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Kolagatla S, Jenkins JK, Elsoueidi J, Wisnieski L, Moka N. Wave-Based Outcomes Comparison of Hospitalized COVID-19 Patients: A Retrospective Multicenter Cohort Study From Rural Appalachia. Cureus 2024; 16:e51845. [PMID: 38327948 PMCID: PMC10849066 DOI: 10.7759/cureus.51845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND There has been little to no characterization of the pandemic's effects on rural Central Appalachia, in which health disparities in the pre-COVID-19 era have historically plagued. This is the first study to compare wave-based differences in outcomes of hospitalized patients with COVID-19 in the rural Appalachian region. This study aims to provide a more comprehensive understanding of the effects of the COVID-19 pandemic on large rural communities and Appalachia. METHODS This is a retrospective cohort study of hospitalized patients with COVID-19 between April 2020 and June 2022, which includes 13 Appalachian Regional Healthcare (ARH) hospitals. The primary outcome of the study was in-hospital mortality. Secondary outcomes included intensive care unit (ICU) stay, need for mechanical ventilation, length of hospital stay, 1-30-day re-admittance, 30-60-day re-admittance, and thromboembolism incidence risk. RESULTS The second wave of infections during the pandemic demonstrated the highest mortality with higher odds of affecting younger patients. The third wave demonstrated similar mortality to the first wave. Elderly patients and patients with chronic morbidities demonstrated the highest mortality and morbidity and the highest requirement for mechanical ventilation across the three waves. Vaccination lowered the odds of mechanical ventilation and ICU stay. CONCLUSIONS This study comprehensively characterizes the impact of the COVID-19 pandemic in rural regions of Appalachian Kentucky and West Virginia. Future studies comparing differences between rural and urban geographies may be able to distinguish whether the disparities in these regions played a role in the impact on residents.
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Affiliation(s)
- Sandhya Kolagatla
- Department of Internal Medicine, Appalachian Regional Healthcare, Whitesburg, USA
| | - Joshua K Jenkins
- Department of Surgery, University of Kentucky College of Medicine, Lexington, USA
| | - Joseph Elsoueidi
- Department of Hematology and Oncology, University of Kentucky College of Medicine, Lexington, USA
| | - Lauren Wisnieski
- Center for Animal and Human Health in Appalachia, Richard A. Gillespie College of Veterinary Medicine, Lincoln Memorial University, Harrogate, USA
| | - Nagabhishek Moka
- Department of Hematology and Oncology, Appalachian Regional Healthcare, Whitesburg, USA
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Walker AE, Yost K, Olfert M. Implementation of Diabetes Education and Support in Appalachia. Eval Rev 2023:193841X231195392. [PMID: 37615089 DOI: 10.1177/0193841x231195392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Limited research on diabetes education and support implementation in Appalachia, which is a critical knowledge gap considering barriers to care, and high prevalence rates. The aim was to understand what each facility is providing regarding diabetes education and services within West Virginia. This study reports cognitive interview qualitative findings from a multi-methods study. Individuals were recruited through an online search to identify clinics, organizations, and hospital staff that provided diabetes education in the state of West Virginia. Eligible participants were individuals who facilitated and managed diabetes education and support in counties of West Virginia. The interviews followed an 11-item interview guide, approved, and reviewed by a practicing Registered Dietitian and Certified Diabetes Care Education Specialist in West Virginia. All qualitative data from the interviews were hand-coded using grounded theory, by two researchers. 15 participating organizations from the state of West Virginia were included and described three phenomena: Diabetes Education Implementation (differences in: evaluation measures, modality, delivery format, topical areas); Barriers to Care (staffing, lack of training, evaluation, loss of research partnerships and funding); and Facilitators to Care (community-based involvement, interdisciplinary collaboration, capacity building (trainings). There are concerns with program drift and "risky" adaptations such as inconsistent evaluative measures, lack of training for program facilitators, variety of delivery formats, and content material. Findings recommend more alignment in program delivery to better implementation. Further studies should assess patient experiences with implemented diabetes education programs in West Virginia to further support the current research findings.
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Affiliation(s)
- Ayron E Walker
- Nutrition and Health Care Management, Beaver College of Health Sciences, Appalachian State University, Boone, NC, USA
| | - Kasey Yost
- Division of Animal and Nutritional Sciences, Davis College of Agriculture, Natural Resources and Design, West Virginia University, Morgantown, WV, USA
| | - Melissa Olfert
- Division of Animal and Nutritional Sciences, Davis College of Agriculture, Natural Resources and Design, West Virginia University, Morgantown, WV, USA
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Thomas MK, Amstutz C, Orr-Roderick D, Horter J, Holben DH. Medical Mistrust Among Food Insecure Individuals in Appalachia. Fam Community Health 2023; 46:192-202. [PMID: 37079541 PMCID: PMC10179979 DOI: 10.1097/fch.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This study focused on the relationship between food insecurity and medical mistrust within Appalachia. Food insecurity has negative consequences on health, while medical mistrust can lead to a decrease in health care use, creating additive consequences to already vulnerable populations. Medical mistrust has been defined in various ways, with measures addressing health care organizations and individual health care providers. To determine whether food insecurity has an additive impact on medical mistrust, a cross-sectional survey was completed by 248 residents in Appalachia Ohio while attending community or mobile clinics, food banks, or the county health department. More than one-quarter of the respondents had high levels of mistrust toward health care organizations. Those with high food insecurity levels were more likely to have higher levels of medical mistrust than those with lower levels of food insecurity. Individuals with higher self-identified health issues and older participants had higher medical mistrust scores. Screening for food insecurity in primary care can reduce the impact of mistrust on patient adherence and health care access by increasing patient-centered communication. These findings present a unique perspective on how to identify and mitigate medical mistrust within Appalachia and call attention to the need for further research on the root causes among food insecure residents.
