Digital Commons Network^™

The State Of Health In Tennessee, 2025 Annual Report To The 114th Tennessee General Assembly, Tennessee. Department Of Health.

State of Health in Tennessee

No abstract provided.

Associations Between County-Level E-Cigarette-Inclusive Tobacco 21 Law Population Coverage And E-Cigarette Use Behaviors Among United States Adolescents In Monitoring The Future, James H. Buszkiewicz, Catherine A. Vander Woude, Yanmei Xie, Steven Cook, Bukola Usidame, Megan E. Patrick, Michael R. Elliott, James F. Thrasher, Nancy L. Fleischer

Department of Health and Kinesiology Faculty Publications

Background and aims

In the United States (US), Tobacco 21 (T21) laws set the minimum legal sale age for all tobacco products to 21 years. This study aimed to examine whether e-cigarette-inclusive T21 laws were associated with e-cigarette use behaviors and related disparities among US adolescents.

Design

We used nationally representative, repeated cross-sectional Monitoring the Future data to compare self-reported current e-cigarette use (2014–2022) and first e-cigarette initiation (2015–2022) among adolescents in counties with 100% ('full') versus < 100% ('partial or no') e-cigarette-inclusive T21 law population coverage using modified Poisson regression, examining differences by sex, race and ethnicity, parental educational attainment and college educational expectations through interactions.

Setting

United States.

Participants

8th, 10th and 12th graders.

Measurements

County-level e-cigarette-inclusive T21 law population coverage was determined using Tobacco 21 Population Coverage …

2025 December 4 - From My Notepads Newsletter, Office Of The President, East Tennessee State University, Brian Noland

From My Notepads: A Newsletter from President Brian Noland

No abstract provided.

Addressing Injustices Toward Individuals With Schizophrenia-Spectrum Conditions: A Call To Action For Social Work Practice, Shannon M. Blajeski, Lindsay A. Bornheimer, Jessica A. Wojtalik, Lynette Studer, Shelly Ben-David, Patricia R. Turner, Ana T. Flores, Matthew J. Smith, Nev Jones, Jordan E. Devylder

School of Social Work Faculty Publications and Presentations

The field of social work has a lengthy history of training social workers for community mental health settings, and an ethical commitment to advance human rights and social justice. However, individuals with schizophrenia-spectrum conditions continue to suffer from myriad social injustices, including poverty, social isolation, and lower-life expectancy. This paper outlines these injustices, and reviews historical social work contributions and current training for supporting this population. Finally, the authors outline actions to 1) adopt national practice guidelines that formally acknowledge injustices, including anti-oppressive practice guidelines that are inclusive of lived experience, and 2) revitalize social work’s contributions to models of …

The Divided Self: Gothic Duality In Literature, Sarah Anna Meeks

Masters Theses

Gothic literature of the nineteenth century is haunting due to its frequent use of ghosts and monsters. However, the true terror lies in a deeper horror, one that is more intimate and destabilizing– a fright that leaps out of the text, looking into the heart of the reader: the fractured mind of the self torn between reality and repression, haunted by its own, newly manifested internal disunity rather than external monsters. The characters of Gothic fiction are typically caught in a psychological turmoil. They battle with split morals between duty and desire, morality and madness, and science and spirituality. Specifically, …

The Differential Effects Of Fast Walking Speed On Muscle Coactivation In The Paretic And Non-Paretic Extremities Post-Stroke, Natalia Sánchez, Andrian Kuch, Samantha N. Jeffcoat, Andrew Hooyman, Aria Haver-Hill, Christina K. Holl, Kristan A. Leech

Physical Therapy Faculty Articles and Research

Background:

Clinical practice guidelines for walking recovery post-stroke recommend high aerobic intensity training, which usually involves walking at fast speeds. However, the acute effect of fast speeds on the neuromuscular control of walking is unclear.

