Medicine and Health Sciences Commons^™

Ensuring Equitable Application Of Interventions To Vulnerable Subpopulations In The Kentucky Consortium For Accountable Health Communities (Kc-Ahc), Jing Li, Jessica M. Clouser, Akosua Adu, Aiko Weverka, Nikita Vundi, Terry D. Stratton, Mark V. Williams

Journal of Appalachian Health

Introduction: The Centers for Medicare and Medicaid Services (CMS) has funded the Accountable Health Communities (AHC) model to test whether systematically identifying and addressing the health-related social needs (HRSNs) of individuals would impact healthcare utilization and total cost of care for Medicare and Medicaid beneficiaries. Toward this effort, AHCs implement screening, referral, and community navigation services in their local areas. There are 28 CMS-funded AHCs nationwide, including the Kentucky Consortium for Accountable Health Communities (KC-AHC).

Purpsoe: This study aims to assess the equity of KC-AHC model activities in three vulnerable sub-populations: dual enrollees, disabled individuals, and women.

Methods: Twenty-eight primary …

Conscientious Objection: Understanding When And Why Primary Care Physicians Object To Providing Health Care To Transgender And Gender-Diverse Patients In An Appalachian Medical Center, Mili S. Patel, Kelley A. Jones, Laura Davisson, Elizabeth Miller, Nicole Kahn, Pamela J. Murray, Kacie M. Kidd

Journal of Appalachian Health

Introduction: Transgender and gender-diverse (TGD) individuals face barriers to accessing primary and gender-affirming care, especially in rural regions where a national shortage of medical providers with skills in caring for TGD people is further magnified. This care may also be impacted by individual providers’ strongly held personal or faith beliefs and associated conscientious objection to care.

Purpose: This study assesses the prevalence of conscientious objection to providing care and gender-affirming hormone (GAH) therapy to TGD individuals among physicians in an Appalachian academic medical center.

Methods: An anonymous, online, cross-sectional survey of physicians was distributed to resident and faculty physicians in …

Creating An Interactive Guide To Support Health Disparities Competency, Lauren E. Robinson, Stephanie Henderson, Cayla M. Robinson, Rebecca J. Morgan, Beth Reeder

2024 R&I Day

Authors share their educational resource developed for the health sciences, that guides users in awareness of health disparities, vulnerable populations, and social determinants of health, directing them to specific guidance and resources available through the library.

Disparities In Mortality Between Appalachian And Non-Appalachian Regions Of Kentucky, Sonali S. Salunkhe, Sahal Alzahrani, Beatrice Ugiliweneza

Journal of Appalachian Health

Introduction: In the opioid epidemic, the U.S. faces a significant public health crisis, with some areas of the country, such as rural and Appalachian regions, suffering more than others. The differential regional impact of the crisis in Kentucky—a state with both non-metropolitan/metropolitan and Appalachian/Non-Appalachian statuses—has not yet been documented despite such knowledge being essential to the success of overdose prevention efforts.

Purpose: This study compares all-cause, drug- and opioid-related mortality between counties in different regions of Kentucky: Appalachian non-metropolitan, Appalachian metropolitan, non-Appalachian non-metropolitan, and non-Appalachian metropolitan.

Methods: Age-adjusted mortality data from the Centers for Disease Control and Prevention’s Wide-ranging Online …

Review Of: Appalachian Health: Culture, Challenges, And Capacity, Danielle M. Davidov

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. This is a review of the text Appalachian Health: Culture, Challenges, and Capacity. This book is an ideal starting point for anyone interested in Appalachian history, public health, and health disparities research.

Prevalence And Correlates Of Invitation To Participate In Clinical Trials Among Us Adults, Aurora Occa, Allison Leip, Allison S. Merritt, Jerod L. Stapleton

Communication Faculty Publications

Clinical trials are essential to modern medicine, but several barriers, including poor communication, hamper their successful completion. We examined the prevalence and correlates of invitation to participate in clinical trials among a nationally-representative sample of US adults using survey responses from the 2020 HINTS (Cycle 5). Analyses were conducted in 2021.

Overall, 9% of respondents reported being invited to a clinical trial, a prevalence that is nearly half of previously reported rates in convenience samples recruited from health care settings. Compared to non-Hispanic Whites, Black respondents reported the higher prevalence of invitation (16.0%) whereas Asian respondents reported the lowest (2%). …

Social And Biological Determinants Of Pregnancy-Related Mortality And Morbidity In A Rural, Underserved Population, Anna Hansen

Theses and Dissertations--Sociology

Cases of severe maternal morbidity (SMM) and pregnancy-related mortality (PRM) are increasing in the US. Research concerning SMM and PRM has neglected women in Central Appalachia; a largely rural, health-disparate population. The aims of this study are two-fold: (1) Examine patient-level and place-based predictors of SMM/PRM via hierarchical logistic regression modeling, and (2) Elucidate Appalachian healthcare patients’ and providers’ experiences with SMM/PRM, perceptions of contributing factors, and insights on points of intervention.

