Medicine and Health Sciences Commons^™

Creating An Interactive Guide To Support Health Disparities Competency, Lauren E. Robinson, Stephanie Henderson, Cayla M. Robinson, Rebecca J. Morgan, Beth Reeder

2024 R&I Day

Authors share their educational resource developed for the health sciences, that guides users in awareness of health disparities, vulnerable populations, and social determinants of health, directing them to specific guidance and resources available through the library.

Adult Asthma Associated With Roadway Density And Housing In Rural Appalachia: The Mountain Air Project (Map)., W Jay Christian, John Flunker, Beverly May, Susan Westneat, Wayne T Sanderson, Nancy Schoenberg, Steven R Browning

UK CARES Faculty Publications

BACKGROUND: Appalachian Kentucky is a rural area with a high prevalence of asthma among adults. The relative contribution of environmental exposures in the etiology of adult asthma in these populations has been understudied.

OBJECTIVE: This manuscript describes the aims, study design, methods, and characteristics of participants for the Mountain Air Project (MAP), and focuses on associations between small area environmental exposures, including roadways and mining operations, and lifetime and current asthma in adults.

METHODS: A cohort of residents, aged 21 and older, in two Kentucky counties, was enrolled in a community-based, cross-sectional study. Stratified cluster sampling was used to select …

Editorial: Individual Differences In Cognition And Affects In The Era Of Pandemic And Machine Learning, Andrea Vranic, Yang Jiang, Xiaopeng Zhao

Behavioral Science Faculty Publications

No abstract provided.

Prevalence And Correlates Of Invitation To Participate In Clinical Trials Among Us Adults, Aurora Occa, Allison Leip, Allison S. Merritt, Jerod L. Stapleton

Communication Faculty Publications

Clinical trials are essential to modern medicine, but several barriers, including poor communication, hamper their successful completion. We examined the prevalence and correlates of invitation to participate in clinical trials among a nationally-representative sample of US adults using survey responses from the 2020 HINTS (Cycle 5). Analyses were conducted in 2021.

Overall, 9% of respondents reported being invited to a clinical trial, a prevalence that is nearly half of previously reported rates in convenience samples recruited from health care settings. Compared to non-Hispanic Whites, Black respondents reported the higher prevalence of invitation (16.0%) whereas Asian respondents reported the lowest (2%). …

A Cluster Randomized Controlled Trial For A Multi-Level, Clinic-Based Smoking Cessation Program With Women In Appalachian Communities: Study Protocol For The "Break Free" Program, Joanne G. Patterson, Tia N. Borger, Jessica L. Burris, Mark Conaway, Robert Klesges, Amie Ashcraft, Lindsay Hauser, Connie Clark, Lauren Wright, Sarah Cooper, Merry C. Smith, Mark B. Dignan, Stephenie Kennedy-Rea, Electra D. Paskett, Roger Anderson, Amy K. Ferketich

Psychology Faculty Publications

BACKGROUND: The cervical cancer burden is high among women living in Appalachia. Cigarette smoking, a cervical cancer risk factor, is also highly prevalent in this population. This project aims to increase smoking cessation among women living in Appalachia by embedding a smoking cessation program within a larger, integrated cervical cancer prevention program.

METHODS: The broader program, the Take CARE study, is a multi-site research collaborative designed to address three risk factors for cervical cancer incidence and mortality: tobacco use, human papillomavirus (HPV) infection, and cervical cancer screening. Break Free is a primary care clinic-based implementation program that aims to promote …

Clinical Geography: A Commentary Response, Jessica M. Finlay, Graham D. Rowles

Graduate Center for Gerontology Faculty Publications

No abstract provided.

