Open Access. Powered by Scholars. Published by Universities.®

Rural Sociology Commons

Open Access. Powered by Scholars. Published by Universities.®

PDF

Appalachia

Discipline
Institution
Publication Year
Publication
Publication Type

Articles 1 - 30 of 75

Full-Text Articles in Rural Sociology

The Impact Of Opioids On Students And Schools In Appalachian And Non-Appalachian Ohio: Educational Leader Perspectives On The Crisis, Charles L. Lowery, Chetanath Gautam Dec 2023

The Impact Of Opioids On Students And Schools In Appalachian And Non-Appalachian Ohio: Educational Leader Perspectives On The Crisis, Charles L. Lowery, Chetanath Gautam

Journal of Research Initiatives

Over the last several decades, the opioid crisis has had an increasing impact on the educational environment of schools. The role that principals and superintendents have in leading schools that have been affected by opioids has been mostly overlooked in the research. The present study was conducted in Ohio, a state with areas that have some of the highest death rates due to opioid-related incidents in the nation. Purpose: This study collected data on the perspectives and perceptions of school leaders in Ohio to better understand how principals and superintendents frame their decisions regarding the opioid crisis. Design: We analyze …


“It Takes A Village”: The Implications For Gender Roles On Appalachian Family Dynamics, Taryn Jayde Rollins May 2023

“It Takes A Village”: The Implications For Gender Roles On Appalachian Family Dynamics, Taryn Jayde Rollins

Undergraduate Theses

When we hear the word “Appalachian”, many will look towards the countless examples of negative stereotypes displayed in the media. From Hillbilly Elegy to hyperbolized stories of blue people in the mountains, Appalachians have been perpetuated as backward, dirty, incestual, and stupid. Through incessant dehumanization by the media, Appalachian communities have been ignored and even blamed for their disparities. However, there are historical and social implications factors that stemmed from the major shift in the economic makeup that has led to Appalachian poverty and in turn, shaped the culture and values of the region. In addition, due to geographic isolation, …


Exploring The Relationship Between Place Attachment And Attitudes Toward Tourism Development In Powell County, Lindsay Vance Jan 2022

Exploring The Relationship Between Place Attachment And Attitudes Toward Tourism Development In Powell County, Lindsay Vance

Theses and Dissertations--Community & Leadership Development

This study explores the relationship between Powell County, Kentucky residents’ place attachment, and the perceived sociocultural, environmental, and financial benefits of the future Warrior’s Path development. A survey consisting primarily of five-point Likert scale questions was shared with several local organizations to distribute to their members. The Pearson’s correlation coefficient and Chi-square test of independence tests were used to discover any correlation between place attachment and perceived sociocultural, environmental, and financial benefits of tourism development. The Pearson’s correlation coefficient (r=.465) determined a moderate positive correlation between place attachment and perceived sociocultural benefits of the Warrior’s Path and tourism development. Of …


Comparisons Of Cooking, Dietary, And Food Safety Characteristics Of Food Secure And Food Insecure Sophomores At A University In Appalachia, Hannah Boone, Melissa D. Gutschall, Alisha Farris, Kimberly Fasczewski, Don Holbert, Laura Mcarthur Oct 2021

Comparisons Of Cooking, Dietary, And Food Safety Characteristics Of Food Secure And Food Insecure Sophomores At A University In Appalachia, Hannah Boone, Melissa D. Gutschall, Alisha Farris, Kimberly Fasczewski, Don Holbert, Laura Mcarthur

Journal of Appalachian Health

Introduction: Food insecurity means lacking access to adequate, nutritious, and safe food. Collegiate food insecurity rates at ten Appalachian campuses range from 22.4% to 51.8%, and have been associated with unfavorable health and academic outcomes.

Purpose: This study compared cooking, dietary, and food safety characteristics of food secure (FS) and food insecure (FI) sophomores at a university in Appalachia in the context of the USDA definition of food security.

Methods: Data were collected using an online questionnaire. Descriptive and inferential procedures compared FS and FI sophomores (p < 0.05).

