Medicine and Health Sciences Commons^™

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 …

Loss Of Obstetric Services In Rural Appalachia: A Qualitative Study Of Community Perceptions, Caroline R. Efird, David Dry, Rachel F. Seidman

Journal of Appalachian Health

Background: As rural hospitals across the United States increasingly downsize or close, the availability of inpatient obstetric services continues to decline in rural areas. In rural Appalachia, the termination of obstetric services threatens to exacerbate the existing risk of adverse birth outcomes for women and infants, yet less is known about how the cessation of these services affects the broader community.

Purpose: The purpose of this paper is to explain how the loss of local obstetric services affects perceptions of healthcare among multi-generational residents of a remote, rural Appalachian community in western North Carolina.

Methods: An interdisciplinary team of researchers …

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.

Spatial Analysis Of Health Care Utilization Among Medicare Beneficiaries With Coal Workers’ Pneumoconiosis And Other Related Pneumoconiosis, Ahmed A. Arif, Claudio Owusu, Rajib Paul, Christopher M. Blanchette, Ripsi P. Patel, Tyrone F. Borders

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• The states with the highest number of Medicare beneficiaries with coal workers’ pneumoconiosis (CWP) were Kentucky, West Virginia, Virginia, and Pennsylvania.
• Significant clustering of health care utilization rates for Medicare beneficiaries with CWP was observed in the central Appalachian states of Kentucky, West Virginia, and Virginia.
• Significant clustering of health care utilization rates for Medicare beneficiaries with Other Related Pneumoconiosis was observed in Appalachia and the southeast parts of Texas and Louisiana. This clustering merits additional research to understand underlying disease etiology.

Understanding Declining Rates Of Drug Overdose Mortality In Eastern Kentucky, Walsh Center For Rural Health Analysis, University Of Chicago, Center Of Excellence In Rural Health, University Of Kentucky

Center of Excellence in Rural Health Reports

With funding from the Centers for Disease Control and Prevention (CDC) and the National Association of County and City Health Officials (NACCHO), the NORC Walsh Center for Rural Health Analysis and the University of Kentucky Center of Excellence in Rural Health (UK CERH) conducted this study to understand possible factors associated with declining rates of drug overdose mortality in Eastern Kentucky. Several counties in Eastern Kentucky have seen declines in drug overdose mortality rates over the past decade, even as overdose rates have risen in the state of Kentucky as a whole, as well as in the Appalachian regions of …

Rural Residents' Perspectives On An Mhealth Or Personalized Health Coaching Intervention: Qualitative Study With Focus Groups And Key Informant Interviews, Nancy Schoenberg, Madeline Dunfee, Hannah Yeager, Matthew Rutledge, Angela Pfammatter, Bonnie Spring

Behavioral Science Faculty Publications

BACKGROUND: Compared with national averages, rural Appalachians experience extremely elevated rates of premature morbidity and mortality. New opportunities, including approaches incorporating personal technology, may help improve lifestyles and overcome health inequities.

OBJECTIVE: This study aims to gather perspectives on whether a healthy lifestyle intervention, specifically an app originally designed for urban users, may be feasible and acceptable to rural residents. In addition to a smartphone app, this program-Make Better Choices 2-consists of personalized health coaching, accelerometer use, and financial incentives.

METHODS: We convened 4 focus groups and 16 key informant interviews with diverse community stakeholders to assess perspectives on this …

Persistent Disparities In Smoking Among Rural Appalachians: Evidence From The Mountain Air Project, Kathryn Cardarelli, Susan C. Westneat, Madeline Dunfee, Beverly May, Nancy Schoenberg, Steven R. Browning

Health, Behavior & Society Faculty Publications

BACKGROUND: Adult smoking prevalence in Central Appalachia is the highest in the United States, yet few epidemiologic studies describe the smoking behaviors of this population. Using a community-based approach, the Mountain Air Project (MAP) recruited the largest adult cohort from Central Appalachia, allowing us to examine prevalence and patterns of smoking behavior.

METHODS: A cross-sectional epidemiologic study of 972 participants aged 21 years and older was undertaken 2015-2017, with a response rate of 82%. Prevalence ratios and 95% confidence intervals for current smoking (compared to nonsmokers) were computed for the entire cohort then stratified by multiple characteristics, including respiratory health. …

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.

Cancer Curriculum For Appalachian Kentucky Middle And High Schools, Lauren Hudson, Katherine Sharp, Chris Prichard, Melinda J. Ickes, Sahar Alameh, Nathan L. Vanderford

Journal of Appalachian Health

Background: Appalachian Kentucky faces the highest cancer incidence and mortality rates in the country due to poor health behaviors and lifestyle choices. These poor health behaviors are facilitated by a lack of cancer education. Youth represent a vulnerable population that could be greatly impacted by increased cancer education. Teachers have the power to facilitate this learning.

Purpose: This study examined the need for cancer education curriculum in Appalachian Kentucky middle and high schools from the perspective of educators.

Methods: An online survey was conducted with science and health teachers (n=21) in Appalachian Kentucky, consisting of questions that investigated existing cancer …

Appalachian Caregiver Perspectives On Childhood Gun Safety In The Home, Dannell Boatman

Journal of Appalachian Health

Background: Childhood gun injuries pose a critical public health challenge. For children, unintentional gun injury deaths primarily occur in the home where parents or other adult guardians, referred to as caregivers hereafter, are responsible for safety. While the American Academic of Pediatrics recommends not having guns in areas where children live and play, firearms are often viewed as normative and fill an important role in many homes. This is particularly true in more rural areas, such as Appalachia, where there is a high density of gun ownership. Additional research is needed to understand rural caregivers’ current gun safety practices in …

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.

