PURPOSE:Anti-Asian discrimination surged in the U.S. during the COVID-19 pandemic. This study examined pandemic-era discrimination among Korean immigrants and Korean Americans living in the southeastern United States (N = 355), a region shaped by a historically entrenched Black - White racial order and a growing Asian population. MATERIALS AND METHODS:Participants completed a survey assessing discrimination during the pandemic, including any discrimination and "blatant" incidents (e.g. threats or harassment). Poisson regression models estimated associations with English proficiency, social support, self-rated health, Adverse Childhood Experiences (ACEs), and an English proficiency × ACEs interaction. RESULTS:Overall, 75% reported any discrimination and 22% reported blatant incidents. In adjusted models, proficient English speakers reported higher discrimination (IRR = 1.43, p = .001). Greater social support and better health were associated with lower discrimination (IRR = 0.99, p = .011; IRR = 0.89, p = .015), while ACEs were associated with higher discrimination (IRR = 1.06, p = .002). The English proficiency × ACEs interaction was significant (IRR = 0.96, p = .042), indicating that the association between English proficiency and discrimination varied by ACEs level. DISCUSSION:Discrimination was widespread in this sample, with a notable share reporting blatant events. Social support and health may be protective, whereas childhood adversity may heighten vulnerability and shape how English proficiency relates to discrimination exposure. CONCLUSION:Anti-Asian discrimination warrants focused attention in the southeastern United States. Interventions that strengthen social support, expand culturally competent healthcare, and increase community awareness may help mitigate discrimination and related harms.

Transportation is a critical social determinant of health and plays a vital role in accessing healthcare services, particularly in rural communities where transportation resources are often limited. This qualitative study explored transportation barriers, financial burdens, and community-identified solutions among residents of Alabama’s Black Belt region. Four focus groups were conducted with 17 adults living in rural Alabama during the COVID-19 pandemic. Discussions were audio-recorded, transcribed verbatim, and analyzed using conventional content analysis. Three major themes emerged. First, participants described significant transportation challenges in accessing healthcare services, including limited public transportation options, infrequent schedules, lengthy travel times, and reliance on family members, friends, and caregivers for transportation. Second, participants highlighted the financial burden associated with transportation, including fuel costs, vehicle expenses, and the need to compensate others for rides. These challenges were compounded by limited transportation infrastructure and scarce local resources. Third, participants offered several recommendations to improve transportation access, including expanding public transportation services, increasing the frequency and flexibility of transportation schedules, and implementing mobile health clinics and other community-based services. Findings suggest that transportation barriers remain a significant obstacle to healthcare access in rural Alabama and contribute to broader health disparities. Addressing transportation needs through expanded services, improved infrastructure, and community-informed strategies may enhance access to healthcare and other essential services while reducing the financial and caregiving burdens experienced by rural residents. These efforts are critical for promoting health equity in underserved rural communities.

The COVID-19 pandemic has significantly impacted healthcare delivery and management in rural areas, where community health providers face unique challenges due to limited infrastructure and low socioeconomic status. This study explores the perspectives of community health providers in rural Alabama on the challenges posed by COVID-19. A qualitative phenomenology approach was employed to gain an in-depth understanding of the experiences of these workers during the peak of the pandemic. Fourteen participants (N = 14) were recruited through two project coordinators who were well-connected within the local communities of the Black Belt region of Alabama. Thematic analysis of the data revealed four main themes: (1) Changes in healthcare service provision and the associated challenges during the COVID-19 pandemic; (2) the mental health of community health providers; (3) vaccine hesitancy among service users; and (4) community health education and promotion strategies amidst the pandemic. The major findings from this study indicate that the global pandemic exacerbated existing challenges in the already struggling healthcare system of rural Alabama, compelling healthcare workers to develop innovative methods to continue delivering services. Additionally, the study uncovered signs of potential occupational burnout among some participants, alongside personal stress linked to the pandemic's effects on family dynamics and well-being. These findings underscore the critical need for policymakers at both the federal and state levels to allocate more resources to support rural counties and healthcare workers.

