Neonatal Abstinence Syndrome (NAS) is the condition which occurs when newborn babies experience withdrawal symptoms from medications taken by their mothers during pregnancy. Prior research suggest NAS is associated with long-term educational difficulties and alterations in neonatal brain structure. Between 2008 and 2017, NAS rates more than tripled in the United States. An epicenter of the NAS epidemic is Southern Appalachia. West Virginia, the only state with all counties located in Southern Appalachia, has an NAS rate roughly seven times the national average, and in 2017, four of the 10 states with the highest NAS rates were part of Southern Appalachia. Upon reviewing Tennessee data, it was noted that increasing NAS rates had a similar curve to buprenorphine prescribing patterns. Buprenorphine is an opioid partial-agonist prescribed in medication assisted therapy (MAT) intended to help individuals, including those pregnant, avoid withdrawal symptoms. Previous research at an East Tennessee clinic identified buprenorphine in urine drug screens of 16% of all pregnant patients; patients admit to both prescribed and illicit use, including snorting, smoking, and injecting. These findings align with a 2017 study suggesting that mothers of NAS infants in eastern Tennessee, compared to mothers across the state, were more likely to use substances prescribed to another person. Despite the drug’s increasing prescribing patterns and popularity for illicit use, its effects on the mother and fetus remain controversial. We therefore felt it appropriate to investigate possible linkages between buprenorphine prescriptions and NAS rates. For the purposes of this study, we define Southern Appalachia as 250 counties from 7 states, including Tennessee, West Virginia, Virginia, North Carolina, Kentucky, Ohio, and Maryland. Annual NAS rates, buprenorphine prescription rates, drug-induced death rates, and opioid prescribing rates from each county in the region were assessed for the years 2008-2018 using data provided by governmental agencies. It was found that buprenorphine prescriptions in the region more than quintupled between 2008 and 2018. NAS rates and drug-induced death rates did not decrease as well; unfortunately, they dramatically increased. We identified a significant linear association between the rate of NAS diagnoses and buprenorphine prescriptions (r = 0.9774, R2 = 0.9553, p-value less than 0.001) and between the rate of buprenorphine prescriptions and drug-induced deaths (r = 0.7129, R2 = 0.5082, p-value .0311). This is the first report which documents a relationship between NAS rates and increasing buprenorphine prescribing. Discussions regarding current policies for buprenorphine management during pregnancy are warranted. We encourage further research on establishing the lowest effective buprenorphine dose for each patient, and we support the CDC’s resumption of tracking the morphine milligram equivalents (MME) of buprenorphine prescribed during pregnancy so that researchers can further study the effect of congenital MME exposure on fetal outcomes.

This thesis addresses the Burley Tobacco Buyout Program and its impact on three local economies. Data collection involved obtaining information from government reports, internet sources, public documents, agriculture offices, federal agriculture officials, and books. Personal interviews were conducted with 32 farmers in Sullivan County, Tennessee; Washington County, Virginia; and Watauga County, North Carolina. This study is significant because it addresses not only the decline of an agricultural product but also changes in a way of life in Southern Appalachia. The future of burley tobacco growing in this region appears to be bleak because of foreign market competition and decreasing domestic demand. From the personal interviews, many farmers had already abandoned tobacco production and older respondents were often planning to stop all farming practices. Specifics of the federal government-mandated Buyout Program to compensate quota holders and growers are presented, as well as the experiences and opinions of farmers regarding this program.

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Southern concepts of gender influenced Appalachian society throughout the antebellum and Civil War eras. Concepts of masculinity and femininity, including “the cult of true womanhood” and Southern manhood, shifted and broaden throughout the South due to wartime stressors. Appalachians adjusted these gender roles in order to survive chaos and turmoil in their region. The brutal political and community divisions, high rates of desertion, guerilla warfare, and threats of invasion in the mountain regions intensified these concepts of gender. Southern constructions of gender molded the Appalachian experience of war but the high level of conflict strengthened these new roles as a means of survival.

