Children of low socioeconomic status (SES) families with intellectual and developmental disabilities have higher rates of dental caries but significant unmet dental needs due to unique factors such as low Medicaid reimbursement rates, confusion surrounding plan choice, and poor provider availability. As a result, children with disabilities experience disproportionate oral healthcare costs and out-of-pocket expenses. Utilizing a critical disability theory lens to review the available published literature by Health Policy, Medicaid and Special Education disciplines revealed not only how to describe what people should research but also how they should approach improving oral health for children with special healthcare needs. Drawing on connections between the literature and the overall cultures of these fields it was concluded that existing literature used the medical model of disability. Therefore, ableism was identified as a cause of oral health disparities for children with special healthcare needs. Adopting the social model of disability will improve oral health outcomes for children with intellectual and developmental disabilities.

In response to the growing desires of American women to reclaim childbirth from the pathologized and technocratic grips of Western medicine, the social media based organization, Birth Without Fear, provides positive birth messages and empowers followers by sharing linguistically positive birth stories and affirmations of childbirth empowerment. A cyber-ethnographic examination of the comments section on 62 blog posts, published by Birth Without Fear between February 1st, 2015 and February 12th, 2016, revealed discourses of self-efficacy, empowerment, and agency that may help reduce childbirth fear, anxiety, and self-inefficacy. Birth Without Fear simultaneously acts as a form of childbirth education intended to empower women to birth fearlessly and also as a safe and supportive kinship cyber network where women can freely exchange, share, process, and make meaning of their birth experiences. Overall, themes of childbirth empowerment, affirmation, and support suggest that positive, empowering birth discourses may help socialize American women to birth fearlessly, embody self-efficacy, agency and empowerment during birth, and have more positive birth experiences overall.

Professional athletes are at unique risk for difficulties during retirement due to factors such as early retirement age, identity change, and financial instability. Due to factors such as the high physicality of the sport, majority minority presence, and large public viewership of football, retired NFL players are especially at a higher risk for negative retirement experiences. A review of the available published literature on retirement of NFL players revealed the six most impactful factors in shaping football playersâ retirement experience, primary identity, health, retirement decision, meaningful post-employment activity, financial status, and available support resources. Eight case studies of former players, four Caucasian and four African-American, were conducted to analyze the role these factors played in the playersâ retirement experiences. Out of the six factors, health, available support resources, and financial status were the most salient contributors to the quality retirement experiences they had. From this, it was concluded that changes in the current NFL system are needed to better protect playersâ physical and mental health and to prepare them for retirement in terms of financial planning courses and networking workshops.

Events that have occurred in the past can be traced along a historical trajectory that is evident in our present day, and those decisions greatly influence the success of future posterity. The construction of interstate-40 through the business district of North Nashville effectively placed this area in economic disadvantage for years to come. Only by examining a small number of past grievances that the Nashville city designers and officials have executedâoften times at the expense of minority populations, can we begin to see the similarities between these historical processes of urban renewal and the gentrification that is occurring today. This thesis examines Nashville as a case study to explore how the influence of public works--specifically those of the federal highway can 'make or break' the success of a community. The relevant literature about Nashvilleâs construction of Interstate-40 was analyzed, and the historical narrative surrounding Nashville's Interstate-40 is contextualized in the larger narrative of the federal transportation policy history. The results of this research found that the local and state highway department did not provide adequate information concerning the relocation of Interstate-40 through the business district of Jefferson Street to the residents. The lack of information prevented the African-American community from organizing a successful movement against the interstate-40 construction. The construction of the interstate resulted in the dislocation of many businesses and families, many of which never recovered economically.

