Department of Medicine, Health, and Society Honors Theses

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Browsing Department of Medicine, Health, and Society Honors Theses by Title

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    An Analysis on Mental Illness and Substance Use among Justice-Involved Individuals: Insights from the National Survey of Drug Use and Health
    (2021-04) Ramakrishnan, Abinaya
    Importance: Although prior research has documented higher rates of incarceration among sexual minorities, little research has examined the intersections of the justice-involved and sexual minority populations. Research is needed to better understand the health needs of justice-involved sexual minorities to make informed policy and public health measures. Objective: To examine the prevalence of mental illness, substance use, and access to treatment among sexual minorities who have been involved with the criminal justice system. Design, Setting, Participants: This retrospective analysis used data from the 2015-2019 National Survey on Drug Use and Health. We conducted multivariable logistic regression to assess the relationship between sexual minority status and criminal justice involvement with mental illness, substance use disorder (SUD), and access to treatment among US adults. Main outcome and measures: Substance use (alcohol, inhalant, hallucinogen, sedative, pain relievers, heroin, cocaine, marijuana, and tranquilizer misuse), severity of mental illness, suicidality, mental health treatment (inpatient, outpatient, prescription), and SUD treatment for individuals based on sexual minority status and criminal justice involvement. Results: Approximately 10% of justice-involved individuals identified as sexual minorities. Among justice-involved individuals, sexual minorities were more likely to have a serious mental illness, suicidal ideation, depressive thoughts, and to use the following substances: inhalants, hallucinogens, alcohol, marijuana, and cocaine. Justice-involved sexual minorities were also more likely to have access to mental health and SUD treatment than their heterosexual justice-involved peers. The increased probability of receiving treatment for mental illness and substance use was also observed when comparing heterosexual and sexual minorities who were not involved with the criminal justice system. Conclusions and relevance: This study provides new population-based research to a limited body of evidence on the health disparities and mental health needs of justice-involved sexual minority populations who may face additional stressors and discrimination. More research and programmatic interventions are needed to better support justice-involved sexual minorities in order to achieve mental health equity for this vulnerable population.
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    ANALYZING SOCIAL MEDIA NARRATIVES OF MATERNAL MORTALITY
    (2021) Joshua, Kaitlin
    The purpose of this study was to investigate agenda-setting activity relevant to maternal mortality by using social media data. The study ultimately sought to determine what subset(s) of social media users dominate conversations of maternal mortality online, and did so by interrogating (1) who discusses maternal mortality online and (2) what narratives of maternal mortality are present among their conversations. To address my research objectives, I utilized the marketing software Brandwatch to amass a database of relevant tweets authored within the past two years, using key phrases and hashtags to isolate data relevant to the American maternal mortality crisis. In my analysis, I engaged several Brandwatch functions, including demographic comparison tools, world cloud analyses, and topic wheels, as well as my own line-by-line content analysis of some of the most popular tweets. Between December 2019 and January 2021, I found approximately 34,000 relevant tweets, among which “women,” “rate,” “health,” and “healthcare” were the most-used words. Ultimately, my findings indicate that a particular narrative’s popularity was significantly associated with the professional affiliations of frequent and/or influential posters. They also indicate that maternal mortality is often framed as being one of several “measuring stick” issues meant to denote a certain set of political, or even moral, beliefs and/or affiliations. This research has implications not only for politicians who may wish to communicate about health issues with their constituents using social media platforms, but also for any organizations, activists, advocates, or unaffiliated individuals who wish to influence health-related discussions online.
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    Animal-Assisted Interventions for Children with Advanced Cancer: The Impact of Canines on Stress
    (2020) Brisman, Rebecca
    Children and the families of children with advanced cancer are at an increased risk of experiencing stress and anxiety, and this can be especially heightened during hospital visits. While there is extensive literature on the positive effects that animal-assisted interventions (AAI) have on the stress levels and quality of life of humans, there is little data indicating the effects that AAIs have specifically on children with advanced cancer and their families. Using a randomized control design, this study examines the effects that AAI sessions have on children with advanced cancer through a number of qualitative and quantitative methods. This research paper specifically explores the impact that AAIs had on the participants by analyzing end of study interviews. The results reveal that participants experienced a significant reduction in stress and anxiety levels, an increased willingness to go to the hospital, and an improvement in communication between the child and caregiver. Furthermore, the results showed that the effects of the AAIs were not impacted by whether or not the participant had a pet at home.
