Medicine and Health Sciences Commons^™

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 …

Association Of Diabetes Prevalence With Labor Force Participation Rates In Kentucky Counties, Ryan Montgomery

MPA/MPP/MPFM Capstone Projects

Compared to other states in the USA, Kentucky has one of the highest rates of diagnosed diabetes and one of the lowest levels of labor force participation. This project employs a multivariable linear regression model to estimate the correlation between county-level diabetes prevalence and county-level labor force participation rates in Kentucky counties from 2015-2019, using publicly available data from the Centers for Disease Control’s Behavioral Risk Factor Surveillance System (BRFSS) and the U.S. Census Bureau’s American Community Survey (ACS). Labor force participation rates serve as the dependent variable and diabetes prevalence rates serve as the primary independent variable, alongside nine …

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% …

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. …

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 …

Triple Negative Breast Cancer In An Appalachian Region: Exponential Tumor Grade Increase With Age Of Diagnosis, Gina Sizemore, Toni Marie Rudisill

Journal of Appalachian Health

Introduction: Triple negative breast cancer is an aggressive breast cancer with decreased five-year survival, increased risk for recurrence, and higher risk for metastases. Unlike other breast cancers, it has no targeted treatment and has heterogeneous genetics which make classification and treatment difficult.

Purpose: The purpose of our research was to compare triple negative breast cancer to non-triple negative breast cancer to identify key epidemiologic factors that might lead to improved basic science directives for biomarkers, treatments, and classification.

Methods: The state cancer registry was used to provide the first West Virginia state-wide population evaluation of triple negative breast cancer.

Results: …

Addressing Diabetes Distress In Self-Management Programs: Results Of A Randomized Feasibility Study, Ranjita Misra, Samantha Shawley-Brzoska, Raihan Khan, Brenna O. Kirk, Sijin Wen, Usha Sambamoorthi

Journal of Appalachian Health

Background: West Virginia ranks 1st nationally in the prevalence of hypertension (HTN; 43.8%) and diabetes (16.2%). Patients with type 2 diabetes mellitus (T2DM) are distressed over physical and psychological burden of disease self-management.

Methods: This study investigated the effectiveness of an intervention to reduce diabetes distress and outcomes [glycemic control, blood pressure (BP)] among T2DM adults with comorbid HTN. Participants were randomized to a 12-week diabetes and hypertension self-management program versus a 3-month wait-listed control group. Trained health coaches and experts implemented the lifestyle program in a faith-based setting using an adapted evidence-based curriculum. Twenty adults with T2DM and HTN …

Effects Of Sleep Duration On Falls In A West Virginia Population-Based Study, Brfss, 2018, R. Constance Wiener, Christopher Waters

Journal of Appalachian Health

Introduction: West Virginia is a state in which most counties are rural, as well as a state with multiple health disparities among its population. The purpose of this study was to determine the association of sleep duration and falls for non-institutionalized West Virginia adults, aged 40 years and above, using the National Sleep Foundation’s definition of “may be appropriate” and “not recommended” sleep durations for specific ages.

Methods: Behavior Risk Factor Surveillance System (BRFSS) 2018 data concerning West Virginia residents were extracted for sleep duration and number of falls within the previous year. Data were analyzed with Chi square and …

Diseases Of Despair: A Commentary, Andrew Howard

Journal of Appalachian Health

Across the nation, and within Appalachia, communities that struggle economically experience greater health challenges, with disparities observed across leading causes of death. Within our region, these disparities are particularly notable across diseases of despair.

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 …

Poll Finds Rural Residents More Hesitant To Get Vaccinated, Tim Marema

Journal of Appalachian Health

Rural residents are more hesitant than their metropolitan counterparts to get a Covid-19 vaccination, even though rural areas have higher rates of infections and deaths from the coronavirus.

Review Of: Ailing In Place: Environmental Inequities And Health Disparities In Appalachia, Jerome A. Paulson Md, Faap, Jennifer A. Mallow Phd

Journal of Appalachian Health

The Journal of Appalachian Health is committed to reviewing published media that relate to contemporary concepts affecting the health of Appalachia. The Appalachian environmental inequities and the health disparities we face have a direct effect on our experience of illness. Dr. Jerome Paulson reviews the book Ailing in Place: Environmental Inequities and Health Disparities in Appalachia.

