Community Health and Preventive Medicine Commons^™

Assessing And Addressing The Determinants Of Appalachian Population Health: A Scoping Review, David L. Driscoll, Hannah O'Donnell, Maitri Patel, David C. Cattell-Gordon

Journal of Appalachian Health

Introduction: Residents of Appalachia experience elevated rates of morbidity and mortality compared to national averages, and these disparities are associated with inequitable exposures to various determinants of population health. Social and environmental determinants of health are a useful lens through which to develop and evaluate programs to mitigate regional health disparities.

Methods: This 2023 scoping review was conducted of studies linking determinants of Appalachian health with leading causes of regional mortality and morbidity. The search strategy employed a keyword search that included geographic terms for the Appalachian Region and the primary adverse health outcomes in that region. Studies meeting the …

Review Of: Coal, Cages, Crisis: The Rise Of The Prison Economy In Central Appalachia, Ted Olson Phd

Journal of Appalachian Health

Ted Olson, PhD, is a professor of both Appalachian Studies and Bluegrass, Old-Time and Roots Music Studies at East Tennessee State University. In this piece, he reviews Professor Judah Schept's Coal, Cages, Crisis: The Rise of the Prison Economy in Central Appalachia and discusses the impacts of incarceration on the health of Appalachia and on its residents more broadly.

Factors Associated With Covid-19 Vaccine Hesitancy In South Central Appalachia, Florence M. Weierbach, Rebecca Adkins Fletcher, Ingrid E. Luffman, Cynthia Meyer, Janet M. Keener, Manik Ahuja, Hadii M. Mamudu

Journal of Appalachian Health

Introduction: The newly emergent COVID-19 virus reached pandemic levels in March 2020. By the middle of August 2020, there were over 1 million deaths attributed to COVID-19 in the U.S., with those in rural areas outpacing urban counterparts. Prior to emergency approval of the Pfizer, Moderna and Johnson & Johnson vaccine formulations, mitigation efforts addressing individual behavior were challenging. However, even with the entrance of these three new vaccines, herd immunity was not achieved in rural areas, as vaccine uptake remained low there. Although there has since been an abundance of COVID-19-related research addressing health literacy, vaccine hesitancy and overall …

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 …

Carbapenem-Resistant Enterobacterales—Kentucky, 2013–2020: Challenges And Successes, Mary Issac, Andrea Flinchum, Kevin Spicer

Journal of Appalachian Health

Introduction: Carbapenem-resistant Enterobacterales (CRE) are considered urgent, antibiotic-resistant threats in the U.S. and are of global concern. Active collaboration between public health authorities and healthcare facilities and providers will be necessary to prevent and contain these organisms.

Purpose: To describe the epidemiology of CRE in Kentucky and to discuss challenges and successes with building and sustaining an effective prevention and containment program.

Methods: Retrospective descriptive summary of CRE isolates reported by healthcare providers, facilities, and laboratories in Kentucky from 2013 through 2020. Data available from case reporting forms and laboratory testing are summarized.

Results: From 2013 through 2020, 1805 CRE …

Changes In Perceptions Of First Responders After Witnessing A Drug Overdose: Individual And Contextual Variations Among People Who Use Opioids In West Virginia, Kathleen L. Egan, Kelly Gurka, Alexandria Macmadu, Herb Linn

Journal of Appalachian Health

Introduction: Success of opioid overdose interventions involving first responders is dependent on the comfort level that bystanders have with first responders and their willingness to call for assistance. Positive or negative experiences with first responders following witnessing an overdose may influence a person’s willingness to call a first responder for assistance in the future.

Purpose: The objective of this study was to examine changes in bystanders’ perceptions of first responders following witnessing an overdose attended by emergency medical services or a law enforcement official. It specifically explored perception changes among a sample of individuals residing in Appalachia who use prescription …

Reimagining A Caregiver-Friendly Society, Jodi L. Southerland

Journal of Appalachian Health

Demographic aging is accelerating in the Appalachian Region, resulting in a growing proportion of caregivers living in areas that lack services to support their needs. Strategies are urgently needed in Appalachia to address deficiencies in the region’s long-term supports and services for older adults and their caregivers. Strengthening equitable access to care and community supports for family caregivers is a policy priority for state and community leaders in Appalachia.

