Social and Behavioral Sciences Commons^™

“We’Re, Like, The Most Unhealthy People In The Country”: Employing An Equity Lens To Reduce Barriers To Healthy Food Access In Rural Appalachia, Kathryn Cardarelli, Emily M. Dewitt, Rachel Gillespie, Heather Norman-Burgdolf, Natalie Jones, Janet Tietyen Mullins

Dietetics and Human Nutrition Faculty Publications

Introduction

Obesity disproportionately affects rural communities, and Appalachia has some of the highest obesity rates in the nation. Successful policy, systems, and environmental (PSE) interventions to reduce obesity must reflect the circumstances of the population. We used a health equity lens to identify barriers and facilitators for healthy food access in Martin County, Kentucky, to design interventions responsive to social, cultural, and historical contexts.

Methods

We conducted 5 focus groups in Martin County, Kentucky, in fall 2019 to obtain perspectives on the local food system and gauge acceptability of PSE interventions. We used grounded theory to identify perceived barriers and …

Preterm Birth Prevention In Appalachian Kentucky: Understanding Barriers And Facilitators Related To Transvaginal Ultrasound Cervical Length Surveillance Among Prenatal Care Providers, Anna Hansen, Mairead E. Moloney, Cynthia Cockerham-Morris, Jing Li, Niraj R. Chavan

Sociology Faculty Publications

Background: Appalachian Kentucky has higher-than-average rates of preterm birth (PTB)—a health disparity associated with increased maternal and fetal/neonatal morbidity and neonatal mortality. Transvaginal ultrasound (TVU) cervical length measurement is the best predictor of PTB risk, but is underutilized in Appalachia. This study explores prenatal care providers' TVU-related knowledge and practices, and identifies barriers and facilitators, which impact the adoption of this evidence-based technology.

Materials and Methods: This study recruited providers from three Appalachian Kentucky health care sites. Prenatal care providers took part in semistructured interviews and completed brief survey scales. Questions focused on PTB knowledge, TVU-related barriers, and suggestions for …

Clinician Identified Barriers To Treatment For Individuals In Appalachia With Opioid Use Disorder Following Release From Prison: A Social Ecological Approach, Amanda M. Bunting, Carrie B. Oser, Michele Staton, Katherine S. Eddens, Hannah K. Knudsen

Sociology Faculty Publications

Background: The non-medical use of opioids has reached epidemic levels nationwide, and rural areas have been particularly affected by increasing rates of overdose mortality as well as increases in the prison population. Individuals with opioid use disorder (OUD) are at increased risk for relapse and overdose upon reentry to the community due to decreased tolerance during incarceration. It is crucial to identify barriers to substance use disorder treatment post-release from prison because treatment can be particularly difficult to access in resource-limited rural Appalachia.

Methods: A social ecological framework was utilized to examine barriers to community-based substance use treatment among individuals …

Mental Health Treatment Seeking Patterns And Preferences Of Appalachian Women With Depression, Claire Snell-Rood, Emily Hauenstein, Carl G. Leukefeld, Frances Feltner, Amber Marcum, Nancy E. Schoenberg

Behavioral Science Faculty Publications

This qualitative study explored social-cultural factors that shape treatment seeking behaviors among depressed rural, low-income women in Appalachia—a region with high rates of depression and a shortage of mental health services. Recent research shows that increasingly rural women are receiving some form of treatment and identifying their symptoms as depression. Using purposive sampling, investigators recruited 28 depressed low-income women living in Appalachian Kentucky and conducted semistructured interviews on participants’ perceptions of depression and treatment seeking. Even in this sample of women with diverse treatment behaviors (half reported current treatment), participants expressed ambivalence about treatment and its potential to promote recovery. …

Aging In Rural Appalachia: Perspectives From Geriatric Social Service Professionals, Natalie D. Pope, Diane N. Loeffler, D. Lee Ferrell

