Inequality and Stratification Commons^™

Examining The Intersection Of Environmental Justice, Chronic Disease, And Pandemics; How A Mobile Health App Could Improve Health Outcomes And Inform Policy, Jessica Snow

Master's Projects and Capstones

The purpose of this paper is to analyze the intersection of environmental justice, chronic disease and illness, and pandemics. The inequitable distribution of polluting factories, landfills, and hazardous waste sites have been a long-standing concern in the field of environmental justice. Local zoning codes and land use policies have been tools for segregating people and concentrating pollution in low-income communities and communities of color. Many studies have found that pollution varies among racial and minority groups, and the burden of pollution is not one that is evenly shared. Communities of color and low income communities are disproportionately affected by air …

Listening To Voices In Appalachia: Gathering Wisdom From The Field About Substance-Abuse Recovery Ecosystems, Bruce Behringer

Journal of Appalachian Health

New qualitative data collected through six regional community-based listening sessions and community meetings are presented that describe elements of the Appalachian Regional Commission’s Recovery Ecosystem Model. These data informed the Model, which was used in formulating the new ARC Recovery-to-Work initiative. Input was intentionally solicited from multiple sectors, including persons recovering from substance abuse disorder, treatment and recovery service providers, workforce development agencies, employers, and community advocacy groups.

Responding To Appalachian Voices: Steps In Developing Substance-Use Recovery Ecosystems, Bruce Behringer

Journal of Appalachian Health

A description is presented of the four-step process used by the Appalachian Regional Commission to develop a new Recovery to Work initiative. The Commission identified, defined, and described issues facing individuals who complete substance abuse disorder treatment and who seek reentry into the workforce. Key elements were identified for resources and supports to develop and maintain community-based substance abuse recovery ecosystems. The steps included conceptualization, data collection, analysis, and review to formulate recommendations for program and policy development. The full process of development was accomplished in twelve months.

Experiencing Cancer In Appalachian Kentucky, Melanie Mccomsey, David Ahern, Robin C. Vanderpool, Timothy W. Mullett, Ming-Yuan Chih, Meghan Johnson, Michele Ellison, Karen Onyeije, Bradford W. Hesse, Eliah Aronoff-Spencer

Journal of Appalachian Health

Nothing tells the story of people working together better than a community quilt. A diversity of talents, colors, and materials brought together through skill and shared purpose. Perhaps never before have we as Americans needed a stronger reminder that many hands make short work of big problems. The work presented here by the L.A.U.N.C.H. Collaborative offers a new framework for health care that could be compared to a digital quilt, powered by community-based participatory design, with lived expertise and the newest advances in broadband-enabled connected health solutions. This work demonstrates the value and need to engage local communities and what …

Preface: Experiencing Cancer In Appalachian Kentucky, Michele Ellison, Robin C. Vanderpool

Journal of Appalachian Health

Connected cancer care is of increasing importance in light of the COVID-19 pandemic. The Linking & Amplifying User-Centered Networks through Connected Health (L.A.U.N.C.H.) Collaborative in Appalachian Kentucky has pioneered a new roadmap for equipping communities with the transformative power of broadband to innovate around the future of cancer care and to better scale their ideas. The roadmap involves reaching across disciplines, including public health, anthropology, telecommunications, and user-centered design. The goal is to leverage connectivity and cancer communication research and practice to make a real difference for patients and families.

Geographic Variation In The Structure Of Kentucky’S Population Health Systems: An Urban, Rural, And Appalachian Comparison, Rachel Hogg-Graham, Angela Carman, Glen P. Mays, Pierre Martin Dominique Zephyr

Journal of Appalachian Health

Introduction: Research examining geographic variation in the structure of population health systems is continuing to emerge, and most of the evidence that currently exists divides systems by urban and rural designation. Very little is understood about how being rural and Appalachian impacts population health system structure and strength.

Purpose: This study examines geographic differences in key characteristics of population health systems in urban, rural non-Appalachian, and rural Appalachian regions of Kentucky.

