Medicine and Health Sciences Commons^™

Opportunities And Barriers To Engaging Caregivers In Firearm Suicide Prevention: Findings From Focus Groups With Caregivers Of Veterans, Katherine Macwilliams, John Marmion, Dee Blascyk, Sharon Urbina, Rachel Moyers, Gala True

School of Medicine Faculty Publications

Background: Firearms are involved in more than 70% of U.S. Veteran suicides. Caregivers, defined as family members or concerned significant others, can play an important role in firearm suicide prevention through initiating conversations about secure firearm storage with Veterans. Our objective was to explore caregivers’ experiences with lethal means safety (LMS) conversations and identify perceived barriers to caregivers discussing LMS with healthcare providers and with Veterans. Methods: We conducted focus groups with 32 caregivers with experience caring for a Veteran at risk for suicide. Qualitative data were analyzed using thematic analysis. Results: We identified three primary themes: 1) caregivers recognize …

“Not Today”: Overcoming Prep Hesitancy, Stigma, And Adherence Barriers With Lenacapavir, Margaret Conrad, Meredith Clement

School of Medicine Faculty Publications

No abstract provided.

Associations Between Individual And Structural Level Discrimination And Psychological And Physiological Stress Indicators During Pregnancy, Özlü Aran, Melissa Nevarez-Brewster, Kimberly D'Anna-Hernandez, Julia Dmitrieva, Curt A. Sandman, Laura M. Glynn, Elysia Poggi Davis

Psychology Faculty Articles and Research

In the United States (U.S.) pervasive health disparities in prenatal care disproportionately impact marginalized individuals. The present study investigates whether discrimination at the individual and structural levels are associated with indicators of psychological and physiological stress among pregnant Latinx people living in the U.S., including both U.S. and foreign-born individuals. Pregnant participants (n = 109) reported on birthplace, lifetime experiences of racial and ethnic discrimination, perceived levels of stress, acculturation, social support, and provided residential address data and hair samples for cortisol analysis. Regression analysis revealed that individual level discrimination was linked to higher psychological stress during pregnancy ( …

Validation Of The Jefferson Health-Related Social Needs Screener, Sara Beachy, Kristin L. Rising, Richard W. Hass, Terry Hyslop, Isabella Muti, Mackenzie Kemp, Rhea E. Powell, Cara Martino, Baligh R. Yehia, Joseph G. Cacchione, Patricia C. Henwood

Jefferson Hospital Staff Papers and Presentations

INTRODUCTION: Screening for health-related social needs (HRSN) is a growing national health priority. While multiple HRSN screening tools currently exist, none to our knowledge have been evaluated using robust statistical analyses. The goal of this work is to provide results from a validation study of the Jefferson HRSN screener conducted across inpatient and outpatient settings.

METHODS: This retrospective cross-sectional psychometric study included HRSN assessments conducted across inpatient and outpatient settings with adult patients from March 2023 to May 2024. The study was conducted across a 17-hospital academic health system serving a diverse community in a 9-county area crossing two states …

Two Essays On Health And Health Behavior In China, Jiamin Tan

Lingnan Theses (MPhil & PhD)

This thesis consists of two empirical studies on elderly mental health and on health behaviors. The first study investigates the long-term impact of childhood hunger on mental health in later life, using data from two nationally representative surveys in China. The study finds that childhood hunger exposure significantly increases the risks of depression and anxiety in later life. These effects are most pronounced among individuals exposed after age 5, suggesting that autobiographical memory formation plays an important role beyond socioeconomic and health pathways. The findings further indicate these impacts can be mitigated through economic interventions, such as welfare programs, and …

Obesity Severity And Cancer Screening In Us Adults, Florina Corpodean, Michael Kachmar, Shengping Yang, Michael W. Cook, Philip R. Schauer, Vance L. Albaugh

School of Medicine Faculty Publications

No abstract provided.