PurposeKorean immigrant families are growing in the Southern United States (U.S), an area where culturally specific resources can be limited. Korean immigrant families encounter distress in navigating the American culture, but cultural stigma impedes discussion within the family. An evidence-based mental health awareness program called Youth Mental Health First Aid (YMHFA) exists to serve as gatekeeper training for lay adults to identify and support youth experiencing mental health challenges. This study aimed to evaluate the feasibility of a culturally adapted Korean-YMHFA (K-YMHFA) program among Korean immigrants in the Southern U.S.Materials and methodUsing a mixed methods approach, a quantitative survey was distributed before and after program completion (N = 24), and a follow-up interview following program completion was also completed (N = 12). Quantitative analysis conducted a paired sample t-test, qualitative analysis conducted directed content analysis, and mixed methods analysis developed joint displays.ResultsParticipant's mental health literacy, confidence and control in YMHFA skills, and positive attitude toward YMHFA skills significantly increased, and stigma decreased after the training. Participants also provided information on specific steps for increasing cultural relevancy and sustainability within the community. Overall, mixed methods analysis indicated that the program was feasible in the context of Korean immigrants in the Southern U.S.ConclusionDespite the growing Korean community, the Southern U.S. has limited Korean ethnic services. With the feasibility of K-YMHFA, advocacy in promoting K-YMHFA is needed to counteract the limited resources while serving as an early intervention for youth and families in distress.

Objectives: This study examines the relationship between social media use for health purposes and depressive symptoms across four age groups: young adults (18‐34), younger middle-aged adults (35‐49), older middle‐aged adults (50‐64), and older adults (65+). While research often focuses on younger or older populations, middle-aged adults receive less attention despite their distinct social media engagement. As social media’s role in health grows, this study explores its varying effects on depression across life stages. Methods: A sample of 6,789 adults aged 18 and older was drawn from the 2017 and 2018 Health Information National Trends Survey (HINTS). Multiple linear regression analyses stratified by age were conducted to predict depression levels based on social media use for health purposes. Results: Social media use for health was positively associated with depressive symptoms in three age groups, but not among those aged 65 and older. The relationship varied by age, with different demographic factors influencing the association. Conclusion: This study highlights the need for targeted interventions to improve digital health literacy, provide age-specific support, and address broader social factors impacting mental health. A comprehensive approach can help mitigate the potential risks of social media use on mental well-being.

Pain is one of the most common concerns among chronically ill older adults. However, access to pain management is not equitable among certain populations, including rural residents. This qualitative study explored rural older adults' experiences with pain and its treatment. Eighteen participants were recruited from rural counties of Alabama, who were age 60+, cognitively intact, community-dwelling, had one or more chronic/serious illnesses, and experienced pain. Open-ended questions were asked in individual interviews, and inductive, thematic analysis was used for data analysis. Findings revealed the impact of pain (physical limitations, psychological distress, and coping strategies), the impact of COVID-19 (physical/mental health and pain management), challenges in pain management in rural areas (lack of provider and healthcare resources, transportation-related issues, mistrust, and limited insurance coverage) and suggestions to address these challenges. Program and policy-level interventions are crucial in improving the resources and education/training needed for effective pain management for rural older adults.

INTRODUCTION:Although the HPV vaccine is known to prevent associated cancers, studies found a low awareness among Korean Americans (KA). This study aimed to examine the HPV and HPV vaccine awareness among KA in Alabama.METHODS:A cross-sectional survey was conducted with a convenience sample of 278 KA residing in Alabama to understand the levels of HPV and HPV vaccine awareness and associated factors.RESULTS:Those who heard of HPV were 31.7% and 29.5% for HPV vaccine. Those who were older than 50 years old and married were less likely to hear of HPV and HPV vaccine. Those who were female and had annual health check-ups were more likely to hear of both. Using the Internet for health information was positively associated with HPV vaccine awareness.DISCUSSION:HPV education tailored to sociodemographic and using the Internet might be an effective strategy in improving the HPV and HPV vaccine awareness levels.

