Public Health Education and Promotion Commons^™

Gender Disparities In Sheltered Status And Systemic Drivers Of Homelessness In Johnson City, Tennessee, Preet Patel, Dr. Opal Frye-Clark

Journal of Appalachian Health

The article examines the homelessness crisis in Johnson City, Tennessee, a mid-sized Appalachian city. First, analysis of Point-in-Time (PIT) counts from 2023 to 2025, conducted in 2025, showed persistently high unsheltered rates (35.88% – 47.17%), with men comprising 60 – 65% of the unhoused population. Men experiencing homelessness also had approximately half the odds of being counted as sheltered compared with women, indicating a gender disparity in sheltered status. Second, an interview with an experienced public health practitioner from the Appalachian Region contextualized these findings by identifying systemic drivers, including the regional housing crisis and policy restrictions, and supporting equitable …

Improving Diabetes Self-Management Through A Partnership Between Clinical Providers And Community Educators In Appalachian Communities, Soghra Jarvandi, Lydia Hoskins, Karen Carver, Andrew May

Journal of Appalachian Health

Introduction: The burden of diabetes is an increasing public health challenge, especially in the Appalachian Region.

Purpose: This study assessed the impact of a community-based diabetes education program on glycemic control.

Methods: Health Extension for Diabetes (HED) is a 4-month diabetes education program offered by Extension educators in collaboration with clinical providers. Participants’ data were collected via phone interviews at baseline and after completing the program. Assessments included self-reported HbA1c, socio-demographics, diabetes knowledge, self-efficacy, and self-management behaviors. Data were analyzed by SAS software using paired analyses.

Results: Of the 105 participants in the program, 87 (83%) completed the post-assessment. Among …

School-Centered Tobacco Retailer Exposure And Neighborhood Opportunity Across Urban And Rural Tennessee, Sima Namin Dr, Jacob Black, Jennifer Ferris, Robert E. Heidel Dr

Journal of Appalachian Health

Introduction: Tobacco retailer availability contributes to youth tobacco use, and retailers are concentrated in socioeconomically disadvantaged communities. However, few studies have examined how school-centered retailer exposure intersects with neighborhood opportunity in a predominantly rural Appalachian state.

Purpose: The purpose of this study is to assess the association between neighborhood opportunity and school-centered tobacco retailer exposure across Tennessee (TN), including differences by rurality and Appalachian status.

Methods: We constructed a tract-level, school-centered youth tobacco exposure index for TN using tobacco retailer locations and public and private K-12 school data. The index incorporated retailer proximity, density, and distance-decay accessibility measures. Child Opportunity …

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 …

Evaluating The Feasibility And Preliminary Effectiveness Of A Tailored Diabetes Education Program For Rural Residents, Brittany L. Smalls, Oluwatosin Leshi, Suraksha Khanal, Grejika E. Abram-Erby

Journal of Appalachian Health

Introduction: Diabetes is a top ten Rural Healthy People 2030 priority for health improvement among rural Americans. Socioeconomic, environmental, geographic and political barriers contribute to the type 2 diabetes (T2D) prevalence and its disparate impact in rural communities. However, promoting proper self-care behaviors via self-management education can help people with diabetes better manage their condition.

Purpose: To account for the social environmental factors that affect rural residents, a tailored diabetes education program was developed, and the program’s effectiveness in improving diabetes knowledge and T2D-related health outcomes was assessed.

Methods: Using data collected from Appalachian Kentucky residents enrolled in a six-week, …

Starting With Story, Not Symptom: Narrative Collapse And Cultural Repair In Appalachia, Wayne Coombs Ph.D.