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Affiliation(s)
- Melissa K. Thomas
- Department of Primary Care (Dr Thomas), Ohio University Heritage College of Osteopathic Medicine (Ms Amstutz), Athens, Ohio; Learning Resource Center, Ohio University Heritage College of Osteopathic Medicine/Medical Education, Athens, Ohio (Ms Orr-Roderick); Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio (Ms Horter); and Department of Nutrition and Hospitality Management, Office of Food and Nutrition Security, The University of Mississippi, University, Mississippi (Dr Holben)
| | - Ciara Amstutz
- Department of Primary Care (Dr Thomas), Ohio University Heritage College of Osteopathic Medicine (Ms Amstutz), Athens, Ohio; Learning Resource Center, Ohio University Heritage College of Osteopathic Medicine/Medical Education, Athens, Ohio (Ms Orr-Roderick); Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio (Ms Horter); and Department of Nutrition and Hospitality Management, Office of Food and Nutrition Security, The University of Mississippi, University, Mississippi (Dr Holben)
| | - Debra Orr-Roderick
- Department of Primary Care (Dr Thomas), Ohio University Heritage College of Osteopathic Medicine (Ms Amstutz), Athens, Ohio; Learning Resource Center, Ohio University Heritage College of Osteopathic Medicine/Medical Education, Athens, Ohio (Ms Orr-Roderick); Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio (Ms Horter); and Department of Nutrition and Hospitality Management, Office of Food and Nutrition Security, The University of Mississippi, University, Mississippi (Dr Holben)
| | - Julia Horter
- Department of Primary Care (Dr Thomas), Ohio University Heritage College of Osteopathic Medicine (Ms Amstutz), Athens, Ohio; Learning Resource Center, Ohio University Heritage College of Osteopathic Medicine/Medical Education, Athens, Ohio (Ms Orr-Roderick); Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio (Ms Horter); and Department of Nutrition and Hospitality Management, Office of Food and Nutrition Security, The University of Mississippi, University, Mississippi (Dr Holben)
| | - David H. Holben
- Department of Primary Care (Dr Thomas), Ohio University Heritage College of Osteopathic Medicine (Ms Amstutz), Athens, Ohio; Learning Resource Center, Ohio University Heritage College of Osteopathic Medicine/Medical Education, Athens, Ohio (Ms Orr-Roderick); Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio (Ms Horter); and Department of Nutrition and Hospitality Management, Office of Food and Nutrition Security, The University of Mississippi, University, Mississippi (Dr Holben)
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4
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Rengifo S, Wu A, Ioffreda P, Ilyas AM. Differences in Opioid-Related Deaths in the Appalachian Region in 2018-2021 by State and Rural-Urban County Classification. Cureus 2023; 15:e40480. [PMID: 37461797 PMCID: PMC10349683 DOI: 10.7759/cureus.40480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/20/2023] Open
Abstract
Introduction The rapid increase in opioid-related deaths since the early 2000s is a major US public health concern. This crisis has transitioned from pharmaceuticals to illicit synthetic opioids and street mixtures. This epidemic has significantly impacted the Appalachian region. This study investigated opioid-related death rates among the Appalachian states, focusing on death rates among urban, suburban, and rural counties. Methods Opioid-related death data from 2018-2021 for the 13 states that make up the Appalachian region were collected using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Opioid analgesic overdose deaths were defined using ICD-10 codes X40-X44, X60-X64, and Y10-Y14, where an opioid analgesic was also coded (T40.2-T40.4). US census data was used to calculate opioid-related death rates by population. Counties were classified as urban, suburban, and rural using the 2013 Rural-Urban Continuum Codes from the US Department of Agriculture. The data were descriptively broken down and reported as either percentages or means. Results Of the opioid-related deaths between 2018 and 2021, 498 counties were identified in the 13 Appalachian states as having reported at least 10 opioid-related deaths per year. Among these counties, 337 (67.7%) were classified as urban/metropolitan, 138 (27.7%) as suburban, and 23 (4.62%) as rural. Overall, mean opioid-related deaths by populations per 1000 among all counties were 0.24 in 2018, 0.24 in 2019, 0.33 in 2020, and 0.38 in 2021. For urban/metropolitan counties, opioid-related deaths per 1000 gradually increased from 0.23 in 2018 to 0.35 in 2021. For suburban counties, the mean opioid-related deaths per 1000 increased from 0.25 in 2018 to 0.43 in 2021. For rural counties, the mean opioid-related deaths per 1000 increased from 0.43 in 2018 to 0.62 in 2021. Conclusion Opioid-related deaths, on average and by population, have risen steadily in the Appalachian region from 2018-2021 across all geographic areas (urban/metropolitan, suburban, rural). Rural counties consistently showed the highest opioid-related deaths per population compared to urban/metropolitan and suburban areas. Addressing social determinants of health such as income level, education level, healthcare access, and community-based interventions is crucial in combating this issue. Community and health system interventions must be implemented to combat the disproportionately high rate of opioid prescribing in the Appalachian region.
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Affiliation(s)
- Santiago Rengifo
- Foundation for Opioid Research & Education, Rothman Orthopaedic Institute, Philadelphia, USA
- Orthopedic Surgery, Drexel University College of Medicine, Philadelphia, USA
- Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, USA
| | - Alice Wu
- Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Patrick Ioffreda
- Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Asif M Ilyas
- Foundation for Opioid Research and Education, Rothman Orthopaedic Institute, Philadelphia, USA
- Orthopedic Surgery, Drexel University College of Medicine, Philadelphia, USA
- Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson, Philadelphia, USA
- Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, USA
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Smothers A, Morrissey E, Melnick H, Beaver M, Wang K, Piamjariyakul U. COVID-19 Caregiving Strategies, Quality of Life, and Stress Among Faith Community Nurses and Faith Leaders in Appalachia. J Christ Nurs 2023; 40:36-41. [PMID: 36469875 DOI: 10.1097/CNJ.0000000000001017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
ABSTRACT Faith community nurses (FCNs), pastors, and priests faced many challenges from the COVID-19 pandemic, serving as frontline sources of support for congregants. The aim of this study was to identify the most common care strategies used during the COVID-19 pandemic and examine professional quality of life, perceived stress, and associated factors in faith leaders and FCNs in rural Appalachia. Using a cross-sectional, descriptive survey design, high compassion satisfaction was reported along with compassion fatigue as caregiving moved to virtual platforms, suggesting the need for greater support.
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Roberson PNE, Cortez G, Freeman T, Lloyd J, Tasman J, Woods SB. Relationship quality and psychophysiological distress for underserved breast cancer patients and their caregiver before treatment. Psychooncology 2022; 31:1904-1912. [PMID: 36116101 DOI: 10.1002/pon.6035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/21/2022] [Accepted: 07/24/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Breast cancer patients and caregivers experience biobehavioral reactivity (e.g., depression, anxiety, pain, fatigue) during breast cancer treatment which predicts cancer recurrence and mortality. High quality patient-caregiver relationships can mitigate this distress during treatment, but this association is unclear pre-treatment. Identifying early interventions that target high risk Appalachian patients could impact biobehavioral reactivity. METHODS We recruited 55 breast cancer patient-caregiver dyads to complete a self-report survey after diagnosis but before treatment. We used a series of Actor-Partner Interdependence Models to test the hypotheses that both patient and caregiver relationship quality would be linked to their own and their partners' biobehavioral reactivity. RESULTS Caregiver reported marital quality lower caregiver anxiety, patient anxiety, caregiver depression, patient depression, caregiver pain, and caregiver fatigue. Interestingly, patient-reported marital quality was linked with higher caregiver anxiety, higher patient anxiety, lower patient depression, and lower patient pain. Patients reported family quality was linked to lower patient and caregiver pain. CONCLUSIONS This study demonstrates that pre-treatment marital and family quality levels are directly related to psychophysiological measures in both the caregiver and the patient, though sometimes in unexpected directions. Additionally, our findings potentially reveal an opportunity to intervene at the time of diagnosis to improve relationship quality, impacting patient and caregiver psychophysiological outcomes.
