Journal of Appalachian health最新文献

State and local governments across Appalachia are allocating opioid-settlement dollars over the coming years. This funding opportunity can support lasting public health infrastructure or be spent on short-term programs anchored in the opioid crisis of the past. Evidence indicates that emerging synthetic drugs such as nitazenes and xylazine are altering overdose risk patterns in ways that require urgent policy attention.

Rae Garringer's Country Queers: A Love Letter examines the experiences of queer individuals in rural America, emphasizing the relationship between place and identity. Through oral histories, the book presents perspectives on community, resilience, and healthcare access. While not centered on medical care, it highlights challenges in obtaining affirming services in rural areas. Garringer's experience as a standardized patient provides additional context on healthcare gaps. For public health professionals, Country Queers offers insight into the structural and social factors affecting rural LGBTQ2+ populations, contributing to a broader understanding of community health and identity in Appalachia and similar regions.

Introduction: Rural areas have limited capacity to provide comprehensive mental health treatment and resources. This creates the need for interventions to ensure individuals with mental health concerns have access to resources to improve their mental health.

Purpose: The purpose of this mixed-methods evaluation was to assess the effectiveness and impact of Libera, a mental health program tailored for girls and women within the Appalachian region.

Methods: Quantitative surveys, including validated measures for depression, anxiety, and eating disorder symptoms, and life satisfaction, were collected pre- and post-Libera intervention for participants. Simultaneously, annual surveys were sent to Listeners in addition to qualitative semi-structured interviews. Data were collected from August 2019 - November 2021. All data were analyzed from December 2021 - March 2022 using SAS JMP 16 for quantitative data and NVivo 14 for qualitative.

Results: Participants showed significant improvements in depressive and anxiety symptoms, and life satisfaction following the Libera intervention. Disordered eating symptoms did not significantly improve. Similarly, Listeners showed changes from their training and experiences, with positive reactions, learning, behavior change, and effective results for them and their participants.

Implications: This study provides evidence for Libera's use among Appalachian women and girls. Participants experienced many improvements in mental health following completion of the Libera program. Additionally, Listeners leading groups experienced positive changes in learning and behavior. The results also indicate areas to continue strengthening the program with resources and training in specialized topics (such as eating disorders or Safe Zone training).

Background: Wearable health devices capture metrics (e.g., physical activity, ECG, sleep) that can enhance care when shared with providers. Yet, willingness to share wearable data may differ in Appalachia, where chronic disease burdens, mistrust, and limited infrastructure pose unique challenges.

Objective: This study explored (1) which sociodemographic, health, and digital behaviors correlate with willingness to share wearable data and (2) how these insights can guide region-specific interventions in Appalachia.

Methods: We analyzed 320 Appalachian respondents from the Health Information National Trends Survey (HINTS 6). Descriptive statistics and logistic regression models examined willingness to share wearable data. Because of small cell counts, we supplemented with a Firth (penalized) logistic regression for robustness.

Results: Approximately 25.0% unweighted (27.9% weighted) were willing to share wearable data, but two-thirds did not respond or were inapplicable. The final adjusted model (n=47) revealed:Income: Higher income correlated with increased willingness (e.g., aOR=8.52e+04 for $35-49k vs.Self-Rated Health: "Good" or "very good" health was associated with higher odds of sharing than "poor" health (aOR=4406.52; p<.05).Messaging: Surprisingly, participants who never messaged providers showed greater willingness (aOR=1.93e+07; p.

Conclusions: These preliminary findings suggest that household income, perceived health, and digital behaviors influence wearable data-sharing in Appalachia, whereas national demographic trends may not apply. Future work should use larger samples, mixed methods, and region-specific approaches to address mistrust, privacy concerns, and infrastructural barriers, aiming to enhance remote patient monitoring and reduce health disparities.

Addressing health-related social needs is crucial for improving health outcomes, especially for vulnerable populations. NCCARE360 is North Carolina's statewide coordinated care platform powered by Unite Us.1 Burke County Public Health (BCPH) identified gaps in the standardized NCCARE360 training, prompting a tailored approach. Using the Plan-Do-Study-Act cycle, BCPH refined training materials with interactive guides, real-life scenarios, and one-on-one sessions. This adaptation led to increased staff engagement and improved referral outcomes. Recognized as a model for local implementation, BCPH's approach signifies the importance of customizing statewide initiatives to meet local operational realities. This case highlights the value of iterative training improvements for optimizing public health interventions in resource-limited settings. Effective use of NCCARE360 will enhance referrals to essential services, helping to address barriers caused by the social determinants of health often seen in the larger Appalachian Region.2.

Introduction: Effective communication between patients and clinicians is a critical component of quality health care, influencing disease prevention, management, and outcomes. In regions with unique socioeconomic and geographic challenges, communication barriers can further exacerbate health disparities. Understanding the factors that facilitate or hinder patient-clinician communication is essential for developing targeted interventions that improve health care delivery.

Purpose: This review explores the existing literature on patient-clinician communication concerning cardiovascular disease (CVD) in the Appalachian Region with the aim to understand existing gaps and interventions.

