Public Health Commons^™

Evidence-Based Best Practices For Diabetes Education And Self-Care In Appalachia: A Literature Review, Angela J. Occidental, Inga M. Zadvinskis, Jacqueline Hoying

Journal of Appalachian Health

Introduction: The Appalachian Region has a higher prevalence of type 2 diabetes mellitus (T2DM) and associated adverse health outcomes. Although numerous papers report best practices for diabetes care and education, a clinician-friendly, synthesized summary of best practices tailored to Appalachian cultural preferences is lacking.

Purpose: This paper uses the Melnyk & Fineout-Overholt evidence-based framework to identify the best practices for T2DM care and education for Appalachian residents.

Methods: A comprehensive literature search using the databases CINAHL, Academic Search Complete, and PubMed was guided by a PICOT question. Quality appraisals were completed for fifty-two articles; thirty papers were selected to synthesize …

The Status Of Children’S Dental Health In Rural Appalachian West Virginia, R. Constance Wiener, Gina Graziani

Journal of Appalachian Health

Introduction: Non-metro/rural Appalachian West Virginia (WV) residents have been stigmatized for poor oral health (OH), despite many advances.

Purpose: The aims of this study were to examine current OH in children in WV, as compared to children in the greater United States (U.S.), and secondarily in subgroup non-metro/rural comparisons.

Methods: This observational study involved the U.S. National Survey of Children’s Health 2022–2023 data from parents/guardians who were asked about their child’s previous 12-month OH. Rao-Scott Chi-square and logistic regression analyses were used.

Results: Nationally, the mean age was 9.7 years; for WV children, it was 9.9 years. Nationally, 12.4% of …

Identifying Barriers And Place-Based Solutions To Physical Activity For Older Adults In East Tennessee, Lydia Hoskins, Jodi Southerland

Journal of Appalachian Health

Introduction: Older adults in East Tennessee (TN), the fastest growing demographic, face significant health challenges, with 44% reporting four or more chronic conditions. The state ranks 45th in physical inactivity among older adults, exacerbating chronic disease risks, fall-related injuries, and mental health issues. Urban-rural disparities in East TN further complicate efforts to promote active living, particularly for rural residents.

Purpose: This qualitative study explored socioecological barriers and solutions to increase physical activity (PA).

Methods: In April 2024, two focus group were conducted in East TN, with a total of 11 participants composed of six community partners and five older adults. …

Person-Centered Trauma-Informed Care (Pctic): A Training Needs Assessment For Home And Community-Based Services In West Virginia, Ranjita Misra, A. Brianna Sheppard, Natalie Wilson, Megan C. Govindan, Matthew Myers, Amanda Acord-Vira, Steven Wheeler, Heather Henderson, Christena Ross, Laura Cooper, Rachel A. Goff

Journal of Appalachian Health

Introduction: Person-centered, trauma-informed care (PCTIC) is a combined, holistic service model promoting the well-being and empowerment of trauma survivors.

Purpose: This study examined the PCTIC knowledge, skills, and abilities needed by West Virginia (WV) Medicaid Home and Community-Based Services (HCBS) direct service professionals (DSPs) to serve clients that may have experienced trauma.

Methods: Semi-structured interviews were conducted with diverse stakeholders (n = 32) from 19 organizations that provide HCBS services in all 55 counties. Interviews focused on identifying current training, needs and knowledge gaps, and priority areas for additional PCTIC training. ATLAS.ti software was used to manage and code. Validity …

Radon Environmental Health Literacy Among Health Council Participants In Northeast Tennessee, Kawther Al Ksir, Stacy Stanifer, Hadii M. Mamudu, Megan Quinn, Deborah L. Slawson

Journal of Appalachian Health

Introduction: Radon, a radioactive gas, poses significant health risks, including lung cancer, and is prevalent in indoor environments. Understanding radon testing behavior and Environmental Health Literacy (EHL) is crucial for individuals to take appropriate preventive measures.

