Digital Commons Network^™

Solving The Healthcare Employee Shortage: The Effectiveness Of Incentive Programs In Enticing Young Health Professionals To Appalachian Kentucky Communities, Taylor Williams

MPA/MPP/MPFM Capstone Projects

Kentucky’s Appalachian counties have long been recognized as medically underserved areas, with access to care being limited by a shortage of healthcare professionals in the region. This issue, specifically as it pertains to primary care physicians, has been the focus of many programs hoping to improve access to care in these communities for many years. Is the ongoing effort to recruit and retain primary care physicians in Appalachian Kentucky counties effective? Hypotheses The mean number of people per physician in Appalachian Kentucky counties reported in 2013 is equal to the mean number of people per physician in Appalachian Kentucky counties …

Exploration Of Factors Associated With Rural Appalachian Women's Use Of Buprenorphine Prior To Incarceration, Kelsey A. Redmayne

Theses and Dissertations--Educational, School, and Counseling Psychology

The Gelberg-Anderson Behavioral Model for Vulnerable Populations was used to identify factors related to buprenorphine use in general and through diversion (versus formal treatment) among rural Appalachian women using substances in the six months prior to their incarceration. This study is a secondary analysis of data from interviews completed with rural Appalachian women (N=400) residing in rural Kentucky jails. Independent variables were analyzed using chi square and independent t-tests for buprenorphine use generally and diverted buprenorphine use. The significant predictors were then evaluated through hierarchical logistic regression to explore which factors account for the most variance in general …

Bolstering Leadership Engagement To Community Coalition Work In Rural Appalachia, Melissa Slone

DSW Capstone Projects

Rural Appalachian communities are overwhelmed with high cancer rates, diabetes, disabilities, and substance use disorder. The challenges in addressing these increase when you factor in workforce shortages and limited funding. The literature documents the effectiveness of coalitions in addressing healthcare challenges within communities. The need is for leaders to reduce their hesitancy to engage in community coalition efforts and increase awareness of the impact community coalitions can have on addressing rural populations' health and well-being needs.

Product One was a systematic review focused on research that examined agency leaders’ perspectives on community coalition involvement. The purpose of conducting the systematic …

Social And Biological Determinants Of Pregnancy-Related Mortality And Morbidity In A Rural, Underserved Population, Anna Hansen

Theses and Dissertations--Sociology

Cases of severe maternal morbidity (SMM) and pregnancy-related mortality (PRM) are increasing in the US. Research concerning SMM and PRM has neglected women in Central Appalachia; a largely rural, health-disparate population. The aims of this study are two-fold: (1) Examine patient-level and place-based predictors of SMM/PRM via hierarchical logistic regression modeling, and (2) Elucidate Appalachian healthcare patients’ and providers’ experiences with SMM/PRM, perceptions of contributing factors, and insights on points of intervention.

This study uses a mixed methods approach guided by the WHO’s conceptual framework for action on social determinants of health to identify determinants of SMM and PRM among …

‘I Went To The One Game In Town’: Obstetric And Maternity Unit Closures, Dwindling Birth Choices, And Resilience In Rural Appalachia, Sia Beasley

Theses and Dissertations--Anthropology

Obstetric and maternity health services are being rapidly eliminated in the rural United States, making maternal care more difficult to access and causing negative birth outcomes. Service closures have a magnified impact in Appalachia due to histories of systemic regional and state policy practices which devalue the lives of people living rural areas, local economic marginalization, geographic barriers, and insufficient health infrastructures. This research investigates how women living in rural Appalachia navigate pregnancy and birth amidst constant care closures. The Sunflower Mountain Region is a seven-county area in rural Southern Appalachia. The region has experienced ongoing obstetric closures over the …

Exploring The Relationship Between Place Attachment And Attitudes Toward Tourism Development In Powell County, Lindsay Vance

