Journal of Appalachian health最新文献

{"title":"Rural Appalachian Women Will Suffer Disproportionately if Attempts to Further Restrict Emergency Contraception are Successful.","authors":"Amie M Ashcraft, Sarah Dotson, Sara Farjo, Courtney S Pilkerton, Pamela J Murray","doi":"10.12023/jah.0501.02","DOIUrl":"https://doi.org/10.12023/jah.0501.02","url":null,"abstract":"<p><p>The removal of federal abortion protection has incited fear that restrictions on contraception may be next. Many states now imposing abortion restrictions and bans are in the South and Appalachian Regions of the U.S., where rates of unplanned pregnancy and poor health outcomes are already disproportionately high. Numerous studies have documented variable access to levonorgestrel EC (LNG EC) in community pharmacies, with particularly low rates of access at independent pharmacies that are more likely to be located in rural communities than chain pharmacies. Since the overturn of <i>Roe v. Wade</i>, some large chain pharmacies and online retailers are restricting the purchase of LNG EC, limiting its availability. Some legislators and activists are calling for a ban on EC based on a misunderstanding about its mechanism of action, equating it with abortion. At a time when access to the full range of contraceptive options is more critical than ever, already limited access to LNG EC is worsening. Extensive data on LNG EC availability in 509 pharmacies and 400 health clinics across West Virginia, contextualized with socioeconomic demographics, illustrate existing disparities in LNG EC access.</p>","PeriodicalId":73599,"journal":{"name":"Journal of Appalachian health","volume":"5 1","pages":"6-21"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10629889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138464821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Better Life: Factors that Help and Hinder Entry and Retention in MAT from the Perspective of People in Recovery.","authors":"Adam D Baus, Martha Carter, Jennifer Boyd, Erin McMullen, Trey Bennett, Alexandra Persily, Danielle M Davidov, Christa Lilly","doi":"10.13023/jah.0501.06","DOIUrl":"10.13023/jah.0501.06","url":null,"abstract":"<p><strong>Introduction: </strong>Opioid addiction and opioid-related overdoses and deaths are serious public health problems nationally and in West Virginia, in particular. Medication-assisted treatment (MAT) is an effective yet underutilized treatment for opioid use disorder (OUD).</p><p><strong>Purpose: </strong>Research examining factors that help individuals succeed in MAT has been conducted from provider and program perspectives, but little research has been conducted from the perspective of those in recovery.</p><p><strong>Methods: </strong>This study, co-developed with individuals in recovery, took place in West Virginia-based MAT programs using an exploratory sequential mixed methods approach. The survey was open February through August 2021. Data were analyzed late 2021 through mid 2022.</p><p><strong>Results: </strong>Respondents experienced many barriers to MAT entry and retention, including community bias / stigma, lack of affordable programming, and lack of transportation. Respondents sought MAT primarily for personal reasons, such as being tired of being sick, and tired of having to look for drugs every day. As one respondent shared, <i>\" I wanted to better my life, to get it under control.\"</i></p><p><strong>Implications: </strong>Programs and policies should make it easy for individuals to enter treatment when ready, through affordable and accessible treatment options, reduced barriers to medications, focused outreach and education, individualized care, and reduced stigmatization.</p>","PeriodicalId":73599,"journal":{"name":"Journal of Appalachian health","volume":"5 1","pages":"72-94"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10629892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138464815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between low health literacy and adverse health behaviors in North Carolina, 2016.","authors":"Manan Roy, Adam Hege, Erin D Bouldin","doi":"10.13023/jah.0403.02","DOIUrl":"https://doi.org/10.13023/jah.0403.02","url":null,"abstract":"<p><strong>Introduction: </strong>Health literacy (HL) is an urgent public health challenge facing the U.S. HL is a critical factor in health inequities and exacerbates underlying social determinants of health.</p><p><strong>Purpose: </strong>This study assesses the association between low HL (LHL) and adverse health behaviors, which contribute to poor health.</p><p><strong>Methods: </strong>Researchers used North Carolina's 2016 Behavioral Risk Factor Surveillance System data, namely, the Health Literacy optional module which asks respondents to rate how difficult it is for them to get health-related advice or to understand medical information (verbal or written). Health behaviors analyzed were excessive alcohol consumption, lack of adequate exercise and sleep, and irregular medical and dental check-ups. The sample was divided into four age categories (18-49, 50-64, and 65-75, and 76 and older) for statistical comparisons. Stata 15 and a user-written Stata command, - <i>psacalc</i>-, were used to examine the relationships by addressing omitted variable bias in OLS regressions.