Digital Commons Network^™

Prescription Drug Abuse And Provider-Patient Communication: A Qualitative Analysis Of The Perspectives Of Prescribers And Patients, Stephanie M. Mathis

Electronic Theses and Dissertations

Prescription drug abuse is a public health problem of epidemic proportions in the United States. Provider-patient communication underpins many initiatives aimed at preventing and reducing the public health burden of prescription drug abuse. The characteristics of and factors contributing to this interpersonal process, however, have not been fully explored.

The purpose of this research was to examine: 1) the overall problem of prescription drug abuse and provider-patient communication about prescription drug abuse from the patient perspective; and 2) provider-patient communication about prescription drug abuse from the prescriber perspective. In 2014-2015, semi-structured interviews were conducted with 20 patients from primary care …

Access To Healthy Foods: A Descriptive Analysis Of Farmers’ Markets, Food Deserts & Usda Food Assistance Programs In Tennessee Census Tracts, Twanda D. Wadlington

Electronic Theses and Dissertations

Food deserts are a growing problem in the United States, and occur in areas of low-income where people have limited access to healthy foods. In response, the presence of farmers’ markets has grown exponentially, and improved healthy food access. Additionally, the USDA has strived to connect families to healthy foods through food assistance programs such as the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the Senior Farmers’ Market Nutrition Program (SFMNP). This study investigated the relationship between farmers’ markets, their acceptance of food assistance benefits, and their locations within Tennessee …

The Effects Of A Supermarket Tour On Improvement Of Nutrition Knowledge And Eating Behavior, Elizabeth Hall

Electronic Theses and Dissertations

The purpose of this study was to determine if participation in a supermarket tour improves nutrition knowledge and eating behavior in adult participants. Participants were recruited in communities surrounding Food City stores, a local supermarket. Prior to completing a standardized tour, participants completed a survey to assess nutrition knowledge and eating behavior. This survey was given to participants again three months later. A program evaluation was given one time at the end of the tour. Data analysis revealed no significant findings, other than the behavior-based question: “How many meals or snacks on most days included vegetables”. Vegetable consumption appeared to …

Effect Of Total Body Iron On Metabolic Dysfunction Among U.S. Females In The Nhanes 2003-2010, Aged 12-49., Joseph Michael Carhart

Electronic Theses and Dissertations

Experimental and epidemiological studies have reported positive associations between iron parameters and metabolic dysfunction including: Type 2 diabetes mellitus (T2DM) (1-6), metabolic syndrome (7-15), non-alcoholic fatty liver disease (NAFLD) (16-22) and insulin resistance (23,24) with a number of studies showing that reductions in total body iron via dietary modification (e.g., reducing red meat intake) or phlebotomy lead to increases in insulin sensitivity (25), decreases in insulin resistance (26), and reductions in the prevalence of complications associated with T2DM (5, 27), metabolic syndrome (28) and NAFLD (22, 29). Moreover, the risk associated with these outcomes and total body iron differ between …

Moving Mountains : A Study Examining Long-Term Impacts Of Mountaintop Removal Coal Mining On Mortality In The Appalachian Region Using Geographic Information Sciences Techniques., James Howard Kent Pugh

Electronic Theses and Dissertations

Over the last hundred years, the Appalachian region has been dominated by the coal industry. It has also been and currently is one of the unhealthiest regions in the United States. Recent scholarship has examined the relationship between coal mining and health and mortality rates in the Appalachian region. The first study incorporates air quality and pollution data to examine if coal mining counties have higher levels of pollution and if this pollution contributes to mortality disadvantage. In the second study, I construct a population-based coal-exposure measure to better evaluate the relationship between coal mining and health I find that …

Social-Ecological Factors Affecting Patient Shield Use Among Radiologic And Computed Tomography Technologists, Megan Housenick-Lee

Electronic Theses and Dissertations

Medical radiation is estimated to contribute to over 200,000 deaths annually. Recent increases in the use of radiation-producing medical imaging examinations have led to increasing cumulative radiation dose to the general public. Multiple measures have been taken to address this alarming trend, including physician education, technologist education on dose reduction, and equipment-facilitated dose reduction techniques. Shield use can reduce the primary beam by up to 95%. Medical imaging technologists are the primary individuals responsible for applying shielding during an examination. Currently, literature shows that technologists are not shielding individuals as often as they should.

