Medicine and 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 …

“Better Late Than Never” – Exploring The Challenges And Triumphs From Late-Diagnosed Autistic Women, Angela C. Altomare

Electronic Theses and Dissertations

The diagnostic process for adult autistic women is a transformative experience that reshapes identity, their histories, and self-understandings. This study examines the impact of a late-in-life autism diagnoses on women through the examination of narratives from the Reddit community r/AutismInWomen, and autoethnography.

Drawing on personal experience as a late-diagnosed autistic researcher, and the shared stories within r/AutismInWomen, the research demonstrates the challenges experienced, such as navigating stigma, negotiating identity, and seeking support.

The research reveals that online platforms serve as critical spaces for stigma negotiation, identity validation, self-advocacy, and community building among autistic women. Furthermore, these narratives underscore …

Hiv And Sti Testing Service Utilization Among Youth Experiencing Homelessness: A Multi-Method Inquiry, Alexander A. Ochs

Electronic Theses and Dissertations

Youth experiencing homelessness (YEH) face disproportionately high risk for HIV and sexually transmitted infections (STIs), yet rates of testing remain low. This dissertation examines the individual and social network level factors that influence HIV/STI testing behaviors among YEH. Guided by insights from multiple theoretical frameworks, this three-paper dissertation integrates quantitative and qualitative approaches to better understand how personal relationships and social context shape HIV/STI testing decisions in this population.

Paper 1 presents a secondary data analysis of the Homeless Youth Risk and Resilience Survey (HYRRS), which includes 1,426 YEH across seven U.S. cities. Logistic regression models identified geographic variation in …

Unveiling Emergency Psychiatric Healthcare Disparities: An Analysis Of U.S. Emergency Department Encounters., Anna Elizabeth Kelecy

Electronic Theses and Dissertations

This thesis seeks to uncover emergency psychiatric healthcare disparities by examining data of emergency departments from the National Hospital Ambulatory Medical Care Surveys, years 2020 and 2021. The two outcome variables are the length of stay in the emergency department and the urgency with which a patient should be seen. There are multiple independent variables that are analyzed, including age, residence, sex, race/ethnicity, pay type, region, and metropolitan statistical area status. The results indicate that there are disparities, especially in terms of race/ethnicity, region, and metropolitan statistical area status for each dependent variable. These findings indicate that there may be …

Comparison Of Self-Reported Depression And Anxiety Scores Between U.S. Households With And Without Children At Early And Later Stages Of The Covid-19 Pandemic, Hanan Mohammed Eissa Jamali

Electronic Theses and Dissertations

Parents in particular, are disproportionately affected by the 2019 coronavirus pandemic and the lockdowns that followed. Parents had to find a way to balance work, teaching, and taking care of their kids when schools were forced to close for safety reasons. While changes in parents' mental health have been the subject of a number of studies, there have been no studies comparing the level of depression and anxiety experienced by parents with and without children below the age of 18 years in the United States. Data for this study came from Households Pulse Survey (HPS) (week 2 N = 41,996; …

Examining Effective And Realized Healthcare Access In The West South Central Division., Katherine Cameron

Electronic Theses and Dissertations

This study explores realized and effective access domains outlined by Andersen’s Behavioral Model of Health Services Use. Exploring other domains of access is critical to understanding how the healthcare system functions (Kirby & Yabroff, 2020). This study evaluates rural-urban and racial/ethnic differences in access to care using two underresearched domains of healthcare access. It also allows for exploring access disparities within rural communities amongst minority populations. This dissertation is divided into five chapters. Chapter One provides an overview of health disparities and inequities and a brief overview of the study. Chapter Two details a high-level history of racism and its …

Our Bodies, Our Stories: Mental And Physical Self Connection As A Protective Factor In Sexual And Gender Minorities, Emerson A. Todd

Electronic Theses and Dissertations

The mind and body connection has been actively examined in neuroscience and developmental psychology backgrounds. Sociological theorists posit ways that individuals develop a sense of self through mind, body, and the social world. While research on the connection between the mind and body in disabled and aging populations is common, less is known of the everyday impact of these connections for other minority populations. The present study uses mixed-methods research to explore the relationship between mind and body and the impacts on internal and social life. The quantitative aspect of the study found significant relationships between physical and mental health …

Public Health Contagion Of White Supremacy: Examining The Pipeline Of Attitudes About Racism And Racial History Education Among High School Students., Trinidad Jackson

Electronic Theses and Dissertations

We are living in compounded states of upheaval. Violence and exemption from it across socioecological levels have shaped how humans survive, thrive, and die. While different violence typologies exist, the U.S., prioritizes interpersonal violence as its primary target of intervention, often through structural means that foster and reinforce interpersonal violence. The omission of structural and cultural agents and outcomes of violence allows perpetrators to infiltrate and reproduce savage, dehumanizing ideologies in perpetuity. Instead of sustaining societal pillars that oppress and destroy, we must fertilize public health research, practice, and sociopolitical activism with pillars that both inform and activate liberatory consciousness …

