Kate Beatty

• PhD Public Health Studies
• Professor (Asssociate) at East Tennessee State University

Objectives Short interpregnancy intervals are associated with preterm births. Increasing access to postpartum contraception is a preventive intervention. Best practice recommendations suggest that postpartum individuals exclusively breastfeed for up to 6 months. Conversations about these two topics tend to occur simultaneously throughout the perina...

The public health workforce continues to atrophy due to mass and early retirement, under-funding, slow hiring processes, lack of advancement opportunities, and shifting policies. Organizational research into workforce sustainability is crucial for ensuring a robust, diverse staff capable of delivering essential public health services. We examined c...

Background and Objectives To fully understand the impact of unintended pregnancy, as well as to evaluate the implementation and outcomes of programs targeted at reducing unintended pregnancy, it is critical that researchers be able to collect comprehensive data from health clinics that provide these services in vulnerable communities. Methods Our...

Objectives: Our aim was to explore postpartum individuals' experiences and perceptions of breastfeeding and International Board Certified Lactation Consultants' (IBCLC) knowledge and perceptions of maternity care practices and perceived barriers to breastfeeding among their patient populations in Appalachia. Methods: Semistructured interviews we...

Objectives Block grant funding provides federal financial support to states, with increased flexibility as to how those funds can be allocated at the community level. At the state level, block grant amounts and distributions are often based on outdated formulas that consider population measures and funding environments at the time of their creation...

Choose Well (CW) is a statewide contraceptive access initiative to reduce unintended pregnancy among patients utilizing federally funded family planning services. We examined CW's impact on contraceptive access at South Carolina federally qualified health centers from 2016 to 2019, which reported significantly higher increases in providing the full...

The Alabama Department of Public Health (ADPH) began allocating Title X funding to intrauterine device (IUD) provision at family planning clinics in 2019, instated more training opportunities, and expanded nurse practitioner scope of practice to include IUD placements. We assessed IUD provision and protocols at ADPH Title X clinics in 2016 and 2019...

Objectives: Health insurance remains an important dimension of contraceptive access. This study investigated the role of insurance in contraceptive use, access, and quality in South Carolina and Alabama. Methods: The study used a cross-sectional statewide representative survey that assessed reproductive health experiences and contraceptive use a...

Objective To assess the association of drug overdose mortality with grandparents serving as caregivers of children in Appalachia and non-Appalachia in the U.S. Methods This study used a cross-sectional design, with percent of grandparents as caregivers and overdose mortality rates being of primary interest. County-level data were combined, and des...

Objective: This study uses findings from the most recent iterations of the Public Health Workforce Interest and Needs Survey (PH WINS) to describe importance, skill level, and gaps of key public health competencies as well as characteristics associated with gaps. Design: Repeated cross-sectional analysis of the 2017 and 2021 PH WINS data. Setti...

Public health scholars have long known that social, economic and cultural factors shape health outcomes. The Appalachian region exemplifies this interaction in the observable correlation between its health disparities and measures of socioeconomic status, such as educational achievement and poverty. This chapter assesses the social determinants of...

Purpose: To investigate telehealth use for contraceptive service provision among rural and urban federally qualified health centers (FQHCs) in Alabama (AL) and South Carolina (SC) during the initial months of the COVID-19 pandemic. Methods: This is a mixed-methods study using data from the FQHC Contraceptive Care Survey and key informant intervi...

Introduction: Access to a full range of contraceptive services is essential for quality health care. Contraceptive provision practices of primary care providers play an important role in patients' decision-making about their reproductive health care. Understanding the multilevel factors influencing contraceptive care delivery in primary care settin...

Objectives: This study examined implementation of telehealth for contraceptive care among health departments (HDs) in 2 Southern US states with centralized/largely centralized governance structures during the early phase of the COVID-19 pandemic. Sustaining access to contraceptive care for underserved communities during public health emergencies i...

Appalachian Health explores major challenges and opportunities for promoting the health and well-being of the people of Appalachia, a historically underserved population. It considers health's intersection with social, political, and economic factors to shed light on the trends affecting mortality and morbidity among the region's residents. Editors...