After pilot testing, medical imaging technologists …

Evaluating Work Place Wellness In Greater Louisville's Technology Organizations : A Case Study., Andrew L. Mccart

Electronic Theses and Dissertations

Employers in the Southern Indiana and Greater Louisville region are looking for strategies to help them become a healthier workplace. Many employers see the expense of paying for an unhealthy workforce and they are looking to limit these expenses. The purpose of the study is to determine the state of workplace wellness activities in organizations in Southern Indiana and Greater Louisville. Due to the poor health statuses of Indiana and Kentucky, 39th and 45th, respectively, this study is significant for a number of stakeholders in our area. The purpose of this case study was to understand the state of health …

Prospective Studies Of Cardiovascular Risk Factors And Mild Cognitive Impairment, Kevin Sullivan

Electronic Theses and Dissertations

The association of cardiovascular risk factors including hypertension, diabetes, cholesterol, kidney function, and arterial stiffness with cognitive impairment in older adults is a well-studied phenomenon. However, there is considerably less evidence relating cardiovascular health specifically to a diagnosis of Mild Cognitive Impairment (MCI). As a precursor state of dementia, MCI is characterized by a decline in cognitive function from previous level, but not to the degree that activities of daily living are impaired. Not everyone who is diagnosed with MCI will eventually transition to dementia, but the transition rates are much higher compared to the general population (5-15% per year …

Merging Cultures: Organizational Behavior, Leadership, And Differentiation In A Health System Merger, Colin G. Chesley

Electronic Theses and Dissertations

Health system mergers and acquisitions (M&As) have increased exponentially in recent years as a result of the Affordable Care Act (Brown, Werling, Walker, Burgdorfer & Shields, 2012). M&As are consummated as a way to control for interdependencies within the market, control costs and leverage debt, and negotiate better rates among health insurers (Bolman & Deal, 2013; Cooper & Finkelstein, 2010; Mirc, 2013). Regardless of the impetus for a merger, the largest predictor of the success or failure of a M&A lies within the organizational culture (Brown, et al., 2012; Cooper & Finkelstein, 2010; Kastor, 2010; Ovseiko, Melham, Fowler & Buchan, …

Coal Ash Exposure And Asthma In Children., Jack Anthony Pfeiffer

Electronic Theses and Dissertations

This study examined the association between exposure to coal ash in the home among children aged 6-14 and asthma. Data was collected using personal modular impactors, lift tape samples, toe/finger nail samples, questionnaires, and peak flow meters. Laboratory methods used to analyze the samples included gravimetric analysis, scanning electron microscopy (SEM) / energy dispersive x-ray (EDX), and proton-induced x-ray emission (PIXE). Statistical methods used to analyze the data included the Chi Square Test of Independence, logistic regression, the Hosmer-Lemeshow Goodness of Fit test, Fisher’s Exact Test, and the Anderson-Darling Normality Test. Sample size was small, making statistical significance in calculated …

Attending To Systemic Racism : Advancing Public Health's Approach To Youth Violence Prevention., Billie Faith Castle

Electronic Theses and Dissertations

This dissertation examines how the field of public health addresses the impact of systemic racism on health and how that informs public health’s approach to youth violence prevention. Beginning with an overview of youth violence, it breaks down the concepts of race and racism and how they are addressed within the science. It also reviews concepts that contribute to risk and protective factors of youth violence. The dissertation is written from a Critical Race Theory approach, argues that the social environment contributes to why youth violence is pervasive in certain neighborhoods, and promotes action from a macro-level approach. Seven chapters …

Relationships Of Weight-Related Dissatisfaction, Body Image Flexibility, And Coping In Women, Pooja Shah

Electronic Theses and Dissertations

Purpose: The present study examined the relationships between body image flexibility, body image dissatisfaction, body image evaluation, and specific coping factors based on the WEIGHTCOPE measure. Body image flexibility was also examined as a mediator of the relationship between body image dissatisfaction and weight-related coping factors in women. Methods: An online link of the survey (Qualtrics Research Software Program) was distributed through social media and word of mouth to women of all body shapes and sizes (N= 267). The survey included the BICS as a measure of body image dissatisfaction, the MBSR (AE) as a measure of body …

Therapy Dogs And The Impact On Employees In The Pediatric Medical Setting, Laine Foith