The Intersection Of Traumatic Brain Injury And Homelessness, Stephanie A. Chassman

Electronic Theses and Dissertations

The rates of TBI are significantly higher among individuals experiencing homelessness compared to the general population. Up to half of individuals experiencing homelessness may have a TBI. Accurate prevalence rates of TBI among individuals experiencing homelessness are difficult to obtain due to different methods of sampling participants and differing definitions of TBI; therefore, estimates may be underrepresented. Despite past research that has examined the relationship between TBI and homelessness, there are specific gaps in knowledge such as correlates and risk factors of TBI among individuals experiencing homelessness. This three-manuscript dissertation attempts to address these gaps in knowledge.

The first manuscript …

Self-Reported Health Among Sexual Minorities In The United States, Christopher Burton

Electronic Theses and Dissertations

Previous literature on LGBTQ+ people (lesbian, gay, bisexual, transgender, queer/questioning, and other sexual minorities) reports that this community experiences greater health problems than heterosexuals. LGBTQ+ people experience higher rates of chronic conditions, STIs, addiction, poor mental health, and cancer, which highlights the importance of capturing data regarding health. A growing concern is that social surveys fail to find meaningful ways to gather gender and sexuality data to understand possible health disparities for LGBTQ+ people. This study uses data from the General Social Survey to examine the physical and mental health outcomes of LGB people compared to straight people in a …

The Social Determinants Of Diabetes And Coronary Heart Disease In South Asian American Immigrants, Mishal Ayaz

Electronic Theses and Dissertations

An astounding 20% of South Asian Americans have diabetes (Matthews and Zachariah 2008). Conventional risk factors for coronary heart disease includes: age older than 65, sedentary lifestyle, cigarette smoking, hypertension, elevated low-density lipoprotein (LDL), cholesterol, and type 2 diabetes, all factors beyond health care (italicized for emphasis) (Mathews and Zachariah 2008). But conventional risk factors alone are not sufficient to predict the alarmingly high rates of coronary heart disease (“CHD”) for South Asian Americans. In fact, the only conventional risk factor more prevalent in this community than others is diabetes. So, the question remains, what factors are contributing to the …

Estimating The Impacts Of Acculturation On The Health Of Immigrants In The United States, Tingting He

Electronic Theses and Dissertations

The growth in the immigration population in the U.S. has transformed American demographic profile and has led to magnification in health disparities in the United States. The main purpose of this dissertation is to examine the relationship between acculturation and health behavior, mental health outcomes, and access to health care service among immigrants in the U.S. Relying on the acculturation framework, the dissertation intends to increase the understanding of health disparities and health patterns among immigrants. The dissertation utilizes the secondary data from National Health Interview Survey (NHIS) data to examine the effects of acculturation on health of immigrants. Measures …

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

Electronic Theses and Dissertations

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

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

Effective Design Features For The Management Of Behavioral Health Patients In General Emergency Departments Of Hospitals, Rheena Ware Luchansky

Electronic Theses and Dissertations

This study investigated nursing staff members perspectives of their existing Emergency Department (ED) and their ability to care appropriately for behavioral health patients within the environment. The study involved three rural hospitals in eastern Texas that may not always have the proper resources to care effectively for this vulnerable patient population. The researcher administered a paper-based survey utilizing a Likert-scale response system to nursing staff across all facilities and received participation from 56 respondents. Survey questions were designed to investigate the current ED environment and identify design features available to assist with caring for behavioral health patients. Data gathered revealed …

Correlates Between Childhood Trauma And Reproductive Health Behaviors Among Women In Appalachia, Haley Metcalf

Electronic Theses and Dissertations

The lasting effects of childhood trauma into adulthood have been well corroborated by research from a variety of sources. Previous research has found a vast number of psychological, behavioral, and health related outcomes that are negatively affected by victimization in childhood. This piece strives to assess the correlates between childhood trauma and adult reproductive behavior and well-being for women living in Appalachia. The NCIPC has found that residents of Appalachia are at higher risks for both experiencing childhood traumas and poor health outcomes (2017). To create long-term positive reproductive health behaviors among Appalachian women, it is essential to examine how …

Understanding The Relationship Between Perfectionism And Health: Mediational Effects Drug Use, Sarah Nelsen

Electronic Theses and Dissertations

Past research has provided evidence on the consequences of perfectionism. One particular consequence of perfectionism is that of general health. Research has suggested that perfectionism type influences general mental health. Using the 3-cluster perspective of perfectionism by Slaney, Rice, Mobley, Trippi, & Ashby (2001), the current work investigates the mediating effects of drug use on the relationship between perfectionism clusters and general mental health, in the context of Conservation of Resources Theory (COR; Hobfoll, 1989). Adaptive perfectionists had higher general mental health compared to non-perfectionists and maladaptive perfectionists. However, the three clusters of perfectionism did not differ in drug use …

