Background: Compared to other regions of the United States, people living in Appalachia bear a heavier burden from obesity related chronic conditions such as cardiovascular disease, stroke, diabetes, fibromyalgia, and sleep apnea as well as higher rates of premature mortality for those diseases. Childhood obesity in particular poses a burgeoning and understated threat to the public health system. Objectives: The purpose of this study was, working with the Appalachian Funders Network, identify the policies and practices that have a positive impact on the reduction of childhood obesity and chronic disease in central Appalachia (TN, VA, KY, WV, NC, and OH). Methods: Mixed methods approach was utilized. Survey of practitioners and funders identified efforts to reduce childhood obesity including obesity prevention, healthy eating and/or physical activity. Focus groups conducted across the region provided participant generated strategies to address gaps and needs. Results: Over 400 practitioners and 40 funders completed the survey. Eight focus groups were conducted across central Appalachia. Based on the finding, a set of recommendations to inform future grant making strategies will be compiled. Preliminary results demonstrate some areas of disconnect between funders and practitioners. Programs were more sustainable if funded from within the community rather than from an outside source. Further, the success of a program seems to be based on need and the collaboration of the practioners and funders. Conclusions: Using a mixed-methods approach, an aggregate of data provides a comprehensive picture of the current health condition of central Appalachia. Working with the Appalachian Funders Network, a group of 80 funders, the findings from this study have the potential to impact the work on practitioners and funders in the region. This collaboration hopes to promote a sustainable healthy lifestyle within Tennessee and greater Appalachia.

Abstract available through the Annals of Behavioral Medicine.

With the passage of the Affordable Care Act, states were given the option to expand their Medicaid programs. Since then, thirty-eight states and Washington, D.C., have done so. Previous work has identified the widespread effects of expansion on enrollment and the financial implications for individuals, hospitals, and the federal government, yet administrative expenditures have not been considered. Using data from all fifty states for the period 2007-17, our study estimated the effects of Medicaid expansion overall, as well as differing effects by the size and nature of the expansions. Using a quasi-experimental approach, we found no overall effect of expansion on administrative spending. However, the size of the expansion may have produced differing effects. States with small expansions experienced some increases in administrative spending, whereas states with large expansions experienced some decreases in administrative spending, including a $77 reduction in per enrollee administrative spending compared with nonexpansion states. As more states consider expanding their Medicaid programs, our findings provide evidence of potential effects.

Background Discrimination is a pervasive societal issue that monumentally impacts people of color (POC). Many Black, Asian, and Hispanic/Latinx individuals report experiencing race-based discrimination in their lifetime. Discrimination has previously been linked to adverse health outcomes among POC, including stress, depressive, and posttraumatic stress disorder symptoms. These health disparities are posited to have become exacerbated by COVID-19 and the racial awakening of 2020. The current study examined the short- and long-term effects of discrimination on stress, depression, and oppression-based trauma among POC. Methods Participants were (n = 398) who identified as Black, Indigenous, Hispanic/Latinx, and Asian completed an online self-report survey assessing discrimination, depression, stress, and oppression-based trauma collected at 3 time points: (T1) beginning of the COVID-19 pandemic (May 2020), (T2) 6 weeks later during the racial awakening of 2020 (June 2020), (T3) one year later (June 2021). Results Significant positive paths were revealed from T1 discrimination to T2 depression, T2 stress, and T3 oppression-based trauma. The association between T1 discrimination and T3 oppression-based trauma was partially mediated by T2 depression, but not by stress; total and total indirect effects remained significant. The final model accounted for a significant proportion of the variance in T3 oppression-based trauma, T2 depression, and T2 stress. Conclusion Findings are consistent with prior research linking discriminatory experiences with mental health symptomatology and provide evidence that race-based discrimination poses harmful short-and long-term mental health consequences. Further research is necessary to better understand oppression-based trauma to improve the accuracy of clinical diagnosis and treatment of POC.

No description available.

