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With the Appalachian Trail (AT) as our research setting, grounded theory as our methodological approach, and qualitative interviews and archival analysis as our methods, we investigate the role crowdsourced data, social media, and smartphone apps could play in sustainable resource management (SRM). Centering the perspectives of AT resource managers, our analysis reveals that digital technologies can create new challenges and exacerbate existing ones. Place-centered challenges intensified by digital technologies are overcrowding and trail infrastructure degradation. Experience-centered challenges posed by digital technologies include information overload, limited operational capacity, and tensions between the traditional "AT experience" and digital life. Further, our analysis illuminates the technological, organizational, ethical, and experiential challenges and barriers to the systemic adoption of digital technologies for SRM. These empirical insights result in a management framework that focuses attention on the humanistic and organizational needs of resource managers that could be used for designing and implementing socio-technical systems that better align with social and cultural values of resource management contexts., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: In the US, violations of drinking water regulations are highest in lower-income rural areas overall, and particularly in Central Appalachia. However, data on drinking water use, quality, and associated health outcomes in rural Appalachia are limited. We sought to assess public and private drinking water sources and associated risk factors for waterborne pathogen exposures for individuals living in rural regions of Appalachian Virginia., Methods: We administered surveys and collected tap water, bottled water, and saliva samples in lower-income households in two adjacent rural counties in southwest Virginia (bordering Kentucky and Tennessee). Water samples were tested for pH, temperature, conductivity, total coliforms, E. coli, free chlorine, nitrate, fluoride, heavy metals, and specific pathogen targets. Saliva samples were analyzed for antibody responses to potentially waterborne infections. We also shared water analysis results with households., Results: We enrolled 33 households (83 individuals), 82% (n = 27) with utility-supplied water and 18% with private wells (n = 3) or springs (n = 3). 58% (n = 19) reported household incomes of <$20,000/year. Total coliforms were detected in water samples from 33% (n = 11) of homes, E. coli in 12%, all with wells or springs (n = 4), and Aeromonas, Campylobacter, and Enterobacter in 9%, all spring water (n = 3). Diarrhea was reported for 10% of individuals (n = 8), but was not associated with E. coli detection. 34% (n = 15) of saliva samples had detectable antibody responses for Cryptosporidium spp., C. jejuni, and Hepatitis E. After controlling for covariates and clustering, individuals in households with septic systems and straight pipes had significantly higher likelihoods of antibody detection (risk ratios = 3.28, 95%CI = 1.01-10.65)., Conclusions: To our knowledge, this is the first study to collect and analyze drinking water samples, saliva samples, and reported health outcome data from low-income households in Central Appalachia. Our findings indicate that utility-supplied water in this region was generally safe, and individuals in low-income households without utility-supplied water or sewerage have higher exposures to waterborne pathogens., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier GmbH. All rights reserved.)

Background: The present commentary highlights the pressing need for systematic research to assess the implementation and effectiveness of medications for opioid use disorder, used in conjunction with peer recovery support services, to improve treatment outcomes for individuals with opioid use disorder in Central Appalachia. This region, encompassing West Virginia, Eastern Kentucky, Southwest Virginia, East Tennessee, and Western North Carolina, has long grappled with a disproportionate burden of the opioid crisis. Due to a complex interplay of cultural, socioeconomic, medical, and geographic factors, individuals in Central Appalachia face challenges in maintaining treatment and recovery efforts, leading to lower success rates., Approach: To address the issue, we apply an exploratory approach, looking at the intersection of unique regional factors with the utilization of medications for opioid use disorder, in conjunction with peer recovery support services. This combined treatment strategy shows promise in addressing crucial needs in opioid use disorder treatment and enhancing the recovery journey. However, there are significant evidence gaps that need to be addressed to validate the expected value of incorporating peer support into this treatment strategy., Conclusion: We identify nine obstacles and offer recommendations to address the gaps and advance peer recovery support services research. These recommendations include the establishment of specific partnerships and infrastructure for community-engaged, peer recovery support research; improved allocation of funding and resources to implement evidence-based practices such as peer support and medication-assisted treatment; developing a more precise definition of peer roles and their integration across the treatment and recovery spectrum; and proactive efforts to combat stigma through outreach and education., (© 2024. The Author(s).)

