Background: Provider–patient communication underpins many initiatives aimed at reducing the public health burden associated with prescription drug abuse in the United States. The purpose of this qualitative analysis was to examine the characteristics of provider–patient communication about prescription drug abuse from the perspective of prescribers. Methods:From 2014 to 2015, 10 semi-structured interviews were conducted with a purposive sample of prescribers from multiple professions and medical fields in Central and South Central Appalachia. The interviews were conducted using a guide informed by Social Cognitive Theory and community theory research, audio-recorded, and transcribed verbatim. Thematic analysis, facilitated by NVivo 10 software, was used to generate themes.Results:Prescribers described 3 primary communication patterns with patients related to prescription drug abuse—informative, counteractive, and supportive. Prescribers also reported multiple factors—personal (e.g., education, experiences, and feelings of tension) and environmental (e.g., relationship with a patient, clinical resources, and policies on controlled prescription drugs)—that affect provider–patient communication and, by association, delivery of patient care related to prescription drug abuse.Conclusions:The findings suggest that provider–patient communication about prescription drug abuse is multidimensional and dynamic, characterized by multiple communication patterns and contributory factors. They have implications for (1) research aimed at advancing theoretical understanding of prescriber prescription drug abuse communication behaviors with patients and (2) interventions aimed at strengthening prescriber prescription drug abuse communication behaviors with patients.

Domestic violence and sexual assault (DVSA) are major health issues on which medical schools across the country fail to adequately educate future physicians. According to the National Coalition Against Domestic Violence, one in three women and one in four men will be a victim of intimate partner violence in their lifetime. The same source reports that one in five women are raped in their lifetime. Because of the widespread nature of these societal problems, the aim of this research was to evaluate the benefit of providing medical students with DVSA education. First and second year medical students at the Quillen College of Medicine attended a mandatory educational lecture on DVSA. We designed a survey to assess the attitudes and knowledge surrounding patient care for DVSA survivors. Students volunteered to complete the same survey before and after the lecture. The surveys were evaluated for statistical significance. A paired t-test showed that the 128 students who took the survey reported a significant increase in comfort level on interviewing, performing a physical exam, and explaining resources to victims of DVSA. Questions regarding knowledge of who should lead exams and the role of emergency contraception in cases of sexual assault also showed statistically significant change by paired t-test analysis following the educational intervention. These findings suggest that medical schools should integrate curriculum on DVSA survivor support in order to increase comfort and knowledge of future physicians in addressing these sensitive topics.

Medical radiation is estimated to contribute to over 200,000 deaths annually. Recent increases in the use of radiation-producing medical imaging examinations have led to increasing cumulative radiation dose to the general public. Multiple measures have been taken to address this alarming trend, including physician education, technologist education on dose reduction, and equipment-facilitated dose reduction techniques. Shield use can reduce the primary beam by up to 95%. Medical imaging technologists are the primary individuals responsible for applying shielding during an examination. Currently, literature shows that technologists are not shielding individuals as often as they should. After pilot testing, medical imaging technologists were recruited via email to participate in a national cross-sectional survey in September 2017. The survey contained items related to technologists’ demographics, shielding behaviors, and attitudes and beliefs measured at four social-ecological levels – intrapersonal, interpersonal, organizational, and community. The American Registry of Radiologic Technologists (ARRT) provided a list of technologists’ email addresses from their directory. One thousand six-hundred and sixty-one email notifications were sent out in the summer of 2017. Of those, 218 technologists (13%) completed the survey. Among technologists who considered their primary modality to be computed tomography (CT), organizational level factors were a positive significant predictor of shielding behavior. None of the four levels were significant in predicting shielding behavior among diagnostic radiological technologists (x-ray). Individual factors were significantly correlated to shielding behavior among radiologic technologists in the intrapersonal, organizational, and community levels. Study results indicated that interventions implemented at the organizational level may be most effective in increasing shield use among CT technologists. Additional research is needed to better understand factors affecting shield use among medical imaging technologists.