Choice Bundling Increases Valuation Of Delayed Losses More Than Gains In Cigarette Smokers, Jeffrey S. Stein, Jeremiah M. Brown, Allison N. Tegge, Roberta Freitas-Lemos, Mikhail N. Koffarnus, Warren K. Bickel, Gregory J. Madden

Family and Community Medicine Faculty Publications

Choice bundling, in which a single choice produces a series of repeating consequences over time, increases valuation of delayed monetary and non-monetary gains. Interventions derived from this manipulation may be an effective method for mitigating the elevated delay discounting rates observed in cigarette smokers. No prior work, however, has investigated whether the effects of choice bundling generalize to reward losses. In the present study, an online panel of cigarette smokers (N = 302), recruited using survey firms Ipsos and InnovateMR, completed assessments for either monetary gains or losses (randomly assigned). In Step 1, participants completed a delay-discounting task to …

The Effect Of Travel Burden On Depression And Anxiety In African American Women Living With Systemic Lupus, Ashley A. White, Brittany L. Smalls, Aissatou Ba, Trevor D. Faith, Viswanathan Ramakrishnan, Hetlena Johnson, Jillian Rose, Clara L. Dismuke-Greer, Jim C. Oates, Leonard E. Egede, Edith M. Williams

Family and Community Medicine Faculty Publications

The United States has a deficit of rheumatology specialists. This leads to an increased burden in accessing care for patients requiring specialized care. Given that most rheumatologists are located in urban centers at large hospitals, many lupus patients must travel long distances for routine appointments. The present work aims to determine whether travel burden is associated with increased levels of depression and anxiety among these patients. Data for this study were collected from baseline visits of patients participating in a lupus study at MUSC. A travel/economic burden survey was assessed as well as the 8-item Patient Health Questionnaire (PHQ-8) and …

Mitochondrial Phenotypes In Purified Human Immune Cell Subtypes And Cell Mixtures, Shannon Rausser, Caroline Trumpff, Marlon A. Mcgill, Alex Junker, Wei Wang, Siu-Hong Ho, Anika Mitchell, Kalpita R. Karan, Catherine Monk, Suzanne C. Segerstrom, Rebecca G. Reed, Martin Picard

Psychology Faculty Publications

Using a high-throughput mitochondrial phenotyping platform to quantify multiple mitochondrial features among molecularly defined immune cell subtypes, we quantify the natural variation in mitochondrial DNA copy number (mtDNAcn), citrate synthase, and respiratory chain enzymatic activities in human neutrophils, monocytes, B cells, and naïve and memory T lymphocyte subtypes. In mixed peripheral blood mononuclear cells (PBMCs) from the same individuals, we show to what extent mitochondrial measures are confounded by both cell type distributions and contaminating platelets. Cell subtype-specific measures among women and men spanning four decades of life indicate potential age- and sex-related differences, including an age-related elevation in mtDNAcn, …

Longitudinal Pre-Exposure Prophylaxis (Prep) Acceptability, Initiation And Adherence Among Criminal Justice-Involved Adults In The Usa: The Southern Prep Cohort Study (Specs) Protocol, Katherine Lemasters, Carrie B. Oser, Mariah Cowell, Katie Mollan, Kathryn Nowotny, Lauren Brinkley-Rubinstein

Sociology Faculty Publications

INTRODUCTION: HIV prevalence among criminal justice (CJ)-involved adults is five times higher than the general population. Following incarceration, CJ-involved individuals experience multilevel barriers to HIV prevention. Pre-exposure prophylaxis (PrEP) is a widely available, daily medication efficacious in preventing HIV. Little is known about PrEP knowledge, acceptability, initiation and sustained use among CJ-involved persons or about how these outcomes vary by multilevel factors. The Southern Pre-Exposure Prophylaxis Study (SPECS) will investigate barriers and facilitators for PrEP initiation and sustained use among CJ-involved adults, building a foundation for PrEP interventions for this underserved population.

METHODS AND ANALYSIS: SPECS uses a mixed-methods sequential …

Temporal Trends In Suicidal Ideation And Attempts Among Us Adolescents By Sex And Race/Ethnicity, 1991-2019, Yunyu Xiao, Julie Cerel, J. John Mann

Social Work Faculty Publications

Importance: Disparities by sex and racial/ethnic group in suicide death rates are present in US adolescents. Whether disparities in suicide death extend to groups targeted for suicide prevention efforts, namely, those with suicidal ideation or nonfatal suicide attempts, is unknown.

