Disparities in Quality of Life by Appalachian-Designation among Women with Breast Cancer

Introduction: Few studies have examined the association of geography and quality of life (QOL) among breast cancer patients, particularly differences between Appalachian and non-Appalachian Kentucky women, which is important given the cancer and socioeconomic disparities present in Appalachia. Purpose: The purpose of this study was to determine whether women with breast cancer residing in Appalachian Kentucky experience poorer health outcomes in regards to depression, stress, QOL, and spiritual wellbeing, relative to those living in non-Appalachian Kentucky after adjusting for demographic, socioeconomic, and health-related factors. Methods: Women, aged 18–79, recruited from the Kentucky Cancer Registry between 2009 and 2013 with an incident, primary breast cancer diagnosis completed a telephone interview within 12 months of diagnosis. In this cross-sectional study, sociodemographic characteristics and mental and physical health status were assessed, including number of comorbid conditions, symptoms of depression and stress, and QOL. Results: Among 1245 women with breast cancer, 334 lived in Appalachia and 911 in non-Appalachian counties of Kentucky. Appalachian breast cancer patients differed from non-Appalachian patients on race, education, income, health insurance status, rurality, smoking, and stage at diagnosis. In unadjusted analysis, Appalachian residence was associated with having significantly more comorbid conditions, more symptoms of stress in the past month, and lower Functional Assessment of Cancer Therapy-Breast scores compared to non-Appalachian residence. Implications: However, adjustment for sociodemographic and health-related differences by region appear to explain geographic differences in these poorer QOL indicators for women living in Appalachian Kentucky relative to non-Appalachian Kentucky. Policy-, provider-, and individual-level implications are discussed

Adverse Childhood Experience and Undergraduate Student Success: A longitudinal investigation into the relationship between childhood stress and success in higher education

Institutions of higher education have long worked to understand factors that influence or predict student success and degree completion. Childhood experiences including potential exposure to toxic stress have been found to impact student success in K-12 schools yet have rarely been evaluated among undergraduates. Therefore, the purpose of this study is to investigate the relationship between Adverse Childhood Experiences (ACEs) and undergraduate degree completion among a random sample of 1,894 students at a state-funded university in the US. Participants completed a web-based survey assessing ACEs in spring 2015. Results from the survey were linked to student academic records for each semester enrolled, spanning from 2008-2020. Chi-square tests and logistic regression models were used. A significant dose-response relationship between ACE score and degree completion was identified. Final analysis included the controls: gender, state residency, first-generation status, race, a composite variable of high school GPA and ACT, academic classification, first-year cumulative GPA, history of part-time enrollment, transfer status, and Greek affiliation. When evaluating the outcome of ever completing a bachelor’s degree, students with an ACE score of 2-3 were 74% more likely not to graduate when compared to students with an ACE score of zero. Further, students with an ACE score of four or higher were 91% more likely not to complete their degree. Four- and six-year graduation rates found similar trends. This study has implications for a variety of student support services. Future projects could partner with these groups to assess the effectiveness of resiliency programming in supporting student success