Social and Behavioral Sciences Commons^™

Introducing The L.A.U.N.C.H. Collaborative, F. Douglas Scutchfield Md, Kevin Patrick

Journal of Appalachian Health

The L.A.U.N.C.H. Collaborative: Linking & Amplifying User-Centered Networks through Connected Health: A Demonstration of Broadband-Enabled Connected Health and Community-Based Co-Design brings together a group of organizations that are eager to use Appalachian Kentucky as a site for the development of a project aimed at creating an environment that addresses two of the nation’s major concerns about cancer. First, individuals who live in rural and remote areas are more likely to die of cancer than those who live in urban or suburban settings. And second, geographic obstacles hinder their ability to access evidence-based strategies that can prevent cancer or treat it …

Adult Food Security And The Relationship With Adverse Childhood Experiences Among Residents Of Appalachian North Carolina, Manan Roy, Erin Bouldin, Maggie Bennett, Adam Hege

Journal of Appalachian Health

Introduction: The Appalachian region has worse health outcomes than the remainder of the United States. These disparities are often linked to the underlying social and environmental determinants of health. Adverse childhood experiences (ACEs) are associated with poor health outcomes across the lifespan and have a significant impact on future social determinants as an adult, including food security status.

Purpose: To explore the relationships between ACEs and food security among adults in the Appalachian counties of North Carolina and make comparisons with the rest of the state.

Methods: Researchers used North Carolina’s 2012 Behavioral Risk Factor Surveillance System data; namely, …

Roanoke's Collective Public Health Activities, Michael Lytton

Journal of Appalachian Health

Roanoke is addressing problems that confront many small and medium sized cities in the U.S., especially disparities in health and life expectancy between neighborhoods. These disparities are often legacies of decades of racial and economic segregation, resulting in low-income or disinvested communities. Typically, such neighborhoods have fewer parks, higher vacancy rates and less stable affordable housing stock, inadequate public transit systems, too few clinics, too many fast food restaurants and insufficient access to high quality schools. In Roanoke these are the northwest and southeast quadrants, both federally designated Medically Underserved Areas, and characterized by a large proportion of the city’s …

Locating Gender In Rural Economic Networks, Ann M. Oberhauser

Ann Oberhauser

In recent decades, increasing entrepreneurial activities among women have contributed to shifting livelihood strategies at the household, community, and regional scales. In this paper I examine home based work in an economic network to highlight the intersection of gender and economic practices in rural Appalachia. The research demonstrates that these livelihood strategies both construct and are shaped by dynamic material conditions and social processes in place. Economic restructuring in the central Appalachian region has led to the reworking of economic strategies, despite a continued reliance by households on homework and informal activities. The case study for this project as an …

A Legacy Of Disease, Arthur L. Frank

Journal of Appalachian Health

In Appalachia, like much of America, there are important health issues that have not always been appropriately predicted or dealt with when they occur. Lifestyle issues in Appalachia lead to obesity and heart disease, not surprisingly due to extensive use of sugary drinks. The current opioid crisis could have been better predicted given the trauma of mining and the past abuse of less-potent narcotics. A continuing major problem in the whole country is inadequate support for preventive health activities.

Using Mini-Grants To Build Multi-Sector Partnerships In Rural Tennessee, Ginny Kidwell, Kristine Bowers, Taylor M. Dula, Randolph F. Wykoff

Journal of Appalachian Health

Rural counties in Tennessee, including those located in Appalachia, face some of the greatest health challenges in the nation. Unpublished data collated by the East Tennessee State University College of Public Health (ETSU) show that Tennessee’s 52 Appalachian counties vary dramatically from its 43 non-Appalachian counties in virtually all socioeconomic, behavioral, and health outcome metrics. Since 2011, the Tennessee Institute of Public Health (TNIPH) has actively encouraged local communities to address behavior change, enhance educational achievement, and improve economic conditions as essential components for improving health and well-being in rural Tennessee.