Although patterns of African American and white women breast cancer incidence and mortality in St. Louis, Missouri is consistent with those seen elsewhere in the United States, rates vary greatly across zip codes within the city of St. Louis. North St. Louis, whose neighborhoods are primarily African American, exhibits rates of breast cancer mortality that are among the highest in the city and higher than the state as a whole. Based on information that up to 50% of women in North St. Louis with a suspicious diagnosis of breast cancer never enter treatment, we conducted three 2-hour group model building sessions with 34 community stakeholders (e.g., breast cancer survivors or family members or caregivers and community support members such as navigators) to identify the reasons why African American women do not begin or delay breast cancer treatment. Participant sessions produced a very rich and dynamic causal loop diagram of the system producing disparities in breast cancer mortality in St. Louis. The diagram includes 8 major subsystems, causal links between system factors, and feedback loops, all of which shed light on treatment delays/initiation. Our work suggests that numerous intersecting factors contribute to not seeking treatment, which in turn may contribute to African American and white disparities in mortality.

The application of sport science is crucial to athlete performance development. However, the frequent disconnection among sport scientists, coaches, and athletes often leads to miscommunication and increased potential for performance barriers. The creation of sport performance enhancement groups (SPEGs) can help with the professional integration and communication among all personnel involved in the training process. However, SPEG formation faces a number of barriers in the current coaching landscape. The application of a benefits-based programming (BBP) model may aid in the formation of an SPEG and the dissemination of education for coaches, athletes, and administrators. A field experience involving the BBP model and SPEG creation in a National Collegiate Athletic Association (NCAA) Division II school is presented with multiple model iterations

No description available.

Bone is a plastic tissue, changing in density and size with different levels of stress. Furthermore, it appears that BMD is altered in a site specific manner. However, BMD has not been studied extensively in all types of athletes, particularly well trained strengthpower athletes, such as throwers. The pwpose of this study was to examine the BMD of USA Division I collegiate throwers (shot put, discus, etc.). BMD was compared to normative data and to different athletes. Measures of whole body maximum strength and throwing performance were correlated with BMDs. Potential right/left side and sex differences were examined. Athletes were 4 males, 3 females age 19.9 ± 0.9 years. BMD was measured with a DEXA Maximum isometric strength was measured using a midthigh pull standing on a force plate. Force time-curves were generated during the strength tests. Peale force (PF) and normalized pealc force (PFa) were correlated with BMDs. Comparison indicates throwers have denser bones compared to normative data and compared to other types of athletes. Male throwers tend to have greater total body BMD than female throwers (p < 0.05). Dominant arm showed slightly greater BMD compared to non-dominant (p < 0.05). Furthermore, BMD is related to PF (r = 0.68) and PFa (r = 0.56). Throwers have greater BMD's than non-athletes or most other types of athletes. However, throwers showed only a small indication of sidedness. These observations likely stem from their training program (whole body heavy loading).

Certain variables: peak aerobic power (PAP), running economy, and lactate threshold, act as limiting factors for endurance running. However, all of the mechanisms underlying high-level endurance running are not completely clear. Alterations in maximum and explosive strength P27 have been shown to effect positive changes in endurance performance, likely by altering P28 running economy. If strength related factors affect running economy, then this should be evident in the running performance of long-distance runners and perhaps PAP. The purpose of this study was to examine the relationships between peak isometric strength (IPF), explosive strength (rate of force development, RFD), PAP and 3 k performance (3KT) among 5 female and 7 male (n = 12) X-country runners. Force-time curve analysis was conducted for each (2 trials) isometric pull and averaged for analyses. IPF and RFD from 0 - 200 ms were determined from appropriate curves. IPFs were normalized using an allometric (IPFa) scaling equation: absolute force/ (body mass (kg)0.67). ICCs were previously shown to be > 0.9. Relationships were established with Pearson's r; statistical differences with at-Test (p < 0.05). !PF, IPFa and RFD were not different between sexes. PAP was statistically greater in males. Correlations were: PAP vs 3KT (r = -0.92); !PF vs PAP (r = 0.58), 3KT (r = -0.66); IPFa vs PAP (r = 0.45), 3KT (r = 0.45). RFD vs PAP (r = 0.58), 3KT (r = -0.65). Results indicate that strength characteristics correlate moderately to strongly with PAP and 3KT. Data suggests that strong.