Methods: Data from a 2018 statewide survey of community networks was used to examine population health system characteristics. Descriptive statistics were generated to examine variation across geographic regions in …

Appalachian Regional Commission Recovery Ecosystem Background And Overview, Kostas Skordas, Andrew Howard

Journal of Appalachian Health

The Appalachian Regional Commission (ARC) has long addressed issues of substance abuse through funded community-based interventions, research, and sponsored conferences. Recently, the opioid crisis created a new urgency for cross-sector collaboration among various partners and funders dealing with this issue. This commentary provides an overview of recent efforts by the ARC to convene stakeholders to focus on assisting individuals with substance abuse disorder to access recovery services while pursuing education and training necessary to reenter the workforce and gain employment. Two papers have been prepared to describe this year-long effort. One paper focuses on the participatory methods used to gather …

Perspective On Substance-Abuse Recovery Ecosystem From The Appalachian Regional Commission Federal Co-Chair, Tim Thomas

Journal of Appalachian Health

The Appalachian Regional Commission (ARC) is a local, state, and federal partnership focused on economic development in the communities of the Appalachian Region. ARC Federal Co-Chairman Tim Thomas provides his perspective on how an economic development entity, such as ARC, can support efforts to address the Region’s drug crisis in a way that both saves lives and strengthens economic opportunity in communities throughout Appalachia.

Fiscal Challenges And Anticipated Changes To Kentucky's Population Health System, Jeffrey Howard

Journal of Appalachian Health

The hallmark of public health is population-level intervention. However, current public health funding in Kentucky is largely programmatic or disease-based. As a result, public health leaders are not able to appropriately utilize present resources to pursue population health endeavors. However, a recent transformation of the public health system has emphasized multisector partnerships and efficient funding mechanisms that may increase resources to pursue population-level health interventions based on community health assessments.

Toxic Stress Among Black And African American Oregonians, Roberta Hunte, Margaret J.F. Braun

School of Social Work Faculty Publications and Presentations

Toxic stress is a reaction to ongoing adversity such as abuse, neglect, poverty, racism, discrimination, and exposure to violence; it is powerful enough to change brain chemistry and architecture. Toxic stress and associated changes to the brain can lead to poor health outcomes later in life. Adverse childhood experiences (ACEs), racism*, and discrimination can trigger toxic stress and have long term consequences for the health of many people, particularly those in the Black and African American community.

The current project examined toxic stress and its impact on the health of Black and African American Oregonians. We looked at two indicators …

Urban-Rural Gaps In The Prevalence Of Hypertension, Obesity And Diabetes In Malaysia, Thangiah Govindamal

Student Works (2020-2029)

Rapid economic growth has driven urbanization in developed and developing economies. However, it also created several problems, such as a deterioration in health conditions worldwide and widening of urban-rural and income inequality. A major consequence of urbanization include the rising prevalence of non-communicable diseases, cardiovascular disease (CVD) and its risk factors, such as hypertension, obesity and diabetes. The rapid nutrient and physical activity transition due to urbanization and the peculiar form of economic transformation has impacted the CVD risk factors. Rising urban-rural differences in health profiles and CVD risk factors in both locations over years in Malaysia prompted this research …

Shadow Standards And The Logic Of Costs: Care, Stewardship, And Data In U.S. Community Health, Margarite J. Whitten

Dissertations, Theses, and Capstone Projects

This dissertation examines the delegation of responsibility for providing health care to particular categories of marginalized populations in the United States in the absence of a uniform and universal health care system. It explores how the U.S. federal government governs patient populations at a distance by mandating that healthcare providers collect, produce, and report on patient data. Drawing from eighteen months of ethnographic research in Massachusetts clinics for the homeless and the frail elderly between 2014-2015, I argue that when marginalized patients are unable to satisfy the neoliberal ideal of self-governance to maintain their health in cost-effective ways, providers are …

A Literature Review Of Community Art Therapy With Youth In Inner City Communities Of Color, Jennifer Habeeb

