KEEPING IT REAL IN THE HILLS: REPRESENTING APPALACHIA IN AMERICANA was led by leading author, journalist and media personality Craig Havighurst and panelists radio producer Kris Truelsen, artist Kathy Mattea, artist Amythyst Kiah, and music educator Ted Olson. The topic of discussion was the state of old-time and Appalachian folk music and its sounds today, and the making of Kathy Mattea’s album Calling Me Home.

Excerpt: Among the most enduring artifacts (along with certain lined-out hymns that are traceable back to sixteenth-century British churches) from the early days of European settlement in Appalachia, ballads are still in everyday use in some regional households and among certain performers, if largely outside the purview of the popular music industry. Even if reduced in range and frequency of performance from their heyday during the preindustrial and early industrial eras, ballads remain relevant today, as they are gems of compact storytelling that communicate thematically timeless narratives.

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At the 2018 Appalachian Studies Association conference, I propose to reassess the work of Appalachian-native W. C. Handy, an influential musician/composer/publisher. During his life (1873-1958), Handy was publicly revered as a successful African American entrepreneur and as a music pioneer—the “Father of the Blues” (a notion advanced by Handy himself through his myth-making autobiography). In recent years, his reputation declined, a situation likely resulting from his political conservatism, his accommodationist stance on racial matters, and a perception—particularly among younger African Americans—that he had co-opted and commodified his music from tradition (rather than innovatively renegotiating tradition). While other African American musicians from his generation have received scholarly and popular attention in recent years (Jelly Roll Morton, Lead Belly), Handy has been generally neglected. Today, few of his own recordings are in general release, while even his legendary compositions (“St. Louis Blues,” “Memphis Blues”) are seldom interpreted by contemporary musicians, probably because of a perspective that Handy’s blues compositions are generally considered as defined by and entrenched in an earlier soundscape. In my presentation, I will provide a biographical sketch of Handy, briefly discussing his upbringing in post-Civil War Florence, Alabama; his years as an itinerant teacher and musician in Alabama, Mississippi, Kentucky, and Indiana; his creatively innovative years in Memphis, Tennessee, as a regionally and then nationally recognized musician and composer; and his years of increasing financial success as a publisher based in New York City. I will suggest that one of the reasons for neglect of Handy as a culture figure was because his artistic identity was complex—he worked in folk, popular, and elite realms simultaneously without obeisance to rigid aesthetic categorizations. As a businessman he was a pragmatist. He was organized and methodical in his interpretation of traditional materials in the pursuit of marketable cultural expressions of African American cultural values that ultimately appealed to Americans on both sides of the Jim Crow Era racial divide.

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Burley tobacco--a key component in American-made cigarettes--has been produced in northeast Tennessee for well over a century. The economic importance of this crop and the peculiar nature of its production has had a profound influence on local agrarian culture. In Austin County, Tennessee--where I conducted approximately two years of ethnographic research--burley tobacco has become a marker of local identity. The crop is still transplanted, harvested, and processed manually. The work required to grow burley tobacco has been described by locals as "difficult, dirty, [and] sometimes dangerous." This is particularly true at harvest time when the five-foot plants must be cut by hand using a simple hatchet-like tool. The labor-intensive nature of the crop, the constraints of local geography (the Appalachian Mountains), and the limitations imposed by a New Deal initiative referred to as the Federal Tobacco Program kept burley tobacco farms small for much of the 20th century. Even so, the labor inputs needed to grow burley tobacco have remained high. Traditionally, Austin County farm families have met their crop's demand for labor by "swapping" work. This reciprocal tradition was made possible by the ubiquitous production of the leaf in Austin County on a relatively small-scale. An examination of the political economy of burley tobacco, particularly as it relates to Austin County, Tennessee, I identify the conditions that (1) helped to shape the reciprocal tradition and (2) that encouraged or made possible the persistence of this tradition well into the 20th century. In addition, I examine the more recent shift from reciprocal labor to wage labor--specifically the increased use of Mexican and Central American migrant farmworkers. I argue that the persistence of reciprocal labor in Austin County has influenced the ways in which rural families (particularly white, land-owning families) conceptualize burley tobacco farming and farm work. Even though most have adopted the use of migrant labor, the tradition of reciprocity contributes to locally specific ways of organizing and managing seasonal farm work. Rural families make use of many of the same strategies used nationwide by farm owners who employ seasonal migrant labor; however, the moral economy of reciprocity informs the management styles of most contemporary tobacco producers in Austin County. The social organization of burley tobacco work is further complicated by the "identity work" accomplished by farm owners. Despite their removal from the field and the curing barn, contemporary farm owner/operators continue to claim what I am calling a farmworking identity--an identity defined by an affinity to hard work, mutual aid, and respect. Both through farm work and discursive work these farm owner/operators are claiming, maintaining, and constructing the farmworking identity as it is conceptualized in Austin County. I argue that this "identity work" highlights and obscures social inequality in the field, the barn, and throughout Austin County as farmworking identities are constructed as both masculine and white. Cultural conceptions of farm work are produced locally by farmers and community members who draw on a shared work history. Although based on a notion of reciprocal labor, access to local definitions of farm work is unequal. These local constructions restrict the identities of some (i.e. women, low-income whites, and Mexican and Central American migrants) and provide others (i.e. white, male farm owners) the authority to claim conflicting identities--e.g farm owner and farmworker.