</p><p><strong>Results: </strong>Findings indicate that LHL has a direct robust relationship with not exercising, inadequate sleep, irregular health and dental checkup, and health screenings across different age groups. Among women, LHL is associated with getting a Pap test in 3 years as opposed to more than 3 years.</p><p><strong>Implications: </strong>The adverse behaviors can explain the mechanisms underlying the link between LHL and adverse health outcomes. Further research on the causal relationship between LHL and adverse health behaviors using longitudinal data on a broader geographic region is warranted.</p>","PeriodicalId":73599,"journal":{"name":"Journal of Appalachian health","volume":"4 3","pages":"23-38"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10655731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138464807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Providers' Stigmas and the Effects on Patients with Opioid Use Disorder: A Scoping Review.","authors":"Peyton Skaggs, Sarah Beth Bell, F Douglas Scutchfield, Lauren E Robinson","doi":"10.13023/jah.0403.06","DOIUrl":"10.13023/jah.0403.06","url":null,"abstract":"<p><strong>Introduction: </strong>One of the most prevalent, dangerous stigmas in health care is the complex bias toward patients with opioid use disorder (OUD). This stigma damages the vital patient-provider relationship, further perpetuating the opioid epidemic.</p><p><strong>Purpose: </strong>Unfortunately, research on the relationship between OUD and provider stigma is greatly lacking. To fill this gap, the present in-depth study undertakes a scoping review of research on providers' stigma toward OUD in order to determine how enacted stigma affects treatment plans.</p><p><strong>Methods: </strong>Four databases were used to identify articles published from 1999 to 2021. A comprehensive search strategy was developed through a collaborative process between the researchers and a medical librarian. The researchers used the methodological framework developed by Arksey and O'Malley (2005) and expanded upon by Levac et al.(2010) to chart study characteristics and themes.</p><p><strong>Results: </strong>A total of 196 search items were retrieved. After de-duplication (n=31), remaining articles were screened based on the inclusion and exclusion criteria detailed in the protocol. After both a title/abstract review and full-text review, an additional 158 articles were removed. This yielded a total of seven articles. Three main themes were identified in the literature: (1) rural-urban differences in bias; (2) provider concern regarding legal implications and regulatory concerns; and (3) the belief that OUD is a moral failing rather than a medical diagnosis.</p><p><strong>Implications: </strong>Additional research should further analyze prescribed treatment plans for patients with OUD and utilize this information to create future considerations aimed at reducing opioid-related stigma in healthcare in Appalachia.</p>","PeriodicalId":73599,"journal":{"name":"Journal of Appalachian health","volume":"4 3","pages":"87-102"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10655729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138464812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Over the Hills and Through the Hollers: How One Program is Assisting Residents of Appalachian with Opioid Use Recovery.","authors":"Aubrey E Jones, Jayme E Walters, Aaron R Brown","doi":"10.13023/jah.0403.05","DOIUrl":"https://doi.org/10.13023/jah.0403.05","url":null,"abstract":"<p><strong>Introduction: </strong>The consequences of increasing opioid misuse in the U.S. over the last two decades have been severe, contributing to hundreds of thousands of lives lost and heavy tolls on individuals, families, and society. The Appalachian Region has been hit particularly hard, with its predominantly rural landscape seeing disproportionate increases in opioid misuse and overdoses. These cases have been difficult to address due to poor treatment access and capacity constraints in many areas of Appalachia.</p><p><strong>Purpose: </strong>The current study focuses on evaluating The Kentucky Access to Recovery Program (KATR), which provides services to individuals recovering from opioid addiction residing in several counties in Eastern Kentucky. Its purpose is to understand the impact of KATR on service recipients' access to recovery services and supports.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with 12 service recipients, three service providers, and four vendors of support services related to housing, transportation, medical/dental care, employment, and childcare. Qualitative data were analyzed using thematic analysis.</p><p><strong>Results: </strong>Themes related to individual-level impacts were identified and discussed, including behavioral changes related to recovery, physical and mental health improvements, relationship repair, regaining custody of children, provision of needed supports, and ability to gain employment and improve finances. Study findings showed that KATR had meaningful impacts on the lives of service recipients by helping meet needs and reducing barriers to their ongoing recovery.</p><p><strong>Implications: </strong>Through its use of vouchers for support services and basic-needs provision, KATR demonstrates a potentially effective strategy for increasing access to health-related social services for persons in recovery in predominantly rural areas.