Search

Background: Central to effective public health policy and practice is the trust between the population served and the governmental body leading health efforts, but that trust has eroded in the years preceding the pandemic. Vaccine hesitancy among adults is also a growing concern across the United States. Recent data suggest that the trustworthiness of information about the coronavirus 2019 (COVID-19) vaccine was a larger concern than the vaccine's adverse effects or risks., Objective: This study aims to describe the methods used to create a public health microinfluencer social media vaccine confidence campaign for the COVID-19 vaccine in underserved Tennessee communities. A secondary objective is to describe how the Social-Ecological Model (SEM) and Social Cognitive Theory may address vaccine hesitancy using community pharmacies., Methods: In late 2020, 50 independent community pharmacies in underserved communities across Tennessee were involved in a public health project with the State of Tennessee Department of Health and the University of Tennessee Health Science Center College of Pharmacy. The project involved a 3-pronged, pharmacy-based COVID-19 vaccination outreach project, including (1) social media messaging (i.e., microinfluencer approach), (2) community partner collaboration, and (3) in-pharmacy promotion. Quantitative and qualitative data will assess the quality and effectiveness of the program. Social media outcomes will also be assessed to measure the impact of the microinfluencer social media training., Results: Project implementation is planned for 6 months (January 2021 to June 2021) after an initial month of planning by the research team (December 2020) and preceding several months of assessment (July 2021 and beyond)., Conclusions: Novel, theory-based approaches will be necessary to improve vaccine confidence. One approach to promoting public health, derived from the SEM, may be to use trusted microinfluencers on social media platforms, such as local community pharmacists and community leaders., (Copyright © 2022 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Objectives. To assess heterogeneity in pandemic-period excess fatal overdoses in the United States, by location (state, county) and substance type. Methods. We used seasonal autoregressive integrated moving average (SARIMA) models to estimate counterfactual death counts in the scenario that no pandemic had occurred. Such estimates were subtracted from actual death counts to assess the magnitude of pandemic-period excess mortality between March 2020 and August 2021. Results. Nationwide, we estimated 25 668 (95% prediction interval [PI] = 2811, 48 524) excess overdose deaths. Specifically, 17 of 47 states and 197 of 592 counties analyzed had statistically significant excess overdose-related mortality. West Virginia, Louisiana, Tennessee, Kentucky, and New Mexico had the highest rates (20–37 per 100 000). Nationally, there were 5.7 (95% PI = 1.0, 10.4), 3.1 (95% PI = 2.1, 4.2), and 1.4 (95% PI = 0.5, 2.4) excess deaths per 100 000 involving synthetic opioids, psychostimulants, and alcohol, respectively. Conclusions. The steep increase in overdose-related mortality affected primarily the southern and western United States. We identified synthetic opioids and psychostimulants as the main contributors. Public Health Implications. Characterizing overdose-related excess mortality across locations and substance types is critical for optimal allocation of public health resources. (Am J Public Health. 2024;114(6):599–609. https://doi.org/10.2105/AJPH.2024.307618) [ABSTRACT FROM AUTHOR]

Eminent domain gives public agencies the right to acquire property from private individuals in exchange for just compensation. Following Kelo vs. New London 2005, the powers of eminent domain were extended, opening the door for potential abuses of power by government officials. In this paper, I empirically investigate the use of eminent domain using newly digitized records from the Tennessee Valley Authority (TVA), which extensively used eminent domain to construct dams in the 1930s. Using a sample of families living in one reservoir location, I find empirical evidence that land tenure, the number of property holdings, and debt levels affected the holdout decision, suggesting that holdouts are individuals with high subjective values. I then develop a screening model with asymmetric information in seller valuations to predict when eminent domain will be used and what settlement values and court awards would be. I test the model's and find that individuals who held out increased their property value by about 5 %, and incentives to holdout existed only for individuals who received initially low settlement proposals. [ABSTRACT FROM AUTHOR]

Copyright of Southeastern Geographer is the property of University of North Carolina Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Cardiovascular events are known to be the leading cause of death among on-duty firefighters. Implementing fitness standards may help reduce the incidence of cardiovascular deaths; however, standards vary between firefighter type and states. We aimed to investigate the rate of cardiovascular events among firefighters across states. Methods: Using publicly available data from the United States Fire Administration, we explored the rates of cardiovascular deaths between firefighter type (e.g., career, volunteer, and wildland) and state. Specifically, we examined rates of cardiovascular deaths between California and Tennessee, which have fitness standards for all firefighters, and New York, which does not have fitness standards for volunteer firefighters. We used descriptive statistics and trend analysis to examine the data. Findings: Most cardiovascular events occur among volunteer firefighters (60.6%, n = 877). Volunteer firefighters had 7.5 (95% CI = [4.8, 11.7], p <.001) greater odds of cardiovascular events compared to wildland firefighters, who had the lowest incidence of cardiovascular events (1.7%, n = 24). New York reported the most cardiovascular events (n = 161), primarily among volunteer firefighters (73.9%, n = 119). After the passage of legislation mandating fitness standards in California, a downtrend in the number of volunteer firefighter fatalities is observed. However, a null effect was observed in Tennessee after the passage of similar fitness standards as in California. Conclusions/Applications to Practice: Volunteer firefighters are significantly more likely to die of a cardiovascular event than career and wildland firefighters, both of which have stricter fitness standards. However, the effect of legislation mandating stricter fitness standards among volunteers did not produce a clear benefit for preventing fatalities. Nurses need to promote cardiovascular health among volunteer firefighters. [ABSTRACT FROM AUTHOR]