The Core Relation Between Hospitality (Philoxenia), Dignity And Vulnerability In Orthodox Christian Bioethics: A Contribution To Global Bioethics, Rabee Toumi

Electronic Theses and Dissertations

In a pluralistic world, reaching consensus in matters of bioethics has proved to be difficult, especially with the political polarization that nurtures inimical differences. This dissertation argues that a middle ground can be identified between the plurality of value systems in contemporary bioethics based on an anthropological approach. This middle ground that reflects commonalities of the human condition can be explored in relation to the foundational principles of Orthodox Christian anthropology. To identify this middle ground the analysis discusses the core relation between hospitality, dignity, and vulnerability as a contribution to global bioethics.

In general, based on Orthodox Christian theology …

Moving Mountains : A Study Examining Long-Term Impacts Of Mountaintop Removal Coal Mining On Mortality In The Appalachian Region Using Geographic Information Sciences Techniques., James Howard Kent Pugh

Electronic Theses and Dissertations

Over the last hundred years, the Appalachian region has been dominated by the coal industry. It has also been and currently is one of the unhealthiest regions in the United States. Recent scholarship has examined the relationship between coal mining and health and mortality rates in the Appalachian region. The first study incorporates air quality and pollution data to examine if coal mining counties have higher levels of pollution and if this pollution contributes to mortality disadvantage. In the second study, I construct a population-based coal-exposure measure to better evaluate the relationship between coal mining and health I find that …

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

Electronic Theses and Dissertations

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

Identity Theory And Women’S Choice Of Medical Specialty, Kelli A. Rolfsmeyer

Electronic Theses and Dissertations

The purpose of this study was to answer the research question: Does a self theory of social action account for female physicians’ perceptions of past choice of specialty? Perceptions of self changed as she prepared herself to become a physician. During her medical training, a medical student gains a better sense of who she is as a person who will become a doctor. The ability to act back on one’s self, called selfreflexivity, is the mechanism involved in the transitions of a physician’s biographical self. The data for this study was collected through interviews centered on questions chosen from the …

From Quackery To Control: Perceptions Of Complementary And Alternative Medicine From Users With Mental Health Disorders, Rachael Welsh Allen

Electronic Theses and Dissertations

This study is an investigation into why people with depression and anxiety use complementary and alternative medicines at higher rates than the general population. The study examines perceptions of mental illness and meanings assigned to depression and anxiety, others’ perceptions of mental illness, and experiences with conventional medicine. All participants were using complementary and alternative medicine at the time of the study; their reasons for CAM use as well as how CAM affected perceptions of their illness were main research questions. I conducted three focus groups with individuals diagnosed with depression who were using complementary and alternative medicine as forms …

Rural Appalachian Health Care Providers' Perceived Barriers To Intimate Partner Violence Screening In Primary Care, Jamie Tedder

Electronic Theses and Dissertations

Intimate Partner Violence (IPV) is a major problem in the United States. There are many health concerns associated with IPV (e.g. chronic pain, gynecological problems), leading researchers to examine the detection and management of IPV in primary care settings. However, a disproportionate amount of this research has focused on the detection and management of IPV in urban primary care clinics, with the detection and management of IPV in rural primary care being largely understudied. The current study addresses this gap in the literature by describing the screening practices and barriers to screening reported by rural providers as well as differences …

Free Clinics And The Uninsured: The Need For Remote Area Medical In Central Appalachia After Health Reform., James W. Watson

Electronic Theses and Dissertations

In 2008, the election of President Barack Obama brought health care to the forefront of national discussions and led to the passage of the Patient Protection and Affordable Care Act (ACA). The legislation changed the rules of health care delivery in the United States, but the ACA did not do one fundamental thing: It did not end the need for many of the nation's most needy patients to seek free medical care from groups such as Remote Area Medical (RAM).

A mobile clinic, RAM brings together volunteer dentists, physicians, nurses, and other professionals as well as support staff for multi-day …

Rural Parents Mental Health Service Delivery Preferences: Overcoming Barriers To Care., Jeffrey H. Ellison

Electronic Theses and Dissertations

Unique barriers prevent parents in rural areas from seeking mental health services for their children. The implementation of innovative models of service delivery may reduce these barriers' impact on rural parents' treatment seeking.

The purpose of this study was to determine: 1) parents' willingness to use innovative service delivery models; 2) barriers that parents perceive to seeking treatment in each of the 4 service delivery models, and; 3) the relationship between perceived barriers and willingness to seek help in the context of 4 service delivery models.

