Appalachia Research Articles

“When people who use drugs can’t differentiate between medical care and cops, it’s a problem.” Compounding risks of law Enforcement Harassment & Punitive Healthcare Policies

BackgroundCommunity-based harm reduction programming is widely recognized as an effective strategy for reducing the increased risks for and spread of HIV, HCV, and for reducing the growing rate of overdose deaths among people who use drugs (PWUD). PWUD in the United States (US) are a highly justice-involved population, also at increased risk for law enforcement interaction, arrest, and incarceration. These risks compound and interact in the context of criminalization and law enforcement surveillance. Justice involvement increases risks for overdose and for riskier injecting behavior among PWUD, in turn increasing HCV and HIV risks. In Central and Southern Appalachia specifically, PWUD have identified fear of law enforcement harassment and arrest as a barrier to engaging in harm reduction behavior, and a deterrent to seeking help at the scene of an overdose. Moreover, stigmatizing and punitive treatment in healthcare settings can deter PWUD from seeking care, with life or death consequences. This evaluation research study assessing the successes and impacts of a grant-funded project to increase access to safer drug consumption supplies and overdose prevention education for PWUD, including justice-involved participants of a syringe access program (SAP), in public housing and beyond in a South-Central Appalachian setting used key informant and opportunistic sampling. Mixed-methods data were compiled and collected including secondary program data; primary interview and participant-observation data.ResultsThe evaluation research identified that grant deliverables were largely achieved, despite challenges presented by the COVID-19 pandemic. In addition, SAP participants and staff reported larger themes surrounding grant-funded activities, in which they perceived that widespread local law enforcement harassment of PWUD increased participants’ risks for overdose death and infectious disease risks and that punitive local healthcare settings and policies acted as deterrents to care-seeking for many PWUD.ConclusionsOverall, the evaluation research found that participants’ experiences with and perceptions of local law enforcement harassment combined with their understandings and experiences of local punitive healthcare settings and policies; together compounding and increasing overdose risks and negative health consequences for local justice-involved PWUD.

Geomorphic Response to the Removal of the Ward’s Mill Dam on the Watauga River, North Carolina

Though economic situations of individual dams vary, current dam removal studies largely indicate that ecological benefits of river re-connectivity may outweigh the costs of maintaining aging infrastructure. However, there is a lack of comprehensive studies in certain regions of the United States, including Southern Appalachia. We used the removal of the 6 m high Ward’s Mill Dam on the Watauga River in North Carolina to conduct a before-after/control-impact study to monitor geomorphic impacts to such removals in this understudied region with the objective of identifying changes in channel form, analyzing bed sediment characteristics, and quantifying rates of volumetric evacuation and deposition. To capture geomorphic change repeated pre- and post-removal cross- sectional surveys, longitudinal profiles, and in-situ particle size sampling was conducted in upstream and downstream reaches. Field collections the day after removal show significant deposition of gravel sized particles immediately downstream of the dam (≤200 m). Channel bed texture remains significantly finer across the 2 km downstream study reach 506 days following removal. Erosion rates of the impoundment during the deconstruction period were on average ~860 m3/day and decreased to 75.5 m3/day by day 74. Below average mean daily flows during this period were able to exhume ~62.9 percent of impounded sediment.

Variations in antibiotic prescribing among children enrolled in North Carolina Medicaid, 2013-2019.

The majority of pediatric antibiotic prescribing occurs in the outpatient setting and inappropriate use contributes to antimicrobial resistance. There are regional variations in outpatient antibiotic use with the highest rates occurring in the Southern states, including in Appalachia. The purpose of this study was to describe the rates and risk factors for inappropriate antibiotic prescription among pediatric patients enrolled in North Carolina (NC) Medicaid. We used Medicaid prescription claims data from 2013 to 2019 to describe patterns of pediatric antibiotic prescription in NC. We assessed patient and provider factors to identify variations in prescribing. Children who were less than 2 years of age, non-Hispanic White, and living in a rural area had the highest overall rates of antibiotic prescription. Compared to pediatricians, the risk of inappropriate antibiotic prescription was highest among other specialists and general practioners and lowest among nurse practitioners. Rural areas of NC had the highest rates of inappropriate antibiotic prescribing, and the risk for non-Hispanic Black children compared to children of other races/ethnicities was compounded by rurality. Prescribing practices in NC differ compared to neighboring states with a lower overall risk of inappropriate prescription in Appalachian regions; however, disparities by race and rurality exist. Outpatient stewardship efforts in NC should focus on ensuring health equity by appreciating racial and geographic variations in prescribing patterns and providing education to all health care providers.

