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Muhammad M, Foster JA, Griffin JT, Kinchelow DL, Sierra-Arce CR, Southall WGS, Albitar F, Moghadamian ES, Wright RD, Matuszewski PE, Zuelzer DA, Primm DD, Hawk GS, Aneja A. Nonoperative Treatment of Humeral Shaft Fractures With Immediate Functional Bracing Versus Coaptation Splinting and Delayed Functional Bracing: A Retrospective Study. J Orthop Trauma 2024; 38:383-389. [PMID: 38527088 DOI: 10.1097/bot.0000000000002810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVES To compare radiographic and clinical outcomes in nonoperative management of humeral shaft fractures treated initially with coaptation splinting (CS) followed by delayed functional bracing (FB) versus treatment with immediate FB. METHODS DESIGN Retrospective cohort study. SETTING Academic Level 1 Trauma Center. PATIENT SELECTION CRITERIA Patients with closed humeral shaft fractures managed nonoperatively with initial CS followed by delayed FB or with immediate FB from 2016 to 2022. Patients younger than 18 years and/or with less than 3 months of follow-up were excluded. OUTCOME MEASURES AND COMPARISONS The primary outcome was coronal and sagittal radiographic alignment assessed at the final follow-up. Secondary outcomes included rate of failure of nonoperative management (defined as surgical conversion and/or fracture nonunion), fracture union, and skin complications secondary to splint/brace wear. RESULTS Ninety-seven patients were managed nonoperatively with delayed FB (n = 58) or immediate FB (n = 39). Overall, the mean age was 49.9 years (range 18-94 years), and 64 (66%) patients were female. The immediate FB group had less smokers ( P = 0.003) and lower incidence of radial nerve palsy ( P = 0.025), with more proximal third humeral shaft fractures ( P = 0.001). There were no other significant differences in demographic or clinical characteristics ( P > 0.05). There were no significant differences in coronal ( P = 0.144) or sagittal ( P = 0.763) radiographic alignment between the groups. In total, 33 (34.0%) humeral shaft fractures failed nonoperative management, with 11 (28.2%) in the immediate FB group and 22 (37.9%) in the delayed FB group ( P = 0.322). There were no significant differences in fracture union ( P = 0.074) or skin complications ( P = 0.259) between the groups. CONCLUSIONS This study demonstrated that nonoperative treatment of humeral shaft fractures with immediate functional bracing did not result in significantly different radiographic or clinical outcomes compared to treatment with CS followed by delayed functional bracing. Future prospective studies assessing patient-reported outcomes will further guide clinical decision making. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Maaz Muhammad
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
| | - Jeffrey A Foster
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
| | - Jarod T Griffin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
| | - Daria L Kinchelow
- Department Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY; and
| | | | - Wyatt G S Southall
- Department Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY; and
| | - Ferras Albitar
- Department Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY; and
| | - Eric S Moghadamian
- Department Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY; and
| | - Raymond D Wright
- Department Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY; and
| | - Paul E Matuszewski
- Department Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY; and
| | - David A Zuelzer
- Department Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY; and
| | - Daniel D Primm
- Department Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY; and
| | - Gregory S Hawk
- Dr. Bing Zhang Department of Statistics, University of Kentucky, Lexington, KY
| | - Arun Aneja
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
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Little MA, Reid T, Moncrief M, Cohn W, Wiseman KP, Wood CH, You W, Anderson RT, Krukowski RA. Testing the feasibility of the QuitAid smoking cessation intervention in a randomized factorial design in an independent, rural community pharmacy. Pilot Feasibility Stud 2024; 10:41. [PMID: 38409089 PMCID: PMC10895740 DOI: 10.1186/s40814-024-01465-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 02/14/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Adult smoking rates in the USA are highest in economically depressed rural Appalachia. Pharmacist-delivered tobacco cessation support that incorporates medication therapy management (such as the QuitAid intervention) is a promising approach to address this need. METHODS Twenty-four adult smokers recruited between September and November 2021 through an independent pharmacy in rural Appalachia were randomized in a non-blinded 2 × 2 × 2 factorial design to (1) pharmacist delivered QuitAid intervention (yes vs. no); (2) combination nicotine replacement therapy (NRT) gum + NRT patch (vs. NRT patch); and/or (3) 8 weeks of NRT (vs. standard 4 weeks). Participants received 4 weeks of NRT patch in addition to the components to which they were assigned. Participants completed baseline and 3-month follow-up assessments. Primary outcomes were feasibility of recruitment and randomization, retention, treatment adherence, and fidelity. RESULTS Participants were recruited in 7 weeks primarily through a referral process, commonly referred to as ask-advise-connect (61%). Participants were on average 52.4 years old, 29.2% were male and the majority were white (91.6%) and Non-Hispanic (91.7%). There was a high level of adherence to the interventions, with 85% of QuitAid sessions completed, 83.3% of the patch used, and 54.5% of gum used. Participants reported a high level of satisfaction with the program, and there was a high level of retention (92%). CONCLUSIONS This demonstration pilot randomized controlled study indicates that an ask-advise-connect model for connecting rural smokers to smoking cessation support and providing QuitAid for smoking cessation is feasible and acceptable among rural Appalachian smokers and independent pharmacists. Further investigation into the efficacy of a pharmacist-delivered approach for smoking cessation is needed. TRIAL REGISTRATION The trial was retrospectively registered at ClinicalTrials.gov. Trial #: NCT05649241.
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Affiliation(s)
- Melissa A Little
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA.
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA.
| | - Taylor Reid
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Matthew Moncrief
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
| | - Wendy Cohn
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Kara P Wiseman
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | | | - Wen You
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Roger T Anderson
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Rebecca A Krukowski
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
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Hudson-Rose L, Weiss LT, Vanderford NL. Impact of a Cancer Education Curriculum on Appalachian Kentucky Middle and High School Students. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1887-1893. [PMID: 37572197 PMCID: PMC10841156 DOI: 10.1007/s13187-023-02354-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 08/14/2023]
Abstract
Appalachian Kentucky is disproportionately affected by elevated cancer incidence and mortality rates. This disparity is driven by inequities in health behaviors and social determinants of health including decreased education attainment levels that cause lower health literacy. To increase cancer literacy in the region, a three-part cancer education curriculum was designed for Appalachian Kentucky middle and high school students. This study was designed to evaluate the effect the curriculum had on students' cancer literacy. The curriculum lessons were disseminated to Appalachian Kentucky middle and high school teachers who engaged 223 students with the material. For each lesson, students filled out a 10-question pretest and an identical 10-question posttest. The average and median percent of correct responses from the pre- to posttests were analyzed. The average percentage of correct responses significantly increased from 40% to 70%, 52% to 69%, and 33% to 53% on lessons 1, 2, and 3, respectively. A significant increase in the average percentage of correct responses on each individual question was also observed. The results demonstrate that the three-part cancer education curriculum intervention can significantly increase Appalachian Kentucky middle and high school students' cancer literacy. Increased cancer knowledge has the potential to encourage behavioral modifications that could reduce cancer incidence and mortality rates over time. Future work will include further improving the content relative to the target age/grade level and implementing the material with a broader group of teachers and students.
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Affiliation(s)
| | - L Todd Weiss
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Nathan L Vanderford
- College of Medicine, University of Kentucky, Lexington, KY, USA.
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA.
- Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, KY, USA.
