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Inequality and Stratification

University of Kentucky

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Full-Text Articles in Sociology

The Conditions Of Oregon's Latinx Farmworkers, Kevin Alejandrez Jan 2023

The Conditions Of Oregon's Latinx Farmworkers, Kevin Alejandrez

Theses and Dissertations--Sociology

The goal of this three-paper dissertation is to better understand inequalities that Latinx farmworkers endure and the ways through which these inequalities can be addressed. As such, this dissertation examines pertinent inequalities Latinx farmworkers experience in the United States, their responses to resulting hardships, and the effects that crises such as the Covid-19 pandemic have in both exacerbating hardship and expanding opportunities to challenge inequitable systems in place. This is done through an intersectional analysis of a multi-year ethnographic study conducted in Oregon’s Willamette Valley.

First, paper one, titled, “Subordinate Adaptation: Intragroup Hierarchies Among Blueberry Pickers,” explores the ways in …


The Isolated As The Revolutionary: How “Leftover” Men In China Challenge Heteronormativity, Ruwen Chang Jan 2022

The Isolated As The Revolutionary: How “Leftover” Men In China Challenge Heteronormativity, Ruwen Chang

Theses and Dissertations--Gender and Women's Studies

In contemporary China, demographers estimate that 30 million men are single because there are simply not enough women in the Chinese population, and the 2020 Chinese census shows that there are 34.9 million more men than women. These men are called guanggun, which can be directly translated to “bare sticks/branches,” a slur that indicates a lack of marriage and sex. In this project, I demonstrate that guanggun’s singlehood marks them as the marginalized at the intersection of heteronormativity, patriarchy, globalizing capitalism, and pronatalist governmentality. In a highly heteronormative and patrilineal culture, guanggun are branded as abnormal/incomplete. However, because …


Facultas Marginem: Assessing Disability Data And Public Aau Universities’ Affirmative Action Plans For Systemic Barriers Facing Faculty With Disabilities, Joseph Carlton Barry Jan 2022

Facultas Marginem: Assessing Disability Data And Public Aau Universities’ Affirmative Action Plans For Systemic Barriers Facing Faculty With Disabilities, Joseph Carlton Barry

Theses and Dissertations--Education Sciences

This dissertation contributes to education equity scholarship produced by academics seeking to develop understandings of disability, Persons with Disabilities (PWD), and how both are situated amongst faculty in institutions of higher education. As such, this dissertation centers on a study of public US universities belonging to the Association of American Universities (AAU). This study looks for institutional level associations between respective rates by which college and university faculty with disabilities (FWD) are employed, certain aspects of disability policy drawn from each institution’s 2020 Affirmative Action Plans (AAP), and various other instances of empirical disability data (EDD).

While this study contributes …


The Influence Of Sociopolitical Factors On Adolescents’ And Youths’ Development, Banafsheh Aghayeeabianeh Jan 2022

The Influence Of Sociopolitical Factors On Adolescents’ And Youths’ Development, Banafsheh Aghayeeabianeh

Theses and Dissertations--Family Sciences

Youths and adolescents are one of the major perpetrators of antisocial and deviant behaviors, which have deleterious consequences for both the perpetrators and society. Although there is extensive literature on youth and adolescent antisocial behavior, some correlates of youth antisociality are not known yet. As such, the present study is devoted to understanding the micro- and macro-level predictors of youth and adolescents’ antisociality in three contexts. Three empirical studies applying bioecological systems theory and analyzing data from the International Dating Violence database using Mixed Effects Models were conducted to investigate the ecology of the development of antisocial behaviors among youth. …


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 Oct 2021

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 Oct 2021

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 Oct 2021

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 Oct 2021

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 Jul 2021

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 Jul 2021

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 Jul 2021

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 Jul 2021

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 …


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 Jul 2021

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 …


Tracking The Impact Of Diseases Of Despair In Appalachia—2015 To 2018, Megan Heffernan, Michael Meit, Margaret Cherney, Victoria A. Hallman May 2021

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 May 2021

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 May 2021

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 Jan 2021

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 Jan 2021

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 Jan 2021

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 Jan 2021

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.