BACKGROUND: The United States Department of Labor's (DOL) Office of Disability Employment Policy (ODEP) initiated the Employment First State Leadership Mentoring Project (EFSLMP) to assist states to align policies, regulations and funding priorities to encourage integrated employment as the primary outcome for individuals with significant disabilities. OBJECTIVE: This paper describes the activities undertaken by two states designated as Protégé States of the Employment First State Leadership Mentoring Project of the United States Department of Labor's (DOL) Office of Disability Employment Policy (ODEP). CONCLUSION: Protégé states received mentoring from the identified mentor state as well as training and technical assistance by Subject Matter Experts (SMEs). While five aspects of system change were shared by the states, the efforts undertaken to effect change were individual to each state. Lessons learned are also noted. [ABSTRACT FROM AUTHOR]

As closed topographic depressions, sinkholes effectively divide karst regions into a series of subwatersheds, where swallets within each sinkhole define the downstream end of each subwatershed. Water and sediment are temporarily stored in sinkholes before continuing to underground streams. While pathways and travel times of water in karst terrain are commonly found using tracing techniques, such techniques do not provide information about the movement and travel time of sediment through these systems. This paper reviews the literature regarding sediment storage within sinkholes and presents a case study, the objective of which is to estimate the magnitude and timing of sediment deposition within three sinkholes in an urbanized area in Tennessee, United States of America. Sedimentation rates in sinkholes were estimated based on age determination of cultural artifacts (buried trash and coal fragments) and by 14C dating. For the three study sinkholes, minimum deposition rates (maximum residence times) were 15 cm yr -1(6 yrs), 1.5 cm yr -1(81 yrs), and 0.2 cm yr -1(640 yrs). The analysis revealed that sinkholes undergo fill and flush cycles at different timescales caused by changes in upland sediment supply and morphologic changes at swallet openings. Sinkholes that lack swallet openings, or with swallets that have become blocked by debris, are effectively disconnected from master streams with regard to sediment. Sediment stored in sinkholes may be released downstream when swallet conditions change. [ABSTRACT FROM AUTHOR]

The market for solar energy in the US has grown exponentially due to increased consumer demand resulting from price reduction via economies of scale, technological progress, and a variety of incentives from federal and state governments as well as utility companies. The installation of solar power in Tennessee has more than doubled each year from 2009 to 2011. In this paper, we focus on the behavior of the Tennessee Solar Value Chain (TNSVC) to study the factors that influence growth of solar industry in the state. The impact of existing incentives on the TNSVC is analyzed. The TNSVC is simulated based on inputs from on-site survey to estimate economic impact in terms of the number of jobs added and the tax revenue generated in the state. In addition, a sensitivity analysis for the impact on the TNSVC under different policies those may be adopted by the state of Tennessee in the future is conducted. This paper employs a holistic model which can predict PV installation demand, understand solar value chain capacity, and estimate the revenue generation. It should be noted that the method employed in this study is not unique to the solar energy industry in Tennessee. The data utilized in this study is a combination of public domain information and surveys of suppliers, manufacturers, distributors, and installers. This makes the model in this paper flexible enough to be applied to assess the solar value chain in other state or country. [ABSTRACT FROM AUTHOR]

A review of the literature suggests that there are few studies on the efficiency of academic research and development (R&D) funding in the United States. Much of the extant literature focuses on efficiency assessments at either the academic department level or the university level. We are not aware of any studies that analyze the efficiency of academic R&D funding at the state level. The purpose of this paper is to fill this void by assessing the efficiency of academic R&D funding at the state level using Data Envelopment Analysis (DEA), a non-parametric efficiency estimation method that can utilize multiple inputs and outputs to create a single efficiency score. The DEA results, along with results in changes in R&D productivity over time, suggest that some U.S. states are relatively better positioned to turn their R&D dollars into academic and business outputs. Tennessee is used as an example to show how to apply the DEA results to guide policy decisions toward efficiency. Tobit model results imply that the diversity of funding source, university R&D intensity, and R&D concentration are key for R&D funding efficiency. The policy implications of the study findings are discussed. [ABSTRACT FROM AUTHOR]

In 2013 Memphis City Schools and Shelby County Schools consolidated into a unified system, creating one of the largest districts in the nation. Six Memphis suburbs subsequently voted to create separate municipal districts. Many school zoning changes resulted from the merger and subsequent splintering of districts, providing a rare opportunity to separately identify the value of both school and district quality as they are capitalized in housing prices. Utilizing school fixed effects and repeat sales data, we find that a one standard deviation increase in test scores increases prices by 3-4% while district administration accounts for 5-8% of home values. [ABSTRACT FROM AUTHOR]

