In an effort to bridge the gap between public health practice and academia, the Health Resources and Services Administration–funded Tennessee Public Health Training Center (LIFEPATH) has supported establishment of an academic health department (AHD) involving the East Tennessee State University College of Public Health (COPH) and the Sullivan County Regional Health Department (SCRHD). The SCRHD identified a need to increase internal capacity to conduct ongoing community health assessment and community-centered practice. Similarly, the COPH recognized the need to expand evidence-based practice implementation and evaluation opportunities for public health students. Personnel from the SCRHD, LIFEPATH, and the COPH developed a formal AHD agreement during the summer of 2012 and launched the program the subsequent fall semester. One aspect of the COPH/SCRHD/LIFEPATH model that addresses financial barriers experienced by other AHDs is the competitive awarding of the coordinator position to a doctor of public health student from the COPH, demonstrating investment in the model by the college. The doctor of public health student gains leadership experience through project management, coordination of the local health council, and day-to-day facilitation of undergraduate and master's student interns. The SCRHD benefits from the formal academic background of graduate-level interns dedicated to working in the community. This AHD framework offers an opportunity for doctoral-level students to develop practical leadership skills in a health department while enhancing the capacity of the SCRHD and the COPH to serve their community and stakeholders.

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Background: Adverse Childhood Experiences (ACEs) are a risk factor for the development of future physical and mental health problems. Programs are needed that prevent and address the impact of ACEs on a population-based level. As a pediatric primary care clinic serving Northeast Tennessee, our goal was to better understand the knowledge and perceptions of the effects of ACEs among parents/caregivers and health professionals in Northeast Tennessee. Methods: During the summer of 2017, 51 parents/caregivers visiting a health education table at a family event in a local public library completed an anonymous survey to help us understand what people think about how ACEs affect children and adults. 20 health care professionals at a local pediatric primary care clinic completed the same anonymous survey. Survey results were entered into Excel and analyzed using Excel and SPSS. Results: Fewer than one-third of parents/caregivers in this sample had heard of the term "ACEs" prior to receiving this survey. However, after being provided with a definition of ACEs, most respondents agreed that ACEs could affect children's behavior and adult mental health. Agreement was less for perceptions of effects on physical health in adults. Most respondents recognized that a parent’s own ACE exposure could make parenting more difficult and that having a strong support system is helpful in counteracting these negative effects. Healthcare providers were more likely than parents/caregivers to have heard of the term ACEs before, however only half were familiar with the term. After being provided with a definition of ACEs, most healthcare providers agreed on their effects on children and adults. Perceptions that having a strong support system could counteract the effects of ACEs were slightly lower among health care providers as compared to parents/caregivers. Conclusion: The low awareness of ACEs found by our survey confirms the need for a new initiative to screen for ACEs and provide trauma-informed care in our clinic. The project, Baby Steps for Success, will involve screening children and parents/caregivers for ACEs, providing brief education on ACEs, and building resilience. Engaging and supporting families around healthy behaviors and interactions will be accomplished using Reach Out and Read and ReadNPlay for a Bright Future beginning in early infancy. Intervention with the Incredible Years program and Ecomap assessments will be provided to high-risk families with 2 or more ACEs. Families with four or more ACEs will be offered the Nurturing Parenting curriculum through a series of home and group visits. Partners for this project will include ETSU Pediatrics, Families Free, and the Northeast TN Regional Health Office.