Electronic Theses and Dissertations

More than 40% of nurses reported experiencing significant burnout. Burnout is characterized by disengagement, cynicism, negative views of personal accomplishment and ability, and emotional exhaustion. The healthcare providers that experience burnout can possibly expect a decrease in ability to recognize/report errors, increase of negative feelings toward the patient, and decrease levels of patient satisfaction (Ernest, 2014). One of the ways Schub (2015) suggested to regulate burnout for employees was to provide psychosocial support to colleagues to reduce stress. This study is one of the first attempts to bridge the gap between the unknown correlation between qualitative and quantitative benefits of …

Case Study: Healthy Texas Women Program In The Abilene-Taylor County Public Health District, Saul Francisco Delgado

Electronic Theses and Dissertations

The public healthcare system faces continuous transformations and challenges of constant adjustments to the increasing usage of fee for service revenue and the decrease of federal investment to women’s healthcare services and to the safety net healthcare providers (Meit, 2013; Weisman, 1997).

In 2016, the Texas 84^th Legislation Session determined to consolidate two existing women’s healthcare service programs into one a single program: the Healthy Texas Women (HTW) program. The new women’s program is a preventative care program that provides services of family planning and chronic illness care under a complete fee for service reimbursement system as its sourse …

An Epidemiological Study Of Obesity Among Asian Americans In California, United States, Shaoqing Gong

Electronic Theses and Dissertations

Obesity has reached epidemic levels in the United States (U.S.). Despite an increasing number of studies on obesity, a very few have addressed this debilitating condition among Asian American adults. The overall objective of this study is to utilize the latest cycles of the California Health Interview Survey (CHIS) to better understand obesity and identify its correlates among Asian Americans. The study population comprised Asian American adults aged 18 years or older from the CHIS with data pooled from the 2013 and 2014 survey years. Obesity (≥27.5 kg/m²) was defined using the World Health Organization (WHO) Asian body …

Reducing Tobacco-Related Health Disparities : Exploring The Barriers And Facilitators To Smoking Cessation Among Individuals Experiencing Homelessness., Bernadette Guzman Antoon

Electronic Theses and Dissertations

Although the prevalence of smoking has declined in the U.S., vulnerable populations continue to suffer from tobacco-related health disparities. An estimated 68.0-80.0% of homeless adults are current cigarette smokers compared to 15.1% in the general population. The large gap in smoking rates suggests that current tobacco cessation programs designed to reduce smoking have little impact among individuals experiencing homelessness. The purpose of this study was to explore the barriers and facilitators to smoking cessation among the homeless. The second aim of this study was to explore if the barriers and facilitators to tobacco cessation differed among male smokers experiencing homelessness …

An Investigation Of The Relationship Between Child, Family, And Community Factors And Early Childhood Oral Health And The Utilization Of Dental Health Services, Nicole Holt

Electronic Theses and Dissertations

Background / Objective: Children under the age of 5 years bear a disproportionate burden of oral disease. The aim of this study is to investigate how child, family, and community determinants impact dental care utilization, and parental report of child’s oral health. Methods: Data for this study came from the 2011/2012 National Survey of Children’s Health for children aged 1 to 5 years old. Dependent variables evaluated were if the child had an oral health problem, been to a dentist in the past year, and parents description of the child’s teeth. Independent variables were selected from child, family, and community …

Assessment Of Social, Dietary And Biochemical Correlates Of Cardiometabolic Risk In Pre-Adolescent Hispanic Children, Abraham Basil Alhassan

Electronic Theses and Dissertations

Obesity, elevated blood pressure and dyslipidemia are highly prevalent in Hispanic children. Compared to their non-Hispanic White peers, Hispanic children experience higher prevalence of obesity and hypertension. The Hispanic population in Tennessee has been growing, with about a tenth of newborn babies being Hispanic. This study aimed to: 1. Examine the influence of sociodemographic factors on Hispanic children’s cardiometabolic risk; 2. Assess the relationship between food group intake and cardiometabolic risk in Hispanic children; and 3. Evaluate the efficacy of non-traditional biomarkers for detecting cardiometabolic risk in Hispanic children. Data for the study came from a larger cross-sectional pilot study …

The Increasing Risk Of Vector-Borne Diseases: Mapping The Effects Of Climate Change And Human Population Density On Future Aedes Aegypti Habitats, Julie Obenauer

