Journal of Appalachian health最新文献

Introduction: Those living in the Appalachian Region face a greater number of significant health disparities than residents of other areas of the U.S. Patient portals can decrease disparities, increase health literacy, and improve health outcomes.

Purpose: This study explores if those living in the Appalachian Region are offered access to and use their patient portals differently than those in the surrounding U.S. Census regions. Additionally, the study aims to determine if there was a difference in reported reasons for the non-use of patient portals.

Methods: A secondary analysis was completed using data from the National Cancer Institute's Health Information National Trends Survey (HINTS) (2017-2020), a nationally representative survey. Descriptive statistics and chi-square tests were used to determine differences in patient portal use between regions.

Results: There was no statistically significant difference between the Appalachian and surrounding U.S. Census regions in being offered access to patient portals. However, there was a statistically significant difference (non-weighted) between regions in the use of patient portals. Common reasons for the non-use of patient portals were a preference to speak directly to the provider and the lack of perceived need to use the portal.

Implications: Providers in the Appalachian Region should be aware of the non-use of patient portals. Moreover, understanding the reported reasons for non-use may help providers tailor educational materials to increase patient portal use.

Introduction: Previous studies have documented geographic variation in preventable hospitalizations between rural and urban areas, but much less is known about preventable hospitalization patterns between heterogeneous rural areas. Unique challenges related to access of care and poverty may put the rural Appalachian Region at risk for higher rates of preventable hospitalizations.

Purpose: This study examines whether within-rural differences in Kentucky's preventable hospitalization rates exist and how these differences may be changing over time.

Methods: Longitudinal and geographic trends in county-level preventable hospitalization rates were examined using Kentucky hospital discharge data from 2016 to 2019. Regression models were run to determine whether changes over time in preventable hospitalization rates led to an increasing or decreasing gap in outcomes between rural Appalachian counties and their urban and rural non- Appalachian counterparts.

Results: Rural Appalachian counties consistently had significantly higher preventable hospitalizations rates compared to their rural non-Appalachian and urban counterparts ( p < 0.01). A downward trend in overall preventable hospitalizations was observed for rural Appalachia over time, but trends were relatively stable for rural non-Appalachian and urban counties. Regression results indicate that there was no significant reduction in the "Appalachian gap" over time.

Implications: The analyses confirm that rural areas within Kentucky experienced highly heterogeneous rates of preventable hospitalizations. Despite Medicaid expansion, there is little evidence of any narrowing of the "Appalachian gap." Focus on improving access to care alone may be insufficient to improve outcomes. Alternative strategies that leverage population health approaches may improve capacity to address complex health and social needs in rural Appalachia.

Introduction: Quantitative studies on drinking water perceptions in Appalachia are limited. High-profile water infrastructure failures in the U.S. and Eastern Kentucky, coupled with human-made and natural disasters in the Appalachian Region, have likely impacted opinions regarding tap water.

Purpose: To use existing unexplored data to describe baseline tap water v. bottled water consumption in Kentucky.

Methods: Telephone-based cross-sectional data were obtained from the 2013 Kentucky Health Issues Poll (KHIP) directed by the Foundation for a Healthy Kentucky. Among many items in KHIP, self-reported consumption of bottled water over tap water, reasons for bottled water use, and demographic data were obtained.

Results: Among Appalachian (n=356) and non-Appalachian (n=1,125) Kentucky respondents, a significantly higher frequency of Appalachian Kentuckians reported drinking bottled water more often than tap water relative to non-Appalachian Kentuckians (57% v. 34%; X² p < 0.001). Appalachian residency significantly predicted bottled water consumption in simple and multivariable logistic regression adjusted for significant covariates (i.e., age, sex, and race). Among persons consuming bottled water more than tap water, Appalachian Kentuckians reported significantly more concerns regarding tap water taste or smell (p = 0.005) and safety (p = 0.008) than non-Appalachians.

Implications: These results from 2013 data pre-date headline news items related to public water and likely underestimate current bottled water preferences. New data are needed, and these results warrant further investigation into tap water aesthetics in Appalachia, bottled water consumption impacts on personal finances, and approaches to build public trust for public drinking water among multiple populations including Appalachian Kentuckians.

Many stereotypes afflict our much-maligned region, and the Jonesborough-Washington County History Museum displays eight of these "myths of Appalachia." Here, our Editor-in-Chief suggests a ninth-that the people of Appalachia "do not care" about their health-and argues that regional health disparities result not from apathy but from a confluence of socioeconomic factors.

For the past five years, the Journal of Appalachian Health has published timely, high-quality research from within Appalachia. We also welcome submissions from those working outside of Appalachia who produce quality research of direct relevance to our region.

Introduction: Physical activity (PA) can prevent and reduce the deleterious physical and mental health effects of COVID-19 and associated lockdowns. Research conducted early in the pandemic demonstrates that a greater proportion of adults in the U.S. have decreased than increased PA, and the effects vary by sociodemographic factors. Ongoing evidence is important to identify patterns in PA changes during the pandemic.

Purpose: This study aims to identify factors associated with increases and decreases in PA during the COVID-19 pandemic in a convenience sample of adults residing in Appalachia. Methods: Surveys were collected from a convenience sample of adults from eight counties in West Virginia from January to March 2021. Logistic regression analysis was used to identify sociodemographic, health, and rurality factors associated with (1) increased PA and (2) decreased PA during the pandemic, assessed retrospectively via self-report.

