Public Health Commons^™

Sex Differences In Revascularization, Treatment Goals, And Outcomes Of Patients With Chronic Coronary Disease: Insights From The Ischemia Trial, Harmony R Reynolds, Derek D Cyr, C Noel Bairey Merz, Leslee J Shaw, Bernard R Chaitman, William E Boden, Karen P Alexander, Yves D Rosenberg, Sripal Bangalore, Gregg W Stone, Claes Held, John Spertus, Kaatje Goetschalckx, Olga Bockeria, Jonathan D Newman, Jeffrey S Berger, Ahmed Elghamaz, Renato D Lopes, James K Min, Daniel S Berman, Michael H Picard, Raymond Y Kwong, Robert A Harrington, Boban Thomas, Sean M O'Brien, David J Maron, Judith S Hochman, Ischemia Research Group

Faculty, Staff and Student Publications

BACKGROUND: Women with chronic coronary disease are generally older than men and have more comorbidities but less atherosclerosis. We explored sex differences in revascularization, guideline-directed medical therapy, and outcomes among patients with chronic coronary disease with ischemia on stress testing, with and without invasive management.

METHODS AND RESULTS: The ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial randomized patients with moderate or severe ischemia to invasive management with angiography, revascularization, and guideline-directed medical therapy, or initial conservative management with guideline-directed medical therapy alone. We evaluated the primary outcome (cardiovascular death, myocardial infarction, or hospitalization for …

High Clinical Exome Sequencing Diagnostic Rates And Novel Phenotypic Expansions For Nonisolated Microphthalmia, Anophthalmia, And Coloboma, Bhavana Kunisetty, Bailey A Martin-Giacalone, Xiaonan Zhao, Pamela N Luna, Brian P Brooks, Robert B Hufnagel, Chad A Shaw, Jill A Rosenfeld, A J Agopian, Philip J Lupo, Daryl A Scott

Faculty, Staff and Student Publications

PURPOSE: A molecular diagnosis is only made in a subset of individuals with nonisolated microphthalmia, anophthalmia, and coloboma (MAC). This may be due to underutilization of clinical (whole) exome sequencing (cES) and an incomplete understanding of the genes that cause MAC. The purpose of this study is to determine the efficacy of cES in cases of nonisolated MAC and to identify new MAC phenotypic expansions.

METHODS: We determined the efficacy of cES in 189 individuals with nonisolated MAC. We then used cES data, a validated machine learning algorithm, and previously published expression data, case reports, and animal models to determine …

Addressing Educational Disparities To Improve Health In The Rio Grande Valley, Ronald A. Shaju, Alex Zuo

Research Symposium

Background. The Rio Grande Valley (RGV) has emerged as a United States region facing great hardships regarding health, with the region identified in the work with the highest rates of diabetes and obesity among the diverse mix of people that inhabit it. This extensive public health research shall seek to delve deeply into the relationships between educational disparities and health outcomes in the RGV population, as this might serve as a pivotal point for breaking down health disparities in the RGV. This comprehensive public health research endeavor seeks to delve deeply into that complicated relationship between educational disparities and the …

Exploring Imageability Through Architecture To Study Neuroscience: Preliminary Results Of A Systemic Review, Cristian Maestre, Shana Garza, Silvia Mejia-Arango, Jesus D. Melgarejo, Gladys E. Maestre

Research Symposium

Background: Neuroscience and architecture are often combined to study the impact of environment, physical spaces, colors, shapes, and buildings on brain activity and health. This is an emerging field with distinct areas examining architecture in relation to neuroscience. Among the numerous elements of architecture, imageability seems to be of particular interest. Imageability refers to the quality of a physical space that evokes strong images in people’s mind, and influence cognitive functions including visual, memory, and spatial recall. It is hypothesized that environments, spaces, and buildings with poor imageability might negatively affect cognition, behavior, and brain health. Diverse studies have been …

The Moderating Effect Of Race On The Relationship Between Perceived Supervisor Support And Burnout Amongst Public Health Workers, Douglas Diontay Gaffney, Jr

Walden Dissertations and Doctoral Studies

Recent research has shown that burnout is a prevalent problem across the public health workforce. Burnout (BO) contributes to workplace challenges in turnover, employee performance, job satisfaction, and overall quality of life, and is more prevalent among racial minorities. Not only has BO been found to differ across racial demographics, employee perceptions about their level of support from supervisors (PSS) also differ. This quantitative study, informed by Meyer’s minority stress theory, examined Black-White differences in PSS and BO, and whether race moderated the relationship between PSS and BO. Data collected by De Beaumont’s 2017 national public health workforce interest and …

