Cattle regenerative grazing alters bat activity in Southern Appalachia

Geographic disparities in board-certified ambulatory care pharmacists in Appalachia.

Emergency departments are vital safety-net resources for adults seeking mental health treatment. Frequent mental health emergency department use has been associated with homelessness and alcohol use. However, little of this research has been conducted in rural settings, particularly in Northern Appalachia. Therefore, this program-level study aimed to describe the relationship between recent mental health emergency department use, homelessness, and alcohol use in intake survey data from one outpatient mental health clinic. Participants were 1,293 adults seeking treatment between June 2020 and August 2022. On average, participants reported using an emergency room for a psychiatric or emotional problem less than one time in the past 30 days. Nights spent homeless were statistically significantly positively associated with recent mental health emergency department use. Additionally, those who used alcohol daily or almost daily demonstrated a statistically significant greater frequency of mental health emergency department use compared with adults who did not use alcohol within the past 30 days. Future social work research should replicate this study with a larger, multisite, random sample of mental health treatment-seeking adults in rural Northern Appalachian settings.

Trailing edge tree populations, located at the warm or dry margins of species' ranges, often harbor unique genetic adaptations to marginal environments. These populations face heightened risks from climate change, potentially threatening the persistence of valuable adaptive traits. Here we identify trailing-edge populations for the 100 most common North American tree species using spatially explicit climate and forest inventory data, and prioritize conservation actions based on projected forest cover loss, climate velocity, and species richness. Assisted migration initiatives for these populations could safeguard the long-term persistence of their adaptive traits, ensuring that valuable genotypes are maintained within future forest ecosystems. Trailing-edge populations were geographically concentrated in the Appalachian region, the Midwest, and southern boreal forests. Areas bordering the central plains faced the highest projected forest cover loss and climate velocity, while the Great Lakes basin and eastern Canada emerged as promising recipient regions. Our findings support targeted conservation and assisted migration strategies to maintain genetic diversity and enhance forest resilience under future climates, facilitated by an online tool for climate-informed seed collection and planning (https://tinyurl.com/past-nam).

Bottled water consumption is rising, influenced by perceptions of taste, convenience, safety, and concerns about other drinking water sources. However, bottled water use raises quality, environmental, and economic concerns. Despite poorer economic and health outcomes in Central Appalachia, there is a severe lack of research about drinking water in the region. This small-scale study explored predictors of bottled water usage among 27 households with utility-supplied water in Virginia. Logistic regression analyses considered the following as potential predictors of bottled water use: income, level of education, marital status, and tap water quality perceptions. About 78% of households reported using bottled water as a primary or secondary source, for reasons including perceptions of taste (43%), convenience (29%), safety (15%), and other reasons (13%). In this study, socioeconomic indicators were not significantly associated with bottled water use, but the perceived quality of households' tap water was a significant predictor of primary bottled water use. This study contributes to our understanding drivers of bottled water use with a focus on the under-studied region of central Appalachia.

Appalachian states are disproportionately impacted by poverty, high rates of fatal overdose, hepatitis A, acute hepatitis B, acute hepatitis C, and human immunodeficiency virus (HIV). We evaluated trends for these syndemic conditions by Appalachian subregion to better inform prevention measures. For the United States, non-Appalachian United States and Appalachian subregions, we calculated annual rates per 100 000 population for unintentional and undetermined fatal overdoses, hepatitis A, acute hepatitis B and acute hepatitis C during 2000-2023; and diagnoses of HIV for persons aged ≥ 15 years attributed to injection drug use (IDU) during 2008-2023. We calculated age and sex-specific rates during 2014-2023 for all diseases and conditions. During 2000-2023 in the central Appalachian subregions, age-adjusted rates of fatal drug overdose, hepatitis A, acute hepatitis B, and acute hepatitis C peaked at 985%, 2173%, 223% and 336% over the year 2000 rates. During 2008-2023, rates of new HIV infections attributable to IDU peaked at 380% over year 2008 rates. Rates of all conditions were higher in the Appalachian Region than in the non-Appalachian USA, especially in adults aged 25-44 years in Central and North Central Appalachian subregions. We documented elevated rates of infectious diseases and fatal drug overdose against a background of increased economic distress in the central Appalachian subregions, especially among working-age adults of reproductive age. Interventions to address social determinants of health and expand access to comprehensive integrated medical and substance use disorder treatment, overdose prevention, and syringe services are critical to control this syndemic.