We characterized concentrations of trihalomethanes (THMs), a measure of disinfection byproducts (DBPs), in tap water samples collected from households with utility-supplied water in two rural counties in Appalachian Virginia, and assessed associations with pH, free chlorine, and metal ions which can impact THM formation. Free chlorine concentrations in all samples ( n = 27 homes) complied with EPA drinking water guidelines, though 7% ( n = 2) of first draw samples and 11% ( n = 3) of 5-min flushed-tap water samples exceeded the US Safe Drinking Water Act (SDWA) maximum contaminant level (MCL) for THM (80 ppb). Regression analyses showed that free chlorine and pH were positively associated with the formation of THM levels above SDWA MCLs (OR = 1.04, p = 0.97 and OR = 1.74, p = 0.79, respectively), while temperature was negatively associated (OR = 0.78, p = 0.38). Of the eight utilities serving study households, samples from water served by three different utilities exceeded the EPA MCL for THM. Overall, these findings do not indicate substantial exposures to DBPs for rural households with utility-supplied water in this region of southwest Virginia. However, given the observed variability in THM concentrations between and across utilities, and established adverse health impacts associated with chronic and acute DBP exposure, more research on DBPs in rural Central Appalachia is warranted., Competing Interests: The authors declare there is no conflict., (© 2024 The Authors This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence (CC BY 4.0), which permits copying, adaptation and redistribution, provided the original work is properly cited (http://creativecommons.org/licenses/by/4.0/).)

In rural areas of the United States, an estimated ~1.8 million people lack reliable access to safe drinking water. Considering the relative dearth of information on water contamination and health outcomes in Appalachia, we conducted a systematic review of studies of microbiological and chemical drinking water contamination and associated health outcomes in rural Appalachia. We pre-registered our protocols, limiting eligibility to primary data studies published from 2000 to 2019, and searched four databases (PubMed, EMBASE, Web of Science, and the Cochrane Library). We used qualitative syntheses, meta-analyses, risk of bias analysis, and meta-regression to assess reported findings, with reference to US EPA drinking water standards. Of the 3452 records identified for screening, 85 met our eligibility criteria. 93 % of eligible studies (n = 79) used cross-sectional designs. Most studies were conducted in Northern (32 %, n = 27) and North Central (24 %, n = 20) Appalachia, and only 6 % (n = 5) were conducted exclusively in Central Appalachia. Across studies, E. coli were detected in 10.6 % of samples (sample-size-weighted mean percentage from 4671 samples, 14 publications). Among chemical contaminants, sample-size-weighted mean concentrations for arsenic were 0.010 mg/L (n = 21,262 samples, 6 publications), and 0.009 mg/L for lead (n = 23,259, 5 publications). 32 % (n = 27) of studies assessed health outcomes, but only 4.7 % (n = 4) used case-control or cohort designs (all others were cross-sectional). The most commonly reported outcomes were detection of PFAS in blood serum (n = 13), gastrointestinal illness (n = 5), and cardiovascular-related outcomes (n = 4). Of the 27 studies that assessed health outcomes, 62.9 % (n = 17) appeared to be associated with water contamination events that had received national media attention. Overall, based on the number and quality of eligible studies identified, we could not reach clear conclusions about the state of water quality, or its impacts on health, in any of Appalachia's subregions. More epidemiologic research is needed to understand contaminated water sources, exposures, and potentially associated health outcomes in Appalachia., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Although the benefits of home- and community-based services (HCBS) to support the needs of older adults are well-established, researchers have persistently reported service underutilization by dementia caregivers to assist them with their caregiving responsibilities. Using the Health Behavior Model and Conservation of Resources Theory, the aim of the current study was to understand what barriers prevent caregivers from using HCBS and the toll it takes on them. Utilizing a sample of 122 rural family caregivers (74% female, 87% white, M age  = 64.86 years) of persons living with dementia (PLwD), simultaneous ordinary least square regressions were employed to understand the association between barriers to service use and the current use of support services and personal services, and concurrently on caregiver role overload. Financial barriers, caregiver's reluctance to use services, and their capability of seeking services were associated with lower use of support services. After controlling for need and enabling factors, caregivers who used more support services, and those who reported system complexities to using support services experienced higher role overload. Financial barriers, system complexities, and caregivers' reluctance also affected the use of personal care services. Despite the use of personal services, caregivers of PLwD with greater needs and fewer enabling factors experienced higher role overload. Study findings suggest that reducing system complexities of HCBS and improving prevention and intervention efforts to facilitate caregivers' awareness of HCBS are needed to address lack of service use and reduce caregiver overload., (© 2022. Society for Prevention Research.)

