Appalachian Caregiver Perspectives on Childhood Gun Safety in the Home

Background: Childhood gun injuries pose a critical public health challenge. For children, unintentional gun injury deaths primarily occur in the home where parents or other adult guardians, referred to as caregivers hereafter, are responsible for safety. While the American Academic of Pediatrics recommends not having guns in areas where children live and play, firearms are often viewed as normative and fill an important role in many homes. This is particularly true in more rural areas, such as Appalachia, where there is a high density of gun ownership. Additional research is needed to understand rural caregivers’ current gun safety practices in the home. Purpose: The purpose of this study was to gain an understanding of Appalachian caregivers’ gun safety practices, perspectives, and attitudes to assist public health professionals develop more effective interventions and targeted messaging. Methods: Ten Appalachian caregivers were interviewed for a qualitative, phenomenologic study designed to elicit an in-depth understanding of firearm safety strategies in the home. An inductive analytic approach to coding and analysis was used to identify main themes and ideas. Results: Current attitudes, practices, and perspectives focused on the primary childhood injury prevention strategies of education, environmental change, and supervision. Findings matched and expanded upon previous literature in the field. Implications: Cross-cutting themes were identified that have practical implications for the development of public health interventions and messaging for this at-risk population

Cancer Screening Behaviors and Associations with Childhood Trauma, Resiliency, and Patient–Provider Relationships: Findings from an Exploratory Study of Appalachian Cervical Cancer Survivors

Introduction: Adverse childhood experiences (ACEs) are associated with increased cancer risk. ACEs may affect this risk in a variety of ways, including cancer screening compliance. ACEs can contribute to mistrust in the medical profession, inhibit patient­–provider relationships and cause at-risk individuals to miss critical access points to preventive services. Protective factors may play an important role in mitigating ACE-related consequences by supporting resiliency. Purpose: This study assesses the associations between ACEs, protective factors, patient–provider relationships, stage of cancer at diagnosis, and cancer screening behaviors for West Virginia (WV) cervical cancer survivors. Methods: WV cervical cancer survivors diagnosed between 2000 and 2020 were mailed a survey which included questions on demographic information and cancer screening behaviors, alongside three scales to measure depth of patient–provider relationships, ACEs, and protective factors. Results: Ninety participants completed the survey. ACEs were associated with weaker patient–provider relationships (p \u3c .01) and fewer protective factors (p \u3c .01). More protective factors were associated with stronger patient–provider relationships (p \u3c .01), earlier stage of cancer at diagnosis (p \u3c .05) and positive cancer screening behaviors. Positive cancer screening behaviors were associated with deeper patient–provider relationships (p \u3c .05). A statistically significant model (p = .004) using ACE and resilience scores was able to account for 13% of the explained variability in depth of patient–provider relationships. Implications: These findings suggest an important interplay between ACEs, protective factors, and patient–provider relationships on cancer screening behaviors. Future studies should consider these variables in different populations. In addition, interventions focused on enhancing patient–provider relationships and supporting acquisition of protective factors should be considered

Advancing Cancer Prevention Practice Facilitation Work in Rural Primary Care During COVID-19

COVID-19 and the response to slow the virus spread in West Virginia (WV), including a statewide stay-at-home order, presented challenges to rural primary care clinics on the frontlines. These challenges affected critical quality improvement work, including cancer screening services. In this commentary, the authors present the results of a survey of WV primary care practices that highlight potential long-term implications and identifies opportunities for practice facilitators to partner with rural primary care clinics to address them

Leveraging Electronic Health Records Data for Enhanced Colorectal Cancer Screening Efforts

Introduction: Colorectal cancer is the third most common type of cancer in the United States for men and women combined. While the current threat of disease nationally is significant, the majority of colorectal cancer cases and deaths could be prevented through established screening tests and guidelines. Within the Appalachian region and West Virginia in particular, colorectal cancer is a significant public health problem. A more systematic, comprehensive approach to preventing and controlling cancer is essential. Methods: Through the West Virginia Program to Increase Colorectal Cancer Screening, primary care systems across the state received data-informed practice facilitation designed to increase screening rates. Results: Year-1 cohort health systems had an overall baseline screening rate of 28.4% during calendar year 2014. This rate increased and remained steady during the three follow-up measurement time periods, with a rate of 49.5% during calendar year 2018. This increase is notably greater than comparable health systems not part of the initiative. Implications: Lessons learned in increasing colorectal cancer screening rates are applicable to other priority health needs as well