Changes In Real-World Dispensing Of Adhd Stimulants In Youth From 2019 To 2021 In California, Anika Patel, Rishikesh Chavan, Cyril Rakovski, Richard C. Beuttler, Sun Yang

Mathematics, Physics, and Computer Science Faculty Articles and Research

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common pediatric neurobehavioral disorders in the U.S. Stimulants, classified as controlled substances, are commonly used for ADHD management. We conducted an analysis of real-world stimulants dispensing data to evaluate the pandemic’s impact on young patients (≤ 26 years) in California.

Methods: Annual prevalence of patients on stimulants per capita across various California counties from 2019 and 2021 were analyzed and further compared across different years, sexes, and age groups. New patients initiating simulants therapy were also examined. A case study was conducted to determine the impact of socioeconomic status on patient …

Medical Home Implementation And Follow-Up Of Cancer-Related Abnormal Test Results In The Veterans Health Administration, Suja S Rajan, Shashank Sarvepalli, Li Wei, Ashley N D Meyer, Daniel R Murphy, Debra T Choi, Hardeep Singh

Faculty, Staff and Student Publications

IMPORTANCE: Lack of timely follow-up of cancer-related abnormal test results can lead to delayed or missed diagnoses, adverse cancer outcomes, and substantial cost burden for patients. Care delivery models, such as the Veterans Affairs' (VA) Patient-Aligned Care Team (PACT), which aim to improve patient-centered care coordination, could potentially also improve timely follow-up of abnormal test results. PACT was implemented nationally in the VA between 2010 and 2012.

OBJECTIVE: To evaluate the long-term association between PACT implementation and timely follow-up of abnormal test results related to the diagnosis of 5 different cancers.

DESIGN, SETTING, AND PARTICIPANTS: This multiyear retrospective cohort study …

Prenatal, Perinatal And Postnatal Risk Factors Associated With Autism Spectrum Disorder In Palestine: A Case-Control Study, Mustafa Ghanim, Mariam Al-Tell, Samaa Staiti, Maha Rabayaa, Johnny Amer, Malik Alqub, Sameeha Atout, Nihad Al-Othman, Marwa Ismail

An-Najah University Journal for Research - B (Humanities)

Background: Autism spectrum disorder (ASD) is a multifactorial neurodevelopment disorder. Several prenatal, perinatal, and postnatal factors are suggested as risk factors for ASD. This study aimed to correlate prenatal, perinatal, and postnatal factors in a limited number of ASD cases in Palestine. Methods: A case-control study involved 120 children (60 typically diagnosed with ASD and 60 healthy matched with the ASD group). The parents of the children in both groups were asked to fill out the questionnaire. Results: The study showed a higher male-to-female ratio in the ASD group. A family history of ASD was reported in 38.3% of the …

Treatment And Mortality Following Cancer Diagnosis Among People With Non-Affective Psychotic Disorders In Ontario, Canada: A Retrospective Cohort Study, Jared C. Wootten, Lucie Richard, Melody Lam, Phillip S. Blanchette, Marco Solmi, Kelly K. Anderson

Epidemiology and Biostatistics Publications

Background and Hypothesis People with psychotic disorders have a higher risk of mortality following cancer diagnosis, compared to people without psychosis. The extent to which this disparity is influenced by differences in cancer-related treatment is currently unknown. We hypothesized that, following a cancer diagnosis, people with psychotic disorders were less likely to receive treatment and were at higher risk of death than those without psychosis. Study Design We constructed a retrospective cohort of cases of non-affective psychotic disorder (NAPD) and a general population comparison group, using Ontario Health (OH) administrative data. We identified cases of all cancers diagnosed between 1995 …

How To Develop A Qualitative Evaluation Plan For A Complex National Intervention: Key Steps And Reflections From The Radx-Up Program, Shelly A. Maras, Josephine Mckelvy, Kelley Milligan, Allyson Kelley, Valerie A. Lucas, Tara Carr, Abisola Osinuga, Leah Frerichs, Gaurav Dave