Objectives:

(1) Assess the criterion validity of the Dynamic Motor Control Index (WalkDMC) as a measure of coactivation post-stroke. (2) Assess acute speed-dependent coactivation post-stroke. (3) Assess how clinical characteristics shape the speed-dependent coactivation response. (4) Assess the relationship between heart rate and coactivation post-stroke. We hypothesized that WalkDMC is correlated with function and impairment measures. We also hypothesize that coactivation measured via the WalkDMC …

Primary Care Provider Communication Barriers With College-Aged Students, Mckenna Mahakian, Sharon Schaeffer, Rachel Immel

Honors Projects

As both a researcher and a college student, I’ve noticed that my peers and I share a common negative sentiment toward scheduling and attending routine doctor’s appointments. There are unique barriers in place for the age demographic; college students encountering the medical system and Primary Care Providers (PCPs) seem to have unique challenges in communication. I released a qualitative, anonymous survey to Bowling Green State University students to gauge opinionated responses on sentiments regarding how they felt about the level of communication between themselves and their provider, how the pediatric switch to a regular doctor impacted their inpatient care, how …

Methylene Blue Associated Retinal Toxicity, Sidra Zafar, Martin Calotti, Timothy T. Xu, Justin Muste, Theodore Bowe, Luis Acaba-Berrocal, Brian Cheng, Samir Patel, Yoshihiro Yonekawa, Jose S. Pulido, Jordan D. Deaner

Wills Eye Hospital Papers

BACKGROUND: To describe a case of inadvertent methylene blue use during pars plana vitrectomy (PPV) for an epiretinal membrane (ERM).

CASE: A 69-year-old man presented with 1 day of severe vision loss in his left eye. Two days prior to presentation, he had undergone PPV that was complicated by accidental methylene blue use. Visual acuity (VA) at presentation to our institution was CF from his baseline VA of 20/60. Optical coherence tomography (OCT) demonstrated diffuse hyperreflectivity and thickening of the inner retinal layers. The patient was started on oral prednisone with no improvement. On postoperative month 1, VA was HM. …

Clinical Practice Guideline On Reducing Catheter -Associated Urinary Tract Infections (Cautis), Nkechi Christiana Udah

Walden Dissertations and Doctoral Studies

The project was a clinical practice guideline (CPG) for early catheter removal to prevent catheter-associated urinary tract infections (CAUTIs). At the project site, the practice gap was the surgical nurses’ nonadherence to clinical guidelines for reducing CAUTIs. This gap resulted in inconsistent catheter care practices and delays in catheter removal. The purpose of this CPG was to enhance surgical nurses’ knowledge and adherence to clinical guidelines for reducing CAUTI rates. The following practice-focused question guided the project: In hospitalized patients in acute care settings, does early removal of the urinary catheter compared to leaving the catheter until discharge reduce the …

Strategies Used By Psychiatric Hospital Directors To Reduce Readmission Rates, Increase Revenue And Improve Patient Outcomes, K'Chinwe Blanche Marie Ezeokoli

Walden Dissertations and Doctoral Studies

High psychiatric hospital readmission rates threaten patient stability, strain hospital finances, and reduce community wellbeing. Psychiatric hospital leaders need effective strategies to lower readmissions. Grounded in complex adaptive systems theory and the balanced scorecard framework, the purpose of this qualitative pragmatic inquiry project was to identify and explore effective strategies used by psychiatric hospital directors to reduce readmission rates, increase revenue, and improve patient outcomes. The participants were seven psychiatric hospital directors who had implemented strategies for reduced readmission rates. Data were collected through semistructured interviews and relevant public documents. Using thematic analysis, five themes were identified: (a) establish a …

Effective Strategies Hawaiian Food Truck Owners Use To Sustain Their Businesses, Eric J. Harring

Walden Dissertations and Doctoral Studies

Food trucks are popular choices for consumers seeking diverse cuisines and unique dining experiences, but running a successful food truck business presents significant challenges, including fluctuating customer preferences, regulatory hurdles, and intense competition. Addressing these obstacles is crucial for food truck owners to ensure the long-term viability of their enterprises. Grounded in contingency theory, the purpose of this qualitative pragmatic inquiry research project was to explore the strategies employed by food truck owners to overcome these challenges and foster sustainable growth. The participants were six business owners of Hawaiian food trucks who sustained their businesses for at least three years. …

Functional Classification Of Platelet Gene Variants Using Crispr Hdr In Cd34+ Cell-Derived Megakaryocytes, Yasuhiro Kosaka, Brandon Lopez, Nina Kishimoto, Shancy Jacob, Emilie Montenont, Rodrigo Huallanca, Graeson Coughenour, Jorge Di Paola, Justyne Ross, Kristy Lee, Matthew T Rondina, Paul F Bray, Jesse W Rowley