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Walker CJ, Kucharska-Newton AM, Browning SR, Christian WJ. County incidence and geospatial trends of early-onset hypertensive disorders of pregnancy in Kentucky, 2008-2017. BMC Pregnancy Childbirth 2023; 23:453. [PMID: 37337164 DOI: 10.1186/s12884-023-05699-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 05/11/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Early-onset hypertensive disorders of pregnancy (eHDP) are associated with more severe maternal and infant outcomes than later-onset disease. However, little has been done to evaluate population-level trends. Therefore, in this paper, we seek to address this understudied area by describing the geospatial and temporal patterns of county-level incidence of eHDP and assessing county-level demographics that may be associated with an increased incidence of eHDP. METHODS Employing Kentucky certificates of live and stillbirth from 2008-2017, this ecological study detected county-level clusters of early-onset hypertensive disorders of pregnancy using SaTScan, calculated average annual percent change (AAPC) with a join point analysis, and identified county-level covariates (% of births to women ≥ 35 years of age, % with BMI ≥ 30 kg/m2, % currently smoking, % married, and % experienced eHDP) with a fixed-effects negative binomial regression model for longitudinal data with an autoregressive (AR) correlation structure offset with the natural log of the number of births in each county and year. RESULTS County-level incidence of eHDP had a non-statistically significant increase of almost 3% (AAPC: 2.84, 95% CI: -4.26, 10.46), while maternal smoking decreased by almost 6% over the study period (AAPC:-5.8%, 95%CI: -7.5, -4.1), Risk factors for eHDP such as pre-pregnancy BMI ≥ 30 and proportion of births to women ≥ 35 years of age increased by 2.3% and 3.4% respectively (BMI AAPC:2.3, 95% CI: 0.94, 3.7; ≥ 35 years AAPC:3.4, 95% CI: 0.66, 6.3). After adjusting for race, county-level proportions of college attainment, and maternal smoking throughout pregnancy, counties with the highest proportion of births to women with BMI ≥ 30 kg/m2 reported an eHDP incidence 20% higher than counties with a lower proportion of births to mothers with a BMI ≥ 30 kg/m2 and a 20% increase in eHDP incidence (aRR = 1.20, 95% CI: 1.00, 1.44). We also observed that counties with the highest proportion vs. the lowest of mothers ≥ 35 years old (> 6.1%) had a 26% higher incidence of eHDP (RR = 1.26, 95%CI: 1.04, 1.50) compared to counties with the lowest incidence (< 2.5%). We further identified two county-level clusters of elevated eHDP rates. We also observed that counties with the highest vs. lowest proportion of mothers ≥ 34 years old (> 6.1% vs. < 2.5%) had a 26% increase in the incidence of eHDP (RR = 1.26, 95% CI: 1.04, 1.50). We further identified two county-level clusters of elevated incidence of eHDP. CONCLUSIONS This study identified two county-level clusters of eHDP, county-level covariates associated with eHDP, and that while increasing, the average rate of increase for eHDP was not statistically significant. This study also identified the reduction in maternal smoking over the study period and the concerning increase in rates of elevated pre-pregnancy BMI among mothers. Further work to explore the population-level trends in this understudied pregnancy complication is needed to identify community factors that may contribute to disease and inform prevention strategies.
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Affiliation(s)
- Courtney J Walker
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA.
- Department of Behavioral Sciences, University of Kentucky College of Medicine, CE Barnhart, Lexington, KY, 40536, USA.
| | - Anna M Kucharska-Newton
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Steven R Browning
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - W Jay Christian
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
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Christian WJ, Flunker J, May B, Westneat S, Sanderson WT, Schoenberg N, Browning SR. Adult asthma associated with roadway density and housing in rural Appalachia: the Mountain Air Project (MAP). Environ Health 2023; 22:28. [PMID: 36967398 PMCID: PMC10041800 DOI: 10.1186/s12940-023-00984-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 03/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Appalachian Kentucky is a rural area with a high prevalence of asthma among adults. The relative contribution of environmental exposures in the etiology of adult asthma in these populations has been understudied. OBJECTIVE This manuscript describes the aims, study design, methods, and characteristics of participants for the Mountain Air Project (MAP), and focuses on associations between small area environmental exposures, including roadways and mining operations, and lifetime and current asthma in adults. METHODS A cohort of residents, aged 21 and older, in two Kentucky counties, was enrolled in a community-based, cross-sectional study. Stratified cluster sampling was used to select small geographic areas denoted as 14-digit USGS hydrologic units (HUCs). Households were enumerated within selected HUCs. Community health workers collected in-person interviews. The proximity of nearby active and inactive coal mining operations, density of oil and gas operations, and density of roadways were characterized for all HUCs. Poisson regression analyses were used to estimate adjusted prevalence ratios. RESULTS From 1,459 eligible households contacted, 1,190 individuals were recruited, and 972 persons completed the interviews. The prevalence of lifetime asthma was 22.8%; current asthma was 16.3%. Adjusting for covariates, roadway density was positively associated with current asthma in the second (aPR = 1.61; 95% CI 1.04-2.48) and third tertiles (aPR = 2.00; 95% CI 1.32-3.03). Increased risk of current asthma was associated with residence in public, multi-unit housing (aPR = 2.01; 95% CI 1.27-3.18) compared to a residence in a single-family home. There were no notable associations between proximity to coal mining and oil and gas operations and asthma prevalence. CONCLUSIONS This study suggests that residents in rural areas with higher roadway density and those residing in public housing units may be at increased risk for current asthma after accounting for other known risk factors. Confirming the role of traffic-related particulates in producing high asthma risk among adults in this study contributes to the understanding of the multiple environmental exposures that influence respiratory health in the Appalachia region.
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Affiliation(s)
- W Jay Christian
- Department of Epidemiology and Environmental Health, College of Public Health, The University of Kentucky, 111 Washington Ave, Lexington, KY, 40536, USA
| | - John Flunker
- Department of Epidemiology and Environmental Health, College of Public Health, The University of Kentucky, 111 Washington Ave, Lexington, KY, 40536, USA
| | - Beverly May
- Department of Epidemiology and Environmental Health, College of Public Health, The University of Kentucky, 111 Washington Ave, Lexington, KY, 40536, USA
| | - Susan Westneat
- Department of Epidemiology and Environmental Health, College of Public Health, The University of Kentucky, 111 Washington Ave, Lexington, KY, 40536, USA
| | - Wayne T Sanderson
- Department of Biosystems and Agricultural Engineering, College of Agriculture, Food, and Environment, University of Kentucky, Lexington, KY, USA
| | - Nancy Schoenberg
- Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Steven R Browning
- Department of Epidemiology and Environmental Health, College of Public Health, The University of Kentucky, 111 Washington Ave, Lexington, KY, 40536, USA.
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Almberg KS, Halldin CN, Friedman LS, Go LHT, Rose CS, Hall NB, Cohen RA. Increased odds of mortality from non-malignant respiratory disease and lung cancer are highest among US coal miners born after 1939. Occup Environ Med 2023; 80:121-128. [PMID: 36635098 PMCID: PMC10428099 DOI: 10.1136/oemed-2022-108539] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/23/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Coal miners suffer increased mortality from non-malignant respiratory diseases (NMRD), including pneumoconioses and chronic obstructive pulmonary disease, compared with the US population. We characterised mortality trends from NMRD, lung cancer and ischaemic heart disease (IHD) using data from the Federal Black Lung Program, National Coal Workers' Health Surveillance Program and the National Death Index. METHODS We compared mortality ORs (MORs) for NMRD, lung cancer and IHD in former US coal miners to US white males. MORs were computed for the study period 1979-2017 by birth cohort (<1920, 1920-1929, 1930-1939, ≥1940), with a subanalysis restricted to Central Appalachia. RESULTS The study population totalled 235 550 deceased miners, aged >45 years. Odds of death from NMRD and lung cancer across all miner birth cohorts averaged twice those of US males. In Central Appalachia, MORs significantly increased across birth cohorts. There was an eightfold increase in odds of death from NMRD among miners born after 1940 (MORBC≥1940 8.25; 95% CI 7.67 to 8.87). Miners with progressive massive fibrosis (PMF) were younger at death than those without PMF (74 vs 78 years; p<0.0001). We observed a pattern of reduced MORs from IHD in coal miners compared with national and regional counterparts. CONCLUSION US coal miners have excess mortality from NMRD and lung cancer compared with total US and Appalachian populations. Mortality is highest in the most recent birth cohorts, perhaps reflecting increased rates of severe pneumoconiosis.
