Medicine and Health Sciences Commons^™

Assessing Virtual Versus In-Person Experiential Learning And Medical High-Fidelity Simulation In Medical Student Pediatric Clerkship Training, Andrew Mitchell Berry

Electronic Theses and Dissertations

Simulation and experiential training have been incorporated into medical school training for decades. The utilization of medical simulations has become an invaluable tool in healthcare education and training. However, circumstances such as limited resources, geographical constraints, or global health crises may hinder the feasibility of conducting in-person medical simulations. In these scenarios, virtual medical simulations emerge as a compelling alternative. While there are many ways to accomplish experiential-based learning, many faculty and students feel Socratic learning styles provide the best learning experience.

As medical students had just finished a predominantly virtual preclinical year due to the COVID-19 pandemic, the research …

Correctional Career Pathways: A Reentry Program For Incarceration, Taylor M. Dula

Electronic Theses and Dissertations

For the past several decades, the United States led the world in incarceration rates. With nearly 2.3 million people being held in state or federal prisons or local jails in 2019, incarceration rates in the United States are over four times higher than in other developed countries. Disparities exist by gender, race, ethnicity, and other special populations. Males are 13 times more likely to be incarcerated than females. Additionally, black males are 5.7 times and Hispanic males are 2.8 times more likely to be incarcerated than white males. Individuals who experience incarceration have poorer mental and physical health outcomes. People …

Positive And Negative Deviant Counties: Identification Of Factors Associated With Health Outcomes, Olivia Egen

Electronic Theses and Dissertations

Rural counties in the United States vary drastically on metrics related to socioeconomic status and dominant economic industry as well as health behaviors and outcomes. This study sought to understand the underlying structural reasons why some rural counties have better or worse than expected health outcomes using a positive deviance (PD) approach. The study aimed to: 1) create an area deprivation index and divide counties into quartiles using the index; 2) identify positive, negative, and non-deviant counties using health outcome metrics; 3) analyze differences between deviance on a variety of local public health system metrics; and 4) analyze differences between …

Evaluating The Effectiveness Of Restorative Justice Rehabilitative Services Available In Northeast Tennessee For Mothers Diagnosed With Substance Use Disorder, Claire Roberson

Undergraduate Honors Theses

Substance Use Disorder (SUD) has plagued families of rural Appalachia for many years, perpetuating involvement in the criminal justice system as well as generational trauma for people diagnosed with SUD and their children. This points to the necessity of a trauma-informed, restorative-justice based framework for rehabilitative services to most effectively heal families, address trauma, and re-integrate people diagnosed with SUD into society. A restorative justice-based program would provide health care services for addiction and any comorbid mental health disorders as well as teach parents how to properly provide for themselves and their families, manage finances, obtain employment, and further education. …

An Exploration Of Low-Income Dental Services In The Tri-Cities, Macie Proffitt

Undergraduate Honors Theses

Dental care has great importance in the overall health of every individual. Many do not realize the effect oral health plays in their overall health and many areas in the United States do not have access to the dental care needed to obtain proper healthcare standards. In many of these areas, such as the Appalachian region, dental services for low-income citizens are limited. Specifically, in the Northeast Tennessee region, these dental services are severely limited. Washington County and Hawkins County of Northeast Tennessee are specific underserved areas in the Appalachian region. The purpose of this project was to explore the …

The Distribution Of Opioid Settlement Funds In Northeast Tennessee, Amani Patel

Undergraduate Honors Theses

Opioid Use Disorder is defined by the NIH as “the chronic use of opioids that causes

clinically significant distress or impairment.”1 Due to a number of factors, the overuse of opioids has become an epidemic in the United States. In recent years there have been a number of lawsuits against pharmaceutical companies and other parties who have benefitted from the proliferation of this issue. In most cases, it is up to the states or local governments who receive these funds to determine their best use. The purpose of this Thesis is to analyze the resources recommended by Ballad Health’s Community …

Economic Insecurity, Poverty, And Parental Alcohol Misuse, Joey Tucciarone

Electronic Theses and Dissertations

Because parental alcohol misuse is associated with numerous negative outcomes for drinkers and other family members, it is important to examine factors predictive of alcohol misuse patterns among parents living with at least one child under the age of 18. Two possible factors include economic insecurity and poverty. This study sought to address whether measures of economic insecurity (i.e., housing and/or food insecurity in the past 12 months) and a dichotomous measure of poverty predict parental binge drinking and parental heavy alcohol consumption in a large population-based sample. It was hypothesized that economic insecurity and poverty, analyzed separately, would predict …

A Qualitative Analysis Of End-Of-Life Healthcare In Tennessee: Politics, Principles, And Perceptions, Erin Mauck

Electronic Theses and Dissertations

The unprecedented growth of the aging population in Tennessee is a significant demographic trend that highlights the necessity for healthcare policy that tackles end-of-life issues. This study examined the perceived quality of end-of-life healthcare in Tennessee, areas that are in need of improvement, policies that have the potential to influence improvements, and the role of politics in end-of-life healthcare policy. It also assessed the support for end-of-life healthcare policy that would advance quality of care and expand end-of-life choices for Tennesseans, while evaluating the policy-making process that legislators employ.