What is in a [poverty] label? The effect of regional poverty labeling in the Appalachian region of the U.S. and self-employment

Extending the growing amount of literature on poverty and entrepreneurship, we draw on stereotype threat theory to test whether labels of regional poverty categories, controlling for regional GDP, influence engagement in self-employment. In using the county designations of at-risk, attainment, competitive, distress, or transitional provided by the Appalachian Regional Commission, the County Business Patterns, Business Dynamics Statistics, and Startup Cartography Project, we find no significant differences in regional entrepreneurial activity among labels. However, in the individual-level analysis using CPS-ASEC two-wave longitudinal data, the findings show that those residing in counties labeled as at-risk counties, relative to attainment counties, had lower odds of being self-employed. These findings at regional and individual levels show stereotype threat may not aggregate to the regional level, but may manifest at the individual level. The findings have implications for stereotype threat based on government-identified regional labels of relative economic standing.

A Scoping Review on the Epidemiology of Orthobunyaviruses in Canada, in the Context of Human, Wildlife, and Domestic Animal Host Species.

Background: Mosquito-borne orthobunyaviruses in Canada are a growing public health concern. Orthobunyaviral diseases are commonly underdiagnosed and in Canada, likely underreported as surveillance is passive. No vaccines or specific treatments exist for these disease agents. Further, climate change is facilitating habitat expansion for relevant reservoirs and vectors, and it is likely that the majority of the Canadian population is susceptible to these viruses. Methods: A scoping review was conducted to describe the current state of knowledge on orthobunyavirus epidemiology in Canada. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guideline was used. Literature searches were conducted in six databases and in gray literature. The epidemiology of orthobunyaviruses was characterized for studies focusing on host species, including spatiotemporal patterns, risk factors, and climate change impact. Results: A total of 172 relevant studies were identified from 1734 citations from which 95 addressed host species, including humans, wildlife, and domestic animals including livestock. The orthobunyaviruses-Cache Valley virus (CVV), Jamestown Canyon virus (JCV), Snowshoe Hare virus (SHV), and La Crosse virus (LACV)-were identified, and prevalence was widespread across vertebrate species. CVV, JCV, and SHV were detected across Canada and the United States. LACV was reported only in the United States, predominantly the Mid-Atlantic and Appalachian regions. Disease varied by orthobunyavirus and was associated with age, environment, preexisting compromised immune systems, or livestock breeding schedule. Conclusion: Knowledge gaps included seroprevalence data in Canada, risk factor analyses, particularly for livestock, and disease projections in the context of climate change. Additional surveillance and mitigation strategies, especially accounting for climate change, are needed to guide future public health efforts to prevent orthobunyavirus exposure and disease.

Lige of the Black Walnut Tree: Growing Up Black in Southern Appalachia

Lige of the Black Walnut Tree: Growing Up Black in Southern Appalachia

Development of an Algorithm to Evaluate the Performance and Economic Feasibility of Expansion of Solar and Wind Power Generation in the Appalachian Region

Development of an Algorithm to Evaluate the Performance and Economic Feasibility of Expansion of Solar and Wind Power Generation in the Appalachian Region

Loneliness and Alcohol use among College Students During the COVID-19 Pandemic in Rural Appalachia

Objective Binge drinking and heavy alcohol use are highly prevalent among college students. During the COVID-19 pandemic, due to lockdown restrictions and other challenges, many college students were burdened with loneliness, which can contribute to chronic stress, and substance use. The current study explores the association between loneliness and various levels of alcohol use among college students in the rural, underserved region of Central Appalachia, USA. Methods Data were collected from a regional sample (n = 320) of college age adults, age 18-25 in the Central Appalachian region. The UCLA-3 item Loneliness Scale (UCLA-3) was used in the study to evaluate loneliness. Logistic regression analysis was conducted to assess the association between levels of loneliness and three separate outcomes, including past year binge drinking, past year heavy alcohol use, and past year weekly alcohol use. Results Overall, 25.5% of the participants reported severe loneliness, 33.6% reported moderate, and 40.9% reported low levels of loneliness. Results of the adjusted models revealed that severe loneliness was associated with higher odds of heavy alcohol use (AOR = 1.89, 95% CI [1.02, 3.50]) and binge drinking (AOR = 2.96, 95% CI [1.16, 7.51]), and not associated with weekly alcohol use. Conclusion The study found that higher levels of loneliness were linked to both binged drinking and heavy alcohol use. Further efforts for counseling and treatment among college students who are burdened with severe loneliness should be considered. The chronic stress associated with severe loneliness needs to be further addressed, particularly among emerging adults.