</p>","PeriodicalId":73599,"journal":{"name":"Journal of Appalachian health","volume":"4 3","pages":"71-86"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10655734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138464811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Association Between Depressive Symptoms and Glycemic Control Among Residents of Rural Appalachia.","authors":"Brittany L Smalls, Adebola Adegboyega, Ellen Combs, Eli W Travis, Felipe De La Barra, Lovoria B Williams, Nancy Schoenberg","doi":"10.13023/jah.0403.03","DOIUrl":"https://doi.org/10.13023/jah.0403.03","url":null,"abstract":"<p><strong>Introduction: </strong>Type 2 diabetes mellitus (T2DM) is associated with a range of co-morbid physical and psychological conditions, including depression. Yet there is a dearth of evidence regarding the prevalence of depression among those in Appalachia living with T2DM; this gap persists despite the higher regional prevalence of T2DM and challenging social determinants of health.</p><p><strong>Purpose: </strong>This study aimed to provide greater detail about the relationships between T2DM and depressive symptoms in adults living in Appalachia Kentucky.</p><p><strong>Methods: </strong>The present study was a cross-sectional analysis of baseline data derived from an ongoing study of Appalachia Kentucky adults living with T2DM. Outcome data included demographics, Center for Epidemiologic Studies Depression Scale, point-of-care HbA1c, and the Summary of Diabetes Self-Care Activities. Bivariate analysis was conducted using Pearson's correlation to determine the statistically significant relationships between variables which were then included in a multiple regression model.</p><p><strong>Results: </strong>The sample (N=365), consisted primarily of women (n=230, 64.6%) of mean age 64 years (±10.6); almost all (98%) were non-Hispanic White (n=349), and most were married (n=208, 59.1%). The majority (47.2%) reported having two comorbid conditions (n=161), including T2DM, and the mean HbA1c was 7.7% (1.7). Nearly 90% were nonsmokers (n=319). Depressive symptoms were reported in 25% (n=90) of participants. A higher number of comorbid conditions, increased age, Medicaid insurance, tobacco use, lower financial status, female sex, and disability compared to fully employed status all were correlated with a higher rate of depressive symptoms (r ≤ 0.2). The regression indicated that depressive symptoms were associated with age (β = -0.010, <i>p</i> = 0.001); full-time employment status compared to those who are disabled (β = -.0209, <i>p</i> = 0.18); men compared to women (β = -0.122, <i>p</i> = 0.042), and those who smoke compared to nonsmokers (β = 0.175, <i>p</i> = 0.038).</p><p><strong>Implications: </strong>Depressive symptoms were correlated with T2DM among this sample of Appalachian residents with poorly controlled T2DM, especially among women. Given the vast number of social determinants (e.g., poverty, food insecurity, and rurality) affecting this population, healthcare providers must assess for depression and consider its negative influence on the patient's ability to achieve glycemic control.</p>","PeriodicalId":73599,"journal":{"name":"Journal of Appalachian health","volume":"4 3","pages":"39-55"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10655730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138464810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in Distress Between Rural and Non-rural Appalachian Breast Cancer Patient/Caregiver Dyads During the First Year of Treatment.","authors":"Jordan Tasman, Callie D McAdams, Jillian Lloyd, Ashton J Brooks, Patricia Nola Eugene Roberson","doi":"10.13023/jah.0403.04","DOIUrl":"https://doi.org/10.13023/jah.0403.04","url":null,"abstract":"<p><strong>Introduction: </strong>Breast cancer patients and their caregivers living in rural Appalachia face substantial health disparities compared to their non-rural Appalachian counterparts. However, there is limited research on how these specific health disparities in rural Appalachian communities may impact patient psychological distress and caregiver strain during the first year of breast cancer treatment.</p><p><strong>Purpose: </strong>The purpose of the current study was to assess differences in patient psychological distress (depression and anxiety) and caregiver strain between rural non-rural Appalachian breast-cancer-affected dyads (patients and their caregivers) during the first year of treatment.</p><p><strong>Methods: </strong>A total of 48 Appalachian breast cancer patients (with a Stage I through Stage III diagnosis) and their identified caregiver (together, 'dyads') were identified from The University of Tennessee Medical Center across 2019 to 2020. Dyads completed follow-up surveys throughout the first year of treatment. In this prospective pilot study, measures on anxiety, depression and caregiver strain were self-reported and then analyzed using RM-ANOVA.</p><p><strong>Results: </strong>There was a statistically significant higher number of reports of patient depression and caregiver strain in rural-residing dyads compared to non-rural-residing dyads. However, there was not a statistically significant difference between rural and non-rural Appalachian dyads for patient-reported anxiety during the first year of treatment.