Scholarship & Research
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Item Medical technology and mortality transition: the diphtheria antitoxin and childhood mortality in the United States, 1880-1910(Montana State University - Bozeman, College of Agriculture, 2023) Salimi Rad, Sadiq; Chairperson, Graduate Committee: D. Mark AndersonDiphtheria was a deadly infectious disease in the late 19th and early 20th centuries, particularly among children. In 1895, an antitoxin was developed that could effectively treat the disease. This was the first and only infectious disease in the United States at the time with a scientifically-based treatment. To gauge the impact of access to the antitoxin on child mortality, I leverage large and stable differences in physicians per capita rates across 38 U.S. cities. Physicians were the primary distributors of the antitoxin at the time. For every percentage point increase in the rate of physicians per capita prior to the antitoxin's availability, there is a corresponding one percent reduction in child mortality. These findings suggest that the introduction of the antitoxin played an important role in saving children's lives and had a significant impact on the course of medical technology and child health in the United States.Item Improving access to peer-to-peer support for caregivers of children and youth with special health care needs: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2022) Patera, Caitlyn Ashley; Chairperson, Graduate Committee: Margaret HammerslaCaregivers of children and youth with special health care needs (CYSHCN) experience stress, burden, and social isolation, which are powerful predictors of poor health outcomes for both the caregivers and their children. Supporting caregivers of CYSHCN in a clinical setting is critical in holistically supporting a CYSHCN medical home. The Montana Parent Partner Program (MTPPP) is an evidence-informed peer-to-peer support opportunity aimed at improving health and social outcomes for caregivers. This program is funded by the Department of Public Health and Human Services (DPHHS) and is available to Montana health care clinics that serve the CYSHCN at no cost to the clinic. At the selected practice site location (PSL), the referral rate and enrollment rate to the program were low; in November and December 2021, only two enrollments were completed into the program out of the 66 patients evaluated aged 0-21 years--a total enrollment rate of 3%. The referral rate was not historically tracked. DPHHS, the PSL, and the MTPPP partnered together in a quality improvement (QI) effort to achieve a referral rate into the MTPPP between January and February 2022 of 50%. The QI team identified barriers to referring and enrolling caregivers into the MTPPP and subsequently proposed opportunities for improvement to reach their goal. First, the team aimed to educate providers at the PSL on the evidence, benefits, and services of the MTPPP. Once the team expressed increased confidence in referring patients to the program, the team re-developed the workflow, referral, consent, and enrollment process and integrated information technology to streamline the processes. Regular PDSA cycles were used in meetings to elicit feedback and address barriers. The results established a referral rate of 40% and an increased enrollment rate of 14% from the previous two months. The findings of this effort can inform current MTPPP hosts and future practices to utilize the PDSA cycle to improve processes. Although the results are affirmative, more time should be dedicated to the quality improvement effort, allowing for more data collection and PDSA cycle completions.Item Childhood obesity: screening and interventions(Montana State University - Bozeman, College of Nursing, 2022) Upham, Meghan Karen; Chairperson, Graduate Committee: Tracy HellemChildhood obesity has been a growing concern in the United States for the last three decades. With the COVID19 pandemic, a substantial increase in weight gain has been noted in the pediatric population, leading to a more alarming obesity trend. The American Association of Pediatrics, Centers for Disease and Control and Prevention and the World Health Organization, have established a standard of care for measuring obesity in children using BMI percentiles for age and sex specific growth charts. However, at a pediatric clinic in Northwest Montana providers were not using BMI percentiles to assess for pediatric overweight/obesity. Therefore, the aim of this project was to standardize practice that included screening for childhood obesity using age and sex specific growth charts, document BMIs in provider charting, add overweight or obese to a child's problem list and refer overweight/obese children to a behavioral therapist or nutritionist. During a six-week data collection a total of 90 well child visits were documented, 92% of the children were screened for overweight/obesity using BMI, documented in the medical record, and added to the problem lists. The referral rate to a behavioral therapist or nutritionist was 41%. The conclusion of this project showed improvement with screening using BMI and documenting in the electronic medical record. However there were limitations for referring children to a behavioral therapist or nutritionist that included, finances, time, bias, and lack of conversations.Item Trauma screening in chronic disease management: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2021) Vaughan, David James; Chairperson, Graduate Committee: Sandra Benavides-Vaello and M. Jean Shreffler-Grant (co-chair)More than two decades of research has established the association of adverse childhood experiences (ACEs) and adverse health outcomes in adults as initially proposed in the original study by Felitti and colleagues across multiple, well-designed studies. Research indicates that this is a common problem affecting nearly two out of three in the general population. The positive, dose-related, cumulative association of ACEs and poor health outcomes in chronic diseases including diabetes, heart disease, lung disease, and others has been shown to shorten life expectancy by as much as twenty years compared to those with fewer ACEs. Despite the evidence, screening for ACEs in adult primary care is rare. This scholarly project utilized the Trauma-Informed Care framework to introduce an ACE screening tool in the electronic