Predicting time-to-harvest in mixed-species forests using a random survival forest algorithm

Survival analysis is composed of a group of analytical approaches that can be used to predict the occurrence of harvest activities, which provides insightful information about the dynamics of natural resources utilization in a region. Recently, random survival forest (RSF) has been proposed in survival analysis to capture the complex relationships among variables. The main objective of this study was to employ the RSF algorithm to examine the temporal evolution of tree harvest, accounting for stand and environmental variables. Specifically, the predictability of the RSF model was compared with the Cox proportional hazard (Cox) model, a popular model in survival analysis. Important variables in explaining the variation of harvest time were identified. Data collected by the USDA Forest Service, Forest Inventory and Analysis (FIA) program from permanent plots in the southern Appalachian region were utilized in the analysis. Results showed that the RSF model consistently outperformed the Cox model based on prediction accuracy. Among 14 variables examined, ownership, forest type, elevation, state, and slope emerged as most important. Utilizing only these five variables in a reduced model produced satisfactory prediction accuracy compared to the full model (i.e., the models with all variables included). The findings of this work provide insights for forest managers and policy makers to utilize survival analysis methods in understanding harvest activities at the regional scale.

Feasibility and efficacy of a novel audiovisual tool to increase colorectal cancer screening among rural Appalachian Kentucky adults.

Residents of Appalachian regions in Kentucky experience increased colorectal cancer (CRC) incidence and mortality. While population-based screening methods, such as fecal immunochemical tests (FITs), can reduce many screening barriers, written instructions to complete FIT can be challenging for some individuals. We developed a novel audiovisual tool ("talking card") to educate and motivate accurate FIT completion and assessed its feasibility, acceptability, and efficacy. We collected data on the talking card via: (1) cross-sectional surveys exploring perceptions of images, messaging, and perceived utility; (2) follow-up focus groups centered on feasibility and acceptability; and (3) efficacy testing in community-based FIT distribution events, where we assessed FIT completion rate, number of positive vs. negative screens, demographic characteristics of participants, and primary drivers of FIT completion. Across the three study phases, 692 individuals participated. Survey respondents positively identified with the card's sounds and images, found it highly acceptable, and reported high-to-very high self-efficacy and response efficacy for completing FIT, with nearly half noting greater likelihood to complete screening after using the tool. Focus group participants confirmed the acceptability of the individuals featured on the card. Nearly 75% of participants provided a FIT accurately completed it, with most indicating the talking card, either alone or combined with another strategy, helped with completion. To reduce CRC screening disparities among Appalachian Kentuckians, population-based screening using contextually relevant implementation strategies must be used alongside clinic-based education. The talking card represents a novel and promising strategy to promote screening uptake in both clinical and community settings.

Limited phylogeographic structure in a flightless, Appalachian chalcidoid wasp, Dipara trilineata (Yoshimoto) (Hymenoptera, Diparidae), with reassessment of the male of the species

Dipara trilineata (Diparidae) is a widespread eastern North American parasitoid with apterous females and winged males. Despite its seemingly limited dispersal capabilities, phylogeographic analysis over southern Appalachia reveals little structure, with only limited population level isolation. DNA barcoding surveys also definitively associate the male of the species, which had previously been misattributed, and a description of the correctly associated male is provided.

Developing evolutionary anthropology in local ecosystems.

The traditional regional focus of evolutionary anthropology-typically defined as places where hominin fossils, nonhuman primates, and non-western populations reside-forms the basis of much evolutionary anthropological research. Using the highly biodiverse temperate region of Appalachia as an example, we suggest that evolutionary anthropologists have much to gain by stepping outside of this traditional geographic area. Being purposely provocative, we argue that evolutionary anthropologists might also benefit from conducting research in Appalachia and other temperate ecosystems. We briefly discuss multiple areas of study-including studies of seed dispersal, functional redundancy, convergent evolution, human behavioral ecology, and conservation-and how they can be considered within the purview of integrative and evolutionary anthropology. We also highlight broader impacts to higher education that evolutionary anthropologists can help promote by working in local ecosystems.