Results: Participants (n = 226) were 65.0% females, 76.1% …


Access To And Use Of Technology For Health: Comparisons Between Appalachian Kentuckians And The General U.S. Population, Robin C. Vanderpool, Lindsay R. Stradtman, Anna Gaysynsky, Quan Chen, Meghan Johnson, Bin Huang Oct 2021

Access To And Use Of Technology For Health: Comparisons Between Appalachian Kentuckians And The General U.S. Population, Robin C. Vanderpool, Lindsay R. Stradtman, Anna Gaysynsky, Quan Chen, Meghan Johnson, Bin Huang

Journal of Appalachian Health

Introduction: Technology may increase the availability of health information and enable health promoting behaviors. However, lack of access to and use of technology may also exacerbate disparities, particularly in rural communities with limited Internet access.

Purpose: The purpose of this study was to compare Internet access, device ownership, and use of technology for health between Appalachian Kentuckians and the general U.S. population.
Methods: Findings from the 2017 Assessing the Health Status of Kentucky (ASK) survey were compared to national estimates from the Health Information National Trends Survey (HINTS) 5, Cycle 1 (2017), with a particular focus on degree of rurality. …


Risk Factors Associated With Passenger Vehicle Fatal Rollover Crashes In West Virginia, 2001-2018, Yuni Tang, Toni Marie Rudisill, Ruchi Bhandari Oct 2021

Risk Factors Associated With Passenger Vehicle Fatal Rollover Crashes In West Virginia, 2001-2018, Yuni Tang, Toni Marie Rudisill, Ruchi Bhandari

Journal of Appalachian Health

Background: Rollover crashes cause more injuries and fatalities than other types of motor vehicle crashes. West Virginia (WV) has high rates of drug overdose deaths and motor vehicle crash fatality. However, no studies have investigated risk factors associated with fatal rollover crashes in WV.

Purpose: The objective of this study is to evaluate whether drug use and other risk factors are associated with fatal rollover crash fatalities in WV.

Methods: This cross-sectional study utilized the Fatality Analysis Reporting System dataset from passenger vehicle crashes involving WV drivers ≥ 16 years of age with known drug test results who died within …


Perceived Hearing Loss And Availability Of Audiologists In Appalachia, Charles B. Pudrith, Ellyn Grider, Blythe Kitner Oct 2021

Perceived Hearing Loss And Availability Of Audiologists In Appalachia, Charles B. Pudrith, Ellyn Grider, Blythe Kitner

Journal of Appalachian Health

Introduction: There is a high demand for audiologists throughout the United States. Previous research has supported an additional demand for these providers within Appalachia.

Purpose: The purpose of the study was to determine if Appalachia has a disproportionally high demand for audiologists compared to the rest of the United States.

Methods: A cross-sectional retrospective study was performed with population data from the Appalachian Regional Commission, the American Academy of Audiology, and the United States Census Bureau. County-level population-weighted averages of individuals with perceived hearing loss and number of audiologists per capita were compared between Appalachian and non-Appalachian counties. …


Review Of: Appalachians For Medicaid Website, Kendra Barker Dnp Jul 2021

Review Of: Appalachians For Medicaid Website, Kendra Barker Dnp

Journal of Appalachian Health

The Journal of Appalachian Health is committed to reviewing published media that relates to contemporary concepts affecting the health of Appalachia. Access to care and the health disparities we face have a direct effect on our experience of illness. Dr. Kendra Barker reviews the website: Appalachians for Medicaid.


Geospatial Analysis Of Rurality And Food Banks In Appalachian Ohio, Cooper T. Johnson, Rebecca Fischbein, Kristin Baughman Jul 2021

Geospatial Analysis Of Rurality And Food Banks In Appalachian Ohio, Cooper T. Johnson, Rebecca Fischbein, Kristin Baughman

Journal of Appalachian Health

Introduction: Food insecurity is a problem for individuals across Ohio, including those living in Appalachia. Adequate access to resources that help combat food insecurity is important for these populations.

Purpose: To examine how rurality relates to food insecurity and need for food resources, as well as availability of those resources including food pantries and soup kitchens, in 15 northern Ohio Appalachian counties.

Methods: A cross-sectional study with a geographical analysis was conducted using data from the American Community Survey census data, County Health Rankings data, and regional foodbank websites.