Electronic Theses and Dissertations

The Aedes aegypti mosquito is the vector for four infectious diseases of global concern – Yellow Fever, Dengue, Chikungunya, and Zikavirus. Previous attempts to model the expansion of the vector habitat due to global climate change have rarely included characteristics related to the human populations on which this mosquito is dependent. The purpose of this research was to determine whether the inclusion of human population density improves model performance while creating risk maps that can be used to determine where humans are most likely to be exposed to the vector in the future. The resulting model demonstrated that the inclusion …

Phenomenological Study Of The Lived Experiences Of Appalachian Spouses Of Combat Veterans With Post Traumatic Stress Disorder, Janice E. Greene

Electronic Theses and Dissertations

This study was conducted to identify gaps in existing knowledge regarding impacts of combat-related PTSD on the spouse and to gain an understanding of the lived experience of Appalachian Spouses of combat veterans with PTSD. A systematic literature review was conducted to identify research and findings on the impacts of combat-related PTSD on spouses of veterans and a qualitative study was conducted to gain an understanding of the lives of Appalachian spouses of combat veterans with PTSD.

The systematic review identified 16 qualitative studies conducted between 1988 and 2016 in five countries spanning five wars. Regardless of the country of …

Correlates Of Human Papillomavirus (Hpv) Vaccine Acceptance In Appalachian Tennessee, Oluwatosin Ariyo

Electronic Theses and Dissertations

Human papillomavirus (HPV) is the most prevalent sexually transmitted infection in the U.S., where one HPV-related cancer is diagnosed every 20 minutes. The most common HPV-related cancer is cervical cancer, with an estimated incidence of 12,000 cases annually, a third of which lead to death. Cervical cancer disparately affects women of ethnic minority groups and geographically isolated regions, such as Appalachia. Tennessee ranks third highest in cervical cancer incidence in the country. Many cases of cervical cancer could be prevented through vaccination against HPV, however, vaccination rates for females in Tennessee are among the lowest in the country. This mixed-methods …

Prenatal Depression Screening Among A Diverse Healthy Start Population., Evangeline Pierce

Electronic Theses and Dissertations

Prenatal depression has been associated with adverse outcomes for both pregnant women and infants. Data was studied from Healthy Start (n=1093). Healthy Start participants were screened for depression using the Edinburgh Postnatal Depression Scale (EPDS) during pregnancy. Data reported included birthweight, gestational length, ethnicity, and sociodemographic variables. No statistically significant association was found between a positive EPDS screen and birthweight-low/normal (OR 1.02 [95% CI 0.53, 1.70]), birthweight-abnormal (OR 1.02 [95% CI 0.53, 1.70], or gestation-preterm/term (OR 1.29 [95% CI 0.68, 2.45]). An association was observed between a positive screen and race, ethnicity by region of origin, immigrant status, English as …

The Effect Of Caffeine On Fecundability : Differences In Coffee, Tea, And Cola Consumption., Emily Kathleen Steinmetz

Electronic Theses and Dissertations

This study examined whether intake of caffeinated beverages (coffee, tea, and cola) was associated with fecundability (time to pregnancy) in a prospective cohort study. Data from 470 women from the Mount Sinai Study of Women Office Workers (1990-1994) were analyzed. Intake of coffee, tea, cola, and other variables were recorded in daily diaries and calculated as menstrual cycle level means for up to 20 cycles. Pregnancy was assayed using hCG and confirmed by physician diagnosis. The associations of caffeinated beverages with the probability of becoming pregnant during a given cycle were determined using discrete survival analysis, adjusted for potential confounders. …

The Particulars About Particulates : Metal Exposure And Self-Regulation Of Children Living Near Coal Ash., Clara G. Sears

Electronic Theses and Dissertations

The use of coal combustion for electricity and the storage of coal combustion by-products known as coal ash occur across the United States and around the world. The most abundant type of coal ash, fly ash, contains small particles with metals, some of which are known neurotoxins. Fly ash is currently stored in open-air landfills and surface impoundments that allow fugitive dust to escape into surrounding communities, potentially exposing children to small neurotoxic particles. This dissertation uses preliminary data from a larger cross-sectional study to investigate the relationship between particulate matter exposure, metal exposure, and problems with self-regulation. Recruitment of …

