Understanding Relationships Between Early Life Toxic Stress, Childhood Socioeconomic Disadvantage, and Allostatic Load in Adolescence

Chronic disease prevalence among children and adolescents is rising, which is thought to result in part from elevations in allostatic load (AL). AL is the cumulative physiological dysregulation that results from exposure to biological, social and environmental stressors over time. Socioeconomic disparities in chronic disease and AL have been well-documented in adult populations, including links between childhood socioeconomic disadvantage (CSD) and AL, yet little is known as to whether CSD may begin to impact AL earlier in life. Differential exposure and vulnerability to stress among racial/ethnic minorities may increase risk for elevated AL among those experiencing CSD. Framed by the Life Course Perspective and the Allostatic Load Framework, the purpose of this dissertation was to determine the best measurement approach for AL, examine direct and indirect pathways between CSD and AL through several environmental and behavioral mediators, and determine whether these relationships varied across race/ethnicity. This was a cross-sectional, correlational study of 1900 adolescents (aged 12 to 18) from four waves (2003 to 2010) of the National Health and Nutrition Examination Survey (NHANES). We constructed latent variables for AL and CSD, based upon biologic and self-reported indicators. Smoking and lead exposure were measured with biomarkers, while nutrition, physical activity, and race/ethnicity were self-reported. Structural equation modeling (SEM) was used to examine relationships between latent construct variables and measured mediating variables across three race/ethnicity groups. The data best supported a unidimensional AL factor structure, with the highest factor loadings found for metabolic indicators. The only significant total effects pathway for CSD on AL was for Whites, indicating the model best explained AL variance for this group. There were small, positive direct effects pathways significant for African Americans (AAs) and Whites, indicating higher CSD predicted higher AL for those groups. A single indirect pathway between CSD and AL mediated by lead was significant for AA adolescents, though the reversed directionality suggests a need for a different measurement approach for cumulative lead exposure. These findings highlight the importance of exposure to CSD as a predictor for development of AL for adolescents, while also elucidating different mechanisms at play across different racial/ethnic populations

Vascular Access Teams and Their Success in the Acute Care Setting

Peripheral intravenous catheters (PIV) are frequently used in acute care settings for short-term delivery of intravenous (IV) medications and fluids (Marsh et al., 2018). While this is a common practice in the hospital, the insertion of these PIVs can be quite difficult. According to Marsh et al. (2018), multiple insertion attempts are common, and post-insertion failures from complications such as occlusion are as high as 69%, triggering the insertion of subsequent catheters. This research analyzed the use of a vascular access team, commonly known as an IV team, to improve PIV outcomes in the acute care setting. These vascular access teams are comprised of individuals who have specialized, extensive knowledge having to do with the insertion of vascular access devices, one of which is a PIV

Success Against All Odds Lessons Learned from Successful, Impoverished Students

The effects of poverty on students’ education have been well documented and a positive correlation can be seen between these effects and their academic success. What is unclear, however, are the exceptions to this correlation. How do students from low-socio-economic status (SES) families succeed despite the seemingly insurmountable odds they face? The literature from a wide variety of longitudinal—and interview-based studies from the past three decades suggests that character traits such as persistence, determination, and curiosity are key to their success. Schools with a majority student body from low-SES homes have found success in meeting and exceeding state standards through fostering an encouraging atmosphere and incorporating these necessary character traits throughout their curriculum. Mentorship in developing these traits is what makes all the difference in both the individual students’ lives and in the school setting. Thus, in order to sustain the development of academically successful students, it is imperative that students not only believe that they can succeed, but that they are given avenues and resources through which they can succeed

Access Versus Success: An Examination of the Effectiveness of the Summer Developmental Program in Mississippi Higher Education

Historical racial segregation within Mississippi’s public universities and colleges has led to litigation that spanned 25 years and eventually led to sweeping changes in policies and practices. Among these changes were the standardization of admission criteria and the creation of the Summer Developmental Program (SDP). This study sought to better understand the intentions and motives behind the creation and implementation of the SDP at all of the four-year public institutions in Mississippi stemming from the United States v. Fordice (1992) higher education desegregation case. This study compared retention and graduation rates of SDP participants to non-SDP participants from the first year of implementation in 1996 through 2013, the most currently available data at the eight public four-year institutions in Mississippi. It then aimed to describe the effectiveness of the program, establish if the program is performing as the Supreme Court intended, and policy makers to determine if revisions, updates, and new directives are needed to improve the program. After analyzing and comparing retention and graduation rates of SDP participants to non-SDP participants in the eight public four-year institutions in Mississippi, the researcher concluded that the treatment of SDP is effective in retaining SDP participants. However, the researcher concluded that the SDP is not effective in graduating SDP participants. Based on the consistent decline of Black SDP participants (95% of total SDP participants were reported as Black), the researcher concluded that the SDP was not providing additional educational opportunities for Blacks and that there is still a “lingering [racial] de jure injury” (Holley & Weeden, 1997, p. 6)

A Case Study Examining the Connections Between Student-Teacher Relationships and Student Motivation in the Upper Elementary Classroom

The purpose of this multiple case study was to develop an in-depth understanding of how student-teacher relationships are connected to student motivation within the upper elementary, fourth, fifth, and sixth grade, classroom for students at Small Rural Elementary School (SRES; pseudonym) in southeastern Pennsylvania. The theory guiding this study is Maslow’s hierarchy of need as it explains the effects human needs have on motivation, confirming the significance of students having their basic needs met in the classroom by their teacher in order to be motivated to achieve greater outcomes in the classroom. The study was guided by a central research question: how are student-teacher relationships connected to student motivation in the upper elementary classroom? The multiple case study utilized three data collection methods: surveys, interviews, and a focus group. Data were then coded to find common themes on how student-teacher relationships are created through the meeting of physical, physiological, mental, and emotional needs of students and examine the impact these relationships have on student motivation in the upper elementary classroom at SRES. The findings of this research suggested SRES upper elementary teachers are able to build authentic relationships with their students through simple acts in the classroom that meet the student physical, physiological, mental, and emotional needs, and in turn students are more motivated within the classrooms of teachers they have genuine relationships with, where trust has become the foundation