Perceptions and Expectations of School-Based Professionals Surrounding School-Based Mindfulness Training in Appalachia During the COVID-19 Pandemic: A Qualitative Study.

Background: School-based professionals often report high burnout, particularly in geographic areas like Appalachia, where school-aged children are exposed to high levels of adverse childhood experiences, which may be exacerbated by the COVID-19 pandemic. While school-based mindfulness trainings can reduce burnout, their efficacy is influenced by the expectations of intervention personnel ahead of implementation. The present study assessed expectations and perceptions of a school-based mindfulness training among school personnel in 21 Appalachian schools during the COVID-19 pandemic. Methods: Upon enrollment in the training, staff (N = 191) responded to open ended survey questions regarding perceived impacts of COVID-19 on students, expected benefits and barriers to school-based mindfulness, and perceived community acceptance of mindfulness. Results: School personnel identified social isolation and lack of structure as negative impacts of COVID-19 on students. Expected benefits of classroom mindfulness included improved coping skills, focus, and emotion regulation, whereas barriers included lack of time and student ability level (e.g., age, attention). While most respondents indicated that their community was accepting of mindfulness practices, some noted resistance to and misperceptions of mindfulness, which may illustrate the influence of local cultural norms and values on the acceptability of mental health interventions. Conclusions: Overall, these findings suggest positive expectations and relative perceived support for mindfulness practices within these Appalachian communities, including in response to negative impacts of the COVID-19 pandemic on students. Adapting practices and language to accommodate barriers such as time, student ability, and cultural misconceptions of mindfulness may increase the feasibility and efficacy of these interventions.

Icelandic Prevention Model for Rural Youth: A Feasibility Study in Central Appalachia.

The purpose of this study was to assess the feasibility of implementing the Icelandic model for Primary Substance Use Prevention (IPM) in rural Central Appalachia. Guided by the IPM's theoretical framework, 26 stakeholders from a single county in West Virginia were purposefully recruited during the spring of 2019 and divided into four focus groups. Interviews were recorded and transcribed verbatim and analyzed into themes based on IPM premises. Focus group material produced seven themes: Drug use overall, Drug treatment and other service needs, Poverty, Parenting/Caregiver practices, Transportation, Downtime/Leisure time activities, and Opportunities for solutions. General support was found for the potential of the IPM in the region. Preferably, the implementation of the model should coincide with attention to the adult population as drug use was reported to be plaguing the whole community. Treatment options were few and mostly far away. General poverty and lack of public transportation further stifled progress and potential for change. Organized leisure time activities and programs for youth were scarce and mostly seasonal. Suggested solutions for the adult community included workforce and skill training, coupled with increased opportunities for organized leisure activities for youth, and access to healthy role models via schools and faith-based organizations. We conclude that implementation of the IPM would be feasible to prevent substance use initiation and progression among youth in the rural Central Appalachia. We present several specific recommendations for policy and practice that address factors unique to this environment to initiate the IPM implementation development and suggest initial model application strategies.

Assessment and Response to Intimate Partner Violence in Home Visitation: A Qualitative Needs Assessment With Home Visitors in a Statewide Program.

There is growing recognition that home visitation programs serving at-risk families may be an appropriate mechanism for detecting and reducing intimate partner violence (IPV). More research is needed about how home visitors assess and respond to IPV, especially in rural and underserved areas with unique social and geographic challenges. This study describes the qualitative, needs assessment phase of a larger mixed-methods evaluation of IPV assessment, referral processes, and safety planning with clients within a statewide home visitation program. Three focus groups were conducted with home visitors (n = 16) in West Virginia's Home Visitation Program in May 2015. Home visitors represented four separate home visitation models and provided services across 12 of West Virginia's 55 counties. Guiding questions focused on home visitors' current protocol, experiences, barriers, and facilitators to (a) screening and assessment for IPV, (b) making referrals after disclosures of IPV, and (c) developing safety plans with IPV-exposed clients. Barriers identified by home visitors included the nature of assessment tools, issues with service availability and access in rural areas, and lack of education and training surrounding safety planning. Facilitators included building relationships and trust with clients, providing anticipatory guidance when making referrals, and tailoring safety plans to clients' unique situations. Participants also expressed a critical need to develop procedures for assuring home visitor safety when supporting IPV-exposed clients. These qualitative data highlight issues surrounding the management of IPV in home visitation and have the potential to inform future enhancements to programs that are specifically tailored to the needs of rural, disadvantaged communities.

Adoption and Reach of a statewide policy, systems, and environment intervention to increase access to fresh fruits and vegetables in West Virginia.

