This collection aims through the use of folktale and familial history to investigate the bounds of gender and memory against a rural Appalachian landscape. The work utilizes superstition, myth, and the commonplace to search the shadows for the forbidden and unspoken, in an attempt to redefine and reconcile personal dissonance through an observational and at times, voyeuristic lens.

As a Kentuckian, the past has always seemed to maintain a complex relationship with the present. Subdivisions spread across what were once tobacco fields and plantation estates; Appalachian folkways have long been slowly disappearing due to technological change, outmigration, and environmental degradation. In the poetry collection “pretty sad endings,” I try to ask— as our physical and cultural landscape changes, what are we losing, and what do we gain? And what remains (however transformed)? I use surrealism throughout the manuscript to elevate aspects of contemporary suburbia, Americana, relationships, and popular culture to the level of the mythical and spiritual. By distorting the everyday, I hope to tease out some of the real wonder that might be waiting in unexpected places, such as a cul-de-sac, a freeway billboard, or a drugstore parking lot. In these poems, I also try to create spaces where humor and emotional sincerity can coexist, while maintaining a raw curiosity in the strangeness and power of words themselves. My hope is not just that this collection can communicate some of the joys and hardships and eccentricities of my home, but that it can also speak relevantly about contemporary American life and relationships to readers anywhere.

Shouting Distance is a collection of ten short stories written by Gary Thomas Smith. Most of the stories take place in Appalachia and rural Kentucky, and the stories set outside of the region still feature characters whose identities are intricately bound to it. The characters' relationships to Appalachia are complex as some embrace the mountains and their culture, while others feel oppressed by that environment. The stories are driven by characters' relationships with family and friends, with their futures and their pasts, or with cultural expectations. The collection explores themes such as poverty, violence, substance abuse, and loss. The natural world is pervasive throughout these stories, and many of them illustrate the effects of human interaction with the environment. While the seeming decline of rural life is at the foreground of this collection, it does not dismiss the beauty of this life. Rather, it suggests that there is promise for the future in spite of loss, hate, and fear.

Background: The opioid epidemic is particularly worrisome in the pregnant population, wherein concerns are raised about the health of a mother and her child, resulting in an alarming incidence and prevalence of Neonatal Abstinence Syndrome (NAS). The 2016 National Survey on Drug Use and Health (NSDUH) show the rate of illicit psychoactive substance use among the females aged 12 or older was 15.5% in the past year. Among pregnant women aged 15 to 44, 6.3% were illicit psychoactive substance users. In Tennessee, the number of hospital discharged NAS cases from 2002 to 2013 increased from 1.50 to 16.6 cases per 1,000 live births. This number is triple the national incidence of NAS cases over the same time period. Between 2013 and 2016, at least 52.5% of children diagnosed with NAS in Tennessee have had exposure to one prescription drug, while 27.2% were exposed to a combination of prescribed medications and illicit substances. We examined the behavioral correlates that determine the wish to quit opioids or not to quit opioids among opioid-dependent pregnant and non-pregnant women in rural Appalachia. Methods: Ten women of childbearing age, whether pregnant or not, who were receiving prescribed opioids, were recruited to join the study. All the participating women were also receiving physician-managed Medication Assisted Treatment (MAT) therapy for the treatment of severe opioid use disorder, or are currently being prescribed an opioid medication. Study variables included age, Hamilton Depression Rating Scale (HAM-D), Visual Analogue Scale – Pain (VAS-P), the Modified Opiate Craving Scale (MOCS), the Visual Analog Commitment to Quit Opiates, the McGill Pain Index (MPI), prescriptions, tobacco and nicotine use, illicit substance use, the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), and the Adverse Childhood Experience (ACE) questionnaire. The HAM-D, MOCS, MPI, and SOCRATES scores were log-transformed to approximate a normal distribution. Descriptive statistics and the Spearman’s rank correlation (with a 95% Confidence Interval) were conducted to examine significant behavioral correlates for quitting opioids. Results: Descriptive statistics show that women with higher HAM-D and MOCS scores are not likely to express willingness to quit opioids. There is a statistically significant strong positive correlation of 0.679 (pppp Conclusion: Women who recognize the need to quit opioids or are “taking steps” to quit are more likely to quit opioids. Women with high depression and pain scores are not likely to quit opioids. Non-opioid medications may reduce the number of opioid-dependent pregnant and non-pregnant women of childbearing age, and, in turn, lower the currently high incidence and prevalence rates of NAS.

This thesis focuses on the social determinants of health in Appalachia. Using anthropological ethnographic field methods, this thesis explores the ways in which public assistance programs and exchanges between health care practitioners and clients result in discourses of blame and responsibly. Also included is a discussion of the role that health insurance plays in granting or denying individuals living in poverty the opportunity for treatment and care. The narratives collected for this project then become the bases for a critical examination of the public discourse surrounding health care reform in the United States in 2009 and 2010.

This Thesis is an exploration into social change strategies in Appalachia that are alternative to conventional economic development practices and discourses. Drawing from original interviews with social justice activists in central and eastern Kentucky, I document a diversity of subversive discourses circulating in Appalachia, and I delineate models alternative to development that are driving action in several different communities. Through what one of my interviewees described as Appalachian ingenuity,1 individuals are enacting extremely hopeful and imaginative projects, and they are conjuring unique formulations that contribute to academic theories on alternative economies, capitalocentrism, neoliberalism, postmodern economics, anti-development, post-development, and spatial strategies of resistance and liberation.

Weathered sandstone materials have seen increased use in reclamation due to the wide-spread adoption of the Forest Reclamation Approach (FRA) in Appalachia. Runoff from these newly FRA reclaimed sites has the potential to adversely impact aquatic environments without fine sediment retention. To reduce the size and capital investment of settling ponds, flocculant utilization was investigated. Preliminary jar tests were conducted using composite weathered mine spoil samples acquired from a surface coal mine in eastern Kentucky. Four flocculants from the Magnafloc family of products were investigated during the initial screening-level testing. Experiments were conducted at three initial sediment concentrations (500 mg/L, 2,500 mg/L and 5,000 mg/L). A nonionic flocculant, Magnafloc 351, performed best, reducing total suspended sediment to below 50 mg/L. Large scale experiments confirmed that Magnafloc 351 was effective in reducing sediment concentrations. Jar tests were expanded to determine age and environmental effects on a Magnafloc 351 solution. Magnafloc 351 performance was slightly reduced after storage in a controlled building environment for 30 days and significantly decreased after 120 days. Magnafloc 351 solution exposed to UV and high heat (111°F) was ineffective after 30 days, while storage at 4°F and 36°F for 30 days did not adversely influence performance.

Women in Central Appalachia represent a significant proportion of those engaging in problematic patterns of opioid use, which is concerning given the limited available services in the region and gender specific treatment barriers. This investigation seeks to understand the role of mental health and substance use symptoms among incarcerated Central Appalachian women and build on the conceptual model of substance use treatment utilization purposed by Leukefeld and colleagues (1998). Data for this study was drawn from a larger longitudinal investigation (NIDA 1R01-DA033866) and baseline data collected during initial interviews was analyzed. The sample included 400 women incarcerated at one of three central Appalachian jails. Bivariate analyses determined significant relationships between symptoms of depression, anxiety, trauma and substance use. Binary logistic regression was used to assess the factors influencing treatment utilization. The overall multivariate model of treatment utilization with eight factors (income, overdose history, injection drug use, entered detox, attended self-help groups, substance use problems, number of children, and no way to get to their provider) significantly improved the prediction of treatment utilization. Implications of this study highlight the importance of continued interventions at the individual, community, and policy level.

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