Public Health Education and Promotion Commons^™

Vision 2050: India’S Path To Becoming A Global Player, Balasubramanian Mahadevan Dr

Journal Of Indian Physician Associates

This study examines India’s strategic plan to become one of the top three global economies by 2050 through data-driven analysis and comparisons of economic indicators from 2024 to 2050, utilizing data from trusted sources such as the Reserve Bank of India and NITI Aayog. We analyze India’s economic growth in relation to other major emerging economies, focusing on technology, manufacturing, and service sectors. Findings suggest that with strategic policy reforms, investment in innovation, and enhanced infrastructure, India can achieve significant GDP and productivity growth. This article concludes with actionable policy recommendations for local and global stakeholders.

Assessing The Impact: Cerebral Palsy On Domains Of Quality Of Life, Sheetal Malhan

Journal Of Indian Physician Associates

Introduction Cerebral palsy (CP) is characterized by a group of permanent movement and posture disorders resulting from nonprogressive disturbances in the developing fetal or infant brain. CP is a chronic condition affecting approximately 1.2–2.5 per 1000 school-aged children, often accompanied by comorbidities such as visual, auditory, and feeding impairments, delayed language development, and epilepsy. These related challenges can markedly reduce a child’s quality of life (QoL), particularly when compounded by social and environmental limitations. Despite the importance of understanding QoL outcomes in this population, limited region-specific data exist. Understanding domain-specific QoL can guide targeted rehabilitation planning.

Methods A cross-sectional survey …

Social Determinants Of Self-Reported Health In Vulnerable Populations During A Polycrisis In Lebanon, Rindala Fayyad, Marie Elizabeth Ragi, Hala Ghattas Ph.D., Stephen J. Mccall

Faculty Publications

Importance: In the context of a polycrisis, which is characterized by multiple interconnected and mutually reinforcing crises, humanitarian and health needs increase. It is therefore crucial to identify social determinants impacting health and well-being of vulnerable populations to better inform appropriate interventions.

Objective: To assess the association between social determinants and pain frequency, self-rated health, and depression over time among vulnerable populations during a polycrisis in Lebanon.

Design, Setting, and Participants: In this population-based longitudinal cohort study, data were collected in Sin-El-Fil, a suburb of Beirut, Lebanon, in 4 waves: June 28 to October 26, 2022; September 8 to December …

Racially-Motivated Discrimination Distress And Tobacco Use Outcomes Among Adolescents In The United States, Raed A. Bahelah, Osayande Agbonlahor, Bernadette Grayson, Thomas Dobbs

Population Health Science Publications

Introduction

Racism and discrimination are a public health problem. This study aims to examine the association of racially-motivated discrimination distress using the Adolescent Discrimination Distress Index (ADDI) and its subscales – institutional, educational, and peer – with tobacco use outcomes.

Methods

Weighted logistic regression was used to model the effect of discrimination on past 30-day tobacco use, poly-tobacco use, use frequency, tobacco dependence, intention to quit, and history of quit attempt using data from the 2023 National Youth Tobacco Survey.

Results

Approximately 53.9% (> 12 million) of adolescents reported discrimination. Higher ADDI scores were associated with higher odds of tobacco …

High Occurrence Of Long Bone Nonunion : Assessing Significant Biological Risk Factors And Management Results, Bimo Sasono, Aldy Dion

Journal of Health Research

Background: A comprehensive study evaluated the risk of nonunion per fracture in a population of over four million adults and determined that rates vary depending on patients' risk factors, nonunion rates can reach in excess of 10%. This study aims to address the issue by scrutinizing the demographic characteristics of patients, pinpointing the biological risk factors for long bone nonunion and evaluating the nonunion management effectiveness.