Objective: To examine differences in temporal trends between suicidal ideation and suicide attempts in US adolescents from 1991 through 2019 by sex and race/ethnicity subgroups.

Design, Setting, and Participants: A cross-sectional analysis of the national Youth Risk Behavior Survey, weighted to represent US adolescents from 1991 to 2019, included 183 563 US high-school students in grades 9 to 12. Data …

Dating App Use Among Rural Men Who Have Sex With Men And Its Relationship To Hiv Prevention And Risk Behaviors: A Mixed-Methods Analysis, Lauren Bineau, Danielle Lambert, Natalia Truszczynski, Nathan Hansen, Carolyn Lauckner

Center for Health Equity Transformation Faculty Publications

INTRODUCTION: Men who have sex with men (MSM) in rural areas have limited access to HIV prevention and education resources. Given the growing usage of mobile dating apps among the wider MSM population, this research sought to explore their use among MSM in rural areas and their potential for delivering HIV prevention information.

METHODS: Participants were recruited from different areas of the rural Southern USA. This mixed-methods study consisted of an online survey (n=85) and follow-up qualitative phone interviews with 20 survey respondents. The survey assessed dating app use, sexual behaviors, and pre-exposure prophylaxis (PrEP) awareness, usage, and attitudes among …

Age At First Alcohol Use And Weapon Carrying Among Adolescents: Findings From The 2019 Youth Risk Behavior Survey, Philip Baiden, Nusrat Jahan, Henry K. Onyeaka, Shawndaya Thrasher, Savarra Tadeo, Erin Findley

Social Work Graduate Research

Background
Although studies have investigated the association between alcohol use and violent behaviors such as weapon carrying, few studies have examined the association between age at first alcohol use and weapon-carrying among adolescents. The objective of this study was to investigate the association between age at first alcohol use and weapon carrying among adolescents.

Methods
Data for this study came from the 2019 Youth Risk Behavior Survey. An analytic sample of 13,442 adolescents aged 14–18 years old (51% female) was analyzed using binary logistic regression. The outcome variable investigated in this study was weapon carrying during the past 30 days, …

Measuring The Impact Of The Affordable Care Act Medicaid Expansion On Access To Primary Care Using An Interrupted Time Series Approach, Elizabeth A. Brown, Brandi M. White, Walter J. Jones, Mulugeta Gebregziabher, Kit N. Simpson

Health and Clinical Sciences Faculty Publications

BACKGROUND: The Patient Protection and Affordable Care Act of 2010, commonly referred to as the Affordable Care Act (ACA), was created to increase access to primary care, improve quality of care, and decrease healthcare costs. A key provision in the law that mandated expansion of state Medicaid programme changed when states were given the option to voluntarily expand Medicaid. Our study sought to measure the impact of ACA Medicaid expansion on preventable hospitalization (PH) rates, a measure of access to primary care.

METHODS: We performed an interrupted time series analysis of quarterly hospitalization rates across eight states from 2012 to …

School Reopenings, Mobility, And Covid-19 Spread: Evidence From Texas, Charles J. Courtemanche, Anh Le, Aaron Yelowitz, Ron Zimmer

Institute for the Study of Free Enterprise Working Papers

This paper examines the effect of fall 2020 school reopenings in Texas on county-level COVID19 cases and fatalities. Previous evidence suggests that schools can be reopened safely if community spread is low and public health guidelines are followed. However, in Texas, reopenings often occurred alongside high community spread and at near capacity, likely making it difficult to meet social distancing recommendations. Using event-study models and hand-collected instruction modality and start dates for all school districts, we find robust evidence that reopening Texas schools gradually but substantially accelerated the community spread of COVID-19. Results from our preferred specification imply that school …

Integrating Policies, Systems, And Environments (Pse) Work Into Fcs Extension Programming: Lessons Learned From A Multi-State Training, Lisa T. Washburn, Heather Norman-Burgdolf, Karen L. Franck, Lauren E. Kennedy, Christopher T. Sneed