Impact Of The Covid-19 Shutdown On Mental Health In Appalachia By Working Status, Erin N. Haynes, Timothy J. Hilbert, Susan C. Westneat, Kate Leger, Katie Keynton, Heather M. Bush

Journal of Appalachian Health

Introduction: To slow the spread of COVID-19 in the United States, businesses shutdown in Spring 2020. Research has indicated the impact on frontline workers, yet little is known about the impact on those who were not working outside the home or switched to working remotely.

Purpose: The purpose of this report is to identify the financial and healthcare issues and mental health impact of the COVID-19 shutdown on Appalachians by worker categories.

Methods: An online survey was administered from May 8 – June 6, 2020 to a convenience sample of previous research participants and shared through social …

Students, Research, And The Health Of Appalachia, F. Douglas Scutchfield Md

Journal of Appalachian Health

The notion of publication in the peer-reviewed literature out of your doctoral or master’s thesis/dissertation or capstone is a characteristic of those who choose a career in the academy. This paper illustrates my pleasure by reflecting a student taking the additional step in research achievement by publishing results that contribute new knowledge to evidence-driven research and practice.

Rural Appalachia Battling The Intersection Of Two Crises: Covid-19 And Substance Use Disorders, Margaret Miller, Rebekah Rollston, Kate E. Beatty, Michael Meit

Journal of Appalachian Health

During the COVID-19 pandemic, rural Appalachia is at great risk of unforeseen side effects including increased mortality from substance use disorders (SUDs). People living with SUDs are at increased risk for both exposure to and poor outcomes from COVID infection. The economic impacts of COVID-19 must also be considered. As rural Appalachia combats the substance use crisis amidst the COVID-19 pandemic, the geographic economic, health and social inequities within our region must be considered. As a national recovery is sought, we should reimagine federal policies that center the economic and public health of rural Appalachia addressing the two crises.

Review Of: From The Front Lines Of The Appalachian Addiction Crisis Healthcare Providers Discuss Opioids, Meth And Recovery, Carl G. Leukefeld

Journal of Appalachian Health

The Journal of Appalachian Health is dedicated to reviewing various types of media related to contemporary concepts that affect the health of Appalachia. As the opioid-related overdose deaths ravish Appalachia, now more than ever, we each must devote energy to understanding addiction and pathways to recovery. Dr. Carl Leukefeld reviews the book From the Front Lines of the Appalachian Addiction Crisis: Healthcare Providers Discuss Opioids, Meth and Recovery.

In Their Own Words: How Opioids Have Impacted The Lives Of “Everyday” People Living In Appalachia, Patricia Nola Eugene Roberson, Gina Cortez, Laura H. Trull, Katherine Allison Lenger

Journal of Appalachian Health

Introduction: The opioid epidemic is ravaging people, families, and communities in Appalachia. However, limited research has examined how “everyday” people (e.g., not chronic pain patients, not medical professionals) living in these communities how opioids have impacted their lives.

Objective: Identify the perception of the opioid epidemic on individuals, families, and communities from people living in region most impacted regions.

Methods: Patients were recruited at Remote Area Medical clinics throughout Central and Southern Appalachia to complete interviews online (N = 169) or over the phone (N = 26), including one open-ended question about how opioids have impacted their lives.

Results: Using …

Improving Access To Treatment For Opioid Use Disorder In High-Need Areas: The Role Of Hrsa Health Centers, Michael Topmiller, Jennifer Rankin, Jessica L. Mccann, Jene Grandmont, David Grolling, Mark Carrozza, Hank Hoang, Josh Bolton, Alek Sripipatana

Journal of Appalachian Health

Introduction: Despite the opioid epidemic adversely affecting areas across the U.S. for more than two decades and increasing evidence that medication-assisted treatment (MAT) is effective for patients with opioid use disorder (OUD), access to treatment is still limited. The limited access to treatment holds true in the Appalachia region despite being disproportionately affected by the crisis, particularly in rural, central Appalachia.

Purpose: This research identifies opportunities for health centers located in high-need areas based on drug poisoning mortality to better meet MAT care gaps. We also provide an in-depth look at health center MAT capacity relative to need …

Rural Community Toolbox To Help Battle Opioid Epidemic, Liz Carey

Journal of Appalachian Health

An online data repository and toolbox created by the Office of National Drug Control Policy is designed to provide communities with knowledge and resources to fight the opioid epidemic according to their unique needs.

