Community Health and Preventive Medicine Commons^™

Impacts Of The Covid-19 Pandemic On Intimate Partner Violence And Child Maltreatment Services In Rural Northwest North Carolina, Elisabeth G. Galphin, Adam Hege, Amy Dellinger Page

Journal of Appalachian Health

The current study examined the impact of the COVID-19 pandemic on IPV and child maltreatment services in rural northwestern North Carolina. Qualitative interviews were conducted with eight professionals representing six service organizations across four counties. The findings highlighted challenges these agencies faced throughout the pandemic, new risks for the clients served, and positive outcomes. In addition, it has been a useful learning experience as public health and social service agencies learn to serve their communities more effectively moving forward. This is especially relevant for rural communities, as it has put public health preparedness at the forefront.

The Impact Of Primary Care Physician Capacity On Preventable Hospitalizations: Identifying Bright Spots In The Appalachian & Mississippi Delta Regions, Michael Topmiller, Peter J. Mallow, Hoon Byun, Mark Carrozza, Yalda Jabbarpour

Journal of Appalachian Health

Introduction: Several studies have documented that higher rates of primary care physicians are associated with lower rates of preventable hospitalizations. Counties with higher rates of preventable hospitalizations are found in the Appalachian and Mississippi (MS) Delta Regions.

Purpose: (1) To determine if the association of primary care capacity with preventable hospitalizations is different in the Appalachian and MS Delta regions compared to the rest of the U.S., and (2) to explore primary care capacity in counties with lower-than-expected preventable hospitalization rates.

Methods: This study modeled preventable hospitalizations with primary care physicians (PCP) per 100,000 (PCP capacity) while controlling for several …

Psychosocial Factors, Stress And Sleep Among Rural Appalachian Kentucky Residents With Type 2 Diabetes Mellitus, Blake Dipaola, Zoe Taylor, Eric Hennemann, Brittany L. Smalls, Philip M. Westgate, Nancy Schoenberg

Journal of Appalachian Health

Introduction: Rural Appalachian residents experience higher rates of most chronic diseases, including type 2 diabetes mellitus (T2DM). Stress and sleep deficiency also are common in the region.

Purpose: To better understand these associated health burdens, the relationship among these conditions and psychosocial factors—such as depressive symptoms, distress, empowerment, and social support—was examined among Appalachian residents with T2DM.

Methods: Using data collected from a community-based sample of Appalachian adults with T2DM, the study examined whether psychosocial factors were associated with perceived stress (Cohen Perceived Stress Scale) and self-reported sleep deficiency (Epworth Sleepiness Scale). Multilevel linear mixed effects regression modeling was used …

Nutrition Education Needs And Barriers Of Uninsured Clients Who Utilize Free Clinics In Western North Carolina, Manan Roy, Alisha Farris, Erin Loy, Lauren Sastre, Danielle L. Nunnery

Journal of Appalachian Health

Introduction: Many uninsured adults rely on free health clinics for prevention and treatment of chronic disease. Little is known about the nutrition education needs of adults served by free health clinics, especially those living in counties within the Western North Carolina Appalachian Mountain Region.

Methods: An in-person survey was distributed to 202 clients of two free health clinics in western North Carolina. Descriptive analyses were conducted to determine frequency distributions for food and physical activity practices, acceptable topics and strategies for nutrition education, and the acceptance and barriers for various modalities.

Results: Depending on the clinic, 49-58% of participants were …

Aftermath: A Word To Appalachia Following Hurricane Helene, Emily Wilson

Journal of Appalachian Health

On September 27, 2024, Hurricane Helene caused massive and catastrophic flash flooding in the lower Appalachian Region, leveling towns and forever altering much of the landscape. This is an open letter to the people of Appalachia who were affected by the disaster that blindsided our region.