A Content Analysis Of Prison/Custodial Suicide In Bangladesh, Anisur Khan, Rasel Hussain

Journal of Social, Behavioral, and Health Sciences

Suicide is the leading cause of death in prisons and custodial settings globally. International studies have consistently shown that prisoners and detainees are at a higher risk of suicide compared to the general population. Despite Bangladesh having a large prison population, there is no scholarly work on suicide within these settings. Against this backdrop, this study explored online newspaper content analysis capturing the characteristics of prison and custodial suicide in Bangladesh from 2014–2024. A total of 20 suicide cases were identified during this period. The data were arranged based on year-wise trends, age, sex, type of custody, nature of criminality, …

Will Anyone Play With Me? Building Resilience Through Community Play With Transgender And Gender Diverse Young Adults, Lee Lebeda

Expressive Therapies Theses

The recent increase in anti-trans legislature in the United States has negatively impacted the mental health of transgender young adults nationwide. Current research suggests that creative expression in a group setting may be uniquely suited to help transgender people combat the negative mental health effects of internalized anti-trans messaging. Based on this research, a community engagement project was designed for transgender young adult participants to explore resilience building through drama therapy-informed community play. Three play-based support groups, facilitated by a drama therapy graduate student who identified as a peer to the participants, were offered to transgender young adults in their …

At Stake In Each Other’S Company: A Systems View Of Compassion Fatigue In Mental Health Work, Susan S. Standen

Journal of Conscious Evolution

Traditional research on the phenomenon of compassion fatigue (CF) in mental health work tends to include recommendations for workers to build skills in psychological detachment and self-care. This puts the burden of coping with vicarious trauma on the individual caregiver, not on the systems they operate within. Alternatively, a transformative systemic perspective suggests that Western cultural assumptions about care-giving and individual resilience need to be reassessed. By broadening the exploration of CF and comparing it with human reactions to overwhelming crises across fields and disciplines, new questions can be asked, and new solutions can be proposed. This essay details how …

Leveraging Ai To Democratize The Hidden Curriculum In Medical Education: An Implementation Framework, James Keith Martin Ii, Mercedes Byrd

Libraries Scholarship

The “hidden curriculum” in medical education—comprising unwritten rules, values, and expectations—significantly impacts student success, yet remains inaccessible to students from underrepresented backgrounds. This paper presents a theoretical framework and practical implementation strategy for using artificial intelligence (AI) to democratize access to this hidden curriculum. We analyze how cognitive load theory and the Fast/Slow Thinking paradigm explain inequities in professional integration, then propose a comprehensive implementation approach to guide equitable AI integration. This model demonstrates how AI tools, when thoughtfully implemented, can reduce cognitive burdens on disadvantaged students, accelerate professional acculturation, and contribute to building an inclusive medical workforce.

Understanding Rural Health Through Rae Garringer's Country Queers: A Love Letter, Bradley A. Firchow

Journal of Appalachian Health

Rae Garringer’s Country Queers: A Love Letter examines the experiences of queer individuals in rural America, emphasizing the relationship between place and identity. Through oral histories, the book presents perspectives on community, resilience, and healthcare access. While not centered on medical care, it highlights challenges in obtaining affirming services in rural areas. Garringer’s experience as a standardized patient provides additional context on healthcare gaps. For public health professionals, Country Queers offers insight into the structural and social factors affecting rural LGBTQ2+ populations, contributing to a broader understanding of community health and identity in Appalachia and similar regions.

The Status Of Children’S Dental Health In Rural Appalachian West Virginia, R. Constance Wiener, Gina Graziani

Journal of Appalachian Health

Introduction: Non-metro/rural Appalachian West Virginia (WV) residents have been stigmatized for poor oral health (OH), despite many advances.

Purpose: The aims of this study were to examine current OH in children in WV, as compared to children in the greater United States (U.S.), and secondarily in subgroup non-metro/rural comparisons.

Methods: This observational study involved the U.S. National Survey of Children’s Health 2022–2023 data from parents/guardians who were asked about their child’s previous 12-month OH. Rao-Scott Chi-square and logistic regression analyses were used.

Results: Nationally, the mean age was 9.7 years; for WV children, it was 9.9 years. Nationally, 12.4% of …

Identifying Barriers And Place-Based Solutions To Physical Activity For Older Adults In East Tennessee, Lydia Hoskins, Jodi Southerland

Journal of Appalachian Health

Introduction: Older adults in East Tennessee (TN), the fastest growing demographic, face significant health challenges, with 44% reporting four or more chronic conditions. The state ranks 45th in physical inactivity among older adults, exacerbating chronic disease risks, fall-related injuries, and mental health issues. Urban-rural disparities in East TN further complicate efforts to promote active living, particularly for rural residents.

Purpose: This qualitative study explored socioecological barriers and solutions to increase physical activity (PA).

