political, and economic instability in Latin America, there is a record number of migrants crossing the U.S. southern border. Latin American migrants are often exposed to traumatic events before leaving their home country and during migration. While prior studies document that sex may play a role in types of traumatic expo...

Purpose The purpose of the study was to investigate the relationship between state regulation of the midwifery workforce, practice environment, and burnout. Background Burnout threatens the US midwifery workforce, with over 40% of certified nurse-midwives meeting criteria. Burnout can lead to poorer physical and mental health and withdrawal from t...

Diversification of the midwifery workforce is key to addressing disparities in maternal health in the United States. Midwives who feel supported in their practice environments report less burnout and turnover; therefore, creating positive practice environments for midwives of color is an essential component of growing and retaining midwives of colo...

Introduction: . To address the ongoing opioid crisis, states use policy enactment to restrict prescribing by licensed health care providers, and mandate use of Prescription Drug Monitoring Programs (PDMP). There have been mixed results regarding the effectiveness of such state policies. The purpose of this study is to evaluate the impact of Colora...

Background: Modern research suggests that the racial influence on smoking and drinking behaviors may not be as prevalent as once thought. This study utilizes national survey data to compare binge drinking and commercial cigarette smoking behaviors between American Indians/Alaskan Natives (AI/AN) and non-Hispanic Whites in the five most populous AI...

Few studies have examined the role adverse childhood experiences (ACEs) have on specific diet patterns. This study assessed the association between ACEs and daily fruit and vegetable intake (FVI). Data were derived from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) which surveys 50 states and three U.S. territories. Participants who c...

Introduction: This study investigated the intersectionality of adverse childhood experiences (ACEs) among subgroups of sex, race/ethnicity, and sexual orientation. Methods: Using data from the Behavioral Risk Factor Surveillance Survey across 34 states (N=116,712) from 2009 to 2018, authors stratified subgroups of sex (male/female), race/ethnici...

Hispanic adolescents report earlier onset and higher substance use rates than their non-Hispanic White and Black peers. This study examines the associations between the immigration-related arrest of a family member and substance use among Hispanic early adolescents and explores the mediating role of depressive symptoms as the mechanism explaining t...

Background Adverse childhood experiences (ACEs) research has yielded important information regarding ACEs prevalence and impacts; however, few studies have included American Indian/Alaska Native (AI/AN) populations. Objective We aimed to update and expand the ACEs literature by using recent data (2009–2018; over 50% from 2015 to 2017); using a lar...

Introduction: COVID-19 vaccination is widely recommended as a prevention strategy; however, vaccine uptake is disproportionately lower among rural Americans compared to their urban counterparts. Development of public health activities to address the rural-urban vaccine gap requires an understanding of determinants of vaccine hesitation. The present...

In response to the COVID-19 pandemic, large swaths of the U.S. were under stay-at-home orders, thus preventing many individuals from leaving their homes. While previous studies have shown that such orders can be detrimental to mental health, specific mental health outcomes, such as loneliness and anxiety, have yet to be fully explored, particularly...

Background The study of adverse childhood experiences (ACEs) has shown deleterious effects throughout adulthood. Little attention, however, is given to specific ACE domains as they relate to mental health outcomes, as most studies use cumulative ACE score models. Objective The current study disaggregates ACEs domains to investigate their independe...

Background People who use drugs have been particularly vulnerable during the COVID-19 pandemic because of their unique social, harm reduction, and treatment needs. These unique needs and challenges have significant influence on the severity of their substance use, mental health symptomatology, willingness to engage in treatment, and adherence to tr...

Co-occurring mental health (MH) problems are common among those with opioid use disorders (OUDs). However, most opioid treatment programs (OTPs) do not provide MH services. We measured the association between state level characteristics (Medicaid expansion status and rurality) and MH/OUD services integration. We used a generalized linear model to e...

Background: Adverse Childhood Experiences (ACEs) show predictive utility concerning binge drinking. However, the literature is limited by 1. a focus on cumulative ACEs with little regard to specific domains, 2. a focus on those with the highest ACE scores, and 3. little consideration for gender differences. These approaches are problematic as ACE...

Introduction: Face masks are widely recommended as a COVID-19 prevention strategy. State mask mandates have generally reduced the spread of the disease, but decisions to wear a mask depend on many factors. Recent increases in case rates in rural areas following initial outbreaks in more densely populated areas highlight the need to focus on preven...

Few studies have focused on within-group heterogeneity about specific factors that make lesbian, gay, or bisexual (LGB) Latinx adolescents at greater odds than other LGB adolescents for suicide We take a unique mixture-modeling approach by creating profiles of Latinx LGB adolescents based on suicide risk factors used in previous investigations (bul...

