Completed Projects

Recently Completed Projects

Caring Workplaces

CRHR is performing a qualitative evaluation of the Caring Workplaces Program. Funded by a grant from the US Department of Labor administered by the First Tennessee Development District Foundation (FTDD), the Caring Workplaces Program focuses on creating a healthy and safe environment where employers, employees, and communities can collaborate to create positive change and eliminate barriers for those impacted by substance use disorder and justice involvement. Comprehensive results and recommendations of the evaluation will guide future improvements and expansion of the geographic reach of the programming.

COVID-19 Vaccination Bright Spots Among Rural Communities

In partnership with NORC at the University of Chicago (NORC), CRHR conducted work for the Centers for Disease Control and Prevention (CDC) to identify rural counties across the United States with higher than expected COVID-19 vaccination rates. Six case study sites were selected based on vaccination rates, geographic location, ethnic and racial diversity, and a mix of public health delivery structures. CRHR researchers focused on Marshall County, IA; Perry County, KY; and Mississippi Delta Region. NORC researchers looked at Starr County, TX; Rio Arriba County, NM; and the North Country Region of New Hampshire.  Read more...

EVALUATION OF A PROGRAM FUNDED THROUGH THE WORKFORCE OPPORTUNITY FOR RURAL COMMUNITIES (WORC) INITIATIVE

CRHR served as an external evaluator for a US Department of Labor grant received by a partnership among Appalachian Sustainable Development (ASD) and Bristol’s Promise. ASD’s Groundwork program focuses on training individuals with barriers to employment, while Bristol’s Promise’s Bristol Connect program provides resources to support frontline employees in the workplace. This project is an innovative, sustainable partnership that aligns ASD’s workforce development activities with Bristol’s Promise’s economic development strategy. 

INSPIRE

The East Tennessee State University (ETSU) Center for Rural Health and Research, in collaboration with the ETSU Addiction Science Center, conducted an evaluation of the INSPIRE Initiative on behalf of the Appalachian Regional Commission in 2022-2023. The Investments Supporting Partnerships in Recovery Ecosystems (INSPIRE) Initiative addresses the substance use disorder crisis across Appalachia by giving grants to organizations that create or expand a recovery ecosystem that will lead to workforce entry or re-entry. The evaluation was designed to advance understanding of the accessibility of the application process, implementation successes and challenges, and preliminary grant impacts. Evaluation findings informed recommendations aimed at strengthening the program.

Kentucky’s Capacity for Substance Use Disorder Treatment Exceeds Nation

A study by East Tennessee State University’s Center for Rural Health and Research finds that Kentucky leads the region and nation when it comes to treating substance use disorder.  For this study, the number of residential beds designated for substance use and mental health services for each state was combined with US Census Bureau total population estimates to create a residential bed rate per 100,000 population for each year. These rates were then compared regionally and nationally to see how states ranked in terms of residential capacity as a measure of the strength of state-level Recovery Ecosystem supports. Kentucky, with a residential designated bed rate of 70.34 beds per 100,000 population, had the highest rate in the country in 2022 – more than twice the rate as the other geographically connected Appalachian states of Ohio (31.23), West Virginia (30.08), Tennessee (29.61), and Virginia (10.27).  Read more...

MASCUP! (Mask Adherence Surveillance at Colleges and Universities) 

CRHR participated in a CDC study at 54 US colleges and universities on mask-wearing behaviors during the COVID-19 pandemic. The ETSU chapter of the CDC MASCUP team published their findings in the Journal of Community Health.  The team also contributed its findings to another article published in the Journal of American College Health.  

NACCHO Rural Public Health Emergency Preparedness (PHEP)

The Center for Rural Health and Research, with partners from NORC and the University of Minnesota, is working with NACCHO and the Centers for Disease Control to create recommendations and considerations for rural and frontier local health departments to develop recommendations to improve public health emergency preparedness (PHEP) capabilities. Rural and frontier jurisdictions have unique emergency preparedness and response needs highlighted by events such as wildfires, winter storms, floods, heat exposures, and the COVID-19 pandemic. The goal is that moving forward, local health departments in rural and frontier areas will have tailored guidance to respond to, recover from, and build community resiliency related to future public health emergencies effectively.

National Indian Health Board (NIHB) Evaluation Review

CRHR collaborated with members of NIHB and the Tribal Technical Advisory Group (TTAG) to create of evaluation materials to assess the success and areas of improvement for grant deliverables under the Centers for Medicare and Medicaid Services (CMS) and Indian Health Service (IHS) cooperative agreements. These evaluation materials were used in TTAG strategic planning activities, as well as NIHB listening sessions and programming. 

