University Student Mental Health: Service Utilization, Equity Gaps, And Strategies To Improve Access, Richard Mutua Kilonzo

Electronic Theses and Dissertations

Student mental health and access to care are pressing concerns in higher education. This study assesses mental health outcomes and access to campus mental health services at East Tennessee State University. Survey data from the 2023–2024 Healthy Minds Study were analyzed to report the prevalence of depression, anxiety, and suicidal ideation across the student population. The study evaluates disparities in these outcomes and barriers to care across student groups, with particular attention to equity-impacted students, especially sexual and gender minority students.

Findings indicate widespread psychological distress alongside persistent barriers, including long wait times, limited-service availability, and stigma-related concerns. These barriers …

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, …

Residential Segregation And Breast Cancer In Louisville: Impact Of Race And Contextual Factors On Advanced-Stage Diagnosis, Delayed Treatment, And Disease-Specific Mortality., Toheeb Ajani Mustapha

Electronic Theses and Dissertations

Female breast cancer (BC) remains the most commonly diagnosed non-skin cancer and the second leading cause of cancer death among U.S. women. Despite advances in detection and treatment, substantial inequities in BC outcomes persist, driven in part by structural forces such as residential segregation. This dissertation examined the relationship between residential segregation, BC outcomes, and key contextual factors in Louisville, Kentucky. Using data from the Kentucky Cancer Registry, American Community Survey, CDC’s Population-Level Analyses and Community Estimates, and the National Neighborhood Data Archive, the study tested two hypotheses: (1) higher Black/low-income segregation is associated with elevated risks of adverse BC …

Engaging In Movement At Work: Exploring Engagement And Physical Activity., Spencer A. Cavan

Electronic Theses and Dissertations

High levels of employee engagement provide organizations competitive advantages such as increased customer satisfaction, profits, and employee productivity. Despite potential benefits, the number of engaged employees is declining and organizations need to find innovative ways to enhance engagement. Emerging evidence suggests workplace physical activity may generate organizational benefits extending beyond health improvement. Therefore, the purpose of this study was to investigate perceptions of engagement among employees participating in a physical activity intervention at work. A qualitative design, guided by phenomenology, examined perceptions of workplace physical activity and perceived levels of engagement, as well as constraints related to involvement among university …

The Impact Of Mindfulness Therapy To Reduce Disruptive Behavior In High School, Wendy Peters

Electronic Theses and Dissertations

The aim of this project was to determine the impact and effectiveness of Gina Biegel’s mindfulness techniques for stressed teens method on adolescent anxiety and the disruptive symptoms that lead to high school adolescents being assigned to detention. This project described a quantitative correlational design research project that investigated a small adolescent sample size, with a goal of decreasing the number of local high school adolescent students who are repeat detention offenders, by implementing Gina Biegel’s mindfulness techniques for stressed teens method on those high school adolescents who were assigned to detention. This was achieved by collecting demographic data from …

Analyzing The Association Of Competitive Food Policy On Competitive Food Content In U.S. Schools., Mary E. Curnutte

Electronic Theses and Dissertations

OBJECTIVES: School food can have a profound effect on the population’s health. Thirty million children receive food at school and consume half their daily calorie intake at school. Competitive foods are foods sold outside of school breakfast and lunch, such as those sold in vending machines. A new ruling for Smart Snacks Standards, a set of competitive food guidelines, started in the school year 2014-2015. It is known that competitive foods undermine school lunch participation, and a decrease in school lunch consumption is associated with poorer student health. Additionally, an increase in competitive foods tends to be of nutrient-poor …

A Descriptive Study: Aging In Place In The Rural Southeastern United States, Dama G. Cooley

Electronic Theses and Dissertations

Older Americans will soon outnumber children and younger adults. In 2022, there were 58 million older adults. By 2050, older adult numbers will grow to 82 million, and by 2060, 100 million. The National Institute on Aging calls for ongoing research on the impact that a historically large aging population will have on health, well-being, and quality of life. A key concern is how to meet needs while decreasing costs associated with institutional long-term care.