Unintentional poisoning and exposure to harmful substances involving illicit drugs, medications other than those taken as prescribed, and biological substances have emerged as a leading cause of preventable death in the United States. The increase in drug-specific toxicity, particularly from synthetic opioids, has accelerated during the COVID-19 pandemic, thus highlighting a need for national surveillance to monitor emerging demographic and geographic patterns. The CDC WONDER Multiple Cause of Death database provided mortality data from 1999 to 2023. Deaths with accidental poisoning (International Statistical Classification of Diseases and Health-Related Problems-10th Revision codes X40-X49) coded as the underlying cause and poisoning due to drugs (T36-T50) as multiple causes were considered. Age-adjusted mortality rates were extracted from the SEER database (number of deaths per 100,000 individuals). They were analyzed according to sex, age strata, race/ethnicity, and geographic region via Joinpoint regression for estimation of annual percentage change and average annual percentage change, with statistical significance set at P < .05. From 1999 to 2023, all-ages age-adjusted mortality rates more than sextupled, from 4.8 (95% confidence interval: 4.7-4.9) to 30.8 (95% confidence interval: 30.6-31.0). The consistently higher male mortality culminated in 2022, where men had a crude mortality of 45.3 per million compared with 18.2 per million in women. The largest increase was from 2019 to 2020, after the start of the COVID-19 pandemic. It is most severe among middle-aged adults (ages 45-64) and is characterized by geographic disparities in mortality, with clustering in counties across the Appalachian region and Southern United States. Non-Hispanic Black and American Indian/Alaska Native people experienced the latest spikes in mortality. The ongoing rise in drug-related accidental poisonings indicates a growing, evolving epidemic in the United States. The findings identified a need for focused equity-based interventions targeting substance use treatment, social determinants of health, and enhanced surveillance to address the escalating burden of mortality due to drug toxicity.

Phylogenomic species delimitation reveals distinct pace and mode of lineage evolution in Amanita jacksonii.

Frequent Police Contact and Nonfatal Overdose Among People Who Use Drugs in Rural Appalachia

PremiseUnderstanding the habitat requirements of imperiled flora is critical for informing ex situ conservation practices, designing effective reintroduction strategies, and understanding how climate change will impact such species, especially in montane regions with high levels of environmental heterogeneity. In southern Appalachia, USA, the mountain sweet pitcher plant (Sarracenia rubra subsp. jonesii) and mountain purple pitcher plant (Sarracenia purpurea var. montana) inhabit overlapping ranges. These taxa rarely co‐occur in the same mountain bogs but frequently hybridize at sites where they do co‐occur.MethodsWe assessed patterns of climatic niche differentiation in these imperiled taxa to explore whether they naturally co‐occur or may have been brought into secondary contact through human translocations. In addition, we constructed ecological niche models to evaluate the comparative availability of suitable habitat for each taxon under present and future climates.ResultsSarracenia purpurea var. montana inhabits higher elevation habitats than Sarracenia rubra subsp. jonesii, and these differences in elevation correspond with differences in climatic niche. Under the most likely future climate scenario, models predicted that habitat matching the climatic niche of Sarracenia rubra subsp. jonesii will decline in area by 95% by 2080, while habitat matching the climatic niche of Sarracenia purpurea var. montana will increase in area by 13%.ConclusionsDespite high spatial overlap, these two related taxa exhibit divergent climatic niches, resulting in highly different management needs and conservation approaches. We raise concerns about the future of mountain bog plant assemblages, and the rare species they include, under climate change.

Abstract This article interrogates the formation of a national political consensus around coal in the United States. In the postwar era, the domestic future of coal was seriously challenged by the oil, gas, and nuclear alternatives. In less than two decades, however, coal mining shifted from being one of multiple energy options to being a national political project tied to regional development and energy sovereignty. Why did this shift occur? Using archival data, I argue that it was not primarily a response to market forces or corporate pressures but was furthered through the work of the Appalachian Regional Commission (ARC). In the years following its inception in 1965, the agency articulated the coal consensus as both a solution to the problem of Appalachian underdevelopment and to the looming energy crisis. In doing so, it brought together the interests of regional, federal, and corporate actors around this consequential project. In this article, I delineate a pathway through which bureaucratic agencies can play a decisive role in the formation of political ideas and advance our understanding of the conditions that make energy transitions possible.