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 …

Listening To Voices In Appalachia: Gathering Wisdom From The Field About Substance-Abuse Recovery Ecosystems, Bruce Behringer

Journal of Appalachian Health

New qualitative data collected through six regional community-based listening sessions and community meetings are presented that describe elements of the Appalachian Regional Commission’s Recovery Ecosystem Model. These data informed the Model, which was used in formulating the new ARC Recovery-to-Work initiative. Input was intentionally solicited from multiple sectors, including persons recovering from substance abuse disorder, treatment and recovery service providers, workforce development agencies, employers, and community advocacy groups.

Responding To Appalachian Voices: Steps In Developing Substance-Use Recovery Ecosystems, Bruce Behringer

Journal of Appalachian Health

A description is presented of the four-step process used by the Appalachian Regional Commission to develop a new Recovery to Work initiative. The Commission identified, defined, and described issues facing individuals who complete substance abuse disorder treatment and who seek reentry into the workforce. Key elements were identified for resources and supports to develop and maintain community-based substance abuse recovery ecosystems. The steps included conceptualization, data collection, analysis, and review to formulate recommendations for program and policy development. The full process of development was accomplished in twelve months.

Experiencing Cancer In Appalachian Kentucky, Melanie Mccomsey, David Ahern, Robin C. Vanderpool, Timothy W. Mullett, Ming-Yuan Chih, Meghan Johnson, Michele Ellison, Karen Onyeije, Bradford W. Hesse, Eliah Aronoff-Spencer

Journal of Appalachian Health

Nothing tells the story of people working together better than a community quilt. A diversity of talents, colors, and materials brought together through skill and shared purpose. Perhaps never before have we as Americans needed a stronger reminder that many hands make short work of big problems. The work presented here by the L.A.U.N.C.H. Collaborative offers a new framework for health care that could be compared to a digital quilt, powered by community-based participatory design, with lived expertise and the newest advances in broadband-enabled connected health solutions. This work demonstrates the value and need to engage local communities and what …

Preface: Experiencing Cancer In Appalachian Kentucky, Michele Ellison, Robin C. Vanderpool

Journal of Appalachian Health

Connected cancer care is of increasing importance in light of the COVID-19 pandemic. The Linking & Amplifying User-Centered Networks through Connected Health (L.A.U.N.C.H.) Collaborative in Appalachian Kentucky has pioneered a new roadmap for equipping communities with the transformative power of broadband to innovate around the future of cancer care and to better scale their ideas. The roadmap involves reaching across disciplines, including public health, anthropology, telecommunications, and user-centered design. The goal is to leverage connectivity and cancer communication research and practice to make a real difference for patients and families.

Appalachian Regional Commission Recovery Ecosystem Background And Overview, Kostas Skordas, Andrew Howard

Journal of Appalachian Health

The Appalachian Regional Commission (ARC) has long addressed issues of substance abuse through funded community-based interventions, research, and sponsored conferences. Recently, the opioid crisis created a new urgency for cross-sector collaboration among various partners and funders dealing with this issue. This commentary provides an overview of recent efforts by the ARC to convene stakeholders to focus on assisting individuals with substance abuse disorder to access recovery services while pursuing education and training necessary to reenter the workforce and gain employment. Two papers have been prepared to describe this year-long effort. One paper focuses on the participatory methods used to gather …

Perspective On Substance-Abuse Recovery Ecosystem From The Appalachian Regional Commission Federal Co-Chair, Tim Thomas

Journal of Appalachian Health

The Appalachian Regional Commission (ARC) is a local, state, and federal partnership focused on economic development in the communities of the Appalachian Region. ARC Federal Co-Chairman Tim Thomas provides his perspective on how an economic development entity, such as ARC, can support efforts to address the Region’s drug crisis in a way that both saves lives and strengthens economic opportunity in communities throughout Appalachia.

Fiscal Challenges And Anticipated Changes To Kentucky's Population Health System, Jeffrey Howard

Journal of Appalachian Health

The hallmark of public health is population-level intervention. However, current public health funding in Kentucky is largely programmatic or disease-based. As a result, public health leaders are not able to appropriately utilize present resources to pursue population health endeavors. However, a recent transformation of the public health system has emphasized multisector partnerships and efficient funding mechanisms that may increase resources to pursue population-level health interventions based on community health assessments.