Introduction: We sought to investigate the association between insurance coverage history and cervical cancer screening among Davidson County, Tennessee, women diagnosed with incident cervical cancer.Methods: We reviewed medical records of women diagnosed with invasive cervical cancer from 2008 through 2018 identified via the state's cancer registry and by active surveillance of diagnostic pathology reports for the HPV-IMPACT project. Per 2012 United States Preventive Services Task Force recommended cervical cancer screening guidelines, women were characterized into three screening history categories: "no screening", "no follow-up" and "test/screening failure". Multivariable logistic regression measured the association of prior inadequate insurance (underinsurance) and screening history ("no screening/no follow-up" compared to "test/screening failure").Results: Of 212 women, most (77%) had not undergone recommended cervical cancer screening or follow-up prior to cancer diagnosis. Overall, 28% of women had history of underinsurance in 5 years prior to diagnosis. In adjusted analyses, underinsured women were more likely to have a "no screening/no follow-up" prior to cancer diagnosis (aOR 4.26; 95% CI 1.15-15.80) compared to "test/screening failure" history. Non-white race (aOR 2.73; 95% CI 0.98-7.61), older age (aOR 1.03 per year; 95% CI 1.00-1.07), and history of smoking (aOR 4.07; 95% CI 1.54-10.74) were also associated with increased likelihood of "no screening/no follow-up".Conclusions: Previous underinsurance was independently associated with non-adherence to cervical cancer screening and follow-up guidelines among women with incident cervical cancer. Further study of factors contributing to inadequate cervical cancer screening and interventions to increase cervical cancer screening in high-risk populations is needed. [ABSTRACT FROM AUTHOR]

This study estimates breakeven price distributions for irrigated and non-irrigated corn, cotton, and soybean production in Tennessee under conventional tillage and no-till for three field sizes and two sources of energy for irrigation. The distributions were compared using forecasted prices of corn, cotton, and soybean realized under different climate scenarios. The price simulation focuses on the short-, medium-, and long-term impacts of drought-induced yield reduction on commodity market prices. Electric pump irrigation systems in the southeastern United States have lower energy costs and, thus, a lower breakeven price than diesel-fueled irrigation pumps. A corn producer could obtain a lower breakeven price per kg by irrigating fields of 51–81 hectares. Cotton and soybean producers managing fields of 81 hectares or less could realize lower breakeven prices by not irrigating. Under extended drought conditions during which the market price for corn, soybeans, and cotton are higher, irrigated corn is more likely to be profitable compared to irrigated cotton or soybeans. These results could inform the development of irrigation management plans for row crop producers in the southeastern United States. [ABSTRACT FROM AUTHOR]

Since January 1, 2017, the United States Food and Drug Administration (FDA) has fully implemented the Veterinary Feed Directive (VFD) final rule aimed at facilitating the judicious use of medically important antimicrobials in food-producing animals. The objective of this study was to identify the common perceptions of Tennessee (TN) cattle producers regarding the VFD. We used a combination of focus groups and survey questionnaires to explore TN cattle producers’ perceptions regarding the VFD. Preliminary findings from seven focus groups of 62 producers were used in the development of the questionnaire sent both online and in-print to rest of cattle producers in TN. The beef focus group participants perceived the VFD: to be a top-down policy; to have led to unregulated access to in-feed antimicrobials; a regulation that has limited the producers’ ability to prevent disease and leading to economic losses; to negatively affect small producers; and to be affected by challenges related to prescription writing and disposal of un-used medicines. The dairy focus group participants perceived the VFD as unnecessary and burdensome, to have affected small producers, and introduced additional costs. Among the survey questionnaire respondents, 35 (15.4%) beef producers and 6 (13.6%) dairy producers respectively were not familiar at all with the VFD. Forty-eight (21.1%) beef producers and 11 (25%) dairy producers were slightly familiar with VFD. Gender was significantly associated (P = 0.02) with the beef producers’ belief in the usefulness of the VFD. Similarly, for dairy producers, herd size was significantly associated (P = 0.002) with their perceptions regarding the usefulness of the VFD. The findings of this study could inform future VFD policy review processes. More awareness regarding the VFD and its benefits is needed among both beef and dairy producers in TN. [ABSTRACT FROM AUTHOR]

In the last two decades, urban and suburban lands grew by 34% in the United States, with 16 to 20 million ha maintained under turfgrass systems. Side-byside comparison of turfgrass systems with other managed and unmanaged ecosystems have not been comprehensively conducted in the climate transition zone of the United States, despite the environmental significance of land use changes. Our objective was to determine the relative effects of C3 and C4 turfgrasses on soil organic carbon (SOC) accumulation and nutrient availability, in comparison with managed row crop and unmanaged woodlot and grassland systems. Soil samples from depths of 0 to 5, 5 to 15, and 15 to 30 cm were collected during March 2017 at the University of Tennessee's East Tennessee Research and Education Center from seven ecosystems: (i) corn (Zea mays L.)-soybean (Glycine max L.) rotation, (ii) continuous soybean, (iii) tall fescue (Festuca arundinacea L.), (iv) Kentucky bluegrass (Poa pratensis L.), (v) bermudagrass (Cynodon dactylon L.), (vi) unmanaged grassland, and (vii) unmanaged woodlot. All turfgrass species were established in 2012 and were managed like low-input residential lawns. Within the 30-cm soil profile, turfgrass systems contained 4.2 kg m-2 SOC at the time of sampling, which was 33% more than croplands and 34% less than unmanaged systems, and the C4 turfgrass system contained 2.3 kg m-2 SOC and 0.4 mg kg-1 inorganic N, which were 56 and 57% lower than C3 systems, respectively. Results from this study highlight that low-input lawns with suitable grass species can offer higher SOC stock and nutrient availability than conventional cropland systems. [ABSTRACT FROM AUTHOR]