Background: Adolescent births are associated with numerous challenges. While adolescent birth rates have declined across the U.S., disparities persist, and little is known about the extent to which broader declines are seen within Appalachia. Purpose: The purpose of this study was to examine the extent to which adolescent birth rates have declin...

Introduction: Federally qualified health centers (FQHCs) provide essential contraceptive services to low-income individuals; yet, access to all method options, notably intrauterine devices (IUDs) and implants, may be limited at non-Title X FQHCs. The South Carolina (SC) Choose Well initiative is a statewide contraceptive access initiative that was...

Purpose Access to the full range of contraceptive options is essential to providing patient-centered reproductive health care. Women living in rural areas often experience more barriers to contraceptive care than women living in urban areas. Therefore, federally funded family planning clinics are important for ensuring women have access to contrace...

This study operationalized the five dimensions of health care access in the context of contraceptive service provision and used this framework to examine access to contraceptive care at health department (HD) (Title X funded) and federally qualified health center (FQHC) (primarily non-Title X funded) clinics in South Carolina and Alabama. A cross-s...

During the COVID-19 pandemic, rural Appalachia is at great risk of unforeseen side effects including increased mortality from substance use disorders (SUDs). People living with SUDs are at increased risk for both exposure to and poor outcomes from COVID infection. The economic impacts of COVID-19 must also be considered. As rural Appalachia combats...

Objectives. To investigate differences in funding and service delivery between rural and urban local health departments (LHDs) in the United States. Methods. In this repeated cross-sectional study, we examined rural–urban differences in funding and service provision among LHDs over time using 2010 and 2016 National Association of County and City He...

Objectives: Understanding the impact of poverty on health can inform efforts to target social programs and regional economic development. This study examined the effects of poverty on health among the 95 counties of Tennessee. Methods: All of the counties of Tennessee were ranked by 5-year median household income, from the wealthiest to the poor...

Purpose Rural communities often experience higher rates of mortality than their urban counterparts, with gaps widening in the foreseeable future. However, the underlying level of socioeconomic vulnerability (area deprivation) among rural communities can vary widely. This study examines rural‐urban differences in mortality‐related outcomes within co...

Foodborne illness is a serious and preventable public health problem affecting 1 in 6 Americans with cost estimates over $50 billion annually. Local health departments license and inspect restaurants to ensure food safety and respond to reports of suspected foodborne illness. The City of St. Louis Department of Health adopted the HealthMap Foodborn...

Objective: Health department accreditation is a crucial strategy for strengthening public health infrastructure. The purpose of this study was to investigate local health department (LHD) characteristics that are associated with accreditation-seeking behavior. This study sought to ascertain the effects of rurality on the likelihood of seeking accr...

Objectives: To more clearly articulate, and more graphically demonstrate, the impact of poverty on various health outcomes and social conditions by comparing the poorest counties to the richest counties in the United States and to other countries in the world. Methods: We used 5-year averages for median household income to form the 3141 US count...

Introduction: The appropriate role of local health departments (LHDs) as a clinical service provider remains a salient issue. This study examines differences in clinical service provision among rural/urban LHDs for early periodic screening, diagnosis, and treatment (EPSDT) and prenatal care services. Methods: Data collected from the 2013 Nationa...

Residents of rural jurisdictions face significant health challenges, including some of the highest rates of risky health behaviors and worst health outcomes of any group in the country. Rural communities are served by smaller local health departments (LHDs) that are more understaffed and underfunded than their suburban and urban peers. As a result...

Background: Engagement in the core public health functions and ten essential services remains the standard for measuring local health department (LHD) performance; their role as providers of clinical services remains uncertain, particularly in rural and underserved communities. Purpose: To examine the role of LHDs as clinical service providers and...

Rural residents in the U.S. face significant health challenges, including higher rates of risky health behaviors and worse health outcomes than many other groups. Rural communities are also typically served by local health departments (LHDs) that have fewer human and financial resources than their suburban and urban peers. As a result of history an...

This secondary analysis describes the additional psychological symptoms experienced by women in substance abuse treatment who have an alcohol use disorder (AUD) in addition to a drug use disorder (DUD). Results show high levels of certain patterns of psychological symptoms, which include Paranoid Ideation, Phobic Anxiety, Anxiety, and Psychoticism,...

