Introduction Tennessee (TN) ranked 16th among US states for the number of HIV diagnoses in 2015. By TN grand division region (East, Middle, and West), the highest rate of persons living with HIV/AIDS (PLWH) were in the Middle and West. Barriers to HIV testing are still very much unknown in research studies. Further, understanding how Adverse Childhood Experience (ACEs) play a role in HIV testing and specifically in marginalized groups is not fully understood. The present study sought to understand the relationship between ACEs, living in poverty, and testing for HIV among adults in Tennessee. Methods Behavioral Risk Factor Surveillance System data for 2016 and 2017 were obtained from the Tennessee Department of Health. Sociodemographic factors, diagnosis of depression, binge drinking behaviors, HIV risk behaviors (one or more of these in the past year: injection drug use, anal sex, sex without a condom, paid sex, four or more sexual partners), grand division, poverty level, and ACEs were analyzed to determine if an association exists with having been tested for HIV in the past year (yes or no). ACEs were categorized into 0, one to three, or four or more, all having occurred before the age of 18. Frequencies, percents, chi-square, and independent T-tests were completed. Sex stratified simple and multiple logistic regression models were conducted to determine the strength of association with having been tested for HIV (N=1,506 males; N=1,433 females). Results Males who reported HIV risk behaviors were 46% less likely to be tested for HIV (aOR: 0.54, 95% CI: 0.53-0.55) whereas females with HIV risk behaviors were 61% less likely to test for HIV (aOR: 0.39, 95% CI: 0.39-0.40) compared to those without HIV risk behaviors. Males with 4 or more ACEs were 38% more likely to be tested for HIV compared to males with 0 ACEs (aOR: 1.38, 95% CI 1.36-1.39), whereas females with 4 or more ACEs were two times more likely to be tested for HIV (aOR: 2.09, 95% CI: 2.07-2.11) compared to females with 0 ACEs. Males making <$25,000 annually were only 5% more likely to be tested for HIV (aOR: 1.05, 95% CI: 1.04-1.06), whereas women making the same income were 30% less likely to be tested for HIV (aOR: 0.70, 05% CI: 0.69-0.71) compared to incomes greater than $25,000. Males in West TN were 12% less likely to be tested for HIV compared to males in East TN (aOR: 0.88, 95% CI: 0.87-0.89). Similarly, females in West TN were 15% less likely to be tested for HIV compared to females in East TN (aOR: 0.85, 95% CI: 0.84-0.86). Conclusion Education and awareness may be too focused on adults with more ACEs rather than ensuring individuals with HIV risk behaviors, living in poverty, or residing in West TN, understand their risk and have access to HIV testing. Regions of TN, specifically West TN compared to East TN, may require additional resources to ensure the general population understands their risk for HIV; however further research is warranted through longitudinal studies.

INTRODUCTION Depression affects over 18 million American adults yearly and has been identified as the leading cause of disability in people between the ages of 15 and 44 years in the United States. The purpose of this study was to analyze the association between individuals who felt unloved or unwanted during their formative years and the occurrence of depressive symptoms in adulthood. METHODS We examined 5,114 participants aged 24–32 years at Wave IV of the National Longitudinal Study of Adolescent Health (Add Health) public use dataset. We used logistic regression analysis to determine the association between an individual feeling unloved or unwanted by their parent or adult caregiver prior to age 18, closeness with their parents, and a host of risk and protective factors with lifetime depression. We controlled by race, income, education, and age. RESULTS Overall (16.2%; n=827) reported lifetime depression diagnosis. Feeling unloved by a parent/ adult caregiver was associated with higher odds of lifetime depression among males (OR= 2.95, 2.22, 3.92) than females (OR=2.16, 1.78-2.61). The participant report of a biological father spending time in prison (OR= 1.40, 1.14, 1.72) was also associated with lifetime depression. CONCLUSION Our results reveal that feeling unloved/unwanted is associated with depression in both males and females. Therefore, it creates the awareness that depression is not gender-based, and that both females and males require the love of their parents and adult caregivers.

