Medicine and Health Sciences Commons^™

Factors Associated With Physical Activity Increases And Decreases Among A Sample Of Appalachian Residents During The Covid-19 Pandemic: A Cross-Sectional Study, Christiaan G. Abildso, Angela M. Dyer, Shay M. Daily, Christa Lilly, Emily A. Sarkees, Samantha I. Moyers, Thomas K. Bias

Journal of Appalachian Health

Introduction: Physical activity (PA) can prevent and reduce the deleterious physical and mental health effects of COVID-19 and associated lockdowns. Research conducted early in the pandemic demonstrates that a greater proportion of adults in the U.S. have decreased than increased PA, and the effects vary by sociodemographic factors. Ongoing evidence is important to identify patterns in PA changes during the pandemic.

Purpose: This study aims to identify factors associated with increases and decreases in PA during the COVID-19 pandemic in a convenience sample of adults residing in Appalachia.

Methods: Surveys were collected from a convenience sample of adults from eight …

Cancer Screening Behaviors And Associations With Childhood Trauma, Resiliency, And Patient–Provider Relationships: Findings From An Exploratory Study Of Appalachian Cervical Cancer Survivors, Dannell Boatman, Stephenie Kennedy-Rea, Lesley Cottrell, Hannah Hazard-Jenkins

Journal of Appalachian Health

Introduction: Adverse childhood experiences (ACEs) are associated with increased cancer risk. ACEs may affect this risk in a variety of ways, including cancer screening compliance. ACEs can contribute to mistrust in the medical profession, inhibit patient­–provider relationships and cause at-risk individuals to miss critical access points to preventive services. Protective factors may play an important role in mitigating ACE-related consequences by supporting resiliency.

Purpose: This study assesses the associations between ACEs, protective factors, patient–provider relationships, stage of cancer at diagnosis, and cancer screening behaviors for West Virginia (WV) cervical cancer survivors.

Methods: WV cervical cancer survivors diagnosed between 2000 and …

Rural Appalachian Women Will Suffer Disproportionately If Attempts To Further Restrict Emergency Contraception Are Successful, Amie M. Ashcraft, Sarah Dotson, Sara Farjo, Courtney S. Pilkerton, Pamela J. Murray

Journal of Appalachian Health

The removal of federal abortion protection has incited fear that restrictions on contraception may be next. Many states now imposing abortion restrictions and bans are in the South and Appalachian Regions of the U.S., where rates of unplanned pregnancy and poor health outcomes are already disproportionately high. Numerous studies have documented variable access to levonorgestrel EC (LNG EC) in community pharmacies, with particularly low rates of access at independent pharmacies that are more likely to be located in rural communities than chain pharmacies. Since the overturn of Roe v. Wade, some large chain pharmacies and online retailers are restricting …

We Welcome Findings From Further Afield, Randy Wykoff Md, Mph & Tm, Rachel E. Dixon Mphil

Journal of Appalachian Health

For the past five years, the Journal of Appalachian Health has published timely, high-quality research from within Appalachia. We also welcome submissions from those working outside of Appalachia who produce quality research of direct relevance to our region.

Providers’ Stigmas And The Effects On Patients With Opioid Use Disorder: A Scoping Review, Peyton Skaggs, Sarah Beth Bell, F. Douglas Scutchfield Md, Lauren E. Robinson

Journal of Appalachian Health

Introduction: One of the most prevalent, dangerous stigmas in health care is the complex bias toward patients with opioid use disorder (OUD). This stigma damages the vital patient–provider relationship, further perpetuating the opioid epidemic.

Purpose: Unfortunately, research on the relationship between OUD and provider stigma is greatly lacking. To fill this gap, the present in-depth study undertakes a scoping review of research on providers’ stigma toward OUD in order to determine how enacted stigma affects treatment plans.

Methods: Four databases were used to identify articles published from 1999 to 2021. A comprehensive search strategy was developed through a collaborative process …

Association Between Low Health Literacy And Adverse Health Behaviors In North Carolina, 2016, Manan Roy, Adam Hege, Erin D. Bouldin

Journal of Appalachian Health

Introduction: Health literacy (HL) is an urgent public health challenge facing the U.S. HL is a critical factor in health inequities and exacerbates underlying social determinants of health.

Purpose: This study assesses the association between low HL (LHL) and adverse health behaviors, which contribute to poor health.