Results: Analysis of 1,401 survey responses revealed that better self-rated health, lower body mass index, and higher income and education were associated with a greater likelihood of more time spent doing PA during the pandemic ( p ≤ .05). Respondents with lower self-rated health, higher body mass index, lower income, and lower levels of education-plus females and those living in a more urban county-were more likely to spend less time doing PA during the pandemic ( p ≤ .05).

Implications: Analyses suggest that pre-pandemic disparities in PA by health, wealth, and education were exacerbated during the pandemic. These must be addressed before physical inactivity and ill health become endemic to the Appalachian Region.

Introduction: Adverse childhood experiences (ACEs) are associated with increased cancer risk. ACEs may affect this risk in a variety of ways, including cancer screening compliance. ACEs can contribute to mistrust in the medical profession, inhibit patient-provider relationships and cause at-risk individuals to miss critical access points to preventive services. Protective factors may play an important role in mitigating ACE-related consequences by supporting resiliency.

Purpose: This study assesses the associations between ACEs, protective factors, patient-provider relationships, stage of cancer at diagnosis, and cancer screening behaviors for West Virginia (WV) cervical cancer survivors.

Methods: WV cervical cancer survivors diagnosed between 2000 and 2020 were mailed a survey which included questions on demographic information and cancer screening behaviors, alongside three scales to measure depth of patient-provider relationships, ACEs, and protective factors.

Results: Ninety participants completed the survey. ACEs were associated with weaker patient-provider relationships (p < .01) and fewer protective factors (p < .01). More protective factors were associated with stronger patient-provider relationships (p < .01), earlier stage of cancer at diagnosis (p < .05) and positive cancer screening behaviors. Positive cancer screening behaviors were associated with deeper patient-provider relationships (p < .05). A statistically significant model (p = .004) using ACE and resilience scores was able to account for 13% of the explained variability in depth of patient-provider relationships.

Implications: These findings suggest an important interplay between ACEs, protective factors, and patient-provider relationships on cancer screening behaviors. Future studies should consider these variables in different populations. In addition, interventions focused on enhancing patient-provider relationships and supporting acquisition of protective factors should be considered.

Introduction: Antimicrobial resistance (AMR) is a serious concern to public health, causing an estimated 35,000 deaths annually in the U.S. Misuse of antimicrobials increases the rate of AMR. Self-medication with antibiotics (SMA) is a primary contributor to AMR that can be addressed through education. SMA has been reported at rates of 3% to 66% in the U.S. but has not been evaluated in Appalachia.1 Low health literacy and barriers to accessing care have been correlated with SMA and are common in many areas of Appalachia.

Purpose: This study aims to assess factors associated with SMA, demographic differences in knowledge of / beliefs about SMA, and describe practices and beliefs of those who self-medicate in the Cumberland Gap region.

Methods: Structured interviews were conducted in a rural health clinic and in a dental office to ascertain demographic information, knowledge of appropriate antibiotic use, and behaviors associated with self-medication. Inferential statistics (chi-squared, Fisher's exact, and ANOVA tests) were conducted.

Results: In the last 3 years, 41% of the 78 respondents had practiced SMA. A higher percentage of those who believed that antibiotics are used to treat viral infections have self-treated compared to those who did not hold that belief. Of those who SMA, convenience was the most common reason, while the common symptoms treated were congestion and fever.

Implications: The current study provides a first estimate of SMA in the Central Appalachian Region and finds the prevalence to be higher than previously reported in other regions of the U.S. Future studies could include larger, more representative samples and longitudinal study designs to confirm these findings.

Introduction: Kentucky ranks first in the U.S. in overall cancer incidence and mortality rates. Areas of the state that fall within the Appalachian Region, along Kentucky's eastern border, experience disproportionately high rates of cancer compared to non-Appalachian counties. Purpose: This pilot study investigates whether oral history interviews can be used to understand perspectives on cancer among residents of Appalachian Kentucky.

Methods: In 2020, participants (n = 5) who identified as being from and/or having strong connections to Appalachian Kentucky were recruited to participate in this pilot study. Participants included individuals working in cancer-related fields, oncology professionals, and those with personal cancer experience. Using an oral history approach, subjects were asked about challenges within Appalachia that contribute to high rates of cancer regionally. Interviews were analyzed using qualitative content analysis, and data were condensed into themes, subthemes, and subtopics. Relational content analysis was then used to illustrate relationships between the problems being faced in Appalachia and their contributing factors, with potential solutions to those problems.

Results: Six key themes emerged from analysis of the oral history interviews: (1) problems being faced in Appalachia; (2) contributing factors; (3) potential solutions; (4) Appalachian disposition; (5) experiences with and thoughts on cancer; and (6) defining success v. the future without changes (intervention). A further 25 subthemes were identified from within these themes. Taken together, these themes and subthemes point to potential areas for specific intervention to shift Appalachia's cancer burden.

Implications: This pilot study demonstrates potential benefit in using oral history interviews to elucidate Appalachian Kentuckians' perspectives on cancer. From the nuanced insights gained through this method, a set of culturally appropriate interventions were identified that could address the disproportionate cancer burden in the region. Future studies using an oral history approach could aim to reveal other specific aspects of how cancer impacts individuals, families, and communities.

The Journal of Appalachian Health is committed to reviewing published media that relates to contemporary concepts affecting the health of Appalachia. This is a review of the text Appalachian Health: Culture, Challenges, and Capacity. This book is an ideal starting point for anyone interested in Appalachian history, public health, and health disparities research.