PHAB Collaboration

CRHR staff collaborated with the Public Health Accreditation Board (PHAB) to review site visit report comments from small health departments. The research team looked at selected measures to identify common themes, with a particular emphasis on promising practices for small health departments when considering applying to PHAB for accreditation.  

Rural Resources 

CRHR is working with Rural Resources in Greeneville, TN, to evaluate their Teen Training Program. This unique program teaches skills in food production, livestock management, kitchen skills, employment, and wellness. Participating students are given a stipend for attending classes and working on the farm. Over the next year, CRHR faculty will conduct qualitative interviews and review program data to document program outcomes. A final report and presentation will be provided to the Rural Resources Board of Directors.

Rural Service & Resource Sharing Arrangements Report 

CRHR collaborated with the Center for Sharing Public Health Services at the Public Health Accreditation Board (PHAB) and the Kansas Health Institute (KHI) to develop a Service and Resource Sharing Arrangements (SRSAs) guide for small and rural health department jurisdictions. The guide was published on PHAB’s website as an additional tool for SRSA planning across the country.   

Tennessee Opportunity Grants Pilot Initiative Data Collection

The Center supported the STRONG ACC and First Tennessee Development District Foundation in convening cross-sector stakeholders regarding participation in the Temporary Assistance for Needy Families (TANF) program. The Center hosted focus groups with families, interviewed community leaders, and surveyed beneficiaries and service agency providers in 10 counties to assess factors influencing the outcomes of families experiencing low income in Northeast Tennessee. Findings from this report informed the region’s successful proposal for one of the seven $25 million Tennessee Opportunity Pilot Initiative Implementation Grants launched in fall 2022.

• Archived Projects

  Appalachian Diseases of Despair Update. On behalf of the Appalachian Regional Commission (ARC), NORC and ETSU investigated how “diseases of despair” impact the Appalachian region, updating a report developed in 2017. Diseases of despair include deaths due to alcohol and drug overdose, suicide, and alcoholic liver disease/cirrhosis. The 2020 update of the Appalachian Diseases of Despair report included 2018 mortality data from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS). In addition to analyzing deaths caused by the diseases of despair, we also analyzed opioid-related deaths for the Appalachian counties of states in the Region. NORC investigated where disparities were concentrated within the region, and specifically, analyzed mortality data by Appalachian sub-region, county economic status, and rurality.

  Standardized Overdose Surveillance Data to Inform Targeted Drug-Related Prevention, Treatment, Policy Making, and Harm Reduction Strategies. On behalf of the American Medical Association (AMA), NORC and ETSU explored current overdose surveillance dashboards and identified parameters, commonalities, best practices, and data quality standards. We reviewed all 50 states and the District of Columbia to identify any existing drug overdose surveillance dashboards, selecting 15 dashboards for more in-depth review. Of those 15 dashboards, we also conducted interviews with 5 of the exemplar dashboards. The study identified best practices and recommendations for dashboard development and maintenance, including establishing a clear understanding of the target audience, building strong relationships with data stewards, establishing processes the streamline dashboard updating, and developing a dashboard that is sustainable and meets individual state needs. Lastly, NORC and ETSU provided several recommendations on how AMA may be able to support standardization and surveillance efforts related to overdose dashboards.

  The State of Tennessee Report on Poverty and Health.  This study was conducted to better understand the association between income and disparities in health, social, and economic metrics at the county-level in Tennessee.

  A qualitative study of community pharmacist engagement in HIV/HCV prevention services in central Appalachia.  Central Appalachia is highly vulnerable to HIV/HCV outbreaks associated with injection drug use. Rural areas like Central Appalachia experience significant gaps in the HIV/HCV continuum of care. Community pharmacists could help close those gaps, yet research on their engagement in HIV/HCV prevention services in rural areas remains limited. This qualitative study sought to describe HIV/HCV-related prevention behaviors, attitudes, and beliefs among community pharmacists in Central Appalachia.

  Children of Incarcerated Parents.  Tennessee Institute of Public Health.

  Creating a Culture of Health in Appalachia: Disparities and Bright Spots: Practical Recommendations and Strategies to Support Positive Health Outcomes in Appalachia. Appalachian Regional Commission/Foundation for Healthy Kentucky. 2018-2019. 

