Community Health and Preventive Medicine Commons^™

Deaths Of Despair Among Cancer Survivors In Rural/Urban Appalachia (2000-2022), Jason Semprini, Anders Erickson, Nosa Osazuwa-Peters

Journal of Appalachian Health

Introduction: Rising deaths of despair (premature deaths from suicide, overdose, alcohol, and violence) in adults under age 65 persist across the United States, especially in Appalachia. People diagnosed with cancer may face elevated risks of such deaths due to pain, psychosocial distress, and financial hardship.

Purpose: Deaths of despair trends were compared among adults with cancer across Appalachian and non-Appalachian regions, stratified by sex and rurality.

Methods: Analyzing SEER-21 Incidence-Based Mortality data (2000–2022), deaths caused by suicide, cirrhosis of the liver, or accidents (includes overdose) were identified among adults aged 20–64 years. Annual mortality rates per 100,000 total population were …

Rural Community Perspectives On Hurricane Helene In Western North Carolina, Jennifer A. Horney, Lilly Moreau, Search Wnc

Journal of Appalachian Health

Introduction: After making landfall on the Florida Gulf Coast in September 2024, Hurricane Helene impacted Western North Carolina (WNC) with historic flooding, landslides, and hurricane-force winds. More than 100 deaths in the region were attributed to the storm’s direct impacts.

Purpose: The purpose of this study was to assess community perspectives of long-term recovery in Mitchell and Yancey Counties, two rural WNC counties severely impacted by Hurricane Helene.

Methods: A 14-question interview guide was developed based on prior disaster research and the community engagement work of Sustaining Essential and Rural Community Healthcare (SEARCH). Questions covered post-Helene experiences related to access …

The Role Of Community Health Workers In Rural South Carolina, Sarah W. Haselden

Senior Theses

This paper aims to explore the role of Community Health Workers (CHWs) in rural South Carolina through a literature review as well as the data supplied from the Community Health Alignment Initiative (CHAI) and Community Health Workers Changing Outcomes in SC (CCOSC). Through reviewing the collection of materials and data, the effectiveness of CHWs can be studied. Community Health Workers (CHWs) provide a unique aspect to primary care within communities through their aid in prevention of health conditions. CCOSC and CHAI collected data throughout South Carolina to determine the needs of communities and how CHWs can work to address those …

Purchasing A Healthier Future: A Nutrition-Focused, Community-Centered Approach To Reduce Obesity And Diabetes In Graves County, Kentucky, Marissa Stephens

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

Obesity and type 2 diabetes are among the most significant public health challenges in the United States, with Kentucky consistently ranking among the states with the highest prevalence of both conditions. Together, these conditions contribute to reduced quality of life, rising healthcare costs, and increased morbidity and mortality, underscoring the need for targeted, community-centered interventions. The disease burden of obesity and diabetes is particularly pronounced in rural areas, including the state’s westernmost region, the Jackson Purchase. Among rural populations, chronic disease risk is driven by a combination of factors, including low socioeconomic status, limited access to healthcare/supermarket options, and food …

Wastewater Surveillance For Sars-Cov-2 In Rural Kentucky, 2021–2023, James W. Keck, Reuben Adatorwovor, Ann Noble, Savannah Tucker, William Strike, Soroosh Torabi, Mohammad Dehghan Banadaki, Blazan Mijatovic, Steven K. Roggenkamp, Donna Mcneil, Lindell Ormsbee, Scott M. Berry

Family and Community Medicine Faculty Publications

Wastewater testing for SARS-CoV-2 provided useful public health information during the COVID-19 pandemic yet was underutilized in rural communities. We addressed this gap by implementing wastewater surveillance and assessing its performance in 10 communities in Eastern Kentucky. We collected wastewater samples 1–2 times weekly at 10 wastewater treatment plants (WWTPs) from May 2021 until April 2023 and measured SARS-CoV-2 RNA concentrations using polymerase chain reaction testing. We calculated time-lagged correlations between wastewater concentrations and county-level reported COVID-19 cases by site. We developed a generalized linear model to estimate COVID-19 incidence from wastewater SARS-CoV-2 concentrations. The 10 participating WWTPs served 2430 …

