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JOHNSON CITY — The East Tennessee State University Center for Applied Research and Evaluation in Women’s Health (CARE Women’s Health) continues to grow with a $3,192,884 research award in 2021 for a total of approximately $18 million in grant funding since 2017.
Dr. Amal Khoury, director of CARE Women’s Health and a professor in the ETSU College of Public Health, said the latest award will expand and extend research and evaluation on priority women’s health issues at the center.
“Obviously, this helps us advance the mission of the center, which is to improve the lives of women and their families in our region and beyond,” said Khoury. “We do that primarily through research and evaluation that seeks to inform policy and practice, and by ‘practice’ we mean public health programs and clinical care. We also do that by training students to become the next generation of public health researchers, and by working in collaboration with partners across campus and the region. This funding will allow us to expand and extend our research in ways that will generate more robust evidence to advance population health — both within our community and nationally.”
CARE Women’s Health is an interprofessional research center with a goal to improve the health and well-being of women across their lifespan, particularly in Appalachia and the Southeast. The center is home to the evaluation of the Choose Well contraceptive access initiative, one of the largest statewide initiatives of its kind across the nation. Ongoing studies examine patient contraceptive decision-making and experiences with care, patient-provider communication, depression and Alzheimer’s Disease among Appalachian women, gestational diabetes, and the impact of the COVID-19 pandemic on reproductive health care, among others.
“Our studies examine the multiple determinants of health,” said Dr. Michael Smith, director of policy and programs. “We examine how people make decisions related to health care use within their community contexts, how providers deliver health care services, and how policies and insurance programs like Medicaid impact health care use and outcomes. By examining how community-based interventions and state- and national-level policies influence the determinants of health, we can be best prepared to make a real difference in people’s health and well-being.”
Currently, three major focuses at the center are advancement of equity in reproductive health care access and use, reduction of teen and unintended pregnancies, and improved maternal and child health outcomes for populations in the U.S. South and beyond.
“We have an opportunity to make an impact on two generations at the same time; to engage in work that contributes to improving the lives of women where they live, work and pray, while potentially improving the life course trajectory of their children. That potential is incredibly exciting,” said Smith.
In addition to research and staffing at the ETSU campus, CARE Women’s Health also has full-time staff in Columbia, South Carolina and Birmingham, Alabama. The center has hired 15 full-time faculty and staff in recent years, as well as part-time staff, and studies are conducted across multiple Southeastern states.
“In addition to our work in the southeast, we are very aware of the health issues facing our Appalachian region, the policy environment and the limitations in access to care that make it difficult to obtain the health care services people need,” said Khoury. “So we feel a responsibility to address these issues through our work in ways that will help improve quality of life and health outcomes in our region.”
Dr. Nathan Hale, director of research, and his team are examining teen birth rates within the Appalachian subregions over time. “While teen birth rates remain higher in most Appalachian subregions than what is observed nationally, the trends are encouraging and the gap has narrowed, particularly for Central Appalachia,” said Hale. “This is good news and shows how evidence-based policy and programs can positively shape population health.”
To date, the center’s work has been presented through more than 30 peer-reviewed publications and presentations including articles in major journals such as the American Journal of Public Health and others.
CARE Women’s Health also provides student training in women’s health research and supports an average of 10 students per year ranging from bachelor’s students to doctoral candidates.
“We offer students new learning opportunities, training in research methods and the smart use of data, and ways to engage with professional and community audiences. Students are involved in all phases of the research process,” said Khoury. “And most of our dissemination products include one or more students as authors or co-authors. They learn how to communicate in addition to research methodologies.”

Hale added, “The questions and issues we examine are as appealing to students as they are to our faculty and staff. ‘How do you improve access to care’ is a very difficult policy question. It requires thoughtful, deliberate and intensive research and evaluation. That’s what really draws me to what we do at the center. You have this intersection of important policy questions, then you have both human and financial resources to devote to trying to cut through the hypothetical and theoretical in order to get the actual answers.”
“It is this motivating passion for applied research and teaching that drives CARE Women’s Health each day, despite any challenges that may come with the work,” said Dr. Randy Wykoff, dean of the College of Public Health.
“To see us develop a center focused on women’s health at ETSU and in this region, to develop this infrastructure and have this highly qualified team compete at this high level nationally, to successfully obtain awards that establish ETSU as a national leader in women’s health while bringing attention to the needs of women and families in our region, is all very exciting,” added Wykoff. “We’re very grateful and thankful for the university and the community’s support.”
To learn more about CARE Women’s Health, contact khoury@etsu.edu or visit www.etsu.edu/cph/care-womens-health/.