How Veeries vary: Whole genome sequencing resolves genetic structure in a long-distance migratory bird

Abstract In high-latitude species with high dispersal ability, such as long-distance migratory birds, populations are often assumed to exhibit little genetic structure due to high gene flow or recent postglacial expansion. We sequenced over 120 low-coverage whole genomes from across the breeding range of a long-distance migratory bird, the Veery (Catharus fuscescens), revealing strong evidence for isolation by distance. Additionally, we found distinct genetic structure between boreal, western montane U.S., and southern Appalachian sampling regions. We suggest that population genetic structure in this highly migratory species is detectable with the high resolution afforded by whole-genomic data because, similar to many migratory birds, the Veery exhibits high breeding-site fidelity, which likely limits gene flow. Resolution of isolation by distance across the breeding range was sufficient to assign likely breeding origins of individuals sampled in this species’ poorly understood South American nonbreeding range, demonstrating the potential to assess migratory connectivity in this species using genomic data. As the Veery’s breeding range extends across both historically glaciated and unglaciated regions in North America, we also evaluated whether contemporary patterns of structure and genetic diversity are consistent with historical population isolation in glacial refugia. We found that patterns of genetic diversity did not support southern montane regions (southern Appalachians or western U.S. mountains) as glacial refugia. Overall, our findings suggest that isolation by distance yields subtle associations between genetic structure and geography across the breeding range of this highly vagile species even in the absence of obvious historical vicariance or contemporary barriers to dispersal.

Geographic and temporal trends in pediatric and young adult brain tumors in Kentucky, 1995–2019

IntroductionPediatric and young adult brain tumors (PYBT) account for a large share of cancer-related morbidity and mortality among children in the United States, but their etiology is not well understood. Previous research suggests the Appalachian region of Kentucky has high rates of PYBT. This study explored PYBT incidence over 25 years in Kentucky to identify geographic and temporal trends and generate hypotheses for future research. MethodsThe Kentucky Cancer Registry contributed data on all PYBT diagnosed among those aged 0–29 during years 1995–2019. Age- and sex-adjusted spatio-temporal scan statistics—one for each type of PYBT, and one for all types—comprised the primary analysis. These results were mapped along with environmental and occupational data. ResultsFindings indicated that north-central Kentucky and the Appalachian region experienced higher rates of some PYBT. High rates of astrocytomas were clustered in a north-south strip of central Kentucky toward the end of the study period, while high rates of other specified types of intracranial and intraspinal neoplasms were significantly clustered in eastern Kentucky. The area where these clusters overlapped, in north-central Kentucky, had significantly higher rates of PYBT generally. DiscussionThis study demonstrates north-central Kentucky and the Appalachian region experienced higher PYBT risk than the rest of the state. These regions are home to some of Kentucky’s signature industries, which should be examined in further research. Future population-based and individual-level studies of genetic factors are needed to explore how the occupations of parents, as well as prenatal and childhood exposures to pesticides and air pollutants, impact PYBT incidence.

Rise in Neonatal Abstinence Syndrome Rate Is Associated with Increase in Buprenorphine Prescription Numbers.

Southern Appalachia is a region of the United States that is disproportionately affected by the opioid epidemic and by increasing rates of neonatal abstinence syndrome (NAS). NAS rates increased approximately 400% between 1999 and 2012. Buprenorphine prescriptions written to treat opioid use disorder also increased dramatically. The present study was undertaken to ascertain any relationship between the number of buprenorphine prescriptions compared with NAS rates in southern Appalachia. A total of 250 southern Appalachian counties across seven states, including all of West Virginia and portions of Virginia, Kentucky, Maryland, North Carolina, Ohio, and Tennessee were identified. A retrospective cohort analysis of these counties was conducted for the years 2005-2018. All of the data were obtained from publicly accessible sources or direct communication with government offices. Measures from each county in southern Appalachia included annual NAS rates, buprenorphine prescription rates, drug-induced death rates, and opioid prescribing rates. Associations among these variables were examined using a generalized linear regression. Significant linear associations exist between the rising rate of NAS diagnoses and the rising rate of buprenorphine prescriptions (r = 0.977, R2 = 95.53%, P < 0.001) and between the rising rate of buprenorphine prescriptions and the increase in drug-induced deaths (r = 0.712, R2 = 50.82%, P = 0.031). This is the first report that documents an association between rising NAS rates and increasing buprenorphine prescribing. Between the years 2010 and 2018, the NAS rate in southern Appalachia rose by 335%, and the number of buprenorphine prescriptions rose by 413%. Discussions regarding the current policies for buprenorphine management during pregnancy are warranted. We suggest a reevaluation of buprenorphine prescribing recommendations during pregnancy and further research on establishing the lowest effective buprenorphine dose for each pregnant patient.