2020-Current year OA Pubs

The interpretation of genetic variants in inherited diseases, such as inherited platelet disorders (IPDs), remains a major clinical challenge, as most are classified as variants of uncertain significance (VUSs). A key barrier to functional evaluation is the lack of accessible, lineage-appropriate assays that reliably reflect native gene regulation and cell-specific biology. To address this gap, we developed CRIMSON HD (CRISPR-edited megakaryocytes [MKs] for surveying platelet variant functions through homology-directed repair [HDR]), a CRISPR-Cas9 HDR-based genome-editing platform applicable to CD34

Enhancing Intergenerational Health In Nigeria: Peripartum As Critical Life Stage For Cardiovascular Health (Enhance-Cvh) Study: Findings From Pre-Implementation Using The Updated Consolidated Framework For Implementation Research (Cfir 2.0), Julia D López, Cecilia Nartey, Debra Haire-Joshu, Victor G Dávila-Román, Mark D Huffman, Clementina E Okoro, Et Al.

2020-Current year OA Pubs

BACKGROUND: Pregnancy is a crucial period to improve cardiovascular health (CVH) for mothers and their families. The current study emphasizes framework-guided factors that influence the adaptation of an evidence-based intervention (Parents as Teachers and Healthy Eating Active Living Taught at Home [PAT + HEALTH]) to support healthy gestational weight gain and postpartum weight management among pregnant women with obesity and their infants in Nigeria.

METHODS: From May to June 2023, 43 in-depth interviews were conducted with 11 parents, 15 community health extension workers (CHEWs)/health educators, and 17 policymakers/ healthcare supervisors in the Federal Capital Territory, Nigeria. Additionally, nine focus groups …

Perceptions Of Stress And Coping Strategies Of Generation Z Nursing Students In The Clinical Setting, Elizabeth Hammond-Ritschard

Biennial Convention (CONV)

The clinical learning environment is very stressful for student nurses, especially among undergraduate Generation Z nursing students. Faced with higher expectations, and perfectionism, Generation Z has been labeled the Anxious Generation. There are mounting concerns with nursing students’ ability to cope and handle stressful situations in the clinical setting. Stress negatively impacts student nurses in the clinical environment. Students often experience anxiety, fear, and an inability to effectively appraise and apply effective coping strategies. The inability to cope with stressors in the clinical setting may lead to inadequate problem-solving, resulting in poor student performance and possible harm to the patient. …

A Hospital Based Residency Program For Newly Arrived Internationally Educated Nurses To The Usa, Jaclynn Morgan, Torri Nicole Trojand

Biennial Convention (CONV)

Purpose: The purpose of this abstract and research is to establish the efficacy of a hospital-based nurse residency program for newly arrived internationally educated nurses to the United States.

Background: Healthcare institutions are recruiting Internationally educated nurses (IEN) to fill gaps in staffing (Spetz et al., 2013). Internationally educated nurses are coming from an entirely different country and healthcare system and are then placed into foreign clinical settings amongst a foreign culture and having to find their place within the culture at the same time (Rosenkoetter et al., 2017). Literature delineates that an approach to support IENs is needed to …

Developing A Waste-To-Energy Assessment Framework Integrating Engineering And Policy Dimensions Using A Triple Bottom Line Approach, Izech Brian O. Edwin, King Harold A. Recto

Electronics, Computer, and Communications Engineering Faculty Publications

The management of municipal solid waste (MSW) in swiftly urbanizing Philippine cities has emerged as a critical concern in both energy and governance. Dependence on landfills is approaching critical thresholds as disposal sites near saturation, transportation costs escalate, and host communities increasingly resist garbage transfers. In response, this study proposes a comprehensive Waste-to-Energy (WtE) assessment framework that integrates engineering evaluation with policy and stakeholder analysis to support sustainable decision- making.

Using Baguio City as a case study, the framework applies a Triple Bottom Line (TBL) approach to evaluate three waste management scenarios: (1) current landfill-dominated practices, (2) engineered landfill with …

Montana Kaimin, December 4, 2025, Students Of The University Of Montana, Missoula

Montana Kaimin, 1898-present

Student newspaper of the University of Montana, Missoula.

