Maternal and Child Health Commons^™

Beyond Symptoms: Examining Perinatal Mental Health Care Among Black, Indigenous And People Of Color With Polyendocrine Metabolic Ovarian Syndrome, Vinaya Thomas

Electronic Theses and Dissertations

Perinatal mood and anxiety disorders (PMADs) are as a public health concern in the United States. Individuals from minoritized racial/ethnic groups face a significantly elevated risk of maternal morbidity, mortality, mental health disorders, and associated adverse outcomes. Emerging studies also reveal a higher likelihood of experiencing perinatal mental health concerns in individuals with polycystic ovarian syndrome (PCOS), currently known as polyendocrine metabolic ovarian syndrome (PMOS). People who identify as Black, Indigenous, or a person of color (BIPOC) face unique healthcare challenges given the added structural and social burdens. This online survey study aimed to 1) understand the relationship between PMOS …

Assessing Post-Pandemic Engagement In The Supplemental Nutrition Program For Women, Infants, And Children (Wic) In Northeast Tennessee, Christen Minnick

Electronic Theses and Dissertations

Since 1974, the federal Supplemental Nutrition Program for Women, Infants, and Children (WIC) has provided healthy food resources, nutrition education, and provider referrals for families at risk for poor nutrition. Public health professionals have consistently presented evidence that WIC engagement reduces premature births and infant mortality, improves child health and development, and increases specialized care access for participants. While average monthly participation in WIC has increased since the program’s inception, trends indicate that only around half of eligible families have consistently engaged with the program since 2011. Research has linked declining WIC participation to administrative burden, citing learning, psychological, compliance, …

Beyond Opioids: The Role Of Polysubstance Exposure In Neonatal Abstinence Syndrome Treatment And Hospitalization, Caelyn Harrison

Undergraduate Honors Theses

This thesis explores the impact of prenatal polysubstance exposure, specifically focusing on the need for pharmacological treatment for Neonatal Abstinence Syndrome (NAS) and the duration of their hospital stay. A retrospective analysis of 462 infants, including 121 exposed to polysubstances during pregnancy, showed significant associations between polysubstance exposure and adverse neonatal outcomes. Infants with prenatal polysubstance exposure were more likely to require pharmacological treatment for NAS (52.8%) compared to non-exposed infants (38.7%), as determined by chi-square analysis (χ²(1, N = 462) = 7.36, p = .007). Additionally, infants exposed to polysubstances experienced longer hospital stays on average (M = 14.88 …

The Association Between Prenatal Care And Postpartum Depression: Current State And Future Directions, Esther Adebayo-Abikoye

Electronic Theses and Dissertations

Background

Postpartum depression (PPD) is a major public health challenge and associated with poor maternal and infant health outcomes. Quality prenatal care decreases adverse outcomes in pregnancy and may reduce PPD risk factors. This study critically reviews the evidence about the role of prenatal care practices in reducing PPD prevalence across population groups and examines the association between prenatal care timing and counseling content with PPD prevalence.

Methods

A scoping review was completed across eight databases to synthesize evidence about prenatal care and PPD across different contextual settings. National data from the Pregnancy Risk Assessment Monitoring System (PRAMS) was used …

Perinatal Buprenorphine Effects On Offspring Growth, Opioid Withdrawal, And Brain Morphology In Rats, Parker Barnes

Electronic Theses and Dissertations

Opioid use disorder (OUD) impacts 5.6 million people in the US. Buprenorphine (BUP) is a commonly prescribed opioid medication used to treat OUD, including in pregnant women. However, opioid use during pregnancy is associated with poorer infant outcomes including reduced fetal growth, neurodevelopmental deficits, and neonatal opioid withdrawal syndrome (NOWS). Recent clinical data suggests that providing mothers with a lower dose of BUP may result in fewer negative outcomes in infants. Here, a preclinical rodent model of low-dose perinatal BUP exposure was used to study offspring health outcomes in the neonate, juvenile, and adolescent offspring. Dams were given clinically relevant …

Familial Sex Trafficking In East Tennessee, Mary K. Brannock

Electronic Theses and Dissertations

This dissertation was completed in partial fulfillment of the Doctor of Public Health program at East Tennessee State University. The dissertation follows the Manuscript Format which includes three manuscripts, these manuscripts regard familial sex trafficking and are as follows, a scoping review, an empirical study on regional familial sex trafficking, and a policy implications paper on criminal record relief for survivors of familial sex trafficking.