Assessing The Feasibility Of Implementing A Hands-On Diabetes Course Curriculum In Community Settings, April Litchford, Jenna Dyckman, Carrie Durward

Transforming Communities

Diabetes remains a significant health concern in the United States, with millions affected and at risk. Despite the known benefits of diabetes education programs, barriers such as accessibility and engagement persist. To address these challenges, Utah State University Extension developed the Diabetes Cook Along (DCA) program and conducted a study to determine the feasibility of implementing these classes in community settings. The DCA curriculum is based on national standards and emphasizes changes in dietary and lifestyle components critical for diabetes management. Data collection included pre- and post-surveys, along with qualitative feedback. Overall participation in the classes and satisfaction of participants …

Changes In The Perceptions Of The Neighborhood Environment And Physical Activity Patterns Among Mexican Americans On The Texas-Mexico Border, Natalia I Heredia, Soo Kyung Park, Minjae Lee, Lisa Mitchell-Bennett, Paul Yeh, Rose Gowen, Arturo Rodriguez, Miryoung Lee, Belinda M Reininger

Faculty, Staff and Student Publications

INTRODUCTION: Little research on the association of neighborhood environment with physical activity in resource-poor communities has been done. This study assessed changes in perceptions of the neighborhood environment and the association between those perceptions and physical activity in Mexican Americans on the Texas-Mexico border in an area where there would be community efforts to enhance pedestrian and cycling infrastructure and programming.

METHODS: We analyzed data from a population-based cohort of Mexican American individuals on the Texas-Mexico border. From 2008 to 2018, interviewer-administered questionnaires were used to collect perceptions of neighborhood environment and physical activity at baseline, 5- and 10-year follow-ups, …

Recruitment And Retention Of Physician Assistants In Rural Medicine: A Novel Approach, Sean Grabbe

Theses and Graduate Projects

Improving the health of patients requires having access to well trained medical providers. This is one of the main goals of the physician assistant profession. For many years research has documented how to recruit and retain physician assistants in the rural areas of the United States. Although created to fill the gaps in primary care medicine physician assistants have moved as all of medicine has into specialization. This gap in primary care has not closed and is most significant in rural areas. This paper reviews the plethora of research and elaborates on the known and best methods for recruitment and …

Writing For The Journal: A Guide For Community-Based Organizations, Randy Wykoff, Rachel E. Dixon

Journal of Appalachian Health

The Journal of Appalachian Health welcomes submissions from a variety of stakeholders interested in and contributing to improvement of health across the Appalachian Region. This editorial provides basic guidelines for those working in community settings who may with to make JAH (or any other journal) their publication home.

Double Burden Of Persons With Disabilities: Are Those More Likely To Suffer From Chronic Disease?, Salsabila Kusumawardani, Hardiyani Puspitasari, Muhammad Ciro Danuza, Yusuf Faisal Martak

Masyarakat: Jurnal Sosiologi

This study examines the likelihood of persons with disabilities experiencing chronic diseases compared to those without disabilities, emphasizing the role of demographic characteristics. Prior research shows that individuals with disabilities have a higher risk of chronic diseases due to pre-existing health conditions, secondary complications, healthcare access barriers, and limited health education. Beyond these factors, we argue that demographic characteristics—such as age, gender, insurance status, and living environment—also shape daily habits and lifestyles that influence long-term health outcomes. Using probit regression analysis, this study quantifies the probability of chronic disease among persons with disabilities. Our findings indicate that individuals with disabilities …

Strengthening U.S. Jail Systems’ Response To Infectious Diseases: An Evaluation Of The Covid-19 Pandemic, Erinn Bacchus

Dissertations and Theses

Jails across the United States were struck with increased infections and deaths during the COVID-19 pandemic. Studies have shown the structural make up of jails, lack of preparedness plans, and overcrowding contributed to health risks and poor health outcomes both inside jails and local communities. Yet little research has been dedicated to strengthening jail responses to infectious disease outbreaks spanning prevention measures, data collection, and reentry planning. Gaps include information on the (1) myriad infectious disease mitigation strategies used in jails and adherence to CDC prevention guidelines, (2) development of a standardized epidemiologic surveillance system, and (3) experiences working at …