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    Asian American Mental Health During the COVID-19 Pandemic
    (2021-04-27) Kim, Iris
    COVID-19 introduced a slew of pandemics, not only in a global response to health crises, but also in the realm of racial justice and socioeconomic disparities. For Asian Americans, the virus unveiled a perpetuation of hate crimes and racial “othering,” elements that impact the mental health of Asian and Asian American individuals. A review of the literature reveals that the current rise in anti-Asian racism is not a new concept, but rather is based in a longstanding history of scapegoating onto minority groups in times of crisis. Consequently, the external context of pandemic racism integrates with cultural and social values that uniquely shape the current landscape of Asian American mental health, factors that range from family and generational status to education and religion. This study analyzes the thematic findings from ten qualitative interviews conducted with Asian American students and mental health professionals, producing integrative questions on the future direction of existing mental health programs and resources for Asian Americans.
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    Cancer Screenings in LGBTQ+ Population: Evidence from the VUSNAPS Study, 2021-2022
    (2022-04) Min, Judy Kyung
    Background Preventive healthcare screenings and tests aid the process of diagnosing and improving one’s overall health by identifying a disease before symptoms are felt or seen by an individual. Within preventive healthcare, cancer screenings play a fundamental role as cancer remains one of the leading causes of death within the United States. Although cancer screenings aid in the process of treating cancer early, there are barriers to care that concern the population of LGBTQ+ individuals. The purpose of this honors thesis is to bring awareness to certain cancer screenings, like breast, cervical, and colorectal cancer, and the factors that may influence access to screenings and care, such as anti-LGBTQ+ policies and legislations, discrimination, access to LGBTQ-affirming healthcare providers, and etc. Furthermore, this paper will touch on how certain aspects of access to care facilitate older LGBTQ+ access and engagement in cancer screenings that are appropriate for their age and gender. Methods Quantitative data obtained from the Vanderbilt University Social Networks, Aging, and Policy Study (VUSNAPS), which identified information on relationships, aging, and health for LGBTQ+ individuals in the South, was used to find comparative data concerning access to preventative care tests or screenings as well as access to LGBTQ-affirming health care providers. The study was conducted on the LGBTQ+ population in order to better understand the relationships and to further gauge how crucial life events, such as marriage, jobs, retirement, illness, and relocation, can impact relationships in terms of physical and emotional support. The data was collected from April 2020 to September 2021 from participants who are within the age range of 50 to 76 from Alabama, Georgia, North Carolina, and Tennessee. These participants were recruited through community outreach at LGBTQ+ organizations and events as well as through social media. Results The results of this study using the Vanderbilt University Social Networks, Aging, and Policy Study (VUSNAPS) Wave 1 data demonstrate that compared to the participants reporting a usual source of the care that was not LGBTQ-affirming, participants with an LGBTQ+ affirming provider were more likely to have ever and recently engaged in preventive care. For the colorectal screening in lifetime, those who had access to an affirming provider were more likely ever to have a colorectal cancer screening (81.9% compared to the 73.8%). However, there were no observed significant differences between having an affirming provider in the timely and lifetime receipt of the Pap Smear for cervical cancer and the mammogram screenings for breast cancer amongst women and transgender women. Conclusion/Implications It is important to determine these significant relationships as there is a lack of LGBTQ+ research that currently exists as well as a need for better education for LGBTQ+ medicine in order to address these health disparities that do exist as well as to improve the health outcomes of the aging LGBTQ+ population.
