Background: Kentucky is within the top five leading states for breast cancer mortality nationwide. This study investigates the association between neighborhood socioeconomic disadvantage and breast cancer outcomes, including surgical treatment, radiotherapy, chemotherapy, and survival, and how associations vary by race and ethnicity in Kentucky. Methods: We conducted a retrospective cohort analysis using data from the Kentucky Cancer Registry for patients with breast cancer diagnosed between 2010 and 2017, with follow-up through December 31, 2022. We linked Kentucky Cancer Registry data with census tract data to examine the relationship between area deprivation index (ADI) and breast cancer outcomes. Logistic regression and Cox proportional hazards models analyzed binary outcomes and time-to-event data, respectively. Results: Women in the most disadvantaged (ADI fourth quartile) neighborhoods were more likely to be diagnosed at later stages (OR, 1.26; 95% confidence interval, 1.12–1.41) and 34% more likely to die from breast cancer (HR, 1.34; 95% confidence interval, 1.14–1.57) after adjusting for age, race, tobacco use, tobacco pack-years, marital status, insurance status, family history, stage at diagnosis, breast cancer subtype, and residence in Appalachia when compared with women living in the least disadvantaged neighborhoods (ADI first quartile). Conclusions: Women in disadvantaged neighborhoods had significantly higher odds of late-stage diagnosis and breast cancer death, regardless of race, indicating that neighborhood factors contribute to breast cancer disparities. Impact: Socioeconomic and neighborhood factors may contribute to breast cancer outcomes, suggesting the necessity for targeted interventions. Future research should explore the effectiveness of such interventions and investigate additional social determinants contributing to disparities.

Purpose: Cancer remains the leading cause of death among Hispanics in the US. While social determinants of health, such as educational attainment, have been linked to negative health outcomes, their biological mechanisms remain poorly understood. We evaluated the association between educational attainment and allostatic load (AL), a measure of chronic physiologic stress, with risk of cancer mortality in Hispanic women from the National Health and Nutrition Examination Survey (NHANES). Methods: We performed a retrospective analysis among 5637 Hispanic women in NHANES from 1988 to 2010 with follow-up data through 2019. Educational attainment was categorized into a two-level variable: less than high school education vs high school graduate and above. AL score was calculated as the sum of nine abnormal biomarkers and health measures. Participants were considered to have high AL if their score was three or more. Weighted Cox proportional hazards models were fitted to estimate adjusted hazard ratios of cancer death between educational attainment and AL (adjusted for age, family poverty to income ratio, country of birth, marital status, preferred language, health insurance, current smoker status, congestive heart failure and history of heart attack). Results: Hispanic women who did not attain high school education and living with high AL had more than a 3fold increased risk of cancer death when compared to Hispanic women with at least high school education with low AL (unadjusted HR: 3.18, CI: 1.64-6.17). Hispanic women who did not complete high school and had high AL had a nearly two-fold increased risk of cancer mortality (unadjusted HR: 1.96, CI: 1.10-3.49) compared to their low AL counterparts. These effects attenuated after adjustments for age. Conclusion: Hispanic women with higher AL face elevated cancer mortality risk, with a greater effect observed among women with lower educational levels. Future research among a larger Hispanic sample should explore additional factors such as length of US residence, citizenship status, and country of birth, to better understand their influence on educational attainment, AL, and cancer mortality.

Background: In recent years, the sociopolitical landscape in the United States has shifted due to an increase in state-level legislation regarding LGBTQ+ rights, a trend that has been particularly pronounced in the Commonwealth of Kentucky. While the mental health impacts of enacted laws are increasingly documented, a critical gap remains in understanding the psychological toll of the legislative debates themselves—the prolonged periods of public discourse surrounding the restriction of rights. Methods: Utilizing data from the 2025 Queer Kentucky Survey (N = 817), this exploratory study examined the association between LGBTQ+ community belongingness and acute suicidality attributed specifically to anti-LGBTQ+ legislative debates. Data were derived from a non-probability snowball sample. Binary logistic regression models that adjusted for age, race, gender identity, education, and income were utilized. Results: Prevalence of debate-attributed suicidality was alarmingly high: 59.7% of the sample attributed increased suicidal thoughts, and 44.1% attributed a suicide attempt, specifically to the legislative debates. LGBTQ+ belongingness was a robust protective correlate, associated with significantly lower odds of both suicidal thoughts (OR = 0.61, p < 0.001) and attempts (OR = 0.41, p < 0.001). Analyses further revealed divergent risk for suicidality across demographic characteristics. Conclusions: Findings are consistent with the interpretation that legislative debates may function as distinct structural stressors associated with suicidal thoughts and suicide attempts. While community belongingness may offer a critical buffer, the elevated risks among Transgender and Black, Indigenous, and People of Color (BIPOC) populations highlight the need for intersectional, structural interventions beyond individual resilience.