The Relationship Between Healthcare Access And Change In Health-Related Quality-Of-Life Among The General Population Of Five Countries During The Covid-19 Pandemic, Nadja Alexandrov, Emily Stella Scott, Mathieu F. Janssen, Erica I. Lubetkin, John N. Yfantopoulos, Gouke J. Bonsel, Juanita A. Haagsma

Publications and Research

Purpose To determine whether (1) healthcare access at onset of the pandemic and (2) age, gender, socioeconomic status (SES), and pre-existing health status were associated with change in health-related quality-of-life (HRQoL) during the COVID-19 pandemic. The study includes a general population sample of five countries.

Methods An online questionnaire was administered to respondents from Greece, Italy, the Netherlands, the UK, and the US at the onset of the COVID-19 pandemic between April 22nd and May 5th of 2020, and 1 year later between May 23rd and June 29th of 2021. The questionnaire included questions on demographic background, health status, and …

Trends In Fatal Opioid-Related Overdose In American Indian And Alaska Native Communities, 1999-2021, Cici Bauer, Ghada H Hassan, Ric Bayly, Jack Cordes, Dana Bernson, Cedric Woods, Xiaona Li, Wenjun Li, Leland K Ackerson, Marc R Larochelle, Thomas J Stopka

Faculty, Staff and Student Publications

INTRODUCTION: Opioid-related overdose mortality rates have increased sharply in the U.S. over the past two decades, and inequities across racial and ethnic groups have been documented. Opioid-related overdose trends among American Indian and Alaska Natives require further quantification and assessment.

METHODS: Observational, U.S. population-based registry data on opioid-related overdose mortality between 1999 and 2021 were extracted in 2023 using ICD-10 codes from the U.S. Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research multiple cause of death file by race, Hispanic ethnicity, sex, and age. Segmented time series analyses were conducted to estimate opioid-related overdose mortality growth …

Social/Emotional Health, Mental Health And Quality Of Life Among Adults With Comorbid Diabetes And Hypertension: A Population-Based Cross-Sectional Study, Ranjita Misra, Sara Nayeem

Journal of Appalachian Health

Introduction: West Virginia has a disproportionately large population of rural adults with diabetes and hypertension, two common chronic, comorbid conditions that represent a national economic, social, and public health burden. Anxiety, depression, and severe mental illness are associated with poor motivation to engage in coping/self-care behaviors and related increased morbidity/mortality.

Purpose: This study examines the relationship between self-reported mental health, selected social and emotional health factors, health-related quality of life (HRQoL), and clinical outcomes among adults with comorbid diabetes and hypertension.

Methods: This cross-sectional study consisted of 75 participants who participated in a diabetes and hypertension self-management program (DHSMP) in …

Community Needs Assessment Collaboration Following The July 2022 Flooding In Eastern Kentucky, Melissa Slone Dsw, Frances Feltner Dnp, William M. Baker Rn, Anthony S. Lockard Msw, Csw, Angela Raleigh Rd

Journal of Appalachian Health

Rapidly rising waters due to flash floods and thunderstorms on the night of July 27, 2022, resulted in hundreds of water rescues throughout 14 rural Appalachian Kentucky counties. Lives were lost, thousands were injured, homes and property were damaged or destroyed, and many roadways were unpassable. Community partners serving these counties collaborated to design and conduct an assessment to gain a better understanding of the needs of individuals residing in certain remote sections within the communities. The assessment, conducted three months after the flood, collected information regarding flooding impact on housing, physical and behavioral health, transportation, work, and finances.

