Paraoxonase-1 (PON1) is a high density lipoprotein (HDL)-associated enzyme displaying esterase and lactonase activity. PON1 hydrolyzes the oxons of several organophosphorous insecticides (e.g. paraoxon, diazoxon and chlorpyrifos-oxon) and metabolizes lipid peroxides of low density lipoproteins (LDL) and HDL. As such, PON1 plays a relevant role in determining susceptibility of organophosphate toxicity and cardiovascular disease. The objective of this study was to determine associations of PON1 status (i.e. genotype and activity levels) with atherosclerosis (ATH) in individuals from the Southeastern United States. An additional objective was to determine whether PON1 genotype and/or PON1 activity levels influence the capacity of PON1 to metabolize chlorpyrifos-oxon (CPO) at a relatively low concentration. Data indicated increasing PON1 activity assessed by hydrolysis of phenyl acetate is associated with decreased odds of ATH. Furthermore, neither PON1 genotype nor PON1 activity levels influence capacity of PON1 to metabolize CPO at a relatively low concentration.

Purpose: Rural communities often experience higher rates of mortality than their urban counterparts, with gaps widening in the foreseeable future. However, the underlying level of socioeconomic vulnerability (area deprivation) among rural communities can vary widely. This study examines rural‐urban differences in mortality‐related outcomes within comparable levels of deprivation. Methods: Rural‐urban differences in Years of Potential Life Lost (YPLL), derived from the County Health Rankings, were examined across comparable levels of area deprivation using a quantile regression approach. Rural‐urban differences in YPLL were estimated at the 10th, 25th, 50th, 75th, and 90th percentiles across levels of deprivation. Findings: Compared to the reference population (urban counties/least deprived) a clear increase in YPLL among both rural and urban counties was noted across levels of deprivation, with the highest level of YPLL occurring in counties with the most deprivation. While YPLL increased across levels of deprivation, the magnitude of these differences was markedly higher in rural counties compared to urban, particularly among the most deprived counties. Rural counties experienced an advantage at the lowest percentiles and levels of deprivation. However, this advantage quickly deteriorated, revealing significant rural disparities at the highest level of deprivation. Conclusions: This study noted a differential effect in mortality‐related outcomes among rural counties within comparable levels of community deprivation. Findings contribute to evidence that many, but not all rural communities face a double disadvantage. This underscores the need for a continued focus on the development and implementation of multiple policies aimed at reducing differences in poverty, education, and access to care.

Throughout the Appalachian Region, smoking is a common health risk that contributes to significantly higher rates of tobacco-related disease and lower life expectancy compared to the rest of the United States. Drawing on the research presented in the health disparities and Bright Spot reports, this brief focuses on promising practices, intervention strategies, and policies aimed at reducing health disparities related to smoking. This brief: ■ summarizes statistics on smoking and related diseases in Appalachian communities, ■ discusses key strategies and resources for reducing tobacco use, and ■ provides recommendations for community leaders, funders, and policymakers. This brief discusses four recommendations in detail: 1. Prevent smoking initiation among youth. 2. Increase access to tobacco cessation interventions. 3. Launch anti-tobacco communication campaigns. 4. Reduce exposure to secondhand smoke.

The Appalachian Region continues to experience higher rates of opioid misuse and overdose deaths than other parts of the country. While the impact of the burgeoning epidemic is being felt nationwide, states and counties within the Appalachian Region are particularly hard hit, with opioid overdose rates more than double national averages. Drawing on the research presented in the health disparities and Bright Spot reports, this brief: ■ summarizes statistics on opioid misuse and overdose deaths in Appalachian communities, ■ discusses key strategies and resources for addressing opioid misuse and overdose deaths, and ■ provides recommendations for community leaders, funders, and policymakers. This brief features promising practices, intervention strategies, and policy development and implementation ideas to reduce health disparities related to opioid misuse and overdose deaths. This brief discusses five recommendations in detail: 1. Prevent opioid misuse. 2. Increase access to treatment for opioid use disorder. 3. Implement harm reduction strategies to reduce the consequences of opioid use disorder. 4. Support long-term recovery of opioid use disorder. 5. Implement community-based solutions to prevent substance misuse.