This study uses a mixed methods approach guided by the WHO’s conceptual framework for action on social determinants of health to identify determinants of SMM and PRM among …

Access To Health Care In Appalachia: Perception And Reality, Michele Morrone, Cory E. Cronin, Kristin Schuller, Shannon E. Nicks

Journal of Appalachian Health

Introduction: Health disparities such as cancer and diabetes are well documented in Appalachia. These disparities contribute to health status, and by many indicators, Appalachian people are less healthy than those who live in other parts of the country. Access to health care is one factor that contributes to health disparities. Access to care is complex and involves both intrinsic and extrinsic aspects, including satisfaction with quality of care. This research sought to compare Appalachian to non-Appalachian communities in terms of perceptions of access to care.

Methods: We implemented a statewide survey to quantify perceptions of multiple components of …

The Importance Of Time, Place, And Person: Applying Elementary Epidemiology To Covid-19 Outcomes In Rural Appalachia, Linda Alexander, F. Douglas Scutchfield Md

Journal of Appalachian Health

Since the 1800s this traditional triad of descriptive epidemiology has allowed for effective interventions to deal with epidemics. A focus on time, place, and person also provides a critical framework for interventions in controlling the epidemic by focusing on those populations with the highest risk for disease.

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.

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.

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.

Racial And Ethnic Disparities In Covid-19: Evidence From Six Large Cities, Joseph Benitez, Charles J. Courtemanche, Aaron Yelowitz

Institute for the Study of Free Enterprise Working Papers

As of June 2020, the coronavirus pandemic has led to more than 2.3 million confirmed infections and 121 thousand fatalities in the United States, with starkly different incidence by race and ethnicity. Our study examines racial and ethnic disparities in confirmed COVID-19 cases across six diverse cities – Atlanta, Baltimore, Chicago, New York City, San Diego, and St. Louis – at the ZIP code level (covering 436 “neighborhoods” with a population of 17.7 million). Our analysis links these outcomes to six separate data sources to control for demographics; housing; socioeconomic status; occupation; transportation modes; health care access; long-run opportunity, as …

Appalachian Research Day: Come Sit On The Porch [2019], Frances J. Feltner, Melissa Slone, Beth Bowling

Center of Excellence in Rural Health Presentations

Rural Appalachian communities in eastern Kentucky suffer from some of the Nation’s most concerning health disparities. Community-based research can be an effective way to address health disparities by identifying problems and sharing workable solutions. However, challenges exist in recruiting and retaining research participants in rural populations that can often be difficult to reach. Partnerships between researchers and communities are essential to the success of the research process, particularly translation of findings back into the community.

Disparities In Quality Of Life By Appalachian-Designation Among Women With Breast Cancer, Robin C. Vanderpool, Ann L. Coker, Heather M. Bush, Sarah E. Cprek

Journal of Appalachian Health

Introduction: Few studies have examined the association of geography and quality of life (QOL) among breast cancer patients, particularly differences between Appalachian and non-Appalachian Kentucky women, which is important given the cancer and socioeconomic disparities present in Appalachia.

Purpose: The purpose of this study was to determine whether women with breast cancer residing in Appalachian Kentucky experience poorer health outcomes in regards to depression, stress, QOL, and spiritual wellbeing, relative to those living in non-Appalachian Kentucky after adjusting for demographic, socioeconomic, and health-related factors.

Methods: Women, aged 18–79, recruited from the Kentucky Cancer Registry between 2009 and 2013 with an …

Modeling Geographic Factors And Assessing Their Accuracy In Identifying Health Disparities In Fayette County, Ian Jones

Lewis Honors College Capstone Collection

The purpose of this capstone is to conduct a review of existing literature to determine the effects of a variety of geographic variables on health and wellness. The student will use their findings to create a visual aid to displaying these geographic factors and their distributions within Fayette County. Furthermore, the student will analyze the intersection of these variables to predict potential pockets of discrepancy within Fayette County. Based on this analysis, the student will propose possible interventions with a basis in current literature. This project will provide the student with the opportunity to conduct a study of existing literature, …

Missed Work Due To Occupational Illness Among Hispanic Horse Workers, Ashley M. Bush, Susan C. Westneat, Steven R. Browning, Jennifer Swanberg

