The field of radiation oncology (RO) involves the use of highly advanced techniques to treat cancer and safely spare healthy organs. The discipline has experienced rapid growth in the past 25 years, with technological advancement as the driving force. Available data and an instrument to effectively measure the accessibility of innovation in the field were lacking. The purpose of this study was to investigate the accessibility of innovative services in RO in the United States and assess possible diffusion patterns. Two hundred and forty medical physicists practicing in RO in the United States completed a custom Internet-based survey. The diffusion of innovation theory was used as the theoretical framework for the study. A quantitative cross-sectional analysis was performed to assess how innovation scores may vary depending on individual and organizational factors. ANOVA, Spearman correlation, and multiple linear regression were used to analyze the data. University affiliation, urbanicity, appreciation, and motivation were found to be statistically significant factors affecting accessibility to innovative services. Statistically significant barriers preventing innovation were lack of evidence, increased complexity, staffing constraints, lack of interest from others, lack of interoperability, and lack of reimbursement. Medical physicists are in a leadership position to influence the adoption of innovative services in RO. Encouraging the utilization of innovative and Food and Drug Administration-approved techniques may improve cancer outcomes and consequently have a positive social change effect on public health.

Education is one of the strongest predictors of health, and well-being. Early termination of education can lead to poorer health, shorter lifespans, and increased stress on the healthcare system. Improving overall high school graduation rates has been debated and discussed by the Toronto District School Board (TDSB) and the Ministry of Education, however, there is a paucity of research on increased graduation rates as they relate to public health in the Canadian context. The purpose of this phenomenological qualitative study was to explore the perceptions of liaison public health nurses (PHNs) who worked directly with the TDSB regarding their roles in terms of influencing students in Toronto, Ontario to complete high school. Bronfenbrenner’s ecological model was the underlying conceptual framework for the study.Purposive sampling was used to select 10 PHNs who were interviewed regarding their role and involvement in high schools. The data was subjected to triangulation and analyzed to identify commonalities, trends and patterns. Findings from this study indicated that liaison PHNs believe that high school dropout rates are a public health issue and collaboration between the Ministry of Education and Public Health is needed to take action. Recommendations include more Canadian research that explores connections between health and school achievements and the expanded role of PHNs in Canadian high schools. Social change implications for this research include highlighting high school dropout rates as a public health concern in Canadian schools, particularly in communities of lower socioeconomic status. With increased research and resources, the Toronto public health system may work toward making improving graduation rates among their core mandate.

Policies mandating HIV status disclosure to decrease incidence create ethical challenges for physicians on whether to breach or maintain infected patients' confidentiality. In Sub-Saharan Africa where HIV incidence is high, there is a need for clear guidelines/policies on making confidentiality decisions. The purpose of this quantitative quasi experiment was to determine whether the gender, gender orientation, and sexual relationship of an infected patient and physicians' demographics predicted physicians' decisions to breach confidentiality. In Plateau State, Nigeria, 222 physicians were given vignette questionnaires containing 6 different descriptions of gender, gender orientation, and sexual relationships of a hypothetical patient. Each physician decided to maintain or breach a patient's confidentiality in a variant. The utilitarian framework was applied, and data were analyzed using logistic regression models. A majority of the participants (70%) indicated a breach by directly informing sex partners or informing or referring to the health department. Only physicians' feature of previous confidentiality breach significantly predicted the decision to breach [p =.028, Exp (B) =.1.345, 95%CI (1.032, 1.753)]. The results suggested that regardless of patients' characteristics, physicians will breach confidentiality to protect sex partners potentially at risk of HIV infection. These findings may bring about positive social change by clarifying reasons for physicians' breach decisions, by informing the development of physicians' decision guidelines that would enhance physicians' practices in managing discordant couples, which could reduce HIV transmission among discordant couples leading to better and longer lives.

