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.

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Introduction: Cardiovascular diseases (CVD) remain the leading cause of death in the United States (U.S.), accounting for one in three deaths annually. Within the U.S., disparities in CVD outcomes and risk factors exist across demographic groups and geographic areas, such as the Central Appalachian region where the burden is higher than state and national rates. Patient-centered care (PCC), is a model of health care delivery that has been shown to improves disease outcomes and quality of life, and is critical in addressing disparities in health care. However, little is known about how high-risk Central Appalachian populations understand or perceive such a model. As such, the objective of this study was to examine the perceptions of PCC among community-dwelling CVD patients/caregivers in the region. Methods: A qualitative study design applying thematic analysis was utilized for data collection and analysis. Seven focus group discussions across six states in Central Appalachia were conducted, and comprised of 78 middle-aged participants selected through purposive sampling. Sessions were guided by standardized instrument regarding current efforts in their communities concerning CVD; challenges and needs; appropriate approaches to their cardiovascular issues; understanding and views about patient-centeredness; and related priorities. The discussions were audio-recorded, transcribed, and then coded for thematic analysis using NVivo qualitative data analysis software. Dependability of data analysis was achieved through an audit trail tracking the NVivo process. Results: Data analysis identified interpersonal relationships with health care providers (HCPs) as the most important aspect of PCC among participants. When asked what PCC meant to them, each group discussed the interpersonal relationship they wanted from HCPs, barriers that kept them from achieving this relationship, and how it impacted their care. Within this theme, two overarching subthemes emerged: (1) developing long-term relationships with HCPs, and (2) developing partnerships with HCPs. The first theme had subthemes that included: turnover of HCPs in their geographical location, the disappearance of family physicians, and preferences related to seeing a physician versus a physician’s assistant or nurse practitioner. The second theme’s subthemes included: communication, feeling cared for as an individual, and input into care. Conclusion: Patients/caregivers stressed the importance of interpersonal relationships with providers in the delivery of PCC. However, patients recognized when PCC was not being provided, provided examples of interactions that were not conducive to providing PCC, and reported feeling disempowered as a person and a patient. The results of this research can be utilized to understand patient/caregiver perceptions of PCC, and indicates the need for further research to reconcile these viewpoints with those of providers to improve the delivery of care, and health outcomes.

Coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving and is a serious public health threat worldwide. Timely and effective control of the pandemic is highly dependent on preventive approaches. Perception of risk is a major determinant of health behavior. The current study explores the association between actual risk and perceived risk for one’s self, family/friends and friends, and community. A questionnaire was administered to participants in Central Appalachia (n = 102). The actual risk was based on the number of chronic conditions of the following conditions: hypertension, heart disease, cancer, diabetes, and chronic obstructive pulmonary disease. Participants were also queried about their perception of risk for COVID-19. Generalized Linear Models were used to independently evaluate the likelihood of perceived risk for one’s: self, family/friends, and community, based on actual risk. Actual risk for COVID-19 was significantly associated with higher likelihood of higher perception of risk for one’s self (b = 0.24; p = 0.04), but not with one’s family/friends (b = 0.05; p = 0.68), or one’s community (b = 0.14; p = 0.16). No health insurance was negatively associated with perception of risk for self (b = −0.59; p = 0.04) and family/friends (b = −0.92; p < 0.001). Male gender (b = −0.47; p = 0.01) was also negatively associated with perception of risk for family/friends. In conclusion, individuals’ actual risk for COVID-19 is associated with their own perception of risk. This indicates that one’s perception of risk for COVID-19 is greater for their own health compared to their family/friends or the community. Therefore, monitoring and following up with chronic disease patients and addressing their lack of awareness of risk to others is needed to prevent and curtail the spread of COVID-19.