Kentucky Injury Prevention and Research Center Faculty Publications

Occupational illnesses are inadequately reported for agriculture, an industry dominated by a vulnerable Hispanic population and high fatal and nonfatal injury rates. Work-related illnesses can contribute to missed work, caused by a combination of personal and work factors, with costs to the individual, employer, and society. To better understand agricultural occupational illnesses, 225 Hispanic horse workers were interviewed via community-based convenience sampling. Descriptive statistics, bivariate analyses, and log binomial regression modeling were used to: (1) describe the prevalence of missed work due to work-related illnesses among Hispanic horse workers, (2) examine work-related and personal factors associated with missed work, and …

Community Leadership Institute Of Kentucky, Beth Bowling, Frances J. Feltner, Nancy E. Schoenberg, Ernie Scott, Gia Mudd-Martin

Center of Excellence in Rural Health Presentations

The Community Leadership Institute of Kentucky(CLIK) aims to improve community research capacity to address health disparities in communities, particularly Appalachia.

Established in 2014, through a partnership of the UK Center of Excellence in Rural Health, the UK Center for Clinical and Translational Science Community Engagement Program, and the Kentucky Office of Rural Health, the intensive four-week training provides:

• Training in research and leadership
• Funding for community research projects
• Technical support for up to one year as participants implement community research projects

Up to 12 slots are available annually, with priority given to leaders from Appalachian Kentucky and to projects related …

An Interactive, Mobile-Based Tool For Personal Social Network Data Collection And Visualization Among A Geographically Isolated And Socioeconomically Disadvantaged Population: Early-Stage Feasibility Study With Qualitative User Feedback, Katherine S. Eddens, Jesse M. Fagan, Tom Collins

Health, Behavior & Society Faculty Publications

Background: Personal social networks have a profound impact on our health, yet collecting personal network data for use in health communication, behavior change, or translation and dissemination interventions has proved challenging. Recent advances in social network data collection software have reduced the burden of network studies on researchers and respondents alike, yet little testing has occurred to discover whether these methods are: (1) acceptable to a variety of target populations, including those who may have limited experience with technology or limited literacy; and (2) practical in the field, specifically in areas that are geographically and technologically disconnected, such as rural …

Defining And Targeting Health Disparities In Chronic Obstructive Pulmonary Disease, Roy A. Pleasants, Isaretta L. Riley, David M. Mannino

Preventive Medicine and Environmental Health Faculty Publications

The global burden of chronic obstructive pulmonary disease (COPD) continues to grow in part due to better outcomes in other major diseases and in part because a substantial portion of the worldwide population continues to be exposed to inhalant toxins. However, a disproportionate burden of COPD occurs in people of low socioeconomic status (SES) due to differences in health behaviors, sociopolitical factors, and social and structural environmental exposures. Tobacco use, occupations with exposure to inhalant toxins, and indoor biomass fuel (BF) exposure are more common in low SES populations. Not only does SES affect the risk of developing COPD and …

Appalachian Research Day: Come Sit On The Porch [2016], Frances J. Feltner, Beth Bowling, Wayne Noble

Center of Excellence in Rural Health Presentations

Rural Appalachian communities in eastern Kentucky suffer from some of the Nation’s most concerning health disparities. Community-based research can be an effective way to address health disparities by identifying problems and sharing innovative solutions. However, challenges exist in recruiting and retaining research participants in rural populations that can often be difficult to reach. Partnerships between researchers and communities are essential to the success of the research process, particularly translation of findings back into the community.

Geographic Health Disparities In Kentucky: Starting A Conversation About Local Solutions, Steven H. Woolf, Derek A. Chapman, F. Douglas Scutchfield Md

Frontiers in Public Health Services and Systems Research

A recently released map of Kentucky demonstrates how life expectancy varies across the state’s 120 counties. The map vividly shows a decline in life expectancy as one travels east from the “Golden Triangle” in central urban Kentucky to the mountains of Appalachia. The lowest life expectancies are largely in the far southeastern portion of the state, where residents of the Central Highlands have confronted adverse social determinants of health for generations. Indeed, companion maps released by the Center on Society and Health, which plot median household income, poverty, and educational attainment at the census tract level, show the stark socioeconomic …

Hispanic Agricultural Workers: The Nexus Of Demographics, Employment Characteristics, And Health, Ashley Michelle Bush

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

Agriculture, which is home to elevated occupational injury and illness rates, has a substantial demographic makeup of Hispanic workers. Hispanic farmworkers are at increased risk of poor occupational health outcomes due to the precarious nature of work and other socio-ecological influences. These adverse occupational health outcome counts are inadequate and undercounted, failing to capture the true scope of agricultural work. To gain more knowledge about agriculture, this capstone will focus on the personal and work characteristics of agricultural workers to help further understand disparities within the agricultural sector by: providing a literature review of agricultural worker health; examining missed work …