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Affiliation(s)
- Kirsten S Almberg
- School of Public Health, Division of Environmental and Occupational Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Cara N Halldin
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Spokane, Washington, USA
| | - Lee S Friedman
- School of Public Health, Division of Environmental and Occupational Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Leonard H T Go
- School of Public Health, Division of Environmental and Occupational Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Cecile S Rose
- Medicine, National Jewish Health, Denver, Colorado, USA
| | - Noemi B Hall
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Robert A Cohen
- School of Public Health, Division of Environmental and Occupational Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
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Horn K, Schoenberg N, Rose S, Romm K, Berg C. Tobacco use among Appalachian adolescents: An urgent need for virtual scale out of effective interventions. Tob Prev Cessat 2022; 8:39. [DOI: 10.18332/tpc/155331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 10/05/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
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Burruss CP, Pappal RB, Witt MA, Harryman C, Ali SZ, Bush ML, Fritz MA. Healthcare disparities for the development of airway stenosis from the medical intensive care unit. Laryngoscope Investig Otolaryngol 2022; 7:1078-1086. [PMID: 36000059 PMCID: PMC9392386 DOI: 10.1002/lio2.865] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives/hypothesis Study design Methods Results Conclusion Level of evidence
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Affiliation(s)
| | - Robin B. Pappal
- Department of Otolaryngology ‐ Head and Neck Surgery University of Kentucky Lexington Kentucky USA
| | - Michael A. Witt
- College of Medicine University of Kentucky Lexington Kentucky USA
| | | | - Syed Z. Ali
- Department of Anesthesiology University of Kentucky Lexington Kentucky USA
| | - Matthew L. Bush
- Department of Otolaryngology ‐ Head and Neck Surgery University of Kentucky Lexington Kentucky USA
| | - Mark A. Fritz
- Department of Otolaryngology ‐ Head and Neck Surgery University of Kentucky Lexington Kentucky USA
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Williams F, Mamudu L, Talham CJ, Montiel Ishino FA, Whiteside M. Sociodemographic Factors and Health Insurance Coverage Are Associated with Invasive Breast Cancer in Tennessee: Appalachian and Non-Appalachian County Comparison. WOMEN'S HEALTH REPORTS 2022; 3:543-551. [PMID: 35651993 PMCID: PMC9148657 DOI: 10.1089/whr.2021.0136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 12/25/2022]
Abstract
Background: Tennessean women experience the 12th highest breast cancer (BC) mortality in the United States. Yet, few studies have examined BC outcomes among Tennessean women in and outside of Appalachia. We examined whether sociodemographic factors and health insurance status were associated with invasive BC in Tennessee by Appalachian and non-Appalachian county designation. Materials and Methods: Using the Tennessee Cancer Registry, we identified 52,187 women, aged ≥18, diagnosed with BC between 2005 and 2015. Multivariable logistic regression was performed to examine associations between invasive BC and sociodemographic characteristics, health insurance coverage, and county designation (Appalachian/non-Appalachian). Regression analyses stratified by county designation were subsequently performed. Results: In Tennessee, younger women had lower odds of invasive BC diagnosis (<45: odds ratio [OR] = 0.74, 95% confidence interval [CI] = 0.67–0.81; 55–64: OR = 0.91, 95% CI = 0.84–0.97) compared to women ≥65. Married Tennessean women had 12% (95% CI = 1.04–1.21) higher odds of invasive BC than single women. Further, both public (OR = 1.81, 95% CI = 1.41–2.33) and private (OR = 1.36, 95% CI = 1.06–1.76) health insurance were found to increase odds of invasive BC compared to no insurance/self-pay. Results from the subpopulation analyses were largely consistent with overall findings. In Appalachian counties, women on public health insurance had increased odds (OR = 1.42, 95% CI = 1.00–2.03) of invasive BC compared to uninsured/self-pay women, while in non-Appalachian counties, women insured both publicly (OR = 2.25, 95% CI = 1.57–3.24) and privately (OR = 1.68, 95% CI = 1.16–2.24) had increased odds of invasive BC. Conclusions: The results identify risk factors for Tennessean women in Appalachian and non-Appalachian counties whose malignancies evaded early detection, increasing risk of mortality.
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Affiliation(s)
- Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Lohuwa Mamudu
- Department of Public Health, California State University, Fullerton, California, USA
| | - Charlotte J. Talham
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Francisco A. Montiel Ishino
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Martin Whiteside
- Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee, USA
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Factors Influencing Cardiovascular Risk Factors and Health Perception Among Kentuckians Living in Appalachia. J Cardiovasc Nurs 2021; 35:E1-E8. [PMID: 31365441 DOI: 10.1097/jcn.0000000000000594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) and risk factors for CVD are prevalent among Appalachians from Kentucky. Appalachian men and women have high rates of engagement in unhealthy behaviors and poor physical health measures that increase their risk for CVD. OBJECTIVE In this study, the relationship among gender, CVD risk factors, and health perception in Appalachians from Kentucky was explored. METHODS This cross-sectional secondary analysis is from a randomized controlled trial on CVD health in rural Kentucky. To assess gender differences in smoking history, χ was used. Independent t tests compared the mean between participants 50 years or younger and those older than 50 years with differences in body mass index (BMI), waist circumference, systolic and diastolic blood pressure, hemoglobin A1C, total cholesterol, and physical activity. A multivariate linear regression analysis assessed variables predicting the outcome of health perception. RESULTS Most participants had a mean BMI of 33 kg/m and 94.3% of men used smokeless tobacco compared to 5.7% of the women. Differences existed between gender and current, ever, or never smoked (P < .001). Women had higher total cholesterol levels but men had higher waist circumference. Participants older than 50 years had higher engagement in physical activity than did those 50 years or younger. Higher BMI and hemoglobin A1C level were significant predictors of worse health perception (P ≤ .05). For every unit increase in the physical activity scale, there was a 0.2-unit improvement in health perception (P ≤ .001). CONCLUSION Appalachians from Kentucky have many CVD risk factors. Minimal engagement in preventative measures against CVD can worsen patient outcomes.
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Khalid S, Sambamoorthi U, Umer A, Lilly CL, Gross DK, Innes KE. Increased Odds of Incident Alzheimer's Disease and Related Dementias in Presence of Common Non-Cancer Chronic Pain Conditions in Appalachian Older Adults. J Aging Health 2021; 34:158-172. [PMID: 34351824 DOI: 10.1177/08982643211036219] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is a growing concern regarding the increasing prevalence of common non-cancer chronic pain conditions (NCPCs) and their possible association with Alzheimer's disease and related dementias (ADRD). However, large population-based studies are limited, especially in Appalachian and other predominantly rural, underserved populations who suffer elevated prevalence of both NCPCs and known ADRD risk factors. OBJECTIVES We investigated the relation of NCPC to risk of incident ADRD in older Appalachian Medicare beneficiaries and explored the potential mediating effects of mood and sleep disorders. METHODS Using a retrospective cohort design, we assessed the overall and cumulative association of common diagnosed NCPCs at baseline to incident ADRD in 161,573 elders ≥65 years, Medicare fee-for-service enrollees, 2013-2015. NCPCs and ADRD were ascertained using claims data. Additional competing risk for death analyses accounted for potential survival bias. MAIN FINDINGS Presence of any NCPC at baseline was associated with significantly increased odds for incident ADRD after adjustment for covariates [adjusted odds ratio (AOR) = 1.26 (1.20, 1.32), p < .0001]. The magnitude and strength of this association increased significantly with rising burden of NCPCs at baseline [AOR for ≥4 vs. no NCPC = 1.65 (1.34, 2.03), p-trend = .01]. The addition of depression and anxiety, but not sleep disorders, modestly attenuated these associations [AORs for any NCPC and ≥4 NCPCs, respectively = 1.16 (1.10, 1.22) and 1.39 (1.13, 1.71)], suggesting a partial mediating role of mood impairment. Sensitivity analyses, multinomial logistic regressions accounting for risk of death, yielded comparable findings. CONCLUSION In this large cohort of older Appalachian Medicare beneficiaries, baseline NCPCs showed a strong, positive, dose-response relationship to odds for incident ADRD; this association appeared partially mediated by depression and anxiety. Further longitudinal research in this and other high-risk, rural populations are needed to evaluate the causal relation between NCPC and ADRD.