Methods: This analytical, observational retrospective cohort study used medical record data from a regional hospital in Surabaya, Indonesia (2020–2023), involving 147 eligible patients. Data were analyzed using logistic regression with a significance level of …

Stay Independent: Enhancing Healthy Aging In Iowa And Louisiana, Sarah L. Francis, Elizabeth Gollub, Savannah Schultz

Journal of Human Sciences and Extension

This evaluation study assessed the impact of Stay Independent participation on topic familiarity and the likelihood of making a recommended behavior change among community-residing older adults. Stay Independent focuses on the nutritional needs of older adults, emphasizing Whole Person Wellness and the Health Belief Model. It was initially created in Iowa for community-residing adults aged 60 and older and has been adapted for cultural appropriateness in Louisiana. Stay Independent is a healthy aging program consisting of six standalone food and health modules. It is offered both virtually and face-to-face (F2F) in Iowa and Louisiana. Participants who attended Stay Independent between …

Undifferentiated Embryonal Sarcoma Of Liver In A Child : A Case Report, Neha Devendra Bhongale, Sumeet Baheti, Poonam Wade, Omkar Khandkar, Meenakshi Balasbramanian

Digital Journal of Clinical Medicine

Background: Undifferentiated Embryonal Sarcoma of liver (UESL) is a rare malignancy of liver originating from primary mesenchymal tissue with overall poor prognosis. Around 220 pediatric cases of UESL have been reported in the literature. The lack of characteristic clinical manifestations, laboratory tests and imaging studies pose a diagnostic challenge and the preoperative misdiagnosis rate is high. Historically, treatment was limited to surgical resection with poor survival rate. In recent times, combination of chemotherapy and surgical resection has improved survival.

Case Presentation: We report a case of undifferentiated embryonal sarcoma of liver in a 6 years old boy who presented …

Implementation Fidelity Of A Smartphone Application For Population-Based General Movement Assessment: The Early Moves Study, Caroline F. Alexander, Sarah E. Hall, Alison Salt, Alicia J. Spittle, Catherine Morgan, Tiffany Grisbrook, Alishum Ali, Natasha Amery, Sue Anne Davidson, Ashleigh Thornton, Mary Sharp, Emily Young, Robert S. Ware, Desiree Silva, Roslyn Ward, Nadia Badawi, Samudragupta Bora, Roslyn N. Boyd, Susan Woolfenden, Catherine Elliott, Jane Valentine

Research outputs 2022 to 2026

Objective: To describe the infant and maternal characteristics of the Early Moves cohort and to assess representativeness to the general population, and to evaluate the implementation fidelity of an application-based collection of General Movement Assessment (GMA) videos at writhing and fidgety age. Study design: Prospective observational study. Mothers who had recently delivered or were enrolled to deliver at maternity hospitals in Perth, Western Australia, were recruited from November 2019 to December 2023. Sociodemographic and infant clinical characteristics were extracted from hospital records. Parents were invited to record GMA videos using the Baby Moves smartphone application, which were assessed for scorability …

Exploring Preferences For Interventions To Increase Active School Transportation Among Children And Adolescents In Australia, Anna Gannett, Paula Hooper, Julie Saunders, Gina Trapp

Research outputs 2022 to 2026

Introduction: The observed decline in children's active school transport (AST) across numerous countries over recent decades necessitates targeted, multi-level interventions to reverse this trend. However, data on young people's preferred AST interventions is lacking. This study aimed to explore children's preferences for AST interventions and assess differences between AST users and non-users among primary and secondary school students. Methods: In 2023, a cross-sectional survey was conducted in Perth, Western Australia with n = 742 primary school students from 23 schools and n = 412 secondary school students from 9 schools. The survey assessed AST frequency, preferred transport mode, and AST …

Healing Right Way: A Stepped Wedge Cluster Randomised Controlled Trial Aiming To Enhance Quality Of Life For Aboriginal Australian Survivors Of Stroke And Traumatic Brain Injury, Elizabeth Armstrong, Tapan Rai, Judith M. Katzenellenbogen, Sandra J. Thompson, Meaghan Mcallister, Natalie Ciccone, Deborah Hersh, Leon Flicker, Dominique A. Cadilhac, Erin Godecke, Graeme J. Hankey, Neil Drew, Colleen Hayward, Deborah Woods, Mel Robinson, Ivan Lin, Sanita Kratina, Jane White, Juli Coffin