Appalachian Research Day: Come Sit On The Porch, Frances J. Feltner, Beth Bowling, Wayne Noble

Center of Excellence in Rural Health Presentations

Rural Appalachian communities in eastern Kentucky suffer from some of the Nation’s most concerning health disparities. Community-based research can be an effective way to address health disparities by identifying problems and sharing innovative solutions. However, challenges exist in recruiting and retaining research participants in rural populations that can often be difficult to reach. Partnerships between researchers and communities are essential to the success of the research process, particularly translation of findings back into the community

Fatalistic Beliefs And Completion Of The Hpv Vaccination Series Among A Sample Of Young Appalachian Kentucky Women, Robin C. Vanderpool, Emily Van Meter Dressler, Lindsay R. Stradtman, Richard A. Crosby

Health, Behavior & Society Faculty Publications

PURPOSE: Uptake and completion of the 3-dose human papillomavirus (HPV) vaccine is important for the primary prevention of cervical cancer. However, HPV vaccination rates among adolescent females and young women remain low in certain geographic areas of the United States, including Appalachia. Although greater fatalistic beliefs have been previously associated with lower rates of preventive cancer behaviors among adults, little research exists on the impact of fatalism on HPV vaccination behaviors, especially among younger individuals. Therefore, the purpose of this study was to examine the association between fatalistic beliefs and completion of the full HPV vaccine series among young women, …

The Influence Of Race And Socioeconomic Status On Routine Screening Practices Of Physician Assistants, Deshana Ann Collett

Theses and Dissertations--Educational Policy Studies and Evaluation

Health disparities in minorities and those of low socioeconomic status persist despite efforts to eliminate potential causes. Differences in the delivery of services can result in different healthcare outcomes and therefore, a health disparity. Some of this difference in care may attribute to discrimination resulting from clinical biases and stereotyping which may provide a possible source for the persistence of health disparities. Health disparities may occur because the delivery of services at some level is inadequate. Disparities resulting from the quality and quantity of care delivered by a practitioner result in differentiated delivery of healthcare, thus unequal health outcomes. The …

Predictors Of Clinician Tobacco Intervention Counseling In Six North Carolina Free Clinics, Joe G. Spangler, Eun-Young Song, Jessica Richardson Pockey, Erin L. Sutfin, Donald W. Helme, Cindy Jones, Kristie L. Foley

Communication Faculty Publications

While the poor and the uninsured are at increased risk for tobacco use, up to two thirds of these patients express interest in near-term quitting. Nonetheless, tobacco counseling rates remain low in clinics serving these patients. As part of a larger tobacco intervention project in North Carolina free clinics, we gathered baseline data on patient characteristics in six randomly selected facilities affiliated with the North Carolina Association of Free Clinics. An exit interview was completed by 231 patients; 126 (54%) were tobacco users. Among all patients, 71% had been asked by a clinician about tobacco use in the past 3 …

Decision-Making Processes And Health Behaviors Among Adults Diagnosed With Schizophrenia, Lillian J. Findlay

Theses and Dissertations--Nursing

Individuals diagnosed with schizophrenia commonly experience problems with accurately assessing their health status due to cognitive deficits including impaired working memory, amotivation, and communication difficulties. Little is known about whether these deficiencies influence health behavior decision-making among individuals with schizophrenia. Individuals with schizophrenia die an average of 25 years earlier than those without a mental illness. Approximately 60% of premature deaths in this population are from medical comorbidities; mortality rates due to cardiovascular and pulmonary diseases are two to three times higher than the general population. In order to reduce morbidity and mortality, it is important to find effective ways …

Racial/Ethnic Disparities In Survival Among Men Diagnosed With Prostate Cancer In Texas, Arica L. White, Ann L. Coker, Xianglin L. Du, Katherine S. Eggleston, Melanie Williams

CRVAW Faculty Journal Articles

BACKGROUND:

To the authors' knowledge, few studies to date have examined racial differences in prostate cancer survival while controlling for socioeconomic status (SES). No such studies have examined this association in Texas, a large state with significant ethnic and racial diversity. The objective of this analysis was to determine whether racial disparities in survival for men diagnosed with prostate cancer in Texas from 1995 through 2002 remained after adjusting for SES, rural residence, and stage of disease.

METHODS:

A cohort of 87,449 men who were diagnosed with prostate cancer was identified from the Texas Cancer Registry. The SES measure was …