Food deserts-areas with limited access to affordable, healthy foods-are disproportionately in low-income areas of the USA and have been linked with poorer nutrition behaviors and health outcomes. From a social ecological perspective, increasing access to affordable fresh fruits and vegetables in communities should encourage consumption and health improvements. Change the Future West Virginia, a statewide intervention, was undertaken to make policy, system, and environment (PSE) changes to enhance access to fresh fruits and vegetables in schools, farmers markets, and retail food outlets. Previous local scale PSE change interventions have shown feasibility and population reach, but broader dissemination has not been evaluated. Thus, the purpose was to evaluate the Adoption and Reach of Change the Future West Virginia statewide nutrition-based PSE strategies, especially in food deserts. Evaluation data were collected monthly using an online performance monitoring tool, including open-ended items to assess barriers and facilitators of PSE changes. Schools from 48 of 55 counties with 261,829 enrollment (54% low-income) implemented 231 PSE activities, resulting in 35 counties serving locally produced foods. Adoption included two thirds (n = 82) of all farmers markets in the state-signed collaboration agreements, adding electronic benefit transfer machines at 29. Retail food Adoption included signed agreements with 22.1% (n = 101) of all grocery stores and 14.1% (n = 162) of all convenience stores in the state reaching 110,258 people (21.5%) in 27 food desert census tracts. Personnel consistency, local connections, and in-person meetings were important for PSE changes, highlighting the importance of human resources in the rural public health system and the potential of these intervention activities in rural, low-income states.

Evaluation of an Intimate Partner Violence Training for Home Visitors Using the Theory of Planned Behavior.

INTRODUCTION: Intimate partner violence (IPV) is a public health issue with recent intervention focus by home visiting programs with at-risk families in the United States. Home visitors are typically required to assess IPV but feel unprepared to do so and desire training. Our aim was to evaluate the impact of a daylong IPV training on the intention to enact three key IPV behaviors (screening, making referrals, and safety planning) using the theory of planned behavior. METHOD: Survey of 125 home visitors in West Virginia was conducted before and after a daylong IPV training. RESULTS: The IPV training had a positive impact on intention to perform the three behaviors of interest, with the greatest impact on the intention to conduct IPV screenings. DISCUSSION: Results provide important preliminary evidence supporting the effectiveness of professional development as a means of increasing intentions to conduct activities related to IPV. The impact on IPV screening intention is promising because screening is the first step in addressing IPV. CONCLUSION: The IPV training proved beneficial in increasing intentions and such trainings should be expanded, but further study is needed to link intentions to subsequent behaviors to address IPV with at-risk families.

The Impact of Community Input in Community Health Needs Assessments.

OBJECTIVE: To determine the impact of community participation on nonprofit hospital priorities as outlined in a Community Health Needs Assessment. DESIGN: Using 3 completed Community Health Needs Assessments, we compare key stakeholder survey responses with community survey responses and determine their contribution to the finalized priorities. SETTING: Three communities in West Virginia served by nonprofit hospitals (1 metropolitan statistical area, 1 micropolitan statistical area, and 1 rural community). PARTICIPANTS: Key stakeholders and the general population of communities served by the hospital. MAIN OUTCOME MEASURE: Finalized priorities as outlined in the Community Health Needs Assessment. RESULTS: Community participation had an impact on finalized priorities. CONCLUSION: Community participation is key in identifying unique health needs and should be incorporated into the assessment process by nonprofit hospitals, local health departments, and other public health practitioners. As reforms are considered to the Patient Protection and Affordable Care Act, it will be important to emphasize the importance of community input in identifying ways nonprofit hospitals contribute community benefit. CHNAs without adequate public input may not translate into implementation plans that accurately address pressing health concerns.

Identifying the people and factors that influence children's intentions to make lifestyle changes.

Childhood obesity and health behavior programs are increasingly a focus within literature and individual provider practices. This study was designed to inform "best practices" for establishing effective programs in the medical setting by identifying persons and factors that influence children's willingness to be active, eat healthy, and lose weight when medically appropriate. A total of 342 child and parent dyads living in a rural setting participated in this study. Child and parent report of theory of planned behavior constructs and child intentions to lose weight, eat healthier, and increase own exercise was established as the study outcomes. Parent and child perceptions and child characteristics (e.g., weight status) were associated with children's intentions to lose weight and obtain more exercise whereas only child perceptions were associated with children's intentions to eat healthier. Incorporating children as young as 10 years of age in conversations and planning for diet and physical activity lifestyle changes is essential for the success of the treatment option.

Developing culturally tailored health belief-based intervention materials to improve child and parent participation in a cardiovascular screening program.

The Coronary Artery Risk Detection in Appalachian Communities Project was developed to reduce children's future cardiovascular risk by implementing a school-based screening program statewide. Despite the elimination of environmental barriers related to screening cost and accessibility, only half of eligible children participate in the program each year. The authors used the theory of planned behavior to identify health beliefs associated with screening participation. This article describes the process used to identify community health beliefs and the development of theoretically based materials to increase participation. Focus groups and individual interviews were conducted to identify core health beliefs held by parents, community leaders, and children (Phase I). Data obtained were used to expand and revise a Health Beliefs Questionnaire, which was distributed to larger samples (Phase II). This information was used to design recruitment materials that emphasized the benefits of screening while directly addressing potential belief-based barriers to screening participation (Phase III).