INTRODUCTION: E-cigarettes have emerged as the most commonly used tobacco or nicotine products among youth in the United States (US), and usage with other products (dual use) is not well understood. This study assessed dual use and identified associated factors of usage in school-going youth in the high tobacco burdened region of rural Appalachian Tennessee. METHODS: Two waves of data for the same cohort of students were collected in 2014 (Wave 1) and 2016 (Wave 2). Dual use of e-cigarettes with any other tobacco product was the dependent variable. The independent variables consisted of exposure to tobacco use at home, home smoking rules, smoking inside the vehicle, attitudes toward smoking, exposure to tobacco industry marketing/promotion, and peer/family pressure. Descriptive statistics and multivariate logistic regression analyses were conducted to determine the prevalence of dual use and delineate factors associated with usage. RESULTS: Dual use increased from 13.3% in Wave 1 to 18.6% in Wave 2. Results of logistic regression show that exposure to tobacco industry marketing/promotion was significantly associated with dual use in the two waves, odds ratio (OR) = 4.18 (confidence interval [CI] = 1.69-10.38) and OR = 4.43 (CI = 2.03-9.67), respectively. While allowing smoking inside the vehicles, sometimes, significantly increased dual use in Wave 1 (OR = 3.18 [CI = 1.19-8.48]), exposure to tobacco use at home (OR = 2.94 [1.24-6.97]), and peer/family pressure (OR = 2.92 [1.87-7.19]) increased usage in Wave 2. CONCLUSION: The increasing trend in dual use of e-cigarettes and other tobacco products among youth in Appalachia Tennessee suggests a critical need for comprehensive tobacco control programs to avert exacerbating disparities in tobacco use and tobacco-related diseases in the US.

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Obesity and inactivity are prevalent among central Appalachian adolescents. Appalachian residents have been labeled "fatalistic," a time perspective unsupportive of health-promoting behaviors such as regular participation in physical activity. The theory of planned behavior has been used extensively to explain the physical activity behaviors of adolescents. Constructs within the theory of planned behavior include attitudes toward the behavior, subjective norms, perceived behavioral control, and intention to perform the behavior. The purpose of this study was to determine the time perspective of central Appalachian adolescents and examine the relationship between time perspective and the constructs within the theory of planned behavior. A descriptive, correlational design was used to examine time perspective and the physical activity behaviors of a convenience sample of 185 central Appalachian adolescents. Data collection occurred in school. Results indicate central Appalachian adolescents are hedonistic with positive attitudes toward the past. Females were more future-oriented than males. Future oriented students were more likely to plan to attend college. Constructs within the theory of planned behavior were moderate predictors of physical activity that lasted long enough or was intense enough to produce sweat.

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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The Central Appalachian region of the United States disproportionately experiences higher rates of cardiovascular diseases (CVD) and associated risk factors. Primary risk factors for CVD include hypertension, hypercholesterolemia, and tobacco use, all of which have the potential to be mitigated through lifestyle behavior changes. Dietary and physical activity practices are the two main driving forces for the development of hypertension and hypercholesterolemia, while tobacco use is a behavioral choice on its own. Subsequentially, shifting lifestyle choices to emphasize healthier living has the potential to reduce CVDs within the Central Appalachian region. Considering behavioral choices are not made in isolation and are the result of internal and external influences, it is necessary to contemplate the multitude of factors driving these rates. Additionally, healthcare systems within this region ability to provide patient-centered care (PCC) is another consideration, as effective point of care also can address these rates from a disease treatment and management level. The purpose of this study was to explore the knowledge, perceptions, and influences among patients with cardiovascular diseases and non-licensed caregivers within these communities, at the behavioral and community levels, in addition to the perceptions of essential components of PCC among professional stakeholders. Seven focus group discussions with CVD patients and non-licensed caregivers were conducted, with a total of 78 participants; additionally, 20 interviews were held with professional stakeholders within the healthcare field. At the behavioral level participants identified internal and external barriers to sustaining healthy diets, the impact of interpersonal relationships on diet and stress, and influential role of cardiac rehabilitation in physical activity following a major cardiac event. At the community level participants discussed the economic characteristics of communities, a need for community infrastructure expansion, and the role of community organizations. Professional stakeholders addressed PCC in the current healthcare system, constructs of effective patient-provider interactions and the role of community outreach. This research serves as a look into the challenges and opportunities within this region and provides insight to inform future research and interventions.