Upstream anthropogenic land cover can degrade source drinking water quality and thereby inhibit the ability of a community water system to provide safe drinking water. This study aimed to predict differences in Safe Drinking Water Act (SDWA) compliance between water systems based on upstream land cover in Central Appalachia and to examine whether national trends correlating violations with system size and source type were relevant for this region. Multiple generalized linear mixed models assessed relationships between SDWA violations and the distance weighted land cover proportions associated with the water system's contributing source watershed, as well as county economic status, system size, and water source. Results indicate that rates of monitoring and reporting violations were significantly higher for smaller water systems in more economically distressed counties. Interestingly, increases in surface mining landuse and high density development decreased monitoring and reporting violations, which may reflect impacts of associated economic development. Increases in low intensity development increased the likelihood of health-based violations. To protect public health, community managers should consider source water protection and/or upgrading drinking water system treatment capacity prior to developing previously undeveloped areas and further motivate compliance with monitoring and reporting requirements., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Ticks are known vectors of several viral, bacterial, and protozoal pathogens that cause disease in both humans and animals. While pathogen prevalence has been studied extensively in other portions of the United States, pathogen surveillance studies within tick populations in the central Appalachian region of Virginia is almost nonexistent. Two prominent species in this region are Ixodes scapularis (the blacklegged tick) and Amblyomma americanum (the lone star tick). In this study, we collected ticks biweekly from three habitat types (forest, urban, and pasture) across eight counties in southwest Virginia from June, 2019-November, 2020. Ixodes scapularis and A. americanum captures were screened for evidence of associated tick-borne pathogens. In this region, Borrelia burgdorferi sensu stricto (15.3% in nymphs and 37.6% in adults), Anaplasma phagocytophilum (1.9% in nymphs and 12.2% in adults), and Borrelia miyamotoi (2.97% in nymphs and 2.33% in adults) were detected in I. scapularis ticks. Aside from two previously reported Powassan-positive I. scapularis ticks from Floyd County, VA, no additional Powassan-positive ticks are reported here. No evidence of Ehrlichia chaffeensis, Heartland virus (HRTV), or Bourbon virus (BRBV) was detected in collected A. americanum. Detection and confirmation of multiple emerging tick-borne pathogens in this region raises an increased concern for public health risk, calling for heightened awareness of tick-borne pathogen transmission and increased tick surveillance in understudied areas.

Campsite impacts in protected natural areas are most effectively minimized by a containment strategy that focuses use on a limited number of sustainable campsites that spatially concentrate camping activities. This research employs spatial autoregressive (SAR) modeling to evaluate the relative influence of use-related, environmental, and managerial factors on two salient measures of campsite impact. Relational analyses examined numerous field-collected and GIS-derived indicators, including several new indicators calculated using high-resolution Light Detection and Ranging (LiDAR) topographic data to evaluate the influence of terrain characteristics on the dependent variables. Chosen variables in the best SAR models explained 35% and 30% of the variation in campsite size and area of vegetation loss on campsites. Results identified three key indicators that managers can manipulate to enhance the sustainability of campsites: campsite type, and terrain characteristics relating to landform slope and topographic roughness. Results support indirect management methods that rely on the location, design, construction, and maintenance of campsites, instead of direct regulations that restrict visitation or visitor freedoms. As visitation pressures continue to increase, this knowledge can be applied to select and promote the use of more ecologically sustainable campsites., (Published by Elsevier Ltd.)

Elevated dissolved major ions (salinization) from surface coal mining are a common impact to central Appalachian headwater streams. Salinization is associated with alterations of benthic macroinvertebrate communities, as many organisms are adapted to the naturally dilute streams of the region. These geochemical and biological alterations have been observed in streams decades after mining, but it remains unclear whether and at what rate water quality and aquatic biota recover after mining. To address this issue, we analyzed temporal trends in specific conductance (SC), ion matrix ratios, and benthic macroinvertebrate communities over an eight-year period in 23 headwater streams, including 18 salinized by surface coal mining. We found strong, negative correlations between SC and diversity of benthic macroinvertebrate communities. Temporal trend analysis demonstrated limited recovery of water chemistry to natural background conditions. Five of the 18 mining-influenced streams exhibited declining SC; however, annual rates of decline in these streams ranged from 1.9% to 3.7% of mean annual SC, suggesting long time periods will be required to reach established benchmark values (ca. 25 years) or values observed in our five reference study streams (ca. 40 years). Similarly, there was limited evidence for recovery of macroinvertebrate community metrics, even in the few mining-influenced streams with decreasing SC. These findings indicate that salinization and its biological effects persist, likely for decades, in central Appalachian headwater streams. Our work also highlights the value of long-term monitoring data for assessing recovery potential of salinized freshwaters, as well as the need for improved understanding of water quality and biological recovery processes and time frames., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