Methods: Researchers used North Carolina’s 2016 Behavioral Risk Factor Surveillance System data, namely, the Health Literacy optional module which asks respondents to rate how difficult it is for them to get health-related advice or to understand medical information (verbal or written). Health behaviors analyzed were excessive alcohol consumption, lack of adequate exercise and …

The Relationship Between Psychosocial Factors, Self-Care, And Blood Sugar In An Appalachian Population, Brittany L. Smalls, Md. Tofial Azam, Madeline Dunfee, Philip M. Westgate, Susan C. Westneat, Nancy Schoenberg

Journal of Appalachian Health

Introduction: Appalachian residents are more likely than other populations to have Type 2 Diabetes Mellitus (T2DM) and to experience more severe complications from the disease, including excess and premature mortality.

Methods: This study examines health alongside sociodemographic factors, psychosocial factors (including knowledge, empowerment, social support/function, religiosity, distress), and perceived problems in diabetes management that may influence self-care and HbA1c among vulnerable rural residents. A survey of a community–based sample of 356 adults with diagnosed diabetes or HbA1c > 6.5 was conducted in six counties in Appalachian Kentucky.

Results: Findings suggest that neither religiosity nor social support/function mediate/moderate the relationship between psychosocial …

A Love Rooted Deep In The Appalachian Mountains: One Part Of The Legacy Of Doug Scutchfield, Charlotte S. Seidman

Journal of Appalachian Health

F. Douglas Scutchfield, MD, died on Monday, May 23, 2022 in Lexington KY.

I have known and worked with Doug for over 40 years and share my personal insights into how he created the Journal of Appalachian Health, one of his last great career adventures and a lasting legacy to his deep investment in the health and vitality of Appalachia and its people.

Assessing The Intention, Attitudes, And Social Influences On Covid-19 Preventive Behaviors Among Non-Rural Black And Rural Appalachian White Populations: A Faith-Based Community Study, Maria L. Gomez, Tofial Azam, Jean Edward, Hannah Bowman, Lovoria B. Williams

Journal of Appalachian Health

Introduction: The COVID-19 pandemic has had detrimental impacts in non-rural Black and rural Appalachian populations. Yet despite the pandemic’s magnitude, there is a scarcity of research exploring potential influences of attitudes and social influences within these populations on their adherence to COVID-19 public health preventive behaviors.

Purpose: This study examines the intention, attitudes, and social influences to adhere to COVID-19 preventive behaviors among non-rural Black and rural Appalachian congregants in Kentucky by integrating the Theory of Planned Behavior (TPB).

Methods: Secondary analysis of cross-sectional data was used to assess the association between the TPB constructs and four key public health …

Covid-19 Pandemic Impact On Essential Public Health Services And Online Health Communication—Appalachian Kentucky, March–December 2020, Margaret A. Riggs, Kenny Ortiz-Jurado, Keith Klein

Journal of Appalachian Health

Introduction: The COVID-19 pandemic posed many challenges for local health departments (LHDs). This study examines how stay-at-home orders impacted the provision of essential public health services and subsequent increased use of online health communication by LHDs for rural populations in Appalachian Kentucky during the first year of the COVID-19 pandemic.

Methods: A survey to gather information about provision of essential public health services was administered to five LHDs representing 13 counties between June 2020 and December 2020. Additionally, demographic and health-outcome data from LHD, state health department, and CDC websites were reviewed, alongside health communications posted on LHD social media …

Sars-Cov-2 (Covid-19) Vaccine Intentions In Kentucky, Kevin A. Pearce Md, Mph, Emily Messerli Dnp, Aprn, Mary E. Lacy, Brittany L. Smalls, Diane B. Francis, Sukruthi Yerramreddy, Marc Kiviniemi

Journal of Appalachian Health

Background: At the time of our writing, the COVID-19 pandemic continues to cause significant disruption to daily lives. In Kentucky, the burdens from this disease are higher, and vaccination rates for COVID-19 are lower, in comparison to the U.S. as a whole. Understanding vaccine intentions across key subpopulations is critical to increasing vaccination rates.

Purpose: This study explores COVID-19 vaccine intentions in Kentucky across demographic subpopulations and also investigates the influences on vaccine intention of attitudes and beliefs about COVID-19.