Geographic variation of prevalence of Alzheimer’s Disease and related dementias in the Central Appalachian region of the United States

AbstractBackgroundAreas within the Appalachian region may have a greater burden of under diagnosed Alzheimer’s disease and related dementias (ADRD). As rural areas have lower reported ADRD prevalence compared to urban areas in spite of lower educational attainment (which should lead to higher ADRD prevalence) this argues that the true burden of ADRD is likely underestimated in areas without adequate detection resources. There is need to understand if ADRD prevalence is truly lower in rural areas, or if this is a disease detection difference. The objective of this proposal is to assess the burden of ADRD in Central Appalachia.MethodsCenters for Medicare and Medicaid Services Public Use Files from 2015‐2018 were used to estimate county‐level ADRD prevalence among all fee‐for‐service beneficiaries in Central Appalachia (Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia). Negative binomial regression was used to estimate prevalence overall, by Appalachian Regional Commission’s Appalachian/non‐Appalachian designation, and by rural/urban (Rural‐Urban Continuum Codes) classification. Models were then adjusted for county‐level demographics including age, gender, Medicaid eligibility, and comorbidities (atrial fibrillation, chronic kidney disease, depression, diabetes, heart failure, hyperlipidemia, hypertension, ischemic heart disease, schizophrenia/other psychotic disorders, and stroke).ResultsThe prevalence of ADRD did not vary over the time period but was higher for Appalachian counties both overall (12.0% vs. 11.6%; p = 0.001; Figure 1) and among both urban (p&lt;0.001) and rural counties (p = 0.024; Figure 2). Urban Appalachian counties had 2‐4% higher prevalence compared to urban non‐Appalachian counties with this difference reaching statistical significance in 2017 and 2018. While a similar trend was observed in rural counties (Appalachian counties having 1‐3% higher prevalence), these yearly ratios did not reach statistical significance. After adjustment, the associations attenuated in urban counties, but over the entire study period, rural Appalachian counties had 2.2% higher prevalence than rural non‐Appalachian counties (Figure 3).ConclusionThere is a consistent difference between Appalachian and non‐Appalachian counties, demonstrated overall and by rural status, with Appalachian counties having ADRD prevalence in the range of 1.0‐4.5% higher than non‐Appalachian counties. However, while county‐level demographics and comorbidities explained the difference in urban counties, the elevated prevalence in rural‐Appalachian counties persisted.

Mystery of the Talking Skull: Family Secrets in Southern Appalachia

Abstract: When an out-of-town merchandiser goes missing in 1930s rural Southern Appalachia, whiskey and foul play are suspected. The small town of Woodbury, Tennessee, soon forgets and moves on, until the man's skeletal remains are uncovered three years later by two boys digging for mayapple root. Two men are immediately charged with the murder, though only one would be convicted. The trial would attract newspapers from across the state and beyond through the end of the decade. The story was lost to time and largely unknown to the descendants of those involved. The tale might have stayed buried in the past if not for a pulp fiction magazine that made its way back to the family some seventy years later.

Risk Factors for Pediatric Facial Trauma in an Appalachian Region: An Epidemiological Review at a Single Institution

Rural and low-income pediatric populations are at higher risk for trauma. Craniomaxillofacial (CMF) trauma in this population has not been studied. This study's purpose was to determine if rural populations or low-income populations are at higher risk for pediatric CMF trauma than urban or high-income populations, respectively, and to determine differences in mechanism of injury (MOI). A retrospective cohort study of CMF trauma patients younger than 17 years-old, living in the region served by one institution in Tennessee, and requiring oral and maxillofacial surgery consultation between January 2011 and December 2022 was performed. Exclusion criteria were incomplete medical records. The primary predictor variable was geographic residence of the patient grouped into two categories: rural or urban defined by the state of Tennessee. Secondary variables were postal code (PC) average median household income (MHI) and PC population density. The main outcome variable was pediatric CMF injury rate per 100,000 people. MOI is a secondary outcome variable. Covariates included sex, age, and race. Frequencies and percentages, Fisher's exact test, and Poisson regression models were utilized. Statistical significance was assumed at P-value <.05. Rural or urban county designation was not associated with differing trauma rates (incident risk ratio (IRR)=0.91; 95% confidence interval (CI) 0.78 to 1.05; P=.18) by itself. One standard deviation increase in MHI decreased CMF trauma rates in rural designation counties by 24% (IRR: 0.76, 95% CI: 0.66, 0.88) and 6% in urban designation counties (IRR: 0.94, 95% CI: 0.87, 1.02). Lower rates of CMF trauma were associated with residence in higher income PCs (IRR=0.91; 95% (CI) 0.86 to 0.97; P=.004), and higher population density (IRR=0.87; 95% CI 0.79 to 0.94; P<.001). Dog bites and falls were more common in infancy and early childhood. Interpersonal violence was more common in older patients. Patients in PCs with lower population density or incomes were at highest risk for CMF injuries. MOI differences by age were similar to findings in other studies. Tennessee's urban/rural county designation has complex interactions with MHI and pediatric CMF trauma rates.