Methods: In April 2024, two focus group were conducted in East TN, with a total of 11 participants composed of six community partners and five older adults. …

Radon Environmental Health Literacy Among Health Council Participants In Northeast Tennessee, Kawther Al Ksir, Stacy Stanifer, Hadii M. Mamudu, Megan Quinn, Deborah L. Slawson

Journal of Appalachian Health

Introduction: Radon, a radioactive gas, poses significant health risks, including lung cancer, and is prevalent in indoor environments. Understanding radon testing behavior and Environmental Health Literacy (EHL) is crucial for individuals to take appropriate preventive measures.

Purpose: This study assessed radon-related EHL among Health Council participants in seven Northeast Tennessee (NETN) counties and examined associations between sociodemographic factors and EHL levels. Understanding radon knowledge and behaviors within this influential group is critical, as they often serve as trusted public health advocates.

Methods: A cross-sectional survey was conducted from September – November 2023 among Health Council participants across seven counties in …

Prevalence Of Screening Patients For Alcohol Use In West Virginia: A Cross-Sectional Observational Study, Bayan Abuhalimeh, Christopher Waters, R. Constance Wiener

Journal of Appalachian Health

Introduction: Consequences of alcohol consumption are well-established and compounded by physiological changes of aging (increased sensitivity; medication interactions; etc.). Alcohol screening for all ages is recommended, especially as most Americans believe moderate drinking is acceptable. Screening is important in high alcohol use regions, such as rural areas where isolation is more likely, especially for older adults. The Appalachian Region has a significant rural population of older adults. West Virginia (WV) is representative of Appalachia. It is a rural state, has many older adults, and all counties are Appalachian.

Purpose: The purpose of this cross-sectional study is to determine the likelihood …

Finding Community: A Thematic Analysis Of Resilience During The Pandemic, Myles Kwitny, Quinn Richards, Grace Digirolamo, Shannon Freedman, Sophie Wenzel

Journal of Appalachian Health

Introduction: The Covid-19 pandemic impacted those within rural Appalachian communities, particularly people with marginalized identities.

Purpose: Through interviewing 44 participants from New River Valley, an Appalachian community in Virginia, this study sought to understand how resilience impacted individuals' experiences during the pandemic.

Methods: Participants belonged to one of the following groups: African American, Hispanic, older adults, or people who use drugs. Participants were required to reside in the New River Valley and be older than 18. Each participant was interviewed either in person, by phone, or over video call. Interviews were recorded, transcribed, then thematically analyzed for themes of resilience. …

Addressing The Root Causes Of Population Health In Central Appalachian Virginia, David L. Driscoll, Kol Gold

Journal of Appalachian Health

Introduction: The Southwest Virginia Health Authority (SWVHA) recently commissioned a community health needs assessment (CHNA) to reduce the high rate of preventable health problems in Virginia’s (VA) Appalachian Region. The CHNA took place over a two-year period from 2023 – 2025.

Purpose: This iterative, mixed-method CHNA informed the development of a new iteration of the regional Blueprint for Health Improvement and Health-Enabled Prosperity identifying and prioritizing health issues and develop strategic planning to address them in VA’s three westernmost regional health districts.

Methods: The CHNA followed a sequential mixed methods design to assess the regional health status, the contextual factors …

Align Appalachia’S Opioid-Settlement Spending With Evidence And Emerging Threats, Bradley Firchow

Journal of Appalachian Health

State and local governments across Appalachia are allocating opioid-settlement dollars over the coming years. This funding opportunity can support lasting public health infrastructure or be spent on short-term programs anchored in the opioid crisis of the past. Evidence indicates that emerging synthetic drugs such as nitazenes and xylazine are altering overdose risk patterns in ways that require urgent policy attention.

Assessing The Psychological Wellbeing And Resilience Of Frontline Health Workers In Uganda: A Cross-Sectional Study, Ahmed Sarki, Joseph Atukwatse, Gideon Mbithi, Sabina Odero, Mary Namuguzi, Bernard Mutwiri, Lestine Bitakwitse, Peninah Wachira, Kevinson Mwangi, Eunice Ndirangu, Amina Abubakar

Institute for Human Development, East Africa

Background: Health workers in the frontline are the major drivers of health systems in low- and middle-income countries. However, these health workers face both chronic and acute shocks and stressors that expose them to mental health problems which are often overlooked. We examined the prevalence of mental health problems, correlates of psychological functioning, and resilience of frontline health workers in Uganda.