The scoping review includes eight peer reviewed studies on familial sex trafficking and a summary of grey literature. Thematic analysis was used to map the existing literature onto the Three Ps of human trafficking: Prevention, …

Youth-Friendly, Person-Centered Contraceptive Care For Adolescents: Exploring The Capacity Of Safety-Net Clinics In Alabama And South Carolina, Kristen Surles

Electronic Theses and Dissertations

Introduction: In recent years, high quality contraceptive care for adolescents has shifted away from tiered effectiveness counseling and toward youth-friendly, patient-centered counseling (YFPCCC). YFPCCC is essential in the South, which has higher rates of sexual activity, lower rates of contraception use, and higher teen birth rates. This study examined Southern clinics’ characteristics which support YFPCCC and youth’s perceptions of the contraceptive care they receive.

Methods: This mixed methods study examined secondary data collected in two surveys and primary data collected through key-informant interviews. The first survey examined clinic characteristics impacting YFPCCC, and the second survey examined adolescents’ (aged 16-24) perspectives …

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. …

Comparison Of Short Chain Volatile Fatty Acids In The Breastmilk Of Normal And Overweight/Obese Mothers, Ellen Gaskill, W Andrew Clark, Kristy L. Thomas, Amy Wahlquist, Michelle E. Johnson

Undergraduate Honors Theses

INTRODUCTION: Health professionals emphasize the importance of breastfeeding in the development of children up to 6-months of age. It is known that short chain volatile fatty acids (SCVFAs) are a byproduct of nutrient fermentation by gut microbiome. These SCVFAs interact with the gut/brain axis and are known to influence infant development. Therefore, a reflection of maternal gut microbiome could likely be found in breastmilk (BM) due to diffusion of SCVFAs across the gut wall into the blood. Previous research in our laboratory has shown differences in the SCVFA fecal fermentation profile between individuals with normal (N) versus overweight/obese (OWOB) body …

Assessing Best Practices, Perceptions, And Barriers To Breastfeeding In The Appalachian Region, Melissa White

Electronic Theses and Dissertations

Background: Breastfeeding protects against a variety of adverse health outcomes for mothers and babies. Global best practices, known as the Baby-Friendly Hospital Initiative (BFHI), have been developed to support the initiation and exclusivity of breastfeeding during the post-delivery hospital stay. The aims of this study were to explore the literature related to the impact of the BFHI on breastfeeding disparities in the U.S.; compare the impact of exposure to these best practices on exclusive breastfeeding rates in Appalachian and non-Appalachian hospitals; and to understand knowledge, perceptions, and barriers to breastfeeding of postpartum mothers receiving care in a Northeast Tennessee OB/GYN …

Early Detection Of Atypical Motor And Neurobehavior Of Infants At Risk Secondary To Opioid Exposure: A Prospective Study, Kara Boynewicz

Electronic Theses and Dissertations

Prenatal opioid exposure has been studied in relation to infants' medical outcomes. However, large gaps exist in the literature supporting early identification of atypical neurobehavior and motor development of infants with prenatal opioid exposure. The purpose of the study was to investigate whether prenatal opioid exposure has a negative influence on a newborn infant’s neurobehavior and motor development to aid in the early identification of potential delays. Using a prospective quasi experimental design, infants motor development using the Test of Infant Motor Performance (TIMP) and neurobehavior using the NICU Neonatal Network Scale (NNNS) was assessed on 58 infants in a …

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 …

Perceptions, Knowledge, And Attitudes About Long-Acting Reversible Contraceptives (Larcs) Among Women In Appalachian Tennessee, Fenose Osedeme

Electronic Theses and Dissertations

In Tennessee (TN), the rate of unintended pregnancies remains higher than the national rate (32.4% vs. 30.3%). Although long-acting reversible contraceptives (LARCs) are 99% effective in preventing undesired pregnancies; uptake remains low in rural and underserved communities. Previous research has provided some insight into women’s perceptions of LARCs; however, those guided by conceptual frameworks to understand the multiple influences that impact perceptions towards LARCs, especially among rural regions, are scarce. This multimethod qualitative study explored multiple influences that impact northeast Tennessee women’s perceptions and attitudes toward LARCs using the Socio-ecological Model (SEM) as a guiding framework.