Preventive care in Appalachia: use of the theory of planned behavior to identify barriers to participation in cholesterol screenings among West Virginians.

CONTEXT: West Virginians are at increased risk for heart disease. Given that the process of atherosclerosis begins in childhood, the Coronary Artery Risk Detection in Appalachian Communities Project was developed to reduce this risk by implementing a cholesterol screening program in the schools. However, participation rates have been less than desired. PURPOSE: This study examined the barriers to participation in preventive health screenings, specifically cholesterol screenings, in adults and children of West Virginia using the theory of planned behavior to guide conceptualization. METHODS: A total of 14 community leaders, 36 parents, and 92 fifth-grade children from 6 West Virginia counties with predominately rural populations participated in individual and focus group interviews. Qualitative analysis was used to examine interview transcripts. FINDINGS: Adult and child attitudes about preventive care were the largest barrier to cholesterol screenings. Adult attitudinal barriers included concerns with outcomes of testing, lack of knowledge about cholesterol and heart disease, concerns about needles, and traditional Appalachian cultural beliefs (resistance to change, denial, and fatalism). Children cited concerns about needles, outcomes of testing, privacy, and lack of concern about health and cholesterol. Adults also acknowledged environmental barriers to screenings. Finally, children reported a lack of social pressure to participate in prevention activities. CONCLUSIONS: Attitudinal, social normative, and environmental barriers to health screenings may be characteristic of impoverished rural Appalachians. Interventions are being designed to target these belief barriers to improve participation in cholesterol screenings for fifth graders.

Blau syndrome mutation of CARD15/NOD2 in sporadic early onset granulomatous arthritis.

Patients with sporadic early-onset granulomatous arthritis are clinically identical to Blau syndrome, but without the family history. Blau syndrome is an autosomal dominant inherited disease and is known to be caused by mutations in the CARD15 gene (also called NOD2). We investigated the hypothesis that an individual with sporadic early onset granulomatous arthritis may have a Blau syndrome mutation in CARD15/NOD2. Our patient's genomic DNA isolated from a buccal swab sample was subjected to amplification to include the region of exon 4 from the CARD15/NOD2 gene that contains known mutations that cause Blau syndrome. This region was screened for mutations by direct DNA sequencing in both directions. One of the mutations in CARD15/NOD2 attributed to Blau syndrome was found in the DNA sample. The nucleotide change encodes an amino acid substitution from arginine to tryptophan at position 334 of the protein. This mutation has been found in some Blau syndrome pedigrees reported in the literature. These data suggest that sporadic granulomatous arthritis may in fact be the sporadic form of Blau syndrome, but arising from a spontaneous neomutation. This would explain the profound clinical identity and the lack of disease history in the parents.

A locus on chromosome 9p predisposes to a specific disease manifestation, acute anterior uveitis, in ankylosing spondylitis, a genetically complex, multisystem, inflammatory disease.

OBJECTIVE: Uveitis or intraocular inflammation is a major cause of visual loss. Acute anterior uveitis (AAU) affects approximately 40% of patients with ankylosing spondylitis (AS) but also affects patients with no evidence of spondylarthritis. We sought to determine whether a unique genetic region could be implicated in a specific manifestation-AAU-of a multisystem, inflammatory, genetically complex disease, AS. METHODS: Individuals from families multiplex for AAU were genotyped at 400 markers representing the ABI PRISM linkage map MD-10, and at the HLA-B, DRB1, DQA1, DQB1, and DPB1 alleles. Among the family members with AAU, 76 affected sibpairs were analyzed (6 without concomitant AS, 12 discordant for AS, and 58 concordant for AS). Two-point and multipoint nonparametric linkage analyses were performed, and 1-parameter allele-sharing model logarithm of odds (LOD) scores were determined. RESULTS: As previously reported for AS, linkage at the major histocompatibility complex region (chromosome 6p21) was evident, exhibiting the highest multipoint LOD score (4.96 at marker HLA-B). Strong linkage was seen at a region on chromosome 9p21-9p24, with a LOD score of 3.72 at marker D9S157. When compared with a companion cohort of AS families, the linkage at this region was found in association with AAU but not with AS. A third region on chromosome 1q23-1q31 was observed to have suggestive linkage (LOD 2.05 at marker D1S238), which overlaps with a region associated with AS. CONCLUSION: This is the first study in which a genetic region for AAU has been identified by genome-wide scan. Even though AS was highly prevalent in this cohort of families, a locus at chromosome 9p21-9p24 was identified that uniquely associates with AAU. Identifying the genetic perturbation at this region may advance our understanding of the mechanisms involved in tissue-specific pathology of complex inflammatory diseases.