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Affiliation(s)
| | - Gina Cortez
- Public Health, University of California, Los Angles, USA
| | - Teri Freeman
- Cancer Institute, University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Jillian Lloyd
- Cancer Institute, University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Jordan Tasman
- Department of Public Health, University of Tennessee, Knoxville, Tennessee, USA
| | - Sarah B Woods
- Family and Community Medicine, University of Texas Southwestern, Dallas, Texas, USA
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7
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Abstract
OBJECTIVE The goal of this study was to compare rural and urban pediatric hospice patients in Appalachia. METHODS Using a retrospective, nonexperimental design, we sought to compare characteristics of Appalachian rural and urban children younger than 21 years enrolled in the Medicaid hospice benefit. Descriptive statistics were calculated on the demographic, hospice, and clinical characteristics of children from Appalachia. Comparisons were calculated using Pearson χ2 for proportions and the Student t test for means. RESULTS Less than half of the 1788 Appalachian children admitted to hospice care resided in rural areas (40%). Compared with children in urban areas of Appalachia, rural children were significantly younger (8 years vs 9.5 years) and more often had a complex chronic condition (56.0% vs 35.1%) and comorbidities (38.5% vs 17.0%) with technology dependence (32.6% vs 17.0%). Children in rural Appalachian were commonly from communities in the southern region of Appalachia (27.9% vs <10.0%), with median household incomes <$50,000/year (96.7% vs 22.4%). Significant differences were present in clinical care between rural and urban Appalachian children. Rural children had longer lengths of stay in hospice care (38 days vs 11 days) and were less likely to use the emergency department during hospice admission (19.0% vs 43.0%). These children more often visited their primary care provider (49.9% vs 31.3%) and sought care for symptoms from nonhospice providers (18.1% vs 10.0%) while admitted to hospice. CONCLUSIONS Our results suggest that children admitted to hospice care in rural versus urban Appalachia have distinct characteristics. Rural children are admitted to hospice care with significant medical complexities and reside in areas of poverty. Hospice care for rural children suggests a continuity of care with longer hospice stays and fewer transitions to the emergency department; however, the potential for care fragmentation is present, with frequent visits to primary care and nonhospice providers for symptom management. Understanding the unique characteristics of children in Appalachia may be essential for advancing knowledge and care for these children at the end of life. Future research examining geographic variation in hospice care in Appalachia is warranted.
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Affiliation(s)
- Mary Lou Clark Fornehed
- From the Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, the College of Nursing, University of Tennessee, Knoxville, the School of Nursing, University of Virginia, Charlottesville, and the Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia
| | - Radion Svynarenko
- From the Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, the College of Nursing, University of Tennessee, Knoxville, the School of Nursing, University of Virginia, Charlottesville, and the Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia
| | - Jessica Keim-Malpass
- From the Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, the College of Nursing, University of Tennessee, Knoxville, the School of Nursing, University of Virginia, Charlottesville, and the Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia
| | - Melanie J Cozad
- From the Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, the College of Nursing, University of Tennessee, Knoxville, the School of Nursing, University of Virginia, Charlottesville, and the Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia
| | - Kerri A Qualls
- From the Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, the College of Nursing, University of Tennessee, Knoxville, the School of Nursing, University of Virginia, Charlottesville, and the Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia
| | - Whitney L Stone
- From the Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, the College of Nursing, University of Tennessee, Knoxville, the School of Nursing, University of Virginia, Charlottesville, and the Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia
| | - Lisa C Lindley
- From the Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, the College of Nursing, University of Tennessee, Knoxville, the School of Nursing, University of Virginia, Charlottesville, and the Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia
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Abstract
We offer these reviewers our heartfelt thanks for a task that usually goes unrewarded in the academic environment. This year, we are especially grateful for those people listed below. They have assisted us in reaching the start of our 4th year, by guiding our decisions with your knowledge and capabilities.
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9
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Abstract
The Journal of Appalachian Health is committed to reviewing published media that relates to contemporary concepts affecting the health of Appalachia. Access to care remains one of the biggest challenges to Appalachian Health. The book, Wide Neighborhoods: A Story of the Frontier Nursing Service by Mary Breckinridge, is a well-known title that seems as relevant today as it was in 1952.
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Hudson L, Prichard C, Weiss LT, Ickes MJ, Vanderford NL. Training Appalachian Kentucky Youth Cancer Advocates. South Med J 2021; 114:356-360. [PMID: 34075428 PMCID: PMC8274365 DOI: 10.14423/smj.0000000000001256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Kentucky has the highest cancer incidence and mortality rates in the United States, with the Appalachian region experiencing the highest of those rates. Cancer advocacy, which is defined as providing support to cancer patients and their communities, represents a means of decreasing the cancer cases in Appalachian Kentucky. This exploratory study examined the effects of advocacy training and experiential learning on Appalachian high school students' cancer advocacy attitudes and self-efficacy. METHODS The design of this study was a mixed-methods, one-group repeated measure with a group of participants from the Appalachian Career Training in Oncology (ACTION) Program (N = 9). The study assessed advocacy attitudes and self-efficacy before and after participants were provided advocacy training and participated in an advocacy event. RESULTS Participating students' attitudes and self-efficacy did not substantially change following the training and their participation in an advocacy event. Through their comments after the event, however, students seem eager to use their voices to influence the actions of state legislators. At the same time, they worry about the apathy of their community members to their cancer advocacy message. CONCLUSIONS Youth represent potentially powerful agents of advocacy that could help address the cancer burden in Kentucky. Participants in this study likely overestimated their advocacy abilities before learning more about advocacy and participating in the process. As such, additional trainings are likely necessary to increase students' self-efficacy, encourage them to share their stories, and help them overcome perceived barriers.