Professional development in health promotion is fundamental to conduct effective multiyear community-based health promotion programs to address tobacco use. Provided with $15 million over 3 years in new resources from the United States' Master Tobacco Settlement Agreement, the Tennessee Department of Health organized a longitudinal staff development effort for 95 county health departments using an experiential pedagogy. Through statewide WORKshops, standardized plans, electronic reporting, use of logic modeling, social and behavior theory, and public health terminology were introduced and emphasized. A summative county evaluation document, entitled the Community Health Improvement Plan Against Tobacco Use (CHIPATU), was part of the experiential approach. The report was completed by health department officials from these 95 counites. This report documented tobacco use problem statements, county investments of Tobacco Settlement funds, strategy and project descriptions, and local changes in statewide outcome measures in three focused areas: reducing pregnancy smoking, reducing secondhand smoke exposure for young children, and reducing youth tobacco use initiation. The CHIPATU became a capstone evaluation document that reinforced county-based responsibility for assessment, goal setting, intervention planning, implementation, application of continuous improvement tools, and results. A statewide summary of 3 years' efforts and outcomes from the 95 county CHIPATUs was included in the state Health Commissioner's annual budget presentation for the Governor and General Assembly. The results documented the efficacy of the Department's primary prevention programs, supported by staff development in use of health promotion approaches, to address long-standing public health issues. [ABSTRACT FROM AUTHOR]

Much has been written about how to conduct insanity defense evaluations, as well as how to operationalize the legal definitions of insanity. However, the insanity defense has never been categorized by a typology. This article describes a typology of six subtypes of the insanity defense: paranoid self-defense, "but it's mine," erotomanic stalking, deific decree, disorganized, and false report. Knowledge of these subtypes, while not all inclusive, can inform insanity defense evaluations, guide training, and potentially increase the reliability of forensic evaluators' opinions. In addition, such subtypes can generate future research regarding prevalence, interrater reliability, and associated features of the different subtypes. [ABSTRACT FROM AUTHOR]

“Free college” has emerged in some states as a new approach for increasing educational attainment. But, these and other states have long had initiatives designed to improve college affordability. To inform how state free tuition programs may improve affordability, increase attainment, and close gaps across groups in attainment, this article begins by providing an overview of the role of state policy in promoting attainment, with particular attention to higher education finance policies. Recognizing the utility of examining free tuition policies within the larger state context, we describe recent initiatives in Tennessee, Oregon, and New York. Given their recent establishment, it is too early to conclude whether state-sponsored free tuition policies improve higher education attainment or close gaps in attainment across groups. We consider emerging and potential outcomes, building on themes drawn from across the three cases and research on other higher education finance policies. We conclude by offering questions to guide policy makers, practitioners, and researchers in further consideration of these policies. [ABSTRACT FROM AUTHOR]

Objectives. To explore whether an emergency preparedness structure is a feasible, efficient, and sustainable way for health care organizations to manage mass vaccination events. Methods. We used the Hospital Incident Command System to conduct a 1-day annual mass influenza vaccination event at Vanderbilt University Medical Center over 5 successive years (2011–2015). Using continuous quality improvement principles, we assessed whether changes in layout, supply management, staffing, and documentation systems improved efficiency. Results. A total of 66 591 influenza vaccines were administered at 5 annual Flulapalooza events; 13 318 vaccines per event on average. Changes to the physical layout, staffing mix, and documentation processes improved vaccination efficiency 74%, from approximately 38 to 67 vaccines per hour per vaccinator, while reducing overall staffing needs by 38%. An unexpected finding was the role of social media in facilitating active engagement. Conclusions. Health care organizations can use a closed point-of-dispensing model and Hospital Incident Command System to conduct mass vaccination events, and can adopt the “Flulapalooza method” as a best practice model to enhance efficiency. [ABSTRACT FROM AUTHOR]

It is common practice for K-12 schools to assess multilingual students' language proficiency to determine language support program placement. Because such programs can provide essential scaffolding, the policies guiding these assessments merit careful consideration. It is well accepted that quality assessments must be valid (representative of the constructs of interest) and reliable (error-free and consistent). However, a tension exists between validity and reliability, known as the attenuation paradox. Validity is strengthened when the range and depth of the assessed construct align with the target domain. Yet, increased domain coverage can introduce construct-irrelevant variance and greater potential for error, negatively impacting reliability. On the other hand, narrowing the assessed construct, which tends to increase reliability, also weakens validity due to construct-underrepresentation. In this paper, we revisit the validity-reliability paradox by examining initial assessment policies for K-12 English language support programs in six nations. We report on each nation's policies for language placement assessment and the associated language support programs and funding mechanisms. We compare the assessment policies on the validity and reliability spectrum, framed by Bachman's assessment use argument heuristic. We conclude with a discussion of implications related to educational equity.