Background: The prevalence of diabetes is disproportionately distributed in Central Appalachia compared with other regions in the U.S. Previous research reveals that nearly 65% and 17% of patients with diabetes reported having history of cardiovascular heart disease (CHD) and coronary artery disease (CAD) respectively. This study examined the prevalence of factors associated with subclinical atherosclerosis (measured as coronary artery calcium) in patients with diabetes in geographic locations of rural Central Appalachia. Methods: The study population consisted of 2479 asymptomatic individuals from the rural Central Appalachian region of Kentucky, North Carolina, Tennessee, and Virginia between August 2012 and November 2016. Descriptive analysis was completed for the total sample size with sub analysis of individuals with diabetes. T-test was used for comparison of categorical (example: hypertension and physical inactivity) and continuous variables (example: age and BMI), respectively. In addition, multinomial logistic regression was conducted to assess the association between multiple risk factors including CAC scores, and geographic locations of patients with diabetes in rural Central Appalachia. Results: There was no significant difference between ages for diabetic and non-diabetic patients. Individual factors which are associated with diabetes include current CAC score (p<0.001, CI: 45.90 – 189.98), BMI (p<0.001, CI: 3.01 – 5.64), sedentary lifestyle (p<0.005, CI: 0.039 – 0.215), history of CAD (p<0.001, CI: 0.08 - 0.19), hypercholesterolemia (p<0.001, CI: 0.64 – 0.23), and hypertension (p<0.001, CI: 0.18 – 0.34). There was no significant correlation between geographic locations and diabetes. Among male and female genders, hypertension, hypercholesterolemia, history of CAD, sedentary lifestyle, current CAC score, and BMI have a significant positive correlation with diabetes except for self-reported obesity which only has a significant positive correlation with the female gender. Conclusion: Individual factors remain associated with diabetes across the male and female genders regardless of the geographic locations of the diabetic patients in rural Appalachia. There is strong evidence that cardiovascular related factors could be associated with diabetes across both genders in rural Central Appalachia. We suggest the implementation of evidence-based public health strategies to address the modifiable behaviors that can improve the health of people in rural Central Appalachia.

People living in rural America face unique social circumstances that can prevent them from reaching optimal health status. This fact holds especially true in the rural Appalachian region of the United States where income, education, living circumstances, and lack of resources create an environment that has some of the highest rates of morbidity and mortality in the country. While the rest of the country has seen improvement in many health behaviors and health outcomes, rural Appalachian communities remain unchanged and further behind other regions. In many cases, programming and policy have failed to create a culture of health in Appalachia. Social determinants of the area should be included in interventions and this practice is imperative to achieve effectiveness. This study examined the social context and definitions of health in a rural, Appalachian community using the Social Quality Theory as a guiding framework. A community-based participatory research approach was adopted and implemented through the use of focus groups. The study generated many meaningful findings. It not only provided a new framework, but also provides an examination of how a rural, impoverished community lacks the social infrastructure to improve health. Current perceptions of health are limited to thoughts of disease or illness and overshadowed by negative social norms. There are few social resources currently available to improve health and a large presence of cultural impediments. Yet this “culture” also provides some advantages and assets that the community may leverage for change.

Background: Transgender or nonbinary (TNB) individuals in the United States experience higher rates of sexual and reproductive health disparities when compared to their cisgender counterparts, along with lower access to care. TNB people in the south experience higher rates of disparities. Societal, interpersonal, and individual barriers contribute to these disparities in the TNB population. However, there is a paucity of research examining the sexual and reproductive health experiences of TNB people living in Central Appalachia. Methods: An interpretive phenomenological analysis (IPA) research design was used to collect and analyze semi-structured interviews with TNB individuals living in central Appalachia regarding their sexual and reproductive health experiences. Transcribed interviews were analyzed repeatedly by the primary investigator and the study equity committee to identify emergent themes which focused on understanding an individual’s lived experiences through interpretation. Results: Twenty participants from eastern Tennessee and western North Carolina from four Appalachian states within three Appalachian sub-regions participated in this study. Four themes were identified: a) perceptions and/or experiences receiving SRH healthcare shaped the individual’s self-agency regarding accessing and receiving SRH care, along with influencing their sense of self regarding their gender; b) heteronormative expectations within the medical field influenced interactions with providers and the care system; c) community is integral to SRH experiences, and d) policy and laws impact willingness and ability to access SRH care. Discussion: TNB individuals living in central Appalachia experience individual, interpersonal, community, and social factors that impact their sexual and reproductive healthcare experiences. By addressing these factors based on recommendations from participants, public health leaders, policy makers, and providers can improve sexual and reproductive healthcare experiences of TNB people living in central Appalachia.