Rural men who have sex with men (MSM) experience numerous barriers to healthcare, including stigma, which impedes medical and mental healthcare engagement. Given this, rural MSM are less likely to be engaged in routine healthcare compared to their urban counterparts. Telemedicine has been advocated for to address these disparities in care access; h...

Students who repeat a grade are at a higher risk of dropping out of high school. Previous research has examined this in a methodologically aggregated way (e.g., repeated any grade versus never repeated) or only specific grades/grade ranges (e.g., Kindergarten or elementary) leaving questions about which grades are more detrimental to repeat with re...

Although men who have sex with men (MSM) within rural communities are disproportionately impacted by HIV, limited HIV research and programmatic resources are directed to these communities within the U.S. There is a need for improved behavioral data collection methods to obtain more detailed information on the relationship between rural environments...

Understanding the beliefs about social distancing behaviors is required to inform 2019 coronavirus disease (COVID-19) interventions that are based on theory, research, and evidence. This study investigated the salient beliefs related to social distancing. United States adults (n = 106) recruited from Amazon’s Mechanical Turk completed an online rea...

Background: College students residing in rural areas of the United States have limited access to HIV and STI screening programs; yet, have increased rates of infection. Methods: Students (N=326), attending a state university located within a rural community, completed an online survey containing open-ended questions that gauged their perceptions...

Pre-exposure prophylaxis (PrEP) uptake has been suboptimal despite its demonstrated efficacy in reducing the risk of HIV acquisition. Medical education is one distal determinant that shapes medical providers' perceived role in the PrEP care continuum. However, there is limited understanding of how osteopathic medical students and those wanting to p...

Introduction Gay and bisexual (GB) men report anxiety about rejection based on sexual identity. The impact rejection has on GB men’s mental health was investigated to understand how rejection impacts positive psychological constructs (hope and self-compassion), as well as anxiety, depression, and internalized homophobia. Rurality was also considere...

A growing body of literature suggests that youth with severe obesity are engaging in substance use. The purpose of the present study was to examine profiles of substance use among adolescents with severe obesity and examine how these profiles are associated with depressive symptomology using data from the Youth Risk Behavior Surveillance System. Th...

Despite the national HIV and sexually transmissible infection (STI) rates growing in rural areas, rural populations - particularly men who have sex with men (MSM), have limited access to secondary (i.e., HIV/STI screening) prevention activities compared with their urban counterparts. We conducted semistructured in-depth interviews with 23 rural MSM...

Latino parents have lower levels of school involvement compared to other ethnic groups, which is often attributed—though not tested—to low English language proficiency. Using a population-based sample of 637 7th grade Latino youth attending an urban school district, we find no significant difference in maternal school involvement when mothers and s...

Introduction Adverse childhood experiences are linked to deleterious outcomes in adulthood. Certain populations have been shown to be more vulnerable to adversity in childhood than others. Despite these findings, research in this area lacks an empirical investigation that examines adverse childhood experiences among American Indian and Alaska Nativ...

Trauma, particularly when experienced early in life, but also throughout the life course, has far-reaching and long-lasting negative impacts. There are a host of biological, cognitive, and relational adversities that stem from past traumas and contribute to additional traumatic experiences that accumulate over time. Individuals who are considered “...

Background: Adversity experienced during childhood manifests deleteriously across the lifespan. This study provides updated frequency estimates of ACEs using the most comprehensive and geographically diverse sample to date. Methods: ACEs data were collected via BRFSS (Behavioral Risk Factor Surveillance System). Data from a total of 211,376 adul...

Sexual minority men have been consistently shown to be at-risk for adverse mental health outcomes due to the stresses of being a sexual minority, yet studies show that some of these men successfully navigate these barriers. What is less known are the environmental and social/emotional factors to which minority stress is amplified (or attenuated). W...

Homelessness is a chronic public health issue in the U.S. This paper reviews the endurance and evolution of individual, youth, and family homelessness over the past 40-plus years. Thematic findings detail research on predictors of homelessness among adolescents, runaway youth, veterans, older adults, sheltered families, and female-headed families....

Purpose The purpose of the study was to identify profiles of lesbian, gay, and bisexual (LGB) youth who are at risk for suicidal behavior. Method Data were collected through the Youth Risk Behavior Surveillance System (N = 2,738). We used latent profile analysis to create identity profiles using variables associated with suicide, including bullyin...

Purpose: Men who have sex with men (MSM) face persistent risk of stigma, with past studies showing unequal treatments of MSM in health care settings. Contextual factors, such as internalized homophobia and connectedness to one's community, have shown to serve as a barrier or facilitator (respectively) with regard to MSM's decisions to seek preventa...

Research investigating the health care experiences of men who have sex with men (MSM) predominately concerns urban populations. This study examines the health care experiences of MSM residing in rural Oklahoma. A total of 40 MSM (aged 21 through 66) living in rural areas were interviewed. Data were analyzed using a qualitative approach to identify...

