Medicine and Health Sciences Commons^™

Development And Early Outcomes Of The Watauga Compassionate Community Initiative, North Carolina, Tim Marema, Erin Bouldin

Journal of Appalachian Health

Addressing adverse childhood experiences has become a public health imperative, and communities across the United States are working to develop and implement programs and policies to both prevent childhood trauma and support adults who experienced trauma as children. Here we describe the development of the Watauga Compassionate Community Initiative (WCCI) in Watauga, County, North Carolina.

Access To Autism Spectrum Disorder Services For Rural Appalachian Citizens, Angela Scarpa, Laura S. Jensen, Denis Gracanin, Sharon L. Ramey, Angela V. Dahiya, L. Maria Ingram, Jordan Albright, Alyssa J. Gatto, Jen P. Scott, Lisa Ruble

Journal of Appalachian Health

Background: Low-resource rural communities face significant challenges regarding availability and adequacy of evidence-based services.

Purposes: With respect to accessing evidence-based services for Autism Spectrum Disorder (ASD), this brief report summarizes needs of rural citizens in the South-Central Appalachian region, an area notable for persistent health disparities.

Methods: A mixed-methods approach was used to collect quantitative and qualitative data during focus groups with 33 service providers and 15 caregivers of children with ASD in rural southwest Virginia.

Results: Results supported the barriers of availability and affordability of ASD services in this region, especially relating to the need for more ASD-trained providers, …

Introduction To The New “Early Reports Of Innovation” Section, Erin Bouldin, Tim Marema

Journal of Appalachian Health

The Journal of Appalachian Health is introducing a new section this issue. While the journal is centralizing some of the best research and commentary on Appalachian health, the editorial team felt that practice-focused groups, organizations, and agencies may not be fully represented in the publication.

Barn-Raising On The Digital Frontier: The L.A.U.N.C.H. Collaborative, Bradford W. Hesse, David Ahern, Michele Ellison, Eliah Aronoff-Spencer, Robin C. Vanderpool, Karen Onyeije, Michael C. Gibbons, Timothy W. Mullett, Ming-Yuan Chih, Victoria Attencio, Grant Patterson, Jessica Boten, Christopher Hartshorn, Ben Bartolome, Katie Gorscak, Melanie Mccomsey, Alexandra Hubenko, Bin Huang, Corey Baker, Don Norman

Journal of Appalachian Health

A meta-analysis of oncology papers from around the world revealed that cancer patients who lived more than 50 miles away from hospital centers routinely presented with more advanced stages of disease at diagnosis, exhibited lower adherence to prescribed treatments, presented with poorer diagnoses, and reported a lower quality of life than patients who lived nearer to care facilities. Connected health approaches—or the use of broadband and telecommunications technologies to evaluate, diagnose, and monitor patients beyond the clinic—are becoming an indispensable tool in medicine to overcome the obstacle of distance.

Introducing The L.A.U.N.C.H. Collaborative, F. Douglas Scutchfield Md, Kevin Patrick

Journal of Appalachian Health

The L.A.U.N.C.H. Collaborative: Linking & Amplifying User-Centered Networks through Connected Health: A Demonstration of Broadband-Enabled Connected Health and Community-Based Co-Design brings together a group of organizations that are eager to use Appalachian Kentucky as a site for the development of a project aimed at creating an environment that addresses two of the nation’s major concerns about cancer. First, individuals who live in rural and remote areas are more likely to die of cancer than those who live in urban or suburban settings. And second, geographic obstacles hinder their ability to access evidence-based strategies that can prevent cancer or treat it …

Why We Can’T Solve The Opioid Problem, Wayne F. Coombs, Ph.D.

Journal of Appalachian Health

Appalachia’s opioid epidemic is a complex, systemic problem being addressed by limited intervention processes conceptualized through narrow disciplinary models that are not working. We need a new comprehensive, collaborative approach if we ever hope to find solutions to this problem.

