Digital Commons Network^™

The Influence Of Support From Family, Friends, And Community On Perceived Mental Health Status In Diabetes, Courtney L. Ortz, Meredith S. Duncan, Oluwatosin Leshi, Suraksha Khanal, Brittany Smalls

Biostatistics Faculty Publications

Strong social support is a protective factor in diabetes and mental health management. The purpose of this study was to examine the influence of the type of support on perceived mental health status among people with diabetes. We used data from the 2021 Household Component of the Medical Expenditure Survey (MEPS). Regression models assessed the association between mental well-being (outcome) and expected help from family, friends, and the community (exposure). Support from both friends and family were significantly associated with better mental well-being, adjusting for covariates. Secondary analyses showed that those who reported greater anticipated support from family were more …

Body Mass Index Has No Impact On Complications And Mortality For Patients With Stage Iv Pancreatic Ductal Adenocarcinoma, Ren Bryant, Hannah Darnell, Megan Hall, Kelsey N. Karnik, Kristen J. Mcquerry, Ruben R. Plentz

Biostatistics Faculty Publications

Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the leading causes of United States (USA) cancer death. Overweight and obesity developing into a growing global medical and socio-economic problem, affecting approximately 42% of adults in the USA population. The aim of our analysis was to evaluate the influence of overweight and obesity on complications and clinical outcome in patients with stage IV PDAC.

Methods: We retrospectively reviewed electronic health records of patients diagnosed with stage IV PDAC (n=162) who followed with the University of Kentucky from January 2017–October 2024. Comparisons were based on the body mass index (BMI): low BMI …

Hurricane Helene, One Year Later: Lived Experience, Geraldine A. Miller

Journal of Appalachian Health

Ashe County is located in the northwestern corner of North Carolina (NC), bordered by Virginia and Tennessee. The county is isolated, mountainous, and historically has lacked good highway access. Hurricane Helene, a category 4 hurricane at landfall, struck Western NC on September 27, 2024, resulting in flooding and wind damage that destroyed local communities in terms of land, homes, bridges, water, electricity, etc. with a damage of $59.6 billion.⁶ One year later, the recovery from the hurricane continues draining individuals and communities of their time, energy, and money. Geri Miller reflects on her hurricane impact experiences a year later. …

Associations Between Social Media Usage, Physical Activity And Flourishing In Rural University Students, Anna Dysart, Minu Sara Thomas

Journal of Appalachian Health

Introduction: Most adolescents and young adults report significant use of social media.^1-3 However, there is limited research on the effect of social media use, specifically on physical activity and flourishing.

Purpose: This pilot research study examines the correlation between social media usage and the physical activity and flourishing levels of college students at a rural university in Appalachia.

Methods: The authors conducted a survey including the validated Secure Flourishing Index and Stanford Leisure-Time Activity Categorical Item, containing questions on social media use and demographics. Spearman’s rho was used for nonparametric correlations. Pearson’s correlation was used to determine the correlation …

Impact Of West Virginia Abortion Ban On West Virginia Physician Trainee Practice Intentions, Rebecca Wald, Kristy Ward, Sarah Dotson

Journal of Appalachian Health

In June 2022, the Dobbs v Jackson Women’s Health Organization overturned the constitutional right to abortion established by Roe vs. Wade. Shortly after, West Virginia (WV) began enforcing a near total ban on abortion. Statewide restrictions on access to reproductive health care have important implications for the recruitment and retention of physicians. This project aimed to determine overall awareness of the 2022 changes in abortion laws among physician trainees, and whether the law influenced the intention of resident/fellow physicians to practice medicine in the state following completion of their medical training. A total of 178 resident and fellow physicians at …

Impact Of A Workshop On Rural Healthcare Delivery On Medical Student Attitudes, Robert L. Snedegar, Ryan Hayes, Jun Xiang, Treah Haggerty, Kendra Unger, Jason Oreskovich, Amie M. Ashcraft

Journal of Appalachian Health

Introduction: Rural residents in the United States (U.S.) experience significant health disparities due to social determinants such as poverty, geographic isolation, and limited healthcare access. Physician shortages in rural areas further exacerbate these challenges.

Purpose: This study evaluates the impact of an educational workshop on medical students’ attitudes toward rural healthcare barriers, aiming to determine whether targeted education can enhance their understanding and interest in rural practice.