Few countries can boast of having the culture of volunteering seen in the United States. In explaining this phenomenon, many empirical studies have found religiosity significant in predicting volunteering behaviors among young adults, adults, and the elderly. However, teens (13 – 17 years) have not attracted much attention from researchers, though they possess the time and resources most needed to volunteer. Using data from the National Study on Youth and Religion (NSYR) Wave 1, this study examines the relationship between volunteering and teens’ private (religious salience and religious experience) and collective religiosity (religious tradition, church attendance, and youth group participation). Parental variables and teen demographics are also tested using a three-stage ordinal logistic regression. Regarding individual religiosity, the results suggested a significant relationship between teens’ religious experiences and volunteering. In addition, parents can induce volunteering by encouraging their teens to volunteer and participate in religious youth groups.

Introduction Hypertension occurs when there is persistent increase in the pressure of blood vessels in the body; this condition affects about 75 million people in the United States (U.S.). Hypertension is a major risk factor for Peripheral Artery Disease (PAD). PAD is a narrowing of the peripheral arteries in legs, stomach, arms and head regions of the body except the heart. Research has shown that hypertension can be life-threatening for patients with PAD. Moreover, research supports an evidence of a low threshold for blood pressure treatment in patients with PAD. Additionally, current American Heart Association guidelines recommend treating hypertension in patients with PAD to reduce the risk of other cardiovascular disease (CVD) comorbidities. In Central Appalachia, the rate of hypertension and the corresponding risk factors is higher than the national average. As such, this study examined the multiple risk factors of hypertension in patients with PAD within the Central Appalachian region. Method The study population consists of patients diagnosed with PAD in a large health system in Central Appalachia from 2008 to 2018. We extracted 13,455 patients with PAD from Electronic Medical Records (EMR) system using ICD- 9 and ICD-10 codes. The outcome variable of the study was hypertension in PAD patients. Explanatory variables included gender, age, and cardiovascular risk factors (myocardial infarction (MI), Body Mass Index (BMI), diabetes mellitus, smoking status, low-density lipoprotein, high-density lipoprotein, triglycerides, and hypercholesterolemia). Multivariable logistic regression was performed to assess the association between risk factors of hypertension in male and female PAD patients. All analyses were performed using SPSS version 24. RESULTS Of the total PAD patients in the study, 45.8% were females and 54.2% were males. Of these patients, 79.1%, 45.7% and 22.6% had hypertension, diabetes and a history of MI, respectively. Upon stratifying based on gender, the odds of hypertension in PAD female patients with a history of MI was approximately 5.4 times (OR: 5.4, CI : 1.80-16.21) and 2.6 times higher with diabetes (OR: 2.6, CI: 1.43-4.83). Whereas in PAD male patients, the odds of hypertension was 3.9 (OR: 2.6, CI: 1.61-9.21) and 2.6 times (OR: 2.6, CI: 1.43-4.83) higher in those with a history of MI and diabetes, respectively. Stratifying by MI, the odds of hypertension in PAD increased by 2.8 times in patients with diabetes (OR: 2.6, CI: 1.75-4.49). Stratifying by diabetes showed that the odds of hypertension in PAD increased by 4.7 times in patients with MI (OR: 4.7, CI: 1.32-17.07). CONCLUSION The study showed that odds of hypertension in PAD patients is increased in the presence of diabetes and history of MI in both genders. Therefore, controlling diabetes and myocardial infarction will have the greatest impact in reducing the likelihood of hypertension leading to decreased morbidity and mortality in patients with PAD.