Evaluating The Impact Of Statewide Policy Implementation On Interorganizational Collaboration At The Regional Level : An Application Of Network Analysis., Nida Moez Ali

Electronic Theses and Dissertations

One challenge to improving population health in the United States is that the systems tasked with the responsibility of providing services across the continuum of care often operate in silos, missing opportunities to provide quality, coordinated care. In 2011, Texas received approval from the Centers for Medicare and Medicaid Services (CMS) for a five-year 1115(a) Medicaid Waiver Demonstration Project. This dissertation focuses on one element of the Waiver, the Delivery System Reform Incentive Payment (DSRIP) Program, which was designed to incentivize activities that support organizations’ collaborative efforts with other organizations in addressing the Triple Aim strategies. DSRIP was implemented through …

Pediatric Anxiety And/Or Depression Problems : Associations With Pm10, Fly Ash, And Metal Exposure., Abby Nicole Burns Hagemeyer

Electronic Theses and Dissertations

Background: In the last several decades, the use of coal has become more prevalent in turn increasing the amount of coal ash being produced. Coal ash, the by-product of coal combustion, is composed of small particles that contain essential elements, hazardous metals, polycyclic aromatic hydrocarbons, and radioactive material. While a small proportion of coal ash is reused, the majority gets discarded in open-air landfills and ash ponds. Fly ash, the major component of coal ash, can become emitted into the air and potentially contribute to the air pollution and metal exposure in the surrounding community. Few studies, particularly in the …

Colorectal Cancer Fit Screening In The Hope Vi Population Of Jefferson County, Kentucky., Jeffrey D. Stone

Electronic Theses and Dissertations

Using pre-post survey data collected from 209 randomly selected African American people from the population of former residents of Clarksdale and Sheppard Square public housing areas, this study explores the relationship between individual characteristics and colorectal cancer screening behavior, measured by the uptake of the Fecal Immunochemical Test (FIT) and by prior colorectal screening, while controlling for neighborhood factors and geographic proximity to healthcare facilities. This particular public housing population is of interest because of their relocation from the downtown area, where healthcare facilities are within walking distances, to other public housing units either in large apartment complexes or scattered …

Factors Influencing Hypoglycemia Care Utilization And Outcomes Among Adult Diabetic Patients Admitted To Hospitals: A Predictive Model, Waleed Kattan

Electronic Theses and Dissertations

Diabetes Miletus (DM) is one of the major health problems in the United States. Despite all efforts made to combat this disease, its incidence and prevalence are steadily increasing. One of the common and serious side effects of treatment among people with diabetes is hypoglycemia (HG), where the level of blood glucose falls below the optimum level. Episodes of HG vary in their severity. Nevertheless, many require medical assistance and are usually associated with higher utilization of healthcare resources such as frequent emergency department visits and physician visits. Additionally, patients who experience HG frequently have poor outcomes such as higher …

Burden Of Illness And Pharmacoeconomic Evaluation Of Lumacaftor/Ivacaftor In Cystic Fibrosis, Pratyusha Vadagam

Electronic Theses and Dissertations

Objectives: (1) To estimate the burden of illness in cystic fibrosis (CF) using 2010-2014 Medical Expenditure Panel Survey (MEPS) data, and (2) to conduct a pharmacoeconomic evaluation of lumacaftor/ivacaftor in the treatment of CF.

Methods: The study was conducted in two parts. Part 1 involved a retrospective analysis using individuals in MEPS database with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code of 277.00 for a principal diagnosis of CF. Dependent variables were cumulative and out-of-pocket (OOP) expenditures and independent variables included patient demographics and clinical characteristics. Unweighted and weighted estimates of expenditure in CF group, …

Mammography Utilization In African American Women, April D. Kidd

Electronic Theses and Dissertations

Purpose: Breast cancer presents differently among women causing breast cancer health disparities with women of color disproportionally shouldering later-stage screening, incidence, and treatment, and greater mortality. This study assessed 10 predictors and rates of recent and long-term mammography utilization for women 43-79 years of age to better understand differences among age strata and races. This was the first study to use both the calculated Gail Risk scores (calculates absolute breast cancer risk over time intervals) from the 2010 National Health Interview Survey (NHIS) and a temporary homelessness variable in predicting mammography utilization using national-level data.

Theoretical Framework: A modified Behavioral …