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Purpose Breastfeeding affords numerous benefits for mothers, infants, families, and communities. Rates of breastfeeding are disproportionately low in rural Appalachia. We will describe how use of the AAP CATCH Grant process aided in building a community breastfeeding coalition, conducting a breastfeeding support needs assessment, and developing interventions to promote and support breastfeeding in the region. Methods In 2005, members of a multidisciplinary regional breastfeeding coalition in Northeast Tennessee wrote and received an AAP CATCH Planning Grant. Funds supported regular meetings of the coalition, a needs assessment consisting of surveys and focus groups conducted with patients and healthcare providers in the region during 2007-2008, and dissemination of the group's findings and recommendations. Patient participants were recruited from three health departments and one Pediatric clinic in the region. Provider participants were recruited from three regional professional conferences. Surveys were entered into and analyzed using SPSS 17. Recordings of focus groups were transcribed and transcripts were reviewed to identify themes. Results 19 pregnant women in their second and third trimesters of pregnancy, 38 new mothers, and 58 healthcare providers completed a survey. Fifty five percent of new mothers reported ever having breastfed their baby. Thirty seven percent of healthcare providers identified Pediatrics, 21% Obstetrics and Gynecology, and 37% Family Medicine/Primary Care as their primary specialty. 52.6% and 81.6% of pregnant women and new mothers, respectively, reported that their healthcare provider had encouraged breastfeeding. Patients described that their healthcare providers discussed little about breastfeeding other than its benefits. Eighty-four percent of providers reported usually recommending exclusive breastfeeding during the first month of life. Only forty-eight percent of providers considered their advice on breastfeeding to be very important to mothers. Twenty-five percent of providers felt that exclusive breastfeeding for the first sixth months of life is unrealistic for many of their patients. The most commonly cited barrier by providers was that mothers had already decided not to breastfeed before they encountered them. Lack of time and lack of referral resources were other common barriers reported. Providers expressed the lowest levels of confidence in their own skills in evaluating latch, resolving problems of low milk production and breast tenderness, and knowing what referral services exist. Conclusion Patients in this sample described receiving little information about breastfeeding from their healthcare provider. Many health care providers in this region do not recognize the importance of their advice on breastfeeding and feel that breastfeeding is unrealistic for many of their patients. The use of study results by a community breastfeeding coalition to increase community awareness of the importance of breastfeeding promotion and support and to address provider concerns about barriers and educational needs will be discussed.

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Purpose While rates of breastfeeding have been increasing in the United States in recent decades, disparities exist among certain populations, including residents of the rural Southeast. Mothers’ perceptions of embarrassment, convenience, and social support related to breastfeeding may affect whether they choose to breastfeed and for how long. This study evaluated the effectiveness of a video intervention in improving perceptions of breastfeeding among pregnant women presenting for a prenatal clinic visit in rural Appalachia. Its effectiveness in increasing reported likelihood of breastfeeding was also assessed. Methods A multidisciplinary course team established a partnership with an OB/GYN clinic that serves a high volume of pregnant women. A 15 minute video addressing issues of embarrassment, convenience and social support related to breastfeeding was shown in the clinic waiting room. The video, Breastfeeding: Another Way of Saying I Love You, had been previously developed and evaluated by the Mississippi Department of Health. Pregnant women visiting the clinic during 8 days in 2009 were invited to complete an anonymous written survey immediately before and after viewing the video. The survey included items on demographics, perceptions of breastfeeding, and intention to breastfeed. Descriptive statistics were calculated. The proportion of women reporting improved perceptions of breastfeeding was compared between subgroups using chi-square testing. Mean breastfeeding perception scores were compared between subgroups and changes in women’s intention to breastfeed were evaluated. Results Before watching the video, of the 77 participants, 38.9% reported previously breastfeeding a child, 51.3% planned to breastfeed, and 25% were undecided. Consistent with demographics of the region, participants were predominantly white (91%). Twenty-six percent were teenagers and 71.5% reported having a high school education or less. After viewing the video, perceptions of embarrassment, convenience, and social support related to breastfeeding improved in a range of 39-44.2%, 37-40%, and 33.3-63% of women, respectively. Mothers who watched the video with a supportive other were more likely to report improved perceptions of embarrassment than mothers who watched the video alone (t=3.577, df=73, p=.001). Of the mothers who reported being undecided about breastfeeding prior to watching the video, 57.9% reported being more likely to breastfeed after watching the video (chi2=10.22, df=2, p=0.006). Conclusion The findings suggest this time-efficient video intervention was an effective means of improving perceptions of breastfeeding during the prenatal period among a sample of rural Appalachian women. Results indicate that its efficacy is significantly improved if pregnant women view it with a supportive other, and it is most useful in increasing likelihood of breastfeeding in women who are undecided about how they will feed their child.