Healthcare inequities disproportionately affect underprivileged groups, leading to negative health outcomes. Challenges are compounded in regions like Appalachian Ohio, where rurality and poverty exacerbate issues such as access to care and environmental stressors, significantly impacting conditions like asthma. In severe cases of asthma, sinus surgery is sometimes indicated, because it has been shown to improve asthma-related symptoms. However, the specialists who perform these procedures, such as otolaryngologists, may be less available to certain underprivileged groups. The purpose of this study was to compare the effects of social determinants of health on the prevalence and treatment of asthma in Appalachian vs. non-Appalachian regions of Ohio, and how those factors affect the rate at which sinus surgery is performed in different populations. This cross-sectional study utilized public data gathered in the year 2021 from the Centers for Disease Control and Prevention (CDC) and the Center for Medicare and Medicaid Services (CMS) to compare asthma prevalence, emergency visit and hospitalization rates, sinus surgery frequencies, and social determinants of health in Appalachian vs. non-Appalachian regions. Both the average prevalence rate of asthma (p<0.001) and the number of emergency department visits as a complication of asthma (p<0.01) in Appalachian Ohio counties were significantly higher than non-Appalachian counties. Interestingly, the ratio between sinus surgery prevalence and the number of procedures was not statistically different between Appalachian and non-Appalachian counties. This included balloon sinuplasty (p=0.4), septoplasty (p=0.4), and functional endoscopic sinus surgery (FESS, p=0.4). Additionally, several social determinants of health, specifically the poverty rate (r=0.9, p<0.001), uninsured rate (r=0.4, p<0.001), unemployment rate (r=0.5, p<0.001), and housing burden rate (r=0.6, p<0.001) were shown to have a significant correlation with the rate of asthma prevalence among adults inOhio. Asthma prevalence and treatment availability differ significantly between Appalachian and non-Appalachian regions of Ohio, highlighting the need to improve access to specialists and address barriers to care in rural populations.

IntroductionDespite statewide growth, rural communities in Western North Carolina (WNC) face persistent barriers to oral health care driven by chronic dental workforce shortages and systemic geographic disparities. Within this Appalachian region, the dental safety net serves as a vital yet strained support system, struggling with limited financial resources and a lack of provider participation that leaves many underserved populations without essential oral health services.PurposeThis study aims to explore the experiences of individuals working within the WNC dental safety net to identify barriers and strategies required to strengthen the delivery of oral health care in high-need rural settings.MethodsSemi-structured interviews were conducted with 17 oral health stakeholders involved in the WNC dental safety-net system between June – August 2024. Interviews explored challenges to meeting community oral health needs and potential solutions. Data were analyzed using thematic analysis.ResultsThree major themes emerged: (1) workforce challenges involving dentists, hygienists, and dental assistants, (2) fragmentation between dental providers and the broader health care system, and (3) financial instability. Proposed solutions corresponding to each theme included streamlined credentialing and expanded allied health training programs to address workforce shortages, skills-based continuing education for public health dentists to reduce specialty referral gaps and fragmentation, and increased Medicaid reimbursement rates paired with coordinated policy advocacy to strengthen financial sustainability across the safety net.ImplicationsThese findings suggest structural challenges facing rural safety-net programs and highlight opportunities to strengthen their capacity to meet growing community oral health needs.