Teacher expectations of students have been consistently linked with student academic achievement. What is less known is how students’ actual behaviors and performance shape teachers’ perceptions of them, particularly when considering student gender and race/ethnicity. A diverse dyadic sample of 1,653 seventh graders with 63 reporting teachers was u...

PURPOSE: While research has documented the healthcare experiences of men who have sex with men (MSM), studies have predominately featured urban populations, leaving rural MSM underrepresented in the research. Because the landscape of healthcare is different in urban versus rural areas (particularly in LGBT health), this study seeks to examine the h...

Objective: The aim of this study was to identify lifestyle profiles of young adult males and females based on their alcohol, diet, and exercise behaviors and then link these profiles with health. Method: We used the nationally representative 2017 Behavioral Risk Factor Surveillance System (BRFSS; N = 17,286; 47% female; Mage = 23.22; SD = 3.16; 65%...

Previous models of sexual minority orientation identity development have theorized disclosure of current orientation as important in accepting one’s sexual minority identity. Furthermore, research into disclosure of sexual orientation highlights positive outcomes for disclosure and negative outcomes for concealment of sexual minority identity. Thes...

Although research has documented that technological advances via online avenues have impacted the way LGBT individuals gain social capital, less is known about how these online experiences influence the coming out processes for gay men. Using a qualitative approach, this study seeks to understand how the online experiences of gay men either enhance...

Objectives: Experiencing an immigration-related arrest of a family member adversely impacts youth well-being, yet the role of parental documentation status for exacerbating adverse mental health outcomes following these arrests has not been investigated. Method: Using a general population sample of Latino 7th-grade students in an urban public schoo...

Background: Research shows individuals experiencing adverse childhood experiences (ACEs) as well as identifying as a man who has sex with other men (MSM) are at an increased risk for mental health issues. Less has been studied, however, on ACEs in MSM; with even fewer studies investigating non-urban (e.g., rural/small town/suburban) MSM, as most r...

Public health literature often neglects populations from rural communities, particularly with men who have sex with men (MSM). Although HIV/STI infections are decreasing slightly, there is an increase within rural MSM, thus opening the door for further research on condom use behavior in a rural context. In-depth interviews were conducted with 40 MS...

Purpose: The unique experiences of men who have sex with men (MSM) residing in culturally conservative rural areas are not well represented in the scientific literature. The human immunodeficiency virus (HIV) epidemic in the United States has shifted toward rural areas where populations are dispersed and health care resources are limited. Methods:...

Rural men who have sex with men (MSM) are particularly vulnerable to HIV/STI infections, though most outreach efforts to reach MSM have been focused on urban populations. More attention is needed to study effective ways of reaching/recruiting rural MSM, yet little is known about their preferences; particularly as studies show significant difference...

Given the dearth of research exploring mental health differences between rural and urban men who have sex with men (MSM), we sought to examine differences in depressive symptomology and loneliness. Concurrently we examined the mediating effects of loneliness on the link between geographic locale and depressive symptoms via a mediation model. Data w...

Background Past research identified individuals who experienced adverse childhood experiences (ACEs) are at a higher risk of drug use. There is evidence to suggest that identifying as a man who has sex with other men (MSM) may increase the likelihood of drug use when adverse childhood experiences are prevalent. However, research has not addressed i...

Previous research indicates a positive link between youth runaway episodes and the likelihood of homelessness in later adolescence and early adulthood. An adolescent's decision to run away from home often accompanies depressive symptomology compared with stably housed youth. The present study used a large, nationally representative sample of 8,560...

Using a population-based sample of 1,311 seventh graders in an urban school district in the South Central United States, we examined the associations between early-life trauma, anger regulation, and early adolescent perceptions about sex and parenthood. Girls and boys with more trauma exposure were more likely to perceive adolescent parenthood as i...

Purpose The purpose of this paper is to explore the relationship between persistently sleeping away from the home as a predictor of adolescent delinquency in a largely Latino sample of 91 adolescents. Design/methodology/approach This study employs multiple linear regressions to examine the relationship between sleeping away from the home (IV) an...

The nature of police work includes toxic work environments and uncertain danger which imparts a unique type of occupational stress spillover or the transfer of stress from work life to home life for law enforcement officers. Work stress places officers at risk for negative health and psychosocial outcomes. While it has been shown that occupational...

Research suggests that Latino adolescents face challenges with respect to their perceptions of success in academia while falling behind in school competencies. This study examines pathways between parent characteristics, adolescent perceptions of parental academic importance, school connectedness, and academic aspirations/expectations for Latinos u...

Many Latino youth are U.S. citizens but live with parents whose immigration status is unauthorized. The association between parental documentation status and early adolescent academic attitudes and expectations is unclear. Using a general population sample of urban 7th grade students who self-identified as Latino in the South Central U.S. (n = 514)...