Despite public health interventions, racial health disparities have proven very difficult to eliminate, particularly between Blacks and Whites. Each racial category carries its own health burden but most approaches use White people and their âWhitenessâ as normative health entities to contrast the wellbeing of a racial minority. The literature describes a âwhite privilegeâ carried by these individuals, benefiting them and their progeny socially, economically, politically, physically, and so on, giving an invisibility to move throughout life âunmarkedâ by a racial category. However, this socialized invisibility can both prevent White individuals from being âseenâ in conditions that benefit or disenfranchise them, and socially render them fragile (âwhite fragilityâ) from understanding and adequately responding to important health decisions. Explored are the social reactions to the âwelfare queenâ, opposition to the Affordable Care Act, and nationwide responses to the U.S. heroin epidemic to assert that this âwhite fragilityâ is detrimental to white health individually and as a group. The de-centering, problematizing, and direct addressing of the health impact âWhitenessâ has on White bodies is expected to assist advancements in closing racial health gaps to benefit both Blacks and Whites.

Despite being the racial/ethnic group that is disproportionately affected by HIV/AIDS, African Americans are underrepresented in HIV/AIDS clinical trials. The reasons for the inadequate participation of African Americans in HIV/AIDS clinical trials are multidimensional, consisting of individual, investigator, study-related, and structural factors, all of which are shaped by larger social, economic, and political forces. In order to comprehensively address the factors that influence African Americans participation in HIV/AIDS clinical trials and move towards reducing the racial disparity in HIV/AIDS clinical trials participation, the biomedical, clinical trials research approach needs to locate individuals and their decision to participate within the larger sociostructural context in which individuals and their decision to participate exist. Incorporating intersectionality, cultural competency, and structural competency into the training of researchers, increasing community involvement in the research process, and increasing the representation of minority researchers on research teams can help clinical researchers learn how to locate individuals within their broader sociostructural contexts so that they can learn how to navigate the multidimensional factors that influence African Americansâ decision to participate in HIV/AIDS clinical trials.

MEDICINE, HEALTH AND SOCIETY Spirituality and Religion as a Social Determinant and Social Mediator of Health Christopher Lee Gross Thesis under the direction of Professors Jonathan M. Metzl and JuLeigh Petty In recent years, the Association of American Medical Colleges (AAMC) has placed significant attention on social determinants of health (SDH) as making significant contributions to patient health and outcomes (AAMC, 2012). Although the medical community has long understood the influence of a patients lived environment on health, medical education has only recently incorporated SDHs into its curriculums, generally defining them as the social, political and economic influence on race, ethnicity, poverty level, socioeconomic status and education level. I contend that this definition is incomplete. Spirituality and religion (SR) informs behaviors that have health implications to at least an equal degree, and therefore should be included as a social determinant of health, and given equal weight to the aforementioned (Idler, 2014). Currently, most relevant literature focuses on the ethicality of SR and medicine or the specific health benefits associated with various religions. Future research should go beyond these questions and address spirituality and religion as a SDH because SR can inform patient health beliefs, practices and behaviors (Idler, 2014). Not only does SR act as a social determinant of health, it acts as a social mediator of health (SMH). Although certain religious practices promote common behaviors among groups that have health specific implications (i.e. following a SR that proscribes alcohol influences health behaviors in regard to alcohol consumption), individuals in the same group might understand or respond differently to illness (health beliefs). In this way, SR can act as social mediator of health during an illness experience. Given its ubiquity, all physicians should be educated to better understand a patients SR, and its relationship to medical practice and patient health. This means that providers should be open to the possibility that a patients SR might be influencing a patients health beliefs and behaviors as it relates to the lived experience, day-to-day life practices/routines, as well as their response to suggested healthcare treatment. If a clinician desires to include SR care, as a part of pastoral care, into her own practice of medicine, she should have the opportunity and resources to be well-educated and well-trained to do so. Since SR in medical education is limited, I will present a program evaluation of a community-based health clinic that incorporates SR for healthcare trainees. Approved: Jonathan M. Metzl, M.D., Ph.D. Approved: JuLeigh Petty, Ph.D.