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Affiliation(s)
- Sumaira Khalid
- Department of Epidemiology, 5631West Virginia University, School of Public Health, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, 5631West Virginia University, School of Pharmacy, Morgantown, WV, USA
| | - Amna Umer
- Department of Pediatrics, 5631West Virginia University, School of Medicine, Morgantown, WV, USA
| | - Christa L Lilly
- Department of Biostatistics, 5631West Virginia University, School of Public Health, Morgantown, WV, USA
| | - Diane K Gross
- Department of Epidemiology, 5631West Virginia University, School of Public Health, Morgantown, WV, USA
| | - Kim E Innes
- Department of Epidemiology, 5631West Virginia University, School of Public Health, Morgantown, WV, USA
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12
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Cardarelli K, Westneat S, Dunfee M, May B, Schoenberg N, Browning S. Persistent disparities in smoking among rural Appalachians: evidence from the Mountain Air Project. BMC Public Health 2021; 21:270. [PMID: 33530976 PMCID: PMC7856720 DOI: 10.1186/s12889-021-10334-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/25/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Adult smoking prevalence in Central Appalachia is the highest in the United States, yet few epidemiologic studies describe the smoking behaviors of this population. Using a community-based approach, the Mountain Air Project (MAP) recruited the largest adult cohort from Central Appalachia, allowing us to examine prevalence and patterns of smoking behavior. METHODS A cross-sectional epidemiologic study of 972 participants aged 21 years and older was undertaken 2015-2017, with a response rate of 82%. Prevalence ratios and 95% confidence intervals for current smoking (compared to nonsmokers) were computed for the entire cohort then stratified by multiple characteristics, including respiratory health. Adjusted prevalence ratios for current smoking versus not smoking were also computed. RESULTS MAP participants reported current smoking prevalence (33%) more than double the national adult smoking prevalence. Current smoking among participants with a reported diagnosis of chronic obstructive pulmonary disease and emphysema was 51.5 and 53.3%, respectively. Compared to participants age 65 years and older, those age 45 years or younger reported double the prevalence of smoking (PR: 2.04, 95% CI: 1.51-2.74). Adjusted analyses identified younger age, lower education, unmet financial need, and depression to be significantly associated with current smoking. CONCLUSIONS Despite declining rates of smoking across the United States, smoking remains a persistent challenge in Central Appalachia, which continues to face marked disparities in education funding and tobacco control policies that have benefitted much of the rest of the nation. Compared with national data, our cohort demonstrated higher rates of smoking among younger populations and reported a greater intensity of cigarette use.
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Affiliation(s)
- Kathryn Cardarelli
- College of Public Health, University of Kentucky, Lexington, KY, USA.
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA.
| | - Susan Westneat
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Madeline Dunfee
- College of Public Health, University of Kentucky, Lexington, KY, USA
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA
| | - Beverly May
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Nancy Schoenberg
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA
- College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Steven Browning
- College of Public Health, University of Kentucky, Lexington, KY, USA
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA
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13
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Ickes MJ, Sampson S, Parsons J, Rayens MK, Xiao M, Fisher A, Mundy M, Hahn EJ. Tobacco-Free Ambassador Partnership: Empowering Youth Advocates in Appalachian Communities. Health Promot Pract 2020; 21:98S-109S. [PMID: 31908203 DOI: 10.1177/1524839919880563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Kentucky youth (14.3%) smoke more cigarettes as compared to the U.S. average (8.8%), and Appalachian communities suffer disproportionately from tobacco-related diseases such as lung cancer. Training youth to become advocates is an effective strategy to improve health equity. This article describes the development and impact of a youth advocacy program to promote tobacco control policies in Appalachian Kentucky. Phase I (2017-2018): two ½-day trainings followed by monthly meetings with one high school (n = 20 youth). Trainings provided information on tobacco use, consequences, industry tactics, evidence-based tobacco control, and advocacy skills. Results provided support for expansion to Phase II (2018-20119): A 1-day training followed by monthly information sharing implemented in three counties (N = 80). Youth were surveyed before and 6-months posttraining during both phases. Phase I: At posttraining, 85% of youth believed they could reduce the amount of tobacco use in their community versus 66% at baseline. More students tried at least once to convince school or government officials to be more concerned about tobacco use (77% vs. 47%). Phase II: More students supported tobacco policies at posttraining survey and realized policies are an effective strategy to reduce tobacco use. At posttraining survey, students reported greater interpersonal confidence talking with others about tobacco-related issues, with a 24% increase in confidence talking with adults in their communities, as well as greater advocacy self-efficacy. Youth in Appalachia demonstrate desire to influence tobacco use and policy to improve health equity. Findings reinforce the need for collaborative public health interventions to promote ongoing training and support for youth living in high-risk communities.
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Affiliation(s)
| | | | | | | | - Min Xiao
- University of Kentucky, Lexington, KY, USA
| | - Amy Fisher
- University of Kentucky, Lexington, KY, USA
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14
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Goodin A, Talbert J, Freeman PR, Hahn EJ, Fallin-Bennett A. Appalachian disparities in tobacco cessation treatment utilization in Medicaid. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:5. [PMID: 31959212 PMCID: PMC6971922 DOI: 10.1186/s13011-020-0251-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/06/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Kentucky Medicaid enrollees, particularly those in the rural Appalachian region, face disproportionate smoking rates and tobacco-related disease burden relative to the rest of the United States (US). The Affordable Care Act (ACA) mandated tobacco cessation treatment coverage by the US public health insurance program Medicaid. Medicaid coverage was also expanded in Kentucky, in 2013, with laxer income eligibility requirements. This short report describes tobacco use incidence and tobacco cessation treatment utilization, comparing by Appalachian status before and after ACA-mandated cessation treatment coverage. METHODS The study design was a retrospective cross-sectional analysis from 2013 to 2015. Subjects were Medicaid enrollees with 1) diagnosis of any tobacco use (2013 n = 541,349; 2014 n = 864,183; 2015 n = 1,090,274); and/or (2) procedure claim for tobacco cessation counseling, and/or (3) pharmaceutical claim for varenicline or any nicotine replacement product. Primary measures included tobacco use incidence and proportion of users receiving cessation treatment. Analysis was via chi square testing of change by year. RESULTS Overall, the proportion of tobacco users utilizing cessation treatment decreased (4.75% tobacco users in 2013; 3.15% in 2015). Tobacco users receiving counseling decreased from 2.06% pre-ACA (2013) to 1.06% post-ACA (2015, p < 0.001), as did the proportion receiving nicotine replacement products post-ACA (2.69% in 2013 to 1.55% by 2015; p < 0.001). More Appalachians received cessation treatment than non-Appalachians in 2013 (2.72% vs. 2.03%), but by 2015 non-Appalachians received more treatment overall (1.50% vs. 1.65%; p < 0.001). Appalachians received more counseling and NRT, but less varenicline, than non-Appalachians. CONCLUSIONS Utilization of all forms of tobacco cessation treatment throughout Kentucky, and particularly in rural Appalachia, remained limited despite Medicaid enrollment as well as coverage expansions. These findings suggest that barriers persist in access to tobacco cessation treatment for individuals in Medicaid.