Unboxing The Japanese Sojourning Mom’S Pediatric-Going Experience: A Phenomenlogical Study Of Culturally And Linguistically Appropriate Health Services, Carolyn Oldham Jan 2021

Unboxing The Japanese Sojourning Mom’S Pediatric-Going Experience: A Phenomenlogical Study Of Culturally And Linguistically Appropriate Health Services, Carolyn Oldham

Theses and Dissertations--Education Sciences

This study explores how twelve former Lexington-area Japanese sojourning mothers define culturally and linguistically appropriate services and how culture, gender and language shaped their health care beliefs, behaviors and experiences in pediatric settings. It is a naturalistic, pragmatic line of inquiry born in collaboration with Japanese sojourning moms across cups of matcha 末茶 and mugicha 麦茶. Framed by constructivist and intersectionality research lenses, this phenomenological study seeks to understand how study participants perceived the cultural and linguistic appropriateness of their interactions with Lexington-area pediatric offices and to begin to ascertain the meanings they created based on their subjective experiences. Its …


A Fat Imposter: The Embodied Intersection Between Race, Body Type And Fatness In Margaret Cho’S Comedy, Julia Cox Jan 2021

A Fat Imposter: The Embodied Intersection Between Race, Body Type And Fatness In Margaret Cho’S Comedy, Julia Cox

Theses and Dissertations--Linguistics

Margaret Cho is a comedic goddess who, in her mockery, serves flaming hot social commentary about race, body image, and fatness. Within this thesis, I used critical discourse analysis to understand how Margaret Cho embodies Asianness, whiteness, and the body types and images prescribed respectively. While working on data analysis, I came across a common media trope of fat women: the use of indexically Southern (United States), Appalachian, and Working class indexicals in speech and lexical items. I connected the ideologies surrounding Southern and Appalachian language to the inequalities that fat women face. This voicing had not previously been written …


Other People’S Families: How Social Ties Shape Entrance Into The Medical Profession, Lillian Sims Jan 2021

Other People’S Families: How Social Ties Shape Entrance Into The Medical Profession, Lillian Sims

Theses and Dissertations--Educational Policy Studies and Evaluation

Not enough members of low-income, rural, and minoritized populations are successfully prepared for and recruited into medical school, exacerbating issues of unequal access to healthcare and limiting access to the profession. While a multitude of factors contribute to this problem, early social exposure to others in a field can act as a key contributor to career interest and a key advantage for entering the profession. Meanwhile, students without early social exposure to healthcare may take unconventional paths to medical school or may struggle to fit into the unique culture of medicine when they do enter training, especially if they belong …


A Qualitative Examination Of The Agency Of Women In Their 30s And 40s Who Use Dating Applications, Tera Buerkle Jan 2021

A Qualitative Examination Of The Agency Of Women In Their 30s And 40s Who Use Dating Applications, Tera Buerkle

Theses and Dissertations--Family Sciences

The use of dating applications (apps) to find romantic and sexual partners is widespread across age groups, however, there is a paucity of research on dating apps with those in middle adulthood. Sexual script theory suggests that women’s agency (i.e. the ability to act in one’s own best interest) may be impacted by expectations from an inherently sexualized context, such as dating apps. Feminist theory contends that women’s agency is complicated by gender socialization due to the imbalance of power in society that greatly favors men. In this study seventeen women aged 30 to 49 completed in-depth semi-structured interviews, and …


Rural Appalachia Battling The Intersection Of Two Crises: Covid-19 And Substance Use Disorders, Margaret Miller, Rebekah Rollston, Kate E. Beatty, Michael Meit Nov 2020

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 Nov 2020

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 Nov 2020

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 Nov 2020

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 Nov 2020

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.


Listening To Voices In Appalachia: Gathering Wisdom From The Field About Substance-Abuse Recovery Ecosystems, Bruce Behringer Jul 2020

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.