This research investigates the influence of layout and design on the severity of trail degradation. Previous trail studies have been restricted by relatively small study areas which provide a limited range of environmental conditions and therefore produce findings with limited applicability; this research improves on this limitation by analyzing a representative sample of the Appalachian Trail with significant topographical, ecological, use-related, and managerial diversity. Many trail science studies have also focused on a singular form of trail degradation, whereas this study investigates all three core types of trail impact: trail soil loss, widening and muddiness. Relational analyses with all three indicators provide a more cohesive understanding of trail impact and reveal interrelationships between trail degradation processes. ANOVA testing of the mean values for these trail impact indicators across categories of influential independent factors confirms and refines the relevance of core trail design principles, specifically the sustainability advantages of trails with low grades and side-hill alignments. Findings also reveal and clarify the importance of landform grade in determining the susceptibility of trails to degradation and the influence of routing decisions; these relationships have received relatively little attention in the literature. The results also reveal several methodological considerations for trail alignment metrics and trail impact indicators., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Previous studies have associated elevated mortality risk in central Appalachia with coal-mining activities, but few have explored how different non-coal factors influence the association within each county. Consequently, there is a knowledge gap in identifying effective ways to address health disparities in coal-mining counties. To specifically address this knowledge gap, this study estimated the effect of living in a coal-mining county on non-malignant respiratory diseases (NMRD) mortality, and defined this as "coal-county effect." We also investigated what factors may accentuate or attenuate the coal-county effect., Methods: An ecological epidemiology protocol was designed to observe the characteristics of three populations and to identify the effects of coal-mining on community health. Records for seven coal-mining counties (n = 19,692) were obtained with approvals from the Virginia Department of Health Office of Vital Statistics for the years 2005 to 2012. Also requested were records from three adjacent coal counties (n = 10,425) to provide a geographic comparison. For a baseline comparison, records were requested for eleven tobacco-producing counties (n = 27,800). We analyzed the association of 57,917 individual mortality records in Virginia with coal-mining county residency, county-level socioeconomic status, health access, behavioral risk factors, and coal production. The development of a two-level hierarchical model allowed the coal-county effect to vary by county-level characteristics. Wald tests detected sets of significant factors explaining the variation of impacts across counties. Furthermore, to illustrate how the model estimations help explain health disparities, two coal-mining county case studies were presented., Results: The main result revealed that coal-mining county residency increased the probability of dying from NMRD. The coal-county effect was accentuated by surface coal mining, high smoking rates, decreasing health insurance coverage, and a shortage of doctors. In Virginia coal-mining regions, the average coal-county effect increased by 147% (p-value< 0.01) when one doctor per 1000 left, and the effect increased by 68% (p-value< 0.01) with a 1% reduction of health insurance rates, holding other factors fixed., Conclusions: This study showed a high mortality risk of NMRD associated with residents living in Virginia coal-mining counties. Our results also revealed the critical role of health access in reducing health disparities related to coal exposure.

Purpose: To test the feasibility of Kids SIP smartER, a school-based intervention to reduce consumption of sugar-sweetened beverages (SSBs)., Design: Matched-contact randomized crossover study with mixed-methods analysis., Setting: One middle school in rural, Appalachian Virginia., Participants: Seventy-four sixth and seventh graders (5 classrooms) received Kids SIP smartER in random order over 2 intervention periods. Feasibility outcomes were assessed among 2 teachers., Intervention: Kids SIP smartER consisted of 6 lessons grounded in the Theory of Planned Behavior, media literacy, and public health literacy and aimed to improve individual SSB behaviors and understanding of media literacy and prevalent regional disparities. The matched-contact intervention promoted physical activity., Measures: Beverage Intake Questionnaire-15 (SSB consumption), validated theory questionnaires, feasibility questionnaires (student and teacher), student focus groups, teacher interviews, and process data (eg, attendance)., Analysis: Repeated measures analysis of variances across 3 time points, descriptive statistics, and deductive analysis of qualitative data., Results: During the first intervention period, students receiving Kids SIP smartER (n = 43) significantly reduced SSBs by 11 ounces/day ( P = .01) and improved media ( P < .001) and public health literacy ( P < .01) understanding; however, only media literacy showed between-group differences ( P < .01). Students and teachers found Kids SIP smartER acceptable, in-demand, practical, and implementable within existing resources., Conclusion: Kids SIP smartER is feasible in an underresourced, rural school setting. Results will inform further development and large-scale testing of Kids SIP smartER to reduce SSBs among rural adolescents.