Research outputs 2022 to 2026

Objective: To determine the effect of cultural security training (CST) for health professionals and access to an Aboriginal Brain Injury Coordinator (ABIC) for Aboriginal Australians with stroke or traumatic brain injury (TBI). Design: A stepped wedge cluster randomised controlled trial; the intervention package consisted of CST for hospital professionals and 6-month access to ABICs providing education, support, liaison and advocacy; the commencement order of the intervention phase was randomised. Setting: Four urban and four rural hospitals in Western Australia, 2018–2022. Participants: Aboriginal adults ≥ 18 years hospitalised with stroke or TBI. Main Outcome Measures: Primary outcome was quality of life …

Knowledge + Innovation = Power: A Protocol For Implementing Aboriginal Data Sovereignty In An Aboriginal Medical Service For Service Delivery Reform, Emma Haynes, Lesley Nelson, Heather D'Antoine, Judith Katzenellenbogen, Elizabeth Armstrong, Lindey Andrews, Jasmin Brown, Nicole Bowser, Roz Walker, Ingrid Stacey, Jessika Purnomo, Dawn Bessarab

Research outputs 2022 to 2026

Context Comprehensive Primary Health Care (CPHC) is an interconnected, holistic, and strengths-based health and wellbeing approach fundamental to Aboriginal Community Controlled Health Organisations (ACCHOs) in Australia. However, policy and funding trends increasingly threaten the capacity of ACCHOs to deliver CPHC by imposing burdensome administrative and accountability requirements. A central constraint is the marginalisation of culturally informed data measures and tools that could enable improved development, implementation, evaluation and reporting of CHPC services and programs. To mitigate this, ACCHOs must be enabled to take charge of collecting and using meaningful data to increase self-determination and drive impactful policy and service delivery. …

Food Insecurity And Social Connection Of Nicaraguan Refugees And Asylum Seekers In Costa Rica: A Qualitative Study, Keren Herran

Theses and Dissertations

Background

Given the physical and mental health consequences of food insecurity, solutions should be evidence-based and seek to prioritize vulnerable populations. This qualitative study adds to limited literature on how refugees and asylum seekers use their social connections to mitigate food insecurity by investigating how Nicaraguan refugees and asylum seekers in Costa Rica foster social connections and use these connections to acquire and manage food.

Methods

In fall 2024, 35 in-depth semi-structured interviews were conducted in San José, Costa Rica. Participants were recruited through six migrant-serving nonprofit organizations. For study inclusion, participants had to: 1) be 18 or older; 2) …

Fit For Success: Exploring Physical Activity Promotion And Effects On Students At The University Of South Carolina Through A Podcast Series, Maia Schwarzmueller

Senior Theses

College students face unique challenges when trying to maintain physical activity levels, such as time constraints, stress, and lack of proper facilities. The Fit for Success podcast will explore how physical activity is a powerful tool towards enhancing self-perception, academic success, and stress management as well as delve into the specific barriers that University of South Carolina students face to physical activity. The podcast will also explore different aspects of physical activity promotion including group fitness, competition, and built environment. The goal of the podcast is to help students to see physical activity as an important component of many facets …

Evaluating The Impact Of The ‘Blow, Breathe, Cough’ Health Promotion Intervention In Resolving Otitis Media With Effusion In Children: An Adaptive Randomized-Controlled Trial Protocol, Jaimee R. Rich, Michael Dymock, Elke J. Seppanen, Elena Montgomery, Tanisha Cayley, Tamara Veselinović, Greta Bernabei, Anri Lester, Amy Hannigan, Nicole Irvine, Kerryn Gidgup, Edna Ninyette, Steph Bray, Tu Trang Tran, Valerie M. Swift, Melinda Edmunds, Natalie Strobel, Daniel Mcaullay, Julie Marsh, Evelyn Tay, Lea Ann S. Kirkham, Ruth B. Thornton, Robyn S.M. Choi