Unveiling The Impact: Structural Racism And Childhood Lead Exposure's Health Consequences In Philadelphia, Mahhum Naqvi, Mahrukh Naqvi, Justin Stout, Colton Spencer

Rowan-Virtua Research Day

Childhood lead exposure poses a significant risk to health and well-being, adversely affecting brain function, nervous system development, and behavioral patterns. This study examines the health disparities and inequities associated with childhood lead exposure in Philadelphia, focusing on structural racism and residential segregation as crucial lenses for analysis. By delving into the sociocultural context of lead exposure, this study underscores the imperative of collaborative efforts among stakeholders to safeguard Philadelphia's most vulnerable populations. Healthcare professionals and policymakers play pivotal roles in enhancing funding and prevention strategies. Addressing this issue through the prism of structural racism allows for the identification and …

Sunscreen Cost And Its Effect On Skin Cancer In Low-Income Communities: A Systemic Review, John Sauer

Rowan-Virtua Research Day

This research examines the pivotal connection between sunscreen affordability and its impact on skin cancer prevalence, especially in low-income communities. Despite universal dermatological recommendations for daily sunscreen use, stringent criteria contribute to elevated prices, averaging around $10 for a 6 oz unit. This financial strain is compounded for families adhering to recommended application rates, leading to significant economic burdens. Outdoor laborers, less likely to follow guidelines, face heightened risks. Government programs' excluding sunscreen costs further exacerbate challenges for low-income communities, contributing to increased skin cancer incidence. This review aims to establish a correlation between sunscreen cost and skin cancer rates, …

Barriers To Healthcare Access Between English And Spanish Speakers In An Underserved Population, Adeena Javed, Dale Johnson, Gerardo J. Rivera-Colón, Nathaniel J. Byrnes, Kristin Bertsch, Anne C. Jones

Rowan-Virtua Research Day

• According to the NJ State Department of Health, Atlantic County has higher rates of smoking, respiratory disease, hypercholesterolemia, as well as death rates due to coronary heart disease, HIV, and all cancers compared to the NJ state average1,2.

• With over 20% of Atlantic County's population identifying as Hispanic, Spanish speakers encounter greater obstacles compared to their English-speaking counterparts in accessing healthcare services and improving health outcomes1,2 .

• Existing research indicates that various factors, including health insurance coverage, proximity to healthcare facilities, transportation options, health literacy levels, and trust in the medical profession, significantly influence access to healthcare …

Cut The Pressure: Blood Pressure Screening In A Community Based Setting, Harold Kareem Knight Jr., Katharine Milani

Rowan-Virtua Research Day

This study addresses the pressing issue of cardiovascular health disparities in African American males through community-based interventions, specifically blood pressure screenings and surveys conducted in a local barbershop setting. Despite a preference among participants for clinical settings, an overwhelming 97.7% expressed high comfort levels in the community-based environment, highlighting the importance of culturally sensitive approaches in healthcare delivery. With 92.5% indicating willingness to return for future screenings, the study underscores the efficacy of non-traditional settings in fostering healthcare engagement. Findings suggest the potential for broader impact through scalable, community-centric initiatives, offering promising avenues for improving health outcomes in underserved populations.

Maternal Age And Inadequate Prenatal Care In West Virginia: A Project Watch Study, Madelin Gardner, Amna Umer, Brian Hendricks, Toni Marie Rudisill, Candice Lefeber, Collin John, Christa Lilly

Journal of Appalachian Health

Introduction: Adequate prenatal care (PNC) is essential to the overall health of mother and infant. Teen age and advanced maternal age (AMA) are known risk factors for poor birth outcomes. However, less is known about whether these age groups are associated with inadequate PNC.

Purpose: This study sought to determine the potential association between maternal age (in groups, aged 20–24, 25–29, 30–34, 35–39, and >40) and inadequate PNC (visits).

Methods: West Virginia (WV) Project WATCH population-level data (May 2018–March 2022) were used for this study. Multiple logistic regressions were performed on inadequate PNC (less than 10 visits) with maternal age …

Trilogies: Lessons From 50 Years Facilitating Community-Based Health Assessments And Planning In Appalachia, Bruce Behringer

Journal of Appalachian Health

Involvement of community and organizational groups is fundamental to most public ventures. Most social, health, economic, and educational improvements in Appalachia have been characterized by successfully integrating community input and finding ways to encourage organizational change and collaboration.