Environmental Respiratory Exposures And Pulmonary Function Among Residents Of Rural Appalachia, Kentucky, John C. Flunker

Theses and Dissertations--Epidemiology and Biostatistics

Introduction

Resource extraction exposures are hypothesized to promote adverse respiratory health outcomes among residents of rural Appalachia, yet no studies to date have simultaneously quantified small-scale geographic variation in residential exposure, individual level health factors, and respiratory health outcomes.

Methods

The Mountain Air Project (MAP) is a community engaged cross-sectional study based in Harlan and Letcher counties of Southeastern Kentucky. MAP utilized a novel small-scale method to define residential exposure boundaries: hydrologic unit code (HUC), which represents distinct drainages (AKA “hollows”) where residents cluster. We assigned the HUC level density of active and abandoned surface and underground mining, oil/gas wells, …

Identification Of Infant Feeding Practices In Eastern Kentucky And Southern West Virginia That Correlate With High Weight-For-Length, Havilah R. Adkins

DNP Projects

Background: Approximately 20% of children in the United States are obese. West Virginia and Kentucky rank in the top 10 for obesity rates in children as young as 2-4 years old. Obesity increases the risk for numerous short-term health problems and impacts long-term health, development, quality of life, and life expectancy. Research indicates that obesogenic behaviors can be addressed prior to the development of obesity or significant health problems to prevent, rather than treat. Interventions targeting caregivers of infants younger than 2-years can promote early development of healthy feeding habits that persist through the developmental stages of nutrition. Before a …

Maternal Proximity To Mountaintop Removal Mining And Birth Defects In Appalachian Kentucky, 1997-2003, Daniel B. Cooper

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background: Extraction of coal through mountaintop removal mining (MTR) alters many dimensions of the landscape, and explosive blasts, exposed rock, and coal washing have the potential to pollute air and water with substances known to increase risk of developmental and birth anomalies. Previous research suggests that infants born to mothers living in MTR coal mining counties have higher prevalence of most types of birth defects.

Objectives: This study seeks to examine further the relationship between MTR activity and birth defects by employing individual level exposure estimation through precise satellite data of MTR activity in the Appalachian region and maternal residence …

Patient Engagement In Patient Portals In Appalachia Versus Surrounding Us Census Regions: An Analysis Of Hints (Health Information National Trends Survey) Data, 2017 - 2020, Heather Lea Tudor

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

OBJECTIVE: Those living in the Appalachian regions face more significant healthcare disparities than those in the US. Patient portals can decrease disparities and increase health outcomes and health literacy. The purpose of this study was to determine if those living in the Appalachian region were offered access to and used their patient portals differently than the surrounding US Census region. Additionally, we aimed to determine if there was a difference in reported reasons for non-use of patient portals.

METHODS: This was a descriptive study using data from the National Cancer Institute’s Health Information National Trends Survey (HINTS) data (2017-2020) to …

2020 Kentucky Dental Workforce Update, Sydney P. Thompson, Melissa Slone, Frances J. Feltner

Center of Excellence in Rural Health Infographics

No abstract provided.

Rates Of Diabetes Screening In Kentucky Before And After Implementation Of The Affordable Care Act (Aca), Cory Reinert

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Diabetes mellitus, commonly referred to as “diabetes”, is currently at epidemic proportions in the United States as its prevalence has drastically increased over the past several decades. The percentage of Americans with diagnosed diabetes has risen from 0.93 percent of the population in 1958 to 10.5 percent in 2018 (ADA, 2021). Diabetes also impacts record numbers of Kentucky residents.

Regular screening for those considered at-risk can encourage patients to implement lifestyle modifications, pharmacological therapy, or other interventions earlier in the course of disease. This can help prevent or delay onset of T2D and can reduce diabetes-related complications in those who …

Maternal Residential Proximity To Surface Mining Associated With Preterm Birth And Low Birth Weight In Appalachian Kentucky, Whitney Smith

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objective: This study aims to examine the relationship between maternal residency in a county with surface coal production and preterm birth or low birth weight.

Methods: A cross-sectional study was conducted using birth records (n=62,766) for 54 Appalachian counties and coal production in tons. Logistic regression and chi-squared analysis was done to analyze the relationship between surface coal mining and preterm birth and low birth weight in two different birth groups.

Results: After controlling for covariates, statistically significant increases were seen in Birth Group 1 and Birth group 2. Birth Group 1 had statistically significant results for preterm birth ((1.19 …

Colorectal Cancer Differences In Staging And Survival: Appalachian And Non-Appalchian Kentuckians, Ripley Lucas

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Colorectal cancer is the third most commonly diagnosed cancer in the United States. Historically, the Appalachian region of Kentucky has experienced disparities in colorectal cancer screening and survival as compared to both the non-Appalachian region of the state and the United States. The aim of this paper is to investigate the differences in cancer staging and survival after diagnosis in Appalachian and non-Appalachian Kentuckians. The present time period of study is a retrospective, population-based cohort with data taken from the Kentucky Cancer Registry. Binomial logistic regression and Cox proportional hazards models were used to estimate unadjusted and adjusted odds ratios …