Association Between Insurer Connectivity In Appalachian Population Health Networks And Preventable Hospitalizations: Evidence From Kentucky, Rachel Hogg-Graham, Kelsey R. Gatton, Rick Ingram, Glen P. Mays

Journal of Appalachian Health

Introduction: Addressing complex health and social needs requires cross-sector collaboration to deliver medical, social, and population health services at the community level. Capacity in community health and social services networks may be constrained in regions like Appalachia due to the combined effects of rurality and persistently poor health and social outcomes. One way that cross-sector networks serving low-resource communities can expand their capacity is by engaging partners, like health insurers, who can leverage resources from outside the local area.

Purpose: This study examines insurer connectivity in cross-sector networks across Kentucky’s geographic regions and the association between connectivity and the probability …

The Ninth Myth Of Appalachia, Randolph Wykoff

Journal of Appalachian Health

Many stereotypes afflict our much-maligned region, and the Jonesborough­­–Washington County History Museum displays eight of these "myths of Appalachia." Here, our Editor-in-Chief suggests a ninth—that the people of Appalachia "do not care" about their health—and argues that regional health disparities result not from apathy but from a confluence of socioeconomic factors.

Self-Reported Consumption Of Bottled Water V. Tap Water In Appalachian And Non-Appalachian Kentucky, Jason W. Marion

Journal of Appalachian Health

Introduction: Quantitative studies on drinking water perceptions in Appalachia are limited. High-profile water infrastructure failures in the U.S. and Eastern Kentucky, coupled with human-made and natural disasters in the Appalachian Region, have likely impacted opinions regarding tap water.

Purpose: To use existing unexplored data to describe baseline tap water v. bottled water consumption in Kentucky.

Methods: Telephone-based cross-sectional data were obtained from the 2013 Kentucky Health Issues Poll (KHIP) directed by the Foundation for a Healthy Kentucky. Among many items in KHIP, self-reported consumption of bottled water over tap water, reasons for bottled water use, and demographic data were obtained. …

Impact Of Interprofessional Student Teams At A Remote Area Medical Event In Rural Appalachia, Emily K. Flores, Karilynn Dowling, Caroline Abercrombie Md, Rick L. Wallace

Journal of Appalachian Health

Introduction: Education in interprofessional collaboration is vital to expand healthcare access, especially in areas of higher disparity. To address this need, interprofessional faculty collaborators incorporated undergraduate and graduate health profession students into teams at an annual Remote Area Medical event in rural Appalachia between 2017 and 2020.

Purpose: This article evaluates the impact of an interprofessional student teams model on both patient care experience and students’ interprofessional collaboration attitudes and behaviors.

Methods: Student volunteers completed pre- and post-event surveys containing questions about demographics, open-ended questions, and questions from two instruments: the Student Perceptions of Interprofessional Clinical Education-Revised Instrument, Version 2 …

Reviewer Acknowledgments, Randy Wykoff Md, Mph & Tm, Rachel E. Dixon Mphil

Journal of Appalachian Health

As we reach our fifth year, we are particularly thankful for the contributions of our peer reviewers. The knowledge, expertise, and guidance offered by the people listed below have ensured that we can continue to share timely research to effect health and well-being across Appalachia.

Piloting An Oral History Approach To Investigate Cancer Perspectives Among Residents Of Appalachian Kentucky, Courtney Martin, Lauren Hudson, Nathan L. Vanderford

Journal of Appalachian Health

Introduction: Kentucky ranks first in the U.S. in overall cancer incidence and mortality rates. Areas of the state that fall within the Appalachian Region, along Kentucky’s eastern border, experience disproportionately high rates of cancer compared to non-Appalachian counties.

Purpose: This pilot study investigates whether oral history interviews can be used to understand perspectives on cancer among residents of Appalachian Kentucky.