Purpose: This study assessed radon-related EHL among Health Council participants in seven Northeast Tennessee (NETN) counties and examined associations between sociodemographic factors and EHL levels. Understanding radon knowledge and behaviors within this influential group is critical, as they often serve as trusted public health advocates.

Methods: A cross-sectional survey was conducted from September – November 2023 among Health Council participants across seven counties in …

Prevalence Of Screening Patients For Alcohol Use In West Virginia: A Cross-Sectional Observational Study, Bayan Abuhalimeh, Christopher Waters, R. Constance Wiener

Journal of Appalachian Health

Introduction: Consequences of alcohol consumption are well-established and compounded by physiological changes of aging (increased sensitivity; medication interactions; etc.). Alcohol screening for all ages is recommended, especially as most Americans believe moderate drinking is acceptable. Screening is important in high alcohol use regions, such as rural areas where isolation is more likely, especially for older adults. The Appalachian Region has a significant rural population of older adults. West Virginia (WV) is representative of Appalachia. It is a rural state, has many older adults, and all counties are Appalachian.

Purpose: The purpose of this cross-sectional study is to determine the likelihood …

Finding Community: A Thematic Analysis Of Resilience During The Pandemic, Myles Kwitny, Quinn Richards, Grace Digirolamo, Shannon Freedman, Sophie Wenzel

Journal of Appalachian Health

Introduction: The Covid-19 pandemic impacted those within rural Appalachian communities, particularly people with marginalized identities.

Purpose: Through interviewing 44 participants from New River Valley, an Appalachian community in Virginia, this study sought to understand how resilience impacted individuals' experiences during the pandemic.

Methods: Participants belonged to one of the following groups: African American, Hispanic, older adults, or people who use drugs. Participants were required to reside in the New River Valley and be older than 18. Each participant was interviewed either in person, by phone, or over video call. Interviews were recorded, transcribed, then thematically analyzed for themes of resilience. …

Addressing The Root Causes Of Population Health In Central Appalachian Virginia, David L. Driscoll, Kol Gold

Journal of Appalachian Health

Introduction: The Southwest Virginia Health Authority (SWVHA) recently commissioned a community health needs assessment (CHNA) to reduce the high rate of preventable health problems in Virginia’s (VA) Appalachian Region. The CHNA took place over a two-year period from 2023 – 2025.

Purpose: This iterative, mixed-method CHNA informed the development of a new iteration of the regional Blueprint for Health Improvement and Health-Enabled Prosperity identifying and prioritizing health issues and develop strategic planning to address them in VA’s three westernmost regional health districts.

Methods: The CHNA followed a sequential mixed methods design to assess the regional health status, the contextual factors …

Align Appalachia’S Opioid-Settlement Spending With Evidence And Emerging Threats, Bradley Firchow

Journal of Appalachian Health

State and local governments across Appalachia are allocating opioid-settlement dollars over the coming years. This funding opportunity can support lasting public health infrastructure or be spent on short-term programs anchored in the opioid crisis of the past. Evidence indicates that emerging synthetic drugs such as nitazenes and xylazine are altering overdose risk patterns in ways that require urgent policy attention.

Impact Wv: Adapting Patient Navigation Models Of Care To Improve Services To Caregivers Of Infants Exposed To Substances In Utero, Charlotte S. Workman Bsms, Ccrp, Lesley Cottrell, Mawyah Bashatah, Aisha Hashmi, Kayla Richard, Poornima Murthy, Susan Harrison, Ashleigh Mckinsey, Amy Bott, Sydney Leary, Cody Smith, Melina Danko

Journal of Appalachian Health

Patient navigation (PN) is a healthcare service delivery model designed to partner clients with service providers to reduce challenges to health care, as well as to improve access to care by identifying opportunities to coordinate services for clients. The IMPACT WV project at the West Virginia University Center for Excellence in Disabilities (WVU CED) implemented PN models of care for caregivers of infants exposed to substances in utero. The purpose of this program was to reduce burden for potentially at-risk families and improve caregiver and infant outcomes as a result. To understand the processes that influence the implementation of PN …

Drive Time Analysis Of New Gynecologic Oncology Patients At West Virginia University, Kassandra Whitfield, Ariel Cohen, Krista Pfaendler, Kristy Ward

Journal of Appalachian Health

Introduction: West Virginia is a rural mountain state; access to medical care, especially specialty care, can be difficult for patients.