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Affiliation(s)
- Lauren Hudson
- Markey Cancer Center, University of Kentucky. Lexington, KY, USA
| | - Chris Prichard
- Markey Cancer Center, University of Kentucky. Lexington, KY, USA
| | - L. Todd Weiss
- Markey Cancer Center, University of Kentucky. Lexington, KY, USA
| | - Melinda J. Ickes
- Department of Kinesiology and Health Promotion, College of Education, University of Kentucky. Lexington, KY, USA
| | - Nathan L. Vanderford
- Markey Cancer Center, University of Kentucky. Lexington, KY, USA
- Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky. Lexington, KY, USA
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11
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Hudson L, Sharp K, Prichard C, Ickes M, Alameh S, Vanderford NL. Cancer Curriculum for Appalachian Kentucky Middle and High Schools. J Appalach Health 2021; 3:43-55. [PMID: 35156057 PMCID: PMC8830599 DOI: 10.13023/jah.0301.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Appalachian Kentucky faces the highest cancer incidence and mortality rates in the country due to poor health behaviors and lifestyle choices. These poor health behaviors are facilitated by a lack of cancer education. Youth represent a vulnerable population that could be greatly impacted by increased cancer education. Teachers have the power to facilitate this learning. PURPOSE This study examined the need for cancer education curriculum in Appalachian Kentucky middle and high schools from the perspective of educators. METHODS An online survey was conducted with science and health teachers (n=21) in Appalachian Kentucky, consisting of questions that investigated existing cancer education efforts, relevance of cancer education, and feasibility of such curriculum being delivered in the classroom. Content analysis was used to analyze teacher comments. A 3-part cancer education curriculum was developed that is culturally relevant and aligned with science and health education standards. RESULTS All participating teachers agree that cancer education is important to students' lives. Teachers also agree that there is an inconsistent amount of cancer education within schools, and qualitative content analysis revealed that cancer education likely fits best in certain course subjects. Cancer education could feasibly be integrated into science and health classrooms, although the perception of needing to teach to the academic standards and having limited time to teach additional lessons outside of the standards are significant barriers. To combat this, a cancer curriculum that aligns with state and national science and health education standards was developed. IMPLICATIONS Cancer education curriculum could play an important role in improving the cancer outlook in Appalachian Kentucky. Teachers have expressed a desire for increased cancer education in the classroom. By disseminating and implementing cancer curriculum in schools in the region and revising the curriculum -based on teacher and student feedback to better fit their needs, it has the potential to increase cancer literacy and improve related health behaviors and outcomes.
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Affiliation(s)
- Lauren Hudson
- Markey Cancer Center, University of Kentucky. Lexington, KY, USA
| | - Katherine Sharp
- Department of STEM Education, College of Education, University of Kentucky. Lexington, KY, USA
| | - Chris Prichard
- Markey Cancer Center, University of Kentucky. Lexington, KY, USA
| | - Melinda Ickes
- Department of Kinesiology and Health Promotion, College of Education, University of Kentucky. Lexington, KY, USA
| | - Sahar Alameh
- Department of STEM Education, College of Education, University of Kentucky. Lexington, KY, USA
| | - Nathan L Vanderford
- Markey Cancer Center, University of Kentucky. Lexington, KY, USA
- Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky. Lexington, KY, USA
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12
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Abstract
Prescription drug use is a growing public health concern and studies show it is a contributing risk to motor vehicle collisions. The Appalachian region is also known to have an ever-increasing number of patients on controlled substances. This retrospective study of patients from the years 2011-2015 on controlled substances presenting to an Appalachian Level 1 trauma center after a motor vehicle or motorcycle collision was analyzed in order to determine the rate of opioid use among victims of motor vehicle collisions in the system, as well as evaluate for any differences in resource utilization between these patients and patients not using controlled substances. A total of 2,570 patients were included in the study. Seven-hundred sixty-eight (29.9%) individuals were found to be on a controlled substance. There was a similar mortality rate in both groups (2.8% vs 3.6%). There was no significant difference in hospital length of stay (LOS), intensive care unit (ICU) LOS, ventilator days, or injury severity score. Statistically significant findings include the type of crash (motor vehicle crash vs motorcycle crash) (p=0.003) and position in the vehicle (driver vs passenger) (p<0.001). Motor vehicle crashes and driver position were significantly associated with the presence of a controlled substance.
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Affiliation(s)
- Rebecca Proctor
- Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
| | - Melissa P Taylor
- Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
| | - Megan Quinn
- Epidemiology and Public Health, College of Public Health, East Tennessee State University, Johnson City, USA
| | - Bracken Burns
- Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
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13
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Hoover AG, Koempel A, Christian WJ, Tumlin KI, Pennell KG, Evans S, McAlister M, Ormsbee LE, Brewer D. Appalachian Environmental Health Literacy: Building Knowledge and Skills to Protect Health. J Appalach Health 2020; 2:47-53. [PMID: 32095784 PMCID: PMC7039621 DOI: 10.13023/jah.0201.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Environmental health literacy (EHL) is an emerging, multidisciplinary field that promotes understanding of how environmental exposures can affect human health. After discussing the regional relevance of environmental health knowledge and skills, this article describes three ongoing Appalachian projects that are focused on measuring and building EHL.
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Affiliation(s)
| | - Annie Koempel
- University of Kentucky Department of Dietetics and Human Nutrition
| | | | | | | | | | | | | | - Dawn Brewer
- University of Kentucky Department of Dietetics and Human Nutrition
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14
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Singh R, Ansinelli H, Katz H, Jafri H, Gress T, Tirona MT. Factors Associated with Functional Decline in Elderly Female Breast Cancer Patients in Appalachia. Cureus 2018; 10:e2612. [PMID: 30027004 PMCID: PMC6044479 DOI: 10.7759/cureus.2612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background Functional status has been previously shown in the elderly cancer population to predict both mortality as well as treatment tolerance. The goal of this study was to determine if there are certain subsets of the elderly breast cancer population that are at higher risk of experiencing functional decline following treatment. Methods Patient charts from the Edwards Comprehensive Cancer Center in Huntington, West Virginia, from January 2006 – January 2016 were reviewed. Relevant inclusion criteria included patients of 65 years of age and older with a new diagnosis of Stage 0-III breast cancer. Functional decline was defined as an increase of at least one point in Eastern Cooperative Oncology Group (ECOG) scores within one year of diagnosis. ECOG performance status was subjectively determined by the physician. Fisher’s exact test and Pearson’s Chi-squared test were initially utilized to assess potential factors associated with functional decline such as pretreatment ECOG score, age at diagnosis, stage, hormone receptor status, type of surgery received, whether radiation therapy, chemotherapy, or hormonal therapy was received, medical comorbidities, body mass index (BMI), complaints of weakness at diagnosis, and ambulatory status. Factors that were found to be significant were further assessed via multivariate logistic regressions. Results Three-hundred and fourteen patients were identified as meeting inclusion criteria. At one-year follow-up, 45 patients (14.3% of the cohort) had documented functional decline. On initial analysis, factors associated with functional decline included Stage III disease (p=0.002) and complaints of weakness at diagnosis (p=0.004). Following multivariate analysis, Stage III disease (p = 0.02), complaints of weakness at diagnosis (p = 0.04), and bilateral mastectomy (p = 0.03) were significantly associated with functional decline. Conclusion Patients who were diagnosed with Stage III breast cancer, had complaints of weakness at time of diagnosis, or had bilateral mastectomies were more likely to have a decline in functional status at one-year follow-up. Awareness of factors associated with functional decline in the elderly Appalachian population with Stage 0-III breast cancer will be useful during discussions regarding patient expectations, treatment, and goals of care. Elderly breast cancer patients for whom bilateral prophylactic mastectomies are not indicated may be better served by lumpectomy alone (based on patient age, hormone receptor status, and tumor size), lumpectomy followed by radiation therapy, or unilateral mastectomy to maximize the likelihood of functional preservation following treatment.