Accreditation of local health departments has been identified as a crucial strategy for strengthening the public health infrastructure. Rural local health departments (RLHDs) face many challenges including lower levels of staffing and funding than local health departments serving metropolitan or urban areas; simultaneously their populations experie...

Objectives: We identified the levels of joint action that led to collaboration between hospitals and local health departments (LHDs) using the hospital's community health needs assessments (CHNAs). Methods: In 2014, we conducted a content analysis of Missouri nonprofit hospitals (n = 34) CHNAs, and identified hospitals based on previously report...

BACKGROUND: Retaining participants in multi-year prospective cohort studies presents challenges, especially in urban settings. Early identification of participants at risk for attrition may enhance retention. We examine the validity of two risk for loss-to-follow-up assessments and early retention efforts in one Primary Sampling Unit during the Nat...

The Healthy People 2020 goal for the public health system is "to ensure that Federal, State, Tribal, and local health agencies have the necessary infrastructure to effectively provide essential public health services." To address this goal, Missouri established the first statewide, voluntary accreditation program of local health departments (LHDs)...

Hospitals and local health departments (LHDs) are under policy requirements from the Affordable Care Act and accreditation standards through the Public Health Accreditation Board. Tax exempt hospitals must perform a community health needs assessment (CHNA), similar to the community health assessment (CHA) required for LHDs. These efforts have led t...

Research Objective: To examine the nature of relationship between LHDs' intentions to seek Public Health Accreditation Board (PHAB) accreditation in the future and having completed within five years the three PHAB pre-requisites: community health assessment (CHA), community health improvement plan (CHIP), and the agency-wide strategic plan. Data...

Accreditation has been identified as a crucial strategy for strengthening the public health infrastructure. As agencies prepare for accreditation, it is important to understand how intentions to seek accreditation are related to the current level of readiness based on the three Public Health Accreditation Board (PHAB) prerequisites. Using the Natio...

BACKGROUND: Signs of neighborhood deterioration have been associated with a variety of health and social outcomes, independent of poverty. We examine associations between the presence of broken windows and the rate of recruitment in a pilot for the National Children's Study (NCS). The NCS will follow 100,000 prenatally-recruited children until age...

BACKGROUND: Obtaining a probability sample of pregnant women presents challenges, particularly in an urban core. We summarize the challenges encountered during a pilot study of the National Children's Study (NCS), the methods used, and how representative the sample was of city births. The NCS will follow 100,000 prenatally recruited children until...

Public Health Services and Systems Research (PHSSR) is concerned with evaluating the organization, financing, and delivery of public health services and their impact on public health. The strength of the current PHSSR evidence is somewhat dependent on the methods used to examine the field. Methods used in PHSSR articles, reports, and other document...

We present here a new method for literature reviews that utilizes citation network analysis from academic databases. Special attention is paid to the construction of the citation network in order to ensure that the sample contains key publications in the field. Keyword searches in databases can be misleading because keywords are not used consistent...

Public health services and systems research (PHSSR) is the field of study charged with evaluating the public health system. PHSSR currently lacks a clear identity integrating the many theories, approaches, and disciplines contributing to the field. Experts in PHSSR were consulted to identify 11 key published PHSSR studies. With these articles as a...

Background: As the public health system (PHS) has adapted and grown over time, the field of public health systems and services research (PHSSR) has also grown. Over many decades PHSSR has evaluated system structures, functions, and outcomes with the goal of increasing efficiency and effectiveness. The PHS is facing unprecedented challenges includin...

With limited resources and increased public health challenges facing the US, the Centers for Disease Control and Prevention and others have identified partnerships between local health departments (LHDs) and nongovernmental organizations (NGOs) as critical to the public health system. LHDs utilize financial, human, and informational resources and d...

The rapid growth of eHealth could have the unintended effect of deepening health disparities between population subgroups. Most concerns to date have focused on population differences in access to technology, but differences may also exist in the appropriateness of online health content for diverse populations. This paper reports findings from the...