Improving Access To Addiction Recovery Care In Central Appalachia Through Organizational Collaboration, Katy Stigers

Journal of Appalachian Health

Fahe, a Network of 50+ members throughout Appalachia based in Berea KY, has brought together a coalition to finance, build, and manage several addiction recovery care centers across Kentucky and West Virginia, increase access to employment, and deploy vouchers for supportive services.

Investigating The Impact Of The Diseases Of Despair In Appalachia, Michael Meit, Megan Heffernan, Erin Tanenbaum

Journal of Appalachian Health

Introduction: Appalachia is one of the regions most significantly impacted by the opioid crisis. This study investigated mortality due to diseases of despair within the Appalachian Region, with an additional focus on deaths attributable to opioid overdose.

Methods: Diseases of despair include: alcohol, prescription drug and illegal drug overdose, suicide, and alcoholic liver disease/cirrhosis of the liver. Mortality data from the National Center for Health Statistics (NCHS) National Vital Statistics System (NVSS) Multiple Cause of Death database were analyzed for this study, focusing on individuals aged 15–64.

Results: Over the past two decades, the mortality rate due to diseases of …

Root Causes Of Appalachia’S Deaths Of Despair, F. Douglas Scutchfield Md

Journal of Appalachian Health

The U.S. is experiencing a decline in life expectancy, particularly among rural white males in their most productive years. Appalachia is disproportionally represented in mortality rates, accounting for 30% of the U.S. population, but 50% of the excess mortality attributed to the “deaths of despair”: drug overdose, suicide, and alcoholic cirrhosis. A substantial proportion of that excess mortality is related to the current opioid crisis we are experiencing. We have data on evidence-based solutions to the treatment of addiction, but little information on prevention of addiction as well as the other deaths of despair, likely with the same etiologic agent. …

The Farmers’ Federation: Regional Racial Mythologies As Agricultural Capital, Jama Mcmurtery Grove

Graduate Theses and Dissertations

In 1927, the Farmers’ Federation agricultural cooperative in Western North Carolina launched an organization to solicit funds from wealthy donors. The money raised through philanthropic campaigns enabled the cooperative to fund large-scale agricultural projects, which helped members navigate the dramatic agricultural transformations of the early twentieth century. Although the cooperative advocated a progressive program of business-minded, scientific farming, its leadership modified programs to reflect farmer members’ limited resources and the realities of mountain production. As a result, the co-op provided a crucial bridge between white farmers and new methods of agricultural production that reached deep into peoples’ familial and productive …

Dusty Shoes: Appalachia Wisdom Fertilizing The Future Of Religious Leadership, Jill Crainshaw

Journal of Appalachian Health

Dust from their journeys through the hills and hollows of Appalachia clings to their shoes and has forever shaped their vocational journeys. This is a refrain I have distilled from the reflections of students who have participated in Wake Forest University School of Divinity’s multicultural contexts course that includes a 10-day sojourn in the mountains of North Carolina.

Identifying Priority And “Bright-Spot” Counties For Diabetes Preventive Care In Appalachia: An Exploratory Analysis, Peter J. Mallow, Michael Topmiller, Jennifer Rankin, Jene Grandmont, David Grolling, Jessica L. Mccann, Mark Carrozza

Journal of Appalachian Health

Introduction: Type 2 diabetes mellitus (T2DM) prevalence and mortality in Appalachian counties is substantially higher when compared to non-Appalachian counties, although there is significant variation within Appalachia.

Purpose: The objectives of this research were to identify low-performing (priority) and high-performing (bright spot) counties with respect to improving T2DM preventive care.