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 …

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 …

"Health Gatekeepers": The Influence Of Women On Health Practices In Rural, Central Appalachia, Reese Lycan

Senior Theses

Women have historically assumed leadership roles in familial and community health promotion, intervention, and facilitation. While the role of women in family health is globally understood and the historical importance of female leadership has been documented, there remains a gap in knowledge regarding the role of women as “health gatekeepers”. Furthermore, when considering the Appalachian region, there are limited studies regarding women’s place in leadership as far as health is concerned. Therefore, this study employs a hermeneutic phenomenological framework to explore the lived experiences of women in relation to their family and community’s health in rural, Central Appalachia- a region …

Researching Dementia Indicators Among Rural Populations, Justin S. Yount

Theses and Dissertations--Community & Leadership Development

The study explored potential dementia indicators and risk factors among older adults residing in rural areas who are actively engaged in farming operations. Data was collected in three components a questionnaire, an audiogram test, and a memory impairment screening. 104 people responded to the questionnaire, 133 participants took the audiogram test, and 94 participated in the memory impairment screening. The findings revealed that 80.9% of participants showed no sign of cognitive impairment while 19.1% showed signs of possible impairment. Participants reported moderate levels of physical and social activity, but common risk factors such as elevated BMI, diabetes, hearing loss, and …

Differences In Mental Health Outcomes In Immigrant Vs. U.S.-Born Populations In Urban Vs. Rural Areas In The United States, Zoë Gentles

Electronic Theses & Dissertations (2024 - present)

Background

The immigration process to the United States creates distinct mental stressors. These stressors are influenced by socioeconomic factors including income, education level and insurance status. In rural America, these factors are intensified due to a poor healthcare infrastructure that is limited. This study examines the relationship between urban-rural residence and mental health outcomes among immigrants vs. native-born residents in the United States.

Methods

Data from the National Health Interview Survey (NHIS) from 2019 and 2022 were used to examine the relationship. The exposure of interest was place of birth, and the outcome of interest was the presence of clinically …

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 …

Seeding Belonging: Project Dig Short Report, Jeff Gutierrez, Connie Lewis, University Of Montana Rural Institute

Health and Wellness

This short report provides a snapshot of Project DIG, a therapeutic horticulture (TH) pilot project of the Rural Institute for Inclusive Communities. It contains information about and recommendations for TH as an increased practice for supporting and promoting the quality of life and well-being of people with intellectual and developmental disabilities.

Veterans In Focus: Disability And Veterans In Rural America, Hannah W. Pepprock, Lillie Greiman, University Of Montana Rural Institute

Health and Wellness

There are an estimated 17 million Veterans living throughout the United States. Relative to the general population, Veterans are more likely to experience disability. Veterans are also disproportionately represented in rural areas across the U.S. As people with disabilities are also disproportionately represented in rural areas, it is valuable to explore the intersection between veteran status, disability, and rurality. This analysis uses publicly available date from the American Community Survey to examine service-connected disability rating status and the ACS-6 questions on functional ability as they related to U.S. regions and rurality.

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.

Evaluation Of Seizure Recognition And First Aid Training Course And Improving Self-Efficacy Related To Medical Emergencies In Mississippi, Anna Katherine Herrington, Collin Earl Wayne Crawson, Daniel Robert Zuckerman

Honors Theses

Within recent years, there has been increased attention to the growing physician shortage across the United States. This shortage has placed substantial strain upon regions of lower healthcare access, particularly those of rural regions such as much of the state of Mississippi. As rural healthcare providers are placed under more strenuous conditions, they encounter issues of increased patient volume, lack of a trauma team, or adequate transportation to higher-level care facilities. These issues may exacerbate the present inequities in cost of living, access to adequate healthcare, and the distress caused by these concerns. Individuals with epilepsy are one cohort with …

Finding A Good Fit: Tips On Hiring Rural Personal Assistants, Rayna A. Sage, Krys Standley

Health and Wellness

Living in rural areas means being part of close communities. For people with disabilities in these areas, Personal Assistance Services (PAS) help them live on their own. But finding good PAS workers in rural places can be hard. To help you pick the right PAS worker, we explored what traits make them a good fit.