Methods: A population-based survey of 1,459 Kentucky adults was conducted between January 26 and March 20, 2021, with over-sampling of …

On We Go, With Hope: Remembering Our Founding Editor-In-Chief, Dr. F. Douglas Scutchfield, Rachel E. Dixon, Randolph F. Wykoff

Journal of Appalachian Health

With the passing of our founding Editor-in-Chief, Dr. F. Douglas Scutchfield, the Journal of Appalachian Health team reflects on a life well lived and a monumental public legacy left behind. We thank "Scutch" for enriching the lives of so many, and we commit to growing the Journal in his honor.

Reviewer Acknowledgments, F. Douglas Scutchfield Md, Charlotte S. Seidman, Robert M. Shapiro Ii

Journal of Appalachian Health

We offer these reviewers our heartfelt thanks for a task that usually goes unrewarded in the academic environment. This year, we are especially grateful for those people listed below. They have assisted us in reaching the start of our 4th year, by guiding our decisions with your knowledge and capabilities.

Review Of: Wide Neighborhoods: A Story Of The Frontier Nursing Service, Tauna Gulley Phd

Journal of Appalachian Health

The Journal of Appalachian Health is committed to reviewing published media that relates to contemporary concepts affecting the health of Appalachia. Access to care remains one of the biggest challenges to Appalachian Health. The book, Wide Neighborhoods: A Story of the Frontier Nursing Service by Mary Breckinridge, is a well-known title that seems as relevant today as it was in 1952.

Prevalence And Types Of Drugs Used Among Hepatitis A Patients During Outbreaks Associated With Person-To-Person Transmission, Kentucky, Michigan, And West Virginia, 2016–2019, Megan G. Hofmeister, Alice Asher, Christopher M. Jones, Ryan J. Augustine, Cole Burkholder, Jim Collins, Monique A. Foster, Shannon Mcbee, Erica D. Thomasson, Doug Thoroughman, Mark K. Weng, Philip R. Spradling

Journal of Appalachian Health

Background: People who use drugs are at increased risk for hepatitis A virus infection. Since 1996, the Advisory Committee on Immunization Practices has recommended hepatitis A vaccination for people who use drugs. Since 2016, the U.S. has experienced widespread hepatitis A outbreaks associated with person-to-person transmission.

Purpose: To describe the prevalence of drug use, route of use, and drugs used among hepatitis A outbreak-associated patients.

Methods: State outbreak and medical records were reviewed to describe the prevalence, type, and route of drug use among a random sample of 812 adult outbreak-associated hepatitis A patients from Kentucky, Michigan, and West Virginia …

Changes In Adolescent Birth Rates Within Appalachian Subregions And Non-Appalachian Counties In The United States, 2012–2018, Nathan Hale, Kathleen Tatro, Sylvester Olubolu Orimaye, Michael Smith, Michael Meit, Kate E. Beatty, Amal Khoury

Journal of Appalachian Health

Background: Adolescent births are associated with numerous challenges. While adolescent birth rates have declined across the U.S., disparities persist and little is known about the extent to which broader declines are seen within Appalachia.

Purpose: The purpose of this study was to examine the extent to which adolescent birth rates have declined across the subregions of Appalachia relative to non-Appalachia.

Methods: We conducted a retrospective study of adolescent birth rates between 2012 and 2018 using county-level vital records data. Differences were examined across the subregions of Appalachia and among non-Appalachian counties. Multiple regression models were used to examine changes in …

Community Strengths And Challenges Related To Opioid Use Disorder In Rural Counties Of East Tennessee, Ashlyn N. Schwartz, Zeruiah V. Buchanan, Laurie L. Meschke

Journal of Appalachian Health

Introduction: Appalachia, particularly Rural East Tennessee, has been and continues to be disproportionately impacted by opioid use disorder and its many tragic ramifications.

Purpose: Community-engaged strategies can inform and support the development of relevant prevention efforts. Hence, people connected to a ten-county rural Appalachian region in East Tennessee were asked to identify and prioritize strengths and challenges related to opioid use disorder (OUD).

Methods: Adult community members (n=577) completed a brief survey administered across 11 days in 2019.

Results: Of the respondents, 85.3% never had been addicted to opioids, but 74.0% had someone close to them with OUD. The most …

They Built My Soul: A Qualitative Analysis Of The Impacts Of Home Repairs In Rural Tennessee, Bethesda O'Connell, Ada Sloop, Nicole Intagliata, Melisa Miller, Megan Quinn

Journal of Appalachian Health

Background: Housing is an important social determinant of health and substandard housing is linked to physical, mental, and social health problems.

Purpose: The purpose of the study was to qualitatively assess the impacts of repairs to substandard housing in rural East Tennessee through twenty-eight interviews.