</p><p><strong>Implications: </strong>The higher reported patient depression and caregiver strain among rural-residing Appalachian patients may indicate the need for implementing remote (e.g., telehealth) Cognitive Behavioral Therapy (CBT) to address the psychological needs of rural-residing dyads. Additionally, greater education from physicians to rural dyads on what to expect during treatment could alleviate caregiver strain.</p>","PeriodicalId":73599,"journal":{"name":"Journal of Appalachian health","volume":"4 3","pages":"56-70"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10655733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138464809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Connections Network: Harnessing the Collective Influence of Grassroots Leaders to Address Health-Related Problems in Hawkins and Hancock County, TN.","authors":"Jodi L Southerland, Teresa Buttry, Connie Johnson, Sheldon Livesay, Lisa Nichols, Priscilla Rogers","doi":"10.13023/jah.0403.08","DOIUrl":"https://doi.org/10.13023/jah.0403.08","url":null,"abstract":"<p><p>In March 2021, grassroots leaders in two counties in northeast Tennessee formed a new network called <i>Connections</i>. Leaders are working to strengthen the capacity of the network and member organizations by promoting partnerships as vital to address effectively rural social determinants of health. Connections provides network members with capacity-building tools and resources, including two funding opportunities, to achieve their missions and sustain impact. Network members are also aligning around common goals to address the socioeconomic conditions affecting health outcomes. Connections will utilize findings from network activities and collaborations to identify synergies that can accelerate improvements in community health and well-being.</p>","PeriodicalId":73599,"journal":{"name":"Journal of Appalachian health","volume":"4 3","pages":"111-114"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10655732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138464808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of <i>Storytelling in Queer Appalachia: Imagining the Unspeakable Other</i>.","authors":"Sandra L Cotton, Laurie A Theeke, James Messer","doi":"10.13023/jah.0403.07","DOIUrl":"https://doi.org/10.13023/jah.0403.07","url":null,"abstract":"<p><p>The Journal of Appalachian Health is committed to reviewing published media that relates to contemporary concepts affecting the health of residents of Appalachia. Improving the health in the region of Appalachia means knowing our people as they live and thrive in communities. The book reviewed here, <i>Storytelling in Queer Appalachia: Imagining the Unspeakable Other</i> (Edited by Glasby, Gradin, and Ryerson), is a must read for people who wish to gain insight on the real experience of being queer in Appalachia.</p>","PeriodicalId":73599,"journal":{"name":"Journal of Appalachian health","volume":"4 3","pages":"103-110"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10655735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138464813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between psychosocial factors, self-care, and blood sugar in an Appalachian population.","authors":"Brittany L Smalls, Tofial Azam, Madeline Dunfee, Philip M Westgate, Susan C Westneat, Nancy Schoenberg","doi":"10.13023/jah.0403.01","DOIUrl":"https://doi.org/10.13023/jah.0403.01","url":null,"abstract":"<p><strong>Introduction: </strong>Appalachian residents are more likely than other populations to have Type 2 Diabetes Mellitus (T2DM) and to experience more severe complications from the disease, including excess and premature mortality.</p><p><strong>Methods: </strong>This study examines health alongside sociodemographic factors, psychosocial factors (including knowledge, empowerment, social support/function, religiosity, distress), and perceived problems in diabetes management that may influence self-care and HbA1c among vulnerable rural residents. A survey of a community-based sample of 356 adults with diagnosed diabetes or HbA1c > 6.5 was conducted in six counties in Appalachian Kentucky.</p><p><strong>Results: </strong>Findings suggest that neither religiosity nor social support/function mediate/moderate the relationship between psychosocial factors and dependent variables (problem areas in diabetes, T2DM self-care or HbA1c). Results also suggest that distress is a predictor of problem areas in diabetes, and both distress and empowerment are predictors of T2DM self-care.</p><p><strong>Implications: </strong>This study addresses the gap in the literature concerning the influence of psychosocial factors on problem areas in diabetes, T2DM self-care and HbA1c among vulnerable rural residents, as well as the potential mediating/modifying effects of religiosity and social function/support. Future research is needed to inform strategies for identifying and addressing distress among vulnerable populations burdened by T2DM, including Appalachian adults.</p>","PeriodicalId":73599,"journal":{"name":"Journal of Appalachian health","volume":"4 3","pages":"1-22"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10655736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138464814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}