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Affiliation(s)
- Raj Singh
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, USA
| | - Hayden Ansinelli
- Department of Radiation Oncology, University of Arizona College of Medicine, Tucson, USA
| | - Heather Katz
- Hematology/oncology, Marshall University, Joan C. Edwards School of Medicine
| | - Hassaan Jafri
- Department of Internal Medicine, Marshall University, Joan C. Edwards School of Medicine
| | - Todd Gress
- Department of Internal Medicine, Marshall University, Joan C. Edwards School of Medicine
| | - Maria T Tirona
- Director of Medical Oncology, Marshall University, Joan C. Edwards School of Medicine
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Abstract
Although health promotion programming in faith institutions is promising, most faith-based or placed health projects focus on diet, exercise, or cancer screening and many have been located in urban environments. This article addresses the notable absence of faith programming for smoking cessation among underserved rural US residents who experience tobacco-related health inequities. In this article, we describe our faith-oriented smoking cessation program in rural Appalachia, involving 590 smokers in 26 rural churches randomized to early and delayed intervention groups. We present three main themes that account for participants' positive evaluation of the program; the program's ability to leverage social connections; the program's convenience orientation; and the program's financial support for smoking cessation. We also present themes on the roles of faith and church in smoking cessation programming, including some mixed perceptions on smoking stigma and comfort in church settings; challenges in faith-placed smoking cessation recruitment; and the positive perception of such programming by church leaders. We conclude that faith-placed smoking cessation programs offer great potential, although they must be administered with great sensitivity to individual and community norms.
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Affiliation(s)
- Nancy E. Schoenberg
- Marion Pearsall Professor of Behavioral Science, 125 Medical Behavioral Science Building, University of Kentucky, Lexington KY USA 40536-0086, tel: (859) 323-8175, fax: (859) 323-5350
| | | | | | | | - Brent J. Shelton
- Division of Cancer Biostatistics and Department of Biostatistics, University of Kentucky
| | - Nell Fields
- Project Director, Faith Moves Mountains, Whitesburg, KY
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Abstract
This essay, which is the third in the series "Recollections, Reflections, and Revelations: Ethnobiologists and their First Time in the Field", is a personal reflection by the researcher on his experience and involvement in kinship and friendship networks while conducting agrobiodiversity research in southern Appalachia, USA. Vignettes are given from moving moments spent with Native spiritual leaders, backcountry mountain people, and local co-collaborators in the research process. The author demonstrates how lasting field friendships have helped lead to groundbreaking ethnoecological research.
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Affiliation(s)
- James R Veteto
- Department of Anthropology, University of North Texas, 1155 Union Circle Drive # 310409, Denton, TX 76203-5017, USA.
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17
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Abstract
Women in Appalachian Kentucky experience a high burden of cervical cancer and have low rates of human papillomavirus (HPV) vaccination. The purpose of this study was to identify normative influences predicting initial HPV vaccine uptake among a sample of young women in southeastern Kentucky. Women (N = 495), ages 18 through 26 years, were recruited from clinics and community colleges. After completing a questionnaire, women received a free voucher for HPV vaccination. Whether women redeemed the voucher for Dose 1 served as the primary outcome variable. Hierarchical logistic regression was used to estimate the influence of healthcare providers, friends, mothers, and fathers on vaccine uptake. One-quarter of the total sample (25.9%) received Dose 1. Uptake was higher in the clinic sample (45.1%) than in the college sample (6.9%). On multivariate analysis, women indicating that their healthcare provider suggested the vaccine, that their friends would "definitely" want them to be vaccinated, and that their fathers would "definitely" want them to receive the vaccine all were 1.6 times more likely to receive Dose 1. Interaction effects occurred between recruitment site (clinic vs. community college) and all three of the normative influences retaining multivariate significance, indicating that the associations only applied to the clinic sample. HPV vaccine interventions may benefit from highlighting paternal endorsement, healthcare provider recommendation, and peer support.
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Affiliation(s)
- Baretta R Casey
- Rural Cancer Prevention Center, University of Kentucky College of Public Health, 151 Washington Avenue, 346 Bowman Hall, Lexington, KY 40506-0059, USA.
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18
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Swanson M, Schoenberg NE, Davis R, Wright S, Dollarhide K. Perceptions of healthful eating and influences on the food choices of Appalachian youth. J Nutr Educ Behav 2013; 45:147-153. [PMID: 22269474 PMCID: PMC3337954 DOI: 10.1016/j.jneb.2011.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 07/12/2011] [Accepted: 07/18/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Patterns of overweight and obesity have an unequal geographic distribution, and there are elevated rates in Appalachia. Perceptions of Appalachian youth toward healthful eating and influences on food choice were examined as part of formative research to address these disparities. METHODS Eleven focus groups, averaging 6 youth (n = 68) and moderated by experienced local residents, were conducted with participants aged 8-17. Session transcripts were coded for thematic analysis, using measures to enhance rigor and transferability. RESULTS Participants discussed numerous internal and external factors affecting dietary choices. They expressed confidence in their own nutritional knowledge, and they stressed the importance of taste preferences, cost, convenience, social influences, and advertising on diet. CONCLUSIONS AND IMPLICATIONS Appalachian youth awareness of the multiple influences on diet may create opportunities for multifaceted, ecologically based interventions. In particular, participants stressed the importance of social influences on diet and on successful nutrition programming.
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Affiliation(s)
- Mark Swanson
- Department of Health Behavior, University of Kentucky, Lexington, KY 40536, USA.
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19
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Reiter PL, Wee AG, Lehman A, Paskett ED. Oral cancer screening and dental care use among women from Ohio Appalachia. Rural Remote Health 2012; 12:2184. [PMID: 23240899 PMCID: PMC3838993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Residents of Appalachia may benefit from oral cancer screening given the region's higher oral and pharyngeal cancer mortality rates. The current study examined the oral cancer screening behaviors and recent dental care (since dentists perform most screening examinations) of women from Ohio Appalachia. METHODS Women from Ohio Appalachia were surveyed for the Community Awareness Resources Education (CARE) study, which was completed in 2006. A secondary aim of the CARE baseline survey was to examine oral cancer screening and dental care use among women from this region. Outcomes included whether women (n=477; cooperation rate = 71%) had ever had an oral cancer screening examination and when their most recent dental visit had occurred. Various demographic characteristics, health behaviors and psychosocial factors were examined as potential correlates. Analyses used multivariate logistic regression. RESULTS Most women identified tobacco-related products as risk factors for oral cancer, but 43% of women did not know an early sign of oral cancer. Only 15% of women reported ever having had an oral cancer screening examination, with approximately 80% of these women indicating that a dentist had performed their most recent examination. Women were less likely to have reported a previous examination if they were from urban areas (OR=0.33, 95% CI: 0.13-0.85) or perceived a lower locus of health control (OR=0.94, 95% CI: 0.89-0.98). Women were more likely to have reported a previous examination if they had had a dental visit within the last year (OR=2.24, 95% CI: 1.03-4.88). Only 65% of women, however, indicated a dental visit within the last year. Women were more likely to have reported a recent dental visit if they were of a high socioeconomic status (OR=2.83, 95% CI: 1.58-5.06), had private health insurance (OR=2.20, 95% CI: 1.21-3.97) or had consumed alcohol in the last month (OR=2.03, 95% CI: 1.20-3.42). CONCLUSION Oral cancer screening was not common among women from Ohio Appalachia, with many missed opportunities having occurred at dental visits. Education programs targeting dentists and other healthcare providers (given dental providers are lacking in some areas of Ohio Appalachia) about opportunistic oral cancer screening may help to improve screening in Appalachia. These programs should include information about populations at high risk for oral cancer (eg smokers) and how screening may be especially beneficial for them. Future research is needed to examine the acceptability of such education programs to healthcare providers in the Appalachian region and to explore why screening was less common among women living in urban areas of Ohio Appalachia.