Expressive Therapies Capstone Theses

This literature review was developed to synthesize the research surrounding community-based art therapy with youth who reside in inner city communities of color. Youth of color in inner city communities face a number of different challenges such as low socioeconomic status, social inequality, discrimination, and lack of political representation. There is currently little research on the impact of art therapy and expressive arts interventions with this population, however; these interventions have shown to be effective in a number of different areas. Literature revealed that community-based art therapy with inner city youth of color has shown to increase self-esteem, decrease symptoms …

Investigation Of The "Cultural Appropriation" Of Yoga, Olivia Bartholomew

Honors Projects

With our world becoming increasingly globalized and cosmopolitan, practices that were once very traditional and spiritual are much different when they confront Western societies. Many yoga instructors and practitioners around the world are concerned about the issue of cultural appropriation within their practice. The researcher defines cultural appropriation to mean the process of a dominant culture manipulating aspects of a marginalized culture for its benefit. Traditionally, yoga comes from India, but it has become popularized throughout the world in our recent human history. Through interviews with nine yoga instructors, each from different yogic traditions, who teach in a variety of …

Socioeconomic Status And Symptoms Of Anxiety And Depression In Pregnant Women, Meagan Mandabach

Honors Theses

Pregnancy is a period of great change in a woman’s body as her baby develops. During this period, women commonly experience symptoms of anxiety (Dennis et al., 2017) and depression (Shidhaye & Giri, 2014). Literature has suggested that socioeconomic status (SES) can contribute to the severity at which pregnant women experience anxiety and depression (Arora & Aeri, 2019; Field et al., 2008; Shagufta & Shams, 2019), and women of low socioeconomic status may be more likely to experience symptoms of anxiety and depression during pregnancy (Field et al., 2008). The present study aimed to assess the relationships between household income …

Health Care Access For Children In Latinx Immigrant Families In The Greater Philadelphia Area, Sophia King

Politics Honors Papers

This work examines the gap that exists in access to health care in the Greater Philadelphia Region for children of Latinx immigrant families in comparison to other children in the nation. It provides a critical analysis of the gap in access to coverage, noting that this exists despite wide support for a human right to health. This study draws on existing scholarly research as well as interviews with staff at two health clinics and one community outreach center that are located in Greater Philadelphia. It demonstrates that Latinx immigrant families are less likely to have health insurance and get primary …

The Effectiveness Of Implementing A Collaborative Mental Health Approach On Quality Of Life For Individuals Of Low Socioeconomic Status, Tyler Z. Tooley

Graduate Theses/Dissertations

The ultimate purpose of this study is to provide insight and education to mental health clinicians, politicians and the general public of the numerous effects poverty has on mental health, in addition to the most beneficial ways to combat those insidious effects. The specific barriers met by individuals of low socioeconomic status severely affect psychological and physical health, as well as social and environmental relationships, which therefore diminish overall quality of life. The aim of this study is to examine the effectiveness of implementing a collaborative mental health approach for low income individuals on length of engagement in services and …

The Impact Of Location On Healthcare Access For Individuals With Disabilities, Addison Kimber

Honors Scholar Theses

This paper analyzes healthcare access for individuals with disabilities living in rural areas. In current political discussion, we typically think of insurance coverage as the metric to analyze healthcare access. However, as demonstrated by studies of healthcare in the United Kingdom, people with disabilities continue to face barriers to health care even with universal healthcare systems. In particular, individuals in rural areas have less healthcare access than urban residents. This is due to factors including socioeconomic status, insurance coverage, access to competent care, and transportation. This study aims to understand if disability status exacerbates the issue of access in rural …

Mental Health And You, Sierra Salvatierra

Capstone Projects and Master's Theses

The Latinx community at the Epicenter in Salinas dealt with mental health illnesses, as well as were brought up with machismo attitudes. This population has a strong stigma against getting help with their mental health. Being faced with immigration, poverty, discrimination and inadequite conversations about health, drives a spike in anxiety levels. Consequences of not dealing with mental health illnesses include unresolved emotions are generational trauma, self harm, substance abuse, and unhealthy relationships. The project created to get in front of this problem was a dialogue series of conversation starters for people who want to open up. The purpose of …