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    Cervical Cancer Screenings in Sexual and Gender Minority Individuals: Evidence from the Behavioral Risk Factor Surveillance System, 2018-2019
    (2021-04) Mosca, Lindsay
    Background: The rate of new cervical cancer cases and cervical cancer deaths in the United States has declined in the last fifty years due to the widespread use of cervical cancer screenings known as Papanicolaou (Pap) tests. Sexual minority women, or women who identify as lesbian, bisexual, queer or otherwise have sex with women, may be less likely to receive Pap test screenings than heterosexual women. Other studies that have been conducted on sexual minority women do not consider the intersection of sexual orientation and gender identity. This study examined sexual orientation disparities in Pap test screenings among cisgender women as well as individuals assigned female at birth with a cervix who identify as transgender (female-to-male, FTM), or gender nonconforming. Methods: This study used data on adults aged 18-64 years who self-responded that their sex assigned at birth was female (n = 147,840) from the 2018 and 2019 Behavioral Risk Factor Surveillance Survey. We used descriptive statistics and logistic regression models to examine the associations between sexual orientation and Pap test use in the previous three years. All analyses were conducted in Stata. Results: Individuals who reported that their sex at birth was female and identified as gay or lesbian were less likely to have had a Pap test in the last three years compared to heterosexual individuals (OR, 0.75; 95% CI, 0.55-0.99). Individuals who responded “something else” when asked about their sexual orientation were less likely to have had a Pap test in the last three years compared to heterosexual individuals (OR, 0.67; 95% CI, 0.48-0.83). Transgender (FTM) individuals were less likely to have received a Pap test in the last three years compared to cisgender women (OR, 0.55; 95% CI, 0.31-0.98). Gender non-conforming individuals were also less likely than non-transgender individuals to have received a Pap test in the last three years, but these results were not significant (OR, 0.90; 95% CI, 0.45-1.82 for gender non-conforming). Conclusions/Implications: All individuals with a cervix are at risk of cervical cancer, regardless of their sexual orientation or gender identity. Sexual orientation and gender identity disparities in sexual and reproductive health services demonstrate a need to reconsider the way in which these services are provided. Our study found that some SGM individuals were less likely to be compliant in Pap test screenings than non-SGM individuals. Further research should be done to conclude the impact of sexual orientation and gender identity on Pap test screening compliance.
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    Changes in College Students’ Perspectives on Abortion
    (2024-04-22) Chang, Anna; Chang, Anna
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    CHARACTERISTICS OF VOCAL INTERACTIONS BETWEEN PARENTS AND CHILDREN WITH AUTISM SPECTRUM DISORDER IN RELATION TO HIERARCHICAL TEMPORAL CLUSTERING
    (2021-04) Zhang, Yumeng
    The current study explores the vocal interactions of parents and children with and without Autism Spectrum Disorder (ASD) through a novel measure of hierarchical acoustic clustering in order to better understand the specific characteristics of parent and child speech that differ within ASD communication. Interactions between the parent and child were video-recorded and coded for the frequency and timing of parent and child vocalizations. To measure hierarchical temporal clustering, audio recordings of the dyadic interactions were analyzed across twelve timescales ranging approximately from the phoneme-level scale to the phrase-level scale and quantified using Allan Factor (AF) variances. There were three main findings of the study. First, significant relationships were found between frequency of interpersonal turns and ASD toddler language and developmental assessment scores. Second, ASD dyads exhibited significantly greater hierarchical temporal clustering compared to TD dyads. Third, the vocal characteristics which most correlated with hierarchical clustering in ASD dyads were frequency of total vocalizations and turn-taking, particularly when considering total interpersonal turns and total turns. These findings call attention to the importance of turn-taking in communication, and the reduced quality of turn-taking in interactions of parents and children with ASD.