The Effect Of Community-Based Exercise For Individuals With Pre-Existing Health Conditions, Amy M. Stahl

Doctoral Dissertations and Projects

Physical inactivity is a growing problem for the health and wellbeing of the world’s population. Increases in physical activity may help to improve health outcomes for the general population of the United States. This study is two-fold and seeks to determine if community-based exercise groups are successful in improving the health of people with preexisting conditions and encouraging community members to adhere to an exercise program. A quasi-experimental 12-week comparison study consists of a control group of standard care and an intervention group that participates in a three-day a week community walking group. The purpose of the group is to …

Substance Use Disorders, Trauma, And Women: A Phenomenological Study, Crystal E. H. Stephenson

Doctoral Dissertations and Projects

Substance use disorders (SUDs) do not discriminate who or how they impact individuals, families, or communities. Women impacted by SUDs face challenges such as lack of transportation, minimal family support, some of the women were triggered by co-ed groups, and childcare needs are just a few categories that prevent them from adhering to and engaging in treatment. This qualitative phenomenological study explored the lived experiences of eight women with substance use disorders and trauma. The participants were interviewed using a semi-structured guide that covered areas of their lives impacted by substance use disorders and trauma. Data was analyzed using methods …

A Phenomenology Study Of African American Male’S Perception Of Black Church Leadership, Eric Lewis

Doctoral Dissertations and Projects

Previous research has identified a gender disparity exists within the context of the Black Church. More specifically, the gender disparity focuses on the fact that there are more women than men in the context of the Black Church. The purpose of this phenomenological study was to explore the perceptions and attitudes that African American males have about Black Church leadership. In addition to this, to also identify if there is a congruence between the perceptions that Black males have about Black Church leadership and their level of engagement or non-engagement. The theory guiding this study is hermeneutic phenomenology, also known …

A Critical Comparative Analysis Of The Ecclesiologies Of Carl F. H. Henry And James H. Cone Through The Lens Of Social Consciousness: Towards A Liberative Ecclesiology, Phyllis D. Johnson

Doctoral Dissertations and Projects

The doctrine of the Church has remained a controversial and enigmatic topic for centuries. Since its inception, scholars have debated the doctrine of the Church, challenged its boundaries, and questioned its role in society. As contemporary society evolves, the Church encounters multifaceted challenges, compelling it to adapt while maintaining its spiritual mission. To address this concern, this study analyzes the ecclesiologies of Carl F. H. Henry and James H. Cone through the lens of social consciousness. A critical comparative analysis provides the most dynamic framework for examining these perspectives. By exploring probable theological points of convergence and divergence, this study …

Developing Healthy Leaders For Multiplication At The Bridge Church, Joshua D. Robinson

Doctoral Dissertations and Projects

The problem addressed in this DMIN action research project is the lack of a clearly defined biblical framework for the ongoing leadership development at TBC in Venice, Florida, amid rapid growth and increasing attendance. This gap has hindered the equipping of leaders to disciple and lead others and fulfill the Great Commission through church multiplication. The purpose of this project was to design and implement a biblically grounded leadership pathway, including The Bridge Institute (TBI), to equip current and future servant leaders for maturity, relational authenticity, and missional impact. The goals included developing improved assimilation, increasing volunteer engagement, and creating …

A Quantitative Study Exploring The Relationship Between Adverse Childhood Experiences And Fibromyalgia Symptoms And The Moderating Role Of Attachment To God, Darlene M. Scott

Doctoral Dissertations and Projects

Fibromyalgia, also known as Fibromyalgia Syndrome (FMS), is a condition that causes widespread musculoskeletal pain throughout the body, insomnia, tenderness and inflammation at specific pressure points on the body. This research aimed to explore the relationship between Adverse Childhood Experiences (ACEs) and FMS symptom severity. In addition, this study examined if attachment to God is a moderator of the relationship between ACEs and FMS symptoms, and if adults with four or more ACEs have higher levels of FMS symptoms than those with three or fewer ACEs. The sample consists of 99 (n = 99) participants diagnosed with FMS recruited online. …

Examining Social Determinants Of Health And The Impact On Hiv Outcomes In Black People In The United States, Triscia G. Martin

Doctoral Dissertations and Projects

Black people are disproportionately affected by HIV as evidenced by poor clinical outcomes and mortality. Clinical outcomes may be potentiated by patient factors, compounded by social determinants of health. This cross-sectional study sought to examine the impact of social determinants of health on AIDS mortality in the United States. Deidentified HIV data from the CDC NCHHSTP Atlas Plus repository and CDC WONDER population data were utilized to examine the association of race, sex, transmission category and geography on AIDS mortality in 43 states during 2018 to 2022. AIDS mortality was further examined through the lens of HIV stigma and housing …