Theses and Dissertations--Community & Leadership Development

This study explores the relationship between Powell County, Kentucky residents’ place attachment, and the perceived sociocultural, environmental, and financial benefits of the future Warrior’s Path development. A survey consisting primarily of five-point Likert scale questions was shared with several local organizations to distribute to their members. The Pearson’s correlation coefficient and Chi-square test of independence tests were used to discover any correlation between place attachment and perceived sociocultural, environmental, and financial benefits of tourism development. The Pearson’s correlation coefficient (r=.465) determined a moderate positive correlation between place attachment and perceived sociocultural benefits of the Warrior’s Path and tourism development. Of …

Appalachians’ Intentions To Use Online And In-Person Counseling, Jade Hollan

Theses and Dissertations--Educational, School, and Counseling Psychology

Appalachians face higher rates of mental health concerns, yet they are less likely to have access to quality treatment. Online counseling, counseling using videoconferencing technology, may provide a viable solution to narrow this gap. However, little is known about Appalachians’ intention to use in-person or online counseling. This study examined Appalachians’ (N = 490) intentions to use online and in-person counseling using the theoretical framework of Theory of Planned Behavior (TPB; Ajzen, 1991). Results from structural equation modeling supported the indirect model for online and in-person counseling, where the associations between distal help-seeking factors (i.e., self-stigma, perceived stigma of …

We Can Still Feed Ourselves: Food Sovereignty, Aid, Sickness, And Health In Eastern Kentucky, Annie Koempel

Theses and Dissertations--Anthropology

Over forty percent of eastern Kentucky residents are classified as obese. From a biomedical perspective, obesity is linked to a range of chronic diseases, including heart disease, diabetes, and high blood pressure and is caused by particular lifestyle behaviors that lead to an increase in calorie consumption and decrease in calorie expenditure. However, these links – individual behavior leads to obesity which leads to chronic disease - do not take into account a wide range of personal, social, environmental, political, and economic conditions. In addition to the assumptions of what it means to become and be obese, Kentucky is regularly …

Producing Possibilities: Envisioning And Mediating Youth, Identities, And Futures In Central Appalachia, Tammy Lynn Clemons

Theses and Dissertations--Anthropology

This dissertation, based on anthropological research between 2015 and 2020, focuses on young people in different yet interconnected social contexts in Central Appalachia and how they envision, construct, and act upon possibilities for themselves and the region through multimodal cultural production processes like visual art, performance, and multisensory media. The research question focusing this project was: How do the social contexts of young Appalachians’ engagement in media consumption and production practices shape the possibilities they envision for themselves, others, and their region? I found that the specific contexts were less important than the interconnected mentoring conversations across sites and generations …

Maternal Proximity To Mountaintop Removal Mining And Birth Defects In Appalachian Kentucky, 1997-2003, Daniel B. Cooper

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background: Extraction of coal through mountaintop removal mining (MTR) alters many dimensions of the landscape, and explosive blasts, exposed rock, and coal washing have the potential to pollute air and water with substances known to increase risk of developmental and birth anomalies. Previous research suggests that infants born to mothers living in MTR coal mining counties have higher prevalence of most types of birth defects.

Objectives: This study seeks to examine further the relationship between MTR activity and birth defects by employing individual level exposure estimation through precise satellite data of MTR activity in the Appalachian region and maternal residence …

The Mothman And Other Strange Tales: Shaping Queer Appalachia Through Folkloric Discourse In Online Social Media Communities, Brenton Watts

Theses and Dissertations--Linguistics

Little work has been conducted on the intersections of queer and Appalachian identities, in part because these two identities are viewed as incompatible (Mann 2016). This study uses a multimodal critical discourse analytic approach to examine the Instagram posts of the Queer Appalachia Project, which represent a substantial body of discourse created by and for queer Appalachians. Of specific interest to this analysis are those posts which employ folkloric figures, such as West Virginia’s Mothman, to do identity work that is queer, Appalachian, and queer-Appalachian. Often, this act is accomplished through juxtaposition with Appalachian imagery and the reclamation of homophobic …

