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Patient-centered contraceptive care is key for ensuring that individuals achieve their personal reproductive goals. Despite public health efforts, preventing undesired pregnancies and improving maternal and child health outcomes remains unresolved in the United States (US). In Tennessee (TN), the rate of unintended pregnancies remains higher than the national rate (32.4% vs. 30.3%). Long-acting reversible contraceptives (LARCs) are 99% effective in preventing undesired pregnancies; however, uptake remains low in rural and underserved communities. Previous research has provided some insight into women’s perceptions of LARCs; however, those guided by conceptual frameworks to understand the multiple influences that impact perceptions towards LARCs, especially among rural regions, are scarce. This multimethod qualitative study explored multiple influences that impact northeast Tennessee women’s perceptions and attitudes toward LARCs using the Socio-ecological Model (SEM) as a guiding framework. The qualitative study comprised six focus groups and seven individual interviews of women aged 18-44, not pregnant, and current residents of five Counties in Northeast TN. Participants’ demographics were captured through an anonymous survey administered through REDCap. Qualitative data from these sessions were recorded via Zoom, an online audio/video conferencing platform. Each interview and focus group lasted 60 to 90 minutes. Focus group and interview data were combined, transcribed, and uploaded into NVivo for thematic analysis. A priori list of codes identified from the constructs of the SEM was initially used to deductively code the data. Subsequently, the data were analyzed inductively for new codes and themes that did not apply to the a priori categories. Quotations that were representative of or inconsistent with the codes of interest were identified. Fifteen themes and 20 sub-themes were identified using the SEM; On the intrapersonal level of the SEM, participants’ attitudes towards a method, perception of method features, and perceived side effects were identified as themes that delineate influences on their LARC utilization. On the interpersonal level, perception of partner support, perceived support from peer/social networks, and provider trust were themes that describe influences on participants’ LARC utilization. On the community level, the cost of the method, access to information, perceived accessibility to a method, social services, and cultural norms themes were identified as influences on participants’ use of LARCs. On the organizational level, the availability of preferred methods in a clinic, the need for multiple clinic visits to enable the use of a method, and provider counseling practices were salient themes impacting LARC utilization. On the policy level, insurance, and billing policies, sex education policies were identified as impacting LARC utilization. The study presents multi-layered influences on LARC utilization among Northeast TN women, highlighting the utility of the SEM in understanding factors that influence contraceptive use. Findings are critical for programming as they highlight the areas of influence that can be addressed to increase LARC uptake and enable women in rural and underserved regions of the US to achieve personal reproductive goals.

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This study describes the changes in prevalence odds ratios (PORs) for Alzheimer disease (AD) in the northeast Tennessee region (NTR) during a 3-year period, describes the statistical assessment process, and critically assesses the database from which the statistical association was derived. The article also examines several beliefs pertinent to the clinical management of AD in the NTR from the perspective of professionals delivering services. Methods We extracted prevalence data for NTR counties for 2013, 2014, and 2015 from the Centers for Medicare and Medicaid Services Geographic Variation Public Use File. We used the crude prevalence and the 2010 US Census Data fixed population for each county to compute the POR. The 2013 Economic Research Service Rural-Urban Continuum Codes were used to identify rural and urban counties in the NTR. We collected primary data on the perceived observation of the increasing prevalence in the NTR during the last 3 years and barriers to early diagnosis through an online survey from 44 experts and professionals working in AD-related fields within the NTR. Results The PORs of AD in rural counties in NTR increased by 18.3%, 4.7%, and 19% compared with urban counties for 2013, 2014, and 2015, respectively. The POR of AD for the entire NTR region increased by 22.7%, 22.5%, and 21.2% compared with other regions in Tennessee for 2013, 2014, and 2015, respectively. Compared with 2012, 68.4% of respondents currently work with more individuals with AD; 71.8% reported that the NTR has a higher number of late-stage diagnoses of AD. A total of 92.3% strongly agreed that early detection of AD is important, and 95% agreed that early diagnosis could prolong the lives of patients with AD; 51.2% were unaware of existing AD screening services. Reported barriers were denial, lack of patient awareness, inefficient screening methods, communication, and lack of community resources. Conclusions Increased prevalence of AD among inhabitants in the NTR and identified barriers to early screening or diagnosis in the management of AD were identified. Access to early screening techniques must be prioritized in deprived areas within the NTR. Healthcare providers and medical professionals in the NTR must be well equipped with the required training and resources to respond adequately to the increasing prevalence of AD.

This study consists of an analysis of hospital discharge data from three Northeast Tennessee hospitals to identify maternal demographic factors that may be linked to higher rates of cesarean sections in this region of Appalachia. Maternal age, race, insurance status, length of stay, and birth weight were evaluated to identify regional trends in the prevalence of these factors over a two-year period. There were 1,678 (23.3%) singleton live births by cesarean section of which 7.6% were repeat cesarean section deliveries. Less than one percent of the 7,181 births were vaginal births after cesarean (VBAC) delivery. Overall, insurance and maternal age was found to be significant predictors of cesarean delivery. Using stepwise logistic regression, age was found to be a significant predictor of cesarean birth for women less than 35 years of age. Significance was found for cesarean birth and insurance status (OR=1.09, 95% CI=1.00,1.19) and for cesarean birth and mother’s age (OR=1.31, 95% CI=1.21,1.41). Mothers under the age of 35 who were insured under a managed care plan were at significant risk for cesarean section delivery. This study was limited in that only hospital discharge data were available and the study population was relatively homogeneous. Further research of this population is needed to continue investigation of the predictors of cesarean birth.