IntroductionHurricane Helene brought widespread damage to Southern Appalachia, disrupting utilities, health care, and recreation. While natural disasters are linked to declines in mental and physical health, few studies have examined their effects on distinct types of physical activity (PA).PurposeThis study evaluated the effects of Hurricane Helene on perceived stress, depressive symptoms, post-traumatic stress disorder (PTSD) symptomology, and intentional (exercise for health benefits) and incidental (physical labor or transportation) PA. Evacuation status influence was also explored.MethodsTwenty participants completed assessments four weeks before (BASE), immediately after (0POST), and four weeks after landfall (4POST). Measures included the Perceived Stress Scale (PSS), Patient Health Questionnaire-9 (PHQ-9), and the Impact of Event Scale–Revised (IES-R). PA was assessed via activity recalls.ResultsPSS and PHQ-9 increased from BASE to 4POST (p = 0.002, p = 0.017; respectively). Overall PA levels remained stable, but incidental PA increased at 0POST among non-evacuated individuals (p = 0.002). Time evacuated negatively predicted hyperarousal (p = 0.007) and PSS change (p = 0.006). Baseline stress positively predicted intentional exercise at 0POST (p = 0.008), while higher PQH-9 at 4POST predicted reduced intentional exercise (p = 0.038).ImplicationsHurricane Helene increased psychological distress in a rural Appalachian population. While incidental PA increased immediately post-Helene in non-evacuated individuals, it may have exposed them to ongoing stressors. Evacuation status influenced mental health outcomes, suggesting non-evacuated individuals may face greater psychological risks. Recovery efforts in Appalachian communities should prioritize mental health support, promote exercise behaviors, and ensure infrastructure for safe evacuation.

Abstract In August 1969, intense rainfall from the remnants of Hurricane Camille triggered &gt;150 debris flows in Fortune's Cove, a first‐order drainage basin in central Virginia. These debris flows reshaped the landscape by stripping colluvium and vegetation from hollows. Yet the roles of debris flows in ecological disturbance and topographic evolution remain incompletely understood. To address these gaps, we used a case study of three hollows in Fortune's Cove to determine the responses of woody plants and soils to debris flow disturbance, and the topographic signatures of debris flows in channel longitudinal profiles. Vegetation showed distinct composition and structure differences between sites disturbed by debris flows, whose overstory was dominated by sweet birch ( Betula lenta ) and tuliptree ( Liriodendron tulipifera ); and undisturbed reference sites dominated by tuliptree, sassafras ( Sassafras albidum ), and snags (all spp.). Soil regeneration varied widely: some disturbed sites showed predominantly exposed bedrock (&lt;2 cm depth) while others had soil profiles comparable to their undisturbed counterparts (20–50 cm depth); soils at undisturbed sites were all thick (&gt;20 cm depth). Topographic analysis indicated that for the same slopes, the transition between hillslope and fluvial erosion processes occurs at much lower drainage areas (10 3 –10 4 m 2 ) compared to more arid, less vegetated areas in the western U.S. (10 5 –10 6 m 2 ). This case study suggests that debris flows may cause persistent changes to soils, vegetation, and topography in the Appalachian region that can inform land management in the context of regional precipitation changes driven by climate change.

The Appalachian region faces persistent health disparities compared to other regions of Kentucky and the broader United States, making it essential to identify its local needs. Using survey data from the Extension statewide needs assessment collected in the fall of 2023 from 29,068 respondents, this study aimed to identify and compare the perceived health education needs of residents in the Appalachian and non-Appalachian regions of Kentucky with the overarching goal of gaining granular insights into their perceived health education priorities. Findings reveal that Appalachian residents report higher needs in health promotion, including food and nutrition, substance use recovery, housing, and disaster preparedness. In contrast, they express lower needs in climate and environmental topics and mixed interest in agriculture and food production. These findings are relevant to all entities addressing public health concerns and highlight the importance of incorporating localized input when identifying regional needs. This ensures interventions are relevant, enhancing the effectiveness of future public health practice and Extension programming.

Background Early-onset colorectal cancer (EOCC) is an escalating clinical challenge. While national incidence is rising, aggregated data may obscure critical differences in mortality trends and geographic burden that are essential for clinical risk assessment. Methods We utilized the Global Burden of Disease (GBD) 2021 study to analyze incidence, mortality, and disability-adjusted life years (DALYs) for colorectal cancer in US adults aged <50 years. Data were stratified by fine 5-year age groups and US state from 1990 to 2021. Results Nationally, incidence rates increased consistently across all cohorts aged 25 to 49 years from 1990 through 2021. In contrast, mortality and DALY rates exhibited a U-shaped trajectory for the 30 to 49 age strata: declining until the mid-2000s, followed by a persistent resurgence through 2021. This mortality reversal was most pronounced in the Southern Census regions. In 2021, the burden was disproportionately concentrated in East South Central and West South Central states, with Mississippi, Kentucky, and West Virginia exhibiting mortality rates up to twofold higher than states in New England or the Pacific West. Conclusion The decoupling of incidence and mortality trends suggests that therapeutic advances are no longer sufficient to offset the accelerating incidence of EOCC in the 30 to 49 age demographic. The distinct geographic clustering of advanced disease burden warrants heightened diagnostic vigilance for symptomatic young adults, particularly in high-prevalence Southern and Appalachian regions.