The Qualitative Report

This article describes the formative process of developing and implementing a Qualitative Evaluation Plan (QEP) for a large-scale, National Institute of Health (NIH) supported program: Rapid Acceleration of Diagnostics — Underserved Populations (RADx-UP). RADx-UP includes over 137 projects in the United States that aim to ensure that all Americans have access to timely, accurate diagnostics for COVID-19, with a specific focus on populations the pandemic disproportionately affects. As part of a comprehensive, mixed-methods strategic evaluation plan, our team developed the QEP. We employed qualitative methods to understand RADx-UP academic and community partners’ experiences implementing community-engaged research strategies, and to understand …

A Greb1-Steroid Receptor Feedforward Mechanism Governs Differential Greb1 Action In Endometrial Function And Endometriosis, Sangappa B Chadchan, Pooja Popli, Zian Liao, Eryk Andreas, Michelle Dias, Tianyuan Wang, Stephanie J Gunderson, Patricia T Jimenez, Denise G Lanza, Rainer B Lanz, Charles E Foulds, Diana Monsivais, Francesco J Demayo, Hari Krishna Yalamanchili, Emily S Jungheim, Jason D Heaney, John P Lydon, Kelle H Moley, Bert W O'Malley, Ramakrishna Kommagani

Faculty, Staff and Students Publications

Cellular responses to the steroid hormones, estrogen (E2), and progesterone (P4) are governed by their cognate receptor's transcriptional output. However, the feed-forward mechanisms that shape cell-type-specific transcriptional fulcrums for steroid receptors are unidentified. Herein, we found that a common feed-forward mechanism between GREB1 and steroid receptors regulates the differential effect of GREB1 on steroid hormones in a physiological or pathological context. In physiological (receptive) endometrium, GREB1 controls P4-responses in uterine stroma, affecting endometrial receptivity and decidualization, while not affecting E2-mediated epithelial proliferation. Of mechanism, progesterone-induced GREB1 physically interacts with the progesterone receptor, acting as a cofactor in a positive feedback …

Vulnerable Neighborhoods Had Smaller Gains In Health Insurance Coverage During Early Covid-19, Ismail Mustafa Aijazuddin, Ammar Sukari

Medical Student Research Symposium

Background:

The Covid-19 pandemic has illuminated the inequities that jeopardize health, prompting rapid interventions to promote care access. However, such efforts have had mixed success in eradicating disparities. One focus is the equity of improvements in insured rates.

Methods:

Self-reported health insurance coverage rates among adults aged 18-64 were obtained from the CDC’s PLACES datasets for collection years 2018 and 2021, at the Census Tract level. These data were merged with the CDC’s 2018 Social Vulnerability Index (SVI), which ranks Tracts on 15 measures of social determinants of health. Across Tracts nationally and by state, univariate correlations between Overall SVI …

Addressing Barriers To Black Americans Participation In Clinical Trials: A Faith-Based Community Survey, Alexandra Stone, Lydell Lettsome Md, Brian A. Stone Md, Clinical Diversity Solutions

Medical Student Research Symposium

Background: The underrepresentation of high-risk minority groups in clinical trials remains a crisis in American healthcare. Despite pressures from the NIH to increase Black-American participation in trials, recruitment and retention in this group rarely match population demographics. Our company launched an opinion survey polling 260 Blacks regarding their thoughts and awareness about clinical trial participation.

Methods: We created a web-based survey consisting of 38 items and subdivided it into three main sections: (1) cultural affinity, (2) trust, and (3) background information. The survey was conducted using Jotform, a HIPAAcompliant web-based application. Our target population was Black Americans in central Alabama. …

Natural Spaces, A Social Determinant Of Health, And Self-Rated Health Among Medical Students, Josiah P. Stryd, Anil N. F. Aranha

Medical Student Research Symposium

Background and Purpose: Natural spaces are areas which have a majority of natural ground cover such as vegetation or water. These spaces have positive effects on both physical and mental health. The purpose of this study was to investigate whether medical students who have greater accessibility and use of natural spaces have better self-rated health.