Little is known about how rural-dwelling older adults anticipate and plan for future care needs. Using a mixed-method explanatory design, structural equation modeling ( n = 535) revealed significant associations between concerns about using services on preference for type of help; preference was associated with likelihood of using future services. Content analysis of interview data from 19 older adults who needed but were not receiving help revealed how they conceptualize their need for assistance and anticipated future care arrangements. Nine older adults were not thinking about future care needs. While most older adults articulated preferences for informal help, they indicated some openness to formal assistance. Preferences did not always align with expectations for the future. Rather, concerns about burdening family and friends outweighed concerns about community services and influenced expectations of using formal services. Understanding rural older adults' expectations for future care arrangements is necessary for advancing policy and implementing successful services options.

Objective: To assess the effects of the national Smart Snacks in School standards, which include nutrient and ingredient limitations for school competitive foods and beverages effective July, 2014, on student intake in low-income rural Appalachian middle schools., Methods: Food-frequency questionnaires were administered to students before and after implementation. Multiple ordinal logistic regression models were conducted to examine effects from year of data collection, grade, and free or reduced price lunch participation rates., Results: No significant changes were observed after implementation except a decrease in consumption of 1% or nonfat flavored milk at school., Conclusions and Implications: Smart Snacks in School standards did not result in significant dietary changes in this study. Longitudinal studies could evaluate long-term impacts of nutrition standards., (Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

The Powell River of southwestern Virginia and northeastern Tennessee, USA, drains a watershed with extensive coal surface mining, and it hosts exceptional biological richness, including at-risk species of freshwater mussels, downstream of mining-disturbed watershed areas. We investigated spatial and temporal patterns of watershed mining disturbance; their relationship to water quality change in the section of the river that connects mining areas to mussel habitat; and relationships of mining-related water constituents to measures of recent and past mussel status. Freshwater mussels in the Powell River have experienced significant declines over the past 3.5 decades. Over that same period, surface coal mining has influenced the watershed. Water-monitoring data collected by state and federal agencies demonstrate that dissolved solids and associated constituents that are commonly influenced by Appalachian mining (specific conductance, pH, hardness and sulfates) have experienced increasing temporal trends from the 1960s through ~2008; but, of those constituents, only dissolved solids concentrations are available widely within the Powell River since ~2008. Dissolved solids concentrations have stabilized in recent years. Dissolved solids, specific conductance, pH, and sulfates also exhibited spatial patterns that are consistent with dilution of mining influence with increasing distance from mined areas. Freshwater mussel status indicators are correlated negatively with dissolved solids concentrations, spatially and temporally, but the direct causal mechanisms responsible for mussel declines remain unknown., (Copyright © 2015 Elsevier B.V. All rights reserved.)

The study objective was to examine the nutritional quality of competitive foods and beverages (foods and beverages from vending machines and à la carte foods) available to rural middle school students, before implementation of the US Department of Agriculture's Smart Snacks in School standards in July 2014. In spring 2014, we audited vending machines and à la carte cafeteria foods and beverages in 8 rural Appalachian middle schools in Virginia. Few schools had vending machines. Few à la carte and vending machine foods met Smart Snacks in School standards (36.5%); however, most beverages did (78.2%). The major challenges to meeting standards were fat and sodium content of foods. Most competitive foods (62.2%) did not meet new standards, and rural schools with limited resources will likely require assistance to fully comply.

Objective: Determine whether select cause of death mortality disparities in four Appalachian regions is associated with coal mining or other factors., Methods: We calculated direct age-adjusted mortality rates and associated 95% confidence intervals by sex and study group for each cause of death over 5-year time periods from 1960 to 2009 and compared mean demographic and socioeconomic values between study groups via two-sample t tests., Results: Compared with non-coal-mining areas, we found higher rates of poverty in West Virginia and Virginia (VA) coal counties. All-cause mortality rates for males and females were higher in coal counties across all time periods. Virginia coal counties had statistically significant excesses for many causes of death., Conclusions: We found elevated mortality and poverty rates in coal-mining compared with non-coal-mining areas of West Virginia and VA. Future research should examine these findings in more detail at the individual level.