Tennessee ranks high for infant mortality (IM) in the United States. Despite public health efforts, the IM rate for Blacks is twice that of Whites mimicking what is observed nationally. Several risk factors for IM have been identified; however, it was still unclear how places of residence and prenatal care (PNC) affect IM for Tennesseans. The purpose of this study was to assess the relationship between places of residence (conceptualized by rurality and racial concentration), PNC, and IM among racial groups across Tennessee and to determine if race modified these associations. This was a cross-sectional study using data from the Tennessee PRAMS survey (2009-2011) and geocoded to 2010 U.S. Census Bureau and U.S. Department of Agriculture data. The study was grounded on the theory of racial residential segregation and concentrated poverty. General linear model and hierarchical binomial logistic regression were used to analyze the data. High racial concentration was associated with IM for Non-Hispanic women and remained significant even after controlling for demographic variables (aOR = 5.33, 95%CI [1.11, 25.67]). Disparity in PNC access for Blacks, Other races, and Hispanics were observed based on racial concentration and rurality; however, PNC was not a risk factor for IM. Black race modified the relationship between high racial concentration and IM. Implications for social change include greater public awareness, education on risk factors, advocacy to decrease disparities in access to care, and resource allocation to highly impacted areas potentially mitigating health outcomes for the most vulnerable women and infants.

In Ethiopia, one of the primary contributors to blindness is trachoma, which is an infectious ocular disease. There is no record of any prevention programs in rural Ethiopian villages of Oromia, where the prevalence of trachoma is high. The original purpose of this phenomenological study was to explore the perceptions of rural Oromo villagers in Ethiopia on the causes, treatment, and prevention of trachoma, using the health belief model and the social-ecological model as a theoretical framework. Due to a security situation in Ethiopia, final interviews were conducted with immigrant Ethiopians in the US, all of them from the trachoma-endemic rural areas of Oromia, all now living in Phoenix, Arizona. Results showed that this sample of former villagers had limited knowledge of the causes, prevention or treatment of trachoma, and could not recognize, or differentiate it from other eye diseases. The participants had some knowledge of governmental and nongovernmental efforts to control trachoma in their home country - through education and pit latrines. They also knew about the limitations of those programs. All reported that people would be willing to attend classes for trachoma prevention if held at a convenient time and place. These results may be useful in preparing a program to prevent trachoma in rural Ethiopia, and reduce blindness in this population, enabling more individuals to become educated and contributing to their community's well-being. Since trachoma is highly infectious, and participants in this study come from a trachoma-endemic area and do not know how to recognize it for themselves, the need for screening for trachoma on arrival in the US should be examined in more detail.

A Collegiate Recovery Community (CRC), also called a Collegiate Recovery Program (CRP) provides a college student in recovery (CSR) an opportunity to attend college with a network that supports their choice to remain free from addictive substances and other addictive behaviors. While research has established the value of CRPs on college campuses, less is known about the connection of a CRP and the role of family through the recovery process. This poster will review the primary components of a CRP and provide findings from a qualitative study seeking to understand how CRPs can involve family. The findings of the study also provide practical application for how CRCs can connect with the families of students in recovery to enhance the recovery process. The key takeaways of this poster include presenting information related to the CRC and evidence for how CRCs can support family members and college students in recovery.

Dental care has great importance in the overall health of every individual. Many do not realize the effect oral health plays in their overall health and many areas in the United States do not have access to the dental care needed to obtain proper healthcare standards. In many of these areas, such as the Appalachian region, dental services for low-income citizens are limited. Specifically, in the Northeast Tennessee region, these dental services are severely limited. Washington County and Hawkins County of Northeast Tennessee are specific underserved areas in the Appalachian region. The purpose of this project was to explore the services for low-income residents of upper East Tennessee (the Tri-Cities region) to analyze if the services being provided are utilized, if they are meeting the needs of the individuals that are utilizing the service, and if there are barriers for access to dental care for low-income East Tennesseans. In this research, we surveyed three of the four safety-net dental clinics in the Tri-Cities region to determine the number of patients seen in a year; number of dental appointments filled in a week; if they have volunteer, full-time, or part-time dentists; and if they would expand their dental services if they could; and reasons a patient could be turned away. After analyzing the surveys, there is a need for more accessible dental care in the Tri-Cities region. While these clinics are seeing many patients, there is a lack of dentists and a lack of extensive care being given, which is often what these patients are seeking. Possible solutions to this problem could be proper oral health education in schools and dental hygienists working alongside school nurses, forms of transportation for patients to safety-net dental clinics, a mobile in-home dental office, and HRSA grants for dental personnel.