Move Or Improve? Place, Policy, And Educator Labor Markets, Cory Curl

Theses and Dissertations--Public Policy and Administration

What is the role of place and policy in shaping educator labor markets during the decade following the Great Recession of 2008? This research leverages data on Kentucky students, educators, schools, and school districts from 2009 to 2018, with a focus on the rural, isolated Appalachian region. Many counties in the region have long struggled with poverty, low rates of labor force participation, lower educational attainment, and dependence on public transfers (Ziliak, 2019). Despite these challenges, the people of Appalachia demonstrate a strong attachment to the region. With this research, I enhance understanding of contexts and conditions, such as unique …

Finding The Singing Spruce: Craft Labor, Global Forests, And Musical Instrument Makers In Appalachia, Jasper Waugh-Quasebarth

Theses and Dissertations--Anthropology

Musical instrument makers in the state of West Virginia in the United States pursue “singing,” lively instruments that capture ideals of musical tone and “re-enchant” their work and lives through relationships with craft materials and the forest landscape. Suitable tonewoods that grow in the region, such as red spruce (Picea rubens), intersect with makers’ desires to craft instruments in the style of famed makers such as the C.F. Martin Company and the Gibson Company as well as provide instruments imbued with a sense of place. While the demand for and symbolic import of instruments made with local wood …

The Drugs/Violence Nexus: Theory Testing And Behavioral Health Factors Among Justice-Involved Appalachian Women, Grant Victor

Theses and Dissertations--Social Work

This study examined the relationship between drug use and violence among justiceinvolved women in Appalachian Kentucky. Goldstein’s (1985) conceptual framework was used as a theoretical guide in formulating the drugs and violence relationships. Therefore, three types of drug use and violence relationships were explored, including: 1) psychopharmacological violence; economic-compulsive violence; and 3) systemic violence. Although these drug-related violence typologies have been investigated, little research has been devoted to rural justice-involved women. Moreover, to date no studies have examined how these drug/violence relationships might be associated with behavioral health factors. Ergo, there were three aims of the current study. First, to …

Unending Mazes: Gendered Inequalities, Drug Use, And State Interventions In Rural Appalachia, Lesly-Marie Buer

Theses and Dissertations--Anthropology

Prescription opioids are associated with rising rates of overdose deaths and hepatitis C and HIV infection in the US, including in rural Central Appalachia. Yet there is a dearth of published ethnographic research examining rural opioid use. The aim of this dissertation is to document the gendered inequalities that situate women’s encounters with substance abuse treatment as well as additional state interventions targeted at women who use drugs. These results are based on ethnographic fieldwork completed from 2013 to 2016 and centered around one county seat in rural Central Appalachia. Data are ascertained through semi-structured interviews with women who have …

Growing Economic Possibility In Appalachia: Stories Of Relocalization And Representation On Stinking Creek, Kathryn Engle

Theses and Dissertations--Sociology

This project explores the agricultural heritage and current social landscape of the Stinking Creek community of Knox County, Kentucky, and the legacy of the local nonprofit organization the Lend-A-Hand Center. Through participatory research, this project presents a reflexive account of the Lend-A-Hand Center Grow Appalachia Gardening Program examining the diverse economy of the Stinking Creek watershed and possibilities for new economic imaginings and post-coal futures for central Appalachia. This dissertation includes an oral history project, a theoretical examination, and an ethnographic reflection, bridging several literatures in the fields of agricultural history, Appalachian Studies, Participatory Action Research, research within the diverse …

“I Wonder What You Think Of Me”: A Qualitative Approach To Examining Stereotype Awareness In Appalachian Students, Chelsea G. Adams

Theses and Dissertations--Educational, School, and Counseling Psychology

Historically, Appalachia has been stereotyped as being a culture bred in poverty and ignorance. Much research has shown that stereotyping reveals a pattern of behavioral change and an impact on psychological well-being for the stereotyped (e.g., Pinel, 1999; Woodcock, Jernandez, Estrada, & Schultz, 2012), and has largely been centered on race and gender (e.g., Byrnes, 2008; Tuckman & Monetti, 2011). Less is known about the development of culture-specific stereotypes such as those related to Appalachians – a highly stigmatized group (Daniels, 2014; Otto, 2002). The purpose of this study was to gain an understanding of how adolescents in rural Appalachia …

Beyond The Coal Divide: The Cultural Politics Of Natural Resource Extraction In Central Appalachia, Julie A. Shepherd-Powell