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Affiliation(s)
- P L Reiter
- The Ohio State University, Columbus, Ohio, USA.
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20
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Abstract
To compare preconception health indicators (PCHIs) among non-pregnant women aged 18-44 years residing in Appalachian and non-Appalachian counties in 13 U.S. states. Data from the 1997-2005 Behavioral Risk Factor Surveillance System were used to estimate the prevalence of PCHIs among women in states with ≥1 Appalachian county. Counties were classified as Appalachian (n = 36,496 women) or non-Appalachian (n = 88,312 women) and Appalachian counties were categorized according to economic status. Bivariate and multivariable logistic regression models examined differences in PCHIs among women by (1) Appalachian residence, and (2) economic classification. Appalachian women were younger, lower income, and more often white and married compared to women in non-Appalachia. Appalachian women had significantly higher odds of reporting
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Affiliation(s)
| | - Reena Oza-Frank
- Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA. Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Elizabeth J. Conrey
- Ohio Department of Health, State Maternal and Child Health Epidemiologist, 246 North High Street, Columbus, OH 43215, USA. Centers for Disease Control and Prevention, Atlanta, GA, USA
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21
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Abstract
BACKGROUND Appalachia is a geographic region with high cervical cancer incidence and mortality rates, yet little is known about human papillomavirus (HPV) vaccination in this region. We determined HPV vaccine coverage among adolescent females from Appalachia, made comparisons to non-Appalachian females, and examined how coverage differs across subregions within Appalachia. METHODS We analyzed data from the National Immunization Survey-Teen 2008-2010 for adolescent females ages 13-17 (n = 1,951, Appalachian females and n = 25,468, non-Appalachian females). We examined HPV vaccine initiation (receipt of at least one dose), completion (receipt of at least three doses), and follow-through (completion among initiators). Analyses used weighted logistic regression. RESULTS HPV vaccine initiation [Appalachian = 40.8% vs. non-Appalachian = 43.6%; OR, 0.92; 95% confidence interval (CI), 0.79-1.07] and completion (Appalachian = 27.7% vs. non-Appalachian = 25.3%; OR, 1.12; 95% CI, 0.95-1.32) were similar between Appalachian and non-Appalachian females. HPV vaccine follow-through was higher among Appalachian females than non-Appalachian females (67.8% vs. 58.1%; OR, 1.36; 95% CI, 1.07-1.72). Vaccination outcomes tended to be higher in the Northern (completion and follow-through) and South Central (follow-through) subregions of Appalachia compared with non-Appalachian United States. Conversely, vaccination outcomes tended to be lower in the Central (initiation and completion) and Southern (initiation and completion) subregions. CONCLUSIONS In general, HPV vaccination in Appalachia is mostly similar to the rest of the United States. However, vaccination is lagging in regions of Appalachia where cervical cancer incidence and mortality rates are highest. IMPACT Current cervical cancer disparities could potentially worsen if HPV vaccine coverage is not improved in regions of Appalachia with low HPV vaccine coverage.
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Affiliation(s)
- Paul L Reiter
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Suite 525, 1590 North High Street, Columbus, Ohio 43201, USA.
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22
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Bornstein MH, Putnick DL, Suwalsky JTD. A longitudinal process analysis of mother-child emotional relationships in a rural Appalachian European American community. Am J Community Psychol 2012; 50:89-100. [PMID: 22080397 PMCID: PMC3424281 DOI: 10.1007/s10464-011-9479-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This prospective longitudinal study examines emotional relationships in 58 Appalachian mother-child dyads observed at home at 5 and 20 months. Between infancy and toddlerhood, 3 of 4 dimensions of dyadic emotional relationships were stable, and three remained continuous in their mean level. Increasing maternal age was associated with greater maternal sensitivity and structuring and with more responsive and involving children. Marital status and father presence in the home as well as maternal openness, parenting knowledge, investment, and satisfaction accounted for effects of maternal age on dyadic emotional relationships. This longitudinal process analysis provides unique insights into temporal dynamics of mother-child emotional relationships and their determinants in an underserved and underresearched US community. Implications for community-specific interventions are discussed.
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Affiliation(s)
- Marc H Bornstein
- Child and Family Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Public Health Service, Rockledge 1, Suite 8030, 6705 Rockledge Drive, MSC 7971, Bethesda, MD 20892-7971. USA,
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23
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Wiener RC, Wu B, Crout RJ, Plassman BL, McNeil DW, Wiener MA, Kao E, Caplan DJ. Hygiene self-care of older adults in West Virginia: effects of gender. J Dent Hyg 2012; 86:231-8. [PMID: 22947846 PMCID: PMC3607540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE This study investigated whether oral hygiene self-care behavior differs between genders in older adults in Appalachia, a geographic area with significant oral health concerns. Identify ing the practices of older adults may provide valuable information for designing interventions and improving overall oral health outcomes. METHODS As part of a larger, on-going study on cognition and oral health in later life in Appalachia, a sample of dentate, older adults without dementia aged 70 and above (n=245, 86 men and 159 women) received an oral assessment by either a dentist or dental hygienist. Psychometricians assessed cognition using a standardized battery of neuropsychological tests. They also administered the General Oral Health Assessment Index and conducted structured interviews concerning diet, oral hygiene practices, oral health, social support, income and years of education Results: Over 80% of women (n=128) and 52.3% of men (n=45) reported brushing their teeth twice daily. Multivariate logistic regression analysis was conducted, controlling for socioeconomic status, social support (i.e., frequency of contacting friends and relatives), general oral health assessment items, number of decayed, missing and filled surfaces, plaque index and having regular dental visits. The results showed that women reported more frequent tooth brushing than their male counterparts (OR=4.04, 95% CI:1.93,8.42). CONCLUSION Older women in West Virginia had significantly better oral hygiene practices than older men, particularly regarding tooth brushing. Interventions are needed to improve older men's dental hygiene behaviors to improve overall oral health outcomes.