Methods: Third-year medical students at the West Virginia University School of Medicine participated in a workshop that included a 20-minute pre-recorded lecture and a 90-minute interactive virtual session. Pre- and post-surveys assessed students’ …

Leveraging Community Health Worker’S Deep Community Knowledge To Address Food And Nutrition Security In Appalachia, Alexis Kimbro Scott, Melissa D. Olfert, Dawn Brewer, Makenzie Barr, Julie Plasencia

Journal of Appalachian Health

Introduction: Community health workers (CHWs) are trusted professionals in communities because of the deep understanding and cultural insights learned from their lived experiences. In Appalachia, CHWs are embedded in the community, giving them a unique understanding of how social determinants, like food and nutrition security, impact health outcomes.

Purpose: This study aimed to examine the professional characteristics and knowledge of CHWs while identifying culturally sensitive practices around food insecurity.

Methods: This cross-sectional, mixed-methods study used an online survey and in-depth phone interviews with CHWs in the Appalachian Region to examine their professional characteristics and knowledge on food security in their …

Stigmatization And Healthcare Inequity Perceived By Individuals Served By Homeless Shelters In An Appalachian City, Molly Powney, James M. Mears, Reagan Sharp, Lisa Calderwood

Journal of Appalachian Health

Introduction: People experiencing homelessness are medically vulnerable and suffer disproportionately from chronic physical and mental health conditions. Evidence-based standards to inform decisions surrounding care would be valuable for this population. Studies exploring how homeless individuals in Appalachia perceive their interactions with the healthcare system remain limited, however.

Purpose: The purpose of this study is to assess perceptions of the healthcare system among homeless individuals served by temporary housing shelters in an Appalachian city.

Methods: A voluntary anonymous survey was administered to residents at three shelters in Charleston, West Virginia (WV) from September 2023 – March 2024. Responses were collected utilizing …

Geospatial Analysis Of Breast Cancer Incidence, Mortality, And Access To Screening In Rural And Appalachian Virginia, Jennifer Osher, Caleb Brown, Phillip Nichols, Tariq Ayubi, Jeremy Powers

Journal of Appalachian Health

Introduction: Breast cancer is the most common malignancy among women in the United States (U.S.), despite recent survival rates improving nationally. However, rural and Appalachian regions have experienced slower mortality declines. These communities face unique health care-related challenges that may contribute to observed disparities.

Purpose: The purpose of this study is to assess differences in breast cancer incidence, mortality, and mortality-to-incidence ratio (MIR) between Appalachian and non-Appalachian counties, as well as rural and non-rural counties in Virginia (VA). Furthermore, we aim to evaluate whether availability of mammography is associated with these differences.

Methods: County-level breast cancer incidence and mortality data …

Influence Of Family Health History And Parental Education On Body Mass Index, Blood Pressure, And Lipid Levels In 5th Grade Children: A Secondary Data Analysis Of The Cardiac Project, Madha Rani Das, Lee A. Plyes, Eloise Elliott, Christa L. Lilly

Journal of Appalachian Health

Introduction: Childhood obesity and related cardiovascular risks reflect the interplay of genetic predispositions and socioeconomic adversity. Appalachia’s poverty, limited health care, and educational gaps worsen family health risks, driving early cardio-metabolic problems in children, highlighting the need for effective interventions.

Purpose: The purpose of this study is to examine the association of family health history and parental education with BMI, BP, and lipid profiles among 5^th grade children in West Virginia (WV).

Methods: The study used WV CARDIAC data from 2006–2009. Outcomes were BMI, SBP/DBP, and fasting lipids (HDL, LDL, TG). Predictors were parental education and family health history …

Understanding Breastfeeding Practices In Tennessee: Goals, Duration, And Reasons For Discontinuation, Amir Alakaam, Chia-Lin Chang, Hannah Jeffery

Journal of Appalachian Health

Introduction: Breastfeeding is widely recognized as the optimal source of infant nutrition, offering many health benefits.

Purpose: The purpose of this study was to examine goals, exclusivity, and duration of breastfeeding and explore factors that influence breastfeeding practices among individuals in Tennessee (TN).

Methods: A cross-sectional study was conducted among individuals (N = 1,249). Participants were recruited and data were collected from June – September 2021. The data were entered and analyzed from September 2022 – March 2023. Descriptive statistics, chi-square test, and ANOVA were used to analyze the data and identify associations between variables.