Dietetics and Human Nutrition Faculty Publications

Public health efforts have emphasized changes to policies, systems and environments (PSEs) to improve health behaviors for individuals and communities. Extension has increasingly emphasized these approaches, particularly for work of Family and Consumer Sciences (FCS) agents. In part, this emphasis on PSEs in Extension has been driven by SNAP-Ed and other federally funded initiatives, such as the Centers for Disease Control and Prevention (CDC) High Obesity Programs (HOP). However, broader adoption and implementation of PSEs at the local level has lagged in some states for various reasons. These include limited understanding about PSE interventions and how this work fits with …

Examining Criteria For Defining Persistent Post-Concussion Symptoms In Children And Adolescents, Grant L. Iverson, Justin E. Karr, Bruce Maxwell, Ross Zafonte, Paul D. Berkner, Nathan E. Cook

Psychology Faculty Publications

Researchers operationalize persistent post-concussion symptoms in children and adolescents using varied definitions. Many pre-existing conditions, personal characteristics, and current health issues can affect symptom endorsement rates in the absence of, or in combination with, a recent concussion, and the use of varied definitions can lead to differences in conclusions about persistent symptoms and recovery across studies. This study examined how endorsement rates varied by 14 different operational definitions of persistent post-concussion symptoms for uninjured boys and girls with and without pre-existing or current health problems. This cross-sectional study included a large sample (age range: 11–18) of girls (n = …

Adaptation Of A Standard Extended-Release Naltrexone (Xr-Ntx) Protocol For Rural Re-Entering Offenders With Oud, Michele Staton, Hannah K. Knudsen, Sharon L. Walsh, Carrie B. Oser, Erika Pike, Michelle R. Lofwall

Behavioral Science Faculty Publications

BACKGROUND: Despite a growing body of empirical support for the effectiveness of extended-release naltrexone (XR-NTX) to reduce opioid relapse among people with opioid use disorder (OUD) transitioning from a correctional facility to the community, continuity of care following release remains challenging. This paper describes a research-based adaptation of a state's standard of care XR-NTX protocol using the ADAPT-ITT framework for delivery in a non-traditional, non-treatment, community criminal justice setting (P&P office), as well as the expansion of services by a local Federally Qualified Health Center (FQHC) provider who would, for the first time, be going to the jail and P&P …

An Egocentric Network Contact Tracing Experiment: Testing Different Procedures To Elicit Contacts And Places, Andrew Pilny, C. Joseph Huber

Communication Faculty Publications

Contact tracing is one of the oldest social network health interventions used to reduce the diffusion of various infectious diseases. However, some infectious diseases like COVID-19 amass at such a great scope that traditional methods of conducting contact tracing (e.g., face-to-face interviews) remain difficult to implement, pointing to the need to develop reliable and valid survey approaches. The purpose of this research is to test the effectiveness of three different egocentric survey methods for extracting contact tracing data: (1) a baseline approach, (2) a retrieval cue approach, and (3) a context-based approach. A sample of 397 college students were randomized …

Effects Of Website Interactivity On Skin Cancer-Related Intentions And User Experience: Factorial Randomized Experiment, Zhaomeng Niu, Jessica Fitts Willoughby, Elliot J. Coups, Jerod L. Stapleton

Health, Behavior & Society Faculty Publications

BACKGROUND: Digital media technologies provide users with the ability to interact with content and to receive information based on their preferences and engagement.

OBJECTIVE: We used skin cancer and sun protection as a health topic to explore how modality interactivity, interface tools that afford users greater activity, resulting in greater depth and breadth of mentally representing and experiencing mediated content, and message interactivity, the extent to which the system allows users to exchange messages back and forth on health websites, influenced users' attitudes, knowledge, behavioral intentions, and experience.