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Affiliation(s)
- Amie Goodin
- University of Florida, College of Pharmacy, Gainesville, FL, USA.,Center for Drug Evaluation and Safety (CoDES), Gainesville, FL, USA
| | - Jeffery Talbert
- University of Kentucky, College of Pharmacy, Lexington, KY, USA
| | | | - Ellen J Hahn
- University of Kentucky, College of Nursing, Lexington, KY, USA
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15
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The Prevalence of Multiple Comorbidities in Stroke Survivors in Rural Appalachia and the Clinical Care Implications. J Stroke Cerebrovasc Dis 2019; 28:104358. [PMID: 31519456 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 08/09/2019] [Accepted: 08/14/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The majority of studies on multimorbidity have been in aging populations and there is a paucity of data on individuals following stroke. OBJECTIVE In order to better understand the overall complexity of the stroke population in rural Kentucky, we examined the prevalence of multimorbidity that impact the overall long-term health and health care for these individuals. METHODS A secondary analysis examined whether there are gender or age differences in this stroke population related to the prevalence of multimorbidity. A total of 5325 individuals, 18 years of age and older, seen at an academic medical center for the primary diagnosis of acute ischemic stroke or transient ischemic attack between the years of 2010-2017 were identified using the Kentucky Appalachian Stroke Registry. Descriptive analysis was used to report the prevalence of each comorbidity in the rural population by age group, gender, and level of multimorbidity by looking at concurrent frequencies. RESULTS Overall, hypertension, dyslipidemia, tobacco use, diabetes, and obesity were the comorbidities with the highest prevalence in our population irrespective of gender. Over 78% (n = 4153) of the individuals had 3 or more comorbidities while 61% (n = 3285) had at least 3 out of the top 5 comorbidities (hypertension, hyperlipidemia, tobacco, obesity, diabetes). With respect to age, 15% (n = 795) of the sample was under the age of 50, while 32% (n = 1704) were between the age of 50 and 64 and 53% (n = 2826) of the sample were 65 years or older. CONCLUSIONS The results of this study indicate the majority of individuals affected by stroke in rural Appalachia Kentucky have multimorbidity. In addition, almost half of these individuals are having their strokes at a younger age, which will require a shift in the focus for therapeutic interventions (eg, reintegration into the workforce versus just community reintegration).
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16
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Hoogland AI, Hoogland CE, Bardach SH, Tarasenko YN, Schoenberg NE. Health Behaviors in Rural Appalachia. South Med J 2019; 112:444-449. [PMID: 31375842 DOI: 10.14423/smj.0000000000001008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To better understand the disproportionate burdens from cancer, cardiovascular disease, diabetes mellitus, stroke, and other chronic conditions related to energy balance, we studied diet and physical activity patterns in younger and older adults in rural Appalachia by using a nonclinical, cross-sectional, community-based sampling approach. METHODS A total of 651 younger (ages 18-59) and 254 older (ages ≥60) Appalachians were recruited from 43 churches or community organizations. Participants answered questions about fruit and vegetable intake and physical activity. Analyses were adjusted for clustering within churches. RESULTS Compared with older Appalachians, younger Appalachians consumed significantly fewer fruits and vegetables (P = 0.01) and reported significantly more moderate-to-vigorous physical activity (P = 0.01). Regardless of age, engagement in healthy behaviors was suboptimal and well below national averages. CONCLUSIONS This community-based sample demonstrated elevated behavioral risk factors that likely contribute to some of the nation's highest rates of premature mortality. Despite suboptimal dietary intake and physical activity, results indicate some potential leverage points between the generations that may be used to improve health. For example, the older generation could benefit from engaging with their younger relatives in physical activities while advocating for a better-rounded diet. Given traditions of intergenerational connectedness, mutual aid, and self-reliance, transmission of healthier behaviors across the generations may be beneficial in the rural Appalachian context.
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Affiliation(s)
- Aasha I Hoogland
- From the Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, the Department of Psychology, University of South Florida, Tampa, the Sanders Brown Center on Aging, Graduate Center for Gerontology, University of Kentucky, Lexington, the Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, and the Department of Behavioral Science, University of Kentucky, Lexington
| | - Charles E Hoogland
- From the Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, the Department of Psychology, University of South Florida, Tampa, the Sanders Brown Center on Aging, Graduate Center for Gerontology, University of Kentucky, Lexington, the Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, and the Department of Behavioral Science, University of Kentucky, Lexington
| | - Shoshana H Bardach
- From the Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, the Department of Psychology, University of South Florida, Tampa, the Sanders Brown Center on Aging, Graduate Center for Gerontology, University of Kentucky, Lexington, the Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, and the Department of Behavioral Science, University of Kentucky, Lexington
| | - Yelena N Tarasenko
- From the Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, the Department of Psychology, University of South Florida, Tampa, the Sanders Brown Center on Aging, Graduate Center for Gerontology, University of Kentucky, Lexington, the Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, and the Department of Behavioral Science, University of Kentucky, Lexington
| | - Nancy E Schoenberg
- From the Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, the Department of Psychology, University of South Florida, Tampa, the Sanders Brown Center on Aging, Graduate Center for Gerontology, University of Kentucky, Lexington, the Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, and the Department of Behavioral Science, University of Kentucky, Lexington
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17
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Lopez AM, Hudson L, Vanderford NL, Vanderpool R, Griggs J, Schonberg M. Epidemiology and Implementation of Cancer Prevention in Disparate Populations and Settings. Am Soc Clin Oncol Educ Book 2019; 39:50-60. [PMID: 31099623 DOI: 10.1200/edbk_238965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Successful cancer prevention strategies must be tailored to support usability. In this article, we will focus on cancer prevention strategies in populations that differ by race and ethnicity, place and location, sexual orientation and gender identity, and age by providing examples of effective approaches. An individual may belong to none of these categories, to all of these categories, or to some. This intersectionality of belonging characterizes individuals and shapes their experiences. Even within a category, broad diversity exists. Effective cancer prevention strategies comprehensively engage the community at multiple levels of influence and may effectively include lay health workers and faith-based cancer education interventions. Health system efforts that integrate cancer health with other health promotion activities show promise. At the individual physician level, culturally literate approaches have demonstrated success. For example, when discussing cancer screening tests with older adults, clinicians should indicate whether any data suggest that the screening test improves quality or quantity of life and the lag time to benefit from the screening test. This will allow older adults to make an informed cancer screening decision based on a realistic understanding of the potential benefits and risks and their values and preferences. Addressing individual and health system bias remains a challenge. Quality improvement strategies can address gaps in quality of care with respect to timeliness of care, coordination of care, and patient experience. The time is ripe for research on effective and interdisciplinary prevention strategies that harness expertise from preventive medicine, behavioral medicine, implementation science, e-health, telemedicine, and other diverse fields of health promotion.