  Identifying Opportunities in Rural Regions to Improve Health and Equity. Robert Wood Johnson Foundation. 2017. 

  Opportunities and Challenges Facing Rural Public Health.  National Association of City and County Health Officials. 2017. 

  Model to Interrupt Social Determinants of Rural Health.  BlueCross BlueShield of Tennessee. 2016-2017.       

  Geographical Distribution of Adverse Childhood Experiences in the United States.  ETSU RDC.  2016-2017.

  Adverse Childhood Experiences at an HIV clinic in rural Appalachia: a pilot study to assess HIV/AIDS treatment barriers. East Tennessee State University Research Development Committee. 2019-2020. 

  Healthcare disparities in rural Appalachia. East Tennessee State University Undergraduate Research, Student Faculty Collaborative Grant. 2019-2020 

  Building Capacity for a Trauma Informed System of Care in Munsieville, South Africa. East Tennessee State University Research Development Committee, Small Grant. 2018-2019 

  Identifying adverse childhood experiences (ACEs) and resilience in college students: steps toward a trauma-informed campus. Tennessee Department of Children’s Services, Building Strong Brains. 2018-2019

  Exploring Adverse Childhood Experiences among Mothers and Daughters in South Central Appalachia. East Tennessee State University Research Development Committee, Small Grant. 2016. 

  Adult health outcomes: Impact of childhood adversity and preventive care on inpatient health risks. ETSU Research Development Committee Major Grant. 2013-2014.

  Assessing Regional Health Priorities Through Community Engagement:  An Application of the World Café Model in Southern Appalachia
  Funding:  Mountain States Health Alliance and Wellmont Health System

  Reducing Childhood Obesity and Chronic Disease in Central Appalachia – Data Analysis and Planning to Support Promising Practices and Strategies. Appalachian Funders Network. 2015.

  Regional Roadmap 2:  Down the Road to a Healthier Appalachia and Healthy WEST:  Working to Energize and Strengthen Tennessee. Appalachian Regional Commission, BlueCross BlueShield of Tennessee, Niswonger Foundation, Eastman Chemical Company

  Statewide Healthcare Provider Assessment of Diabetes Practices. Tennessee Department of Health. 2015-2016.

  Improving population health: a systems perspective. East Tennessee State University RDC. 2015.

  Accreditation of rural health departments: social, economic, cultural and regional factors. Robert Wood Johnson Foundation, 2012.

  Survive and Thrive Southeastern Regional Training Center, May 2012-December 2013. National Association of County and City Health Officials.

  Public Health Training Center Performance Site, Health Resources and Service Administration.

  Public Health Traineeship, Health Resources and Service Administration.

  Methodology in Public Health Systems and Services Research (PHSSR). Robert Wood Johnson Foundation, 2010.

  College Students As Facilitators to Reduce Adolescent Obesity Disparity In Southern Appalachia. NIH-NIMHD, 2011-2013.

  Tennessee Coordinated School Health Evaluation. Tennessee Department of Education, 2005-2011

  Combating Child Obesity and Diabetes in Northeast Tennessee: Winning with Wellness. Tennessee Center for Diabetes Prevention and Health Improvement, 2007-2008.

  Role of foods fortified with iron, omega-3 fatty acids and fiber in improving elementary school-aged children’s behavioral outcomes. Research Development Committee, 2008-2009.

  Fiscal Constraints and Access to Reproductive Health Services in South Carolina: The Impact of Local Clinic Retraction on Utilization, Outcomes, and Quality of Services in South Carolina.  Robert Wood Johnson Foundation.  Public Health Services and Systems Research, Investigator Initiated Award

  Measuring the Effects of Public/Private Transition of Pediatric Preventive Services on Unmet Need Among Medicaid Eligible Children.  Robert Wood Johnson Foundation.  
  Public Health Services and Systems Research, Investigator Initiated Award

  Impact of the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) on Selected Outcomes in South Carolina.  Children's Trust Fund of South Carolina

  Evaluating the Implementation of a Parenting and Pregnant Team Program. Children's Trust Fund of South Carolina

  TN Ceal. Meharry Medical College as part of a National Institutes of Health (NIH) initiative

  Child Friendly Cities Initiative (CFCI). UNICEF.

  Strong Starts Universal Screening and Navigation.  Ballad Health.

  Tennessee Department of Health - National Initiative to Address COVID-19 Health Disparities
  Centers for Disease Control and Prevention