The study comprised six …

A Mixed-Methods Analysis Of Abortion Attitudes And Perceptions Among Women Living In Alabama And South Carolina, Anthony Peluso

Electronic Theses and Dissertations

Legal induced abortion is a safe option for terminating a pregnancy for women of reproductive age in the United States (U.S.), though access has varied since the Roe v. Wade and Doe v. Bolton cases in 1973. Information is lacking on women’s attitudes toward and perceptions of abortion as well as on related constructs such as pregnancy attitudes and contraceptive use. Exploring these constructs is important in that it can provide much needed context to women’s reproductive life planning. This research aimed to explore perceptions of abortion access and safety and examine the potential associations between attitudes toward abortion access …

Polysubstance Exposure And Its Relationship To Pharmacological Treatment Characteristics, Parker Miller

Undergraduate Honors Theses

Neonatal Abstinence Syndrome (NAS) remains an ever-growing public health issue and a continued avenue for future research. The research question for this retrospective study was whether polysubstance exposure is related to the dose of medication the infant received or to the number of opioid-medications required to treat the infants’ withdrawal symptoms? The hypothesis for the retrospective study was there will be a significant relationship between polysubstance exposure and the dose of medication the infant received as well as the number of opioid-medications required to treat the infants’ withdrawal symptoms. A bivariate correlational indicated that there was not a significant association …

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 …

The Use Of Vital Statistics Data For Research Of Consequence: Birth Outcomes And Population Health In A Rural Region, Claudia Kozinetz, Shimin Zheng, Eunice Mogusu

ETSU Faculty Works

Objective: The Affordable Care Act (ACA) has influenced increasing interests in population health and population health outcomes. The purpose of this study was to exemplify the importance of using existing vital statistics data for understanding and monitoring health outcomes and consequentially health disparities at the population level. Data from birth records for two geographic regions from 2009-2014 were compared; low birth weight (LBW) and preterm delivery (PD) were used as surrogates for population health outcomes.

Methods: A population-based, multi-year, cross-sectional study design using a pooled dataset of birth records from Tennessee (TN) was the framework for the analyses. …

Predictors Of Neonatal Abstinence Syndrome In Buprenorphine Exposed Newborn: Can Cord Blood Buprenorphine Metabolite Levels Help?, Darshan Shah, Stacy Brown, Nick Hagemeier, Shimin Zheng, Amy Kyle, Jason Pryor, Nilesh Dankhara, Piyuesh Singh

ETSU Faculty Works

Background

Buprenorphine is a semi-synthetic opioid used for the treatment of opioid dependence. Opioid use, including buprenorphine, has been increasing in recent years, in the general population and in pregnant women. Consequently, there has been a rise in frequency of neonatal abstinence syndrome (NAS), associated with buprenorphine use during pregnancy. The purpose of this study was to investigate correlations between buprenorphine and buprenorphine-metabolite concentrations in cord blood and onset of NAS in buprenorphine exposed newborns.

Methods

Nineteen (19) newborns who met inclusion criteria were followed after birth until discharge in a double-blind non-intervention study, after maternal consent. Cord blood and …

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. …

Assessing The Social And Ecological Factors That Influence Childhood Overweight And Obesity, Katie Callahan

Electronic Theses and Dissertations

The prevalence of childhood overweight and obesity is increasing at an alarming rate in the United States. Currently more than 1 in 3 children aged 2-19 are overweight or obese. This is of major concern because childhood overweight and obesity leads to chronic conditions such as type II diabetes and tracks into adulthood, where more severe adverse health outcomes arise. In this study I used the premise of the social ecological model (SEM) to analyze the common levels that a child is exposed to daily; the intrapersonal level, the interpersonal level, the school level, and the community level to better …

Preventing Skin Cancer In Adolescent Girls Through Intervention With Their Mothers, Mary K. Baker

Electronic Theses and Dissertations

Indoor tanning (IT) before the age of 35 increases one’s risk for melanoma by 75%, and epidemiological data show a 6.1% annual increase in the incidence of melanomas in white women younger than age 44 in the US. Population-based studies reveal that 15% of adolescents and 8% to 14% of their primary caregivers have engaged in IT in the past year.

The compelling case for IT being a significant risk factor for melanoma, together with the high rates of IT in teen girls and their mothers, provided a strong rationale for conducting an antitanning intervention directed at mother-daughter dyads. This …

Perceptions Of Maternal Stress And Neonatal Patient Outcomes In A Single Private Room Versus Open Room Neonatal Intensive Care Unit Environment., Lisa M. Smithgall

Electronic Theses and Dissertations

Limited clinical evidence exists regarding whether the single private room Neonatal Intensive Care Unit (NICU) environment of care delivery has a positive, negative, or neutral impact on health outcomes for the high risk neonate and on maternal stress as compared to the open room design. The study purpose was to examine whether a difference exists in health outcomes in the open room versus single private room NICU environment. The factors considered were weight gain, ventilator days, hospital length of stay, incidence and grade of intraventricular hemorrhage (IVH), the number of parental visits, and perceptions of maternal stress. Infants hospitalized in …