Purpose: The purpose of this study is to analyze the geographic status and transportation times of new gynecologic oncology patients.

Methods: Home zip codes for new patient gynecologic oncology patients were analyzed for drive times to the cancer center. Zip codes of oncology providers in the state were compared to the location of patients.

Results: A total of 1,097 new gynecologic oncology patients lived within a 240-minute drive of MBRCC; nearly half (48.9%) of them drove greater than 60 minutes. …

Patient-Clinician Communication In The Appalachian Region: A Scoping Review, Kawther Al Ksir, Hadii M. Mamudu, Chidiebube J. Ugwu, Emily K. Flores, Tracy Fasolino, Holly Wei, Rick L. Wallace, Florence M. Weierbach

Journal of Appalachian Health

Introduction: Effective communication between patients and clinicians is a critical component of quality health care, influencing disease prevention, management, and outcomes. In regions with unique socioeconomic and geographic challenges, communication barriers can further exacerbate health disparities. Understanding the factors that facilitate or hinder patient-clinician communication is essential for developing targeted interventions that improve health care delivery.

Purpose: This review explores the existing literature on patient-clinician communication concerning cardiovascular disease (CVD) in the Appalachian Region with the aim to understand existing gaps and interventions.

Methods: PubMed and Web of Science databases were utilized to conduct a systematic search. The Population, Concept, …

Using Photovoice To Define The Experiences, Needs, Strengths, And Priorities Of Gay Men In South Central Appalachia, Ana D. Sucaldito, Lilli Mann-Jackson, Jorge Alonzo, John W. Chaffin, Scott D. Rhodes

Journal of Appalachian Health

Introduction: Gay, bisexual, queer, and other men who have sex with men and transgender and nonbinary persons living in rural Appalachia experience profound health disparities. Limited research, however, has focused on the needs, strengths, and priorities of these communities.

Purpose: This study sought to better understand the lived experiences of the vulnerable, underrepresented, and underserved Appalachian gay male community by working with a small group of self-identified gay Appalachian men.

Methods: As part of a larger community-based participatory research study (the Appalachian Access Project), four self-identified gay men participated in a photovoice project. Participants took photos based on …

Determinants Of Willingness To Share Wearable Health Data With Health Care Providers In Appalachian Populations: An Exploratory Study, Gilbert Munoz Cornejo, Joonghee Lee

Journal of Appalachian Health

Background: Wearable health devices capture metrics (e.g., physical activity, ECG, sleep) that can enhance care when shared with providers. Yet, willingness to share wearable data may differ in Appalachia, where chronic disease burdens, mistrust, and limited infrastructure pose unique challenges.

Objective: This study explored (1) which sociodemographic, health, and digital behaviors correlate with willingness to share wearable data and (2) how these insights can guide region-specific interventions in Appalachia.

Methods: We analyzed 320 Appalachian respondents from the Health Information National Trends Survey (HINTS 6). Descriptive statistics and logistic regression models examined willingness to share wearable data. Because of small cell …

Heartache In The Heartland: Unraveling The Social Roots Of Deaths Of Despair In Kentucky, Lyndsey K. Blair, Madeline M. Tomlinson, Michele Abee-Biskis, Jessica Hume, Gabri Warren

Journal of Appalachian Health

Introduction: Deaths of despair (DoD), encompassing suicides, drug overdoses, and alcohol-related liver diseases, have emerged as a critical public health crisis in the United States, with their rise particularly pronounced from 1995 to 2013 and exacerbated by the COVID-19 pandemic. Kentucky, grappling with high rates of substance use disorder, poor mental health, and economic hardship, is at the forefront of this issue, particularly in its rural and Appalachian regions.