Methods: Using data from the Centers for Medicare and Medicaid (CMS), the Dartmouth Atlas of Health Care, and the Appalachia Regional Commission, conditional maps were created using county-level estimates for T2DM prevalence, mortality, and annual hemoglobin A1c (HbA1c) testing rates. Priority counties were identified using the following criteria: top 33rd …

The Social Determinants Of Health And The Decline In U.S. Life Expectancy: Implications For Appalachia, Steven H. Woolf, Heidi Schoomaker, Latoya Hill, Christine M. Orndahl

Journal of Appalachian Health

For the past century, life expectancy in industrialized countries has increased, and the U.S. has shared in that progress. However, beginning in the 1980s, advances in U.S. life expectancy began to lose pace with peer countries. By 1998, U.S. life expectancy had fallen below the average for Organisation for Economic Cooperation and Development nations. U.S. life expectancy peaked in 2014 and has been decreasing for three consecutive years, a trend not been seen since the influenza pandemic a century ago. Put simply, U.S. health is in decline.

An Economic Analysis Of The Appalachian Coal Industry Ecosystem: Summary Report, Randall W. Jackson, Eric Bowen, Christiadi, John Deskins, Brian Lego, Péter Járosi, Mark L. Burton, Rebecca J. Davis, Charles Simms, Matthew Murray, Péter Schaeffer

Appalachian Coal Industry Ecosystem

The decline in the demand for coal has led to significant negative impacts in areas throughout Appalachia. Consider the integrated effects across components of the coal industry ecosystem (CIE). As extraction activity is diminished, there are ripples through the industry supply chain that extends to a wide number of sectors, occupations, and county and multi-county regions of the Appalachian economy. As these suppliers are impacted, jobs are imperiled, and the fiscal health of communities i s weakened. Displaced workers will need to seek alternative employment opportunities that may entail investments in formal education and training, and this takes both time …

An Overview Of The Coal Economy In Appalachia, Eric Bowen, Christiadi, John Deskins, Brian Lego

Appalachian Coal Industry Ecosystem

This report notes that coal production in the Appalachian Region fell nearly 45 percent between 2005 and 2015, more than double the rate of the national decline during the same period. It outlines how regional coal production losses intersect with regional data on employment and unemployment, population and labor force, income and poverty, and education and health in Appalachia’s subregions.

Transportation Implications Of Coal, Mark L. Burton, David B. Clarke

Appalachian Coal Industry Ecosystem

This report describes the direct economic relationship between the coal and railroad industries in Appalachia. It finds that between 2015 and 2016, changing electric generation strategies—including accelerated coal-powered plant retirements—combined with a downturn in coal demand contributed to losses of nearly 2,000 full-time jobs and $150 million in income across Appalachia’s railroad sector.

County-Level Cie Supply Chain Analysis, Randall Jackson, Peter Jarosi

Appalachian Coal Industry Ecosystem

This report examines the impact of the decline in coal production on supply chain industries at the county level across Appalachia. It offers, and uses, a typology to classify counties based on their dependence on the CIE, recent employment changes due to reduced coal production, and their risk for further impacts due to any future declines in the coal industry.

The Economic Impacts And Risks Associated With Electric Power Generation In Appalachia, Eric Bowen, Christiadi, Rebecca J. Davis, John Deskins, Charles Sims

Appalachian Coal Industry Ecosystem

This report provides a detailed examination of the economic impacts of changes in electric power generation in Appalachia between 2005 and 2015. It finds that while coal represented around 74 percent of total electric generation in Appalachia in 2005, that percentage dropped to 53 percent in 2015. However, despite this decline, Appalachia remains more dependent on coal for electricity generation when compared with the rest of the country. This report also offers a risk factor analysis for coal-fired generation retirements and repowerings, and notes that coal prices have little influence on coal-fired power plant retirement decisions.

