BACKGROUNDGiven the amount of time children and adolescents spend in school, these locations may be ideal for simultaneously supporting young people's health and academic achievement. School‐based health centers (SBHCs) not only bring care to students in accessible and familiar locations, these centers also provide guidance for young people during a life stage when they are establishing lifelong health behavior habits.METHODSThis article examines the literature exploring the impact of SBHCs from the perspective of multiple stakeholder groups including students, guardians, school personnel, community members, providers, hospital administrators, public health officials, and insurers.RESULTSStudies describe the positive effects of SBHCs on students' health and educational outcomes. SBHCs are generally associated with decreased health care disparities among students, accelerated treatment, and increased school attendance.CONCLUSIONSAdditional research exploring strategies for optimizing SBHC's economic efficiency and tailoring SBHC services to meet the needs of vulnerable patient populations is essential. Investigation into the impacts of SBHCs on community stakeholders outside of the student population is also vital.

Background Adult smoking prevalence in Central Appalachia is the highest in the United States, yet few epidemiologic studies describe the smoking behaviors of this population. Using a community-based approach, the Mountain Air Project (MAP) recruited the largest adult cohort from Central Appalachia, allowing us to examine prevalence and patterns of smoking behavior. Methods A cross-sectional epidemiologic study of 972 participants aged 21 years and older was undertaken 2015–2017, with a response rate of 82%. Prevalence ratios and 95% confidence intervals for current smoking (compared to nonsmokers) were computed for the entire cohort then stratified by multiple characteristics, including respiratory health. Adjusted prevalence ratios for current smoking versus not smoking were also computed. Results MAP participants reported current smoking prevalence (33%) more than double the national adult smoking prevalence. Current smoking among participants with a reported diagnosis of chronic obstructive pulmonary disease and emphysema was 51.5 and 53.3%, respectively. Compared to participants age 65 years and older, those age 45 years or younger reported double the prevalence of smoking (PR: 2.04, 95% CI: 1.51–2.74). Adjusted analyses identified younger age, lower education, unmet financial need, and depression to be significantly associated with current smoking. Conclusions Despite declining rates of smoking across the United States, smoking remains a persistent challenge in Central Appalachia, which continues to face marked disparities in education funding and tobacco control policies that have benefitted much of the rest of the nation. Compared with national data, our cohort demonstrated higher rates of smoking among younger populations and reported a greater intensity of cigarette use.

Appalachian Kentucky reports some of the highest rates of respiratory illness in the United States, including chronic obstructive pulmonary disease and asthma. While smoking rates are high in the region, unexplained variation remains, and community-engaged research approaches are warranted to identify contributing factors. The Mountain Air Project’s community advisory board recommended that investigators invite youth to provide their perspectives on possible contributing factors to respiratory illness, and we undertook an exploratory study to determine the utility of photovoice to elicit such perspectives with this population. While photovoice has been employed for other youth-focused health studies in Appalachia, to our knowledge, this work represents the region’s first environmental study using photovoice among youth. Over eight weeks, ten participants (age 12–18) represented their perspectives through photographs and accompanying narratives. A brief thematic content analysis of the youth narratives that accompanied the photos revealed three primary themes of environmental determinants of respiratory illness. These themes included compromises community members make regarding respiratory health in order to secure a livelihood; tension between cultural legacies and respiratory health; and consequences of geographic forces. This study demonstrates the value of incorporating youth perspectives in environmental health research, and that photovoice was a valuable approach to elicit such perspectives.

Poverty and poor health disproportionately affect older adults serving as primary caregivers to their grandchildren. In underserved, rural regions, where grandparent caregivers may be especially vulnerable, grandparent caregivers may find support in cultural traditions. As part of a mixed methods study investigating stress among grandparent caregivers, the role religion and spirituality play in coping was explored using a survey complemented by semi-structured interviews with 26 rural grandparent caregivers. Findings suggest religion and spirituality facilitate coping by (a) providing a sense of purpose and perspective; (b) fostering peace and perseverance; and (c) promoting stability and social cohesion. This study describes how cultural assets aid grandparent caregivers’ coping and may inform supportive policies and practices for grandfamilies.

Objective: Appalachian women continue to die younger than in other US regions. We performed a rapid scoping review to summarize women’s health research in Appalachia from 2000 to 2019, including health topics, study populations, theoretical frameworks, methods, and findings. Data Source: We searched bibliographic databases (eg, PubMed, PsycINFO, Google Scholar) for literature focusing on women’s health in Appalachia. Study Inclusion and Exclusion Criteria: Included articles were: (1) on women’s health in Appalachia; (2) published January 2000 to June 2019; (3) peer-reviewed; and (4) written in English. We excluded studies without reported data findings. Data Extraction: Two coders reviewed articles for descriptive information to create summary tables comparing variables of interest. Data Synthesis: Two coders co-reviewed a sub-sample to ensure consensus and refine data charting categories. We categorized major findings across the social-ecological framework. Results: A search of nearly 2 decades of literature revealed 81 articles, which primarily focused on cancer disparities (49.4%) and prenatal/pregnancy outcomes (23.5%). Many of these research studies took place in Central Appalachia (eg, 42.0% in Kentucky) with reproductive or middle-aged women (82.7%). Half of the studies employed quantitative methods, and half used qualitative methods, with few mixed method or community-engaged approaches (3.7%). Nearly half (40.7%) did not specify a theoretical framework. Findings included complex multi-level factors with few articles exploring the co-occurrence of factors across multiple levels. Conclusions: Future studies should: 1) systematically include Appalachian women at various life stages from under-represented sub-regions; 2) expand the use of rigorous methods and specified theoretical frameworks to account for complex interactions of social-ecological factors; and 3) build upon existing community assets to improve health in this vulnerable population.