Purpose: This study explores the social determinants contributing to DoD in Kentucky, focusing on economic and social factors that influence rising rates of suicide, drug overdose, and alcohol-related liver disease. The …

Finding Freedom In Appalachia: Evaluating A Mental Health Intervention In West Virginia, Elizabeth A. Claydon, Karen Haring, Jessica Haring, Kelsey Riggi, Beth Currence

Journal of Appalachian Health

Introduction: Rural areas have limited capacity to provide comprehensive mental health treatment and resources. This creates the need for interventions to ensure individuals with mental health concerns have access to resources to improve their mental health.

Purpose: The purpose of this mixed-methods evaluation was to assess the effectiveness and impact of Libera, a mental health program tailored for girls and women within the Appalachian region.

Methods: Quantitative surveys, including validated measures for depression, anxiety, and eating disorder symptoms, and life satisfaction, were collected pre- and post-Libera intervention for participants. Simultaneously, annual surveys were sent to Listeners in addition to qualitative …

Time And Location: Physical Activity Trends In Parents And Children In A Rural Region During Covid-19, Brooke C. Towner, Robert Broce, Rebecca A. Battista

Journal of Appalachian Health

Introduction: COVID-19 restrictions altered the structure of the school and workday for families with children and led to changes in active transportation. Continued restrictions impacted access to many community locations and led to changes in physical activity (PA) behavior.

Purpose: The objectives of the study were to describe the changes in the 1) amount of PA time per day, 2) frequency of PA, and 3) sitting time. Information about how PA changed for parents and children during the COVID-19 pandemic will have potential implications for education, public health, and recreation management.

Methods: This cross-sectional study enlisted participants via an online …

Children Living With Type 1 Diabetes In The Public School System, Madison M. Wilson

Kentucky Undergraduate Journal for the Health Humanities

Type 1 Diabetes is a worldwide chronic condition that typically develops during adolescence and requires life-long treatment and management. Management of this disease is extremely complicated for a child to manage on their own and requires a community of individuals to help them. With children spending most of their days at school, the school’s teachers and staff are vital to the care and management of their condition while attending public school. Children with Type 1 Diabetes in public school systems face many disparities and a reform is needed. Looking at this population through a holistic health science lens can help …

Rural Access To Certified Community Behavioral Health Clinics (Ccbhcs), Aaron P. Smith, Jeffrey Talbert

Rural & Underserved Health Research Center Publications

Overview of Key Findings

▪ The number of Certified Community Behavioral Health Clinics (CCBHCs) expanded from 2022 to 2023, increasing from 371 to 480. Most of the growth was driven by rural counties (57.9% increase, 126 to 199) while urban counties increased by 14.7% (245 to 281).

▪ The number of services offered at CCBHCs is similar in both rural and urban localities, but urban CCBHCs were more likely to offer services that cater to a diverse client base, such as speaking different languages, and nicotine cessation programs. Rural CCBHCs were more likely to have programs for minors, veterans, and …

Sociodemographic Factors Associated With Prenatal Care Utilization In Arkansas, United States., Pearl A Mcelfish, Aaron Caldwell, Donya Watson, Jonathan Langner, Jennifer Callaghan-Koru, Austin Porter, Don E Willis, Jennifer A Andersen, Nicola L Hawley, James P Selig, Amir Forati, Maria R Alcala, Lanita White, Enrique Gomez-Pomar, Clare C Brown

Pediatrics Faculty Publications

OBJECTIVES: This study examines prenatal care utilization differences in Arkansas.

METHODS: Birth records data from the National Center for Health Statistics were used. The study population consisted of singleton live births in Arkansas from 2014 to 2022. Primary outcomes included number of prenatal visits, fewer than the recommended number of prenatal visits, late prenatal care, and no prenatal care. Summary statistics were computed, and adjusted rates ratios were calculated adjusting for maternal age, maternal education, and parity for payer, race/ethnicity, and rural/urban residence.