Methods: PubMed and Web of Science databases were utilized to conduct a systematic search. The Population, Concept, and Context (PCC) framework guided the inclusion and exclusion criteria, focusing on Appalachian residents and CVD. The selected studies were assessed based on predefined criteria, leading to the inclusion of eight relevant articles. Data analysis was conducted to identify themes and interventions related to patient-clinician communication in the context of CVD.

Results: This review examined interventions emphasizing electronic health records (EHRs), patient engagement, clinician availability, and contextual factors affecting communication. While EHR-based initiatives showed promise in closing preventive care gaps, challenges persisted in addressing patient perspectives and fostering interprofessional collaboration.

Implications: Addressing communication barriers requires tailored strategies that consider patient engagement, clinician availability, and contextual factors, particularly in underserved regions such as Appalachia. Future efforts should prioritize interprofessional collaboration and patient-centered care to enhance equitable cardiovascular health outcomes among diverse populations, including those facing geographic and socioeconomic challenges in Appalachia.

Introduction: West Virginia is a rural mountain state; access to medical care, especially specialty care, can be difficult for patients.

Purpose: The purpose of this study is to analyze the geographic status and transportation times of new gynecologic oncology patients.

Methods: Home zip codes for new patient gynecologic oncology patients were analyzed for drive times to the cancer center. Zip codes of oncology providers in the state were compared to the location of patients.

Results: A total of 1,097 new gynecologic oncology patients lived within a 240-minute drive of MBRCC; nearly half (48.9%) of them drove greater than 60 minutes. There are large geographical areas of West Virginia without an oncology practice location.

Implications: West Virginians face barriers to gynecologic oncology care secondary to drive times.

Patient navigation (PN) is a healthcare service delivery model designed to partner clients with service providers to reduce challenges to health care, as well as to improve access to care by identifying opportunities to coordinate services for clients. The IMPACT WV project at the West Virginia University Center for Excellence in Disabilities (WVU CED) implemented PN models of care for caregivers of infants exposed to substances in utero. The purpose of this program was to reduce burden for potentially at-risk families and improve caregiver and infant outcomes as a result. To understand the processes that influence the implementation of PN models of care with this population, the project modified existing surveys developed by the Fox Chase Virtual Health Cancer Program.

Introduction: COVID-19 restrictions altered the structure of the school and workday for families with children and led to changes in active transportation. Continued restrictions impacted access to many community locations and led to changes in physical activity (PA) behavior.

Purpose: The objectives of the study were to describe the changes in the 1) amount of PA time per day, 2) frequency of PA, and 3) sitting time. Information about how PA changed for parents and children during the COVID-19 pandemic will have potential implications for education, public health, and recreation management.

Methods: This cross-sectional study enlisted participants via an online survey to evaluate their and their children's perceived PA behaviors before and during COVID-19. The study focused on parents in a rural Appalachian region within a Southeastern state, recruited through convenience sampling.

Results: About one-third of parents reported an increase in time (37%) and frequency (33%) while two-thirds either stayed the same or decreased. Parents' time spent sitting increased in over half of the sample (50.8%). Parent perceptions of their children's changes in PA indicate that 49.2% reported lower recreational (i.e., free/leisure) PA, 13.7% reported less time participating in PA overall, and 43.8% noted a decrease in the number of days their child was physically active per week.

Implications: Findings from this study show that trends in PA for rural families shifted during COVID-19 restrictions. Despite these restrictions, some parents demonstrated resilience by maintaining or increasing their PA levels. This highlights the need to further explore factors that support PA behaviors during periods of limited access to structured PA settings.

Introduction: Deaths of despair (DoD), encompassing suicides, drug overdoses, and alcohol-related liver diseases, have emerged as a critical public health crisis in the United States, with their rise particularly pronounced from 1995 to 2013 and exacerbated by the COVID-19 pandemic. Kentucky, grappling with high rates of substance use disorder, poor mental health, and economic hardship, is at the forefront of this issue, particularly in its rural and Appalachian regions.

Purpose: This study explores the social determinants contributing to DoD in Kentucky, focusing on economic and social factors that influence rising rates of suicide, drug overdose, and alcohol-related liver disease. The goal is to provide evidence to guide policy and intervention strategies.

Methods: An ecological study was conducted across 120 Kentucky counties from 2011 - 2020. DoD mortality data were sourced from the CDC WONDER database, and socioeconomic variables from the American Community Survey. Principal Component Analysis (PCA) reduced 10 county-level socioeconomic variables. Poisson regression estimated associations between socioeconomic principal component scores and DoD mortality, adjusting for confounders like age, and racial demographics.

Results: The median DoD mortality rate was 59.7 per 100,000 people, with geographic variation. Three principal components explained 78.4% of the variance in socioeconomic factors. Counties with extreme socioeconomic disadvantages (low education, high poverty, high disability, high unemployment) were strongly associated with higher DoD rates (RR=1.07; 95% CI=1.02-1.12).

Implications: Extreme socioeconomic disadvantage is a key predictor of DoD rates in Kentucky. These findings can inform public health interventions and policy changes targeting high-risk areas, especially rural and Appalachian regions.