Abstract B016: Associations between geographic residence, social support and resilience among Kentucky cancer survivors

Abstract Background: Rural and Appalachian cancer survivors have higher rates of invasive stage of disease, increased challenges in accessing health care services, and report poorer health outcomes and greater psychological distress compared to urban cancer survivors. Factors such as resilience-the ability of patients to bounce back after the trauma of a diagnosis- may be an important predictor of well-being, overall cancer experience, and treatment outcomes. In this exploratory study we assess whether residing in urban or rural geographic areas at diagnosis predicts level of self-perceived resilience and correlate relationships with mental and emotional health and social support. Methods: LADDER ‘Life After Diagnosis and Descriptors of Experience and Responses’ (LADDER) Study is an online pilot survey to evaluate experiences of Kentucky adult cancer survivors within the first year of diagnosis. Self-perceived resilience was measured by the 10-item Connor-Davidson Resilience Scale; higher scores indicate better resilience (range 0-40). Multivariable logistic regression was used to estimate Odds Ratios (OR) and 95% Confidence Intervals (CI) for likelihood of low resilience, dichotomized at median score. Spearman Rank Correlation Coefficients (ρ) measured the strength and direction of associations between continuous measures of anxiety, depression, social support, and resilience. Results: Among 46 participants, most were female aged 65 and older, living in non-Appalachian KY with 33% reporting a history of breast cancer. Rural cancer survivors scored 4 points lower in resilience on average than urban cancer survivors. In multivariable models, compared to urban KY survivors, rural KY survivors had a 2-fold higher likelihood of self-perceived low resilience (OR=2.70:95% 0.58-12.5)). Adjusting for age, sex, Appalachian region, and employment partially attenuated the difference in resilience scores; however, estimates were not significant (OR=2.20: 95% 0.24-20.7). Social support, anxiety, and depression were moderately correlated with resilience among both urban (ρ= 0.36 to 0.64) and rural cancer survivors (ρ range: 0.21 to 0.54) Conclusion: The first year after a cancer diagnosis marks the transition into survivorship with major emotional adjustments. Additional recruitment of survivors will allow examination of diverse experiences post-diagnosis which may lead to interventions to improve quality of life in cancer survivors. Citation Format: Hoa Nguyen, Stephie Abraham, Kathy Baumgartner, Richard Baumgartner, Stephanie Boone. Associations between geographic residence, social support and resilience among Kentucky cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B016.

The importance of family relationships for the health of underserved Appalachians: An application and extension of the biobehavioral family model.

Appalachia is characterized by many contextual stressors, including geographic, economic, and cultural barriers to healthcare. Guided by the biobehavioral family model (BBFM), an understanding of the influence of interpersonal relationships (i.e., marital and nonmarital relationships) on health outcomes could be critical to mitigating the region's contextual stressors. Data were collected from 2018 to 2019 among 243 participants across seven pop-up medical clinics in central and southern Appalachia 59% from rural Appalachian counties (rural Mage = 41, 66% women, 90% White; urban Mage = 36, 74% women, 82% White). A series of multivariate regression models were conducted for outcome measures (i.e., depression, pain, physical symptoms, number of conditions, and perceived health). The results suggest that family quality was significantly related to all outcome measures except for perceived health, whereas marital satisfaction was only significantly linked to physical symptoms. Rurality was not significantly associated with any outcome measures and only moderated the association between family quality and a number of conditions. These findings demonstrate the importance of nonmarital family relationships on health outcomes for people in Appalachia. Given the limited direct impact rurality in this sample, close relationships may be important for the health and well-being of all economically marginalized Appalachians regarding where they live. Given the cultural tendency for Appalachians to rely on family and kinship networks for healthcare support and the findings in this study, medical professionals should develop innovative programs to incorporate family into healthcare visits, and disease management interventions for people living in Appalachia. (PsycInfo Database Record (c) 2024 APA, all rights reserved).