Obesity, which is both a chronic disease and a risk factor for other chronic diseases, contributes to higher rates of premature mortality in Appalachia. Drawing on research presented in the health disparities and Bright Spot reports, this brief focuses on promising practices, intervention strategies, and policies aimed at reducing health disparities related to obesity. This brief: ■ summarizes statistics on obesity and related disease in Appalachian communities, ■ discusses key strategies and resources for preventing and reducing obesity, and ■ provides recommendations for community leaders, funders, and policymakers. This brief discusses four recommendations in detail: 1. Establish healthy behaviors among children and youth to prevent childhood obesity. 2. Increase the availability of affordable healthy foods and beverages in communities. 3. Create safe communities that support physical activity. 4. Increase physical activity and healthy eating among adults.

East Tennessee State University and NORC at the University of Chicago (on behalf of the Appalachia Funders Network) documented the current burden of obesity, diabetes, and chronic disease mortality in central Appalachia. We conducted an analysis of county-level data to provide a comprehensive picture of the health condition of the region and explore urban/rural disparities. More than two-thirds (68.6%) of the 234 counties in central Appalachia have an adult obesity prevalence above the national median of 30.9% (defined as BMI over 30). Over 85% of the counties in central Appalachia have a percentage of physically inactive adults higher than the national median of 26.4% (defined as not participating in physical activity or exercise in the past 30 days). When analyzing the combined chronic disease mortality for heart disease, stroke, diabetes and chronic lower respiratory disease, the combined national mortality rate is 93.0 deaths per 100,000 population. Nearly 90% of central Appalachian counties have a higher combined morality rate. The disparity is more pronounced in rural communities. The combined mortality rate for these four diseases is 74% higher in rural central Appalachia than urban counties nationally. Compared to the rest of the country, people in central Appalachia are more likely to experience and prematurely die from obesity-related chronic disease, including diabetes and heart disease. Residents of rural central Appalachia face even more significant disparities as compared to urban residents within the region and nationally. We will present study methods and findings, including maps and graphs that document these disparities.

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Appalachia is characterized as being a place of health inequalities, including substandard health care access. Health disparities in access to health care persist in the region, and many Tennessee residents are unable to afford premiums, if they can afford insurance at all. Uninsured individuals rely on community based free clinics, which serve as health care safety nets and allowing people to obtain limited health care. This ethnographic investigation, involving semi-structured interviews and participant-observation of the Blackberry Spruce Free Clinic, provides insight into the continued need of health care safety net resources. This research provides a patient’s perspective on the barriers to care for the uninsured, the difficulties in managing chronic illnesses and other medical needs when relying on charity care, and the problems of clinic management in its role as a temporary solution for the uninsured population.

Since 2021, some state legislators have passed laws that limit what public institutions can teach about discrimination. The number of these laws, also called gag orders, is increasing despite a national outcry against racism, homophobia and transphobia, and other forms of discrimination. Many nursing and other professional healthcare organizations have recognized and published statements decrying racism in healthcare and calling for an increased focus on health disparities and advancing health equity. Similarly, national research institutions and private grant funders are funding health disparities research. Nursing and other faculty in higher education, however, are being gagged by laws and executive orders which prevent them from teaching and conducting research about historic and contemporary health disparities. This commentary seeks to highlight the immediate and long-term impact of academic gag orders and to encourage action in opposition of such legislation. Supported by professional codes of ethics and discipline-specific education, we present concrete activities readers can use to address gag order legislation and in doing so, protect patient and community health outcomes.

Introduction: The purpose of this study is to examine how nursing home (NH) characteristics, specifically racial composition of nursing homes residents, influences the use of physical restraints. As the population ages and becomes more diverse, it is essential to mitigate/eliminate racial/ethnic disparities in quality care. Methods: This is cross-sectional study using a 2010 national data set from Brown University Center for Gerontology and Healthcare Research. This study employs Donabedian's Structure-Process-Outcome (SPO) conceptual framework. Statistical analysis includes univariate, bivariate, and a logistic regression model. It is hypothesized that nursing homes with higher proportions of black residents, more Medicaid residents, and for-profit ownership status will be associated with higher prevalence of physical restraint use. Results: Findings show that nursing homes with high proportions of blacks have a lower likelihood of high physical restraint use. Nursing homes with a higher proportion of Medicaid-reliant residents have a higher likelihood of restraint use, as does for-profit nursing homes. Discussion: The findings indicate that there are no racial/ethnic disparities present in the use of physical restraints in nursing homes. There is indication of socio-economic disparities, since nursing homes with higher Medicaid-reliant residents are associated with greater restraint. There are policy implications associated with these findings, including raising Medicaid per diem or implementing a quality performance payment incentive. Further research will be needed to determine ways to reduce racial/ethnic disparities in nursing homes. This research, adds to the nursing home literature focused on socio-economic disparities.