Methods: We conducted a cross-sectional study comprising 1800 frontline health workers across all regions of Uganda from August through October 2023. We used tools such as the PC-PTSD-5, PHQ9, PSS, GAD-7, Oldenburg Burnout Inventory, and CD-RISC-10 to assess PTSD, …

Strategies And Considerations For Forming And Managing Community Advisory Boards From Health Research With Transgender And Nonbinary Communities, Mannat Malik, Anushka Aqil, Jennifer L. Glick, Jean Michel Brevelle, Anthony Black, Kellan Baker, Arjee Restar, Molly Gribbin, Colin Flynn, Danielle German

School of Public Health Faculty Publications

Purpose: There is limited research on the use of community advisory boards (CABs) in health research with transgender and nonbinary communities. Transgender communities are navigating challenging histories of health researcher exploitation and research distrust alongside exponential research growth. We explored strategies for forming and managing CABs when conducting transgender community-informed health research. Methods: We used purposive and snowball sampling to identify key informants (KIs): research leaders, implementing staff, and community partners engaging in transgender health research. Between October 2018 and December 2020, we conducted 30 semi-structured in-depth interviews. We used coding followed byiterative thematic analysis and memoing to identify themes. …

Parent Needs, Recommendations, And Systemic Challenges Affecting Pediatric Hypertension Detection, Abbas H. Zaidi, Erica D. Sood, Sarah De Ferranti, Samuel Gidding, Varsha Zadokar, Jonathan M. Miller, Anne E Kazak

Department of Pediatrics Faculty Papers

Pediatric hypertension (HTN) affects 3%-5% of children in the United States, yet only 25% are diagnosed and 60% lack recommended follow-up care. Skepticism about elevated blood pressure (BP) readings and reluctance to use antihypertensive medications by parents and clinicians highlight the need for stakeholder-informed strategies to address these challenges. This study examined parents' perceived needs, their recommended strategies to improve HTN detection, and contextual health system challenges. Parents and clinicians from 10 pediatric primary care clinics participated in semi-structured qualitative interviews. Only parents of children with documented stage 2 BP readings and a HTN diagnosis, but with gaps in care …

Towards A New Health Politics In Kenya: Labor Organizing And Strikes By Health Workers In The Public Health Sector, Michael Scanlon

Graduate Doctoral Dissertations

There has been insufficient attention by global health scholars to labor organizing by health workers, including when and why organizing occurs, what forms and strategies it takes and its implications for governance and policy. These questions are critical but largely absent in research on what has been called the “global health workforce crisis.” Kenya represents an important case study. A new constitution in 2010 expanded institutional spaces for labor organizing and decentralized governance of the health system. Both reforms had significant implications for the health workforce and strikes by health workers have been pervasive. In 2017, nationwide strikes by public …

Institutionalized Bullying In Tertiary Institutions In Nigeria And Perceived Mental Health Impacts: A Phenomenological Qualitative Study, Chika Bosah, Casey Mace Firebaugh, Tara R. Zolnikov

The Qualitative Report

Institutionalized bullying is when bullying moves beyond individual instances of bullying and is culturally embedded in an institution, such as a school or workplace. This type of bullying has not been thoroughly examined in tertiary school settings in Nigeria. This phenomenological qualitative study examined the experiences of tertiary students (from four different institutions in Nigeria) and their experiences of institutionalized bullying to determine if and to what extent this practice is occurring. There were (n=48) tertiary students engaged in open-ended, semi-structured interviews in Nigeria in 2022. Interviews were transcribed, coded, and thematically analyzed. Overall, this study found that institutionalized bullying …

Enhancing Cataract Surgery Outcomes: Optimal Use Of Pre- And Post-Operative Eye Drops, Keith Skolnick M.D., Anu Valiaveedu

Mako: NSU Undergraduate Student Journal

Many preoperative and postoperative cataract patients struggle with comprehending the use of prescription medication as directed. Language barriers and low health literacy levels are major factors contributing to improper use of prescriptions. To increase patients comprehension, the Fort Lauderdale Eye Institute employed an educational intervention consisting of a live presentation and an instructional video. Results found that 44% of patients were hesitant to ask questions to clinical staff, 32% felt overwhelmed, and nearly 70% lacked confidence in using their prescribed eye drops. Following the intervention, 91% of patients reported increased confidence in their medications, and most indicated that the video …