For this study, data were collected using semi-structured, in-depth interviews with …

The Impact Of State-Level Laws On Syringe Service Program Access And Risk Environment Of People Who Inject Drugs (Pwid), Samuel Pettyjohn

Electronic Theses and Dissertations

Background: Understanding concentrated areas with high rates of opioid use disorder (OUD) allows for improved placement of Narcan access points through syringe services programs (SSPs). People Who Inject Drugs (PWID) have lower risk of contracting infectious diseases the closer they are to SSPs. Tennessee law prohibits SSPs within 2000ft of a school or park, impacting the placement of SSPs in non-urban areas. Testing factors related to SSP siting placement within a system dynamic model can better determine the relationship between PWID risk environment and SSP access and utility.

Methods: We identified areas of greatest need for harm reduction interventions within …

Rural-Urban Variations In Meals On Wheels Programs, Lea C. Florence

Electronic Theses and Dissertations

Older adults are living longer than ever before. By 2060, the U.S. population aged 65 or older is projected to reach 98 million. As adults age, the prevalence of chronic diseases and disabilities increases. The need for Meals on Wheels (MOW) services is growing alongside the aging population. Yet, little is known about the geographic variation of services. Little is documented about the organizational capacity of MOW organizations in terms of geography. The current policies supporting home-and community-based services, including MOW, may be insufficient to support all older adults in all types of communities. An analysis of the More Than …

Heat Waves And Heat-Related Mortality In East Tennessee, Taiwo Adesoba

Electronic Theses and Dissertations

Heat waves represent a public health challenge that requires multiple responses and warnings to protect vulnerable populations. Although studies have reported an increasing trend of heat wave occurrence in many areas of the world, no clear trend exists in East Tennessee. Using data from Parameter-elevated Relationships on Independent Slope Models (PRISM), CDC WONDER and the United States Census Bureau, the relationship between mortality rates and year was estimated during heat wave events between 1999 and 2010. Five heat wave definitions were tested. Overall, 2007 and 2010 stand out as the years with the highest number of heat wave days in …

Adverse Childhood Experiences, Homeless Chronicity, And Age At Onset Of Homelessness, Joseph T. Tucciarone Jr.

Electronic Theses and Dissertations

Childhood adversity is associated with numerous negative outcomes across multiple domains, including mental and physical health, interrelationships, and social functioning. Notably, research suggests that childhood adversity has a dose-response relationship with these outcomes; that is, greater numbers of adverse experiences in childhood are associated with worse outcomes. These outcomes overlap with many risk factors of homelessness. This study sought to address two questions: 1) Does a dose-response relationship exist between childhood adversity and chronic homelessness? 2) Does childhood adversity negatively predict the age at which homelessness first occurs? Adults experiencing homeless who are accessing homeless services in the Tri-Cities area …

Evaluating Socially Determined Health In Rural Appalachia: Use Of The Social Quality Theory, Paula Masters

Electronic Theses and Dissertations

People living in rural America face unique social circumstances that can prevent them from reaching optimal health status. This fact holds especially true in the rural Appalachian region of the United States where income, education, living circumstances, and lack of resources create an environment that has some of the highest rates of morbidity and mortality in the country. While the rest of the country has seen improvement in many health behaviors and health outcomes, rural Appalachian communities remain unchanged and further behind other regions. In many cases, programming and policy have failed to create a culture of health in Appalachia. …

Exploration Of Rape Myths Among Former Military Professionals, Gabrielle Caldara

Electronic Theses and Dissertations

Sexual violence is sometimes considered a taboo topic for discussion, but it gained widespread attention in the media in late 2017 due to the social movements addressing the sexual assault of women. However, sexual violence perpetrated against men lacks publicity in America, and highlights a similar situation in the Armed Forces. A discussion of sexually violent acts committed against men is sometimes impeded by cultural norms. This discrepancy associated with civilian and military communities inspired this exploratory study.