Human Capital And The Cie, Matthew Murray, Péter Schaeffer

Appalachian Coal Industry Ecosystem

This report explores two economic issues in Appalachia: future employment prospects for coal workers and changes in funding for K–12 education. The first part of the report identifies occupations that may be affected by losses in the coal industry ecosystem and offers state-by-state analyses comparing these impacted occupations to similar occupations in other industries. These analyses suggest other industries where former coal industry workers might find alternative employment opportunities. The second part of the report discusses how the changing coal economy may be impacting public funding for K–12 education at the state and local levels. It finds declines in both …

The Effect Of Health Care Entrepreneurship On Local Health: The Case Of Medexpress In Appalachia, Amir Borges Ferreira Neto, Joshua C. Hall

Regional Research Institute Working Papers

We test the hypothesis that the opening of an Urgent Care Center (UCC) has positive impacts on the local community. There are several mechanisms through which a UCC can have an impact: lower health care costs, emergency room decongestion, and improved access to medical information. We examine the entry of MedExpress into Appalachian counties between 2001 and 2013. Employing data from Health Resources Files, which provides information for all counties for specific years, we use Propensity Score Matching to create a year 2000 control group for the counties “treated” by MedExpress entry beginning in 2001. We then employ a standard …

Financial Literacy In Local At-Risk Appalachia, Elijah R. Osborne

Undergraduate Honors Theses

Unfortunately, rural Appalachia is perennially one of the poorest areas of the United States. Many scholars have offered opinions as to why this trend of poverty continues in this region, but one potential cause has not been the subject of much research: do residents in Appalachia have a functional knowledge of the financial system, or even a simple understanding of basic savings, which is necessary for achieving certain levels of financial security?

We conduct a survey modeled after a national study which measures basic financial literacy in local Appalachia, expecting to find that at-risk Appalachians would have less financial literacy …

The Effect Of Health Care Entrepreneurship On Local Health: The Case Of Medexpress In Appalachia, Amir B. Neto, Joshua C. Hall

Economics Faculty Working Papers Series

We test the hypothesis that the opening of an Urgent Care Center (UCC) has positive impacts on the local community. There are several mechanisms through which a UCC can have an impact: lower health care costs, emergency room decongestion, and improved access to medical information. We examine the entry of MedExpress into Appalachian counties between 2001 and 2013. Employing data from Health Resources Files, which provides information for all counties for specific years, we use Propensity Score Matching to create a year 2000 control group for the counties “treated” by MedExpress entry beginning in 2001. We then employ a standard …

A Spatial Analysis Of Supplemental Nutrition Assistance Program And Economic Conditions In The Appalachian Region, Nyakundi M. Michieka, Archana Pradhan, Tesfa Gebremedhin

Regional Research Institute Working Papers

Supplemental Nutrition Assistance Program (SNAP) helps low income people and families buy food they need for good health. The main objective of this study is to examine the effects of changes in the economic conditions and welfare on SNAP participation in the Appalachian region. The study employs county level data to capture variation in SNAP participation. Spatial econometric models are developed to examine the relationship among the economic and business cycle conditions, changes in welfare reforms, demographic and household attributes, institutional factors, and SNAP participation. The findings from this study could be helpful in improving welfare programs in this region.

An Empirical Analysis Of The Interactions Between Environmental Regulations And Economic Growth, Chali Nondo, Peter V. Schaeffer, Tesfa Gebremedhin, Jerald J. Fletcher

Regional Research Institute Working Papers

The purpose of this research is to examine the relationship between environmental regulation and economic growth. A four-equation regional growth model is used to analyze the simultaneous relationships among changes in population, employment, per capita income, and environmental regulations for the 410 counties in Appalachia. Our results reveal that initial conditions for environmental regulation are negatively related to regional growth factors of change in population, per capita income, and total employment. From this, we infer that the diversion of resources from production and investment activities to pollution abatement is inadvertently transmitted to other sectors of the economy—thereby resulting in a …

Lung Cancer Mortality Is Elevated In Coal Mining Areas Of Appalachia, Michael Hendryx, Kathryn O'Donnell, Kimberly Horn