Abstract Background: Over 100 million people in the United States (U.S.) have diagnosed diabetes or pre-diabetes. People with this condition are at an increased risk of Peripheral Arterial Disease (PAD). There is a high prevalence of people with risk factors of diabetes especially in the rural Central Appalachia region. People with diabetes are at a higher risk of developing atherosclerosis, which is the most common cause of PAD. Although about 20–30% of 12 million people affected with PAD in the U.S. have diabetes, little is known about diabetes in PAD patients in Central Appalachia. Therefore, this study aimed to examine the risk factors of diabetes in patients with PAD within the Central Appalachian region. Methods: The study population consisted of patients with PAD with medical comorbidities of Cardiovascular disease (CVD). All patients were admitted to a large health system in Central Appalachia between 2008 and 2018. 13,455 index cases were extracted from the Electronic Medical Records (EMR) using the ICD-9 and ICD-10 codes. With diabetes as the outcome variable under study, the risk factors included Myocardial Infarction (MI) history, hypertension, smoking status and hypercholesterolemia. Socio-demographic variables considered in the study included gender, age, ethnicity and marital status and the covariates were Body Mass Index (BMI), Low density lipoproteins (LDL), High density lipoproteins (HDL), Total Cholesterol, and Triglycerides (TG). Multivariable logistic regression was performed to examine potential risk factors of diabetes in PAD patients. Results: The results showed that BMI {OR =1.056 (CI: 1.039, 1.073)}, HDL {OR =0.980 (CI: 0.965, 0.995)}, TG {OR=1.003 (CI: 1.001, 1.005)}, MI history {OR= 1.375 (CI: 1.111, 1.703)}, hypertension {OR=2.822 (CI: 1.804, 4.415)} and smoking {OR =0.802(CI: 0.641, 1.003)} were significant for diabetes in known PAD. To control for potential confounders, Stratification was used. Among males and females with PAD, diabetes was associated with last BMI, MI, hypertension and TG. HDL seemed to be negatively associated with hypertension and female diabetics while smoking seemed to be negatively associated in males. Upon stratification with hypertension, diabetes in PAD patients was significant with BMI, TG, MI history and HDL. After stratification with MI, diabetes in PAD female patients was associated with BMI, and previous MI history. On the other hand, patients without MI had an elevated TG level and an increased risk of hypertension. Conclusion: CVD risk factors are strongly associated with PAD comorbidities, which are worsened in the presence of diabetes. We suggest that hospitals and health care systems should strongly control for the risk factors of diabetes and adopt a multi-risk-factor approach for improving health outcomes for PAD patients.

Introduction Hypertension occurs when there is persistent increase in the pressure of blood vessels in the body; this condition affects about 75 million people in the United States (U.S.). Hypertension is a major risk factor for Peripheral Artery Disease (PAD). PAD is a narrowing of the peripheral arteries in legs, stomach, arms and head regions of the body except the heart. Research has shown that hypertension can be life-threatening for patients with PAD. Moreover, research supports an evidence of a low threshold for blood pressure treatment in patients with PAD. Additionally, current American Heart Association guidelines recommend treating hypertension in patients with PAD to reduce the risk of other cardiovascular disease (CVD) comorbidities. In Central Appalachia, the rate of hypertension and the corresponding risk factors is higher than the national average. As such, this study examined the multiple risk factors of hypertension in patients with PAD within the Central Appalachian region. Method The study population consists of patients diagnosed with PAD in a large health system in Central Appalachia from 2008 to 2018. We extracted 13,455 patients with PAD from Electronic Medical Records (EMR) system using ICD- 9 and ICD-10 codes. The outcome variable of the study was hypertension in PAD patients. Explanatory variables included gender, age, and cardiovascular risk factors (myocardial infarction (MI), Body Mass Index (BMI), diabetes mellitus, smoking status, low-density lipoprotein, high-density lipoprotein, triglycerides, and hypercholesterolemia). Multivariable logistic regression was performed to assess the association between risk factors of hypertension in male and female PAD patients. All analyses were performed using SPSS version 24. RESULTS Of the total PAD patients in the study, 45.8% were females and 54.2% were males. Of these patients, 79.1%, 45.7% and 22.6% had hypertension, diabetes and a history of MI, respectively. Upon stratifying based on gender, the odds of hypertension in PAD female patients with a history of MI was approximately 5.4 times (OR: 5.4, CI : 1.80-16.21) and 2.6 times higher with diabetes (OR: 2.6, CI: 1.43-4.83). Whereas in PAD male patients, the odds of hypertension was 3.9 (OR: 2.6, CI: 1.61-9.21) and 2.6 times (OR: 2.6, CI: 1.43-4.83) higher in those with a history of MI and diabetes, respectively. Stratifying by MI, the odds of hypertension in PAD increased by 2.8 times in patients with diabetes (OR: 2.6, CI: 1.75-4.49). Stratifying by diabetes showed that the odds of hypertension in PAD increased by 4.7 times in patients with MI (OR: 4.7, CI: 1.32-17.07). CONCLUSION The study showed that odds of hypertension in PAD patients is increased in the presence of diabetes and history of MI in both genders. Therefore, controlling diabetes and myocardial infarction will have the greatest impact in reducing the likelihood of hypertension leading to decreased morbidity and mortality in patients with PAD.