A convenience sample of 520 former American military professionals completed an anonymous online survey to describe their attitudes and beliefs regarding rape …

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 …

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 …

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 …

Social Support For Physical Activity For High Schoolers In Rural Appalachia, Pooja M. Shah

Undergraduate Honors Theses

The purpose of the present study is to conduct a secondary qualitative analysis to examine parent, teacher, and high school adolescents’ perceptions of social support for physical activity (PA) for high schoolers in Southern Appalachia. Social support for PA is linked to higher rates of PA participation in adolescents. Parents, siblings, and peers provide key sources of support. Social support for PA may be even more important in under-resourced communities such as Appalachia, where geographic, economic, and environmental barriers negatively impact PA engagement. During 2013-2014, focus groups and semi-structured interviews were conducted with parents of adolescents (n=39), high school teachers …

Burn Wound Bacteria Susceptibility To A Novel Antimicrobial Compound, Bo H. Marshall

Undergraduate Honors Theses

A breach of the skin barrier, due to a burn wound, facilitates colonization by various microorganisms. Burn wounds can become colonized from the patients’ own skin flora, respiratory tract, or with exogenous bacteria from the environment. Strategies to treat burn wound infections are multipronged: removal of the infected necrotic tissue, wound dressing to protect the damaged area, and treatment with specific antimicrobials to prevent reinfection. The development of chronic infections, which could potentially lead to sepsis, depends largely on how well the microorganisms form biofilms within the wound. There are numerous antimicrobial gels and antibiotics that help prevent a burn …

Self-Perceived Coordinated School Health Coordinator Leadership Styles And Practices, Heather R. Ledbetter

Electronic Theses and Dissertations

School-aged children’s health needs have changed over the last several decades to the present day population of many overweight and obese children with health complications (Centers for Disease Control & Prevention, 2015). Tennessee has implemented the Centers for Disease Control and Prevention’s (CDC) model for Coordinated School Health (CSH) in all public schools. Leading each school district’s program is a CSH Coordinator. The role of CSH Coordinators is to provide leadership to district and school administrators while effectively and efficiently implementing the CSH program (Wechsler, 2012).

The purpose of this quantitative study was to explore the self-perceived leadership styles and …

Biosand Water Filter Evaluation: Meta-Evaluation And Pilot Study Of Field Use Indicators, Bethesda O'Connell

Electronic Theses and Dissertations

Diarrheal diseases are a global public health burden, killing 1.8 million people annually. Diarrhea disproportionately affects children and those in poverty. Most diarrheal cases can be prevented through safe drinking water, basic hygiene and/or sanitation measures, with drinking water interventions having the most impact on reducing diarrheal disease. A meta-evaluation was completed of studies evaluating a specific household water treatment method, the biosand water filter. Results from the meta-evaluation illustrate that biosand water filters improve drinking water quality and reduce diarrheal disease. However, there is no generally agreed upon field method for determining biosand water filter effectiveness that is useable …

Women And Healthcare In Appalachia: Impeding Circumstance And The Role Of Technology, Ashley Cano

Electronic Theses and Dissertations

For decades, healthcare access and quality in central and southern Appalachia have trailed the rest of the country. Entrenched poverty and low educational attainment compound healthcare problems. This study examines the healthcare obstacles women encounter in southern and central Appalachia and analyzes how technology use, such as Internet searching and social media affect women’s healthcare decisions. Data were analyzed from four focus groups conducted with women from the region. Results indicate that seeing a physician or not did not influence women’s propensity to search the Internet for health-related information or to seek support through social media sites. Additionally, women reported …

Psychological And Sociocultural Influences Of Current And Historical Intimate Partner Violence In Pregnancy, Cindy D. Phillips

Electronic Theses and Dissertations

The Centers for Disease Control and Prevention (CDC) estimates that 1.5 million women are victims of intimate partner violence (IPV) each year, and 324,000 of these women are pregnant (2013). Research on the predictability of certain factors and their relationship to current and historical IPV is limited. In order to better understand IPV as it related to a sample of 1,016 Appalachian pregnant women selected for the Tennessee Interventions for Pregnant Smokers (TIPS), it was important to evaluate various influences that may predict the prevalence of IPV in this population when compared to the State of Tennessee and the U.S. …

Collaborative Models Of Care In The Appalachian Region Of Tennessee: Examining Relationships Between Level Of Collaboration, Clinic Characteristics, And Barriers To Collaboration, Jeffrey Ellison

Electronic Theses and Dissertations

Decades of research have shown that there are significant advantages to maintaining close communicative and collaborative relationships between primary care and behavioral health providers. Fiscal, structural, and systemic barriers, however, often restrict the degree to which such interprofessional collaboration can occur. In the present study the authors examined relationships between primary care clinics in the Appalachian region’s characteristics (i.e., clinic type, rurality, and clinic size), barriers (i.e., fiscal, structural, and systemic) reported to using increased collaboration, and the level of collaboration used at a particular clinic.