Most of these elders reside in the community and wish to live in their homes throughout their lives, but they will experience an increased need …

Enriching The Pcos Lifestyle, Callie Coleman

Electronic Theses and Dissertations

Polycystic Ovary Syndrome (PCOS) is an endocrine disorder affecting approximately 4 – 20% of women worldwide. It is associated with insulin resistance, fertility problems, and an increased susceptibility to chronic conditions through multiple inflammatory pathways. Women with PCOS are also at increased risk for disordered eating. The Mediterranean diet is associated with decreased inflammation and risk of chronic conditions, and intuitive eating principles are associated with decreased disordered eating patterns. The purpose of this study was to determine if a six-week nutrition education workshop incorporating information and skills related to both the Mediterranean lifestyle and intuitive eating principles can improve …

Parental View On Hpv Vaccination, Rebecca Elaine Rhodes

Electronic Theses and Dissertations

The human papillomavirus (HPV) is a sexually transmitted infection widely seen in the United States. Millions of Americans are affected by it each year, especially those in their late teens and early 20s. Although most infections will resolve on their own, 1 in 10 will lead to health problems such as cancer. The HPV vaccine can prevent over 90% of associated precancers and cancers. However, uptake of the HPV vaccine and its completion among adolescents are significantly lower than other recommended adolescent immunizations, falling short of the Healthy People 2030 goal of 80% coverage. Understanding parental attitudes, beliefs, and perceptions …

Impact Of An Electronic Human Papillomavirus Vaccination Catch-Up Module For Women With Criminal-Legal System Involvement, Shawana Moore

Electronic Theses and Dissertations

Introduction: Cervical cancer can often be prevented with targeted strategies such as Pap smear screenings and the human papillomavirus (HPV) vaccination, now also recommended for those aged 27-45 who have not received the vaccine previously. However, women involved in the criminal-legal system often miss out on primary and secondary prevention measures and are at increased risk for the development of cervical cancer caused by HPV. Purpose: The purpose of this study was to examine the feasibility and acceptability of an electronic HPV catch-up module for women in the criminal-legal system aged 27-45. The study, guided by the Health Belief Model, …

Cost Saving And Resource Limited Public Health Interventions In Southeast Asia, Amanda Blackwelder

Electronic Theses and Dissertations

Background: Public health interventions are any activity with the objective of improving human health such as preventing or curing disease, reducing the severity or duration of a disease, or assisting in regaining function after a disease or injury. These interventions are known to be impactful; however, those living with the highest burden of disease such as individuals in low- and middle-income countries have limited money and resources to successfully implement these interventions. Southeast Asian countries are among some of the middle-income countries effected by the lack of affordable interventions. The aims of this study were to assess cost saving and …

Exploring The Lived Experience Of Self-Care In Young Adults With Type 2 Diabetes, Holly Berry-Price

Electronic Theses and Dissertations

Introduction

The prevalence of prediabetes in adults aged 18 or older was as high as 38% between 2017-2020. Youth-onset T2DM is a more aggressive phenotype than T2DM that occurs later in life. Young adults with T2DM have poorer health outcomes, lose an average of 15 years of life, all resulting in significant economic burden impacting the person. Current self-management interventions do not improve health outcomes in young adults with T2DM.

Purpose

The purpose of this research was to explore the self-care experiences of young adults living with T2DM.

Methods

Existential hermeneutic phenomenology informed the research. Inclusion criteria as follows: adults …

Exploring Influencing Factors On The Adoption Of Non-Pharmaceutical Interventions During Pandemics: Covid-19 As An Example., Ahmed Abdulmohsen I Alobaydullah

Electronic Theses and Dissertations

Background: Pandemics are associated with loss of life, hospitalizations, and disruption to people’s social and economic lives. As the 2019 pandemic illustrates, COVID-19 can be prevented by pharmaceutical and non-pharmaceutical interventions (NPIs). Recommended measures such as wearing a mask, washing hands, social distancing, and self-quarantine have been proven to curb the spread of the coronavirus. Identifying the factors associated with adherence to NPIs is the first step in understanding which levers of change to pull when designing health promotion interventions such as health communication campaigns. This dissertation explores these factors and proposes a health communication framework during pandemics. Research Questions: …

