Dissertation Defense Announcements

Green burial places are cemeteries and funeral homes that embrace green burial practices by providing green burial funeral services and educating their clients about green burial options. A green burial place within a cemetery may be a part or whole cemetery that is dedicated to following green burial protocol. Green burial involves the use of biodegradable containers rather than steel or hardwood caskets. The decedent is not embalmed and is buried directly in the ground instead of within a burial vault. The grave is typically more shallow than contemporary burials; this encourages natural decomposition of the body. Green burial places within cemeteries are designated areas where green burials can happen and can contribute to the overall ecological well-being of the land.

Although not new in concept, green burial places are not as abundant or accessible as green burial advocates such as the Green Burial Council, International 501(c)(3) non-profit would like. Compared to contemporary burial in the United States, green burial has greater ecological and social benefits, as it reduces resource consumption standard to contemporary burial and supports regulatory and social ecosystem services. However, there are many funeral homes and cemeteries who do not currently provide green burial. Therefore, this dissertation asks and answers the overarching question: What are the opportunities for successful green burial placemaking that address the obstacles faced and anticipated by death care professionals?

This dissertation uses qualitative methods, specifically grounded theory methods, to answer the overarching question. I do this via three lines of inquiry: 1) examining obstacles to green burial placemaking that are presented by a sample of funeral directors from across the United States (§5.1 - §5.3), 2) Analyzing current death care consumers’ awareness of and attitudes towards green burial (§5.3 - §5.4), and 3) Uncovering the opportunities that successful green burial placemakers employed to successful create green burial places (§5.5 - §5.7).

The key methods used in this study are semi-structured interviews and online surveys, which have produced robust qualitative data. Semi-structured interviews were used to ascertain the perspectives and experiences of funeral industry professionals who have successfully started and continue to operate a green cemetery. The purpose of these interviews is to provide an understanding of the local and regional obstacles to green burial provision that death care providers anticipated, faced, and overcame. A total of nine interviews were conducted, and ten people were interviewed. In one case, the semi-structured interview involved two interviewees. The interviewees represented green burial cemeteries across the Mid-Atlantic States of North Carolina, Tennessee, and Virginia.

Two questionnaires were developed to understand obstacles at a national level. The first questionnaire was targeted towards funeral directors; the questions were targeted to understand funeral directors’ level of knowledge about green burial, their willingness to provide green burial to their families, and the obstacles that they anticipate or currently face when considering whether to provide green burial. The second questionnaire, informed by both the interviews and the responses from the funeral directors, was directed at death care consumers—adults in the United States, eighteen years or older. The purpose of this survey was to explore one specific obstacle that death care providers have identified: there is not a market for green burial, i.e. no one knows about green burial and therefore no one asks for green burial. The consumer survey in the proposed research asks consumers to explain what they would like to have happen to their body after death. Consumers are then presented with the definition of green burial and asked if this is something that they would be interested in. Responses are again analyzed using grounded theory methods.

The grounded theory that emerges from the proposed research will make contributions on two fronts. First, the knowledge will directly benefit the Green Burial Council International 501(c)3, a non-profit whose mission is to make green burial more accessible via educational outreach to both death care providers and consumers. As a member of the board of directors, I am committed to making practical use of the knowledge uncovered in this research. Second, this research will contribute to the scholarly pursuit present and legitimized by Palko (2021) to understand the relationships between death care decision-making and ecological and social consciousness.

Sleep health is an important aspect of an individual’s overall health; however, it is often overlooked. Despite the promotion of healthy sleep practices, many individuals have competing demands that interfere with sleep (e.g., work, socializing, school), contributing to poor sleep outcomes. This, in part, seems to be a result of having certain values about sleep. What is less understood, however, are how these values become embedded within an individual’s system of beliefs, and, if they are related to sleeping behaviors. This dissertation first crafted a theory based on the pre-existing literature related to internalization to create the construct conceptualization for internalized sleep culture. Internalized sleep culture was intended to help explain the process of adopting ideas related to sleep into one’s own belief system, ideas which are thought to be transmitted through cultural memes, messages, and social channels, and how this may predict subsequent behaviors related to sleep. Next, a measurement scale was developed to assess the degree to which individuals have internalized sleep culture, and the initial validation process was started. Two separate studies utilizing independent samples (N = 669 adults), as well as data from three subject matter experts were used to help develop a 12-item scale consisting of one higher order factor (global internalized sleep culture), and two lower order factors (sleep as a commodity versus a biological/psychological need, and sleep as a mechanism for bonding). Though the scale passed initial validation checks and was found to demonstrate convergent and discriminant validity through correlations with sleep attitudes, sleep hygiene, sleep outcomes (duration, quality, latency), and social desirability, further analyses demonstrated that internalized sleep culture as it was conceptualized and measured was not empirically distinct enough than the pre-existing construct of sleep attitudes. Implications of these findings and future directions related to internalized sleep culture and sleep attitudes are discussed.

Compared to their cisgender counterparts, transgender, and gender diverse youth (TGDY) disproportionately experience an increased risk for poor patient safety and healthcare disparities. TGDY report poorer mental and physical health and lower rates of utilization of preventive medicine. These health and healthcare disparities may be due to a lack of access to gender-affirming care – an integrative approach to providing developmentally appropriate healthcare and facilitating conversation and exploration of gender identity with patients and their families in a supportive environment. Gender-affirming care is associated with increased healthcare utilization, quality of life, and decreased rates of depression and suicidality among TGDY. In the United States, TGDY report difficulty finding gender-affirming providers as well as trans-specific healthcare. To meet the healthcare needs of TGDY, in 2018, the American Academy of Pediatrics (AAP) issued the policy statement, “Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents” to provide clinical practice guidelines for physicians to provide gender-affirming care to youth. However, little is known about physicians’ knowledge, agreement, or perceived barriers to implementing the AAP recommendations. Further, TGDY in rural and fringe urban areas face unique healthcare challenges and experience greater discrimination and negligence in the healthcare setting, such as receiving delayed medical care. The specific aims of this study were: To assess (1a) pediatrician’s knowledge, agreement with, and perceived barriers of the AAP recommendations as well as provision of gender-affirming care (i.e., psychoeducation, patient interaction, providing care in a safe environment, and referrals) and (1b) if this differs based on practice setting urbanization level; to examine the role of provider characteristics and practice setting in explaining the variability in: (2a) AAP policy knowledge; (2b) agreement with the AAP Policy; and (2c) perceived implementation barriers of the AAP policy; and to examine the role of provider characteristics and practice setting in explaining physician’s provision of: (3a) total GAC; (3b) GAC psychoeducation; (3c) GAC patient interaction; (3d) GAC safe environment; and (3e) GAC referrals; when accounting for AAP policy knowledge, agreement, and perceived implementation barriers. In this study, 199 physicians were recruited to participate in an online survey. Findings from this study will inform efforts to improve healthcare safety, accessibility, and equitability for TDGY by informing the future development of a context-tailored, theory-based intervention to promote gender-affirming care in diverse geographical areas.