Adult Food Security And The Relationship With Adverse Childhood Experiences Among Residents Of Appalachian North Carolina, Manan Roy, Erin Bouldin, Maggie Bennett, Adam Hege

Journal of Appalachian Health

Introduction: The Appalachian region has worse health outcomes than the remainder of the United States. These disparities are often linked to the underlying social and environmental determinants of health. Adverse childhood experiences (ACEs) are associated with poor health outcomes across the lifespan and have a significant impact on future social determinants as an adult, including food security status.

Purpose: To explore the relationships between ACEs and food security among adults in the Appalachian counties of North Carolina and make comparisons with the rest of the state.

Methods: Researchers used North Carolina’s 2012 Behavioral Risk Factor Surveillance System data; namely, …

Roanoke's Collective Public Health Activities, Michael Lytton

Journal of Appalachian Health

Roanoke is addressing problems that confront many small and medium sized cities in the U.S., especially disparities in health and life expectancy between neighborhoods. These disparities are often legacies of decades of racial and economic segregation, resulting in low-income or disinvested communities. Typically, such neighborhoods have fewer parks, higher vacancy rates and less stable affordable housing stock, inadequate public transit systems, too few clinics, too many fast food restaurants and insufficient access to high quality schools. In Roanoke these are the northwest and southeast quadrants, both federally designated Medically Underserved Areas, and characterized by a large proportion of the city’s …

A Legacy Of Disease, Arthur L. Frank

Journal of Appalachian Health

In Appalachia, like much of America, there are important health issues that have not always been appropriately predicted or dealt with when they occur. Lifestyle issues in Appalachia lead to obesity and heart disease, not surprisingly due to extensive use of sugary drinks. The current opioid crisis could have been better predicted given the trauma of mining and the past abuse of less-potent narcotics. A continuing major problem in the whole country is inadequate support for preventive health activities.

Using Mini-Grants To Build Multi-Sector Partnerships In Rural Tennessee, Ginny Kidwell, Kristine Bowers, Taylor M. Dula, Randolph F. Wykoff

Journal of Appalachian Health

Rural counties in Tennessee, including those located in Appalachia, face some of the greatest health challenges in the nation. Unpublished data collated by the East Tennessee State University College of Public Health (ETSU) show that Tennessee’s 52 Appalachian counties vary dramatically from its 43 non-Appalachian counties in virtually all socioeconomic, behavioral, and health outcome metrics. Since 2011, the Tennessee Institute of Public Health (TNIPH) has actively encouraged local communities to address behavior change, enhance educational achievement, and improve economic conditions as essential components for improving health and well-being in rural Tennessee.

Improving Access To Addiction Recovery Care In Central Appalachia Through Organizational Collaboration, Katy Stigers

Journal of Appalachian Health

Fahe, a Network of 50+ members throughout Appalachia based in Berea KY, has brought together a coalition to finance, build, and manage several addiction recovery care centers across Kentucky and West Virginia, increase access to employment, and deploy vouchers for supportive services.

Investigating The Impact Of The Diseases Of Despair In Appalachia, Michael Meit, Megan Heffernan, Erin Tanenbaum

Journal of Appalachian Health

Introduction: Appalachia is one of the regions most significantly impacted by the opioid crisis. This study investigated mortality due to diseases of despair within the Appalachian Region, with an additional focus on deaths attributable to opioid overdose.

Methods: Diseases of despair include: alcohol, prescription drug and illegal drug overdose, suicide, and alcoholic liver disease/cirrhosis of the liver. Mortality data from the National Center for Health Statistics (NCHS) National Vital Statistics System (NVSS) Multiple Cause of Death database were analyzed for this study, focusing on individuals aged 15–64.

Results: Over the past two decades, the mortality rate due to diseases of …

Root Causes Of Appalachia’S Deaths Of Despair, F. Douglas Scutchfield Md

Journal of Appalachian Health

The U.S. is experiencing a decline in life expectancy, particularly among rural white males in their most productive years. Appalachia is disproportionally represented in mortality rates, accounting for 30% of the U.S. population, but 50% of the excess mortality attributed to the “deaths of despair”: drug overdose, suicide, and alcoholic cirrhosis. A substantial proportion of that excess mortality is related to the current opioid crisis we are experiencing. We have data on evidence-based solutions to the treatment of addiction, but little information on prevention of addiction as well as the other deaths of despair, likely with the same etiologic agent. …

Psychosocial Well-Being And Efforts To Quit Smoking In Pregnant Women Of South-Central Appalachia, Brittney Stubbs, Valerie Hoots, Andrea D. Clements, Beth Bailey

ETSU Faculty Works

Introduction: Psychosocial well-being variables from the Tennessee Intervention for Pregnant Smokers (TIPS) study, a longitudinal smoking cessation study in South-Central Appalachia, were investigated as potential predictors of smoking status.