Regional Research Institute Working Papers

Previous research has documented increased lung cancer incidence and mortality in Appalachia. The current study tests whether residence in coal mining areas of Appalachia is a contributing factor. We conducted a national county-level analysis to identify contributions of smoking rates, socioeconomic variables, coal mining intensity and other variables to age-adjusted lung cancer mortality. Results demonstrate that lung cancer mortality for the years 2000-2004 is higher in areas of heavy Appalachian coal mining after adjustments for smoking, poverty, education, age, sex, race and other covariates. Higher mortality may be the result of exposure to environmental contaminates associated with the coal mining …

County-Level Determinants Of Local Public Services In Appalachia: A Multivariate Spatial Autoregressive Model Approach, Gebremeskel H. Gebremariam, Tesfa Gebremedhin, Peter V. Schaeffer

Regional Research Institute Working Papers

A multivariate spatial autoregressive model of local public expenditure determination with autoregressive disturbance is developed and estimated in this paper. The empirical model is developed on the principles of utility maximization of a strictly quasi concave community utility function. The existence of spatial interdependence is tested using Moran’s I statistic and Lagrange Multiplier test statistics for both the spatial error and spatial lag models. The full model is estimated by efficient GMM following Kelejian and Prucha’s (1998) approach using county-level data from 418 Appalachian counties. The results indicate the existence of significant spillover effects among local governments with respect to …

Modeling Small Business Growth, Migration Behavior, And Household Income In Appalachia: A Spatial Simultaneous Equations Approach, Gebremeskel H. Gebremariam, Tesfa Gebremedhin, Peter V. Schaeffer

Regional Research Institute Working Papers

In this paper, a spatial simultaneous equations model of business growth, migration behavior and median household income is empirically estimated. The empirical simultaneous model is developed from the equilibrium relationships among these variables where each variable is assumed to adjust to its equilibrium level with a substantial lag through a partial equilibrium adjustment process. We use Generalized Spatial Three-Stage Least Squares estimator to estimate the empirical model using data from 418 Appalachian counties for 1990- 2000. The results suggest the existence of very strong interdependences among business growth, migration behavior and median household income in the form of feed-back simultaneities, …

An Empirical Analysis Of County-Level Determinants Of Small Business Growth And Poverty In Appalachia: A Spatial Simultaneous-Equations Approach, Gebremeskel H. Gebremariam, Tesfa Gebremedhin, Peter V. Schaeffer

Regional Research Institute Working Papers

A spatial simultaneous-equations growth equilibrium model estimated by GS2SLS and GS3SLS estimators is used to determine the interdependence between small business growth and poverty. The parameter estimates are mostly consistent with the theoretical expectations. The coefficients for the endogenous variables of the model are positive and significant indicating strong interdependence (feedback simultaneity) between small business and median household income growth rates. The results also show the presence of spatial autoregressive lag simultaneity and spatial cross-regressive lag simultaneity, with respect to both small business and median household income growth rates, and the existence of spatial correlation in the error terms. In …

Locating Gender In Rural Economic Networks, Ann M. Oberhauser

Regional Research Institute Working Papers

In recent decades, increasing entrepreneurial activities among women have contributed to shifting livelihood strategies at the household, community, and regional scales. In this paper I examine home based work in an economic network to highlight the intersection of gender and economic practices in rural Appalachia. The research demonstrates that these livelihood strategies both construct and are shaped by dynamic material conditions and social processes in place. Economic restructuring in the central Appalachian region has led to the reworking of economic strategies, despite a continued reliance by households on homework and informal activities. The case study for this project as an …

Quicksand Craft Center: Documentation & Analysis Of A Handweaving Program In Vest, Kentucky, Deborah Champion

Masters Theses & Specialist Projects

Data on the handweaving program at the Quicksand Craft Center in the Appalachian Mountains of Eastern Kentucky were compiled and analyzed. Four areas--history of the craft program, business organization and financial structure, weave patterns of goods woven and sold by the craft center, and weavers employed in the program --were examined to assess the success of the program in the local community. Factors in the four areas examined contributed to the success of the program. The benevolence, perseverance, and co-operation of the founders, directors and community members involved with the craft center have been largely responsible for the continued success …