Journal of Appalachian Health

Appalachia’s opioid crisis reflects uneven burdens, especially in distressed coalfield counties, and it cannot be solved by symptom tracking alone. This commentary argues for a narrative shift, starting with story and cultural repair alongside clinical care. Narrative collapse is defined here as the loss of shared, dependable public meaning across groups, not the absence of storytelling in families, churches, and recovery circles. Trauma science suggests that chronic threat reshapes nervous systems across generations, making safety a prerequisite for renewed trust. Drawing on narrative identity research, the piece proposes peer story work as infrastructure that can reduce shame, support treatment engagement, …

Hurricane Helene, One Year Later: Lived Experience, Geraldine A. Miller

Journal of Appalachian Health

Ashe County is located in the northwestern corner of North Carolina (NC), bordered by Virginia and Tennessee. The county is isolated, mountainous, and historically has lacked good highway access. Hurricane Helene, a category 4 hurricane at landfall, struck Western NC on September 27, 2024, resulting in flooding and wind damage that destroyed local communities in terms of land, homes, bridges, water, electricity, etc. with a damage of $59.6 billion.⁶ One year later, the recovery from the hurricane continues draining individuals and communities of their time, energy, and money. Geri Miller reflects on her hurricane impact experiences a year later. …

Associations Between Social Media Usage, Physical Activity And Flourishing In Rural University Students, Anna Dysart, Minu Sara Thomas

Journal of Appalachian Health

Introduction: Most adolescents and young adults report significant use of social media.^1-3 However, there is limited research on the effect of social media use, specifically on physical activity and flourishing.

Purpose: This pilot research study examines the correlation between social media usage and the physical activity and flourishing levels of college students at a rural university in Appalachia.

Methods: The authors conducted a survey including the validated Secure Flourishing Index and Stanford Leisure-Time Activity Categorical Item, containing questions on social media use and demographics. Spearman’s rho was used for nonparametric correlations. Pearson’s correlation was used to determine the correlation …

Impact Of West Virginia Abortion Ban On West Virginia Physician Trainee Practice Intentions, Rebecca Wald, Kristy Ward, Sarah Dotson

Journal of Appalachian Health

In June 2022, the Dobbs v Jackson Women’s Health Organization overturned the constitutional right to abortion established by Roe vs. Wade. Shortly after, West Virginia (WV) began enforcing a near total ban on abortion. Statewide restrictions on access to reproductive health care have important implications for the recruitment and retention of physicians. This project aimed to determine overall awareness of the 2022 changes in abortion laws among physician trainees, and whether the law influenced the intention of resident/fellow physicians to practice medicine in the state following completion of their medical training. A total of 178 resident and fellow physicians at …

Leveraging Community Health Worker’S Deep Community Knowledge To Address Food And Nutrition Security In Appalachia, Alexis Kimbro Scott, Melissa D. Olfert, Dawn Brewer, Makenzie Barr, Julie Plasencia

Journal of Appalachian Health

Introduction: Community health workers (CHWs) are trusted professionals in communities because of the deep understanding and cultural insights learned from their lived experiences. In Appalachia, CHWs are embedded in the community, giving them a unique understanding of how social determinants, like food and nutrition security, impact health outcomes.

Purpose: This study aimed to examine the professional characteristics and knowledge of CHWs while identifying culturally sensitive practices around food insecurity.

Methods: This cross-sectional, mixed-methods study used an online survey and in-depth phone interviews with CHWs in the Appalachian Region to examine their professional characteristics and knowledge on food security in their …

Stigmatization And Healthcare Inequity Perceived By Individuals Served By Homeless Shelters In An Appalachian City, Molly Powney, James M. Mears, Reagan Sharp, Lisa Calderwood

Journal of Appalachian Health

Introduction: People experiencing homelessness are medically vulnerable and suffer disproportionately from chronic physical and mental health conditions. Evidence-based standards to inform decisions surrounding care would be valuable for this population. Studies exploring how homeless individuals in Appalachia perceive their interactions with the healthcare system remain limited, however.

Purpose: The purpose of this study is to assess perceptions of the healthcare system among homeless individuals served by temporary housing shelters in an Appalachian city.

