Large-scale land uses such as residential wastewater discharge and coal mining practices, particularly surface coal extraction and associated valley fills, are of particular ecological concern in central Appalachia. Identification and quantification of both large-scale land use and microhabitat alterations to ecosystems are a necessary first-step aid in mitigation of negative consequences to biota. In central Appalachian headwater streams absent of fish, salamanders are the dominant, most abundant vertebrate predator providing a significant intermediate trophic role. Stream salamander species are considered to be sensitive to aquatic stressors and environmental alterations with past research having shown linkages among microhabitat parameters, and large-scale land use such as urbanization and logging to salamander abundances. However, there is little information examining these linkages in the coalfields of central Appalachia. In the summer of 2013, I visited 70 sites (sampled three times each) in the southwest Virginia coalfields to collect salamanders and quantify stream and riparian microhabitat parameters. In an information-theoretic framework I compared the effects of microhabitat and large-scale land use on salamander occupancy and abundances. My findings indicate that dusky salamander (Desmognathus spp.) occupancy and abundances are more correlated to microhabitat parameters such as canopy cover than to subwatershed land uses. Brook salamander (Eurycea spp.) occupancy show negative associations to large-scale land uses such as percent recent mining and percent forested. Whereas Eurycea spp. abundances are negatively influenced by suspended sediments, stream bank erosion and stream substrate embeddedness. Management implications of these findings include erosion prevention and control as well as protection and management of riparian habitats. However, quantifying physical environmental quality such as stream and riparian habitat often can be quite difficult, particularly when there are time or fiscal limitations. In order to accurately assess stream and riparian habitat in a time- and cost- effective manner, the U.S. Army Corps of Engineers (USACE) developed a functional condition index (FCI) assessment for streams that measures 11 stream and riparian parameters along with watershed land use to calculate three different scores: a hydrology score, biogeochemical score, and habitat score (Noble et al 2010). Using the salamander data from 2013, I then analyzed the FCI scores using collected occupancy and abundance analyses. Both analyses supported the Habitat FCI score as it had strong correlations with both occupancy and abundance of three Desmognathus spp., and support the use of the USACE protocol for stream and riparian habitat assessment. / Ph. D.

This study examines cultural issues surrounding family cancer communication in Appalachia, providing insight into participants’ communication choices regarding their illness within their families. Stories of 29 female Appalachian cancer survivors from Northeast Tennessee and Southwest Virginia were collected via a mixed methods approach in either a day-long story circle (N=26) or an in-depth interview (N=3). Qualitative content analysis was used to identify unique barriers to family cancer communication in Appalachia. Two barriers emerged: 1) the health of other family members and 2) cancer in a “taboo” area. These findings suggest that Appalachian female cancer survivors struggle with similar issues as survivors outside of the region regarding family cancer communication. However, there appear to be additional barriers to family cancer communication for Appalachian women that may be a result of cultural norms of the region.

Aim To examine the risk factor of coronary artery calcium (CAC) in individuals with diabetes and those without diabetes in Central Appalachia. Methods Study population included 2479 asymptomatic participants who underwent CAC screening between August 2012 and November 2016. CAC score was classified into four categories [0 (no plaque), 1–99 (mild plaque), 100–399 (moderate plaque), and ≥400 (severe plaque)]. Multinomial logistic regression analyses were conducted to test the association between CAC and cardiovascular disease (CVD) risk factors among participants with diabetes, age and gender matched controls, and randomly selected controls. Results 13.6% of total participants had diabetes. Around 69%, 59.8%, and 57.7% of the participants with diabetes, matched controls, and randomly selected controls had CAC score ≥1, respectively. Participants with diabetes had higher prevalence of all CVD risk factors than controls. Among participants with diabetes, hypertension and physical inactivity increased the odds of CAC = 100–399, while among those without diabetes, hypertension and hypercholesteremia increased the odds of having CAC = 1–99 and CAC ≥ 400. Conclusion Half of study participants had subclinical atherosclerosis (i.e., CAC), and individuals with diabetes had higher CAC scores. This study suggests that individuals with diabetes in Central Appalachia might benefit from screening for CAC.

Semi-structured interviews were administered to 16 married couples in Central Appalachia. Questions addressed power relations and division of labor in marriage.