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Affiliation(s)
- Ana Maria Lopez
- 1 Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Lauren Hudson
- 2 University of Kentucky Markey Cancer Center, Lexington, KY
| | | | | | | | - Mara Schonberg
- 4 Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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18
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Nahar VK, Wilkerson AH, Patel FC, Kim RW, Stephens PM, Sharma M. Utilizing Multi-Theory Model in Determining Intentions to Smoking Cessation Among Smokers. Tob Use Insights 2019; 12:1179173X19843524. [PMID: 31065217 PMCID: PMC6487755 DOI: 10.1177/1179173x19843524] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/19/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Smoking is a risk factor for lung cancers, and a myriad of other acute and chronic ailments. The purpose of this study was to predict initiation and sustenance of smoking cessation among smokers using a fourth-generation behavioral framework, multi-theory model (MTM) of health behavior change. Methods: A convenience sample of smokers from a shopping mall in rural, Appalachian Kentucky county was invited to participate in this cross-sectional study. A 38-item, face and content validated, MTM-based survey instrument was administered to the participants. Results: A total of 148 participants completed the study. The mean age of the participants was 35.53 (SD = 14.52) years. Most were male (58.1%) and Caucasian (95.9%). Participants reported smoking for an average of 16.45 (SD = 13.12) years. Participatory dialogue (β = 0.235, P = .003) and behavioral confidence (β = 0.305, P = .005) were significant predictors of intention for initiation for smoking cessation behavior. Emotional transformation (β = 0.319, P = .001) was a significant predictor of intention for sustenance for smoking cessation behavior. Discussion: Two of the MTM constructs for initiation and one of the MTM constructs for sustenance of change accounted for a moderate amount of variance in initiation and sustenance of smoking cessation behavior among community members in a rural, Kentucky county. MTM has utility for predicting both initiation and sustenance of smoking cessation behavior. Future interventions using MTM constructs should be developed for smoking cessation behavior change.
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Affiliation(s)
- Vinayak K Nahar
- Center for Animal and Human Health in Appalachia, College of Veterinary Medicine, DeBusk College of Osteopathic Medicine and School of Mathematics and Sciences, Lincoln Memorial University, Harrogate, TN, USA.,Department of Dermatology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Amanda H Wilkerson
- Community Physical Activity and Health Lab, Department of Health and Exercise Science, College of Arts and Sciences, The University of Oklahoma, Norman, OK, USA
| | - Falguni C Patel
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN, USA
| | - Richard W Kim
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN, USA
| | - Philip M Stephens
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN, USA
| | - Manoj Sharma
- Department of Behavioral and Environmental Health, School of Public Health, Jackson State University, MS, USA.,Health for All, Inc., Omaha, NE, USA
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19
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Hendryx M, Yonts SD, Li Y, Luo J. Mountaintop removal mining and multiple illness symptoms: A latent class analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 657:764-769. [PMID: 30677941 DOI: 10.1016/j.scitotenv.2018.12.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Mountaintop removal mining has been associated with multiple types of disease outcomes for populations living nearby. The current study tested whether latent classes identifying people with symptoms from multiple organ systems were associated with residence in mountaintop mining communities. METHODS We used data from three cross-sectional household community surveys conducted in three Appalachian states (N = 2756). The surveys contained information on 29 recent illness symptoms grouped into eight organ systems (respiratory, cardiovascular, gastrointestinal, musculoskeletal, skin, eye-ear-nose-throat, neurological, and other.) We identified latent classes, and then tested whether classes with higher probabilities of multiple symptoms would be associated with residence in mountaintop removal areas after control for covariates. RESULTS Three latent classes were identified, including a low-symptom referent class, an intermediate class, and a class with high symptom probability across organ systems. Controlling for covariates, latent classes characterized by intermediate and high multi-symptom probabilities were significantly associated with residence near mountaintop removal mining, with the highest odds ratio for the MTR versus control condition for the high multi-symptom group (OR = 2.17, 95% CI = 1.80-2.61). CONCLUSIONS Symptoms across multiple organ systems were related to residential proximity to mountaintop removal mining. Prior research has established multiple environmental contaminants related to mining that may contribute to poor population health through more than one exposure route or chemical of concern.
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Affiliation(s)
- Michael Hendryx
- Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, IN 47405, United States of America.
| | - Sarah D Yonts
- Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, IN 47405, United States of America
| | - Yueyao Li
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN 47405, United States of America
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN 47405, United States of America
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20
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Vanderpool RC, Huang B, Deng Y, Bear TM, Chen Q, Johnson MF, Paskett ED, Robertson LB, Young GS, Iachan R. Cancer-Related Beliefs and Perceptions in Appalachia: Findings from 3 States. J Rural Health 2019; 35:176-188. [PMID: 30830984 DOI: 10.1111/jrh.12359] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Appalachians experience increased rates of cancer incidence and mortality compared to non-Appalachians. Many factors may contribute to the elevated cancer burden, including lack of knowledge and negative beliefs about the disease. METHODS Three National Cancer Institute (NCI)-designated cancer centers with Appalachian counties in their respective population-based geographic service areas-Kentucky, Ohio, and Pennsylvania-surveyed their communities to better understand their health profiles, including 5 items assessing cancer beliefs. Weighted univariate and bivariate statistics were calculated for each of the 3 state's Appalachian population and for a combined Appalachian sample. Weighted multiple linear regression was used to identify factors associated with a cancer beliefs composite score. Data from the combined Appalachian sample were compared to NCI's Health Information National Trends Survey (HINTS). RESULTS Data from 1,891 Appalachian respondents were included in the analysis (Kentucky = 798, Ohio = 112, Pennsylvania = 981). Significant differences were observed across the 3 Appalachian populations related to income, education, marital status, rurality, perceptions of present income, and body mass index (BMI). Four of 5 cancer beliefs were significantly different across the 3 states. Education, BMI, perceptions of financial security, and Kentucky residence were significantly associated with a lower composite score of cancer beliefs. When comparing the combined Appalachian population to HINTS, 3 of 5 cancer belief measures were significantly different. CONCLUSIONS Variations in cancer beliefs were observed across the 3 states' Appalachian populations. Interventions should be tailored to specific communities to improve cancer knowledge and beliefs and, ultimately, prevention and screening behaviors.
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Affiliation(s)
| | - Bin Huang
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | | | - Todd M Bear
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Quan Chen
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Meghan F Johnson
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Electra D Paskett
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Linda B Robertson
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gregory S Young
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
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21
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Liu J, Murali T, Yu T, Liu C, Sivakumaran TA, Moseley HNB, Zhulin IB, Weiss HL, Durbin EB, Ellingson SR, Liu J, Huang B, Hallahan BJ, Horbinski CM, Hodges K, Napier DL, Bocklage T, Mueller J, Vanderford NL, Fardo DW, Wang C, Arnold SM. Characterization of Squamous Cell Lung Cancers from Appalachian Kentucky. Cancer Epidemiol Biomarkers Prev 2018; 28:348-356. [PMID: 30377206 DOI: 10.1158/1055-9965.epi-17-0984] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/08/2018] [Accepted: 10/25/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer mortality in the United States (U.S.). Squamous cell carcinoma (SQCC) represents 22.6% of all lung cancers nationally, and 26.4% in Appalachian Kentucky (AppKY), where death from lung cancer is exceptionally high. The Cancer Genome Atlas (TCGA) characterized genetic alterations in lung SQCC, but this cohort did not focus on AppKY residents. METHODS Whole-exome sequencing was performed on tumor and normal DNA samples from 51 lung SQCC subjects from AppKY. Somatic genomic alterations were compared between the AppKY and TCGA SQCC cohorts. RESULTS From this AppKY cohort, we identified an average of 237 nonsilent mutations per patient and, in comparison with TCGA, we found that PCMTD1 (18%) and IDH1 (12%) were more commonly altered in AppKY versus TCGA. Using IDH1 as a starting point, we identified a mutually exclusive mutational pattern (IDH1, KDM6A, KDM4E, JMJD1C) involving functionally related genes. We also found actionable mutations (10%) and/or intermediate or high-tumor mutation burden (65%), indicating potential therapeutic targets in 65% of subjects. CONCLUSIONS This study has identified an increased percentage of IDH1 and PCMTD1 mutations in SQCC arising in the AppKY residents versus TCGA, with population-specific implications for the personalized treatment of this disease. IMPACT Our study is the first report to characterize genomic alterations in lung SQCC from AppKY. These findings suggest population differences in the genetics of lung SQCC between AppKY and U.S. populations, highlighting the importance of the relevant population when developing personalized treatment approaches for this disease.