Methods: M2-M4 students from Wayne State University School of Medicine received an email link to the Qualtrics-based study. Variables evaluated included: sociodemographics, residence zip code, natural spaces access frequency, distance, and transportation method. Self-rated physical and mental health was measured using the Healthy Days measure …

Vaccine Hesitancy Among Youth Living With Hiv In Detroit, Madeline B. Simone

Medical Student Research Symposium

Vaccine hesitancy among youth with human immunodeficiency virus (HIV) was evaluated to determine if the pandemic affected vaccine acceptance. A retrospective chart review was conducted to analyze vaccine rates over a five-year (pre-post COVID) in one university-based clinic. Results indicated a variation in acceptance rates between vaccines, with the MenACWY, MenB, tetanus, and HPV having the highest acceptance rates and COVID-19 and annual flu vaccine having the lowest acceptance rates. Vaccine hesitancy did not correlate with HIV treatment hesitancy nor with aversion to needles. Negative messaging around vaccines from a variety of sources appeared to be the primary factor in …

M-Chat Implementation Strategies To Improve Autism Screening Rates In Pediatric Clinics In Metro Detroit, Karamoja Monchamp

Medical Student Research Symposium

The Modified Checklist for Autism in Toddlers (M-CHAT) is the most widely used autism screening tool. However, current practices for M-CHAT roll-outs and follow-ups are not wide-reaching, culturally sensitive, or consistent. This study aims to address the existing barriers to universal autism screenings and design a sustainable implementation strategy for a successful M-CHAT roll-out. We implemented strategies in five Henry Ford Health pediatric clinics, incorporating iPad-administered M-CHAT in waiting rooms, multilingual options, task shifting for referrals, forced choice mechanisms, and audit-and-feedback support. A Clinical Screening Dashboard tracked real-time M-CHAT data, including demographic information, collected from EPIC. Our goal is to …

Assessment Of Breastfeeding Education In Medical Training, Saranya Madan, Abigail Kuplicki

Medical Student Research Symposium

In 2019, the Academy of Breastfeeding Medicine issued a revised set of educational objectives for medical trainees at various stages of education. In this statement, objectives for medical school were broken down into preclinical and clinical training objectives. In this project, our goal is to assess the degree to which medical training at Wayne State University School of Medicine is addressing these aims.

The assessment of breastfeeding education is accomplished by surveying medical students at various stages of training (M1-M4) and eliciting their level of confidence in and understanding of the topics outlined in the objectives by the Academy of …

Clinical Pathway Using Arabic Written Medical Information To Improve Incontinence Healthcare Utilization, John F. Knapp, Codrut Radoiu, Emma Ross, Jack Vercnocke Md, Aron Liaw Md, Nivedita Dhar

Medical Student Research Symposium

Introduction and Objective: Metro Detroit holds ~13% of all Arabic speakers in the U.S.A. and 91% of those in Michigan. Evidence supports that patients who do not speak the local language have poor access to healthcare. This study describes our preliminary experience of managing Arabic only speaking women with bothersome stress urinary incontinence (SUI) from May 2022 to October 2023. These women routinely request same-sex interpreters, which is not always possible, leading to a lack of detailed translation. A potential solution is to use Arabic written medical information (AWMI). The purpose of the study was to retrospectively look at the …

Histories, Cultural Contexts, Health Status, Wildlife Contact Characteristics, And Perception Towards Covid-19 Of The Urak Lawoi Ethnic Group In Koh Lanta District, Krabi Province Of Thailand: A Qualitative Study, Kanokwan Suwannarong, Paisit Boonyakawee, Thanomsin Ponlap, Kannika Thammasutti, Phitsanuruk Kanthawee, Nisachon Bubpa, Chularat Boonyakawee, Vittaya Pulkird, Junsri Changnum

Journal of Health Research

Background: The Urak Lawoi ethnic group is an indigenous community residing in the Andaman Sea of southern Thailand and are engaged in various activities related to wild animals. This qualitative study was conducted from November 2022 to February 2023 to collect information on wildlife contact characteristics and determine the level of awareness and understanding of zoonotic diseases and COVID-19 risks among this ethnic group in Koh Lanta district, Krabi province.

Methods: This qualitative study collected data through key informant interviews (KIIs) and focus group discussions (FGDs). The study respondents included 29 Urak Lawoi village health volunteers (VHVs), To Mo …

Assessing Oral Health-Related Quality Of Life And The Application Of Silver Diamine Fluoride (Sdf) In Arresting Caries Among Older Adults, Palinee Detsomboonrat, Panatcha Weerapol, Sirinan Tangyusuk

Journal of Health Research

Background: This study aimed to evaluate the impact of oral health problems on oral health-related quality of life (OHRQoL) and assess the effectiveness of the application of 38% silver diamine fluoride (SDF) solution in arresting dental surface caries among the older adults.