Methods: In 2020, participants (n = 5) who identified as being from and/or having strong connections to Appalachian Kentucky were recruited to participate in this pilot study. Participants included individuals working in cancer-related fields, oncology professionals, and those with personal …

Prevalence And Factors Of Self-Medication With Antibiotics In Claiborne County, Tennessee, Kimberly A. Carney, Lauren Wisnieski, Tristan Lackey, Donald Noah

Journal of Appalachian Health

Introduction: Antimicrobial resistance (AMR) is a serious concern to public health, causing an estimated 35,000 deaths annually in the U.S. Misuse of antimicrobials increases the rate of AMR. Self-medication with antibiotics (SMA) is a primary contributor to AMR that can be addressed through education. SMA has been reported at rates of 3% to 66% in the U.S. but has not been evaluated in Appalachia.¹ Low health literacy and barriers to accessing care have been correlated with SMA and are common in many areas of Appalachia.

Purpose: This study aims to assess factors associated with SMA, demographic differences in knowledge …

Factors Associated With Physical Activity Increases And Decreases Among A Sample Of Appalachian Residents During The Covid-19 Pandemic: A Cross-Sectional Study, Christiaan G. Abildso, Angela M. Dyer, Shay M. Daily, Christa Lilly, Emily A. Sarkees, Samantha I. Moyers, Thomas K. Bias

Journal of Appalachian Health

Introduction: Physical activity (PA) can prevent and reduce the deleterious physical and mental health effects of COVID-19 and associated lockdowns. Research conducted early in the pandemic demonstrates that a greater proportion of adults in the U.S. have decreased than increased PA, and the effects vary by sociodemographic factors. Ongoing evidence is important to identify patterns in PA changes during the pandemic.

Purpose: This study aims to identify factors associated with increases and decreases in PA during the COVID-19 pandemic in a convenience sample of adults residing in Appalachia.

Methods: Surveys were collected from a convenience sample of adults from eight …

We Welcome Findings From Further Afield, Randy Wykoff Md, Mph & Tm, Rachel E. Dixon Mphil

Journal of Appalachian Health

For the past five years, the Journal of Appalachian Health has published timely, high-quality research from within Appalachia. We also welcome submissions from those working outside of Appalachia who produce quality research of direct relevance to our region.

Providers’ Stigmas And The Effects On Patients With Opioid Use Disorder: A Scoping Review, Peyton Mashni, Sarah Beth Bell, F. Douglas Scutchfield Md, Lauren E. Robinson

Journal of Appalachian Health

Introduction: One of the most prevalent, dangerous stigmas in health care is the complex bias toward patients with opioid use disorder (OUD). This stigma damages the vital patient–provider relationship, further perpetuating the opioid epidemic.

Purpose: Unfortunately, research on the relationship between OUD and provider stigma is greatly lacking. To fill this gap, the present in-depth study undertakes a scoping review of research on providers’ stigma toward OUD in order to determine how enacted stigma affects treatment plans.

Methods: Four databases were used to identify articles published from 1999 to 2021. A comprehensive search strategy was developed through a collaborative process …

The Relationship Between Psychosocial Factors, Self-Care, And Blood Sugar In An Appalachian Population, Brittany L. Smalls, Md. Tofial Azam, Madeline Dunfee, Philip M. Westgate, Susan C. Westneat, Nancy Schoenberg

Journal of Appalachian Health

Introduction: Appalachian residents are more likely than other populations to have Type 2 Diabetes Mellitus (T2DM) and to experience more severe complications from the disease, including excess and premature mortality.

Methods: This study examines health alongside sociodemographic factors, psychosocial factors (including knowledge, empowerment, social support/function, religiosity, distress), and perceived problems in diabetes management that may influence self-care and HbA1c among vulnerable rural residents. A survey of a community–based sample of 356 adults with diagnosed diabetes or HbA1c > 6.5 was conducted in six counties in Appalachian Kentucky.

Results: Findings suggest that neither religiosity nor social support/function mediate/moderate the relationship between psychosocial …

On We Go, With Hope: Remembering Our Founding Editor-In-Chief, Dr. F. Douglas Scutchfield, Rachel E. Dixon, Randolph F. Wykoff

Journal of Appalachian Health

With the passing of our founding Editor-in-Chief, Dr. F. Douglas Scutchfield, the Journal of Appalachian Health team reflects on a life well lived and a monumental public legacy left behind. We thank "Scutch" for enriching the lives of so many, and we commit to growing the Journal in his honor.

