1. Zinn, Caleb L. BPH
  2. Hopgood, Daniel PhD
  3. Cronin, Cory E. PhD
  4. Burns, Ashlyn MPH
  5. Lenhart, Margaret
  6. Franz, Berkeley PhD




Context: As substance use continues to be a public health crisis nationally, it disproportionately affects the Appalachian region.


Objectives: Our research seeks to explore whether there is a greater substance use burden in Appalachia and whether that burden is being prioritized in local hospital systems' community health needs assessments (CHNAs) and implementation strategies (ISs).


Setting: The setting for this study is the 13 states that are represented within the Appalachian region.


Participants: This study examines CHNAs and ISs of a stratified random sample (n = 140) representing 20% of the hospital population within the identified states (those with counties within the Appalachian region). Each sampled hospital is labeled as Appalachian or non-Appalachian based on its county designation.


Main Outcome Measures: Our main outcome measures were the percentage of hospitals listing substance abuse in their CHNAs, with comparisons between Appalachian and non-Appalachian subgroups, and percent addressing substance use in their ISs in Appalachia and non-Appalachia.


Design: Community health needs assessments and ISs produced between the years 2018 and 2021 were gathered for each hospital within the sample; each document was then coded for the inclusion of substance use. Chi-square tests and logistic regression were employed to conduct the analysis and draw conclusions.


Results: Although all non-Appalachian Counties that had substance use listed as a need within a CHNA correspondingly addressed that need in their ISs, only 75% of Appalachian counties that listed substance use a need went on to prioritize substance use in an IS. In addition, logistic regression indicated no significant link between overdose rates and addressing substance use.


Conclusions: These findings further support other literature that suggests that lack of resources is limiting Appalachian health care organizations' ability to address substance use issues.