During the COVID-19 pandemic, high-risk clients’ and caregivers’ access to essential personal protective equipment (PPE) was limited especially in many remote areas of Appalachia. A multidisciplinary team of community and university partners explored how to coordinate the use of community health workers (CHWs) and drone technologies to increase access to PPE in rural and remote Appalachian regions. CHWs recruited 10 Homeplace clients in an exploratory study of drone-based package delivery of PPE to assess importance and effectiveness of PPE self-efficacy related to PPE use, use of PPE, and ease and acceptability of drone delivery (following delivery only). CHWs educated each participant via in-person and Zoom meetings on the reasons for using PPE and proper use of PPE using Centers for Disease Control and Prevention guidelines. Most participants found the drone delivery of PPE easy and 80% were extremely satisfied with the drone delivery process. The frequency of mask-wearing increased from 60% at baseline to 90% at follow-up. On average, participants rated all types of PPE as effective in preventing the spread of disease. Drone officials used the findings of this pilot study to develop a waiver application to the U.S. Federal Aviation Administration to request permission to fly beyond visual line of sight in remote areas. Aerial drone technology could be a cutting-edge approach to health promotion in remote areas. The study results provide the proof of concept to assist investigators in designing future projects to promote healthy homes by collecting air and water samples and testing novel interventions deploying drone technology in remote Appalachian regions.

Background/Objectives: Robust, state-level LGBTQ+ health surveillance is scarce in Kentucky, limiting evidence-based healthcare planning and policy. We aimed to evaluate the feasibility and early public-health utility of a community-partnered annual survey and compare selected mental health stressors between Kentucky and non-Kentucky respondents. Methods: We conducted a cross-sectional online survey (13 April–15 July 2024) developed with a statewide LGBTQ+ nonprofit. Recruitment occurred via organizational channels and community events. A content warning preceded the survey, which was administered via Qualtrics. Data quality was screened using reCAPTCHA. We assessed feasibility metrics including recruitment and completion rates. Mental health stressors were captured with a six-item scale. Group differences were estimated with Welch’s t-tests. Results: Of 3852 survey starts, 1559 were retained as analyzable completes (completion rate: 40.47%), with 78.7% residing in-state. Initial analysis revealed a significant divergence in mental health patterns: while Kentucky participants reported lower stress regarding their personal mental health, they reported significantly higher stress stemming from socio-political issues like homophobia and transphobia compared to out-of-state respondents. Conclusions: An annual, community-partnered surveillance platform is a feasible strategy for generating actionable mental health signals relevant to healthcare. These findings will inform targeted outreach and guide health system partnerships to enhance LGBTQ+-affirming care in Kentucky.

LGBTQ+ individuals face substance use disparities linked to minority stress. While community belongingness may buffer stress, its role is complex. This study examined divergent associations between belongingness within the LGBTQ+ community and lifetime illicit drug use versus past-year alcohol frequency among LGBTQ+ adults in Kentucky (n = 2953), a region with notably high rates of substance use. Methods: Cross-sectional online survey data were analyzed. We measured LGBTQ+ belongingness, lifetime use of cocaine/crack/heroin/methamphetamine, and past-year alcohol frequency. Logistic and linear regressions controlled for age, education, gender identity, and income. Results: Greater belongingness predicted significantly higher odds of lifetime illicit drug use (OR = 1.24) but lower past-year alcohol consumption frequency (B = −0.094). Transgender and gender expansive identity predicted significantly higher illicit drug use odds and higher alcohol frequency. Conclusions: In this Kentucky sample, LGBTQ+ belongingness showed divergent substance use associations: it was protective against frequent alcohol use but, unexpectedly, was associated with higher odds of lifetime illicit drug use. Findings highlight belongingness’s complex, context-dependent nature and the need for nuanced research and interventions considering substance type and specific vulnerabilities, particularly for TGE individuals.