METHODS: We employed a 2×2 (modality interactivity: high vs low; message interactivity: …

Gender In The Time Of Covid-19: Evaluating National Leadership And Covid-19 Fatalities, Leah C. Windsor, Gina Yannitell Reinhardt, Alistair J. Windsor, Robert Ostergard, Susan Allen, Courtney Burns, Jarod Giger, Reed Wood

Social Work Faculty Publications

In this paper we explore whether countries led by women have fared better during the COVID-19 pandemic than those led by men. Media and public health officials have lauded the perceived gender-related influence on policies and strategies for reducing the deleterious effects of the pandemic. We examine this proposition by analyzing COVID-19-related deaths globally across countries led by men and women. While we find some limited support for lower reported fatality rates in countries led by women, they are not statistically significant. Country cultural values offer more substantive explanation for COVID-19 outcomes. We offer several potential explanations for the pervasive …

“We’Re, Like, The Most Unhealthy People In The Country”: Employing An Equity Lens To Reduce Barriers To Healthy Food Access In Rural Appalachia, Kathryn Cardarelli, Emily M. Dewitt, Rachel Gillespie, Heather Norman-Burgdolf, Natalie Jones, Janet Tietyen Mullins

Dietetics and Human Nutrition Faculty Publications

Introduction

Obesity disproportionately affects rural communities, and Appalachia has some of the highest obesity rates in the nation. Successful policy, systems, and environmental (PSE) interventions to reduce obesity must reflect the circumstances of the population. We used a health equity lens to identify barriers and facilitators for healthy food access in Martin County, Kentucky, to design interventions responsive to social, cultural, and historical contexts.

Methods

We conducted 5 focus groups in Martin County, Kentucky, in fall 2019 to obtain perspectives on the local food system and gauge acceptability of PSE interventions. We used grounded theory to identify perceived barriers and …

Experimental Manipulations To Test Theory-Driven Mechanisms Of Cognitive Behavior Therapy, Matthew W. Southward, Shannon Sauer-Zavala

Psychology Faculty Publications

Despite decades of randomized-controlled trials demonstrating the efficacy of cognitive-behavior therapy (CBT), the mechanisms by which CBT achieves its effects remain unclear. Here, we describe how one adaptive intervention, the sequential multiple assignment randomized trial (SMART), can be used to randomize patients at multiple decision points in treatment to draw stronger causal claims about mechanisms unfolding in the course of CBT. We illustrate this design using preliminary data and case examples from an ongoing SMART in which we are testing the role of aversive reactions to negative emotions as a hypothesized mechanism of change in the Unified Protocol. Finally, we …

Cellphone Laws And Teens' Calling While Driving: Analysis Of Repeated Cross-Sectional Surveys In 2013, 2015, 2017, And 2019, Li Li, Caitlin N. Pope, Rebecca R. Andridge, Julie K. Bower, Guoqing Hu, Motao Zhu

Graduate Center for Gerontology Faculty Publications

BACKGROUND: Distracted driving among teens is a public health and safety concern. Most states in the U.S. have sought to restrict cellphone use while driving by enacting laws. This study examines the difference in prevalence of self-reported calling while driving (CWD) between states with different cellphone bans.

METHODS: Demographics and CWD data were extracted from state Youth Risk Behavior Surveys (YRBS) from 14 states in 2013, 2015, 2017, and 2019. The state YRBS is conducted every 2 years with a representative sample of 9th through 12th grade students attending public school. States were grouped by type of cellphone law(s): no …

Developing A Health Communication Campaign For Disposal Of Unused Opioid Medications, Kathleen L. Egan, Mark Wolfson, Kaylee M. Lukacena, Carina Mazariegos Zelaya, Monique S. Mcleary, Donald W. Helme

Communication Faculty Publications

Introduction

Communities throughout the United States have implemented medicine disposal programs to prevent diversion of unused opioid analgesics from homes but a general lack of awareness may contribute to low rates of utilization. The objective of this study was to develop and test community-based campaign messages promoting appropriate disposal of unused opioids at disposal programs.