The enactment of the Patient Protection and Affordable Care Act (ACA) has been expected to improve the coverage of health insurance, particularly as related to the coordination of seamless care and the continuity of elder care among Medicare beneficiaries. The analysis of longitudinal data (2007 through 2013) in rural areas offers a unique opportunity to examine trends and patterns of rural disparities in hospital readmissions within 30 days of discharge among Medicare beneficiaries served by rural health clinics (RHCs) in the eight southeastern states of the Department of Health & Human Services (DHHS) Region 4. The purpose of this study is twofold: first, to examine rural trends and patterns of hospital readmission rates by state and year (before and after the ACA enactment); and second, to investigate how contextual (county characteristic), organizational (clinic characteristic) and ecological (aggregate patient characteristic) factors may influence the variations in repeat hospitalizations. The unit of analysis is the RHC. We used administrative data compiled from multiple sources for the Centers of Medicare and Medicaid Services for a period of seven years. From 2007 to 2008, risk-adjusted readmission rates increased slightly among Medicare beneficiaries served by RHCs. However, the rate declined in 2009 through 2013. A generalized estimating equation of sixteen predictors was analyzed for the variability in risk-adjusted readmission rates. Nine predictors were statistically associated with the variability in risk-adjusted readmission rates of the RHCs pooled from 2007 through 2013 together. The declined rates were associated with by the ACA effect, Georgia, North Carolina, South Carolina, and the percentage of elderly population in a county where RHC is located. However, the increase of risk-adjusted rates was associated with the percentage of African Americans in a county, the percentage of dually eligible patients, the average age of patients, and the average clinical visits by African American patients. The sixteen predictors accounted for 21.52 % of the total variability in readmissions. This study contributes to the literature in health disparities research from the contextual, organizational and ecological perspectives in the analysis of longitudinal data. The synergism of multiple contextual, organizational and ecological factors, as shown in this study, should be considered in the design and implementation of intervention studies to address the problem of hospital readmissions through prevention and enhancement of disease management of rural Medicare beneficiaries. [ABSTRACT FROM AUTHOR]

ObjectiveLimited acceptance of government food assistance programmes such as the US Department of Agriculture’s (USDA) Supplemental Nutrition Assistance Program (SNAP) is a barrier that produces unequal access to market products for SNAP beneficiaries. There is a dearth of published evidence to explain the limited SNAP acceptance at farmers’ markets. The current project aimed to fill this gap; to identify and describe the barriers to markets’ acceptance of SNAP.DesignCross-sectional, semi-structured interviews were conducted.SettingAll interviews were conducted via telephone.SubjectsTwelve East Tennessee area market managers, vendors and other key stakeholders.ResultsMultiple barriers exist for SNAP implementation at markets including administrative and time limitations, prejudice from market vendors against SNAP beneficiaries, and resistance to invasive and burdensome requirements of the USDA SNAP application required for farmers’ markets.ConclusionsSNAP acceptance at farmers’ markets is a complex issue, especially for small, rural markets. If farmers’ markets are to serve as sustainable resources to increase food access, these issues must be addressed so that SNAP can be accepted. Successful implementation of SNAP at rural markets requires increased administrative support and vendor education about SNAP and its beneficiaries. A revised USDA SNAP application process for farmers’ markets should also be considered. [ABSTRACT FROM PUBLISHER]

Across the United States, Black Churches play a significant role among the Black community and are increasingly being used to deliver Human Immunodeficiency Virus (HIV) prevention services. This study sought to investigate HIV service providers' strategies for strengthening partnerships with churches to deliver HIV prevention services. Using a community-based participatory research approach, an HIV coalition and an academic institution formed a partnership to address the study aim. Individual interviews (n = 16) were conducted with providers from medical institutions and HIV social support agencies. A thematic analysis focusing on recommendations for addressing the challenges and benefits of partnership with churches for HIV services was conducted. Participants' interest in and intention to work with churches, as well as their comfort level discussing sexual health-related topics with religious congregations, was high. Four themes emerged to highlight the different perspectives of service providers' recommendations for addressing challenges and strengthening partnerships with churches to deliver HIV services including: (1) carefully selecting churches and HIV services to provide, (2) gaining "buy-in" and support of church leadership, (3) taking advantage of conflict with church doctrine, and (4) choosing appropriate delivery strategies. Study findings demonstrate that although challenges exist, heath service providers in this region of the United States may be interested in addressing HIV among faith communities. Study findings also provide concrete solutions to previously documented barriers to HIV prevention in Black Churches. Such information will benefit researchers and practitioners seeking to expand effective HIV prevention efforts with Black Churches in communities who bear a disproportionate burden of HIV infections. [ABSTRACT FROM AUTHOR]