Social Work Faculty Publications

This paper uses qualitative methodology to explore the experience of growing old in rural Appalachia. Given the growing population of older adults seeking and utilizing services, it is important to understand the challenges and specific needs related to aging. Within the context of rural Appalachia, these challenges and needs may be different than those in urban areas or areas outside of the region itself. From interviews with 14 geriatric service providers in rural southeast Ohio, the authors were able to identity three prevalent themes associated with aging in rural North Central Appalachia: scarcity of resources, valuing neighbors and family, and …

Notes On Poverty Traps And Appalachia, Steven Durlauf

University of Kentucky Center for Poverty Research Discussion Paper Series

In these notes, I provide some general ideas on how to conceptualize poverty traps and speculate on their applicability to understanding Appalachian poverty. My goal is to stimulate thinking on Appalachia that exploits contemporary perspectives in economics on the sources of persistent poverty and inequality. To do this, I focus on both the theory of poverty traps as well as issues in the econometric assessment of their empirical salience.

Family Change And Poverty In Appalachia, Daniel Lichter, Lisa Cimbulak

University of Kentucky Center for Poverty Research Discussion Paper Series

The current economic and political climate provides a vivid contrast with the circumstances of the 1990s, when the passage of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) ushered in welfare reform during a period of unprecedented economic expansion and job growth (Blank 2002; Ziliak 2009). This legislation sought to “end the dependence of needy parents on government benefits by promoting job preparation, work, and marriage.” Among PRWORA’s goals were to reduce out-of-wedlock births and encourage the formation of two-parent families. For most states, much of the initial emphasis on self-sufficiency was placed on “work first” programs (i.e., …

Down From The Mountain: Skill Upgrading And Wages In Appalachia, Christopher Bollinger, James P. Ziliak, Kenneth R. Troske

University of Kentucky Center for Poverty Research Discussion Paper Series

Despite evidence that skilled labor is increasingly concentrated in cities, whether regional wage inequality is predominantly due to differences in skill levels or returns is unknown. We compare Appalachia, with its wide mix of urban and rural areas, to other parts of the U.S., and find that gaps in both skill levels and returns account for the lack of high wage male workers. For women, skill shortages are important across the distribution. Because rural wage gaps are insignificant, our results suggest that widening wage inequality between Appalachia and the rest of the U.S. owes to a shortage of skilled cities.

Socioeconomic Status, Child Health, And Future Outcomes: Lessons For Appalachia, Janet Currie

University of Kentucky Center for Poverty Research Discussion Paper Series

Appalachians are in poor health relative to other Americans. For example, the ageadjusted all cause mortality rate for Appalachian in 2006 was over 900 per 100,000 compared to a rate of 760 per 100,000 for those outside of Appalachia. This essay shows that health disparities start before birth—the incidence of low birth weight is 90 1,000 in rural Appalachia compared to 83 per 1,000 outside the U.S. These disparities continue through childhood and into adulthood. Moreover, although African Americans are generally in poorer health relative to white Americans, disparities between Appalachia and the rest of the U.S. are much greater …

Inequality And Human Capital In Appalachia: 1960-2000, Dan Black, Seth Sanders

University of Kentucky Center for Poverty Research Discussion Paper Series

This paper examines changes in the earnings distribution of men age 25-64 between 1960 and 2000 in Appalachia and in the remainder of the U.S. Because Appalachia is more rural than the remainder of the U.S. we also examine changes in the earnings distribution in rural vs. urban areas. Our central finding is that there have been large differences in the evolution of the earnings distribution in rural vs. urban areas and this is the principal reason that Appalachia’s earnings distribution differs to some degree from the remainder of the U.S. We find that the bottom of the earnings distribution …

Cities, Economic Development, And The Role Of Place-Based Policies: Lessons For Appalachia, Matthew Kahn

University of Kentucky Center for Poverty Research Discussion Paper Series

This paper surveys economic research on the association between economic development and urban areas, links this summary to some important trends in economic outcomes in Appalachia in recent decades, highlights areas in need of future research on the role of urban areas as engines of economic development in Appalachia, and discusses what types of place-based policies might be effective to promote economic growth and development in the Appalachian region.