The Role Of Culture In Engaging The Senior Population In Omaha, Ne, Jamie Bish

Theses/Capstones/Creative Projects

In recent years, the senior care industry has become the focus of many public health initiatives as we have come to better understand the significance of our aging population (Olivari et al., 2020). Between the years 2010 and 2050, the population of the United States over 65 years is expected to more than double, from 40.5 to 89 million (Dall et al., 2013). While this data provides a national outlook, further research is needed to determine local impacts. This project centers on developing a better understanding of the demographics of seniors in the Omaha-Council Bluffs Metropolitan Statistical Area and how …

“Disbelieving Black Women To Death”; The “Double Jeopardy”: Racism And Sexism Affects Black Women’S Access To And Quality Of Care During Pregnancy, Birth, And Postpartum, Madeline St. Clair

Theses/Capstones/Creative Projects

This paper explores possible reasons why Black women in the United States experience a higher maternal mortality rate than their white counterparts. Using books, articles, journals, documentaries, personal experiences and stories of Black women and mothers, I argue that barriers from the societal to the individual level create health and medical disparities for Black mothers in pregnancy, during delivery, and the postpartum period. The paper concludes with a multifaceted solution and call to action.

Promoting Resilience In Self-Management (Prism): Adverse Childhood Experiences And Impacts On Emotion Regulation, Kasey Ann Macedo

Honors Scholar Theses

PRISM (Promoting Resilience in Self-Management) is a mindfulness-based intervention that aims to strengthen emotion regulation skills among individuals by employing cognitive behavioral therapy components. The purpose of the current study is to identify the relationship between adverse childhood experiences (ACEs) and depression, as well as to examine the changes in emotion regulation strategies of participants by comparing pre and post test data. The participants were voluntarily recruited from the Cornerstone Foundation, a homeless shelter, food pantry, and community center in Vernon, CT. The 13 participants completed PRISM through four weeks of two-hour workshop sessions in a small-group format. Results indicate …

Seeking Care At Free Episodic Health Care Clinics In Appalachia, Malerie Lazar, Sandra Thomas, Lisa Davenport

Journal of Appalachian Health

Background: People who live in rural Appalachia experience a wide variety of problems when seeking access to health care. Health care disparities continue to be one of the most complex and prevalent problems, and many barriers exist for impoverished men and women such as a lack of education, complications with health insurance, and personal distrust of healthcare providers.

Purpose: A critical gap in the literature is the unheard voice of persons in rural underserved areas. The purpose of this study was to explore the perspectives of persons in rural Appalachia who seek healthcare services at free episodic health care clinics, …

Skin Cancer And Uv Exposure-Related Behaviors Among Appalachian And Non-Appalachian Adults, Minal Patel, Katrina Serrano, Elise Rice, Chan Thai, Kelly Blake, Robin C. Vanderpool

Journal of Appalachian Health

Introduction: Appalachian communities experience elevated rates of cancer incidence and mortality relative to other regions in the U.S. Specifically, melanoma mortality rates are higher in Appalachia compared to the national average, despite comparable incidence rates.

Purpose: To examine differences in self-reported history of skin cancer and prevalence of two UV exposure behaviors between Appalachian and non-Appalachian adults in a nationally representative sample.

Methods: Data are from four cross-sectional cycles of the Health Information National Trends Survey (2011–2014) (N=14,451). We examined sunscreen use and tanning bed use, and self-reported history of melanoma and non-melanoma skin cancer. Descriptive and weighted …

Impact Of The Affordable Care Act On Referral To Care For People Living With Hiv In Appalachia, Cameron A. Wade, Timothy N. Crawford, Nicole Leedy, Alice C. Thornton

Journal of Appalachian Health

Introduction: The Affordable Care Act (ACA) enacted on March 23, 2010 significantly impacted access to healthcare for people living with HIV (PLWH). Expansion of care was accomplished in three areas: eliminating exclusions for pre-existing conditions, elimination of lifetime caps on healthcare expenditures, and expansion of Medicaid eligibility.

