Journal of Appalachian health最新文献

The establishment of a student-run mobile clinic in Morehead, Kentucky, led by students from the University of Kentucky College of Medicine's (UKCOM) Rural Physician Leadership Program (RPLP), aims to address health inequities in rural Appalachian communities. This pilot program is designed to serve vulnerable populations, including the unhoused, by delivering free, accessible healthcare services directly to underserved populations. This program serves as a model for expanding access to healthcare in rural regions while promoting a collaborative, community-based approach to addressing social determinants of health.

Introduction: Conventional academic rotations lack in-depth exposure to rural community members, systems, and resources surrounding specific rural-focused health issues.

Purpose: This study aims to explore health professional students' experiences within a community-based multidisciplinary rural immersion through their personal reflections.

Methods: Written reflective entries were extracted from the online classroom system from 2019-2021. Data analysis was guided by thematic analysis. An iterative process of qualitatively coding the interviews was conducted. Themes were reviewed and agreed upon by consensus and assessed for validity by two senior researchers.

Results: Sixty-two reflective essays were included from 11 unique professional programs. Resulting themes included (1) immersion was a transformative experience, (2) immersion experiences resulted in planned future practice changes, (3) immersion provided increased familiarity with stigmatizing diagnoses and contact with stigmatized groups, and (4) the experience provided knowledge of resources for future practice.

Implications: Rural immersions provide a rich understanding of cultural identities, health systems, and health issues in a specific rural environment. Through the immersive experience, students identified future practice considerations, placed context to stigma and its effect on health, and concretely demonstrated interprofessional resources in rural clinical practice.

The Journal of Appalachian Health continues to grow in strength and reach, serving as a critical platform for research and discussion on the unique health challenges and opportunities in Appalachia, as well as how the challenges and opportunities Appalachia faces are local manifestations of broader regional and global phenomena. Over the past year, we have witnessed a remarkable expansion in our readership, reflecting the increasing demand for evidence-based insights into the health of our region.

Introduction: Social Determinants of Health (SDOH) are the conditions in which people are born, grow, live, work, and age. SDOH significantly influence health outcomes; as such, healthcare systems should screen for patients' social needs. PRAPARE is standardized screening tool designed to assess and address patients' social needs.

Purpose: This study examines SDOH screening at Valley Health Systems, a federally qualified health center based in Huntington, West Virginia. The aim of this research is to assess clinician attitudes and experiences in using the PRAPARE tool to screen for SDOH.

Methods: A self-administered online survey was conducted from April to May 2022 among Valley Health Systems clinicians. The survey focused on SDOH screening frequency, clinician attitudes, barriers to screening, and PRAPARE tool usage. Survey questions were adapted from previously published instrument.

Results: Among the 36 clinicians (response rate: 24.0%) who participated, 55.6% sometimes, rarely, or never asked about patient social needs and 47.2% sometimes, rarely, or never reviewed patient charts for social needs information. Common barriers to screening included patient discomfort (38.9%), lack of referral systems (30.6%), and time constraints (27.8%). Although only 30.6% used the PRAPARE tool, those who did found it easy to use (81.8%) and helpful in identifying social needs (81.8%). However, 63.6% felt inadequately trained in using the tool.

Implications: Similar to national trends, some clinicians at Valley Health Systems are overall supportive of SDOH screening. However, they face many common barriers to screening despite integration of PRAPARE. The results of this study provide valuable insights for those navigating the complexities of implementing SDOH screening tools and sustaining use within clinical settings.

Introduction: This study explores the challenges faced by residents of rural West Virginia in accessing orthopaedic care due to geographic and socioeconomic barriers.

Purpose: This study seeks to survey rural West Virginia residents about their attitudes and experiences regarding access to orthopaedic care in southern West Virginia.

Methods: A total of 132 electronic surveys were collected from rural West Virginia residents during an appointment with their primary care provider located at an affiliated outreach clinic. The survey was designed to investigate various factors influencing their access to orthopaedic care.

Results: Delays in seeking orthpaedic care are common in rural West Virginia. A shortage of orthopaedic specialists and the long distances required to travel to treatment centers significantly exacerbates health issues and complicates the management of orthopaedic conditions. Although participants express high levels of satisfaction with their orthopaedic treatment, they consistently identify the remote location of specialized services as the primary barrier.

Implications: The study highlights the need for further research to evaluate the feasibility of expanding orthopaedic services into more isolated regions of West Virginia. This approach could improve healthcare access and potentially lead to better orthopaedic outcomes for these underserved populations.

Introduction: Despite the known risks associated with substance use following incarceration, no studies have examined substance-impaired driving as a post-incarceration health risk behavior in rural Appalachia.

Purpose: The present study examined differences by impaired driving following incarceration and identified predictors of impaired driving in sample of rural Appalachian women with a history of drug use and risky sex.

Methods: Women (N=340) from three rural Appalachian jails completed a baseline interview in jail and follow-up interviews at six and 12 months post-release. Interview questions included demographic characteristics and information on substance use risk, mental health, criminal legal system involvement, and impaired driving. Data were collected from 2012 to 2019. Secondary data analysis performed in 2024 compared women who reported driving impaired during the 12-month follow-up period (n=76) to those who did not (n=257). A multivariable logistic regression was performed to identify predictors of impaired driving.