Background: Over 100 million people in the United States (U.S.) have diagnosed diabetes or pre-diabetes. People with this condition are at an increased risk of Peripheral Arterial Disease (PAD). There is a high prevalence of people with risk factors of diabetes especially in the rural Central Appalachia region. People with diabetes are at a higher risk of developing atherosclerosis, which is the most common cause of PAD. Although about 20–30% of 12 million people affected with PAD in the U.S. have diabetes, little is known about diabetes in PAD patients in Central Appalachia. Therefore, this study aimed to examine the risk factors of diabetes in patients with PAD within the Central Appalachian region. Methods: The study population consisted of patients with PAD with medical comorbidities of Cardiovascular disease (CVD). All patients were admitted to a large health system in Central Appalachia between 2008 and 2018. 13,455 index cases were extracted from the Electronic Medical Records (EMR) using the ICD-9 and ICD-10 codes. With diabetes as the outcome variable under study, the risk factors included Myocardial Infarction (MI) history, hypertension, smoking status and hypercholesterolemia. Socio-demographic variables considered in the study included gender, age, ethnicity and marital status and the covariates were Body Mass Index (BMI), Low density lipoproteins (LDL), High density lipoproteins (HDL), Total Cholesterol, and Triglycerides (TG). Multivariable logistic regression was performed to examine potential risk factors of diabetes in PAD patients. Results: The results showed that BMI {OR =1.056 (CI: 1.039, 1.073)}, HDL {OR =0.980 (CI: 0.965, 0.995)}, TG {OR=1.003 (CI: 1.001, 1.005)}, MI history {OR= 1.375 (CI: 1.111, 1.703)}, hypertension {OR=2.822 (CI: 1.804, 4.415)} and smoking {OR =0.802(CI: 0.641, 1.003)} were significant for diabetes in known PAD. To control for potential confounders, Stratification was used. Among males and females with PAD, diabetes was associated with last BMI, MI, hypertension and TG. HDL seemed to be negatively associated with hypertension and female diabetics while smoking seemed to be negatively associated in males. Upon stratification with hypertension, diabetes in PAD patients was significant with BMI, TG, MI history and HDL. After stratification with MI, diabetes in PAD female patients was associated with BMI, and previous MI history. On the other hand, patients without MI had an elevated TG level and an increased risk of hypertension. Conclusion: CVD risk factors are strongly associated with PAD comorbidities, which are worsened in the presence of diabetes. We suggest that hospitals and health care systems should strongly control for the risk factors of diabetes and adopt a multi-risk-factor approach for improving health outcomes for PAD patients.