Methods: This study assessed the oral impact on daily performance (OIDP) scores and evaluated the percentage of arrested caries and patient satisfaction levels before and after receiving SDF treatment among older, community-dwelling adults attending the Diabetes Mellitus Clinic under the care of Bangkok Public Health Center 5.

Results: In total, 42.9% of 49 participants encountered a minimum of …

Finding A Good Fit: Tips On Hiring Rural Personal Assistants, Rayna A. Sage, Krys Standley

Health and Wellness

Living in rural areas means being part of close communities. For people with disabilities in these areas, Personal Assistance Services (PAS) help them live on their own. But finding good PAS workers in rural places can be hard. To help you pick the right PAS worker, we explored what traits make them a good fit.

Wastewater Surveillance For Identifying Sars-Cov-2 Infections In Long-Term Care Facilities, Kentucky, Usa, 2021–2022, James W. Keck, Reuben Adatorwovor, Matthew Liversedge, Blazan Mijotavich, Cullen Olsson, William D. Strike, Atena Amirsoleimani, Ann Noble, Soroosh Torabi, Alexus Lori Rockward, Mohammad Dehghan Banadaki, Ted Smith, Parker Lacy, Scott M. Berry

UK CARES Faculty Publications

Persons living in long-term care facilities (LTCFs) were disproportionately affected by COVID-19. We used wastewater surveillance to detect SARS-CoV-2 infection in this setting by collecting and testing 24-hour compos- ite wastewater samples 2–4 times weekly at 6 LTCFs in Kentucky, USA, during March 2021–February 2022. The LTCFs routinely tested staff and symptomatic and exposed residents for SARS-CoV-2 using rapid antigen tests. Of 780 wastewater samples analyzed, 22% (n = 173) had detectable SARS-CoV-2 RNA. The LTCFs reported 161 positive (of 16,905) SARS-CoV-2 clinical tests. The wastewater SARS-CoV-2 signal showed vari- able correlation with clinical test data; we observed the strongest …

“No Matter How Hot It Is, You Just Have To Do The Work”: Examining Farmworkers’ Experiences With Heat And Climate Change In Idaho, Carly Hyland, Delmy Flores, Grace Augusto, Irene Ruiz, Marielena Vega, Rulon Wood

Public and Population Health Faculty Publications and Presentations

Introduction: Farmworkers are one of the populations most vulnerable to climate change. In addition to disproportionate exposure to climate-intensified hazards such as extreme heat and wildfire smoke, many farmworkers face situational and psychosocial stressors that also impact their health.

Methods: We conducted open-ended interviews with 16 farmworkers in Southcentral Idaho during June-August 2023 as part of a digital storytelling project in partnership with the Idaho Organization of Resource Councils (IORC). Interviews assessed participants’ experiences with climate change, perceived impacts on their health, and strategies and barriers to protecting themselves. Bilingual (English/Spanish) study staff translated and transcribed all video recordings verbatim, …

Enhancing Patient Safety In Spain: Streamlining Adverse Event Detection In Occupational Healthcare Records, Diego Moya, Rafael Manzanera, Jordi Ortner, Marta Torres, Joan Carles Serfaty, Carme Sauri, Ma. Lourdes D. Jimenez, Jose Joaquin Mira

Ateneo School of Medicine and Public Health Publications

Background

Given the lack of previous studies on adverse events (AEs) in the area of occupational healthcare in Spain, it is very important to begin to understand this phenomenon in order to act on it. The objective was to accurately quantify AE occurring in occupational healthcare in MC Mutual during May 2021.

Methods

We conducted a review of a representative random sample of 250 clinical records to identify AEs through an active search audit, focused on the frequency, type, severity, and preventability of these events, categorized using standardized scales.

Results

We detected seven AEs in the sample of clinical records, …

Personal Dosimeter Testing For High Altitude Air Crew, Seth D. Bacon

Theses and Dissertations

In 2014 the Thermo Scientific N2 electronic personal dosimeter became the aircrews’ sole means to record ionizing radiation dose. The production of this dosimeter was discontinued in July of 2021, motivating the Air Force to seek a flight-certifiable replacement. The Thermo Scientific Trudose NG, Mirion DMC 3000, and Fuji NRF-51 electronic personal dosimeters, as well as the Landauer InLight optically stimulated luminescent dosimeter, were subjected to mixed gamma and fast neutron fields simulating a high-altitude flight environment. Dosimeters are evaluated on their consistency and accuracy in reporting dose and compared to the current N2 dosimeter’s reported dose.