Managing group process and related facilitation skills are fundamental competencies for public health professionals and others guiding change efforts. Groups from communities and organizations can get stalled in their deliberations; a facilitator frequently must think quickly to diagnose the situation and propose alternative approaches. Creative and flexible approaches, learned through practice experiences, can blend with theories and frameworks learned in academic preparation …

Treatment At An Academic Medical Center Eliminates Survival Disparities For Appalachian Kentuckians With Pancreatic Ductal Adenocarcinoma, Emily Cassim, Hannah Mcdonald, Megan Harper, Quan Chen, Miranda Lin, Reema Patel, Michael Cavnar, Prakash Pandalai, Bin Huang, Pamela C. Hull, Joseph Kim, Erin Burke

Journal of Appalachian Health

Introduction: Rates of cancer mortality in Appalachian Kentucky is among the highest in the nation. It is unknown whether geographic location of treatment for pancreatic ductal adenocarcinoma (PDAC), one of the deadliest cancers worldwide, influences survival in Appalachian Kentuckians.

Purpose: This study compares outcomes among Appalachian Kentuckians with PDAC who received treatment at an academic medical center (AMC) or community facility (CF).

Methods: Using the Kentucky Cancer Registry, patients diagnosed with PDAC between 2003 and 2018 were identified. Patients were categorized according to treatment location (AMC v. CF) and county of residence (Appalachian v. non-Appalachian). Kaplan-Meier curves were constructed to …

Check With The Intended Audience First! Content Validation As A Method For Inclusive Research For Primary Care Engagement In Rural Appalachia, Sydeena E. Isaacs, Jennifer Schroeder Tyson, Ashley Parks, Danielle Adams

Journal of Appalachian Health

Introduction: To date, referral practices based on social determinants of health (SDOH) among primary care providers (PCPs) and clinic staff in rural regions, including Appalachian North Carolina (NC), are not well understood.

Purpose: This study aims to develop and content validate a primary care engagement (PCE) survey to assess (1) engagement and burnout; (2) referral practices; and (3) self-efficacy and confidence in making referrals based on SDOH among PCPs and clinic staff in Appalachian NC.

Methods: Using the Social-Ecological Model as a theoretical framework, researchers developed a 37-item PCE survey. Content validation was completed by a panel of experts recruited …

Independent Study Project: The Impact Of Digitization And Payment On Community Health Promoter (Chp) Motivation And Effectiveness In A Peri-Urban Community In Kisumu, Kenya., Fiona Yohannes

Independent Study Project (ISP) Collection

Community Health Promoters (CHPs) in Kenya are the liaison between the community and higher levels of healthcare. As CHPs’ responsibility in the country has grown, stipends started being distributed, and digitization efforts have begun to support them. This ISP paper aims to investigate how recent digitization and payment of CHPs impact their motivation and effectiveness in a peri-urban community in Kisumu, Kenya. The project includes data analysis on CHP performance data from 2016 to 2021 and analyses of interviews with CHPs and CHAs in April of 2024. It was found that time was positively related to CHP performance. It was …

Complementariedad En La Comuna De Putre: Reflexiones Sobre El Sistema De Salud Y Los Conocimientos Comunitarios Aymaras, Grace Benish

Independent Study Project (ISP) Collection

In the comuna of Putre, which lies in the XV region of Chile, exists a community and culture unique from the rest of the country. Half of the population identifies as part of the Aymara indigenous group, which according to Chilean law, means that a system of intercultural health must exist in the commune. Our objective included establishing the format in which the intercultural system of health functions nowadays and assessing how well the system serves the community, keeping in mind the history of the commune, barriers to access, community needs, and Aymaran culture. Furthermore, the domination of the Aymaran …

Close Contacts Of Xenograft Recipients: Ethical Considerations Due To Risk Of Xenozoonosis, Daniel J Hurst, Luz Padilla, Daniel Rodger, Tamar Schiff, David K C Cooper