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Affiliation(s)
- R Constance Wiener
- Department of Dental Practice and Rural Health at West Virginia University, WV, USA
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24
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Studts CR, Tarasenko YN, Schoenberg NE, Shelton BJ, Hatcher-Keller J, Dignan MB. A community-based randomized trial of a faith-placed intervention to reduce cervical cancer burden in Appalachia. Prev Med 2012; 54:408-14. [PMID: 22498022 PMCID: PMC3368037 DOI: 10.1016/j.ypmed.2012.03.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 03/26/2012] [Accepted: 03/27/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Faith Moves Mountains assessed the effectiveness of a faith-placed lay health advisor (LHA) intervention to increase Papanicolaou (Pap) test use among middle-aged and older women in a region disproportionately affected by cervical cancer and low screening rates (regionally, only 68% screened in prior 3 years). METHOD This community-based RCT was conducted in four Appalachian Kentucky counties (December 2005-June 2008). Women aged 40-64 and overdue for screening were recruited from churches and individually randomized to treatment (n=176) or wait-list control (n=169). The intervention provided LHA home visits and newsletters addressing barriers to screening. Self-reported Pap test receipt was the primary outcome. RESULTS Intention-to-treat analyses revealed that treatment group participants (17.6% screened) had over twice the odds of wait-list controls (11.2% screened) of reporting Pap test receipt post-intervention, OR=2.56, 95% CI: 1.03-6.38, p=0.04. Independent of group, recently screened participants (last Pap >1 but <5 years ago) had significantly higher odds of obtaining screening during the study than rarely or never screened participants (last Pap ≥5 years ago), OR=2.50, 95% CI: 1.48-4.25, p=0.001. CONCLUSIONS The intervention was associated with increased cervical cancer screening. The faith-placed LHA addressing barriers comprises a novel approach to reducing cervical cancer disparities among Appalachian women.
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Affiliation(s)
- Christina R Studts
- Department of Behavioral Science, University of Kentucky, Lexington, KY 40536-0086, USA.
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25
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Reiter PL, Wewers ME, Paskett ED, Klein EG, Katz ML. Ohio Appalachian residents' views on smoke-free laws and cigarette warning labels. Rural Remote Health 2012; 12:1945. [PMID: 22300190 PMCID: PMC3881177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Smoke-free laws and the addition of graphic warning labels to cigarette packages represent public health policies that can potentially reduce smoking and smoking-related disease. The attitudes and beliefs relating to these policies were examined among residents of Ohio Appalachia, a mostly rural region with high smoking prevalence among its residents. METHODS Focus groups were conducted with participants from Ohio Appalachia during the summer of 2007. Groups included healthcare providers (n=37), community leaders (n=31), parents (n=19), and young adult women aged 18-26 years (n=27). RESULTS Most participants were female (94%), non-Hispanic White (94%), and married (65%). Participants believed that most non-smokers supported Ohio's enforced statewide comprehensive smoke-free law that began in 2007, while some smokers opposed the law due to a perceived infringement of their rights. They also reported that most residents and local businesses were abiding by and enforcing the law. Participants supported the addition of graphic warning labels to cigarette packages in the USA. They believed that such warning labels could help deter adolescents and adult non-smokers from smoking initiation, particularly if the negative aesthetic effects of smoking were emphasized. However, they felt the labels would be less effective among current smokers and older individuals living in their communities. CONCLUSIONS Participants generally held positive views about both the smoke-free law and the addition of graphic warning labels to cigarette packages in the USA. These tobacco-related public health policies are promising strategies for potentially reducing smoking and its associated diseases among residents living in Appalachia. Additional research is needed to further examine support for these policies among more diverse Appalachian populations.
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Kruger TM, Swanson M, Davis RE, Wright S, Dollarhide K, Schoenberg NE. Formative research conducted in rural Appalachia to inform a community physical activity intervention. Am J Health Promot 2012; 26:143-51. [PMID: 22208411 PMCID: PMC3252212 DOI: 10.4278/ajhp.091223-qual-399] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Despite the well-established benefits of physical activity (PA), most Americans, especially those in rural, traditionally underserved areas, engage in considerably less PA than recommended. This study examines perceived barriers to and facilitators of PA and promising organized PA programs among rural Appalachians. DESIGN Eight focus groups and seven group key informant interviews were conducted. SETTING This study was conducted in eastern Kentucky, in central Appalachia. SUBJECTS One hundred and fourteen rural Appalachian residents (74% female, 91% white) participated. MEASURES Open-ended, semistructured, and structured questions regarding perceptions of, barriers to/facilitators of, and examples of successful/failed PA programs were asked. ANALYSIS Qualitative data analysis was conducted, including codebook development and steps taken to ensure rigor and transferability. Interrater reliability was over 94%. RESULTS In addition to barriers that are consistent with those found in other populations, rural Appalachian residents indicated that travel time, family commitments, and inadequate community resources undermine PA. Suggested avenues to increase PA include partnership with churches and the U.S. Department of Agriculture's Cooperative Extension Service; programs that include families, are well advertised, and focus on health rather than appearance; and, underlying all suggestions, culturally relevant yet nonstereotyping activities. CONCLUSIONS When developing PA interventions in rural Appalachia, it is important to employ community-based participatory approaches that leverage unique assets of the population and show potential in overcoming challenges to PA.
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Affiliation(s)
- Tina M. Kruger
- University of Kentucky, Graduate Center for Gerontology, 900 S. Limestone, 304 Wethington, Lexington, KY 40536-0200, Tel. (859) 257-1450 x80195, Fax. (859) 323-5747,
| | - Mark Swanson
- University of Kentucky, Department of Health Behavior, College of Public Health, 121 Washington Avenue, Ste. 111B, Lexington, KY 40536-0003, Tel: (859) 218-2060, Fax: (859) 323-2933,
| | - Rian E. Davis
- University of Kentucky, Department of Anthropology, 211 Lafferty Hall, Lexington, KY 40536-0024, Tel.859-257-2710, Fax.859-323-1959,
| | - Sherry Wright
- 298A Main Street, Whitesburg, KY 41858, Tel: (606) 622-2229, Fax: (606) 633-3311,
| | - Katie Dollarhide
- 298A Main Street, Whitesburg, KY 41858, Tel. (606) 633-3339, Fax: (606) 633-3311,
| | - Nancy E. Schoenberg
- University of Kentucky, Behavioral Science, 125 College of Medicine Office Bldg., Lexington, KY 40536-0086, Tel: (859) 323-8175, Fax: (859) 323-5350,
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Abstract
Researchers have long held that fatalism (the belief in a lack of personal power or control over destiny or fate) constitutes a major barrier to participation in positive health behaviors and, subsequently, adversely affects health outcomes. In this article, we present two in-depth, ethnographic studies of rural women's health decisions surrounding cancer treatments to illustrate the complexity and contestability of the long-established fatalism construct. Narrative analyses suggest that for these women, numerous and complex factors--including inadequate access to health services, a legacy of self-reliance, insufficient privacy, combined with a culturally acceptable idiom of fatalism--foster the use of, but not necessarily a rigid conviction in, the notion of fatalism.