Church interventions can reduce obesity disparities by empowering participants with knowledge and skills within an established community. The purpose of this study was to evaluate the Biomedical/Obesity Reduction Trial (BMORe) and investigate changes in health beliefs among obese adult participants. Ten pre-/post-intervention focus groups applying the Health Belief Model conducted in two African-American churches in Tennessee (n = 20) and South Carolina (n = 20), and one rural Appalachian church in Kentucky (n = 21). Two independent coders using NVivo analyzed transcribed audio data and notes. Participants' health status of being overweight/obese and having comorbidities of diabetes and high blood pressure motivated enrollment in BMORe. Initially participants voiced low self-efficacy in cooking healthy and reading food labels. BMORe made participants feel 'empowered' after 12 weeks compared to initially feeling 'out of control' with their weight. Participants reported improvements in emotional health, quality of life, and fewer medications. During post-intervention focus groups, participants reported increased self-efficacy through family support, sharing healthy eating strategies, and having accountability partners. Solidarity and common understanding among BMORe participants led focus group attendees to comment how their peers motivated them to stay in the program for 12 weeks. Long-term barriers include keeping the weight off by maintaining habits of exercise and healthy eating. Implementation of pre-/post-intervention focus groups is an innovative approach to evaluate an obesity intervention and track how changes in health beliefs facilitated behavior change. This novel approach shows promise for behavioral interventions that rely on participant engagement for sustained effectiveness. [ABSTRACT FROM AUTHOR]

Background: Community pharmacists are legally required to evaluate and confirm the legitimacy of prescription opioids (POs) prior to dispensing. Yet, previous research has indicated community pharmacists perceive nearly 50% of dispensed POs to be issued lacking a legitimate medical purpose. Objective: To analyze correlates of PO legitimacy judgments across pharmacist and pharmacy setting characteristics. Methods: A cross-sectional study of 2000 Tennessee pharmacists was conducted during October and November of 2012. Community pharmacists' self-reported attitudes, beliefs, and behaviors specific to PO legitimacy were elicited. Step-wise multinomial logistic regression techniques were used to model correlates of PO legitimacy across low, moderate and high PO legitimacy estimations. Results: Being female, practicing in a chain or independent practice setting, fear of employer disciplinary action if PO legitimacy is questioned, and self-confidence in one's ability to detect PO abuse increased the odds of low (vs. high) PO legitimacy estimation (p < 0.05). Employment in chain and independent pharmacies, having POs as a greater percent of total prescriptions filled, and having the perception of PO abuse as a problem in the practice setting were significant positive correlates of moderate (vs high) PO legitimacy estimation (p < 0.05). Conclusions: Both modifiable and non-modifiable correlates were statistically significantly associated with PO legitimacy judgments. Distinct correlates were noted across low and moderate as compared to high estimations of PO legitimacy. Legitimacy judgments can inform theoretical exploration of PO dispensing behaviors and inform intervention development targeted at reducing and preventing prescription drug abuse. [ABSTRACT FROM AUTHOR]

Purpose of the Study: This study examined patient satisfaction among community-dwelling older adults by their citizenship and nativity statuses. Since the welfare reform of 1996, citizenship has been an important factor in determining health care access among foreign-born individuals. Little is known regarding how the perceived satisfaction of older noncitizens compares with that of U.S.-born and naturalized citizens and how it is affected by county-level contextual characteristics. Design and Methods: The 2000-2007 Medical Expenditure Panel Survey and linked Area Resource File were analyzed for 27,383 individuals (65+).Two dimensions of satisfaction (perceived access and ease of access) were examined using the Consumer Assessment of Health Plans Survey. Multilevel models were conducted using STATA. Results: After both individual- and county-level covariates were controlled for, noncitizens were less likely to agree that their providers had spent enough time with them (p = .03) or had sufficiently explained treatment (p = .01) compared with U.S.-born citizens. Noncitizens' overall ratings of their providers were also lower (p < .001). Among those reported needs, noncitizens reported greater difficulties in accessing acute care (p < .001), routine care (p < .001), and specialty care (p = .009). In these models, some county-level characteristics (e.g., % of foreign-born individuals) were negatively associated with individual-level satisfaction. Interestingly, noncitizens from counties with high densities of foreign-born populations had higher overall satisfaction levels than did their U.S.-born counterparts (i.e., interaction effect). Implications: Guided by the expanded Andersen model, this study demonstrates the importance of considering both individual- and county-level contextual characteristics to accurately understand older noncitizens' access to health care and patient satisfaction. [ABSTRACT FROM AUTHOR]

Information on the Prognosis, Examining and Treating the Ailments of Healthcare Law and Policy symposium at the University of Tennessee College of Law (UT) in 2015 is presented. The symposium discussed topics related to healthcare and health law policy of the U.S. and Tennessee, including the Affordable Care Act, innovations to healthcare services, and how healthcare is being adapted and improved. Keynote speaker is James C. Pyles, healthcare attorney, legislation author, and policy advocate.

The article chronicles the events that led to the dismantling of Tennessee's judicial selection, evaluation and retention system by the General Assembly. These include the state's adoption of the merit-based selection system Tennessee Plan for appellate court judges in 1971 and the implementation of the judicial performance evaluation program in 1994. The judicial power of the General Assembly is also discussed.

Some postulate that spatially targeted grants and tax cuts stimulate jobs and establishment openings, and reduce closures in distressed urban neighbourhoods. The scholarly literature is mixed and mostly argues that at best these programmes have no impact and at worst raise land rents, spurring gentrification. The USA designated three rounds of Renewal Communities, Empowerment Zones or Enterprise Communities (RC/EZ/EC) to receive wage credits or grants. While others have estimated the impact of Round I EZ/ECs, this article estimates the impact of more recent rounds in Tennessee and California on job and businesses using propensity score matching. Data are presented by RC/EZ for retail, very small and minority establishments. Jobs increased in RC/EZs compared with control areas during the wage credit period. In general, establishment openings rose for small establishments but fell for retail. Closures overall fell. Future place-based initiatives should be strategic about industry mix and minority establishments. [ABSTRACT FROM PUBLISHER]

The article presents a report related to a legal counsel symposium related to the essential factors for the Tennessee district court justices. Details to the development and success of the Tennessee law firm Orr Brown law firm which aims to provide legal services to poor communities in Tennessee is presented. An overview on the legal system in the county is also noted.