Theses and Dissertations--Anthropology

During the last several years far southwest Virginia, like elsewhere in the central Appalachian region, has faced a decline in all coal mining activity and a subsequent loss of coal mining jobs, meaning that local economies are suffering and the unemployment line is long. In addition, this area continues to face environmental pollution from surface coal mines that are still in operation or have not been reclaimed. Drawing upon anthropological literature on natural resource extraction and economic and environmental inequality, this dissertation highlights the lives of members of a local grassroots environmental organization, as well as other local residents, in …

Politics Below The Surface: A Political Ecology Of Mineral Rights And Land Tenure Struggles In Appalachia And The Andes, Lindsay Shade

Theses and Dissertations--Geography

This dissertation examines how confusion and lack of access to information about subsurface property rights facilitates the rapid acquisition of mineral rights by mining interests, leaving those who live 'above the surface' to contend with complicated corporate and bureaucratic apparatuses. The research focuses on the first proposed state-run large scale mining project in Ecuador, believed to contain copper ores, and on the natural gas hydrofracking industry in three counties in north central West Virginia. Qualitative and visual methods, including mapping, are employed to determine (i.) how the geography of subsurface ownership patterns is changing, (ii.) links between changes in subsurface …

Rural Reality: How Reality Television Portrayals Of Appalachian People Impact Their View Of Their Culture, Ivy Jude Elise Brashear

Theses and Dissertations--Community & Leadership Development

Appalachian people have faced stereotyping of their culture and region in popular culture, news media, and art for generations. For more than 150 years, images of the region have been extracted by outside media makers and disseminated widely, solidifying the “hillbilly” stereotype in the national lexicon. This study focuses on such images in reality television shows about Appalachia, and seeks to determine whether or not those images, and the proliferation of them, has an impact on the ways in which Appalachian people understand and accept their own culture.

Adolescent Perceptions Of Nutrition: Identifying Memorable Messages, Audrey S. Bachman

Theses and Dissertations--Communication

Research is necessary to uncover ways to improve adolescent nutrition and reduce obesity rates, particularly in the Appalachian region, which has high rates of food insecurity and adolescent obesity. The current study examines rural cultural norms about food, memorable messages adolescents received about nutrition, and the sources of identified memorable messages. Adolescents shared memorable messages during comprehensive, semi-structured, small group interviews in which participants revealed their individual experiences. Thematic framework analysis is used to present the range and nature of memorable messages about nutrition and to develop strategies for future health campaigns and interventions. This qualitative method of sequential inductive …

The Relationship Between Intercultural Communication Experience And College Persistence Among First Generation Appalachian Students, Meredith A. Garrison

Theses and Dissertations--Communication

This study seeks to explore the relationship between intercultural communication experiences and college persistence in first-generation college students from the Central Appalachian region. Because Appalachia has a rich and unique culture, which is often misunderstood, the literature review seeks to establish a basis for studying this relationship as a way to understand the multi-dimensional nature of low-educational attainment in the Appalachian region, particularly Eastern Kentucky, Tennessee, Virginia, and West Virginia. Using a survey-based quantitative method this study examines Appalachian first generation students attending college as an intercultural communication process through the frame of acculturation theory. Specifically, the study seeks information …

Redefining Development: Exploring Alternative Economic Practices In Appalachia, Amanda Fickey

Theses and Dissertations--Geography

This dissertation examines alternative economic practices and regional economic development strategies in the Appalachian region. First, I deconstruct regional economic development policies and practices. I argue that policy documents produced by the Appalachian Regional Commission and the State of Kentucky have often limited economic imaginings through the perpetuation of regional stereotypes and short-term, decontextualized strategies. Then, I explore the existence of alternative economic practices as well as the contradictory role of the state within the context of Eastern Kentucky’s craft industry. Using a mixed methods approach, I investigate how the state simultaneously supports cooperative craft production by perpetuating a geographical …

Education Policies And Migration Realities: Utilizing A State Longitudinal Data System To Understand The Dynamics Of Migration Choices For College Graduates From Appalachian Kentucky, Charles E. Mcgrew