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Affiliation(s)
- Elaine M Drew
- Department of Family and Community Medicine, Medical College of Wisconsin, USA
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28
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Abstract
UNLABELLED The examination of health disparities among people within Appalachian counties compared to people living in other counties is needed to find ways to strategically target improvements in community health in the United States of America (USA). METHODS A telephone survey of a random sample of adults living in households within communities of all counties of the state of Virginia (VA) in the USA was conducted. FINDINGS Health status was poorer among those in communities within Appalachian counties in VA and health insurance did not make a difference. Health perception was significantly worse in residents within communities in Appalachian counties compared to non-Appalachian community residents (30.5 vs. 17.4% rated their health status as poor/fair), and was worse even among those with no chronic diseases. Within communities in Appalachian counties, black residents report significantly better health perception than do white residents. CONCLUSION Residents living in communities in Appalachian counties in VA are not receiving adequate health care, even among those with health insurance. More research with a larger ethnic minority sample is needed to investigate the racial/ethnic disparities in self-reported health and health care utilization within communities.
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Affiliation(s)
- Elizabeth L. McGarvey
- School of Medicine, Department of Public Health Sciences, University of Virginia, P.O. Box 800717, Charlottesville, VA 22908 USA
| | - MaGuadalupe Leon-Verdin
- School of Medicine, Department of Public Health Sciences, University of Virginia, P.O. Box 800717, Charlottesville, VA 22908 USA
| | - Lydia F. Killos
- Office of Health Promotion, University of Virginia, P.O. Box 00760, Charlottesville, VA 22908 USA
| | - Thomas Guterbock
- Department of Sociology & Cooper Center for Survey Research, University of Virginia, Charlottesville, VA 22908 USA
| | - Wendy F. Cohn
- School of Medicine, Department of Public Health Sciences, University of Virginia, P.O. Box 800717, Charlottesville, VA 22908 USA
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Brown RA. Crystal methamphetamine use among American Indian and White youth in Appalachia: Social context, masculinity, and desistance. Addict Res Theory 2010; 18:250-269. [PMID: 21637733 PMCID: PMC3104682 DOI: 10.3109/16066350902802319] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Rural areas and American Indian reservations are hotspots for the use of crystal methamphetamine ("meth") in the United States, yet there is little ethnographic data describing meth use in these areas. This study draws upon three years of ethnographic work conducted with American Indian and White youth in Appalachia during the height of the meth epidemic. It describes how historical, cultural, and socioeconomic processes influence vulnerability to meth use in Appalachia, and highlights the role of social relationships and meaning-making in facilitating desistance and recovery from meth use. The first section shows how crystal meth filled a particular functional niche in the lives of many young men, alleviating boredom and anomie linked to recent socioeconomic changes and labor opportunities in the region, and intersecting with local understandings of masculinity and forms of military identity. Here, ethnographic and interview data converge to illustrate how social role expectations, recent socioeconomic change, and meth's pharmacological properties converge to create vulnerability to meth use in Appalachia. The second section draws upon two American Indian narratives of desistance. These youth described recently severed social relationships and acute feelings of social isolation during the initiation of meth use. Both also described dramatic close calls with death that facilitated their eventual desistance from use, involving repaired social relationships and the establishment of new lives and hope. These interviews illustrate how changes in social relationships were linked with both initiation and desistance from meth use, and how religious interpretations of near-death experiences structured narratives of cessation and redemption.
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Affiliation(s)
- Ryan A Brown
- School of Education and Social Policy, Human Development and Social Policy, Northwestern University, Walter Annenberg Hall, 2120 Campus Drive, Evanston, IL 60208, USA
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Brown RA, Adler NE, Worthman CM, Copeland WE, Costello EJ, Angold A. Cultural and community determinants of subjective social status among Cherokee and White youth. Ethn Health 2008; 13:289-303. [PMID: 18701990 PMCID: PMC4075651 DOI: 10.1080/13557850701837302] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND . Subjective social status (SSS) is associated with physical and mental health in diverse samples. However, community, cultural, and ethnic influences on SSS are poorly understood, especially among rural and American Indian populations. OBJECTIVE We aimed to examine similarities and differences in how community poverty, family context, and life course attainment predict SSS among Cherokee and White youth in Appalachia. DESIGN We assessed culturally and developmentally appropriate aspects of life course attainment among 344 Cherokee and White youth (age 19-24) using the Life Trajectory Interview for Youth (Brown et al. 2006. International Journal of Methods in Psychiatric Research, 15, 192-206). Combined with information regarding community context and family history, these data were used to examine common patterns and ethnic differences in community, family, and cultural influences on SSS. RESULTS Overall, both Cherokee and White youth rank their families lower in SSS than previously studied US youth. Family poverty during childhood and low parental education negatively influence family SSS, Cherokee youth rank higher on subjective socioeconomic status (SES) than Whites, as do participants in high poverty areas. However, White youth rank higher on peer SSS. Ethnographically generated items perform better than standard demographic markers in predicting SSS. Educational attainment is associated with peer SSS among Cherokee (but not White) youths. CONCLUSIONS Cultural identity, community context, and local reference groups are crucial determinants of SSS. Both White and Cherokee youth in Appalachia exhibit SSS rankings consistent with socioeconomic and cultural marginalization. On a local scale, however, living in high poverty areas or minority communities may buffer individuals from some negative social comparisons regarding subjectively perceived SES. Meanwhile, social monitoring in small minority communities may constrain optimistic bias in assessments of peer popularity and status. Social ecology, family context, and individual attainment appear to exert distinctive influences on SSS across different cultural and ethnic groups.
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Affiliation(s)
- Ryan A Brown
- Robert Wood Johnson Health and Society Scholars Program, UC-San Francisco / Berkeley, CA, USA.
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Abstract
Higher-than-average cervical cancer incidence and mortality rates occur in Ohio Appalachia. Little is known, however, about societal norms and social determinants that affect these rates. To examine county-level sociocultural environments to plan a cervical cancer prevention program, the authors interviewed key informants from 17 of 29 Ohio Appalachia counties. Findings include the perceived offensiveness of the term Appalachia, the importance of long-standing family ties, urban and rural areas within counties, use and acceptability of tobacco, the view that cancer is a death sentence, and the stigmatization of people with cancer. Barriers to screening included cost, lack of insurance, transportation problems, fear, embarrassment, and privacy issues. These findings highlight the important role of geography, social environment, and culture on health behaviors and health outcomes. The interviews provided information about the unique characteristics of this population that are important when developing effective strategies to address cancer-related health behaviors in this medically underserved population.
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Affiliation(s)
- Mira L Katz
- Division of Health Behavior and Health Promotion, School of Public Health, Comprehensive Cancer Center, The Ohio State University, Columbus, USA
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