This article summarizes a survey designed to assess consumer health information services in United States medical libraries and describes how survey data informed the planning process for redesigning a medical library. The survey included multiple choice and ranking questions about staffing, space, services, and resources. Identifying characteristics of existing consumer health information services may be useful for libraries implementing or expanding such a service. The importance of patient education is acknowledged through recent research, Joint Commission, and Centers for Medicare and Medicaid Electronic Health Records requirement for patient education. Hospital libraries can play a key role in this domain. [ABSTRACT FROM AUTHOR]

The article presents research which analyzed the cost-effectiveness of early and delayed repair for anterior cruciate ligament injuries. Topics covered include the importance of surgical reconstruction to treat tear in anterior cruciate ligament (ACL) as well as use of Markov decision model to assess the repair. Also mentioned is the application of the Multicenter Orthopaedic Outcomes Network (MOON) database in the study.

Objectives: The Care and Prevention in the United States Demonstration Project included implementation of a Data to Care strategy using surveillance and other data to (1) identify people with HIV infection in need of HIV medical care or other services and (2) facilitate linkages to those services to improve health outcomes. We present the experiences of 4 state health departments: Illinois, Louisiana, Tennessee, and Virginia. Methods: The 4 state health departments used multiple databases to generate listings of people with diagnosed HIV infection (PWH) who were presumed not to be in HIV medical care or who had difficulty maintaining viral suppression from October 1, 2013, through September 29, 2016. Each health department prioritized the listings (eg, by length of time not in care, by viral load), reviewed them for accuracy, and then disseminated the listings to staff members to link PWH to HIV care and services. Results: Of 16 391 PWH presumed not to be in HIV medical care, 9852 (60.1%) were selected for follow-up; of those, 4164 (42.3%) were contacted, and of those, 1479 (35.5%) were confirmed to be not in care. Of 794 (53.7%) PWH who accepted services, 694 (87.4%) were linked to HIV medical care. The Louisiana Department of Health also identified 1559 PWH as not virally suppressed, 764 (49.0%) of whom were eligible for follow-up. Of the 764 PWH who were eligible for follow-up, 434 (56.8%) were contacted, of whom 269 (62.0%) had treatment adherence issues. Of 153 PWH who received treatment adherence services, 104 (68.0%) showed substantial improvement in viral suppression. Conclusions: The 4 health departments established procedures for using surveillance and other data to improve linkage to HIV medical care and health outcomes for PWH. To be effective, health departments had to enhance coordination among surveillance, care programs, and providers; develop mechanisms to share data; and address limitations in data systems and data quality. [ABSTRACT FROM AUTHOR]

Background: First investigated in the 1990s, medication therapy management (MTM) is an evidence-based practice offered by pharmacists to ensure a patient's medication regimen is individualized to include the safest and most effective medications. MTM has been shown to a) improve quality of patient care, b) reduces health care costs, and c) lead to fewer medication-related adverse effects. However, there has been limited testing of evidence-based, a-priori implementation strategies that support MTM implementation on a large scale., Methods: The study has two objectives assessed at the organizational and individual level: 1) to determine the adoption, feasibility, acceptability and appropriateness of a multi-faceted implementation strategy to support the MTM pilot program in Tennessee; and 2) to report on the contextual factors associated with program implementation based on the Consolidated Framework for Implementation Research (CFIR). The overall design of the study was a hybrid type 2 effectiveness-implementation study reporting outcomes of Tennessee state Medicaid's (TennCare) MTM Pilot program. This paper presents early stage implementation outcomes (e.g., adoption, feasibility, acceptability, appropriateness) and explores implementation barriers and facilitators using the CFIR. The study was assessed at the (a) organizational and (b) individual level. A mixed-methods approach was used including surveys, claims data, and semi-structured interviews. Interview data underwent initial, rapid qualitative analysis to provide real time feedback to TennCare leadership on project barriers and facilitators., Results: The total reach of the program from July 2018 through June 2020 was 2033 MTM sessions provided by 17 Medicaid credentialed pharmacists. Preliminary findings suggest participants agreed that MTM was acceptable (μ = 16.22, SD = 0.28), appropriate (μ = 15.33, SD = 0.03), and feasible (μ = 14.72, SD = 0.46). Each of the scales had an excellent level of internal (> 0.70) consistency (feasibility, α = 0.91; acceptability, α = 0.96; appropriateness, α = 0.98;). Eight program participants were interviewed and were mapped to the following CFIR constructs: Process, Characteristics of Individuals, Intervention Characteristics, and Inner Setting. Rapid data analysis of the contextual inquiry allowed TennCare to alter initial implementation strategies during project rollout., Conclusion: The early stage implementation of a multi-faceted implementation strategy to support delivery of Tennessee Medicaid's MTM program was found to be well accepted and appropriate across multiple stakeholders including providers, administrators, and pharmacists. However, as the early stage of implementation progressed, barriers related to relative priority, characteristics of the intervention (e.g., complexity), and workflow impeded adoption. Programmatic changes to the MTM Pilot based on early stage contextual analysis and implementation outcomes had a positive impact on adoption., (© 2021. The Author(s).)

