College of Public Health

Doctoral student Chase Harless publishes two articles and a book chapter

Chase Harless, doctoral student in East Tennessee State University College of Public Health’s Department of Community and Behavioral Health, is lead author of two articles in the Southern Medical Journal, and co-author of a book chapter.  

The first article,”Eligible Prescriber Experiences with Substance Use Disorder Treatment and Perceptions of Pharmacy Barriers to Buprenorphine” aimed to better understand North Carolina providers' specific substance use disorder (SUD) and opioid use disorder treatment practices and buprenorphine prescribing.  Co-authors include faculty from the University of North Carolina at Chapel Hill and Boston University.

The study also aimed to provide novel information regarding US South and rural providers' opioid use disorder treatment behaviors and perceptions of patient experience at community pharmacies.  An online survey consisting of closed-ended and open-ended questions was used. Surveys were delivered to healthcare providers' e-mails and self-administered through an online survey platform.  In total, 332 healthcare providers, who were eligible to be X-waivered to prescribe buprenorphine, completed the online survey. Survey participants reported not having their X-waiver to prescribe buprenorphine or actively prescribing buprenorphine. The majority of participants were uncertain of potential barriers to filling buprenorphine prescriptions. Providers treating a mix of rural and urban patients reported being less likely to screen for substance use disorders. Although there were no rurality differences in screening, providers who treat mostly rural patients reported a lack of substance use disorder treatment options in their area. The study concluded that early detection of substance use disorders can help prevent negative health outcomes for patients. The article recommended that providers should screen for substance use disorders and familiarize themselves with the patient's experience when filling a buprenorphine prescription.. Furthermore, providers should incorporate questions about their patient's ability to receive buprenorphine to help ensure that patients are receiving proper and necessary treatment.

The second article, “Hepatitis C and HIV Screening, Testing, and Risk Perceptions among South-Central Appalachian County Health Department Staff,” aimed to fill gaps that persist in local health department resources for meeting these demands, especially in Appalachia and the US South.  Members of the Mountain Area Health Education Center and Boston University served as co-authors.

Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are significant public health concerns, especially given the risks for disease interactions. Rates of HCV and HIV are increasing, especially in rural areas. Local health departments (LHDs) play an important role in rural health care, offering screening, testing, and treatment for HCV and HIV. Gaps persist in LHD resources for meeting these demands, especially in Appalachia and the US South.  

To explore HCV/HIV screening, testing, and treatment approaches and perspectives in south-central Appalachian North Carolina, structured telephone questionnaires were administered to communicable disease nurses and other health department staff directly involved in screening and testing. Mixed-methods data analyses were conducted and triangulated with stakeholders.

Eighteen participants representing 19 counties completed the questionnaire. Participants reported that barriers to screening and testing included housing insecurity, lack of transportation and insurance, unemployment, and geographic isolation. Divergence in perceptions of barriers between public health regions emerged, as did perceptions of who is at risk and use of stigmatizing language about people at risk for HCV/HIV.  This study highlighted the impact of local health department behaviors and perceptions on screening and testing, and offers recommendations to improve HCV/HIV screening and testing accessibility in south-central Appalachia, a high-risk region.

Harless also co-authored the book chapter “Transgender, Nonbinary, and Gender Diverse Health in the US Southeast: A Quantitative Look at the Influence of Gender Identity and Sexuality in a Sample of LGBT Southerners” in the book Demography of Transgender, Nonbinary and Gender Minority Populations.

Lead author of the chapter is Austin H. Johnson of Kenyon College.  An additional co-author is faculty from East Carolina University.

In order to develop protections, interventions, and other resources to support the health and well-being of transgender, nonbinary, and gender diverse Southerners, providers must first understand who trans Southerners are as a community, and how they currently understand and experience their health and healthcare. The chapter contributes to this growing understanding of the experiences of LGBT health in the South, including the experiences of trans, nonbinary, and gender diverse Southerners in particular... 

Using quantitative data from the 2018 to 2019 Southern LGBT Health Survey, this chapter presents an overview of transgender, nonbinary, and gender diverse Southerners’ health perspectives and experiences across a range of health-related contexts and interactions. The Southern LGBT Health Survey includes a total of 5716 respondents, 1205 (30.2%) of whom identify as transgender, nonbinary, or otherwise gender diverse. Comparing the transgender, nonbinary, and gender diverse subsample to the cisgender subsample from this regional LGBT community survey, the authors offer a quantitative overview of trans health in the American South, with special attention to the ways that race, class, and income impact factors related to health for trans Southerners.