Retrospective Cohort Study Of Pure Tone Audiometry Hearing Changes From Ototoxic Metalsand Solvents, Continuous Noise, And Impulse Noise Exposures At Hill Air Force Base From 2005 To 2019, Zachary I. Johnson

Theses and Dissertations

This retrospective cohort epidemiological study investigated the relative risks of hearing loss associated with ototoxicants in combination with noise exposure. Utilizing Department of Defense (DoD) industrial hygiene and hearing conservation data, this research expanded on a 2020 thesis conducted on Tinker Air Force Base (AFB), applying a similar methodology to Hill AFB, adding 893 evaluated individuals. Grouped into twelve exposure combinations with a minimum of three years of exposure duration, the study assessed various hearing loss indicators, including DoD Standard Threshold Shift (STS) and NIOSH STS. Ototoxic substances consistently elevated relative risk (RR) compared to noise-only exposure groups, but none …

Why I Chose To Practice In Rural Michigan, Lisenia M. Collazo Dmd, Mph

The Journal of the Michigan Dental Association

This article explores the motivations behind dentists choosing rural practice, focusing on personal experiences and factors influencing career decisions. The narrative outlines the author’s journey from Pennsylvania to the Upper Peninsula of Michigan, emphasizing a commitment to addressing oral health disparities in underserved communities. The discussion covers training experiences, financial considerations, community engagement, and the challenges of rural health care. The author also highlights the role of mentorship and advocates for building relationships with mentors in the profession, especially in rural settings. The essay underscores rural practice’s unique advantages, including professional growth, lower living costs, and a supportive community.

Policy Brief: Decreasing Unintended Pregnancy Rates In Mississippi, Jaycee S. Pilcher

Honors Theses

On June 24th, 2022, the U.S. Supreme Court’s decision to reverse Roe v. Wade marked a pivotal moment, eliminating the federal right to pregnancy termination. This thesis examines the challenges of restricted abortion access and emphasizes preventative strategies for unintended pregnancies. Analyzing both pre- and post-pregnancy interventions, such as enhanced sex education, hormonal contraceptives, insurance coverage, prescribers, and post-pregnancy policies, this thesis urges Mississippi residents and legislators to consider policy adjustments for reducing the occurrence of unintended pregnancies.

This research includes an analysis of literature, legislative records, and statistical data. It takes a comparative approach to evaluate the effectiveness of …

Altered Mitochondrial Respiration In Peripheral Blood Mononuclear Cells Of Post-Acute Sequelae Of Sars-Cov-2 Infection, Sahera Dirajlal-Fargo, Jared C. Durieux, Grace A. Mccomsey

Faculty Scholarship

Peripheral blood mononuclear cells (PBMC) mitochondrial respiration was measured ex vivo from participants without a history of COVID (n = 19), with a history of COVID and full recovery (n = 20), and with PASC (n = 20). Mean mitochondrial basal respiration, ATP-linked respiration, maximal respiration, spare respiration capacity, ATP-linked respiration, and non-mitochondrial respiration were highest in COVID + PASC+ (p ≤ 0.04). Every unit increase in non-mitochondrial respiration, ATP-linked respiration, basal respiration, spare respiration capacity, and maximal respiration increased the predicted odds of PASC between 1 % and 6 %. Mitochondrial dysfunction in PBMCs may be contributing to the …

The Great Resignation: Narratives Of Mid-Career Teacher Burnout And Attrition, Nicole Burton

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

The COVID-19 pandemic has increased the issues of teacher attrition. According to the U.S. Bureau of Labor and Statistics, from January to November 2021, there was a 40% increase in the quit levels of teachers within the state and local education agencies (John, 2022). While prior research has examined early-career teachers leaving the profession, mid-career teachers have largely been left out of the conversation. This narrative inquiry investigates the reasons that mid-career teachers are leaving the profession. Semi-structured interviews were conducted with four mid-career teachers hailing from the Midwest region. Interviews focused on understanding how teachers have experienced stress and …