FUNDING :
No additional funding was received for this study .
INSTITUTIONAL REVIEW BOARD STATEMENT :
This study received Institutional Review Board approval from West Virginia University Institutional Review Board .
CORRESPONDENCE :
Jason S . Hedrick , MA Director of Academic Operations & Accreditation , Department of Medical Education , West Virginia University School of Medicine PO Box 9111 Morgantown , WV 26506 jhedric8 @ hsc . wvu . edu
14 . Drake , R . A history of Appalachia . Lexington Kentucky : University Press of Kentucky ; 2003 .
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17 . Puckett , A . Negotiating rural southern mountain Speech . In : Keef , S . E . ( eds .) Appalachian cultural competency : A guide for medical , mental health , and social services professionals . Knoxville : The University of Tennessee Press ; 2005 : 31-54 .
18 . Pritchett , C . “ Religion .” e-WV : The West Virginia Encyclopedia . https :// www . wvencyclopedia . org / articles / 54 Updated October 22 , 2010 . Accessed September 03 , 2020 .
19 . Fleming , D . B . “ John F . Kennedy .” e-WV : The West Virginia Encyclopedia . https :// www . wvencyclopedia . org / articles / 1184 November 27 , 2013 . September 3 , 2020 .
20 . Miller , D . “ Poverty .” e-WV : The West Virginia Encyclopedia . Updated August 27 , 2012 . Accessed September 9 , 2020 . https :// www . wvencyclopedia . org / articles / 1909
21 . Trotter Jr ., J . W . “ African-American Heritage .” e-WV : The West Virginia Encyclopedia . https :// www . wvencyclopedia . org / articles / 27 Updated October 19 , 2010 . Accessed September 3 , 2020 .
22 . Health Care Systems . Appalachian Regional Commission . https :// www . arc . gov / assets / research _ reports / Health _
Disparities _ in _ Appalachia _ Health _ Care _ Systems _ Domain . pdf Accessed September 10 , 2020 .
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24 . County Economic Status , Fiscal Year 2020 . Appalachian Regional Commission . https :// www . arc . gov / reports / custom _ report . asp ? REPORT _ ID = 76 Accessed September 10 , 2020 .
25 . Meit , M ., Heffernan , M ., Tenenbaum , E ., & Hoffman , T . Disease of Despair . Appalachian Regional Commission . https :// www . arc . gov / wp-content / uploads / 2020 / 06 / Appalachian DiseasesofDespairAugust2017 . pdf Published August 2017 . Accessed October 20 , 2020 .
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