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    Controversy Over the Diagnosis and Treatment of Hypothyroidism
    (2021-04) Schwartz, Lana
    This study surveys clinicians’ hypothyroidism diagnosis and treatment practices and their opinions on current diagnostic standards. By distributing a redcap survey, the study ascertained whether practicing clinicians disagree with each other, where they stand on the debate over appropriate standards, and which standards they apply in practice. The survey garnered participants’ opinions on seven primary aspects of hypothyroidism: organizations’ differing recommendations, arguments for changing the standards, which thyroid hormones are worth testing, which ranges of thyroid hormones are appropriate, the psychosocial effects of the condition, their experience with clinical disagreements in practice, and their confidence in current standards. After asking for their opinions on these topics, participants were presented with nine fictional patient cases. Each patient case presented a fictional patient’s age, BMI, thyroid hormone levels, and symptoms. Participants were asked to indicate whether they were “very likely,” “likely,” “moderately,” “unlikely,” or “very unlikely” to diagnose the hypothetical patients. The survey was distributed to 750 healthcare providers, including endocrinologists, GPs, PAs, and NPs that practice in the United States. 48 practitioners responded. The results of the survey indicated that clinicians consistently and drastically disagree over diagnostic and treatment standards for hypothyroidism. Clinicians recommended testing for different hormones, indicated different healthy ranges of hormones, sided with opposing organizations, valued the psychosocial effects of the disease differently, and indicated varying levels of confidence in modern standards. Notably, practitioners’ likelihood of diagnosing and treating the fictional patients varied drastically. Qualitative responses provided the study with reasons for their answers. The qualitative results illustrated the polarizing nature of the disagreements; some practitioners deem clinicians of opposing opinions as committing “malpractice.” In conclusion, current standards are not unambiguous enough to create near-unanimous agreement among clinicians regarding the diagnostic threshold.
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    Determining how Legislators and Media Sources portray Health Issues
    (2021-04-27) Deepak, Aditi
    This thesis examines the relationship between law and the media by looking at two important and politicized health issues, abortion and HIV/AIDS, in New York and Tennessee. In order to achieve this goal, legislative discussion and media articles were dissected using MAXQDA and results were analyzed using Excel. Results demonstrated that abortion and HIV/AIDS differ in how they are portrayed in state legislatures and media sources. My findings show that abortion is a highly opinionated topic that struggles with scientific legitimacy due to the political domination of abortion frames while HIV is considered more of a scientific issue but struggles with stigma. The results also show that, based on the topic, media sources vary in the extent to which they follow the frames and biases perpetuated by partisan politics. Overall, this thesis sheds light on the relationship between legislators and media journalists and between abortion and HIV/AIDS.
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    The Effect of Ownership on Length of Stay and Total Charges for Hospital Inpatient Substance Abuse Treatment
    (2016-04-29) Hill, Anna
    The purpose of this study is to determine if hospital ownership has an effect on economic factors and quality outcomes related to inpatient substance abuse treatment. The study examines these factors through analyzing the effect of ownership on length of stay and total revenue charges for inpatient substance abuse treatment provided at hospitals in Florida. Hospital inpatient data were collected from the Florida Agency for Health Care Administration. Two multiple regression models were used to compare the effect of ownership, along with other patient factors, on length of stay and total revenue charges. Overall, three key conclusions were made. First, for-profit hospitals charged substance abuse patients more for inpatient care than non-profit hospitals. Second, patients treated in for-profit general hospitals stayed fewer days and received higher charges than patients treated in non-profit general hospitals. Lastly, Medicare patients stayed more days and received higher charges than patients with other types of payers in both facilities, but this trend was stronger in for-profit hospitals. This study concludes that, while hospital ownership results in economic differences in care, the measure of quality of care is inconclusive. It is important that further information is collected to understand the difference in the quality of care provided at non-profit and for-profit hospitals.
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    The Effect of Ownership on Length of Stay and Total Charges for Hospital Inpatient Substance Abuse Treatment
    (2016-04-29) Hill, Anna
    The purpose of this study is to determine if hospital ownership has an effect on economic factors and quality outcomes related to inpatient substance abuse treatment. The study examines these factors through analyzing the effect of ownership on length of stay and total revenue charges for inpatient substance abuse treatment provided at hospitals in Florida. Hospital inpatient data were collected from the Florida Agency for Health Care Administration. Two multiple regression models were used to compare the effect of ownership, along with other patient factors, on length of stay and total revenue charges. Overall, three key conclusions were made. First, for-profit hospitals charged substance abuse patients more for inpatient care than non-profit hospitals. Second, patients treated in for-profit general hospitals stayed fewer days and received higher charges than patients treated in non-profit general hospitals. Lastly, Medicare patients stayed more days and received higher charges than patients with other types of payers in both facilities, but this trend was stronger in for-profit hospitals. This study concludes that, while hospital ownership results in economic differences in care, the measure of quality of care is inconclusive. It is important that further information is collected to understand the difference in the quality of care provided at non-profit and for-profit hospitals.
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