Methods

In Fall 2019, 491 residents (79% female, 97% White, mean age: 40 years) of five rural, Appalachian counties (3 in Kentucky and 2 in North Carolina) completed a web-based, experimental survey. Participants were randomly exposed to two of four messages and rated each message …

An Experimental Investigation Into Promoting Mental Health Service Use On Social Media: Effects Of Source And Comments, Zhaomeng Niu, Lun Hu, David C. Jeong, Jared Brickman, Jerod L. Stapleton

Health, Behavior & Society Faculty Publications

Mental health is an increasingly prevalent topic of public interest, but remains a complex area requiring focused research that must account for negative perceptions surrounding mental health issues. The current work explores the roles of social media information source credibility and valence of social media comments on health outcomes in such a mental health context. We used a 2 (message source: professional vs. layperson) × 3 (valence of comments: positive vs. negative vs. mixed) online experiment to examine the effects of source and valence of comments on trust, attitudes and intentions related to mental health information and services among 422 …

Measuring The Spread Of Covid-19 In Kentucky: Do We Have The Right Data?, Kenneth R. Troske, Paul A. Coomes

Institute for the Study of Free Enterprise Working Papers

We examine various measures of COVID-19 infections, hospitalizations and deaths, with an emphasis on data for Kentucky. We find that: Data on the number of new reported cases of the disease obtained from convenience samples (as opposed to representative random samples) is an inaccurate measure of the spread of the disease in the State. Using CDC data and national studies, it appears that there were ten times the number of infections in March than reported for Kentucky at the time and by September the State is still capturing only one out of two people infected.

A better measure of new …

Preterm Birth Prevention In Appalachian Kentucky: Understanding Barriers And Facilitators Related To Transvaginal Ultrasound Cervical Length Surveillance Among Prenatal Care Providers, Anna Hansen, Mairead E. Moloney, Cynthia Cockerham-Morris, Jing Li, Niraj R. Chavan

Sociology Faculty Publications

Background: Appalachian Kentucky has higher-than-average rates of preterm birth (PTB)—a health disparity associated with increased maternal and fetal/neonatal morbidity and neonatal mortality. Transvaginal ultrasound (TVU) cervical length measurement is the best predictor of PTB risk, but is underutilized in Appalachia. This study explores prenatal care providers' TVU-related knowledge and practices, and identifies barriers and facilitators, which impact the adoption of this evidence-based technology.

Materials and Methods: This study recruited providers from three Appalachian Kentucky health care sites. Prenatal care providers took part in semistructured interviews and completed brief survey scales. Questions focused on PTB knowledge, TVU-related barriers, and suggestions for …

Rural Snap Participants And Food Insecurity: How Can Communities Leverage Resources To Meet The Growing Food Insecurity Status Of Rural And Low-Income Residents?, Emily M. Dewitt, Rachel Gillespie, Heather Norman-Burgdolf, Kathryn Cardarelli, Stacey A. Slone, Alison A. Gustafson

Dietetics and Human Nutrition Faculty Publications

The burden of obesity disproportionately influences poor health outcomes in rural communities in the United States. Various social and environmental factors contribute to inadequate food access and availability in rural areas, influencing dietary intakes and food insecurity rates. This study aims to identify patterns related to food insecurity and fruit and vegetable consumption within a SNAP-eligible and low-income, highly obese rural Appalachian community. A prospective cohort was implemented to identify gaps in resources addressing obesity and food insecurity challenges. SAS 9.4 software was used to examine differences in dietary intakes and shopping practices among SNAP participants. Among participants (n …

Are College Students’ Attitudes Related To Their Application Of Sanctions For Campus Sexual Assault Cases?, Jaspreet K. Chahal, Caihong R. Li, Diane R. Follingstad, Claire M. Renzetti

CRVAW Faculty Journal Articles

With growing attention to adjudication of campus sexual assault cases, more is known regarding students’ views of sexual assault, but little the literature focuses on how students perceive “justice” in terms of assigning sanctions or guilt/responsibility for such cases. The present study focused on understanding whether college students’ preformed attitudes and beliefs were associated with the severity of sanctions they applied across a range of sexual assault cases as well as their assignments of guilt and responsibility to the parties involved. To determine students’ attitudes and beliefs mediating effects on sanction choices, five scales (i.e., rape myth acceptance, downplaying the …