Two Human Immunodeficiency Virus (HIV) outbreaks occurred almost simultaneously in the United States (US) (2014-2015) and in Cambodia (2015). Information is lacking on HIV-related knowledge, stigmatizing attitudes, and high-risk behaviors (KAB) among the general population, which may affect the transmission of HIV and lead to outbreaks. The current study aimed to: 1) assess KAB among the general population in a high-risk county in the US, 2) analyze KAB among the general population of Cambodia, and 3) compare KAB across samples from a high-risk county in Northeast Tennessee and a province in Cambodia. Tennessee data were collected in 2017 and Cambodian Demographic and Health Survey data were from 2014. Descriptive, Kruskal-Wallis, Wilcoxon, Bonferroni, and Spearman’s correlation as well as simple and multiple logistic regression analyses were conducted on individual questions and KAB variables. Among Northeast Tennessee participants, 92.6% had heard of HIV, 43.5% knew that HIV could not be transmitted by mosquitos, and 67.8% of participants had never tested for HIV. Cambodian females aged 20-29, 30-39, and ≥40 were more likely to have a high level of HIV knowledge than those aged 15-19 (Odds Ratio (OR): 1.4, 1.6, and 1.6, respectively). Cambodian males who completed secondary and higher education had significantly higher odds of having a high level of HIV knowledge (OR: 2.3 and 2.9, respectively) and lower odds of engaging in some high-risk behaviors (OR: 0.3 and 0.2, respectively) than those who had completed no level of education. Battambang participants were more likely to have a high level of HIV knowledge (OR: 4.44; 95% CI: 2.14-9.24) and less likely to have at least one stigmatizing attitude (OR: 0.47; 95% CI: 0.24-0.94) and one high-risk behavior (OR: 0.16; 95% CI: 0.08-0.33) compared to Northeast Tennessee participants. Future studies are needed to determine associations between results and policies/laws, frequency of personal contact, and other differences between the two locations. KAB can greatly impact the outcome of HIV prevalence within a community. Having a greater understanding of KAB and creating interventions based on that understanding can have a positive influence on HIV infection and related outcomes.

TITLE: Intent to Vaccinate Children Against COVID-19 by Caregiver Vaccination Status in Northeast Tennessee AUTHOR INFO Yordanos Tafesse MD1 tafesse@etsu.edu Olivia A. Sullivan, EMT, MPH1 sullivano@etsu.edu Samuel Pettyjohn, DrPH, MPH1 pettyjohns@etsu.edu 1 Center for Rural Health Research, East Tennessee State University, Johnson City, TN. Addressing vaccine hesitancy is crucial in mitigating the spread of the ongoing COVID-19 pandemic. Children are mostly asymptomatic or have milder symptoms of COVID-19 than adults, and thus may remain undiagnosed, allowing the disease to spread to a large number of people; they are also at a high risk of long-term morbidity from as-of-yet undetermined effects of “long COVID.” Therefore, this analysis sought to examine caregivers’ intent to have their children vaccinated against COVID-19 based on the caregivers’ vaccination status and the age of the children. Using a secondary dataset from a survey in Northeast Tennessee, researchers found a significant difference between vaccinated and unvaccinated caregivers in intent to vaccinate their children in all age groups. Among caregivers with vaccine-eligible (12+ years children), unvaccinated caregivers (n=16) were significantly more likely than vaccinated caregivers (n=71) to not have had their child vaccinated (X2=24, df=1, p=7.8x10-7). Among caregivers who had not yet had their children vaccinated, unvaccinated caregivers (n=23) were significantly more likely to indicate they would “definitely not” get their children vaccinated than vaccinated caregivers (n=76) among all age groups of children: 0-4 years (X2=7.8, df=1, p=5.1x10-3), 5-9 years (X2=28, df=1, p=1.4x10-7), 10-13 years (X2=30, df=1, p=3.6x10-8), and 14+ years (X2=16, df=1, p=6.1x10-5) (Figure 2). The percentage of caregivers indicating they would “definitely not” get their child vaccinated differed by age of children among vaccinated caregivers (X2=11, df=3, p=0.011) but not unvaccinated caregivers (X2=5.1, df=3, p=0.16). Limitations include a small number of unvaccinated caregivers in the sample and the inability to account for correlation in the data. These results corroborate other findings nationwide, and demonstrate the need to provide high-quality education to address vaccine hesitancy in Northeast Tennessee.

Antebellum political historians have long studied the era between Andrew Jackson’s election and the secession crisis through the colored knowledge of the Civil War. This project is an effort to reverse that trend. It explores northeast Tennessee’s political culture from the late 1830s through the start of the Civil War. It reveals that the Second American Party System, a wave of new enfranchised voters, and the area’s demographics mixed together to lay a foundation for the aggressive and populist political style that permeated the region from the 1830s through the 1850s. At the heart of these issues was the transition of power from East Tennessee to Middle Tennessee. As a way to analyze the region’s political culture, I look specifically at Democrats Andrew Johnson and Landon Carter Haynes and Whigs William Brownlow and Thomas Nelson.