For the present study 136 surveys were completed by providers working in primary care …

Exploring The Role Of Religiosity On Suicidal Ideation: A Study Among A Population-Based Sample Of Adolescents In The United States, Grace E. Tettey

Electronic Theses and Dissertations

Suicide is a major public health issue in the United States. Some studies show decreased suicide rates in religious populations, but it is unclear how religiosity might be linked to suicidal behavior of adolescents emerging into adulthood. To this point few studies have examined the relationship between adolescent suicidal ideation and several risk factors at once and the role of religiosity in these relationships.

Drawing from Waves I-III of the National Longitudinal Survey of Adolescent Health data from 1994 to 2002, I sought to explore the relationship between religiosity (i.e. religious affiliation, service attendance, prayer, perceived importance of religion) and …

Vitamin D Status Of College Students: Implications For Health Leaders, Eileen M. Cress

Electronic Theses and Dissertations

Vitamin D deficiency is considered to be a pandemic with implications for compromised bone health and other chronic diseases. Few studies have examined vitamin D status in college-aged individuals where prevention of future health consequences is still possible. Serum vitamin D 25(OH)D status and vitamin D intake were examined in 98 college students ages 18-29 years during winter. BMI was classified as < 25and 25 or greater. Race was categorized as Caucasian or other. Overall, 69.5% had suboptimal serum vitamin D levels, <30ng/mL. Only 8 students (8.2%) met the EAR (400 IU) per day for vitamin D intake. t tests were used to determine if there were significant differences in serum vitamin D level and dietary intake based on gender, race and BMI. Significant differences were found in serum vitamin D level when compared by gender and race. Females tended to have a higher serum vitamin D level than males. Those representing minorities had lower serum vitamin D levels than Caucasians; One hundred percent of the minority students had suboptimal serum vitamin D levels. Based on these findings, dietitians should increase efforts to target college-aged individuals in educational programming related to factors affecting vitamin D synthesis, vitamin D intake, and health consequences of suboptimal vitamin D status, particularly in winter. Consideration should be given to vitamin D fortification of foods that meet the preferences of today’s consumer.

"Nursing Contamination: Wearing Scrubs In Public", Kemble Green

Undergraduate Honors Theses

Nurses are frequently seen in public in their “scrubs,” which could mean that contaminated clothing is being brought into the community, thereby posing an infection risk. The purpose of this study is to investigate if and which contaminants are present on the fabrics and the actions nurses are taking to eliminate contamination risks.

Eleven scrub tops were worn on hospital units over one twelve-hour shift. The contaminated scrubs and three control tops were then swabbed and used to inoculate agar plates. After incubation, colonies were counted, streaked onto nutrient and Mannitol-salt agar for isolation, and incubated. Using API Staph strips …

The Johnson City Community Health Center: A Qualitative Analysis Of The Center's Strengths, Weaknesses, Opportunities, And Threats In Johnson City, Tennessee, Enrique A. Cruz Enriquez

Undergraduate Honors Theses

The Johnson City Community Health Center is one of over 1200 community health centers serving over 22 million patients across the United States. Community health centers primarily serve patients with low income or without health insurance, but most serve all the members of their communities. These centers provide many services and treat health problems in a holistic manner in order to improve the health of their communities and also allow the members of those communities to progress. The Johnson City Community Health Center is compared to successful CHCs from across the nation to determine if it has characteristics to be …

The Prevalence Of Smoking In Nursing Students, Jennifer Trotter

Undergraduate Honors Theses

Tobacco use is one of the most preventable sources of death and disease, and yet remains a worldwide problem. With the rising costs of healthcare, the focus of efforts to control them has honed in on lifestyle behaviors that contribute to the escalating costs. Within the scope of this scrutiny, the prevention or cessation of smoking and tobacco usage has become a global priority and a major focal point of worldwide anti-tobacco initiatives. The World Health Organization (WHO) has identified cessation interventions by health care professionals as a crucial factor in successful patient smoking cessation, and studies have shown that …

Who Done It? Rurality Vs. Ses As Critical Factors In Evaluating The Prevalence Of Child Psychosocial Concerns In Primary Care, Robert M. Tolliver

Electronic Theses and Dissertations

The purpose of this study was to evaluate the prevalence of child psychosocial concerns in rural primary care, hypothesized to be greater than national averages due to lacking mental health services in rural areas. This study was an examination of the role of SES, various definitions of “rural,” and the interaction of SES and rurality, in predicting parent-reported child psychosocial concerns in Appalachian primary care clinics. Caregivers presenting with their child at one of 8 pediatric primary care sites (n=2,672) were recruited to complete a measure assessing demographics and the Pediatric Symptom Checklist (PSC). Results showed that while rural status …