Value-based healthcare in the US is a payment structure that ties reimbursement to quality rather than volume alone. One model of value-based care is the Tennessee Division of TennCare's Episodes of Care program, which groups common health conditions into episodes using specified time windows, medical code sets and quality metrics as defined in each episode's Detailed Business Requirements [1,2]. Tennessee's program assigns responsibility for an episode to a managing physician, presenting a unique opportunity to study physician variability in cost and quality within these structured episodes. This paper proposes a pipeline for analysis demonstrated using a cohort of 599 Outpatient and Non-Acute Inpatient Cholecystectomy episodes managed by BlueCross BlueShield of Tennessee in 2016. We sorted episode claims by date of service, then calculated the pairwise Levenshtein distance between all episodes. Next, we adjusted the resulting matrix by cost dissimilarity and performed agglomerative clustering. We then examined the lowest and highest average episode cost clusters for patterns in cost and quality. Our results indicate that the facility type where the surgery takes place is important: outpatient ambulatory care center for the lowest cost cluster, and hospital operating room for the highest cost cluster. Average patient risk scores were higher in the highest cost cluster than the lowest cost cluster. Readmission rate (a quality metric tied to managing physician performance) was low for the whole cohort. Lastly, we explain how our analytical pipeline can be generalized and extended to domains beyond Episodes of Care., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Fatal drug overdose in the United States is a public health crisis fueled by increased opioid and polysubstance use. Few studies have compared the neighborhood-level socioeconomic characteristics associated with overdoses of various substance classes and, to our knowledge, no investigation has yet assessed these factors in relation to polysubstance overdoses. Further, no study has determined whether socioeconomic conditions predict other contextually relevant aspects of overdoses such as whether they occur at-home or out-of-home., Methods: Overdose data (2015-2018) were obtained from the Coroner/Medical Examiner's Office of Jefferson County, Alabama. The toxicology results of decedents with a known overdose locations (N = 768) were assessed for the presence of synthetic opioids, natural and semi-synthetic opioids, heroin, stimulants, benzodiazepines, and alcohol. Socioeconomic characteristics were obtained from the Unites States Census Bureau at the census tract level., Results: Stimulant overdoses occurred in neighborhoods with the highest rates of disadvantage relative to other substance and polysubstance overdose types. The majority of included overdoses occurred at-home (63.7%) and an index of socioeconomic disadvantage predicted overdose rates for both at-home and out-of-home overdoses. Heroin overdose deaths were more likely to occur at-home while polysubstance stimulant-heroin overdoses were more common out-of-home., Conclusions: An index of socioeconomic disadvantage was generally predictive of overdose, regardless of the setting in which the overdose occurred (in-home vs. out-of-home). The associations between neighborhood-level socioeconomic characteristics and fatal overdose can be tailored by substance type to create targeted interventions. Overdose setting may be an important consideration for future policy efforts, as overdoses were nearly twice as likely to occur at-home., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Forest understory plant communities in the eastern United States are often diverse and are potentially sensitive to changes in climate and atmospheric inputs of nitrogen caused by air pollution. In recent years, empirical and processed-based mathematical models have been developed to investigate such changes in plant communities. In the study reported here, a robust set of understory vegetation response functions (expressed as version 2 of the Probability of Occurrence of Plant Species model for the United States [US-PROPS v2]) was developed based on observations of forest understory and grassland plant species presence/absence and associated abiotic characteristics derived from spatial datasets. Improvements to the US-PROPS model, relative to version 1, were mostly focused on inclusion of additional input data, development of custom species-level input datasets, and implementation of methods to address uncertainty. We investigated the application of US-PROPS v2 to evaluate the potential impacts of atmospheric nitrogen (N) and sulfur (S) deposition, and climate change on forest ecosystems at three forested sites located in New Hampshire, Virginia, and Tennessee in the eastern United States. Species-level N and S critical loads (CLs) were determined under ambient deposition at all three modeled sites. The lowest species-level CLs of N deposition at each site were between 2 and 11 kg N/ha/yr. Similarly, the lowest CLs of S deposition, based on the predicted soil pH response, were less than 2 kg S/ha/yr among the three sites. Critical load exceedance was found at all three model sites. The New Hampshire site included the largest percentage of species in exceedance. Simulated warming air temperature typically resulted in lower maximum occurrence probability, which contributed to lower CLs of N and S deposition. The US-PROPS v2 model, together with the PROPS-CLF model to derive CL functions, can be used to develop site-specific CLs for understory plants within broad regions of the United States. This study demonstrates that species-level CLs of N and S deposition are spatially variable according to the climate, light availability, and soil characteristics at a given location. Although the species niche models generally performed well in predicting occurrence probability, there remains uncertainty with respect to the accuracy of reported CLs. As such, the specific CLs reported here should be considered as preliminary estimates., Competing Interests: Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)