Methods: A sample of 1031 pregnant women participated in an expanded 5A's (Ask, Advise, Assess, Assist, Arrange) program, from 2008 to 2011. Measures of stress, self-esteem, depressive symptoms, and disordered eating collected by interview during the first trimester, or during the third trimester in a combined interview if participants began prenatal care late, were hypothesized to differ among three groups of participants: pregnant women who never smoked, pregnant women who smoked …

Dusty Shoes: Appalachia Wisdom Fertilizing The Future Of Religious Leadership, Jill Crainshaw

Journal of Appalachian Health

Dust from their journeys through the hills and hollows of Appalachia clings to their shoes and has forever shaped their vocational journeys. This is a refrain I have distilled from the reflections of students who have participated in Wake Forest University School of Divinity’s multicultural contexts course that includes a 10-day sojourn in the mountains of North Carolina.

Identifying Priority And “Bright-Spot” Counties For Diabetes Preventive Care In Appalachia: An Exploratory Analysis, Peter J. Mallow, Michael Topmiller, Jennifer Rankin, Jene Grandmont, David Grolling, Jessica L. Mccann, Mark Carrozza

Journal of Appalachian Health

Introduction: Type 2 diabetes mellitus (T2DM) prevalence and mortality in Appalachian counties is substantially higher when compared to non-Appalachian counties, although there is significant variation within Appalachia.

Purpose: The objectives of this research were to identify low-performing (priority) and high-performing (bright spot) counties with respect to improving T2DM preventive care.

Methods: Using data from the Centers for Medicare and Medicaid (CMS), the Dartmouth Atlas of Health Care, and the Appalachia Regional Commission, conditional maps were created using county-level estimates for T2DM prevalence, mortality, and annual hemoglobin A1c (HbA1c) testing rates. Priority counties were identified using the following criteria: top 33rd …

The Social Determinants Of Health And The Decline In U.S. Life Expectancy: Implications For Appalachia, Steven H. Woolf, Heidi Schoomaker, Latoya Hill, Christine M. Orndahl

Journal of Appalachian Health

For the past century, life expectancy in industrialized countries has increased, and the U.S. has shared in that progress. However, beginning in the 1980s, advances in U.S. life expectancy began to lose pace with peer countries. By 1998, U.S. life expectancy had fallen below the average for Organisation for Economic Cooperation and Development nations. U.S. life expectancy peaked in 2014 and has been decreasing for three consecutive years, a trend not been seen since the influenza pandemic a century ago. Put simply, U.S. health is in decline.

Clinician Identified Barriers To Treatment For Individuals In Appalachia With Opioid Use Disorder Following Release From Prison: A Social Ecological Approach, Amanda M. Bunting, Carrie B. Oser, Michele Staton, Katherine S. Eddens, Hannah K. Knudsen

Sociology Faculty Publications

Background: The non-medical use of opioids has reached epidemic levels nationwide, and rural areas have been particularly affected by increasing rates of overdose mortality as well as increases in the prison population. Individuals with opioid use disorder (OUD) are at increased risk for relapse and overdose upon reentry to the community due to decreased tolerance during incarceration. It is crucial to identify barriers to substance use disorder treatment post-release from prison because treatment can be particularly difficult to access in resource-limited rural Appalachia.

Methods: A social ecological framework was utilized to examine barriers to community-based substance use treatment among individuals …

The Relationship Between Breastfeeding Practices And Postpartum Depressive Symptoms In Appalachian Women, Rose Stephens, Andrea D. Clements, Valerie M. Hoots, Beth A. Bailey

ETSU Faculty Works

Abstract available through the Annals of Behavioral Medicine.