Results: Rural counties had a higher ratio of potential clients per …


Triple Negative Breast Cancer In An Appalachian Region: Exponential Tumor Grade Increase With Age Of Diagnosis, Gina Sizemore, Toni Marie Rudisill Jul 2021

Triple Negative Breast Cancer In An Appalachian Region: Exponential Tumor Grade Increase With Age Of Diagnosis, Gina Sizemore, Toni Marie Rudisill

Journal of Appalachian Health

Introduction: Triple negative breast cancer is an aggressive breast cancer with decreased five-year survival, increased risk for recurrence, and higher risk for metastases. Unlike other breast cancers, it has no targeted treatment and has heterogeneous genetics which make classification and treatment difficult.

Purpose: The purpose of our research was to compare triple negative breast cancer to non-triple negative breast cancer to identify key epidemiologic factors that might lead to improved basic science directives for biomarkers, treatments, and classification.

Methods: The state cancer registry was used to provide the first West Virginia state-wide population evaluation of triple negative breast cancer.

Results: …


Addressing Diabetes Distress In Self-Management Programs: Results Of A Randomized Feasibility Study, Ranjita Misra, Samantha Shawley-Brzoska, Raihan Khan, Brenna O. Kirk, Sijin Wen, Usha Sambamoorthi Jul 2021

Addressing Diabetes Distress In Self-Management Programs: Results Of A Randomized Feasibility Study, Ranjita Misra, Samantha Shawley-Brzoska, Raihan Khan, Brenna O. Kirk, Sijin Wen, Usha Sambamoorthi

Journal of Appalachian Health

Background: West Virginia ranks 1st nationally in the prevalence of hypertension (HTN; 43.8%) and diabetes (16.2%). Patients with type 2 diabetes mellitus (T2DM) are distressed over physical and psychological burden of disease self-management.

Methods: This study investigated the effectiveness of an intervention to reduce diabetes distress and outcomes [glycemic control, blood pressure (BP)] among T2DM adults with comorbid HTN. Participants were randomized to a 12-week diabetes and hypertension self-management program versus a 3-month wait-listed control group. Trained health coaches and experts implemented the lifestyle program in a faith-based setting using an adapted evidence-based curriculum. Twenty adults with T2DM and HTN …


Establishing Peer Recovery Support Services To Address The Central Appalachian Opioid Epidemic: The West Virginia Peers Enhancing Education, Recovery, And Survival (Wv Peers) Pilot Program, Stephen M. Davis, Amanda Stover, Herb Linn, Jon Dower, Dan Mccawley, Erin Winstanley, Judith Feinberg Jul 2021

Establishing Peer Recovery Support Services To Address The Central Appalachian Opioid Epidemic: The West Virginia Peers Enhancing Education, Recovery, And Survival (Wv Peers) Pilot Program, Stephen M. Davis, Amanda Stover, Herb Linn, Jon Dower, Dan Mccawley, Erin Winstanley, Judith Feinberg

Journal of Appalachian Health

Introduction: Central Appalachia has been disproportionately affected by the opioid epidemic and overdose fatalities. We developed West Virginia Peers Enhancing Education, Recovery, and Survival (WV PEERS), a program based on peer recovery support, to engage individuals using opioids and link them with a range of services.

Methods: Community partners providing services to individuals with opioid use disorder (OUD) were identified and collaborations were formalized using a standardized memorandum of understanding. The program was structured to offer ongoing peer recovery support specialist (PRSS) services, not just a one-time referral. A website and cards describing the WV PEERS program were developed and …


Different Hollers, Different Outcomes: Differences In Health Outcomes Among Appalachian And Non-Appalachian Counties In Kentucky, Allexys Krasnopolsky, James N. Maples Jun 2021

Different Hollers, Different Outcomes: Differences In Health Outcomes Among Appalachian And Non-Appalachian Counties In Kentucky, Allexys Krasnopolsky, James N. Maples

Kentucky Journal of Undergraduate Scholarship

This study examines difference in health outcomes, health insurance, and doctor access between Kentucky’s Appalachian and non-Appalachian counties. Using 2018 data curated by the Robert Wood Johnson Foundation, this study analyzes differences in means in overall health outcomes, health insurance, and the number of primary care physicians at the county level for Appalachian and non-Appalachian counties in Kentucky .This study finds that persons living in Appalachian Kentucky counties have statistically-different and worse overall health outcomes, health insurance access, and physician access compared to those living in non-Appalachian Kentucky counties.