Methods: Zoom was utilized for recording phone interviews in January– February 2021 and NVivo software was used for thematic analysis in May–July 2021.

Results: Themes that emerged included environmental risk reduction, impacts on physical health, impacts on mental health, impacts on financial well-being, and willingness to receive future assistance from service organizations.

Implications: Further …

Access To Health Care In Appalachia: Perception And Reality, Michele Morrone, Cory E. Cronin, Kristin Schuller, Shannon E. Nicks

Journal of Appalachian Health

Introduction: Health disparities such as cancer and diabetes are well documented in Appalachia. These disparities contribute to health status, and by many indicators, Appalachian people are less healthy than those who live in other parts of the country. Access to health care is one factor that contributes to health disparities. Access to care is complex and involves both intrinsic and extrinsic aspects, including satisfaction with quality of care. This research sought to compare Appalachian to non-Appalachian communities in terms of perceptions of access to care.

Methods: We implemented a statewide survey to quantify perceptions of multiple components of …

Covid-19 Experiences, Behaviors, Beliefs, And Well-Being Among Students And Employees At A University In Rural Appalachia: A Cross-Sectional Study, Lauren Wisnieski, Kimberly A. Carney, Jenny L. Thornley

Journal of Appalachian Health

Introduction: In response to the coronavirus disease (COVID-19) pandemic, most universities experienced drastic operational changes with shifts to online learning, work-from-home policies, and social distancing measures. These changes have caused concern for social isolation and mental health.

Purpose: This cross-sectional study explores differences in COVID-19 experiences, behaviors, beliefs, and well-being among students and employees (faculty and staff) at a rural Appalachian university.

Methods: Data were collected with an online anonymous survey in September-October 2020 using convenience sampling. The survey measured multiple domains including COVID-19-related 1) beliefs, 2) symptoms and diagnoses, 3) exposure and preventive behavior, and 4) social, mental, and …

Comparisons Of Cooking, Dietary, And Food Safety Characteristics Of Food Secure And Food Insecure Sophomores At A University In Appalachia, Hannah Boone, Melissa D. Gutschall, Alisha Farris, Kimberly Fasczewski, Don Holbert, Laura Mcarthur

Journal of Appalachian Health

Introduction: Food insecurity means lacking access to adequate, nutritious, and safe food. Collegiate food insecurity rates at ten Appalachian campuses range from 22.4% to 51.8%, and have been associated with unfavorable health and academic outcomes.

Purpose: This study compared cooking, dietary, and food safety characteristics of food secure (FS) and food insecure (FI) sophomores at a university in Appalachia in the context of the USDA definition of food security.

Methods: Data were collected using an online questionnaire. Descriptive and inferential procedures compared FS and FI sophomores (p < 0.05).

Results: Participants (n = 226) were 65.0% females, 76.1% …

Understanding Polarizing Community Perspectives On Harm Reduction Strategies: Challenges To Addressing The Opioid Crisis In Appalachian Pennsylvania, Stephanie L. Creasy Mph, Jessica R. Thompson Med, Christina F. Mair Phd, Jessica G. Burke Phd

Journal of Appalachian Health

Introduction: Rural communities face barriers to opioid treatment and overdose prevention including concerns about stigma and lack of harm reduction services.

Purpose: The aim of this study was to explore community perspectives and understanding of harm reduction approaches to opioid use and overdose in a high-risk Northern Appalachian case community in Pennsylvania.

Methods: A small town approximately 10 miles from Pittsburgh was identified as the community with the greatest predicted probabilities of epidemic outbreak using posteriors from spatial models of hospitalizations for opioid use disorders. We interviewed 20 key stakeholders in the case community in using a semi-structured interview guide …

Access To And Use Of Technology For Health: Comparisons Between Appalachian Kentuckians And The General U.S. Population, Robin C. Vanderpool, Lindsay R. Stradtman, Anna Gaysynsky, Quan Chen, Meghan Johnson, Bin Huang

Journal of Appalachian Health

Introduction: Technology may increase the availability of health information and enable health promoting behaviors. However, lack of access to and use of technology may also exacerbate disparities, particularly in rural communities with limited Internet access.