Moving Mountains : A Study Examining Long-Term Impacts Of Mountaintop Removal Coal Mining On Mortality In The Appalachian Region Using Geographic Information Sciences Techniques., James Howard Kent Pugh

Electronic Theses and Dissertations

Over the last hundred years, the Appalachian region has been dominated by the coal industry. It has also been and currently is one of the unhealthiest regions in the United States. Recent scholarship has examined the relationship between coal mining and health and mortality rates in the Appalachian region. The first study incorporates air quality and pollution data to examine if coal mining counties have higher levels of pollution and if this pollution contributes to mortality disadvantage. In the second study, I construct a population-based coal-exposure measure to better evaluate the relationship between coal mining and health I find that …

Mental Health Treatment Seeking Patterns And Preferences Of Appalachian Women With Depression, Claire Snell-Rood, Emily Hauenstein, Carl G. Leukefeld, Frances Feltner, Amber Marcum, Nancy E. Schoenberg

Behavioral Science Faculty Publications

This qualitative study explored social-cultural factors that shape treatment seeking behaviors among depressed rural, low-income women in Appalachia—a region with high rates of depression and a shortage of mental health services. Recent research shows that increasingly rural women are receiving some form of treatment and identifying their symptoms as depression. Using purposive sampling, investigators recruited 28 depressed low-income women living in Appalachian Kentucky and conducted semistructured interviews on participants’ perceptions of depression and treatment seeking. Even in this sample of women with diverse treatment behaviors (half reported current treatment), participants expressed ambivalence about treatment and its potential to promote recovery. …

Women And Healthcare In Appalachia: Impeding Circumstance And The Role Of Technology, Ashley Cano

Electronic Theses and Dissertations

For decades, healthcare access and quality in central and southern Appalachia have trailed the rest of the country. Entrenched poverty and low educational attainment compound healthcare problems. This study examines the healthcare obstacles women encounter in southern and central Appalachia and analyzes how technology use, such as Internet searching and social media affect women’s healthcare decisions. Data were analyzed from four focus groups conducted with women from the region. Results indicate that seeing a physician or not did not influence women’s propensity to search the Internet for health-related information or to seek support through social media sites. Additionally, women reported …

Marital Status And Religious Commitment Predict Prenatal Tobacco, Alcohol, And Illicit Substance Use In Southern Appalachia, Andrea D. Clements, Tifani R. Fletcher, Lana Mcgrady, Beth A. Bailey

ETSU Faculty Works

Abstract available through the Annals of Behavioral Medicine.

Untangling Neoliberalism’S Gordian Knot: Cancer Prevention And Control Services For Rural Appalachian Populations, George F. Bills

Theses and Dissertations--Sociology

In eastern Kentucky, as in much of central Appalachia, current local storylines narrate the frictions and contradictions involved in the structural transition from a post-WWII Fordist industrial economy and a Keynesian welfare state to a Post-Fordist service economy and Neoliberal hollow state, starving for energy to sustain consumer indulgence (Jessop, 1993; Harvey, 2003; 2005). Neoliberalism is the ideological force redefining the “societal infrastructure of language” that legitimates this transition, in part by redefining the key terms of democracy and citizenship, as well as valorizing the market, the individual, and technocratic innovation (Chouliaraki & Fairclough, 1999; Harvey, 2005). This project develops …

Opportunity, Community, And Teen Pregnancy In An Appalachian State, Robert Bickel, Susan Weaver, Tony Williams, Linda Lange

SHU Faculty Publications

Teen pregnancy has become an issue that educators and public policy makers are obliged to treat as a serious problem. Too often, explanations of teen pregnancy have included uncritical use of the notion of adolescents at risk. Recently, however, attention has been given to structurally-determined contextual factors in explaining teen pregnancy. Such contextual factors include economic and educational opportunities and costs, as well as chances for valued participation in socially and culturally stable communities. This interest in contextual factors parallels a development in the literature on high school dropouts. A data set previously employed to study variability in drop-out rates …