Research outputs 2022 to 2026

Introduction: Otitis media with effusion (OME) affects hearing, speech development, and quality of life (QoL) in children. The ‘Blow, Breathe, Cough’ (BBC) intervention promotes nasal, respiratory, and middle ear clearance through nose blowing, deep breathing, coughing, and hand hygiene. It shows promise in resolving OME but lacks randomized-controlled trial (RCT) evaluation. This paper presents a RCT protocol evaluating BBC's effect on OME resolution, hearing, speech, and QoL in children aged two to seven years. Methods: This parallel-group, 1:1, outcome assessor-blinded, individual adaptive RCT investigates whether completing the BBC intervention plus hand hygiene twice-daily at home increases OME resolution after 4-to-6 …

Focus Group Interview: Perspectives Of Virtual Dietary Counseling Method’S Post Covid-19 Pandemic, Maria Mendoza

Journal of the Symposium of University Research and Creative Expression

Project Mentor(s): Nicole Stendell-Hollis, PhD; Tafere Belay, PhD; Katy Williams; Jessica Tyrrell

The purpose of this study is to examine the perceptions related to different delivery methods of dietary counseling. This qualitative research study will examine the perceptions related to different methods of dietary counseling (telephone calls, video calls, or face-to-face visits). Focus group one contained provider participants (N = 7), which were all RDNs and focus group two hosted patient participants (N = 6). Semi structured interviews were performed asking subjects about any personal experiences related to receiving or providing nutrition education, positive or negative, as they participated in …

Dermatological Primary Health Care Services For Older Adults In Thailand, Chinmanat Lekhavat, Jiruth Sriratanaban

Journal of Health Research

Background: The increasing population aging worldwide poses challenges to accessibility to dermatological care, especially in rural areas with limited dermatologist availability. Establishing dermatological primary health care (PHC) services for older adults is crucial for improving access, efficiency, and equity. However, no study has systematically explored such a system.

Method: This mixed-methods study employed a participatory action research (PAR) model to identify structural and procedural requirements, patient journeys, health needs, and expectations. Data were collected through focus groups, in-depth interviews, and surveys. Design thinking workshops, guided by PAR principles, were used to develop dermatological PHC services. A survey was conducted across …

Opportunities And Barriers To Engaging Caregivers In Firearm Suicide Prevention: Findings From Focus Groups With Caregivers Of Veterans., Katherine Macwilliams, John Marmion, Dee Blascyk, Sharon Urbina, Rachel Moyers, Gala True

School of Medicine Faculty Publications

Background: Firearms are involved in more than 70% of U.S. Veteran suicides. Caregivers, defined as family members or concerned significant others, can play an important role in firearm suicide prevention through initiating conversations about secure firearm storage with Veterans. Our objective was to explore caregivers' experiences with lethal means safety (LMS) conversations and identify perceived barriers to caregivers discussing LMS with healthcare providers and with Veterans. Methods: We conducted focus groups with 32 caregivers with experience caring for a Veteran at risk for suicide. Qualitative data were analyzed using thematic analysis. Results: We identified three primary themes: 1) caregivers recognize …

Parental Expectations Of Pediatric Care For Children, Brenan T. Cash, Jacquelyn D. Wiersma-Mosley, Donia Timby, Laura Herold

Discovery, The Student Journal of Dale Bumpers College of Agricultural, Food and Life Sciences

Access to childhood pediatrics is a major factor for a full and healthy childhood for all children from adolescence to adulthood. However, the physical health aspect has been the main focus of most primary care clinics, and there is little focus on mental health. Mental health issues, which involve anxiety, depression, and post-traumatic stress, are more prominent than they have ever been, as up to 30% of children have experienced mental health issues that involve post-traumatic stress disorder, especially during the pandemic years. This study employed a non-experimental, quantitative analysis utilizing online closed-ended survey questions. Caretakers were offered an anonymous, …