Background: Effects of cardiovascular (CV) risk factors on the diameter of the thoracic aorta have not been fully studied. This study examined the associations between CV risk factors and diameter of thoracic aorta. Materials and Methods: Study population comprised of 1273 asymptomatic adults aged ≥18 years from Central Appalachia region of the United States who participated in a coronary artery screening between January 2014 and December 2016. Descriptive statistics and multiple linear regression analyses were performed to examine associations between multiple CV risk factors and diameters of the thoracic aorta. Results: Mean (±SD) age of participants was 57.9±9.7 years; that of body mass index (BMI) was 29.4±5.9. The mean aortic sinus, ascending aorta, and descending aorta diameter were 34.1±4.4 mm, 33.8±4.4 mm, and 26.0±3.6 mm, respectively. Increasing age, being male, and having a higher BMI were associated with wider aortic sinus, ascending aorta, and descending aorta diameters. Hypertension (p < 0.05) and obesity (p < 0.0001) were significantly associated with wider diameter for all measured aortic diameters. Participants with diabetes had wider descending aorta compared to those without (26.6±3.9 mm vs. 25.9±3.5 mm, P = 0.012). Participants who had ever smoked a cigarette had significantly wider descending aorta diameter compared to never smokers (26.3±3.6 mm vs. 25.9±3.5 mm, p = 0.031). Conclusions: The study results suggest that decreasing BMI and management of CV risk factors such as hypertension and modifying behavioral risk factors such as smoking are likely to be emphasized in order to decrease the rate of aortic dilatation and subsequent aortic dissection, if aortic dilatation is detected during a CT scan.

Objective. To examine alternative tobacco product (ATP) use and associated factors among middle school students in Appalachian Tennessee. Method. Data (2015– 2016; N=573) from school-based tobacco surveys in 11 middle schools in Appalachian Tennessee were analyzed. Multiple logistic regression model described factors associated with ATP use. Results. More than one-tenth (13.2%) of participants have ever used ATPs. Approximately 9%, 7%, 6%, and 2% of participants have ever used e-cigarettes, cigarettes, smokeless tobacco, and little cigars or cigarillos, respectively. The following were significantly associated with ever use of ATPs: believing tobacco users have more friends, owning tobacco-branded item(s), living with a tobacco user, having ever smoked cigarettes, and living in homes where smoking is allowed. Conclusion. More than one in 10 of participants have ever used at least one ATP, and association with desirable objects and situations may promote ATP use. Interventions should seek to reduce these positive images and make all tobacco products unappealing.

No description available.

On behalf of the Appalachia Funders Network (AFN), with funding from the Robert Wood Johnson Foundation, East Tennessee State University and NORC at the University of Chicago conducted a study to analyze the current burden of obesity and chronic disease in central Appalachia and identify promising practices and strategies that are having a positive impact on the reduction of obesity in the region. Central Appalachia consists of parts of Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia. Regional recommendations to reduce childhood obesity and improve the overall population’s health were developed based on a review of current literature, a survey, and focus groups with both community groups and funders.

On behalf of the Appalachia Funders Network (AFN), with funding from the Robert Wood Johnson Foundation, East Tennessee State University and NORC at the University of Chicago conducted a study to analyze the current burden of obesity and chronic disease in central Appalachia and identify promising practices and strategies that are having a positive impact on the reduction of obesity in the region. Central Appalachia consists of parts of Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia. Regional recommendations to reduce childhood obesity and improve the overall population’s health were developed based on a review of current literature, a survey, and focus groups with both community groups and funders.

Research Objective: On behalf of the Appalachian Funders Network, with funding from the Robert Wood Johnson Foundation, East Tennessee State University and NORC at the University of Chicago documented the current burden of obesity, diabetes, and chronic disease mortality in central Appalachia. An analysis of county-level data was conducted in order to provide a picture of the health condition of the region. This study identified both the magnitude of obesity-related health problems in central Appalachia as well as promising practices, policies and strategies aimed at reducing obesity rates, especially among children. Study Design: A mixed methods approach was used to assess 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). Along with a literature review and analysis of national and regional health data, the study included surveys and focus groups of community members, practitioners and funders to identify the region’s current obesity prevention efforts. Activities were broken into (1) healthy eating, including promotion of policies and/or changes to the built environment and promotion of healthy food; and (2) physical activity. Population Studied: The central Appalachian region ranks amongst the highest in the nation for percentage of obese high school students. There, children are disproportionately affected by rates of obesity by location; specifically, rural children differ from urban children, 16.5% to 14.4%, respectively, in prevalence of obesity. Focus groups comprising community members, practitioners and funders were held to obtain internal stakeholder input and secure community buy-in. Principal Findings: Across central Appalachia, participants in the surveys and focus groups identified a number of recommendations to advance regional efforts to reduce obesity and improve the overall population’s health. Survey results indicate the most promising and prevailing nutritional practices comprise community-based, locally led support strategies spanning multisector approaches to endorse schools' feeding programs, community and school gardens, and farmers' market SNAP programs via co- investment and funding. Concurrently, promising physical activity promotion practices include stepping up community walkability, enhancing physical education requirements, expanding and revitalizing trails, tracks, playgrounds, gyms and other exercise opportunities within built environments. Conclusions: This study provides evidence-based, promising practices to address obesity in rural communities. For long-term changes to occur programs that are successful need to be evaluated rigorously and shared widely. Implications for Public Health Policy or Practice: Improving the local food and physical activity environment in a community requires participation of many dedicated partners. Government, the health care system, schools, private businesses and community organizations all have critical roles to play in this effort. Cross-sector collaboration creates local ownership leading to more sustainable programs that are valued not only by the foundations and grantees but also by the larger community.