Review Of: The Cancer Crisis In Appalachia: Kentucky Students Take Action, Stephenie Kennedy-Rea May 2021

Review Of: The Cancer Crisis In Appalachia: Kentucky Students Take Action, Stephenie Kennedy-Rea

Journal of Appalachian Health

The Journal of Appalachian Health is committed to reviewing published media that relates to contemporary concepts affecting the health of Appalachia. With cancer mortality rates higher in rural and Appalachian communities, a focus on how cancer impacts our families and communities is more important than ever. Dr. Stephenie Kennedy-Rea reviews the book The Cancer Crisis in Appalachia: Kentucky Students Take Action.


Effects Of Sleep Duration On Falls In A West Virginia Population-Based Study, Brfss, 2018, R. Constance Wiener, Christopher Waters May 2021

Effects Of Sleep Duration On Falls In A West Virginia Population-Based Study, Brfss, 2018, R. Constance Wiener, Christopher Waters

Journal of Appalachian Health

Introduction: West Virginia is a state in which most counties are rural, as well as a state with multiple health disparities among its population. The purpose of this study was to determine the association of sleep duration and falls for non-institutionalized West Virginia adults, aged 40 years and above, using the National Sleep Foundation’s definition of “may be appropriate” and “not recommended” sleep durations for specific ages.

Methods: Behavior Risk Factor Surveillance System (BRFSS) 2018 data concerning West Virginia residents were extracted for sleep duration and number of falls within the previous year. Data were analyzed with Chi square and …


Diseases Of Despair: A Commentary, Andrew Howard May 2021

Diseases Of Despair: A Commentary, Andrew Howard

Journal of Appalachian Health

Across the nation, and within Appalachia, communities that struggle economically experience greater health challenges, with disparities observed across leading causes of death. Within our region, these disparities are particularly notable across diseases of despair.


Poll Finds Rural Residents More Hesitant To Get Vaccinated, Tim Marema Jan 2021

Poll Finds Rural Residents More Hesitant To Get Vaccinated, Tim Marema

Journal of Appalachian Health

Rural residents are more hesitant than their metropolitan counterparts to get a Covid-19 vaccination, even though rural areas have higher rates of infections and deaths from the coronavirus.


Review Of: Ailing In Place: Environmental Inequities And Health Disparities In Appalachia, Jerome A. Paulson Md, Faap, Jennifer A. Mallow Phd Jan 2021

Review Of: Ailing In Place: Environmental Inequities And Health Disparities In Appalachia, Jerome A. Paulson Md, Faap, Jennifer A. Mallow Phd

Journal of Appalachian Health

The Journal of Appalachian Health is committed to reviewing published media that relate to contemporary concepts affecting the health of Appalachia. The Appalachian environmental inequities and the health disparities we face have a direct effect on our experience of illness. Dr. Jerome Paulson reviews the book Ailing in Place: Environmental Inequities and Health Disparities in Appalachia.


Impact Of The Covid-19 Shutdown On Mental Health In Appalachia By Working Status, Erin N. Haynes, Timothy J. Hilbert, Susan C. Westneat, Kate Leger, Katie Keynton, Heather M. Bush Jan 2021

Impact Of The Covid-19 Shutdown On Mental Health In Appalachia By Working Status, Erin N. Haynes, Timothy J. Hilbert, Susan C. Westneat, Kate Leger, Katie Keynton, Heather M. Bush

Journal of Appalachian Health

Introduction: To slow the spread of COVID-19 in the United States, businesses shutdown in Spring 2020. Research has indicated the impact on frontline workers, yet little is known about the impact on those who were not working outside the home or switched to working remotely.

Purpose: The purpose of this report is to identify the financial and healthcare issues and mental health impact of the COVID-19 shutdown on Appalachians by worker categories.

Methods: An online survey was administered from May 8 – June 6, 2020 to a convenience sample of previous research participants and shared through social …


A Description Of Covid-19 Lifestyle Restrictions Among A Sample Of Rural Appalachian Women, Michele Staton, Martha Tillson, J. Matthew Webster Jan 2021

A Description Of Covid-19 Lifestyle Restrictions Among A Sample Of Rural Appalachian Women, Michele Staton, Martha Tillson, J. Matthew Webster

Journal of Appalachian Health

Background: COVID-19 has led to swift federal and state response to control virus transmission, which has resulted in unprecedented lifestyle changes for U.S. citizens including social distancing and isolation. Understanding the impact of COVID-19 lifestyle restrictions and related behavioral risks is important, particularly among individuals who may be more vulnerable (such as rural women with a history of substance use living in Appalachia).