The HIV/AIDS pandemic is currently one of the most pressing world-wide concerns regarding the health and well-being of our global population. Due to the lack of a cure, recent efforts have focused on prevention measures for the disease. HIV prevention, particularly with the youth population, has spawned creative programs, such as the use of sport as an educational tool to equip youth with the skills to avoid contracting HIV. Due to the potent effect sport-for-development efforts exhibit on both individual and cultural level change, it can be assumed that HIV prevention sport-for-development programs are worth maintaining. Within the use of sport-for-development programs comes the problem under investigation: the need to establish a uniform method from which to evaluate HIV sport-for-development program effectiveness- specifically in regards to cultural relevance, level of community ownership, and sustainability through partnership resources. In order to address this problem, this analysis used qualitative content analysis to examine the promotional documents of three best practice football-for-development organizations- Grassroot Soccer, Mathare Youth Sports Association, and WhizzKids United. The purpose was to determine whether the Community Organization Health Model (COHM) was reflected in the values promoted through each organization’s electronic promotional material. The content analysis showed a strong qualitative presence of all six of the COHM tenets in the promotional documents, as well as a meaningful theme of expanding partnerships to enhance sustainability. These findings indicate that the tenets of the COHM are valued by best practice football-for-development organizations, which presents the opportunity for this model to be used in creating an evaluation procedure able to bridge cultural differences in programs. Keywords: HIV prevention, football, sport-for-development, evaluation

COVID-19 presented unique challenges for rural Mississippi communities including impacts on the mental health of rural individuals. This research study aimed to identify opportunities for mental health interventions to provide health promotion professionals with quantitative data on the accessibility and the likelihood of engagement with mental health-fostering behaviors. A secondary objective of this research was to categorize these behaviors within the constructs of the Social Ecological Model. Demographics for rural Mississippi communities were collected and displayed, and using multivariate analyses including Spearman’s correlation and a Mann-Whitney U test the correlation between mental health fostering behaviors and demographic factors was obtained. Results showed differences in self-reported accessibility and likelihood of engagement when broken down by race, age, and gender.

With the increasing incidence of chronic diseases such as Type 2 Diabetes Mellitus and cardiovascular disease and the growing obesity epidemic, the need to increase nutritional literacy amongst the general public is paramount. Men tend to lack a strong base of nutritional knowledge. Masculinity is one of the factors preventing many men from making good nutritional choices. The aim of this study was to investigate hegemonic masculinity in relation to current level of nutritional knowledge as well as perceptions and attitudes regarding dietary behaviors and intention to eat a healthy diet among a sample of males. A convenience sample of males 18+ (n=87) was categorized according to hegemonic masculinity level by the Masculine Role Inventory. An amended survey gathered information regarding nutritional knowledge level. An original survey gathered information on confidence in one’s nutritional knowledge, intention to eat healthier, and motivation to expand nutritional knowledge. Analyses examined the association between hegemonic masculinity and nutritional knowledge, confidence in nutritional knowledge, intention to change dietary behavior and motivation to learn new nutritional knowledge. No significant association was found between hegemonic masculinity level and nutritional knowledge, confidence, intention, or motivation. The null results can be attributed to the low hegemonic status of the majority of participants. Analyses also examined the relationship between actual nutritional knowledge and confidence in nutritional knowledge. A positive association between higher confidence level and greater nutrition knowledge was found to be significant, p < 0.006. A positive association between higher confidence level and higher levels of motivation to learn new nutritional information was also found to be significant, p < 0.000. The results of this study suggest that an increased level of confidence in nutritional knowledge may be necessary to encourage accumulation of new nutritional knowledge.

Gay and bisexual men infected with human immunodeficiency virus (HIV) comprise a sizable, medically vulnerable population. Depression is the most commonly experienced mental health disorder affecting this group of people, lending itself to a host of risks associated with depression. As screening of depression in this population can be challenging, it is vital that clinicians have the best available tools and guidelines to detect depressive symptomology. This focused, comprehensive review of the literature examined current data describing the clinical instruments used to detect depressive symptoms in HIV-infected gay and bisexual men. The aim of this analysis was to seek out which instruments were the most widely and successfully employed for this population. An initial search using EBSCOhost and associated databases CINAHL, MEDLINE, PsycINFO, and Health and Psychosocial Instruments alongside inclusion and exclusion criteria found 1,899 articles. Results were narrowed using additional inclusion and exclusion criteria and relevancy, yielding a total of 13 articles for review. The findings of this review suggest screening of depressive symptoms in HIV-infected gay and bisexual men was most successful using the CES-D, the BSI-18, and the BDI. Health care providers should have an understanding of the importance in assessing this population for depression and have access to the best possible tools to do so.