health record of a rural primary care setting. The target population for screening was adults with specific chronic medical conditions. The primary outcome measure was screening tool utilization, and the secondary measure was the referral to integrated behavioral health (IBH). In a six-week period, ACE screening tool utilization was low, being completed in only 9 of 494 included patient encounters. During the project period, the IBH referral rate increased from 1% to 12% in the same patient sample. Provider and organizational acceptance of the tool were modest. This scholarly project demonstrates several challenges that exist when translating research to practice. More time, education, and resources are needed to close this important research to practice gap.Item Developing a family based program to reduce the incidence of obesity in American Indian children(Montana State University - Bozeman, College of Nursing, 2021) Crowley, Jacy Kate; Chairperson, Graduate Committee: Angela JukkalaChildhood obesity is a significant health problem resulting in decreased lifespan related to chronic health problems. Prevalence of childhood obesity is experienced in American Indian (AI) children at greater rates than their non-native peers. Social determinants of health significantly impact AIs; socioeconomic status, geographic location of reservations, and family and community dynamics uniquely impact health outcomes and risk factors of AI families and communities. This scholarly project investigates the disparity of childhood obesity within the AI community and the potential of a culturally relevant and acceptable family-based program to reduce the prevalence. A community advisory board (CAB) and components of successful AI-specific programs will guide the development of a culturally relevant family-based program. This project aims to reduce the prevalence of childhood obesity in AI children by supporting nutritional knowledge and sovereignty, family engagement, and positive behavior support and coping mechanisms. A culturally relevant family-based program has the potential to reduce the prevalence of childhood obesity in AI children and improve health equity.Item Evaluating communication methods and their impact on vaccination rates in early childhood(Montana State University - Bozeman, College of Nursing, 2020) Antos, Kelly Suzanne; Chairperson, Graduate Committee: Angela JukkalaYearly vaccination against seasonal influenza is the most effective prevention against an illness with especially dangerous implications for young children. The Center for Disease Control and Prevention (CDC) recommends two doses of influenza vaccine in the first eligible flu season for young children under the age of two. Communication of reminders for the second dose can be an integral aspect of improving rates at which young children receive the recommended two doses of influenza vaccine. Not all methods of communication are as effective, and the understanding and evaluation of each respective method provides the healthcare professional with information about how to best reach their families/caregivers with important information. The purpose of this paper is to evaluate these methods as they pertain to not only influenza vaccination rates, but also other routinely recommended early childhood vaccines. While technological advances have brought about many new and innovative ways to communicate with families, the literature suggests that reminder telephone calls remain the most effective method to communicate regarding vaccines which are due. New research is also emerging on this topic and will likely further guide the way in which healthcare providers communicate with their patients and families/caregivers. Sustainable improvement in uptake of vaccine rates are specific to the type of vaccine. Trends specific to the seasonal influenza vaccine will also be evaluated through the course of this paper to identify and evaluate additional interventions which may be necessary to achieve sustained improvement to protect the youngest members of our population.Item Early family environments and memory: the role of physiological and psychological responses to acute stress(Montana State University - Bozeman, College of Letters & Science, 2020) Counts, Cory; Chairperson, Graduate Committee: Neha John-HendersonChildhood family environments have important implications for outcomes in adulthood. Specifically, the experience of adversity in childhood is related to numerous maladaptive outcomes later in life. It is currently unknown how early adversity affects memory consolidation and processing. Previous research has established an association with anxiety and depression possessing a negative memory bias. A negative memory bias is defined as attentional and perceptual favor towards information that is contextually negative or threatening. Research has not examined the relationship between negative memory bias and childhood adversity after the induction of stress. Stress has previously shown to be disruptive to memory outcomes. Further, a growing body of research has shown that early childhood adversity associates with blunted physiological responses to stress. It is possible that through the pathway of blunted reactivity, early childhood adversity associates with negative memory bias. To test these hypotheses, a sample of college students (N=64) studied a 50-word list that included 25 emotionally negative words and 25 emotionally neutral words. Participants then completed the Trier Social Stress Test, an evaluative stressor well known for inducing stress. After the stress task, participants were asked to freely recall words they previously studied. Results showed that higher ratings or risk and emotional abuse in childhood associated with increased negative word recall. The relationship was partially mediated through blunted heart rate reactivity to the stress task. Implications and future directions are discussed.Item Childhood depressive disorder symptoms: relations with two physiological indices of emotion regulation(Montana State University - Bozeman, College of Letters & Science, 2019) Armstrong, Eleanor Jane; Chairperson, Graduate Committee: Brandon ScottTheoretical models of depression postulate that one's ability to regulate emotions may be a core factor in the development of depressive disorder symptoms. The present study aimed to understand how physiological measures