Results: About 32% of the …

Pathways To Better Sleep, Mairead E. Moloney, Emily Slade, Joon Chung, Kory Heier, Daniela C. Moga

Sociology Faculty Publications

Background: Rural Appalachia has some the highest rates of sleep and health disparities in the United States. This study investigates the relationship between social support and insomnia severity in rural Appalachian adults, with specific attention to the potential mediating roles of depression, anxiety, and stress. Methods: Participants from 12 rural Eastern Kentucky counties completed validated measures of insomnia severity, social support, depression, anxiety, and perceived stress. Using R, we calculated descriptive statistics and fit mediation models for depressive symptoms, anxiety symptoms, and stress, with social support as the exposure and insomnia severity as the outcome. Results: Aligning with regional demographics, …

Migratory Songbirds As Potential Ectozoochorous Protist Dispersal Vectors, Silas E. Fischer, Joy J. Jackson, Elise C. Hoffman, Henry M. Streby, Trisha L. Spanbauer

Earth and Environmental Sciences Faculty Publications

Protist biogeography, speciation, and systematics continue to generate debate and inquiry because protist distributions and dispersal remain poorly resolved. Identifying potential vectors and basibionts for epibiont protists would contribute to our limited understanding of their ecology. Migratory animals seasonally link disparate landscapes, incidentally transporting other organisms in the process. Waterbirds are known microbe dispersers, but evidence for other avian groups is limited-such as taxa that often migrate longer distances. We asked whether terrestrial songbirds (Passeriformes) host diatoms (Bacillariophyta) by sampling tail plumage of four thrush species (Hermit Thrush Catharus guttatus, Swainson's Thrush C. ustulatus, Wood Thrush Hylocichla mustelina, American Robin …

Becoming Steve Bright, Robert L. Tsai

Kentucky Law Journal

No abstract provided.

¿Cómo Se Dice, "Liberty And Justice For All Cannot Exist Without Equal Access For All" En Español?, Turner Denise Reynolds

Kentucky Law Journal

No abstract provided.

Like Balance On Ice: Towards A New Approach To The Open And Obvious Doctrine Under Kentucky Law, Hayden T. Crosby

Kentucky Law Journal

No abstract provided.

Just A Place Or A Just Place?: Domestic Violence, Urban-Rural Differences, And Access To Justice, Cassie Chambers Armstrong

Kentucky Law Journal

No abstract provided.

Prosecutorial Discretion And Digital Democracy, Erin Sheley

Kentucky Law Journal

No abstract provided.

Founder Worship, Effective Altruism, And Corporate Governance, Jennifer S. Fan, Xuan-Thao Nguyen

Kentucky Law Journal

No abstract provided.

Gene Expression Profile–Based Test To Predict Melanoma Sentinel Node Status, Tina J. Hieken, Michael E. Egger, Christina V. Angeles, John R. Hyngstrom, Erin E. Burke, Michael C. Lowe, Georgia M. Beasley, Edmund K. Bartlett, Scott C. Bresler, Kelly L. Harms, Jonathan S. Zager, Julia S. Lehman, Nabil Wasif, Sanjay P. Bagaria, Kelly M. Mcmasters, David A. Wada, Prakash Pandalai, Keith A. Delman, Jay Lee, Klaus J. Busam, Jane L. Messina, Vernon K. Sondak

Surgery Faculty Publications

Importance Contemporary guidelines recommend sentinel lymph node biopsy (SLNB) for patients with melanoma with predicted risk of SLN metastasis greater than 10% and consideration of SLNB when the risk is 5% to 10%. A gene expression profile (GEP)–based test that can accurately identify patients with a low risk of SLN metastasis would refine selection for SLNB. Objective To establish the predictive capability of the combined clinicopathological factors and GEP (CP-GEP) test to identify patients with primary cutaneous melanoma who can safely forgo SLNB and to investigate the prognostic value of CP-GEP regarding the outcome in patients with cutaneous melanoma after …

Trends In Cardiovascular Disease Prevalence Among Adults With Type 1 Diabetes In The Usa, Orighomisan Freda Agboghoroma, Kory R. Heier, Omer Atac, Meredith S. Duncan, Anna Kucharska-Newton, Mary E. Lacy

Epidemiology and Environmental Health Faculty Publications

Introduction Cardiovascular disease (CVD) is a common complication and major cause of mortality in people with type 1 diabetes (T1D). This study quantifies the prevalence of CVD among commercially insured adults with T1D in the USA from 2017 to 2021, overall and among age-defined and sex-defined subgroups. Research design and methods We used Merative MarketScan nationwide commercial insurance claims database (2017–2021) to identify adults ≥20 years with T1D (International Classification of Diseases, 10th Revision (ICD-10) codes). CVD ascertainment was based on ICD-10 codes for myocardial infarction, atrial fibrillation, ischemic heart disease, heart failure, peripheral artery disease, and stroke. Comorbidities included …