This study examines how racial/ethnic discrimination influences financial access and material hardship, using survey data collected from self-identified Korean immigrants living in two counties in Alabama (N = 241). Key variables are experiencing racial/ethnic discrimination, two subjective measures of financial access, and four indicators of material hardship (overall, food-related, health insurance, and medical care). Descriptive analyses show a high rate of experiencing racial/ethnic discrimination, limited access to basic financial services and credit, and considerable rates of material hardship. Regression analyses indicate that experiencing discrimination has a significant association with access to credit but not with access to basic financial services. Access to credit has a significant and negative association with all types of material hardship. Our findings challenge the model minority myth of socially and economically integrated Asian/Korean immigrants. Results call for anti-discrimination policies and public efforts to expand financial access and reduce material hardship among Korean immigrants.

This study examines how racial/ethnic discrimination influences financial access and material hardship, using survey data collected from self-identified Korean immigrants living in two counties in Alabama ( N  = 241). Key variables are experiencing racial/ethnic discrimination, two subjective measures of financial access, and four indicators of material hardship (overall, food-related, health insurance, and medical care). Descriptive analyses show a high rate of experiencing racial/ethnic discrimination, limited access to basic financial services and credit, and considerable rates of material hardship. Regression analyses indicate that experiencing discrimination has a significant association with access to credit but not with access to basic financial services. Access to credit has a significant and negative association with all types of material hardship. Our findings challenge the model minority myth of socially and economically integrated Asian/Korean immigrants. Results call for anti-discrimination policies and public efforts to expand financial access and reduce material hardship among Korean immigrants.

Limited research examining opioid literacy among African Americans (AAs) have been conducted. The current study examined the association between opioid literacy levels among AAs in rural Alabama using the social determinants of health framework. Three subscales in the Brief Opioid Overdose Knowledge questionnaire were used to measure opioid literacy. Among a sample of 253, limited opioid literacy was found. Social contact was found to be significantly associated with overall opioid literacy (B = .36, p < .05) and opioid general knowledge subscale (B = .14, p < .05). For the subscale of opioid overdose response knowledge, health insurance (B =−.59, p = .06) and social contact (B = .13, p = .07) emerged as marginally significant. The findings suggest that educational interventions are needed to increase opioid literacy among rural AAs, especially among those with limited social contact.

Rural areas with limited access to preventive care, treatment, and recovery services are particularly affected by the opioid crisis. This study identified four rural areas in Alabama that had higher opioid prescription rates than the state and national average. This study explores the views of three groups [healthcare service providers, persons who use/used opioids (PWUO), and community stakeholders] on the barriers to and needs for opioid prevention, treatment, and recovery services using a phenomenological qualitative design. Purposeful and snowball sampling was used to recruit 95 participants across 12 focus groups which were audio-recorded and transcribed verbatim. A seven-member analysis team conducted a directed content analysis using a semi-structured script and seeded themes with a rigorous plan to promote trustworthiness. Regardless of group type, commonly identified barriers and needs related to rural locality, financial factors, cultural norms, and stigma among others. Prominent needs included education and healthcare coordination. Findings suggest recommendations for community and provider interventions to address the knowledge gaps and recovery needs. They also supported the suitability of the Telehealth Extension for Community Healthcare Outcomes, a videoconferencing tool that networks multidisciplinary experts and professionals around specialty topics, as a promising intervention to increase training among providers.

Certain populations have been excluded from the benefits of telehealth and the recent advances and widespread use of technology in health promotion due to limited technology access. Although research has identified these specific groups, none has explored these issues using the social determinants of health (SDH) framework. This exploratory study aimed 1) to investigate technology access and 2) to identify associated SDHs. A cross-sectional research design was implemented, and participants were recruited from rural Alabama (N=185). Binary logistic regressions were conducted. Only 60% of participants had technology access. People with food insecurity and health illiteracy were less likely to have internet and PC/tablet access. In addition, older age was associated with a lower likelihood of access to a smartphone. This study provided insights into SDH correlates of the digital divide, particularly among rural African Americans, and indicated that addressing affordability could be a partial solution.