"I Live My Best Life In The Garden": Project Dig Summary Report, Tracy Boehm Barrett, University Of Montana Rural Institute

Health and Wellness

People with intellectual and developmental disabilities (IDD) are commonly overlooked in society because of a combination of social, economic, political, and cultural barriers. Due to such constraints, they also experience a wide range of health and community disparities that result in negative impact on their quality of life and well-being (Mpofu et al., 2020; Akyurek & Bumin, 2017). While many community-based organizations provide a variety of supports for people with disabilities, far less common are those providing therapeutic horticulture (TH) programs within the scope of their services. This report provides information about and recommendations for TH as an increased practice …

Self-Efficacy, Grit, And Rural Career Aspirations Among Early Career Nurses: A Repeated Cross-Sectional Study, Daniel Terry, Blake Peck, Ed Baker, David Schmitz

Public and Population Health Faculty Publications and Presentations

Background Global nursing workforce shortage represents an impediment to the delivery of safe, evidence-based healthcare. Despite collective efforts, a consistent stream of nurses leaving the profession remains, particularly within the first five years of practice, which is exacerbated in rural communities. The aim of the study was to compare self-efficacy, grit, and rural career aspirations among nursing graduates between their second and fourth year of their nursing profession.

Methods As part of a longitudinal investigation, a repeated cross-sectional design was utilised. Participants included, 117 (response rate 52.2%) who completed an online questionnaire 18–24 months after graduating, and 32 participants (response …

Understanding Intention And Behavior Of Practicing Yoga Through The Lens Of Theory Of Planned Behavior Specifically In Rural Communities; A Qualitative Study, Shelley Meyer

Theses and Dissertations--Kinesiology and Health Promotion

While there are known health benefits for participating in yoga, little has been studied on the intention and behavior for why individuals practice yoga especially through a theoretical lens and intense qualitative thematic analysis. Targeting the rural community considers other extenuating circumstances experienced by rural residents that can impact yoga participation in rural areas. Interviews were used to gain insight into a holistic viewpoint with the rich data bringing clarity to an individual’s thought process (of intention) to incorporate yoga (behavior) in their daily life. Utilizing the Theory of Planned Behavior as the theoretical framework for developing interview questions allowed …

See Me, Hear Me, Know Me: Perspectives On Diet And Physical Activity Influences Among Teens Living In Rural Texas Communities, Debbe Thompson, Julie Miranda, Chishinga Callender, Jayna M Dave, Godlove Appiah, Salma M A Musaad

Faculty, Staff and Students Publications

Teens in rural communities are at greater risk of obesity than teens in urban areas. Diet and physical activity influence obesity risk. Understanding their perspectives is an important step in intervention design. This qualitative investigation explored teen perspectives on how living in a rural community influenced their diet and physical activity choices. Forty parent-teen pairs were recruited. Data collection included surveys and telephone interviews. This paper reports teen perspectives identified in the first interview. Thematic analysis was used to code and analyze the data. Findings revealed that the primary factor driving teens' diet and physical activity behaviors was the teens …

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 …

Family Caregivers Of Older Adults With Physical Disabilities In Rural Thailand, Denis Tuttle, Jiranan Griffiths, Anuchart Kaunnil

The Qualitative Report

Thailand is one of many countries experiencing changes in the demographics of its population. People are living longer and having fewer children resulting in an increasing percentage of older adults in the general population. This presents a challenge in providing care for older adults, especially in countries where there is a culture of family caregiving. This study aims to investigate the experience of family caregivers, exploring the problems of caring for older people with physical disabilities and the needs of family caregivers. This is done to better understand ways to support caregivers. Using a descriptive qualitative approach, 15 family caregivers …

Urbanization And Physical Activity In The Global Prospective Urban And Rural Epidemiology Study, Kwadwo Boakye, Marit Bovbjerg, John Schuna Jr, Adam Branscum, Ravi Prasad Varma, Rosnah Ismail, Olga Barbarash, Juan Dominguez, Yuksel Altuntas, Romaina Iqbal