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Affiliation(s)
- Jinpeng Liu
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Thilakam Murali
- Department of Molecular & Cellular Biochemistry, University of Kentucky, Lexington, Kentucky
| | - Tianxin Yu
- Department of Molecular & Cellular Biochemistry, University of Kentucky, Lexington, Kentucky
| | - Chunming Liu
- Department of Molecular & Cellular Biochemistry, University of Kentucky, Lexington, Kentucky
| | - Theru A Sivakumaran
- Department of Pathology and Laboratory Medicine, Phoenix Children's Hospital, Phoenix, Arizona
| | - Hunter N B Moseley
- Department of Molecular & Cellular Biochemistry, University of Kentucky, Lexington, Kentucky
| | - Igor B Zhulin
- Department of Microbiology, The Ohio State University, Columbus, Ohio.,Center for Bioinformatics, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Heidi L Weiss
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Eric B Durbin
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky.,Division of Biomedical Informatics, University of Kentucky, Lexington, Kentucky
| | - Sally R Ellingson
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky.,Division of Biomedical Informatics, University of Kentucky, Lexington, Kentucky
| | - Jinze Liu
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky.,Department of Computer Science, University of Kentucky, Lexington, Kentucky
| | - Bin Huang
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky.,Department of Biostatistics, University of Kentucky, Lexington, Kentucky
| | - Brent J Hallahan
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Craig M Horbinski
- Department of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois
| | - Kurt Hodges
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky
| | - Dana L Napier
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Thèrése Bocklage
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky
| | - Joseph Mueller
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Nathan L Vanderford
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky.,Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, Kentucky
| | - David W Fardo
- Department of Biostatistics, University of Kentucky, Lexington, Kentucky
| | - Chi Wang
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky. .,Department of Biostatistics, University of Kentucky, Lexington, Kentucky
| | - Susanne M Arnold
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky. .,Department of Medicine, University of Kentucky, Lexington, Kentucky
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22
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Kitzman P, Wolfe M, Elkins K, Fraser JF, Grupke SL, Dobbs MR. The Kentucky Appalachian Stroke Registry (KApSR). J Stroke Cerebrovasc Dis 2018; 27:900-907. [PMID: 29269220 DOI: 10.1016/j.jstrokecerebrovasdis.2017.10.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/25/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The population of rural Kentucky and West Virginia has a disproportionately high incidence of stroke and stroke risk factors. The Kentucky Appalachian Stroke Registry (KApSR) is a novel registry of stroke patients developed to collect demographic and clinical data in real time from these patients' electronic health records. OBJECTIVE We describe the development of this novel registry and test it for ability to provide the information necessary to identify care gaps and direct clinical management. METHODS The KApSR was developed as described in this article. To assess utility in patient care, we developed a "Diabetes Quality Assurance Dashboard" by cross-referencing patients in the registry with a diagnosis of ischemic cerebrovascular disease with patients that were tested for hemoglobin A1c (HbA1c) levels, patients with HbA1c levels diagnostic for diabetes mellitus (DM), and patients with an elevated HbA1c that were formally diagnosed with DM. RESULTS For the 1008 patients treated for ischemic cerebrovascular disease in the year studied, 859 (85%) had their HbA1c tested. Of those, 281 had levels of 6.5 or greater, although only 261 (93%) were discharged with a formal diagnosis of DM. CONCLUSIONS The KApSR has practical value as a tool to assess a large population of patients quickly for care quality and for research purposes.
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Affiliation(s)
- Patrick Kitzman
- College of Health Sciences, University of Kentucky, Lexington, Kentucky; HealthCare Stroke Network, Norton Healthcare/UK, Lexington, Kentucky
| | - Marc Wolfe
- College of Health Sciences, University of Kentucky, Lexington, Kentucky; HealthCare Stroke Network, Norton Healthcare/UK, Lexington, Kentucky
| | - Kelley Elkins
- HealthCare Stroke Network, Norton Healthcare/UK, Lexington, Kentucky
| | - Justin F Fraser
- Department of Neurology, University of Kentucky, Lexington, Kentucky; Department of Neurological Surgery, University of Kentucky, Lexington, Kentucky; Department of Radiology, University of Kentucky, Lexington, Kentucky; Department of Anatomy and Neurobiology, University of Kentucky, Lexington, Kentucky
| | - Stephen L Grupke
- Department of Neurological Surgery, University of Kentucky, Lexington, Kentucky
| | - Michael R Dobbs
- HealthCare Stroke Network, Norton Healthcare/UK, Lexington, Kentucky; Department of Neurology, University of Kentucky, Lexington, Kentucky.
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23
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Singh GK, Kogan MD, Slifkin RT. Widening Disparities In Infant Mortality And Life Expectancy Between Appalachia And The Rest Of The United States, 1990-2013. Health Aff (Millwood) 2018; 36:1423-1432. [PMID: 28784735 DOI: 10.1377/hlthaff.2016.1571] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Appalachia-a region that stretches from Mississippi to New York-has historically been recognized as a socially and economically disadvantaged part of the United States, and growing evidence suggests that health disparities between it and the rest of the country are widening. We compared infant mortality and life expectancy disparities in Appalachia to those outside the region during the period 1990-2013. We found that infant mortality disparities widened for both whites and blacks, with infant mortality 16 percent higher in Appalachia in 2009-13, and the region's deficit in life expectancy increased from 0.6 years in 1990-92 to 2.4 years in 2009-13. The association between area poverty and life expectancy was stronger in Appalachia than in the rest of the United States. We found wide health disparities, including a thirteen-year gap in life expectancy among black men in high-poverty areas of Appalachia, compared to white women in low-poverty areas elsewhere. Higher mortality in Appalachia from cardiovascular diseases, lung cancer, chronic lower respiratory diseases or chronic obstructive pulmonary disease, diabetes, nephritis or kidney diseases, suicide, unintentional injuries, and drug overdose contributed to lower life expectancy in the region, compared to the rest of the country. Widening health disparities were also due to slower mortality improvements in Appalachia.
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Affiliation(s)
- Gopal K Singh
- Gopal K. Singh is a senior health equity adviser in the Office of Health Equity, Health Resources and Services Administration (HRSA), Department of Health and Human Services, in Rockville, Maryland
| | - Michael D Kogan
- Michael D. Kogan is director of the Office of Epidemiology and Research, Maternal and Child Health Bureau, at HRSA
| | - Rebecca T Slifkin
- Rebecca T. Slifkin is an associate professor and associate chair of health policy and management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
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24
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Rice EL, Patel M, Serrano KJ, Thai CL, Blake KD, Vanderpool RC. Beliefs About Behavioral Determinants of Obesity in Appalachia, 2011-2014. Public Health Rep 2018; 133:379-384. [PMID: 29791807 DOI: 10.1177/0033354918774064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The populations of many Appalachian communities have high rates of unhealthy body weight. This study aimed to identify differences in beliefs about obesity between Appalachians and non-Appalachians. Our analyses explored health beliefs and behaviors among US adults aged ≥18 (n = 14 451) who responded to the Health Information National Trends Survey (2011-2014), of whom 1015 (8%) resided within the 420 counties recognized as Appalachian by the Appalachian Regional Commission. Using weighted regression analyses and controlling for sociodemographic characteristics and general health, we determined that self-reported body mass index was higher among Appalachians than among non-Appalachians ( B = 0.75, P = .03, 95% confidence interval, 0.08-1.47) and that Appalachians were less likely than non-Appalachians to believe that lifestyle factors were related to obesity ( B = -0.37, P = .03, 95% confidence interval, -0.04 to -0.71). Results suggest that Appalachians may regard behavioral prevention differently from non-Appalachians, perhaps with less confidence in the effectiveness of certain behaviors to reduce obesity risk. Future research may determine whether such beliefs could complicate efforts to encourage healthy lifestyles throughout the region.