Surveys were distributed to parents of children attending school in several counties in rural …

"Knowing Where I Am At": The Experience Of Self-Monitoring Blood Glucose For People With Non-Insulin-Requiring Type 2 Diabetes., Dana Elisabeth Brackney

Electronic Theses and Dissertations

Eleven participants living with non-insulin-requiring Type 2 Diabetes (T2DM) discussed their self-monitoring blood glucose (SMBG) experience. All had been recently diagnosed (< 2 years) and treated for diabetes with a self-regulating SMBG guideline for primary care practice. Their digitally-recorded interviews and photographed logbooks were analyzed thematically and interpreted through the lens of numeracy literature to answer 2 questions: 1. What is the meaning of SMBG among people with non-insulinrequiring T2DM? 2. How do people with non-insulin-requiring T2DM perceive the function of SMBG in diabetes self-management? The meanings of SMBG were patient competence, "It is easy, just a little pin prick"; patient control, "I can control it. It doesn't control me"; and patient security, "It is not that way anymore." Three periods of lived time were observed: Diagnosis "The numbers say I have diabetes"; "I just can't figure out why it does that"; and Routine "I make my numbers." Prominent numeracy functions emerged by time period. During Diagnosis primary numeracy functions included comparing SMBG results to target values. Participants expressed this experience as, "I am some kind of O.K." During applied numeracy functions included taking medication correctly. SMBG readings were experienced as a clue to the diabetes mystery, sometimes confusing the participants, "I just don't …

Family Income, Maternal Marital Status, Maternal Employment, And The Development Of Overweight And Obesity During Childhood., Shaoqing Gong

Electronic Theses and Dissertations

This study examined the longitudinal associations of family income level, maternal marital status, and maternal employment with body mass measurements and the development of overweight and obesity. Multiple linear and logistic regressions were used to assess the effects of the exposure variables on weight status with simultaneous adjustment for the exposure variables and the covariates. Key findings include: Children in families with incomes below the poverty line at child's 24 or 54 months of age were at a higher risk of becoming overweight and obese at child's third grade than children in families with incomes above the poverty line; longer …

Surviving Cancer In Appalachia: A Qualitative Study Of Family Cancer Communication And Changing Personal Identities Through The Cancer Journey., Kathryn L. Duvall

Electronic Theses and Dissertations

The Appalachian region is known for its beautiful mountains, close-knit communities, and health care disparities including higher rates of cancer and premature mortality. Being diagnosed with cancer in the region may present a unique experience for survivors in regards to family cancer communication and changing personal identities. In a multiphasic study, the stories of 29 female Appalachian cancer survivors were collected through either a day-long modified story circle event (n=26) or an in-depth interview (n=3). Qualitative content analysis was used to identify emergent themes in the data. The analysis revealed 5 types of family cancer communication and five barriers to …

Police Stress: An Examination Of The Effects Of Stress And Coping Strategies., Derrick Kenwright

Electronic Theses and Dissertations

How police officers deal with stress greatly affects how they carry out their daily lives and how they treat family and friends. In this study 2 police departments were issued surveys to see how the police officers experienced stress. Questions on the survey asked the officers about the sources of stress, sources of support, and which methods they used to alleviate the stress. The surveys were given to the respective departments over a period of 2 months, and 132 surveys were returned. The statistical analysis performed showed danger was a factor when examining stress. Administration support was found to be …

Evaluating Satisfaction And Benefit Of Nutrition Counseling Provided By A Registered Dietitian Among Cancer Patients Receiving Radiation Therapy., Bethany A. Stuart

Electronic Theses and Dissertations

The purpose of this study was to determine if patients with cancer receiving radiation therapy were satisfied with the nutrition counseling they were receiving and if they obtained any benefit. Radiation increases the risk for side effects such as taste changes, chewing/swallowing problems, constipation, diarrhea, nausea, and vomiting. When these side effects are present, a decrease in food and fluid intake occurs, which leads to weight loss, increased risk of morbidity and mortality, as well as decreased quality of life. Subjects were recruited from a regional cancer treatment facility and a survey was administered to those who met criteria. Subjects …

The Impact And Efficacy Of Diabetes Education Programs Among Adults., Mireille Hamdan

Electronic Theses and Dissertations

The purpose of this study was to measure the impact of diabetes education classes in increasing knowledge and promoting healthy lifestyle behaviors. Thirty-three subjects participated in the classes between October 2004 and October 2005. Only six subjects agreed to participate in this study. Changes in knowledge after the classes were measured by a survey test one year following the completion of classes. Survey responses were analyzed using percentages. Subject's Hgb A1C and weights were also collected to measure the direct impact of education on participants' blood glucose management. Overall, participants were very knowledgeable of diabetes symptoms, complications, carbohydrate counting, and …