The Tracking And Reducing Alcohol Consumption (Trac) Intervention For Veterans Living With Hiv/Aids, Carolyn Lauckner, Reuben Adatorwovor, Erica Taylor, Fidelis Sesenu, Tehquin Tanner, Alexis Whitmire, Vincent Marconi, Trace Kershaw, Nathan Hansen

Biostatistics Faculty Publications

Background: Veterans with HIV/AIDS (VWH) frequently report alcohol misuse, which can impact antiretroviral therapy (ART) adherence and lead to poorer clinical outcomes. The TRAC (Tracking and Reducing Alcohol Consumption) intervention was developed to help VWH reduce alcohol use and its associated consequences. TRAC is delivered via mobile device, incorporates eight counseling sessions based in cognitive behavioral therapy and motivational interviewing, and utilizes mobile surveys and breathalyzers for daily monitoring of alcohol and ART use. Methods: We conducted a pilot randomized waitlist-controlled trial (N = 50). Participants were allocated to an immediate intervention group (N = 26), which received the TRAC …

Genomic Surveillance Uncovers Regional Variation In Hcv Transmission Networks In Rural United States, Damien C. Tully, David J. Bean, Jacklyn Sarette, Thang Long Ngo, Karen A. Power, Daniel Brook, Hannah Cooper, Judith Feinberg, Peter D. Friedmann, Karli R. Hochstatter, Jennifer R. Havens, Shanna Babalonis, Christopher Hurt, Wiley Jenkins, P. Todd Korthuis, William Miller, Mai T. Pho, Gordon Smith, Thomas J. Stopka, Judith I. Tsui, L. Sarah Mixson, Ryan P. Westergaard, April M. Young, Todd M. Allen

Epidemiology and Environmental Health Faculty Publications

Hepatitis C virus (HCV) remains a public health concern in the United States, particularly in rural communities where the opioid epidemic accelerates transmission among people who use drugs (PWUD). Despite this growing burden, the genetic features and transmission dynamics of HCV in these settings are poorly understood. We analyze 692 HCV antibody-positive specimens collected from rural communities in ten U.S. states using amplicon-based deep sequencing and the Global Hepatitis Outbreak and Surveillance Technology (GHOST) platform to reconstruct transmission networks. Among sequenced individuals, 29.5% are linked within clusters. Cluster structure varies by region from sparse networks in Ohio to dense clusters …

Development Of A Kytc Highway Geometric Design Workshop, Jill Asher, Jeff Jasper, Travis Thompson, Chris Van Dyke

Kentucky Transportation Center Research Report

In-depth knowledge of geometric design principles is a prerequisite for delivering road projects that provide safe and efficient multimodal mobility for all users. Historically, Kentucky Transportation Cabinet (KYTC) early-career design staff arrived at the agency with little design experience. The agency has relied on a combination of short courses and mentorship provided by experienced personnel to bring early-career design staff up to speed on design best practices. However, this approach to training carries limitations. Employee turnover and imposing workloads make it challenging for early- and even mid-career design professionals to receive guidance from seasoned designers who have long tenures at …

Storage-Dependent Variability In Alzheimer Disease-Related Plasma Biomarker Results Using The Fujirebio Lumipulse G1200 Platform, Ibrahim Choucair, Tiffany L. Lee, Linda J. Van Eldik, Jeffrey L. Dage, Brian T. Gold, Erin L. Abner, Gregory A. Jicha, Peter T. Nelson

Epidemiology and Environmental Health Faculty Publications

Alzheimer disease plasma biomarkers have emerged as minimally invasive, cost-effective tools for early diagnosis and disease monitoring yet their stability under common “real world” pre-analytical conditions remains incompletely characterized. We evaluated the stability of six plasma biomarkers, Aβ40, Aβ42, pTau181, pTau217, NfL, and glial fibrillary acidic protein (GFAP) using the Fujirebio Lumipulse G1200 platform. Plasma samples were initially collected from four healthy and cognitively unimpaired volunteers. Samples were stored under four conditions: room temperature (0-4h), +4°C (1-10days), −20°C (1-3weeks), and −80°C (4-8weeks). In this pilot study, Aβ40 and Aβ42 remained generally stable. In contrast, pTau181 readings exhibited marked elevations in …

Using Low-Cost Sensors And Gps To Assess Spatiotemporal Variations In Personal Exposure To Pm2.5 In The Washington State Twin Registry, Ningrui Liu, Ally Avery, Elena Austin, John S. Meschke, Nicola K. Beck, Graeme Carvlin, Yisi Liu, Anne V. Moudon, Igor Novosselov, Jeffry H. Shirai, Glen E. Duncan, Edmund Seto