Covid-19 Pandemic Impact On Essential Public Health Services And Online Health Communication—Appalachian Kentucky, March–December 2020, Margaret A. Riggs, Kenny Ortiz-Jurado, Keith Klein

Journal of Appalachian Health

Introduction: The COVID-19 pandemic posed many challenges for local health departments (LHDs). This study examines how stay-at-home orders impacted the provision of essential public health services and subsequent increased use of online health communication by LHDs for rural populations in Appalachian Kentucky during the first year of the COVID-19 pandemic.

Methods: A survey to gather information about provision of essential public health services was administered to five LHDs representing 13 counties between June 2020 and December 2020. Additionally, demographic and health-outcome data from LHD, state health department, and CDC websites were reviewed, alongside health communications posted on LHD social media …

Sars-Cov-2 (Covid-19) Vaccine Intentions In Kentucky, Kevin A. Pearce Md, Mph, Emily Messerli Dnp, Aprn, Mary E. Lacy, Brittany L. Smalls, Diane B. Francis, Sukruthi Yerramreddy, Marc Kiviniemi

Journal of Appalachian Health

Background: At the time of our writing, the COVID-19 pandemic continues to cause significant disruption to daily lives. In Kentucky, the burdens from this disease are higher, and vaccination rates for COVID-19 are lower, in comparison to the U.S. as a whole. Understanding vaccine intentions across key subpopulations is critical to increasing vaccination rates.

Purpose: This study explores COVID-19 vaccine intentions in Kentucky across demographic subpopulations and also investigates the influences on vaccine intention of attitudes and beliefs about COVID-19.

Methods: A population-based survey of 1,459 Kentucky adults was conducted between January 26 and March 20, 2021, with over-sampling of …

Assessing The Intention, Attitudes, And Social Influences On Covid-19 Preventive Behaviors Among Non-Rural Black And Rural Appalachian White Populations: A Faith-Based Community Study, Maria L. Gomez, Tofial Azam, Jean Edward, Hannah Bowman, Lovoria B. Williams

Journal of Appalachian Health

Introduction: The COVID-19 pandemic has had detrimental impacts in non-rural Black and rural Appalachian populations. Yet despite the pandemic’s magnitude, there is a scarcity of research exploring potential influences of attitudes and social influences within these populations on their adherence to COVID-19 public health preventive behaviors.

Purpose: This study examines the intention, attitudes, and social influences to adhere to COVID-19 preventive behaviors among non-rural Black and rural Appalachian congregants in Kentucky by integrating the Theory of Planned Behavior (TPB).

Methods: Secondary analysis of cross-sectional data was used to assess the association between the TPB constructs and four key public health …

Community Strengths And Challenges Related To Opioid Use Disorder In Rural Counties Of East Tennessee, Ashlyn N. Schwartz, Zeruiah V. Buchanan, Laurie L. Meschke

Journal of Appalachian Health

Introduction: Appalachia, particularly Rural East Tennessee, has been and continues to be disproportionately impacted by opioid use disorder and its many tragic ramifications.

Purpose: Community-engaged strategies can inform and support the development of relevant prevention efforts. Hence, people connected to a ten-county rural Appalachian region in East Tennessee were asked to identify and prioritize strengths and challenges related to opioid use disorder (OUD).

Methods: Adult community members (n=577) completed a brief survey administered across 11 days in 2019.

Results: Of the respondents, 85.3% never had been addicted to opioids, but 74.0% had someone close to them with OUD. The most …

They Built My Soul: A Qualitative Analysis Of The Impacts Of Home Repairs In Rural Tennessee, Bethesda O'Connell, Ada Sloop, Nicole Intagliata, Melisa Miller, Megan Quinn

Journal of Appalachian Health

Background: Housing is an important social determinant of health and substandard housing is linked to physical, mental, and social health problems.

Purpose: The purpose of the study was to qualitatively assess the impacts of repairs to substandard housing in rural East Tennessee through twenty-eight interviews.

Methods: Zoom was utilized for recording phone interviews in January– February 2021 and NVivo software was used for thematic analysis in May–July 2021.

Results: Themes that emerged included environmental risk reduction, impacts on physical health, impacts on mental health, impacts on financial well-being, and willingness to receive future assistance from service organizations.