Adolescents are individuals who are gradually approaching adulthood and begin to experience some changes in their lives owing to their exposure to environmental influences. These individuals also indulge in behaviors that may be harmful to them and will require the guidance of health providers to stay healthy. However, many adolescents have reported unmet health care needs or guidance from health care providers. The purpose of this study was to determine the prevalence of provider anticipatory guidance reported by adolescents in rural Appalachia. The study participants were aged 16 to 19 years and a total of 762 participants in rural Appalachia were recruited from the 2016 Adolescent Community Health Survey. Participants were asked to indicate whether a provider asked them about a series of health behaviors in a 12-month period. Health behaviors included healthy eating/diet, physical activity, school performance/grades, friends, emotions, feeling sad, suicide, chewing tobacco, drug use, use of steroids, risks of drinking, smoking, and the importance of wearing seatbelts whilst driving. Descriptive statistics were conducted using SAS 9.4. Of the 762 study participants, 53.4% were females. Less than 30% of the study participants reported a doctor had talked to them about their weight/ healthy eating in the last 12 months. In the last 12 months,18.3% reported a doctor had talked to them about suicide, 26.4% reported a doctor had talked to them about their moods and emotions. Less than 25% reported a doctor had talked to them about drug use and 22.31% reported a doctor had talked to them about wearing a seat belt while driving in the last 12 months. Adolescents are in need of anticipatory guidance from health care providers. Our studies reveal more than 70% of adolescents report not receiving anticipatory guidance in several areas including drug use, chewing tobacco, use of steroid pills or shots without a doctor’s prescription, weight, school performance, healthy eating/diet, suicide, their emotions and the importance of wearing a seatbelt whilst driving. The prevalence of anticipatory guidance as reported by these adolescents in Appalachia is low. Therefore, there is a need to create awareness amongst healthcare providers such as physicians, nurses, psychologists, etc. to ensure that whilst they treat medical illnesses, they also talk to young adolescents about risky behaviors. This awareness will go a long way in mitigating adolescent risky behaviors. This study also has implications that drive policy decision-making.

Through verbal and nonverbal dyadic engagement with caregivers, infants acquire two critical capacities for social engagement: joint attention and language. Children initiate joint attention (IJA) when they use eye contact and pointing (IJA bids) to direct the attention of a social partner to objects of common interest, which then helps children acquire object labels from their social partners. The present study was designed to examine differences in the effect of the number of children in the household (also known as “parity”) on the relationship between IJA and language development. We reasoned that infants who are only children (i.e., in uniparous homes), relative to infants who have one or more siblings (i.e., in multiparous homes), would have more opportunity to engage in IJA, and would, therefore, acquire a larger number of object labels. We tested the hypotheses that: 1) there would be a positive correlation between the number of IJA bids and language overall, and 2) parity would moderate the IJA-language relationship such that in uniparous households, the aforementioned correlation would be stronger than in multiparous homes. For this study, 73 primarily white, middle-class infants ranging from 12 to 20 months of age (30 uniparous, 40 multiparous, 3 missing) visited the lab. Using the Picture Book Task of the Early Social Communication Scales, IJA behaviors were coded when children made eye contact with the experimenter (lower IJA) or pointed to pictures in the book (higher IJA) without elicitation. Productive and receptive vocabulary was measured through parental report using the MacArthur-Bates Communicative Development Inventory. Preliminary analyses showed that older children had larger productive [r(30) = .50, p = .000] but not receptive vocabularies relative to younger children. Also, we were surprised to find that the ages of the infants in our investigation were not associated with the number of siblings in their homes since older infants would have been more likely to have younger siblings. In terms of our hypotheses, it was found that IJA was not associated with either language measure. To test for a moderation effect, we conducted a moderated regression analysis in which each language measure was regressed on IJA, the number of siblings in the home, and the interaction term for these two variables. The interaction term was statistically significant, indicating a moderation effect [B = -8.09, SD = 4.00, t = -2.02, p = .047]. However, this association disappeared after controlling for child age. Overall, our hypotheses were not supported. Although it is possible that parity has no moderating effect of on the IJA-language relationship, our sample size did not provide for large amounts of statistical power to make such a strong claim in this direction. Still, these null findings may provide positive reassurance for families with multiple children that their younger children are not at an IJA/language acquisition disadvantage.