Societal Impact Statement American ginseng is a shade‐obligate, North American medicinal plant that is widely traded and used internationally. To meet global demand, ginseng is cultivated in forest farms in the Appalachian region of the USA and field‐based artificial shade farms in two regions: Ontario, Canada, and Wisconsin, USA. We conducted social research leveraging in‐depth interviews with growers to inform wild population genetics and future crop development efforts by examining how ginseng genetic materials are sourced, selected, and distributed in forest‐based and artificial shade farming systems. We identified patterns in grower practice that inform global conservation efforts in ginseng and other medicinal plants. Summary Understanding the population genetics of threatened medicinal plant species is essential to building effective conservation management strategies that promote sustainable plant use for human health and wellbeing. Yet molecular approaches on their own do not incorporate human perspectives and behaviors, including trading planting stock and intensive cultivation, that may influence genetic population structure. Research continues to assess genetic and phenotypic variation in cultivated and wild ginseng plants; however, the practices associated with ginseng planting have mostly been overlooked. In this study, we incorporated the knowledge of ginseng growers by conducting key informant interviews with artificial shade and forest growers in the U.S.A. and Canada (N = 34) and analyzed these data using Grounded Theory methods. Results from these interviews highlight the importance of artificial shade farms in Wisconsin and Ontario as likely sources of genetic and phenotypic variation in forest‐cultivated and wild‐occurring ginseng populations. Plant selection and seed saving practices were mostly unconscious decisions, and evidence of deliberate selection of genetic materials for specific traits was largely absent. Growers reported that lack of access to local seed sources is an important driver of planting stock movement from artificial shade farms to forest farms that can be used to establish “wild” forest populations. Artificial shade farms were found to produce large seed surpluses, while forest farms reported difficulties obtaining planting stock, leading to heavy reliance on importing non‐local cultivated planting materials. These results highlight the importance of involving growers in future efforts involving planting stock conservation and seed banking for sustainable medicinal plant use.

The opioid crisis has severely impacted Ohio, with overdose death rates surpassing national averages and disproportionately affecting rural and Appalachian regions. Accurately predicting county-level opioid overdose (OD) deaths is critical for timely intervention but remains challenging due to the wide differences in opioid OD deaths between large and small counties. We propose a Spatial-Temporal Graph Neural Network (ST-GNN) framework that integrates graph neural networks (GNNs) to capture spatial relationships between counties and Long Short-Term Memory (LSTM) networks to model temporal dynamics. Using quarterly OD death data from Q1 2017 to Q2 2023 for 88 Ohio counties, we incorporate a nine-dimensional dynamic feature set, including naloxone administration events and high-risk opioid prescribing, along with a static Social Determinants of Health (SDoH) index. Compared to traditional statistical models and temporal deep learning baselines, our ST-GNN demonstrates superior performance, particularly in larger counties, while a classification-based strategy improves predictions for small counties, leading to more stable and reliable results. Our findings emphasize the need for spatial-temporal modeling and customized training to enhance public health decision-making in addressing the opioid crisis.

This article reports on a summer 2024 study of public colleges and universities located in the Appalachian region of the United States and the digital collections they make accessible in the Digital Public Library of America (DPLA). Using data retrieved with the DPLA’s API, the study analyzes Language and Subject metadata to shed light on the primary themes of these collections and to evaluate whether the metadata supports negative stereotypes of the region. Format metadata are also examined at a high level to contextualize the types of materials contributing to descriptive patterns. The findings reveal that, of the institutions eligible for inclusion in the study, only 44% made their digital collections accessible on the DPLA site, with the Northern and South Central subregions serving as the highest contributors. An analysis of Subject metadata highlighted diverse representations, from labor history and rural life to civil rights and institutional history. The study’s findings suggest that, while Appalachian culture is present in the metadata, it is not framed in ways that align with negative stereotypes. Notably, 4% of items were associated with languages other than English, and only 3% of items referenced “Appalachia” in the Subject metadata. The findings also reveal the need for more inclusive terminology to represent the region.