Regional Disparities In The Diagnostic Age Of Skin Carcinomas: An Analysis Of The Rio Grande Valley, Miguel A. Lopez, Natasha Quailes, Elias Arellano Villanueva, Maria Villegas

Research Colloquium

The Rio Grande Valley (RGV) is a region of South Texas with limited dermatologic diagnostic data, particularly among non-melanoma skin carcinomas. The rising rates of chronic conditions and mortality can be attributed to the limited access to healthcare in the region, with skin conditions taking less priority in patients with numerous comorbidities. Data on the age of diagnosis for skin carcinomas between 1995-2019 for Hispanic and non-Hispanic individuals was obtained from the Texas Cancer Registry. It is important to note that the TCR considers primary skin cancers, such as basal and squamous cell carcinoma coded as C44.0-C44.9, as non-reportable cases. …

Continuous Glucose Monitoring Versus Self-Monitoring For Patients With Type 1 Diabetes: A Systematic Review And Meta-Analysis, Prayuth Poowaruttanawiwit, Kwanchai Rattanamanee, Nonnachanok Chaiyot, Saranpreeya Srisinroongruang

The Thai Journal of Pharmaceutical Sciences

Background: Patients with type 1 diabetes mellitus (T1DM) require intensive glucose monitoring to achieve optimal glycemic control and prevent complications. While self-monitoring of blood glucose (SMBG) has long been the standard approach, continuous glucose monitoring (CGM) offers real-time data and trend analysis that may enhance clinical decision-making.

Objective: This study aimed to evaluate whether CGM provides superior glycemic outcomes compared with SMBG in individuals with T1DM.

Materials and Methods: A systematic review and meta-analysis were conducted following preferred reporting items for systematic reviews and meta-analyses guidelines. Four randomized controlled trials involving T1DM patients using either CGM or SMBG were included. …

Inovasi Aplikasi Adhimukti Brata Care Stunting Berbasis Appsheet Untuk Pendataan Status Gizi Anak Di Kabupaten Banggai, Moh. Saputra Tambora, Imelda Hutasoit

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

Stunting merupakan masalah kesehatan serius di Indonesia, termasuk di Kabupaten Banggai dengan prevalensi 29,1% pada tahun 2023. Keterlambatan intervensi sering terjadi akibat keterbatasan data gizi anak yang akurat, terbaru, dan mudah diakses. Penelitian ini bertujuan mendeskripsikan pengembangan Aplikasi Adhimukti Brata Care Stunting berbasis AppSheet sebagai solusi pendataan gizi anak secara real-time. Metode yang digunakan adalah research and development (R&D) dengan model prototyping, meliputi tahap analisis kebutuhan, perancangan, implementasi, uji coba teknis, dan penyempurnaan. Data diperoleh dari hasil uji coba aplikasi, observasi proses input, serta masukan pengguna awal yaitu petugas DP2KBP3A, PKB, dan kader posyandu. Hasil pengembangan menunjukkan aplikasi …

Geographic Disparities In Birth Outcomes: County-Level Investigation On Pm2.5 And Low Birth Weight In The United States, Eunice Y. Park, Ranju Mainali

Department of Public Health Scholarship and Creative Works

Exposure to air pollution adversely affects health and is highly associated with birth outcomes. This study analyzes the relationship between air pollution and low birth weight (LBW; less than 2,500 g at birth) at the county level in the United States. Using the latest publicly available data from the County Health Rankings and Roadmaps across 3,027 counties and equivalents, simple and quantile regression analyses were conducted to test the association between the average daily density of fine particulate matter (PM2.5) and LBW. The LBW data were from 2016 to 2022 from the National Center for Health Statistics and PM2.5 data …

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.

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

Journal of Appalachian Health

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

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

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

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

Journal of Appalachian Health

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

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

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

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

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

Journal of Appalachian Health

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

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

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

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

Journal of Appalachian Health

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

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

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

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

Journal of Appalachian Health

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

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

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

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

Journal of Appalachian Health

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

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