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Affiliation(s)
- Elise L Rice
- 1 Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Minal Patel
- 1 Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Katrina J Serrano
- 1 Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Chan L Thai
- 2 Department of Communication, College of Arts and Sciences, Santa Clara University, Santa Clara, CA, USA
| | - Kelly D Blake
- 1 Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Robin C Vanderpool
- 3 Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY, USA
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25
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Pravosud V, Huang B, Tucker T, Vanderford NL. Development of Multiple Primary Cancers in Lung Cancer Patients: Appalachian Versus Non-Appalachian Populations of Kentucky. South Med J 2017; 110:775-781. [DOI: 10.14423/smj.0000000000000742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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26
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Tompkins LK, Sears CG, Hart JL, Walker KL, Lee AS, Bhatnagar A. "If You Are Old Enough to Die for Your Country, You Should Be Able to Get a Pinch of Snuff": Views of Tobacco 21 Among Appalachian Youth. THE JOURNAL OF APPLIED RESEARCH ON CHILDREN : INFORMING POLICY FOR CHILDREN AT RISK 2017; 8:2. [PMID: 29379673 PMCID: PMC5787053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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27
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Harrison AL, Hunter EG, Thomas H, Bordy P, Stokes E, Kitzman P. Living with traumatic brain injury in a rural setting: supports and barriers across the continuum of care. Disabil Rehabil 2016; 39:2071-2080. [PMID: 27549899 DOI: 10.1080/09638288.2016.1217081] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Traumatic brain injury (TBI) is prevalent in Kentucky and comes with a high cost in care and quality of life for individuals and caregivers affected. Many people living with the condition of TBI have unmet needs. Research among people living with TBI in rural areas is limited. The purposes of this study were to (1) increase understanding of the lived experience of people with TBI and caregivers in rural regions of Kentucky across the continuum of their care and (2) provide their perspectives on barriers and facilitators of optimal function and well-being. METHODS A qualitative descriptive interview study was conducted by a multidisciplinary team. Content analysis was completed with data-derived coding and iterative modifications to analysis, coalescing codes into categories and themes. RESULTS Thirteen people with TBI and six caregivers participated in the interview. Categories that emerged in analysis included the experiences under each locus of care; themes included relationships, functional competence, and participation in meaningful activity. CONCLUSION Relationships represented both barriers and facilitators of well-being. Major unmet needs persisted in terms of medical problems, support for caregivers, community linkages, and participation in meaningful activities. Recommendations are made regarding avenues for addressing unmet needs. Implications for Rehabilitation People with TBI are living with chronic conditions and may need intensive rehabilitation after the injury and intermittent rehabilitation throughout life to develop and maintain functional competence. Rehabilitation providers need to understand the unique aspects of the rural home environment to which a patient will be discharged (e.g., mountainous terrain, lack of transportation, dimensions of home) and communicate with rural providers directly. Rehabilitation providers need additional focus on improving patient's and caregiver's abilities to advocate for themselves. Patients with TBI should be referred to vocational rehabilitation as soon as possible to make the transition to meaningful activity at home more of a possibility.
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Affiliation(s)
- Anne L Harrison
- a Department of Rehabilitation Sciences , Kentucky Appalachian Rural Rehabilitation Network (KARRN), College of Health Sciences, University of Kentucky , Lexington , KY , USA
| | - Elizabeth G Hunter
- b The Graduate Center for Gerontology, College of Public Health, University of Kentucky , Lexington , KY , USA
| | - Heather Thomas
- c Kentucky Outpatient Rehabilitation Therapy , Lebanon , Kentucky , USA
| | - Paige Bordy
- d Pediatric Rehabilitation and Development Outpatient Pavilion, Advocate Children's Hospital , Oak Lawn , IL , USA
| | | | - Patrick Kitzman
- a Department of Rehabilitation Sciences , Kentucky Appalachian Rural Rehabilitation Network (KARRN), College of Health Sciences, University of Kentucky , Lexington , KY , USA
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28
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Wong S. Geographies of medicalized welfare: Spatial analysis of supplemental security income in the U.S., 2000–2010. Soc Sci Med 2016; 160:9-19. [DOI: 10.1016/j.socscimed.2016.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/11/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
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29
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Kim Y, Jeong SM, Yoo B, Oh B, Kang HC. Associations of smoking with overall obesity, and central obesity: a cross-sectional study from the Korea National Health and Nutrition Examination Survey (2010-2013). Epidemiol Health 2016; 38:e2016020. [PMID: 27221478 PMCID: PMC4967909 DOI: 10.4178/epih.e2016020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 05/19/2016] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The association between smoking and obesity is a significant public health concern. Both are preventable risk factors of cardiovascular disease and a range of other conditions. However, despite numerous previous studies, no consensus has emerged regarding the effect of smoking on obesity. We therefore carried out a novel study evaluating the relationship between smoking and obesity. METHODS A total of 5,254 subjects aged 19 years or older drawn from the 2010-2013 Korea National Health and Nutrition Examination Survey were included in this cross-sectional study. Smoking was examined both in terms of smoking status and the quantity of cigarettes smoked by current smokers. Multiple logistic regression analysis was used to assess the association between smoking and obesity. Overall obesity was defined as a body mass index (BMI) ≥25 kg/m(2), and central obesity was defined as a waist circumference ≥90 cm for males and ≥85 cm for females. We adjusted for the possible confounding effects of age, sex, physical activity, alcohol consumption, and the presence of hypertension or diabetes. RESULTS A statistically significant difference in central obesity according to smoking status was identified. Current smokers were more likely to be centrally obese than never-smokers (adjusted odds ratio,1.30; 95% confidence interval, 1.02 to 1.67). However, no significant association was found between smoking and obesity defined by BMI. Moreover, among current smokers, no statistically significant association was found between the daily amount of smoking and obesity or central obesity. CONCLUSIONS Smoking was positively associated with central obesity. Current smokers should be acquainted that they may be more prone to central obesity.
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Affiliation(s)
- Yeonjung Kim
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Min Jeong
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Bora Yoo
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Bitna Oh
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee-Cheol Kang
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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30
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Abstract
Smoking continues to be the leading cause of preventable death in the USA, despite the vast and widely publicized knowledge about the negative health effects of tobacco smoking. Data show that smoking cessation is often accompanied by weight gain and an improvement in insulin sensitivity over time. However, paradoxically, post-cessation-related obesity might contribute to insulin resistance. Furthermore, post-cessation weight gain is reportedly the number one reason why smokers, especially women, fail to initiate smoking cessation or relapse after initiating smoking cessation. In this Review, we discuss the metabolic effects of stopping smoking and highlight future considerations for smoking cessation programs and therapies to be designed with an emphasis on reducing post-cessation weight gain.
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Affiliation(s)
- Kindred K Harris
- Division of Endocrinology, Metabolism and Molecular Medicine, Charles R. Drew University of Medicine and Science, 1731 East 120th Street, Los Angeles, California 90059, USA
| | - Mohan Zopey
- Division of Endocrinology, Metabolism and Molecular Medicine, Charles R. Drew University of Medicine and Science, 1731 East 120th Street, Los Angeles, California 90059, USA
| | - Theodore C Friedman
- Division of Endocrinology, Metabolism and Molecular Medicine, Charles R. Drew University of Medicine and Science, 1731 East 120th Street, Los Angeles, California 90059, USA
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31
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Mas FS. Commentary on “Trends in Cigarette Smoking Obesity in Appalachian Kentucky”. South Med J 2015; 108:178-9. [DOI: 10.14423/smj.0000000000000247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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