Our nation has made great strides since 1954's Brown v. Board of Education, 1963's I Have a Dream speech, and the passage of the Civil Rights Act of 1964. However, Jeannie and other minorities continue to endure in a struggle for true equality. A debate exists as to whether race issues are improved by discussion, or if they improve by ceasing these types of discussions and not even mentioning race. The purpose of this qualitative biographical narrative is to vicariously relive Jeannie's Journey and ascertain what relevance her life story has to our historical timeline. The sole participant in this study was Jeannie Hodges. Data for this study were collected through 3 in-depth interviews using an interview protocol based upon a conversational interview process. Who we are is a direct manifestation of where we have been and the journeys we have taken. Jeannie's journey shows us that we can look at the past and discuss history without hate, pointing fingers, or laying blame. We benefit from gaining a deeper understanding of where we as a people have been as opposed to as individual races of blacks and whites. Understanding our combined histories provides an appreciation for where we are today as well as guidance for the future. The point is to gain a deep understanding of the interconnectedness of our individual histories, like threads in a tapestry. It is crucial to our continued progress that we not cease discussions about race or about this part of our historical timeline. Can we as a nation, acknowledge our past, embrace our future, and continue the journey together?

Complementary and Alternative Medicine (CAM) has been demonstrated to be an effective addition to traditional medical practice. However, patient awareness of CAM techniques may be low, particularly in rural areas. The aim of this study is to measure adult patient interest in CAM, particularly Osteopathic Manipulative Medicine (OMT), acupuncture, meditation, nutrition, and breathing techniques in a community Family Medicine practice. An anonymous survey was given to 200 adult patients in an outpatient clinic over the course of 3 months. Survey items were designed to assess if patients were aware of CAM, if they had experience with any of the mentioned modalities, if they were interested in the mentioned modalities, and which CAM services patients would like to see offered in clinic. In regards to having heard of CAM, 57.3% of patients had reported that they were aware of CAM, while 42.7% were not. Of those that had heard of CAM, 42.4% had experience with OMT, 55.1% had experienced acupuncture, 7.6% had experienced breathing techniques group, 14.4% had experienced nutrition groups, and 5.1% had experienced meditation groups. 22.3% of patients were not interested in any form of CAM being offered in clinic, while 77.7 were interested in at least one type of CAM. OMT held the highest rating among interested patients, with 29.1% wanting to see it offered in clinic. These results indicate that, while many patients were not aware of CAM, there was nonetheless a high degree of interest in seeing CAM techniques offered. The implication of this study is that CAM should be implemented in the clinic as soon as possible. Future research should assess the degree to which patients actually utilize these services, once offered.

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Literature provides evidence for disparities and inequities in health and birth outcomes based on geographical location, which highlight differential mother characteristics. These differences influence behaviors associated with adverse birth outcomes such as premature birth and low birth weight (LBW), the leading causes of infant morbidity and mortality. Consistent with the Healthy People 2020 and Millennium Development goal, to reduce infant morbidity and mortality rates, we sought to compare maternal characteristics and behaviors and the occurrence of adverse birth outcomes in Northeast (NETN) region, as defined by the Tennessee Department of Health, compared to the rest of Tennessee (TN). TN vital statistics birth record data for the years 2009 - 2014 were used in this analysis; n = 20,786 and 482,681 live births for NETN and TN respectively. Bivariate analyses were performed to deduce the demographic and birth characteristics and their proportions across the years. Logistic regression was used to calculate crude odds ratios for pre-pregnancy smokers, with the dependent variables of preterm birth and LBW. We followed with adjusted odds ratios, which controlled for mother’s demographic variables; age, education years and reported household income and mother’s behavioral characteristics; pre-pregnancy cigarette smoking, prenatal care by first trimester and previous preterm birth. From 2009 through 2014, the percentage of teenage mothers decreased for both TN groups, with a larger proportion in NETN (%:13.8,12.2,12.5, 11.9,9.6,9.4) compared to TN (%:12.8,11.8,10.8,10.0,9.0,8.4). A larger percentage of TN mothers did not have a high school degree or completed GED compared to NETN. A larger proportion of NETN mothers were married at the time of birth of the infant (%:60.3,60.5,59.3,58.6,57.6,57.8) compared to TN mothers (%:55.5,55.9,55.9,55.8,56.0,56.0). Over the period, 34% of NETN women smoked during the 3 months prior to pregnancy versus 21% for TN mothers. Through the third trimester 24% of NETN mothers reported cigarette smoking compared to 13% of TN mothers. Throughout, more adverse birth outcomes were observed in NETN. Compared to non-smokers, for six consecutive years and overall, the odds of a LBW among pre-pregnancy smoking mothers were higher in NETN (odds ratio (OR):2.16,1.73,2.56,2.03, 2.02,1.83,2.05) than in TN (OR:1.51,1.53,1.56,1.56,1.56,1.52,1.54), p-values