Purpose: The overall purpose of this study was to better understand the perceptions of lifestyle changes due to COVID-19 restrictions among this vulnerable group.

Methods: The study included a mixed methods survey with a convenience sample of …


Students, Research, And The Health Of Appalachia, F. Douglas Scutchfield Md Jan 2021

Students, Research, And The Health Of Appalachia, F. Douglas Scutchfield Md

Journal of Appalachian Health

The notion of publication in the peer-reviewed literature out of your doctoral or master’s thesis/dissertation or capstone is a characteristic of those who choose a career in the academy. This paper illustrates my pleasure by reflecting a student taking the additional step in research achievement by publishing results that contribute new knowledge to evidence-driven research and practice.


A Latent Profile Analysis Of Rural Women Who Use Drugs And Commit Crimes, Michele Staton, Amanda M. Bunting, Erika Pike, Danelle Stevens-Watkins Jan 2021

A Latent Profile Analysis Of Rural Women Who Use Drugs And Commit Crimes, Michele Staton, Amanda M. Bunting, Erika Pike, Danelle Stevens-Watkins

Journal of Rural Social Sciences

The majority of rural Appalachian women in jail meet criteria for a drug use disorder and need treatment. Using a latent profile analysis of a random sample of rural women in Appalachian jails (N=400) the current study established groups of women based on criminal history, drug use in the commission of crimes, and role of the partner’s drug use in the commission of crimes. Analysis found five distinct profiles of rural women based on involvement of criminal activities as a function of drug use severity. Results suggest that among criminally involved rural women, severity of drug use is a critical …


“We Didn’T Have A Lot Of Money, We Worked Hard, And We Ate Beans”: Examining The Narrative Inheritance From An Appalachian Father To His Son, Thomas Townsend Dec 2020

“We Didn’T Have A Lot Of Money, We Worked Hard, And We Ate Beans”: Examining The Narrative Inheritance From An Appalachian Father To His Son, Thomas Townsend

Electronic Theses and Dissertations

The author contends that narratives, shaped not only by events but also by socioeconomic and geographic factors, are narratives that require exploration and analysis because these narratives build the lives in which individuals exist. By understanding narratives passed down with which they have built their lives, individuals can come to greater understanding of the narratives in which they live. To understand the narratives, he created and continues to craft about his life, the author needed to understand his narrative inheritance. When a proposed thesis study imploded, the focus of the study shifted to exploring the circumstances of a single interview …


Rural Appalachia Battling The Intersection Of Two Crises: Covid-19 And Substance Use Disorders, Margaret Miller, Rebekah Rollston, Kate E. Beatty, Michael Meit Nov 2020

Rural Appalachia Battling The Intersection Of Two Crises: Covid-19 And Substance Use Disorders, Margaret Miller, Rebekah Rollston, Kate E. Beatty, Michael Meit

Journal of Appalachian Health

During the COVID-19 pandemic, rural Appalachia is at great risk of unforeseen side effects including increased mortality from substance use disorders (SUDs). People living with SUDs are at increased risk for both exposure to and poor outcomes from COVID infection. The economic impacts of COVID-19 must also be considered. As rural Appalachia combats the substance use crisis amidst the COVID-19 pandemic, the geographic economic, health and social inequities within our region must be considered. As a national recovery is sought, we should reimagine federal policies that center the economic and public health of rural Appalachia addressing the two crises.


Review Of: From The Front Lines Of The Appalachian Addiction Crisis Healthcare Providers Discuss Opioids, Meth And Recovery, Carl G. Leukefeld Nov 2020

Review Of: From The Front Lines Of The Appalachian Addiction Crisis Healthcare Providers Discuss Opioids, Meth And Recovery, Carl G. Leukefeld

Journal of Appalachian Health

The Journal of Appalachian Health is dedicated to reviewing various types of media related to contemporary concepts that affect the health of Appalachia. As the opioid-related overdose deaths ravish Appalachia, now more than ever, we each must devote energy to understanding addiction and pathways to recovery. Dr. Carl Leukefeld reviews the book From the Front Lines of the Appalachian Addiction Crisis: Healthcare Providers Discuss Opioids, Meth and Recovery.


