Obesity is caused by a variety of contributing factors including genetics, behavior, and environment, which contribute to weight gain in children and adults. The obesity epidemic is growing rapidly, predisposing both children and adults to preventable chronic diseases such as heart disease and type 2 diabetes. Obese children often become obese adults, further contributing to the obesity epidemic and its economic consequences including higher healthcare costs and lost productivity. The obesity epidemic also exposes significant health disparities; non-Hispanic Blacks and Hispanics represent a disproportionate number of obese adults and children in the United Community Health Workers (CHWs) are uniquely positioned to support current efforts in the prevention and treatment of childhood obesity. Studies have found CHWs to be effective at increasing healthy behaviors and reducing disparities in cancer screenings for adult minority groups. CHWs can be trained to provide a variety of health services, reducing the burden of healthcare professionals, and reducing cost of care. CHWs provide peer to peer, culturally sensitive health information in an individual’s preferred language. The proposed study is a three-year randomized controlled clinical trial with 262 participants divided equally into two groups, intervention, and control. Non-Hispanic Black and Hispanic children ages 1-5 years old will be recruited from their pediatrician’s offices in the Boston Metropolitan Statistical Area (MSA). Participants will be identified and enrolled by research assistants based on language of care and BMI (body mass index) as recorded in the electronic medical record (EMR). Both groups will receive standard of care treatment throughout the study. The intervention group will additionally receive monthly in-home CHW visits for the first one and a half years. CHWs will take quarterly BMIs and provide education materials on healthy eating and physical activity. The primary outcome is BMI and the secondary outcomes will include healthy behaviors such as average weekly servings of fresh fruits and vegetables. At the end of the study period, all guardians will be given a survey to assess their opinions on the standard of care treatment and CHW interventions. CHWs are an untapped resource in the fight against childhood obesity, reducing health disparities, and the obesity epidemic. However, more research is needed in this area and the proposed study is a step toward proving their efficacy and efficiency. In the United States, the implementation of CHWs over time could make a huge impact on public health by reducing preventable chronic diseases.

Single parents face many challenges when accessing healthcare for their children and themselves, and have health issues that may go unrecognized, particularly for single fathers. The number of single father households has increased dramatically over the past few decades. There were fewer than 300,000 single father households in 1960, but in 2011 that number increased to more than 2.6 million—a 8.6-fold increase from baseline. Despite this jump in numbers, the literature addressing health-related issues of single fathers is rather scant. In this blog, we disseminate the limited number of studies on the subject and make recommendations for nurses to address the health disparities for this unique segment of population.

Background: Coronary Heart Disease (CHD) & depression problems are increasing concerns globally as cardiovascular diseases (CVD) solely account for almost one-half of NCD deaths. Similarly, 280 million people i.e., 3.4% of the world population are suffering from depression. There is a direct association between CHD and depression as studies show that up to one in five people with CHD may experience depression. Coronary artery disease (CAD) is the most common type of CHD in the United States. There have been studies examining the association between these, but none in Tennessee. This study aims to investigate the association between CHD and depression. Methods: We used cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System a nationally representative U.S. telephone-based survey of adults aged 18 years and extracted data for Tennessee (n=4,788). Logistic regression analyses were conducted to test the association between coronary artery disease and depression. We controlled for the past month's income, race/ethnicity, educational status, gender, and age. Results: Overall, 25.5% (n=1,209) reported having been diagnosed with depression, while 6.0% (n=289) reported coronary artery disease. Coronary artery disease predicted higher odds of depression (OR=1.86, 95% CI, 1.44, 2.41) along with low income (OR=2.14, 95% CI, 1.85, 2.48) and female gender (OR=1.94, 95% CI, 1.69, 2.23). Conclusion: High prevalence of depression is one of the major health challenges in Tennessee. Similarly, the prevalence of coronary artery disease was also prominent. We found a significant association with higher odds of depression among patients with coronary artery disease. Along with this, low income and female gender were also associated with depression. To address patients with depression, targeted efforts and disease management are needed among patients with CHD. More research focusing on the other associated variables is to be studied. Keywords: Coronary Heart Disease, Depression, Health disparities in Tennessee