Exploring The Differences In Personal Transformations Of Travel Types: A Comparative Study Of Self-Efficacy, Grit, And Memorable Experiences Amongst Solo And Group Travelers, Ashley Christine Holland

Doctoral Dissertations and Projects

The purpose of this quantitative research study was to use survey data to explore personal transformations that occur through travel experiences, with a primary focus on comparing any differences of self-efficacy, grit, and memorable travel experiences between solo travelers and those who traveled with a group or companion. A correlational and quasi-experimental design was used consisting of online survey data using measurements of general self-efficacy, grit, and memorable traveling experiences from 128 participants (61 solo and 67 group travelers). Descriptive statistics, Pearson correlations, and multivariate analyses of variance were used to analyze the relationships and differences between the study variables. …

Exploring Gen Z Adults From Military Families: Perspectives On Work Ethics And Values, Sonia Lee

Doctoral Dissertations and Projects

This research explored the work ethics and values of Generation Z (Gen Z) adults who grew up in military-connected households. The purpose was to identify strategies that enhance organizational recruitment, retention, and engagement. Qualitative research methods, such as interviews and thematic analysis, were used to achieve this objective. Insights into how Gen Z adults from military households perceive their work ethic, prioritize their values in the workplace, and how organizations can integrate those values were gained. Findings revealed that discipline, dependability, excellence, responsibility, integrity, respect, and adaptability defined their work ethic, reflecting values shaped by their upbringing. Participants also expressed …

Perspectives Of School Based Mental Health Workers Supporting Intellectual Disabilities & Mental Health Disorders, Anna R. Cleeland

Doctoral Dissertations and Projects

This study aimed to investigate the current training of school based mental health (SBMH) professionals working with individuals with dual diagnosed individuals with Intellectual/Developmental disabilities and mental health disorders. A triangulated data approach of survey, focus group and journal reflection was completed providing opportunities for the SBMH professionals to describe their professional training to work with the population and expound on their experiences providing services in the K12 school setting. Results from all three data points indicated a large deficit in training options available specifically for professionals working with those who have an IDD/MH diagnosis. Results also outlined three themes/10 …

The Unashamed Plan: Expository Methods For Reconciling Unchurched Young Adults At The Friendship Baptist Church Of West End, James Daniel Spencer Ii

Doctoral Dissertations and Projects

Young adults are absent from the pews of churches within the urban African American community. Churches within the community face dissolution because a generation no longer seeks to solve its problems by connecting with the household of faith due to shame-based alienation. There is a need to reconcile young adults into the citadel of invincible grace, God’s church, to fulfill the Great Commission and ensure a generation is not lost. Therefore, this action research project teaches church members through expository preaching and teaching The Unashamed Plan to educate them to reach youth for Christ. The Unashamed Plan is a theological …

Healthcare Disparities Related To Income In South Carolina, Rebekka Byrd

Doctoral Dissertations and Projects

Low-income individuals and families in South Carolina face significant barriers to accessing healthcare, despite the presence of public health programs like Medicaid. Many fall into the healthcare coverage gap, earning too much to qualify for Medicaid but too little to afford private insurance. This study explored the consequences of the healthcare coverage gap by examining the relationships between income, healthcare access, and the ability to afford healthcare services among 500 adults aged 19–64 who participated in the National Health Interview Survey between 2018 and 2023. Utilizing a retrospective quantitative analysis of secondary data from the National Health Interview Survey (NHIS) …

Investigation In The Association Of Opioid Administration And Access To A Primary Care Provider In Patients Who Frequently Use The Emergency Department In A Rural And Urban Hospital In Arkansas, Cheyenne Star Lowrey-Lagrone

Doctoral Dissertations and Projects

The overuse of emergency department (ED) services presents challenges for hospitals and communities as valuable resources are funneled repeatedly into the same patients. Frequent ED users account for a significant portion of used resources, and efforts have been made to address this public health concern. This paper sought to identify associations between opioid administration and access to a PCP in one rural and one urban hospital in Arkansas. Through an investigation of 200 medical records of ED users identified as frequent users of one rural (n=100) and one urban (n=100) hospital between 2018 and 2023, the researcher identified associations between …