of emotion regulation are related to depressive disorder symptoms among a community sample of 7-10 year-old children. Specifically, we sought to investigate how resting heart rate variability and the change in heart rate variability from a resting baseline to a stressor are related to child- and-caregiver- reported depressive symptomology. The children's physiological measures (i.e., heartbeat patterns, respiration) used to calculate high-frequency heart rate variability for each task were collected as the child sat quietly (3 minutes), watched a relaxing Coral Reef video (3 minutes), traced a star pattern while looking in a mirror (3 minutes), and played Hungry, Hungry Hippos on an iPad (3 minutes). In addition, children and their primary caregivers completed a series of questionnaires about the child and family demographics and child's depressive disorder symptoms. We conducted bivariate correlations, paired samples t-tests, multiple regression analyses (controlling for age, gender, and mean respiration rate at baseline) to examine the relations between both resting heart rate variability and change in heart rate variability in response to a stressor or positive task and child- and caregiver-reported depressive disorder symptoms. We found a significant relation between the child-reported depressive disorders and the change in HRV from resting baseline (traditional and video) to the stress task. However, we did not find that gender moderated this relation, nor did we find any significant relations between the resting baseline (traditional and video) and child-or-caregiver-reported depressive symptoms. Finally, not associations were found between and the change in HRV from resting baseline (video) or the Mirror Star Tracer task Baseline to the Hungry Hungry Hippo task and child-or-caregiver-reported depressive symptoms. Future research should consider the nature of the task demands relative to arousal and also the diversity and size of the sample. Our findings demonstrated a unique pattern in HRV change from resting baseline (traditional and video) to a stress task that allow for new questions to be asked and a foundation for further research.Item Childcare as a protective factor for childhood obesity(Montana State University - Bozeman, College of Nursing, 2020) Carnahan, Brittany Anne; Chairperson, Graduate Committee: Susan RaphChildhood obesity is a major public health crisis. Obese children are at risk for developing chronic diseases and are more likely to become obese adults. Despite efforts to decrease the number of obese children, the rate has more than tripled since the 1980s. Since childhood obesity is multifactorial, any person involved in caring for a child outside of the home can have an impact on the child's life helping to minimize risk factors, such as poor nutrition, which is known to contribute to obesity. Purpose: The purpose of the project was to 1) assess ECE providers' understanding of national childhood nutrition guidelines in relation to whether or not they participate in the STARS to Quality program or the CACFP; 2) create and provide childhood nutrition education to ECE providers with the objective to reinforce or increase knowledge on childhood nutrition and the important role of the ECE provider to deliver sound nutrition; and 3) to evaluate the effectiveness and sustainability of the education tool in increasing ECE provider knowledge of national childhood nutrition guidelines. Methods: Licensed ECE programs in the State of Montana completed a demographic survey, pre-test, educational video viewing, and posttest regarding childhood nutrition recommendation guidelines. The project was developed using the National Dietary Guidelines for all Americans and the Child and Adult Care Food Program recommendations for reimbursable meals. Pre and posttest scores were compared and analyzed. Evaluation: Overall, there was an 11.5% improvement in correct answers from the pretest to the posttest indicating that viewing of the educational tool was successful in increasing knowledge. Discussion: The use of a guideline based educational tool for ECE programs has the potential to increase caregiver knowledge regarding childhood nutrition recommendations and contribute to prevention efforts concerning childhood obesity.Item Breaking the cycle of adverse childhood experiences: a program evaluation(Montana State University - Bozeman, College of Nursing, 2019) McAnally, Jennifer Lyles; Chairperson, Graduate Committee: Dale MayerAdverse childhood experiences (ACEs) are specific types of childhood trauma, that, when experienced, have been found to have dose-response relationship to poor health outcomes later in life, namely, many of the leading causes of death in adults. ACEs include psychological, physical, or sexual abuse, witnessing violence against the mother, living with household members who were substance abusers, mentally ill or suicidal, or who are imprisoned. Recognizing a need for intervention to disrupt this ACE to illness trajectory, The American Academy of Pediatrics has called upon medical providers to address ACEs through screening and community-building. Since there is currently no guideline for how to address ACEs, the purpose of this scholarly project was to evaluate the Lewis and Clark County Health Department (L&CHD) ACE program for effectiveness and alignment with evidence-based practice. Using the Centers for Disease Control and Prevention manual titled Introduction to Program Evaluation for Public Health Programs (IPEPHP), an evaluation was completed. Steps included engaging stakeholders, describing the program, developing an evaluation plan, gathering credible evidence, and analyzing the evidence in order to develop conclusions and make recommendations. The L&CHD ACE program was found to be a largely progressive model that is consistent with most program goals and literature. Those who participated in the program tended to complete the program successfully, however, a majority of those who were referred to the ACE program either chose not to take advantage of the referral or declined to participate in the program. This finding was unexpected and warrants further inquiry. It appears that an integrated behavioral health model may be more effective for engaging potential participants, where they are able to initially meet with mental and behavioral health experts in the familiar primary care setting.