Epidemiology and Environmental Health Faculty Publications

Epidemiological studies typically rely on exposure assessments based on ambient PM_2.5 concentrations at participants' home addresses. However, these approaches neglect personal exposures indoors and across different non-residential microenvironments. To address this problem, our study combined low-cost sensors and GPS to conduct two-week personal PM_2.5 monitoring in 168 adults recruited from the Washington State Twin Registry between 2018 and 2021. PM_2.5 mass concentration, size-resolved particle number concentration, temperature, humidity, and GPS coordinates were recorded at 1-min intervals, providing 5,161,737 data points. We used GPS coordinates and a processing algorithm for automatic classification of microenvironments, including seven land use …

Discreet But Accessible, Rachel M. Marschke, April M. Young, Hannah K. Knudsen, Chelsi N. Cheatom, Hannah L.F. Cooper

Epidemiology and Environmental Health Faculty Publications

Background: Rural Appalachia has been significantly affected by drug-related harms (Hepatitis C, HIV, overdose deaths) over the past two decades, but harm reduction responses still lag behind other regions. Harm reduction vending machines (HRVMs) are an effective intervention for preventing overdose and the spread of infection, though they are newer to the US and have rarely scaled out to rural areas. Here, we report on guidance from people who use drugs (PWUD) and health department staff on how to adapt HRVMs to suit local needs in rural Appalachian Kentucky. Methods: Focus groups were conducted with local health department and syringe …

Engagement And Retention In A Motivational, Discovery, And Transitional Track Based Substance Use Disorder Recovery Program, Terry Lee Bunn, Robin Thompson, Madison Ashworth, Ernest Fletcher

Epidemiology and Environmental Health Faculty Publications

Background: St. Matthew’s House® Justin’s Place® Recovery Program (JPRP) is a substance use disorder recovery housing program that employs Motivational, Discovery, and Transitional Tracks. This study examined whether resident retention, resumption of substance use, family relationship restoration, and acquisition of employment were associated with JPRP completion. Methods: Secondary quantitative data from individuals with a substance use disorder who were accepted into the JPRP program and who stayed for at least one day (n = 447) was collected from January 1, 2022-August 31, 2024. Characteristics of the JPRP and its residents were identified. Logistic regression was utilized to determine the resident …

Knowledge-Informed Deep Learning To Mitigate Bias In Joint Air Pollutant Prediction, Lianfa Li, Roxana Khalili, Frederick Lurmann, Nathan Pavlovic, Jun Wu, Yan Xu, Yisi Liu, Karl O’Sharkey, Beate Ritz, Luke Oman, Meredith Franklin, Theresa Bastain, Shohreh F. Farzan, Carrie Breton, Rima Habre

Epidemiology and Environmental Health Faculty Publications

Accurate prediction of atmospheric air pollutants is critical for public health protection and environmental management. Traditional machine learning (ML) methods achieve high spatial resolution but lack physicochemical constraints, leading to systematic biases that compromise exposure estimates for epidemiological studies. Chemical transport models incorporate atmospheric physics but require expensive parameterization and often fail to capture local-scale variability crucial for health impact assessment. This gap between data-driven accuracy and physical realism presents a major obstacle to advancing air quality science. We address this challenge through a novel physics-informed deep learning framework that integrates advection–diffusion equations and fluid dynamics constraints directly into neural …

Long-Term, Bidirectional Associations Between Depressive Symptom Severity And Opioid Use Among People With Hiv, Alexandria Macmadu, Yu Li, Fiona Bhondoekhan, Chung Chou H. Chang, Anees Bahji, Stephen Crystal, Kirsha S. Gordon, Robert D. Kerns, Rachel A. Vickers-Smith, E. Jennifer Edelman, Brandon D.L. Marshall

Epidemiology and Environmental Health Faculty Publications

Background: The bidirectional relationships between opioid use and depressive symptom severity among people living with HIV (PLHIV) are poorly understood. We hypothesized that higher opioid use frequency would be associated with greater subsequent depressive symptom severity and that greater depressive symptom severity would be associated with higher subsequent opioid use frequency. Methods: We analyzed data from the Veterans Aging Cohort Study (VACS) – survey sample, a prospective cohort including PLHIV receiving care at 8 US Veterans Health Administration sites. From 2002 to 2018, we assessed past year opioid use frequency based on self-reported heroin and/or prescription opioid use at study …