RESULTS: Mothers with a Medicaid-covered birth had 0.90 times fewer prenatal care visits and were 1.26 times …

Evaluating Maternal Drug Use Disparities, Risk Factors And Outcomes In Northeast Arkansas: A Pre, During, And Post-Covid-19 Pandemic Analysis., Enrique Gomez Pomar, Johnna Berryhill, Sudeepa Bhattacharyya

Pediatrics Faculty Publications

INTRODUCTION: The use of addictive substances remains a major health problem in the U.S. An increase in drug overdose and mortality was observed during the COVID-19 pandemic, especially in underserved populations. This surge also impacted pregnant women especially with the use of marijuana (THC) and opioids.

METHODS: Retrospective study analyzing mother-infant dyads with reported Meconium Drug Screen (MDS) results, from January 2018 through April 2023 at a reference hospital serving an urban and rural area of Arkansas. Due to the absence of universal screening, the prevalence of drug use was variable during the study period. An adjusted monthly positive rate …

Gestational Weight Gain And Increased Risk Of Cesarean Delivery Across Body Mass Index Categories., Pearl A Mcelfish, Britni L Ayers, Nicola L Hawley, Aaron Caldwell, Austin Porter, Michael D Macechko, Donya Watson, Jennifer A Callaghan-Koru, James P Selig, Jennifer A Andersen, Nirvana Manning, Lanita White, Enrique Gomez-Pomar, Clare C Brown

Pediatrics Faculty Publications

BACKGROUND: Unnecessary cesarean delivery can have negative implications for both mothers and infants. In the United States, the proportion of women undergoing cesarean delivery exceeds the acceptable World Health Organization proportion. Reducing cesarean deliveries is a national goal of Centers for Disease Control and Prevention Healthy People 2030, the American College of Obstetricians and Gynecologists, and the Alliance for Innovation on Maternal Health.

OBJECTIVE: This study aimed to examine if excessive gestational weight gain is associated with increased risk of cesarean delivery across multiple body mass index categories.

STUDY DESIGN: Analysis was conducted using vital records data from the National …

Establishing A Student-Run Mobile Clinic In Appalachian Kentucky: A Community-Based Pilot Program To Address Health Inequities, Bradley A. Firchow, John C. Cornelius

Journal of Appalachian Health

The establishment of a student-run mobile clinic in Morehead, Kentucky, led by students from the University of Kentucky College of Medicine’s (UKCOM) Rural Physician Leadership Program (RPLP), aims to address health inequities in rural Appalachian communities. This pilot program is designed to serve vulnerable populations, including the unhoused, by delivering free, accessible healthcare services directly to underserved populations. This program serves as a model for expanding access to healthcare in rural regions while promoting a collaborative, community-based approach to addressing social determinants of health.

Impaired Driving Among Rural Appalachian Women In The Year Following Incarceration, J. Matthew Webster, Megan F. Dickson, Shawn M. Jamison, Michele Staton

Journal of Appalachian Health

Introduction: Despite the known risks associated with substance use following incarceration, no studies have examined substance-impaired driving as a post-incarceration health risk behavior in rural Appalachia.

Purpose: The present study examined differences by impaired driving following incarceration and identified predictors of impaired driving in sample of rural Appalachian women with a history of drug use and risky sex.

Methods: Women (N=340) from three rural Appalachian jails completed a baseline interview in jail and follow-up interviews at six and 12 months post-release. Interview questions included demographic characteristics and information on substance use risk, mental health, criminal legal system involvement, and impaired …

Investigating Suicide Risk Factors Among Appalachian West Virginian Adults, Erin D. Caswell, Angela M. Dyer, Summer D. Hartley, Caroline P. Groth, Mary Christensen, Sahiti K. Tulabandu, Bryce K. Weaver, Ruchi Bhandari

Journal of Appalachian Health

Introduction: Suicide rates in the United States have increased over the past two decades, with rural areas, particularly the Appalachian Region, facing unique challenges that elevate suicide risk. These include economic hardships, social isolation, and limited access to mental health services.