Theses and Dissertations--Educational Policy Studies and Evaluation

Census data indicates people with higher levels of education are leaving Appalachian Kentucky as they do in other rural areas. Aside from anecdotal information and primarily qualitative community studies, there is little quantitative evidence of the factors which may influence these migration decisions. State policies and regional efforts to increase educational attainment of people in the region have focused on producing more college degrees however may be contributing to the out-migration of those with higher levels of education. The study incorporates community level data with demographic, academic, and employment data from a cohort of 2005-06 college graduates from Appalachian Kentucky. …

Untangling Neoliberalism’S Gordian Knot: Cancer Prevention And Control Services For Rural Appalachian Populations, George F. Bills

Theses and Dissertations--Sociology

In eastern Kentucky, as in much of central Appalachia, current local storylines narrate the frictions and contradictions involved in the structural transition from a post-WWII Fordist industrial economy and a Keynesian welfare state to a Post-Fordist service economy and Neoliberal hollow state, starving for energy to sustain consumer indulgence (Jessop, 1993; Harvey, 2003; 2005). Neoliberalism is the ideological force redefining the “societal infrastructure of language” that legitimates this transition, in part by redefining the key terms of democracy and citizenship, as well as valorizing the market, the individual, and technocratic innovation (Chouliaraki & Fairclough, 1999; Harvey, 2005). This project develops …

“You’Re Surviving But I Don’T See How You’Re Living” Appalachian Women Talk About Tanf And Employment In Their Communities, Pon-Chu Tsou

University of Kentucky Master's Theses

This thesis studies qualitative data to examine the lived experiences of Kentucky Transitional Assistance Program (K-TAP) recipients in Appalachian Kentucky. This research suggests that PRWORA legislation utilize the importance of place-based analyses to implement and evaluate poverty policy. For women who are attempting to meet PRWORA’s goals, the local services available to the women and the barriers they face to employment highlight the role place has in this national policy discussion. Of the women interviewed, recipients who resided in economically distressed areas had fewer opportunities to participate in employment activities than women in at-risk or transitional areas. While many strived …

Global Transformations, Local Activism: “New” Unionism’S Engagement With Economic And Health Care Transformation In Urban Central Appalachia, Rebecca Adkins Fletcher

University of Kentucky Doctoral Dissertations

It has long been argued that the organization of the U.S. health care system is shaped by the struggles between capital and labor, and this relationship is of increasing significance today. Transformations from an industrial to a service economy, rising insurance costs, neoliberal social policies, and decreased labor union power have increased the number of Americans with reduced access to health care, especially for service workers and women. This dissertation is an ethnographic study of how workers in two leading unions in the “new” unionism movement, the Retail, Wholesale, and Distribution Service Union (RWDSU) and the United Steelworkers (USW) in …

Breast Cancer Trends Among Kentucky Women, 2004-2007, Kara Ann Hagan

Theses and Dissertations--Nutrition and Food Systems

The purpose of this study is to investigate the discrepancies of female breast cancer mortality between the Appalachian and Non-Appalachian regions of Kentucky using data from the Kentucky Cancer Registry. This study identified subtype, reproductive, and regional differences in women with breast cancer in Kentucky. Among women with breast cancer living in Kentucky from 2004 to 2007, one and three live births significantly increased a woman’s risk of breast cancer mortality by 91% and 58% respectively, compared to a woman with zero live births. Progesterone receptornegative tumor status significantly increased a woman’s risk of breast cancer mortality by 64% compared …

Constructing Inequality In Three Kentucky Communities: Discourses Of Blame And Responsibilty, Elizabeth J. New

University of Kentucky Master's Theses

This thesis focuses on the social determinants of health in Appalachia. Using anthropological ethnographic field methods, this thesis explores the ways in which public assistance programs and exchanges between health care practitioners and clients result in discourses of blame and responsibly. Also included is a discussion of the role that health insurance plays in granting or denying individuals living in poverty the opportunity for treatment and care. The narratives collected for this project then become the bases for a critical examination of the public discourse surrounding health care reform in the United States in 2009 and 2010.