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In response to the striking health and social inequalities existing across communities within a large Southern Ontario City the McMaster University School of Nursing has partnered with the local family health team, municipal government, and other community partners to evaluate a pilot program designed to enhance health and social outcomes within a specific priority neighbourhood. The innovative pilot program is a nursing-based system navigation role, grounded concurrently in the community and a local Primary Care Practice. The role is uniquely designed as the nurse provides navigation for individuals and families while functioning as a networker to facilitate improved service integration at a systems level. This study serves as a narrative person-centered evaluation of the program, emphasizing the impact on the lives of community members. This study employed the Three-Dimensional Narrative Inquiry Space method as described by Clandinin and Connelly (2000) to explore the experience of nine community residents utilizing navigation services through the Community Nurse Navigator/Networker (CNN). Programs tell a story; therefore, the collection and analysis of participants’ life stories, in conjunction with field notes, observations, and documents, created a common narrative of the experience of navigation in a community setting. A thematic analysis of participants’ life stories was conducted to present a common narrative of community members’ experience of navigation. The major finding of this study was the positive experience residents shared interacting with the CNN. Participants valued the development of a therapeutic relationship through social interactions, the significance of place on the impact of the CNN role, and the effect of the navigation role to address health disparities over time. Study findings have implications for continued development of the CNN role and other community-based nurse navigation roles in priority neighbourhoods to address health inequities. / Thesis / Master of Science in Nursing (MSN)

I conducted a four-month ethnographic fieldwork study to document the stories of thirteen post-kidney-transplant minority patients and three nephrologists at Boston Medical Center. My research explores how patients’ interactions with health professionals, medical regimens, dialysis treatments, and adaptation to living with transplanted kidneys constantly shape their identities and perceptual worlds. Patients’ narratives highlighted the emotional struggles they encountered along the path of End-Stage Renal Disease, which unfolded as distinct experiences influenced by their varied backgrounds. The majority of my patient-participants lived on the verge of poverty, and in some cases, their insurance status caused delays in their being registered on the transplant waiting list, making them endure a long wait. Some patients were afraid of wearing short sleeves because they thought the scars on their arms from dialysis treatment would lead others to think they were gangsters. Instantiations of various theories emerged from the saturated data and narrative analysis, from Bourdieu’s concept of habitus with regard to the process of how patients alter their consciousness through interactions with medicine to Foucault’s ideas of power relations and technologies of the self that address the issues of agency and power that influence the formation of patients’ identities. The intersection of these theoretical frameworks led me to develop the critical medical anthropological-oriented concept of biological citizenship. This paper examines 1) the ways in which “race” interacts with the theoretical concept of biological citizenship and 2) the ways in which socioeconomic status and race tailor a kidney transplant patient’s illness experience, and related discourse.

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Sociological theory and literature in the study of disparities in health and access to care in old age has, with few exceptions, not considered important political contexts for the aging AI/AN community. Political histories have unique implications for this population, and particularly those in old age. Native Peoples are affected by federal old age and health policies as well as AI/AN specific policies, which creates a unique intersection of inequality for this group. This project engages with three distinct areas of sociological scholarship in this area and works to highlight the strengths and gaps of existing frameworks to work towards more inclusive scholarship for Native Peoples in sociological scholarship. The first article uses a quantitative analysis using secondary data from the National Health Interview survey to explore how helpful sociological frameworks are in explaining health disparities in old age for the AI/AN population. The second article, using the same dataset, engages with Andersen's behavioral model of care utilization and its developments and couples it with important scholarship emerging about policy, AI/AN healthcare organization, and funding. The third article offers a qualitative analysis of reports and policy recommendations from Native organizations focused on increasing well-being for Native elders to further understand how healthcare, old age, and AI/AN specific polices work to create intersections of inequality for this group. This analysis further informs future directions for sociological theory and application to promote a more inclusive field in the sociology of aging and inequality. / Doctor of Philosophy / How policy impacts aging American Indian and Alaskan Native (AI/AN) has been largely overlooked in the field of sociology. Through three distinct studies, this dissertation project seeks to connect policy to disparities in health outcomes, issues in access to care, and the provisioning of health resources for this group. Native Peoples, through treaty agreements, have a right to healthcare, which has been poorly fulfilled by the US government. Because of this, Native Tribes and organizations have increasingly relied on other healthcare policies and social welfare programs to meet the needs of AI/AN elders. Policies like Medicare, Medicaid, and the Older Americans Act are all important policies in generating health resources for Native elders, but they also overlap in ways that can also create barriers to health equity. This project, in three articles, explores 1.) how policy-based resources affect health outcomes in old age across racial groups, 2.) how equitable healthcare access for the aging AI/AN population, and 3.) how organizations understand and navigate policy landscapes in order to promote health and well-being for Native elders. These three studies work together to inform theories of aging and health disparities in order to work towards scholarship that is more inclusive of Native Peoples.