Examining The Relationship Between Mass Incarceration, Gender Norms, And Hiv Vulnerability For Formerly-Incarcerated Black Men Who Have Sex With Men And Women., Adrienne B. Smith

Electronic Theses and Dissertations

In 2018, Black Americans represented 42% of new HIV diagnoses, despite comprising only 13% of the population. Moreover, Black men accounted for three-quarters of new HIV cases in 2016, with Black gay/bisexual men contributing to the majority of incidence among Black Americans. Existing literature suggests that individual behavior alone cannot explain these racial inequities in HIV rates. This study aims to explore the role of the criminal legal system (CLS) as a structural determinant of health, given its historical racial implications that disproportionately affect Black Americans. Additionally, the study examines masculinity’s influence as a predictor of risky sexual behavior. This …

Reimaging Safety After Sexual Violence: A Qualitative Exploration Of Survivors' Experiences With Formal And Informal Crisis Response Networks., Hallie Ruth Decker

Electronic Theses and Dissertations

Sexual violence (SV) is a highly prevalent public health and human rights concern impacting communities across the United States. SV is associated with a myriad of adverse physical, reproductive, sexual, mental, behavioral, financial, and social health outcomes which may be acute or chronic. Health challenges associated with post-traumatic stress and post-traumatic stress disorder are particularly common among victims and survivors of SV. Engagement in early psychological/psychosocial intervention strategies may prevent or reduce PTSD-related symptomatology after experiencing an SV encounter. Despite the availability of crisis response and support options to support individuals who have experienced SV, significant barriers exist across social …

"They Are Who We Thought They Were": The Influence Of White Supremacist Discourse On Voter Suppression And Black Health., Tanisha Howard Lewis

Electronic Theses and Dissertations

Political systems in the United States have contributed to health outcomes in the through the historic and legal doctrine related to race and racism, segregation, housing, employment, and education. In recent years, significant attention has been given to theorizing the political determinants of health and what it means in the overall conversation about health equity. The equity implications of the political determinants of health are innumerable because they are the origin point of the structural determinants of health and the primary drivers of the social determinants of health, which span from environmental conditions to food security. The focal determinant of …

Effectiveness Of Antibiotic Stewardship For Healthcare Providers At Urgent Care Clinics, Helen T. Adewole

Electronic Theses and Dissertations

Antibiotics have revolutionized modern medicine; however, the overuse in urgent care and primary care significantly contributes to the global burden of infections resistant to available antimicrobial medicines. Approximately 30% of the antimicrobials prescribed in acute care settings are unnecessary. Patient demand for antibiotics has seemingly skyrocketed following the recent COVID-19 pandemic. Practitioners must be knowledgeable about antibiotic stewardship initiatives, such as the wait-and-see approach, to reduce antibiotic overuse and improve the trajectory of antibiotic resistance and patient health outcomes. The gap in practice was the limited awareness of scientific evidence-based tools to partner with patients and improve antibiotic prescription patterns. …

A Case Study Of The Political Determinant Of Health On The Public Health Crisis Of Malaria In Nigeria, Bisola M. Olumegbon

Electronic Theses and Dissertations

Abstract

Globally, there were about 229 million cases of malaria in 2022. The sub-Saharan African region accounted for 92% of the reported cases and 94% of deaths. Nigeria had the highest number of malaria cases and deaths, representing 27% of global cases. This scholarly project was a case study guided by the political determinants of health. Triangulation of data using thematic analysis was used to identify the political determinants of malaria in Nigeria and to understand how the concept of interaction contributes to the persistence of the disease. The analysis involved a deductive and inductive approach based on the literature …

School Nurses And The Sexual Health And Education Of Public-School Students In Tennessee, Amy Wake