In Their Own Words: How Opioids Have Impacted The Lives Of “Everyday” People Living In Appalachia, Patricia Nola Eugene Roberson, Gina Cortez, Laura H. Trull, Katherine Allison Lenger Nov 2020

In Their Own Words: How Opioids Have Impacted The Lives Of “Everyday” People Living In Appalachia, Patricia Nola Eugene Roberson, Gina Cortez, Laura H. Trull, Katherine Allison Lenger

Journal of Appalachian Health

Introduction: The opioid epidemic is ravaging people, families, and communities in Appalachia. However, limited research has examined how “everyday” people (e.g., not chronic pain patients, not medical professionals) living in these communities how opioids have impacted their lives.

Objective: Identify the perception of the opioid epidemic on individuals, families, and communities from people living in region most impacted regions.

Methods: Patients were recruited at Remote Area Medical clinics throughout Central and Southern Appalachia to complete interviews online (N = 169) or over the phone (N = 26), including one open-ended question about how opioids have impacted their lives.

Results: Using …


Improving Access To Treatment For Opioid Use Disorder In High-Need Areas: The Role Of Hrsa Health Centers, Michael Topmiller, Jennifer Rankin, Jessica L. Mccann, Jene Grandmont, David Grolling, Mark Carrozza, Hank Hoang, Josh Bolton, Alek Sripipatana Nov 2020

Improving Access To Treatment For Opioid Use Disorder In High-Need Areas: The Role Of Hrsa Health Centers, Michael Topmiller, Jennifer Rankin, Jessica L. Mccann, Jene Grandmont, David Grolling, Mark Carrozza, Hank Hoang, Josh Bolton, Alek Sripipatana

Journal of Appalachian Health

Introduction: Despite the opioid epidemic adversely affecting areas across the U.S. for more than two decades and increasing evidence that medication-assisted treatment (MAT) is effective for patients with opioid use disorder (OUD), access to treatment is still limited. The limited access to treatment holds true in the Appalachia region despite being disproportionately affected by the crisis, particularly in rural, central Appalachia.

Purpose: This research identifies opportunities for health centers located in high-need areas based on drug poisoning mortality to better meet MAT care gaps. We also provide an in-depth look at health center MAT capacity relative to need …


Rural Community Toolbox To Help Battle Opioid Epidemic, Liz Carey Nov 2020

Rural Community Toolbox To Help Battle Opioid Epidemic, Liz Carey

Journal of Appalachian Health

An online data repository and toolbox created by the Office of National Drug Control Policy is designed to provide communities with knowledge and resources to fight the opioid epidemic according to their unique needs.


The Interaction Of Adversity, Hope, Social Support, And Academic Resilience In Emerging Appalachian Adults, Daniel Joseph Gottron Jr. Sep 2020

The Interaction Of Adversity, Hope, Social Support, And Academic Resilience In Emerging Appalachian Adults, Daniel Joseph Gottron Jr.

Electronic Theses and Dissertations

The negative impact of adverse childhood experiences on both short-term and long-term wellbeing has been repeatedly validated across multiple populations. While adverse childhood experiences have been thoroughly researched in many contexts, this is not the case for Appalachia, which has often been relegated to the fringe of scholarly research, resulting in an overall lack of research on Appalachia. Further lacking is research into how protective factors might be utilized to help overcome adversity. While some recent research on the relationship between adverse childhood experiences, hope, and resilience has been conducted, it too has been limited to select populations. It is …


The Health Wagon Partners With The Virginia Department Of Health To Provide Covid-19 Testing In Rural Southwest Virginia, Tauna Gulley, Teresa Tyson, Ethan Collins, Rachel Helton, Paula Hill-Collins, Nicole France, Sarah Hubbard Jul 2020

The Health Wagon Partners With The Virginia Department Of Health To Provide Covid-19 Testing In Rural Southwest Virginia, Tauna Gulley, Teresa Tyson, Ethan Collins, Rachel Helton, Paula Hill-Collins, Nicole France, Sarah Hubbard

Journal of Appalachian Health

The Health Wagon has been providing care for the rural population of southwest Virginia for the past 40 years. The mission of the Health Wagon is to provide quality health care to the medically underserved people in the mountains of Appalachia. It has expanded to two stationary clinics, three mobile units, and a mobile dental unit, logging over 19,000 patients encounters in the past year.