This study aims to examine the factors associated with the level of HPV infection and HPV vaccine awareness among rural African Americans living in the Black Belt region of Alabama. A cross-sectional survey on cancer screening and health behaviors was conducted in the Black Belt region of Alabama. Adults (18 years or older) recruited through convenience sampling completed the self-administered survey. Binary logistic regressions were conducted to identify factors associated with HPV infection and HPV vaccine awareness among African American participants. Slightly more than half of the participants were aware of HPV (62.5%) and HPV vaccine (62.1%). Married or partnered participants had lower awareness of HPV or HPV vaccine. Family cancer history and self-reported health status were positively associated with both HPV and HPV vaccine awareness. In addition, employment was positively associated with HPV awareness, and participation in social groups was positively associated with HPV vaccine awareness. Tailored educational interventions that consider our findings might increase HPV and HPV vaccine awareness and contribute to better vaccine uptakes.

Objective: Using the Andersen’s behavioral model of health services use as a framework, this study aims to examine factors (predisposing, needs, and enabling) related to American Indian (AI) women’s cervical cancer knowledge. Methods: Andersen’s behavioral model of health services was used to examine factors predisposing, needs, and enabling related to AI women’s cervical cancer knowledge. A sample of 259 AI women residing in the Northern Plains was recruited using a convenience sampling strategy. Cervical cancer knowledge was measured using guidelines from the American Cancer Society. Three predisposing factors, six enabling factors, and four need factors were observed. Result: The mean score of knowledge was 9.11 out of 13. Higher cancer knowledge was associated with 3 enabling factors (higher education, higher HPV knowledge, and use of TV/radio to gain health literacy) and one needs factor (experience in hospitalization). Conclusion: Our findings indicate that culturally sensitive educational interventions, especially those using media, to increase cervical cancer knowledge are needed among AI women.

OBJECTIVES:The purpose of this study was to examine racial differences in the discussion of advance care planning among older adults using Andersen's behavioral model of health care utilization.METHOD:This cross-sectional study utilized data from the 2018 National Health and Aging Trends Study. Weighted multivariable logistic regressions were used to predict advance care planning discussion (n = 1,326).RESULTS:After accounting for predisposing, enabling, and need factors, Black older adults were less likely to discuss end-of-life care (odds ratio [OR] = .527) and medical power of attorney (OR = .531) compared with Whites. Hispanic older adults were also less likely to discuss end-of-life care (OR = .389) and power of attorney (OR = .384) compared with Whites.DISCUSSION:These results point to significant racial disparities in advance care planning discussions among older adults and call for future examinations of cultural, historical, and systemic factors that could influence the discussion of advance care planning among this population.

Background: Pain and symptom management is critical in ensuring quality of life for chronically ill older adults. However, while pain management and palliative care have steadily expanded in recent years, many underserved populations, such as rural older adults, experience barriers in accessing such specialty services, in part due to transportation issues. The purpose of this systematic review is to examine the specific types of transportation-related barriers experienced by rural older adults in accessing pain and palliative care. Methods: Studies were searched through the following 10 databases: Abstracts in Social Gerontology, Academic Search Premier, CINAHL, MEDLINE, PsycINFO, SocINDEX with Full Text, Cochrane Database of Systematic Reviews, Nursing & Allied Health Database, Sociological Abstracts, and PubMED. Studies were chosen for initial review if they were written in English, full text, included older adults in the sample, and examined pain/palliative care/hospice, rural areas, and transportation. A total of 174 abstracts were initially screened, 15 articles received full-text reviews and 8 met the inclusion criteria. Results: Findings of the 8 studies identified transportation-related issues as major access barrier to pain and palliative care among rural older adults: specifically, lack of public transportation; lack of wheelchair accessible vehicles; lack of reliable drivers; high cost of transportation services; poor road conditions; and remoteness to the closest pain and palliative care service providers. Conclusion: Results suggest that rural older adults have unique transportation needs due to the urban-centric location of pain and palliative care services. Implications for practice, policy and research with older adults are discussed.