The goal of this project is to re-evaluate patient awareness of Vanderbilts biobanking practices and whether patients are interested in having more information of the project. 61 exit-interviews were conducted with adult patients to answer the following questions: (1) Are Vanderbilt patients aware of BioVU? (2) Do patients actually know what BioVU is? (3) Do patients realize their participation in BioVU? (4) Do patients want more information? (5) If the information is made available to them, will they access it? The answers to these questions address the concerns that BioVU planners have expressed regarding the problem of confusion and help to illustrate the source of that confusion. It was hypothesized first that the confusion that BioVU planners cited as a reason to limit information is caused not by patients having too much information, but instead from having too little. In such case, is was hypothesized second that the confusion is a direct result of BioVU planners decisions on which information is or is not necessary for patients to have regarding their participation in the project. Using the results collected from the survey data, a constructive recommendation will be offered with the intention of improving Vanderbilts current biobanking practices.

This thesis examines the federal governmentâs current approach to HIV/AIDS prevention in the United States. In 2010, President Obama released the National HIV/AIDS Strategy (NHAS) to direct and to align the nationâs collective HIV/AIDS efforts through 2020. While many institutions and actors are involved with this effort, the Centers for Disease Control and Prevention (CDC) is the lead federal agency responsible for HIV prevention. The NHAS vision emphasizes the role that structural factors play in contributing to our nationâs HIV/AIDS burden. However, the CDCâs prevention strategies revolve around individual-level interventions, like behavior modification programs, rather than structural interventions, like policy advocacy. The CDC enables our countryâs HIV/AIDS burden because its individually focused prevention strategies do not adequately map onto the structural-level factors that predominately contribute to the burden. First, I use qualitative data techniques (semi-structured interviews and literature reviews) to show that the CDCâs current behavioral interventions are not suitable for any population because they reflect an over-privileging of scientific authority, evidence-based methodology, and Westernized individualism. Second, I use quantitative data techniques (original statistic regression analyses) to evaluate how well the CDCâs current prevention programs map onto HIV risk factors. My findings revealed that structural-level factors contribute to more variation in HIV incidence rates compared to individual-level factors. Specifically, high school graduation had the largest relative effect on reducing HIV incidence rates, which suggests education has a protective effect on preventing HIV incidence. Third, I provide actionable strategies on how to improve the CDCâs HIV/AIDS prevention efforts within the current HIV/AIDS budget limitations. This section also includes specific policy recommendations detailing the importance of emphasizing education policy as health policy, and more specifically, education policy as HIV prevention policy. To ground my research in real world application, I provide case illustrations of the U.S. South where HIV incidence is currently highest. Ultimately, this thesis argues that order to realize the NHAS goals of reducing HIV/AIDS rates and HIV/AIDS-related disparities, the federal government must better align its interventions with the structural factors that predominately contribute to HIV rates.

This thesis illuminates the ways that medicalization of female sexual desire disorder lends authority to and is legitimized by heteronormative, patriarchal sexual norms. The Food and Drug Administrationâs approval of Flibanserin, a drug intended to treat this disorder, solidifies low libidoâs classification as a medical dysfunction. Through a review of relevant biomedical literature and semi-structured interviews with ten women who have low libido, I demonstrate that this disorderâs medicalization strips women of their subjectivity and disregards the contextual factors that influence sexual desire and attitudes toward sex. This thesis relies upon social constructionist approaches to conceptualize sexuality, underscoring the biomedical approachâs failure to account for the complex sociocultural expectations that shape understandings of sexual normalcy. The first section of this thesis employs feminist critiques to problematize conventional understandings of female sexuality and to reveal that female sexual desire disorder represents an additional attempt to exert social control over womenâs bodies. The second section analyzes interviews with a nurse practitioner working for a womenâs sexual health clinic and the manager of an adult entertainment store to exemplify medicalized and non-medicalized treatments of low libido. The third and final section examines interview data from ten women with low libido, revealing that their low libido-induced distress stems from their self-perceived inability to meet the sociocultural expectations required for successful romantic relationships. Ultimately, I argue medicalization legitimizes the idea that womenâs sexualitiesâand not the narrow constructions of normalcy with which they must attempt to align themselvesâexist as the primary issue necessitating alteration.