Electronic Theses and Dissertations

Tennesseans have been experiencing increasing rates of sexually transmitted diseases since the year 2000. Those rates are highest among those 15- to 24-year-olds. At the same time, Tennessee policy requires the teaching of abstinence as the primary form of sexual health education and emphasized the use of abstinence-only curriculum. The school nurse represents an available resource in the Tennessee public schools. The purpose of the qualitative study was to explore, describe, and interpret the perceptions and experiences of public-school nurses from rural, suburban, and urban areas of Tennessee related to the sexual health and sexual health education of students. School …

An Educational Program To Improve African American Women’S Knowledge And Self Efficiency In Seeking Treatment For Endometrial Cancer, Lauren Elise Rosenthall

Electronic Theses and Dissertations

In the United States, there is a significant difference in the survival rate for endometrial cancer for African American women when compared to women of other ethnic groups, specifically White women. There is supporting evidence that supports that morbidity and mortality rates for endometrial cancer increase if diagnosed in later stages. There are many contributing factors to a patient receiving an early diagnosis of a disease. One of the key determinants to early diagnosis of endometrial cancer is understanding risk factors, and what symptoms require further evaluation. An educational program was developed to identify knowledge deficits in the African American …

Food Insecurity And Residential Segregation Among Adults In The United States: The National Health And Nutrition Examination Survey 2017- March 2020 Pre-Pandemic Data., Chandre' L. Chaney

Electronic Theses and Dissertations

Food insecurity is when a household has insufficient food supply due to limited economic resources. It is a public health issue that continues to persist. The health, social, and economic impact affects millions of people nationwide. Residential segregation is a primary cause of inequities and health disparities. It shapes the differences in socio-economic conditions between Blacks and Whites living in the U.S. This country is segregated across racial lines in many of our most populated metropolitan cities. Americans worship in different churches, learn in disparate schools, and live in separate neighborhoods. Residential segregation has consequences that impact the economy, professional …

Cardiovascular Disease In Central Appalachia, An Exploratory Study Of Behavioral, Community, And Patient-Centered Care Influences, Kristy Gagnon

Electronic Theses and Dissertations

The Central Appalachian region of the United States disproportionately experiences higher rates of cardiovascular diseases (CVD) and associated risk factors. Primary risk factors for CVD include hypertension, hypercholesterolemia, and tobacco use, all of which have the potential to be mitigated through lifestyle behavior changes. Dietary and physical activity practices are the two main driving forces for the development of hypertension and hypercholesterolemia, while tobacco use is a behavioral choice on its own. Subsequentially, shifting lifestyle choices to emphasize healthier living has the potential to reduce CVDs within the Central Appalachian region. Considering behavioral choices are not made in isolation and …

Key Determinants Of Using Telehealth Technologies Among Underserved Populations From The Perspective Of Patients And Providers, Johanna Cimilluca

Electronic Theses and Dissertations

Background: The utilization of telehealth has had a substantial impact on transforming and enhancing the methods by which healthcare is presently delivered. The potential benefits of telehealth in improving the health of vulnerable populations and underserved communities are substantial. The aims of this study were to examine the association between social determinants of health and patient perceptions of their experiences with telehealth. We will analyze how perceptions differ across specialization, race, gender, and other key determinants; examine how patient’s self-rated physical health and mental health influences perceptions and attitudes about telehealth utilization; and evaluate differences in perceptions and attitudes, …

Exploring Sexual And Reproductive Health Care In Central Appalachia Through The Experiences Of Transgender And Gender Non-Binary People, Chase Harless

Electronic Theses and Dissertations

Background: Transgender or nonbinary (TNB) individuals in the United States experience higher rates of sexual and reproductive health disparities when compared to their cisgender counterparts, along with lower access to care. TNB people in the south experience higher rates of disparities. Societal, interpersonal, and individual barriers contribute to these disparities in the TNB population. However, there is a paucity of research examining the sexual and reproductive health experiences of TNB people living in Central Appalachia.