Abstract Although pain control is an essential factor in promoting quality of life, pain is undertreated among certain sub-populations, such as older adults and rural residents. The purpose of this study was to explore pain experiences and its treatment among rural older adults. A qualitative research design was adopted to capture the common essence of participants’ experiences through a phenomenological method. Purposeful sampling was used, and the participant criteria was: age 55+, have good thinking skills, resident of Alabama, have chronic/serious health conditions, and experienced pain or discomfort in the last 3 months. Twenty-three participants were recruited from rural counties of West and South Alabama through the local Area Agency on Aging and health and senior service centers. Individual semi-structured interviews were conducted via phone and were recorded and transcribed verbatim. Thematic analysis was conducted to identify emerging themes and repeated patterns from the data. Our results revealed themes in four categories: 1) impact of pain: physical limitations and coping strategies, 2) Impact of Covid-19: physical health, social, and mental health impact, 3) challenges in pain treatment: transportation (driver/time/cost/Covid-19 exposure) and non-transportation related problems (lacking resources/mistrust/limited health insurance coverage), and 4) suggestions: transportation-related (more transportation options/financial assistance) and non-transportation-related support (improved insurance coverage/non-pharmacological care) . Findings of this study highlight rural older adults’ unique needs in access to pain treatment, further amplified during the Covid-19 pandemic. Increase in sustainable, funded transportation programs and the supply of local pain specialists is critical to meet such needs and improve their quality of life.

Introduction: Opioid crisis has disproportionately affected Alabamians with the highest opioid prescription rate, and it is subjected to affect Korean Americans (KA) negatively based on common predictors of opioid misuse that KA possess. Method: Cross-sectional data of KA in rural Alabama (N = 230) were analyzed. Opioid literacy was assessed by the Brief Opioid Overdose Knowledge survey. Six social determinants of health factors were considered: financial status, educational attainment, English proficiency, household food insecurity, health literacy, and social contact. Results: Participants had limited opioid literacy (M = 3.56, SD = 3.06). After adjusting for demographics and health covariates, higher levels of overall opioid literacy were associated with higher household income (B = .48, p < .01), higher levels of health literacy (B = .71, p < .01), and less frequent social contact (B = −.40, p < .01). Significant social determinants of health predictors varied across subdomains of opioid literacy. Discussion: The findings suggest that culturally competent and community-level interventions are needed to increase opioid literacy in KA in rural Alabama.

Objectives: In this study, we investigated the health status trajectory of Korean older adults with chronic diseases and its relationship with relevant ecological level factors. Methods: We analyzed data from the 2013 to 2015 Korea Health Panel Survey using the latent growth model. Results: Results showed that Korean older adults' health status decreased over time. Relevant ecological level factors affecting older adults' health status directly or indirectly included alcohol problems, caregiver burden, and healthcare cost burdens. The higher the initial health status was found to be, the higher the initial alcohol problem and initial caregiver burden. The higher the initial caregiver burden was found to be, the higher the initial alcohol problem and initial healthcare cost burden. Conclusions: To improve the health status of older adults with chronic diseases, interventions and health policies to reduce alcohol problem, caregiver burden, and healthcare cost burden should be developed and implemented.

Background caregiving responsibilities significantly impact females’ decisions on adhering to preventive mammography. The purpose of this study is to examine (1) the levels of Mammogram receipt, (2) the role of caregiving factors on the receipt of mammogram in caregiving group, and (3) the role of cancer beliefs on Mammogram screening in caregivers and non-caregivers. Methods the 2017 Health Information National Trends Survey (HINTS) provides samples of 1228 women aged 40 to 75 years old for this secondary analysis. By using Andersen’s Behavioral Model of Health Services Use, a binomial logistic regression model was used to analyze associations between mammography and socioeconomic factors, caregiving factors, and cancer belief factors. Results caregivers who provided more hours of caregiving per week (OR=0.749, 95% CI=0.564-0.94) and caregivers who had the belief of rather not know the likelihood of getting cancer (OR=0.673, 95% CI=0.496-0.914) were less likely to use mammogram. However, caregivers who believed cancer is more common than heart disease (OR=1.490, 95% CI=1.302- 2.151) were more likely to use mammogram. Non-caregivers who worried about getting cancer (OR=1.158, 95% CI=0.793-1.691) were more likely to use mammogram, but non-caregivers who had the belief of rather not know the likelihood of getting cancer (OR=0.825, 95% CI=0.713-0.955) were less likely to use mammogram. Conclusions to support caregivers’ breast cancer prevention, caregiving-related policies based on caregiving hours should be developed. Particularly, effort to promote breast cancer screening education and care support among older primary caregivers will likely increase their adherence to preventive mammography uptake. Development of targeted cancer prevention interventions on specific cancer beliefs held by both groups are also urgently needed to promote mammography.