Results: Lifetime arrests, substance use risk, and symptoms of major depressive disorder were associated with impaired driving. The logistic regression model indicated that participants with major depressive disorder symptoms had twice the odds of driving impaired in the year following incarceration. Implications: Almost one-fourth of women in the sample reported driving impaired during the follow-up period, suggesting that impaired driving should be examined as a post-release health risk behavior for rural Appalachian women in future research. Furthermore, study findings highlight an important opportunity for targeted prevention and intervention for women who may experience increased risk as they return to rural Appalachian communities following incarceration.

Introduction: Suicide rates in the United States have increased over the past two decades, with rural areas, particularly the Appalachian Region, facing unique challenges that elevate suicide risk. These include economic hardships, social isolation, and limited access to mental health services.

Purpose: This study addresses critical gaps in understanding lifetime suicide risk in West Virginia (WV), a predominantly rural state entirely within the Appalachian Region. By identifying the factors driving urban-rural differences in suicide risk, this research seeks to inform interventions tailored to the state's distinct needs and provide insights applicable to the broader Appalachian.

Region methods: Using 2021 Mountain State Assessment of Trends in Community Health (MATCH) survey data, we examined socioeconomic and related factors associated with lifetime suicide risk in WV, measured by the first item of the Suicide Behaviors Questionnaire-Revised (SBQ-R). Logistic regression models identified significant risk and protective factors. Models were stratified by rural residence using 2023 Rural-Urban Continuum Codes (RUCC) to examine rural-urban disparities, given WV's predominantly rural yet urban-diverse geography.

Results: In the weighted sample (N=372,665), 27.5% reported lifetime suicide risk. Those with suicidal thoughts were younger (median age 41), unmarried, in poorer health, and often enrolled in Medicaid. Despite WV's rural profile, 60.21% of respondents resided in urban-classified counties. Rural residents showed lower odds of suicidal thoughts or behaviors (aOR = 0.87), but factors such as substance use (aOR = 3.75), unmarried status (aOR = 1.51), and mental health disorders (aOR = 2.93) were significant risk factors.

Implications: Suicide risk factors in WV differ from broader suicidology findings, underscoring the need to address substance use, chronic pain, and mental health in prevention strategies. Further research is needed to explore regional differences in the Appalachian Region for better-targeted interventions.

Introduction: Rural Appalachian women who use drugs and are involved in the criminal legal system are at increased risk for health consequences (such as HIV/Hepatitis C). Service barriers throughout rural communities have prompted a need to examine the effectiveness of novel intervention delivery methods (e.g., social media).

Purpose: This study aims to determine if enhancing an existing HIV prevention intervention with additional modules delivered via Facebook improves service access by examining short-term outcomes among Appalachian women returning to the community following jail release.

Methods: Between 2019 and 2022, consenting women from two rural Appalachian jails were randomly selected, screened, interviewed, and randomized to either the National Institute on Drug Abuse (NIDA) Standard alone (n=30) or the NIDA Standard delivered via Facebook post-incarceration (n=30). Women were included in the final sample after completing both baseline and three-month follow-up interviews (N=50). In 2022, bivariate analyses were used to identify differences in drug use, injection drug use, and drug use before sex across intervention groups, and McNemar's test was used to measure changes in these risk behaviors within groups over time.

Results: The percent of individuals reporting past three-month HIV-risk behaviors significantly decreased between baseline and follow-up for both groups. There were no between-group differences in risk behaviors.

Implications: Results suggest that high-risk, rural Appalachian women may benefit from HIV prevention interventions delivered via Facebook, particularly during community re-entry following jail release. Facebook intervention delivery is an efficient way to expand the reach of HIV prevention services in a region with known barriers to traditional modes of intervention delivery.

The recent death of a 33-year-old mother of three at a Central Appalachian surface coal mine highlights the persistent dangers faced by miners, particularly from powered haulage incidents. As of December 2, 28 mining fatalities have occurred in the U.S. in 2024, with four in Appalachian coal mines attributed to powered haulage. These deaths underscore the urgent need to address this cause of fatalities in the mining industry and to provide a safe workplace to protect all miners.

Introduction: Many uninsured adults rely on free health clinics for prevention and treatment of chronic disease. Little is known about the nutrition education needs of adults served by free health clinics, especially those living in counties within the Western North Carolina Appalachian Mountain Region.

Methods: An in-person survey was distributed to 202 clients of two free health clinics in western North Carolina. Descriptive analyses were conducted to determine frequency distributions for food and physical activity practices, acceptable topics and strategies for nutrition education, and the acceptance and barriers for various modalities.

Results: Depending on the clinic, 49-58% of participants were female with an average age of 45, and Caucasian (48-66%). Around half reported barriers to cooking. The majority frequently ate takeout and engaged in exercise. Participants were most interested in receiving local produce and recipes and were most likely to use a smartphone for nutrition information. Participants preferred actionable interventions but needed help overcoming barriers to food access and cooking.

Implications: Future interventions within clinics should focus on assessing patient needs and tailoring services. As transportation was the most commonly cited barrier, clinics could leverage online modalities to enhance clinic education in this population since a majority of clients had access to the internet via smartphone and over half cited interest in online nutrition education.