Purpose: This study evaluated the impact of state implementation of the ACA Medicaid expansion on referral to HIV care at a Ryan White federally funded clinic in Kentucky (University of Kentucky Bluegrass Care Clinic [UK BCC]).

Methods: Retrospective chart review of all newly enrolled patients at the UK BCC between March 2010 and …

Food Insecurity Among College Students With And Without Medical Disorders At A University In Appalachia, Laura Mcarthur, Melissa D. Gutschall, Kimberly Fasczewski, Anna Jackson

Journal of Appalachian Health

Objective: This study compared severity of food insecurity, characteristics, and behaviors of college students with and without diagnosed medical disorders.

Design: Data were collected using a cross-sectional online questionnaire. Variables measured were food security status, disorders, coping strategies, and perceived barriers to food access. Descriptive and inferential statistics examined associations and compared groups. Statistical significance was p≤0.05.

Setting: Data were collected at Appalachian State University in North Carolina.

Participants: The sample was 247 food insecure students, of whom 60% were females, 50% 3rd- and 4th-year students, and 75% whites.

Results: Medical disorders were reported by 67.2% of food insecure students, …

A Nutritional And Environmental Analysis Of Local Food Pantries Accessible To College Students In Rural North Carolina, Emily E. Frymark, Jonathon Stickford, Alisha Farris

Journal of Appalachian Health

Introduction: Food insecurity is a growing concern among college students and is especially prevalent in rural areas. Food pantries often serve as a resource to food insecure individuals yet, their policies, standards, and nutritional quality vary due to the unpredictability of food donations.

Purpose: To examine the nutritional quality of food items and adherence of best practices at local food pantries accessible to college students near a university in rural Appalachia.

Methods: Three food pantries in North Carolina were selected due to their proximity to a local, rural university. Food items were analyzed for nutrient and food …

Use And Perceptions Of A Campus Food Pantry Among Food Insecure College Students: An Exploratory Study From Appalachia, Laura Mcarthur, Kimberly S. Fasczewski, Alisha Farris, Miranda R. Petrone

Journal of Appalachian Health

Introduction: Food insecurity has emerged as a public health problem among college students in Appalachia, jeopardizing their physical, mental, and emotional health and academic success. Campus food pantries have been established in this region, but no data are available concerning student use or perception of services.

Purpose: This study measured use and perceptions of a campus food pantry by students at a mid-sized university in rural North Carolina.

Methods: An online questionnaire collected behavioral and perceptual data, and follow-up interviews explored these variables. Descriptive statistics with significance at p<0.05 and thematic analytical procedures were used.

Results: Questionnaires were submitted by 896 of 6000 recruited students (14.9%), …

The Need For Evidence-Based Interventions To Reduce Food Insecurity Among College Students, Sarah Brothers, Stephanie Jilcott-Pitts Phd

Journal of Appalachian Health

Food insecurity is defined as insufficient resources to meet food needs. This is a global problem but is not confined to those countries identified as poor. One group of Americans who are particularly affected, and for whom the effects are particularly severe, is college students.

Evaluasi Formatif Program Rehabilitasi Sosial Bagi Korban Perdagangan Anak(Studi Kasus Program Rehabilitasi Sosial Rumah Faye Batam), Ranggi Lukfi Aprilianzah, Wisni Bantarti

Jurnal Ilmu Kesejahteraan Sosial

This research is about the evaluation of social rehabilitation program for children trafficking victims conducted by Rumah Faye Batam, which is generally aimed to restore the social functions of the victims. The thesis is formative-evaluative research using a qualitative approach specified to elaborate on the implementation of the program, and also to identify and analyze the supporting factors and the constraints as a foundation of the program development. The result of the research shows that in the implementation of social rehabilitation programs at Rumah Faye, there are 7 stages which include various activities that refer to the flow of services …