Social and Behavioral Sciences Commons^™

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 …

Establishing Peer Recovery Support Services To Address The Central Appalachian Opioid Epidemic: The West Virginia Peers Enhancing Education, Recovery, And Survival (Wv Peers) Pilot Program, Stephen M. Davis, Amanda Stover, Herb Linn, Jon Dower, Dan Mccawley, Erin Winstanley, Judith Feinberg

Journal of Appalachian Health

Introduction: Central Appalachia has been disproportionately affected by the opioid epidemic and overdose fatalities. We developed West Virginia Peers Enhancing Education, Recovery, and Survival (WV PEERS), a program based on peer recovery support, to engage individuals using opioids and link them with a range of services.

Methods: Community partners providing services to individuals with opioid use disorder (OUD) were identified and collaborations were formalized using a standardized memorandum of understanding. The program was structured to offer ongoing peer recovery support specialist (PRSS) services, not just a one-time referral. A website and cards describing the WV PEERS program were developed and …

Rural Re-Entry And Opioid Use: Identifying Health-Related Predictors Of Relapse Among Formerly Incarcerated Women In Appalachia, Joseph M. Calvert, Megan F. Dickson, Martha Tillson, Erika Pike, Michele Staton

Journal of Appalachian Health

Introduction: Despite improved knowledge of the health care needs of formerly incarcerated women, there exists a gap regarding the relationship between health, health care access, and relapse among rural women returning to the community during the opioid epidemic.

Purpose: With an emphasis on health care access, this study examined health-related factors associated with opioid relapse among women reentering the community in rural Appalachia.

Methods: As part of a larger study, 400 rural women reporting a history of substance use were recruited from three Appalachian jails in Kentucky. Analyses focused on participants reporting a history of illicit opioid use prior to …

Emergence Of Covid-19 And Patterns Of Early Transmission In An Appalachian Sub-Region, Abbey K. Mann, Timothy A. Joyner, Ingrid E. Luffman, Megan Quinn, William Tollefson, Ashley Frazier

Journal of Appalachian Health

Background: In mid-March 2020, very few cases of COVID-19 had been confirmed in the Central Blue Ridge Region, an area in Appalachia that includes 47 jurisdictions across northeast Tennessee, western North Carolina, and southwest Virginia. Authors described the emergence of cases and outbreaks in the region between March 18 and June 11, 2020.

Methods: Data were collected from the health department websites of Tennessee, North Carolina, and Virginia beginning in mid-March for an ongoing set of COVID-19 monitoring projects, including a newsletter for local healthcare providers and a Geographic Information Systems (GIS) dashboard. In Fall 2020, using these databases, authors …

Review Of: The Cancer Crisis In Appalachia: Kentucky Students Take Action, Stephenie Kennedy-Rea

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. With cancer mortality rates higher in rural and Appalachian communities, a focus on how cancer impacts our families and communities is more important than ever. Dr. Stephenie Kennedy-Rea reviews the book The Cancer Crisis in Appalachia: Kentucky Students Take Action.

Tracking The Impact Of Diseases Of Despair In Appalachia—2015 To 2018, Megan Heffernan, Michael Meit, Margaret Cherney, Victoria A. Hallman

Journal of Appalachian Health

Introduction: This study provides an update on mortality due to diseases of despair within the Appalachian Region, comparing 2015 to 2018.

Methods: Diseases of despair include: alcohol, prescription drug and illegal drug overdose, suicide, and alcoholic liver disease/cirrhosis of the liver. Analyses are based on National Vital Statistics System (NVSS) mortality data for individuals aged 15-64.

Results: Between 2015 and 2017, the diseases of despair mortality rate increased in both Appalachia and the non-Appalachian U.S., and the disparity grew between Appalachia and the rest of the county. In 2018, the disease of despair mortality rate declined by …

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.

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 …

A Description Of Covid-19 Lifestyle Restrictions Among A Sample Of Rural Appalachian Women, Michele Staton, Martha Tillson, J. Matthew Webster

Journal of Appalachian Health

Background: COVID-19 has led to swift federal and state response to control virus transmission, which has resulted in unprecedented lifestyle changes for U.S. citizens including social distancing and isolation. Understanding the impact of COVID-19 lifestyle restrictions and related behavioral risks is important, particularly among individuals who may be more vulnerable (such as rural women with a history of substance use living in Appalachia).

Purpose: The overall purpose of this study was to better understand the perceptions of lifestyle changes due to COVID-19 restrictions among this vulnerable group.

Methods: The study included a mixed methods survey with a convenience sample of …

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.

The Landscape Of Connected Cancer Symptom Management In Rural America: A Narrative Review Of Opportunities For Launching Connected Health Interventions, Ming-Yuan Chih, Anna Mccowan, Sadie Whittaker, Melinda Krakow, David K. Ahern, Eliah Aronoff-Spencer, Bradford W. Hesse, Timothy W. Mullett, Robin C. Vanderpool

Journal of Appalachian Health

Background: The 2016 President’s Cancer Panel called for projects focusing on improving cancer symptom management using connected health technologies (broadband and telecommunications). However, rural communities, like those in Appalachia, may experience a “double burden” of high cancer rates and lower rates of broadband access and adoption necessary for connected health solutions.

Purpose: To better understand the current landscape of connected health in the management of cancer symptoms in rural America.

Methods: A literature search was conducted using four academic databases (PubMed, CINAHL, MEDLINE, and PsycINFO) to locate articles published from 2010 to 2019 relevant to connected cancer symptom management in …

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.

The Health Wagon Partners With The Virginia Department Of Health To Provide Covid-19 Testing In Rural Southwest Virginia, Tauna Gulley, Teresa Tyson, Ethan Collins, Rachel Helton, Paula Hill-Collins, Nicole France, Sarah Hubbard

Journal of Appalachian Health

The Health Wagon has been providing care for the rural population of southwest Virginia for the past 40 years. The mission of the Health Wagon is to provide quality health care to the medically underserved people in the mountains of Appalachia. It has expanded to two stationary clinics, three mobile units, and a mobile dental unit, logging over 19,000 patients encounters in the past year.

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.

Geographic Variation In The Structure Of Kentucky’S Population Health Systems: An Urban, Rural, And Appalachian Comparison, Rachel Hogg-Graham, Angela Carman, Glen P. Mays, Pierre Martin Dominique Zephyr

Journal of Appalachian Health

Introduction: Research examining geographic variation in the structure of population health systems is continuing to emerge, and most of the evidence that currently exists divides systems by urban and rural designation. Very little is understood about how being rural and Appalachian impacts population health system structure and strength.

Purpose: This study examines geographic differences in key characteristics of population health systems in urban, rural non-Appalachian, and rural Appalachian regions of Kentucky.

Methods: Data from a 2018 statewide survey of community networks was used to examine population health system characteristics. Descriptive statistics were generated to examine variation across geographic regions in …

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.

Seeking Care At Free Episodic Health Care Clinics In Appalachia, Malerie Lazar, Sandra Thomas, Lisa Davenport

Journal of Appalachian Health

Background: People who live in rural Appalachia experience a wide variety of problems when seeking access to health care. Health care disparities continue to be one of the most complex and prevalent problems, and many barriers exist for impoverished men and women such as a lack of education, complications with health insurance, and personal distrust of healthcare providers.

Purpose: A critical gap in the literature is the unheard voice of persons in rural underserved areas. The purpose of this study was to explore the perspectives of persons in rural Appalachia who seek healthcare services at free episodic health care clinics, …