Purpose: The purpose of this study was to compare Internet access, device ownership, and use of technology for health between Appalachian Kentuckians and the general U.S. population.
Methods: Findings from the 2017 Assessing the Health Status of Kentucky (ASK) survey were compared to national estimates from the Health Information National Trends Survey (HINTS) 5, Cycle 1 (2017), with a particular focus on degree of rurality. …

Risk Factors Associated With Passenger Vehicle Fatal Rollover Crashes In West Virginia, 2001-2018, Yuni Tang, Toni Marie Rudisill, Ruchi Bhandari

Journal of Appalachian Health

Background: Rollover crashes cause more injuries and fatalities than other types of motor vehicle crashes. West Virginia (WV) has high rates of drug overdose deaths and motor vehicle crash fatality. However, no studies have investigated risk factors associated with fatal rollover crashes in WV.

Purpose: The objective of this study is to evaluate whether drug use and other risk factors are associated with fatal rollover crash fatalities in WV.

Methods: This cross-sectional study utilized the Fatality Analysis Reporting System dataset from passenger vehicle crashes involving WV drivers ≥ 16 years of age with known drug test results who died within …

Perceived Hearing Loss And Availability Of Audiologists In Appalachia, Charles B. Pudrith, Ellyn Grider, Blythe Kitner

Journal of Appalachian Health

Introduction: There is a high demand for audiologists throughout the United States. Previous research has supported an additional demand for these providers within Appalachia.

Purpose: The purpose of the study was to determine if Appalachia has a disproportionally high demand for audiologists compared to the rest of the United States.

Methods: A cross-sectional retrospective study was performed with population data from the Appalachian Regional Commission, the American Academy of Audiology, and the United States Census Bureau. County-level population-weighted averages of individuals with perceived hearing loss and number of audiologists per capita were compared between Appalachian and non-Appalachian counties. …

The Compounding Effect Of Rurality On Health Disparities Among Black Patients With Covid-19, Jessica E. Johnson, Ruchi Bhandari, Allison Lastinger, Rebecca Reece

Journal of Appalachian Health

Background: West Virginia had garnered national attention for its vaccination rollout against coronavirus 2019 (COVID-19). Outcomes of this mostly rural population, however, have been underreported. As the pandemic continues, identifying high risk populations remains important to further epidemiologic information and target vaccines.

Purpose: The objective of this study is to examine the effects of COVID-19 and the influence of race and rurality on hospitalization and outcomes in Appalachians.

Methods: In this retrospective study, data from patients who tested positive and were admitted for COVID-19 and seen within the state’s largest health system (West Virginia University Health System) between March …

The Importance Of Time, Place, And Person: Applying Elementary Epidemiology To Covid-19 Outcomes In Rural Appalachia, Linda Alexander, F. Douglas Scutchfield Md

Journal of Appalachian Health

Since the 1800s this traditional triad of descriptive epidemiology has allowed for effective interventions to deal with epidemics. A focus on time, place, and person also provides a critical framework for interventions in controlling the epidemic by focusing on those populations with the highest risk for disease.

Review Of: Understanding And Dismantling Racism: Crowdsourcing A Pathway Model In Appalachia, Matthew F. Hudson

Journal of Appalachian Health

The Journal of Appalachian Health is committed to reviewing published media that relates to contemporary concepts affecting the health of Appalachia. Examining Institutional Racism’s impact on health, career advancement and outcomes in Appalachian communities, impacts our ability to address and identify solutions to inform the fundamental framing of health equity. Dr. Matthew F. Hudson critiques the website: Understanding and Dismantling Racism: Crowdsourcing a Pathway Model in Appalachia.

Review Of: Appalachians For Medicaid Website, Kendra Barker Dnp

Journal of Appalachian Health

The Journal of Appalachian Health is committed to reviewing published media that relates to contemporary concepts affecting the health of Appalachia. Access to care and the health disparities we face have a direct effect on our experience of illness. Dr. Kendra Barker reviews the website: Appalachians for Medicaid.

Geospatial Analysis Of Rurality And Food Banks In Appalachian Ohio, Cooper T. Johnson, Rebecca Fischbein, Kristin Baughman

Journal of Appalachian Health

Introduction: Food insecurity is a problem for individuals across Ohio, including those living in Appalachia. Adequate access to resources that help combat food insecurity is important for these populations.

Purpose: To examine how rurality relates to food insecurity and need for food resources, as well as availability of those resources including food pantries and soup kitchens, in 15 northern Ohio Appalachian counties.

Methods: A cross-sectional study with a geographical analysis was conducted using data from the American Community Survey census data, County Health Rankings data, and regional foodbank websites.

Results: Rural counties had a higher ratio of potential clients per …