Implications: Further …

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 …

Understanding Polarizing Community Perspectives On Harm Reduction Strategies: Challenges To Addressing The Opioid Crisis In Appalachian Pennsylvania, Stephanie L. Creasy Mph, Jessica R. Thompson Med, Christina F. Mair Phd, Jessica G. Burke Phd

Journal of Appalachian Health

Introduction: Rural communities face barriers to opioid treatment and overdose prevention including concerns about stigma and lack of harm reduction services.

Purpose: The aim of this study was to explore community perspectives and understanding of harm reduction approaches to opioid use and overdose in a high-risk Northern Appalachian case community in Pennsylvania.

Methods: A small town approximately 10 miles from Pittsburgh was identified as the community with the greatest predicted probabilities of epidemic outbreak using posteriors from spatial models of hospitalizations for opioid use disorders. We interviewed 20 key stakeholders in the case community in using a semi-structured interview guide …

Case Study Of A Comprehensive Team-Based Approach To Increase Colorectal Cancer Screening, Lauren E. Wright, Adam Baus, Andrea Calkins, Holly Hartman-Adams, Mary E. Conn, Susan Eason, Stephenie Kennedy-Rea

Journal of Appalachian Health

Introduction: Colorectal cancer is the second leading cause of cancer deaths among men and women in West Virginia. In addition, 51% of all colorectal cancers diagnosed in West Virginia from 2012 to 2016 were detected at either regional (31%) or distant (20%) stages indicating a need for improved early detection.

Methods: West Virginia University Cheat Lake Physicians participated in the West Virginia Program to Increase Colorectal Cancer Screening, a program of Cancer Prevention and Control at the WVU Cancer Institute. As a result, Cheat Lake Physicians assembled a team of health care professionals to implement evidence-based interventions and …

Diabetes Knowledge, Behaviors, And Perceptions Of Risk In Rural West Virginia Counties, Ranjita Misra, Sara Farjo, Renee Mcginnis, Megan Adelman Elavsky, Summer Kuhn, Catherine Morton-Mcswain

Journal of Appalachian Health

Introduction: A little less than half of American adults have diabetes or pre-diabetes. In 2016, West Virginia (WV) had the highest percentage (15.2%) of adults with diagnosed diabetes in the U.S.

Purpose: In partnership with the Health Sciences and Technology Academy (HSTA), a cross-sectional study was preformed to assess knowledge, behaviors, and perceptions of diabetes risk.

Methods: Data was collected by trained HSTA students and teachers who lived in rural counties in WV. Information was assessed using validated surveys, and HbA1c was obtained by utilizing professional point-of-care (Bayer) kits.

Results: Mean age and Body Mass Index (BMI) was 36.11±17.86 years …

Exploring Covid-19 Case Fatality In Relation To The Prevalence Of Chronic Conditions And Health Behaviors In Appalachian Kentucky, W. Jay Christian

Journal of Appalachian Health

Background: Research has demonstrated that common chronic conditions, especially those related to cardiovascular health, are important risk factors for severe COVID-19 symptoms or hospitalization. Population prevalence rates of such conditions have not previously been examined in relation to COVID-19 case fatality rates in the Central Appalachian region.

Purpose: This study examined prevalence rates of selected chronic conditions and COVID-19 case fatality rates to determine whether the relationship between them is consistent across Appalachian and non-Appalachian regions of Kentucky.

Methods: Data from Kentucky’s Behavioral Risk Factor Survey (KyBRFS) were used to calculate prevalence rates of asthma, diabetes, influenza vaccination, hypertension, obesity, …

Skin Cancer And Uv Exposure-Related Behaviors Among Appalachian And Non-Appalachian Adults, Minal Patel, Katrina Serrano, Elise Rice, Chan Thai, Kelly Blake, Robin C. Vanderpool

Journal of Appalachian Health

Introduction: Appalachian communities experience elevated rates of cancer incidence and mortality relative to other regions in the U.S. Specifically, melanoma mortality rates are higher in Appalachia compared to the national average, despite comparable incidence rates.

Purpose: To examine differences in self-reported history of skin cancer and prevalence of two UV exposure behaviors between Appalachian and non-Appalachian adults in a nationally representative sample.

Methods: Data are from four cross-sectional cycles of the Health Information National Trends Survey (2011–2014) (N=14,451). We examined sunscreen use and tanning bed use, and self-reported history of melanoma and non-melanoma skin cancer. Descriptive and weighted …