Surface coal mining in Appalachia has caused extensive replacement of forest with non-forested land cover, much of which is unmanaged and unproductive. Although forested ecosystems are valued by society for both marketable products and ecosystem services, forests have not been restored on most Appalachian mined lands because traditional reclamation practices, encouraged by regulatory policies, created conditions poorly suited for reforestation. Reclamation scientists have studied productive forests growing on older mine sites, established forest vegetation experimentally on recent mines, and identified mine reclamation practices that encourage forest vegetation re-establishment. Based on these findings, they developed a Forestry Reclamation Approach (FRA) that can be employed by coal mining firms to restore forest vegetation. Scientists and mine regulators, working collaboratively, have communicated the FRA to the coal industry and to regulatory enforcement personnel. Today, the FRA is used routinely by many coal mining firms, and thousands of mined hectares have been reclaimed to restore productive mine soils and planted with native forest trees. Reclamation of coal mines using the FRA is expected to restore these lands' capabilities to provide forest-based ecosystem services, such as wood production, atmospheric carbon sequestration, wildlife habitat, watershed protection, and water quality protection to a greater extent than conventional reclamation practices.

We study the potentially unnecessary costs imposed by strict performance standards for forest restoration of surface coal mines in the Appalachian region under the Surface Mining Control and Reclamation Act of 1977 (SMCRA) that can vary widely across states. Both the unnecessary private costs to the mine operator and costs to society (social costs) are reported for two performance standards, a ground cover requirement, and a seedling survival target. These standards are examined using numerical analyses under a range of site productivity class and market conditions. We show that a strict (90%) ground cover standard may produce an unnecessary private cost of more than $700/ha and a social cost ranging from $428/ha to $710/ha, as compared with a 70% standard. A strict tree survival standard of 1235 trees/ha, as compared with the more typical 1087 trees/ha standard, may produce an unnecessary private cost of approximately $200/ha, and a social cost in the range of $120 to $208/ha. We conclude that strict performance standards may impose substantial unnecessary private costs and social costs, that strict performance standards may be discouraging the choice of forestry as a post-mining land use, and that opportunities exist for reform of reforestation performance standards. Our study provides a basis for evaluating tradeoffs between regulatory efficiency and optimal reforestation effort.

Recent clinical trials indicate that type 2 diabetes can largely be prevented through lifestyle factors. In order to identify important modalities for the prevention of diabetes in medically underserved counties of Virginia (Appalachia), a questionnaire was administered to 135 at-risk individuals, having reported at least one risk factor for diabetes. The questionnaire assessed attitudes, self-efficacy, diet, and physical activity toward the prevention of type 2 diabetes. Overall, none of the respondents reported being told by a physician that they were at risk for diabetes. Overweight was the most frequently reported risk factor (87.0%), followed by physical inactivity (67.3%). More than one-third (38.9%) reported at least three diabetes symptoms. When stratified by low and high risk level, there were no significant differences in self-efficacy, control, and healthy dietary behaviors (p < .05). High risk individuals did report having lower rates of full health insurance coverage, being less active and running out of food more frequently than low risk individuals, however. The findings suggest that cost-effective prevention efforts should incorporate physician education, include screenings, and address self-efficacy enhancing strategies toward preventing type 2 diabetes.

Cribellar thread is the most primitive type of sticky prey capture thread found in aerial spider webs. Its outer surface is formed of thousands of fine fibrils that issue from a cribellum spinning field. The fibrils of primitive cribellar thread are cylindrical, whereas those of derived threads have nodes. Cribellar threads snag on insect setae but also adhere to smooth surfaces. A previous study showed empirically that cylindrical fibrils use only van der Waals forces to stick to smooth surfaces, as their stickiness is the same under different humidity. By contrast, noded fibrils are stickier under high humidity, where they are presumed to adsorb atmospheric water and implement hygroscopic (capillary) adhesion. Here, we model thread stickiness according to these two adhesive mechanisms. These models equate stickiness with the force necessary to overcome the adhesion of fibril contact points in a narrow band along each edge of the contact surface and to initiate peeling of the thread from the surface. Modeled and measured thread stickiness values are similar, supporting the operation of the hypothesized adhesive forces and portraying an important transition in the evolution of spider threads. Cribellar threads initially relied only on van der Waals forces to stick to smooth surfaces. The appearance of fibril nodes introduced hydrophilic sites that implemented hygroscopic force and increased thread stickiness under intermediate and high humidity.