Methods: An interpretive phenomenological analysis (IPA) research design was used to collect and analyze semi-structured interviews with TNB individuals living in central Appalachia regarding their …

Our Story, Our Song: Assessing And Addressing Black Women's Healthcare Experiences., Jason Deakings

Electronic Theses and Dissertations

Despite advancements in medicine and health sciences, health disparities and declining life expectancy persists among Black women in the United States. Researchers and non-traditional healthcare providers suggest alternative healing (e.g., music and Sister Circles) and research methodologies to achieve a culturally conscious, traumainformed, quality, and holistic care and practice. The intersecting identities and cultural responsibility of Black women highly influences the barriers and facilitators on the uptake of healthcare services. Utilizing a community engaged research approach, this qualitative study assessed the healthcare experiences, as well as the role of music in the lived and retold experiences of Black women navigating …

Emergency Care For Youth Who Experience Suicidality And Identify As Lesbian Gay Bisexual Transgender Queer/Questioning (Lgbtq+): An Interpretive Phenomenology, Theresa Schultz

Electronic Theses and Dissertations

Purpose: Suicide is a leading cause of death in children; youth who identify as LGBTQ+ are at an exponentially higher risk of suicide. The purpose of this study was to explore the lived experiences of young adults who identify as LGBTQ+ and sought emergency care for suicidality when they were adolescents.

Methods: Heideggerian hermeneutics phenomenology is the research method used in this study. Youth, ages 18-25 years, who identify as LGBTQ+ and sought emergency treatment for suicidality when they were adolescents (13-17 years) were recruited to participate;fifteen youth enrolled. Individuals ranged in age from 20 to 25 years. Participants described …

Respecting The Ethical Tension Between Surveillance And Privacy In Promoting Public Health And Disease Management, Kamal Althobaiti

Electronic Theses and Dissertations

The recognition of the need to undertake surveillance and to protect privacy is well established. However, the continually changing circumstances and fast-paced development of healthcare today requires a continuing need to respect this ethical tension between surveillance and privacy. Hence, this dissertation is to respect the ethical tension between surveillance and privacy in promoting public health and disease management. This dissertation investigates the ethics of conducting public health surveillance, including the challenges associated with obtaining consent and protecting data from unauthorized access. The dissertation will focus on the ethical consequences of big data, including issues associated with obtaining informed consent, …

Addressing Stress In Graduate Nurse Practitioner Nursing Students, Shandria K. Sawyer

Electronic Theses and Dissertations

This project was developed to address the issue of high stress levels among graduate nursing students, which is a common phenomenon that increases the risks of mental health disorders, professional burnout, and poor-quality patient care among students and professional nurses after earning their degrees. This project sought to utilize a simple educational intervention delivered online to impart coping skills to graduate nursing students to assist them in reducing their stress levels. The intervention was a brief, single-session, self-guided educational module featuring informational and participative elements related to stress causes, the impacts of stress, and stress reduction techniques. In total, 11 …

“…You Can't Unknow It, It's A New Reality": A Case Study Exploring A Social Justice Public Health Intervention's Impact On Critical Consciousness Development In Youth., Monique Williams

Electronic Theses and Dissertations

Even though public health purports to be rooted in social justice, it is not clear how social justice frameworks are integrated in public health research and intervention. The discipline focuses on groups/populations on the margins, without integrating the social and political factors that cause marginalization into the intervention. Seeing communities, and individuals, as assets and experts in their own experiences is key to population-level health improvement. Particularly for public health youth intervention, how youth are labeled and engaged in social change is critical to their healthy development. While public health lags in practically applying asset-based approaches to youth intervention, research …

Overview Of Transition Care Clinics And Patient No-Shows, Manul Awasthi

Electronic Theses and Dissertations

Introduction

Transition care clinics (TCCs) have proven to be effective in meeting the time-sensitive needs of patients in the post-discharge period and ensuring smooth transitions of patients from hospital to home. These clinics have led to lower readmissions, lower emergency department visits, cost savings, and lower rates of other adverse events following discharge. However, TCCs, including the East Tennessee State University Family Medicine (ETSU-FM) TCC have been facing high rates of patient no-shows.

Aim

The aim of this dissertation is to identify the different components and outcomes of TCC based on the literature. We further aim to analyze the TCC …