Rowan-Virtua School of Osteopathic Medicine Departmental Research

With decades of pre-clinical studies culminating in the recent clinical application of xenotransplantation, it would appear timely to provide recommendations for operationalizing oversight of xenotransplantation clinical trials. Ethical issues with clinical xenotransplantation have been described for decades, largely centering on animal welfare, the risks posed to the recipient, and public health risks posed by potential spread of xenozoonosis. Much less attention has been given to considerations relating to potentially elevated risks faced by those who may care for or otherwise have close contact with xenograft recipients. This paper examines the ethical and logistical issues raised by the potential exposure to …

How To Develop A Qualitative Evaluation Plan For A Complex National Intervention: Key Steps And Reflections From The Radx-Up Program, Shelly A. Maras, Josephine Mckelvy, Kelley Milligan, Allyson Kelley, Valerie A. Lucas, Tara Carr, Abisola Osinuga, Leah Frerichs, Gaurav Dave

The Qualitative Report

This article describes the formative process of developing and implementing a Qualitative Evaluation Plan (QEP) for a large-scale, National Institute of Health (NIH) supported program: Rapid Acceleration of Diagnostics — Underserved Populations (RADx-UP). RADx-UP includes over 137 projects in the United States that aim to ensure that all Americans have access to timely, accurate diagnostics for COVID-19, with a specific focus on populations the pandemic disproportionately affects. As part of a comprehensive, mixed-methods strategic evaluation plan, our team developed the QEP. We employed qualitative methods to understand RADx-UP academic and community partners’ experiences implementing community-engaged research strategies, and to understand …

Human Zoo Healthcare At The 1904 World’S Fair, Angel Blake

Undergraduate Research Symposium

Human Zoo Healthcare at the 1904 World’s Fair

Were precautions taken or put into place for the Human Zoo performers at the 1904 World’s Fair? This topic has been overlooked and understudied by historians, there are few articles written and we do not know the true death toll which shows the racism towards these indigenous peoples. The research for this project was conducted at the State Historical Society of Missouri, the St. Louis Mercantile Library, Newspapers.com, Archives.com, St. Louis Public Library, and the Missouri Historical Society, including research on primary sources such as official World’s Fair committee meeting minutes, hospital …

Experiences Of Family Communication And Cascade Genetic Testing For Hereditary Cancer In Medically Underserved Populations-A Qualitative Study, Erica M Bednar, J Alejandro Rauh-Hain, Jose J Garcia, Norma De Aguinaga, Mary Anne Powell, Sylvia L Peral, Roni Nitecki, Kirsten Jorgensen, Natasha L Rudy, Karen H Lu, Charles A Leath, Isabel C Scarinci

Faculty, Staff and Student Publications

UNLABELLED: We sought to explore the intrafamilial communication and cascade genetic testing (CGT) experiences of patients with hereditary cancer from diverse, medically underserved populations and their relatives. Participants included patients receiving oncology care at an urban, safety net hospital in Texas or comprehensive cancer center in Alabama and their first-degree relatives. In-depth semi-structured qualitative interviews were completed wherein patients shared their experiences with genetic counseling (GC), genetic testing (GT), and communicating their results to relatives. Relatives shared their experiences receiving information from the patient and considering CGT. Interviews were transcribed, coded, and themes were identified. Of 25 participating patients, most …

Primary Care Physician Trust: The Importance Of Early Medical Intervention For African American Children With Asthma, Harrish Ganesh

AUCTUS: The Journal of Undergraduate Research and Creative Scholarship

Asthma is a prevalent condition characterized by an individual’s airway becoming inflamed, constricted, and leads to the formation of mucus and difficulty breathing. Nearly 27 million individuals are currently diagnosed with Asthma in the United States, and African Americans are 40% more likely to be diagnosed with asthma than Caucasians. This literature review analyzed multifaceted barriers that restrict African American asthmatic children from gaining consistent asthma treatment. Some of these barriers range from historical racial discrimination that leads to parental mistrust to financial and educational barriers that result in inconsistent pediatric care for asthmatic children. The combination of the above …