Community Health Sciences

Urbanization may influence physical activity (PA) levels, although little evidence is available for low- and middle- income countries where urbanization is occurring fastest. We evaluated associations between urbanization and total PA, as well as work-, leisure-, home-, and transport-specific PA, for 138,206 adults living in 698 communities across 22 countries within the Prospective Urban and Rural Epidemiology (PURE) study. The 1-week long-form International PA Questionnaire was administered at baseline (2003-2015). We used satellite-derived population density and impervious surface area estimates to quantify baseline urbanization levels for study communities, as well as change measures for 5- and 10-years prior to PA …

Comparing The Impact Of Food Insecurity, Access To Exercise Opportunities, And County Classification On Obesity Rates In Ohio, Ankur Parekh, Deborah Lee

Scholarship in Medicine - All Papers

Objective: We completed a study to determine how food insecurity, access to exercise opportunities, and county classification (rural or urban) impacted obesity rates in Ohio. We hypothesized that the county classification impacted obesity the most followed by food insecurity and access to exercise opportunities.

Methods: We obtained data on food insecurity, access to exercise opportunities, and obesity from County Health Rankings and county classification data from the United States Department of Agriculture Census. We analyzed correlations between obesity and food insecurity and obesity and access to exercise opportunities in both county types. We also analyzed changes in obesity rates in …

A Descriptive And Visual Analysis Of The North Coast Fall Prevention Survey Data, Mishell Lopez

Cal Poly Humboldt theses and projects

Older adults over 65 will double from 52.4 million in 2018 to 94.7 million in 2060. Among this aging group, falls affect one out of four older adults and are a critical economic concern for our American society, with yearly costs of $50 billion. In older adults, falling can result in negative consequences such as fear of falling, injuries, mobility restrictions, and loss of independence. California has one of the highest costs per fall ($4 billion annually) and a high percentage of adults who have fallen (30.6%) compared to the nation. Moreover, two of California’s northwest rural counties, Del Norte, …

Evaluating How Physical Activity Affects The Perception Of Resilience In Box Butte County, Nebraska, Eric Pulver

Capstone Experience: Master of Public Health

Physical activity is one of the modern hallmarks for good health in individuals and the public, in general. Resiliency is a growing concentration in all levels of disaster preparedness where the focus is on how to deal with the growing number of disasters stemming from global climate change. This research project’s aim is to look at the possible relationships between physical activity and resiliency in a rural Nebraska population. This was done with the use of a cross-sectional study utilizing a fifteen-question survey to gather demographics, assess the amount of physical activity, and then apply a perception of resilience tool …

Telemedicine And Healthcare Implications For Central Virginia: A Systematic Review Of The Literature, Patricia A. Lynch, Charletta H. Barringer-Brown, Daniel N. Brown, Taneisha D. Brown

Journal of Research Initiatives

Background: Uncertainties and challenges associated with COVID-19 have affected the efficient delivery of health care in Central Virginia. Integrating and redesigning health systems could boost the quality and efficiency of care delivery. Telemedicine has been suggested as a viable solution to increase virtual access to patient advocacy healthcare education and training programs and has the potential to help facilitate the delivery of health services to rural and remote areas. It is projected that access to quality telehealth services can minimize the need for in-person hospital visitation amid the pandemic. The innovation also facilitates remote assessment of patients and monitoring of …

Creating Rural Community Outreach Materials Related To Covid-19 And Disability, University Of Montana Rural Institute

Health and Wellness

RTC:Rural researchers led by Andrew Myers present best practices in rural COVID-19 outreach based on feedback from regional rural disability leaders.

Positive And Negative Deviant Counties: Identification Of Factors Associated With Health Outcomes, Olivia Egen

Electronic Theses and Dissertations

Rural counties in the United States vary drastically on metrics related to socioeconomic status and dominant economic industry as well as health behaviors and outcomes. This study sought to understand the underlying structural reasons why some rural counties have better or worse than expected health outcomes using a positive deviance (PD) approach. The study aimed to: 1) create an area deprivation index and divide counties into quartiles using the index; 2) identify positive, negative, and non-deviant counties using health outcome metrics; 3) analyze differences between deviance on a variety of local public health system metrics; and 4) analyze differences between …