Methods: A voluntary anonymous survey was administered to residents at three shelters in Charleston, West Virginia (WV) from September 2023 – March 2024. Responses were collected utilizing …

Geospatial Analysis Of Breast Cancer Incidence, Mortality, And Access To Screening In Rural And Appalachian Virginia, Jennifer Osher, Caleb Brown, Phillip Nichols, Tariq Ayubi, Jeremy Powers

Journal of Appalachian Health

Introduction: Breast cancer is the most common malignancy among women in the United States (U.S.), despite recent survival rates improving nationally. However, rural and Appalachian regions have experienced slower mortality declines. These communities face unique health care-related challenges that may contribute to observed disparities.

Purpose: The purpose of this study is to assess differences in breast cancer incidence, mortality, and mortality-to-incidence ratio (MIR) between Appalachian and non-Appalachian counties, as well as rural and non-rural counties in Virginia (VA). Furthermore, we aim to evaluate whether availability of mammography is associated with these differences.

Methods: County-level breast cancer incidence and mortality data …

Influence Of Family Health History And Parental Education On Body Mass Index, Blood Pressure, And Lipid Levels In 5th Grade Children: A Secondary Data Analysis Of The Cardiac Project, Madha Rani Das, Lee A. Plyes, Eloise Elliott, Christa L. Lilly

Journal of Appalachian Health

Introduction: Childhood obesity and related cardiovascular risks reflect the interplay of genetic predispositions and socioeconomic adversity. Appalachia’s poverty, limited health care, and educational gaps worsen family health risks, driving early cardio-metabolic problems in children, highlighting the need for effective interventions.

Purpose: The purpose of this study is to examine the association of family health history and parental education with BMI, BP, and lipid profiles among 5^th grade children in West Virginia (WV).

Methods: The study used WV CARDIAC data from 2006–2009. Outcomes were BMI, SBP/DBP, and fasting lipids (HDL, LDL, TG). Predictors were parental education and family health history …

Understanding Breastfeeding Practices In Tennessee: Goals, Duration, And Reasons For Discontinuation, Amir Alakaam, Chia-Lin Chang, Hannah Jeffery

Journal of Appalachian Health

Introduction: Breastfeeding is widely recognized as the optimal source of infant nutrition, offering many health benefits.

Purpose: The purpose of this study was to examine goals, exclusivity, and duration of breastfeeding and explore factors that influence breastfeeding practices among individuals in Tennessee (TN).

Methods: A cross-sectional study was conducted among individuals (N = 1,249). Participants were recruited and data were collected from June – September 2021. The data were entered and analyzed from September 2022 – March 2023. Descriptive statistics, chi-square test, and ANOVA were used to analyze the data and identify associations between variables.

Results: About 32% of the …

Leveraging Academic Health Departments For Place-Based Disaster Response: Lessons From Helene In Western North Carolina, Danny Scalise Ii, Sarah B. Thach, Ellis V. Matheson

Journal of Appalachian Health

This article examines the role of two Academic Health Departments (AHDs) in Buncombe and Burke Counties, North Carolina in responding to Hurricane Helene in 2024. The partnership between local health departments and the UNC Asheville – UNC Gillings Master of Public Health (MPH) Program fostered a place-based approach to public health. After the hurricane disrupted regional infrastructure, the AHDs integrated students and faculty into recovery efforts. This paper identifies key lessons for strengthening public health preparedness through academic-practice partnerships and highlights the importance of embedding education in local contexts.

Understanding Rural Health Through Rae Garringer's Country Queers: A Love Letter, Bradley A. Firchow

Journal of Appalachian Health

Rae Garringer’s Country Queers: A Love Letter examines the experiences of queer individuals in rural America, emphasizing the relationship between place and identity. Through oral histories, the book presents perspectives on community, resilience, and healthcare access. While not centered on medical care, it highlights challenges in obtaining affirming services in rural areas. Garringer’s experience as a standardized patient provides additional context on healthcare gaps. For public health professionals, Country Queers offers insight into the structural and social factors affecting rural LGBTQ2+ populations, contributing to a broader understanding of community health and identity in Appalachia and similar regions.

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 …