Characterizing streamflow trends is important for water resources management. Streamflow conditions, and trends thereof, are critical drivers of all aspects of stream geomorphology, sediment and nutrient transport, and ecological processes. Using the non-parametric modified Mann-Kendall test, we analyzed streamflow trends from 1996 to 2022 for the Southern Appalachian (SA) region of the U.S. The forested uplands of the SA receive high amounts of rain and act as a "water tower" for the surrounding lowland area, both of which have experienced higher than average population growth and urban development. For the total of 127 USGS gages with continuous streamflow measurements, we also evaluated precipitation and land change rates and patterns within the upstream contributing areas. Statistical methods (i.e., generalized linear models) were then used to assess any linkages between land cover change (LCC) and streamflow trends. Our results show that 42 drainage areas are experiencing increasing trends in their precipitation, and 1 is experiencing a negative trend. A total of 71 drainage areas are experiencing increasing trends in either their annual streamflow minimums, maximums, medians, or variability, with some experiencing changes in multiple. From our models, it is suggested that agricultural expansion is associated with increasing minimum streamflow trends, but increasing precipitation is also positively linked. With this information, water managers would be aware of which areas are experiencing changes in streamflow amounts from LCC or precipitation and could then apply this in planning and predictions. / Master of Science / Water availability is important for resources management. Streamflow is a measure of available surface water and is an important component in the hydrological cycle. Using the non-parametric modified Mann-Kendall test, we analyzed streamflow trends from 1996 to 2022 for the Southern Appalachian (SA) region of the U.S. The forested uplands of the SA receive high amounts of rain and act as a "water tower" for the surrounding lowland area, both of which have experienced higher than average population growth and city expansion. For the total of 127 USGS gages with continuous streamflow measurements, we also evaluated precipitation and land cover change rates within the area upstream of the gage (or drainage/contributing area). Statistical methods (i.e., generalized linear models) were then used to assess any linkages between land cover change (LCC) and streamflow trends. Our results show that 42 drainage areas are experiencing increasing trends in their precipitation, and 1 is experiencing a negative trend. A total of 71 drainage areas are experiencing increasing trends in either their annual streamflow minimums, maximums, medians, or variability, with some experiencing changes in multiple. From our models, it is suggested that agricultural expansion is associated with increasing minimum streamflow trends, but increasing precipitation is also positively linked. With this information, water managers would be aware of which areas are experiencing changes in streamflow amounts from LCC or precipitation and could then apply this in planning and predictions.

No description available.

Published in 1983 by the U.S. Geological Survey, this map denotes land use and land cover in the northeast Tennesee/Johnson City area for the years 1975-83. Base map from U.S. Geologic Survey, 1966. The legend along the right edge denotes different types of land use and coverage using a numeric code. Additional details on how the map was compiled can by found on the lower right corner. The North Carolina portion of this map was prepared in cooperation with the North Carolina Department of Natural Resources and Community Development. Physical copy resides in the Government Information, Law and Maps Department of East Tennessee State University’s Sherrod Library. Scale - 1: 250,000. / https://dc.etsu.edu/rare-maps/1044/thumbnail.jpg

Produced by the Johnson City GIS Division on December 1, 1999, this map denotes the land use of Johnson City as of 1998. The key along the bottom edge identifies the types of land use via a color code. Major roads and highways are labeled on the map itself. Physical copy resides with Johnson City, Geographic Information Systems Division. Scale - 3" = 6000’ / https://dc.etsu.edu/rare-maps/1070/thumbnail.jpg

This study addressed the academic, cultural, and social expectations and experiences of 20 Black students at 2 predominantly White high schools in the Southern Appalachian region of the United States. The participants' experiences revealed how institutional practices promoted or obstructed their successful experiences at high school. Qualitative ethnographic methodology guided the study. The data collected included the stories of the Black students based on individual interviews, focus groups, and document reviews. The data showed the positive and negative experiences of the Black students in predominantly White high schools and the negative impacts of racism and racist behaviors on Black students' experiences at their high schools. Findings indicate a difference between the students' academic, cultural, and social expectations and experiences. Many of these differences in expectations and actual experiences were caused by the racist experiences of the Black students. Social networks were shown to contribute to the students' need for a place of safety. Recommendations based on the results of the study are provided for school administration, teachers, and other staff members.