The Residual Impact Of Slavery On How Enslaved Black Females Defined And Made Meaning Of Sexual Violence: A Content Analysis, Suzanne R. Bates

Dissertations

Thompson-Miller & Picca (2016) and Feimster (2023) argued that enslaved African American women, and even free African Americans after the Civil War were victims of non-consensual sexual activity and rape. The NISVS report revealed that before the age of 18 years old, 35.5% of African American women experienced contact sexual violence, 29.5% experienced non-contact unwanted sexual encounters, and 20.7% experienced rape (Basile et al., 2022). Researchers of slave scholarship have made the case for the importance of including discourse on slavery and enslaved Black females’ experiences when discussing present day sexual violence among Black women in the US today (Balfour, …

A Religious Etiology Of Genito-Pelvic Pain And Pain With Penetration, Emily L. Carlson

Theses and Graduate Projects

Pelvic pain during penetration (PPDP) has been described using various diagnostic terms, including vaginismus, dyspareunia, and vulvodynia. The most recent and comprehensive classification is Genito-pelvic pain/penetration disorder (GPPPD) which is characterized by psychological distress associated with pain during or in anticipation of vaginal penetration (DSM-5-TR; American Psychiatric Association [APA], 2022). The etiology of PPDP is multifactorial, involving a complex interplay of biological, psychological, and relational factors. Religious and cultural influences may play a significant role in shaping individuals’ experiences of sexual pain. This study investigated the etiology of PPDP in relation to the religious influences among women raised in Judeo-Christian …

Is Health Insurance Related To Breastfeeding Duration?, Anna De La Paz

Population Health Research Brief Series

Breastfeeding duration, which plays an important role in shaping maternal and infant health, can be influenced by insurance type. This data slice uses data from the 2022-2023 National Survey of Family Growth (NSFG) to described differences in breastfeeding duration by insurance type among females ages 15-49 in the United States. Findings show that mothers with private insurance breastfeed longer than mothers with public insurance, such as Medicaid, net of controls for maternal age, race, education, and income.

Promising Practices To Address Healthcare Needs Voiced By Local Native Americans, Noelle Taylor, Mykin R. Higbee, Raiden Gaul

Transforming Communities

Purpose

To examine barriers and facilitators to nursing education among Native Americans and identify evidence-based strategies to increase the number of Native American nurses working in their local communities to address health disparities.

Background

Native Americans experience significantly higher rates of chronic illnesses such as diabetes and heart disease, and lower life expectancies. Only 4% of registered nurses identify as Native American, with no growth despite increased funding for diversity in nursing education. This underrepresentation contributes to culturally insensitive care and persistent healthcare inequities stemming from historical marginalization and trauma.

Methods

A comprehensive literature review was conducted using CINAHL, PubMed, …

Addressing Psychosocial Barriers To Participation In People Experiencing Homelessness: An Occupational Therapy Workshop, Preston E. Bender

Student Capstone Papers

This capstone project addressed the critical gap in occupational therapy education and practice regarding the psychosocial needs of people experiencing homelessness. Despite the occupational therapy profession’s emphasis on holistic, person-centered care, many occupational therapy practitioners and occupational therapy students report feeling a lack of self-efficacy and preparedness to navigate the complex psychological, social, and systemic barriers that hinder occupational participation among this population. This capstone project aimed to address the perceived unpreparedness among clinicians through the creation of an 8-hour interactive educational workshop. The workshop is grounded in the Model of Human Occupation and informed by the Bridging the Transition …

Stress Management Is ‘In The Cards’ For Farmers And Ranchers: The Mental Wellness Conversation Curriculum, Alison L. Brennan, Katharine Sutphen, Parker T. Webb, Michelle U. Grocke-Dewey

Journal of Extension

Farmers, ranchers, and other agricultural workers need practical, culturally appropriate stress management resources. The Mental Wellness Conversation Curriculum (MWCC) is a novel approach to health promotion that relies on community facilitators to share stress management information using a customized deck of playing cards organized around specific wellness themes. We implemented and evaluated two facilitator trainings in 2023. Training participants reported increases in relevant knowledge, as well as improved confidence about leading mental wellness events. The MWCC is currently being adapted for use with additional, diverse audiences. Future research should explore the implementation and impact of this innovative health promotion modality.