Background: In late 2019, the SARS-CoV-2 virus was identified in Wuhan, China. Within a matter of weeks, the virus spread to the United States and many other countries around the world. By March 5, 2020, the first case of COVID-19 (the disease caused by the SARS-CoV-2 virus) was identified in the state of Tennessee, and the first known COVID-19 associated death in the state followed on March 20, 2020. In 2020 alone, there were 514,922 confirmed cases and 6,760 COVID-19 attributed deaths in the state of Tennessee. It is important to understand, however, that confirmed COVID-19 deaths do not accurately capture the overall impact of the COVID-19 pandemic. Many additional deaths resulted either directly from COVID-19 disease, or indirectly from the COVID-19 pandemic. This report seeks to briefly summarize the early stages of the COVID-19 pandemic and its immediate impact on the state of Tennessee and outline a novel tool for rapidly identifying excess mortality using publicly available data. Methods: Calculating excess mortality is likely to accurately capture the total deaths that occurred because of the COVID-19 pandemic, including deaths that may not have been directly attributed to COVID-19 disease. To calculate excess mortality, four years (2017-2020) of data were collected from three sources, online funeral home listings, newspaper obituaries, and the state health department. Using simple linear regression, number of deaths by month for 2017, 2018 and 2019 were used to predict expected deaths, by data source, for each month of 2020 as the baseline for comparison. The percent difference of actual deaths from the expected deaths was then calculated and compared by data source. Results: By quarter, 2020 actual funeral home listings differed from the expected by Q1:-9.29%, Q2:11.50%, Q3:7.36% and Q4:55.90%. Newspaper obituaries differed from the expected by Q1:8.05%, Q2:20.00%, Q3:9.93% and Q4:44.55%. State reported Washington County data differed from the expected by Q1:7.68%, Q2:18.85%, Q3:12.21%, Q4:48.91%. When comparing online funeral listings and newspaper obituaries to state reported data for Washington County, it is clear that either of the public data sources could have been used to identify spikes in excess mortality throughout 2020. Conclusion: These findings reveal that publicly available online funeral home death listings and local newspaper obituaries can be used as a tool to help identify spikes in excess mortality in ‘real-time’. The most notable impact being that the newspaper obituary and funeral home data was available in near real time, whereas the state reported Washington County data was not made available until October of 2021.

While systemic lupus erythematosus (SLE) has been traditionally viewed as a woman's disease, SLE impacts men as well. Although most research on SLE has concentrated on how it affected women, little is known about how it impacts men. The purpose of this phenomenological study was to examine how men who live with SLE perceive its psychological impact. Using the lens of the biopsychological theory, common themes were examined pertaining to how men with SLE perceive the impact that SLE has on their cognitive and emotional functioning. Data were collected via interviews with 9 men with SLE, and the data were analyzed using thematic analysis to determine common themes. The following common themes emerged: reflections on life before SLE, changes in interpersonal relationships, changes in intimate relationships, changes in self-concept, and changes in perspective about living with lupus. These themes suggest that, in order to improve the quality of life for patients living with SLE, it is not enough to address the physical symptoms; it is necessary to address the cognitive and emotional impacts of the disease process as well. Implications for positive social change of this research study include providing a greater level of understanding of the psychological impact of SLE on men as a resource for professional therapists and psychologists who are trying to find information that would be beneficial for their male SLE clients. Additional potential implications for positive social change include providing information for families and caregivers of those men with SLE, and how the disease impacts them from a psychological standpoint.

Military stigma is a heavy burden of social stigma internalized by veterans who are diagnosed with posttraumatic stress disorder (PTSD) during post-deployment psychological screening. PTSD is classified as a mental disorder associated with widespread reluctance to seek medical assistance. Among military veterans who suffer from combat-related posttraumatic stress (PTS), military stigma is considered a widespread problem. The purpose of this phenomenological study was to explore veterans' perceptions of various aspects of military stigma, including post-deployment psychological screening, the diagnosis of PTSD, and factors associated with reluctance to seek medical assistance for PTS. In-depth interviews were conducted with a convenience sample of 10 veterans of 2 recent operations in Iraq and Afghanistan. A modified form of labeling theory was applied to address the role of cultural stereotypes in stigma (societal and self-internalized), and the discriminatory factors associated with them. Multiple themes emerged, including a commonly held view that post-deployment health screenings are superficial, inconsistent, and ineffective procedures in which veterans feel the need to lie about their experience for fear of being stigmatized with a mental disorder. The findings confirm that the stigma associated with a diagnosis of PTSD perpetuates veterans' reluctance to seek help for PTS, which results in multiple personal and professional problems. Remedies recommended by these veterans included improved post-deployment medical screening procedures, reclassification of PTSD as a war injury instead of a mental disorder, and PTS-related stigma awareness training.