Purpose: This study addresses critical gaps in understanding lifetime suicide risk in West Virginia (WV), a predominantly rural state entirely within the Appalachian Region. By identifying the factors driving urban-rural differences in suicide risk, this research seeks to inform interventions tailored to the state's distinct needs and provide insights applicable to the broader Appalachian Region

Methods: Using 2021 Mountain …

Comparative Outcomes Following Randomization To A Pilot Facebook-Based Hiv Prevention Intervention Among Appalachian Women Involved In The Criminal Legal System, Megan F. Dickson, Erika Pike, Michele Staton

Journal of Appalachian Health

Introduction: Rural Appalachian women who use drugs and are involved in the criminal legal system are at increased risk for health consequences (such as HIV/Hepatitis C). Service barriers throughout rural communities have prompted a need to examine the effectiveness of novel intervention delivery methods (e.g., social media).

Purpose: This study aims to determine if enhancing an existing HIV prevention intervention with additional modules delivered via Facebook improves service access by examining short-term outcomes among Appalachian women returning to the community following jail release.

Methods: Between 2019 and 2022, consenting women from two rural Appalachian jails were randomly selected, screened, interviewed, …

Current Attitudes And Barriers Among Appalachian Patients Towards Orthopaedic Surgery, Dylan Smith Md, Justin B. West Ms, Wade Smith Md, Micah Macaskill Md, Jonathan Lash, Matthew W. Bullock Do, Mpt

Journal of Appalachian Health

Introduction: This study explores the challenges faced by residents of rural West Virginia in accessing orthopaedic care due to geographic and socioeconomic barriers.

Purpose: This study seeks to survey rural West Virginia residents about their attitudes and experiences regarding access to orthopaedic care in southern West Virginia.

Methods: A total of 132 electronic surveys were collected from rural West Virginia residents during an appointment with their primary care provider located at an affiliated outreach clinic. The survey was designed to investigate various factors influencing their access to orthopaedic care.

Results: Delays in seeking orthpaedic care are common in rural West …

Clinician Attitudes And Experiences In Screening Patients For Social Determinants Of Health Using Prapare, Pranav Rane, Mathew B. Weimer M.D., Adam Baus

Journal of Appalachian Health

Introduction: Social Determinants of Health (SDOH) are the conditions in which people are born, grow, live, work, and age. SDOH significantly influence health outcomes; as such, healthcare systems should screen for patients’ social needs. PRAPARE is standardized screening tool designed to assess and address patients’ social needs.

Purpose: This study examines SDOH screening at Valley Health Systems, a federally qualified health center based in Huntington, West Virginia. The aim of this research is to assess clinician attitudes and experiences in using the PRAPARE tool to screen for SDOH.

Methods: A self-administered online survey was conducted from April to May 2022 …

Rural Reflections Of Appalachia: A Qualitative Study Of Health Professional Students’ Experiences From A Rural Immersion Experience In West Virginia, Treah Haggerty Md Ms, Jessica Stidham Ma, Stephan Brooks Mph, Abigail Cowher Ba, Sandra Pope Msw, Patricia Dekeseredy Mscn Rn, Cara L. Sedney Md,Ma

Journal of Appalachian Health

Introduction: Conventional academic rotations lack in-depth exposure to rural community members, systems, and resources surrounding specific rural-focused health issues.

Purpose: This study aims to explore health professional students’ experiences within a community-based multidisciplinary rural immersion through their personal reflections.

Methods: Written reflective entries were extracted from the online classroom system from 2019–2021. Data analysis was guided by thematic analysis. An iterative process of qualitatively coding the interviews was conducted. Themes were reviewed and agreed upon by consensus and assessed for validity by two senior researchers.

Results: Sixty-two reflective essays were included from 11 unique professional programs. Resulting themes included (1) …

Powered Haulage Fatalities In Appalachian Coal Mines, Nirmala T. Myers, Noemi B. Hall, Nadia T. Saif, A. Scott Laney

Journal of Appalachian Health

The recent death of a 33-year-old mother of three at a Central Appalachian surface coal mine highlights the persistent dangers faced by miners, particularly from powered haulage incidents. As of December 2, 28 mining fatalities have occurred in the U.S. in 2024, with four in Appalachian coal mines attributed to powered haulage. These deaths underscore the urgent need to address this cause of fatalities in the mining industry and to provide a safe workplace to protect all miners.