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No description available.

Substance abuse has become a major health concern in Appalachia. In pockets of rural Appalachia, poor economic prospects, high unemployment rates, limited transportation networks, long distances to medical facilities, and a scarcity of treatment facilities and service organizations influence a community's ability to cope with the production, distribution, and use of drugs, illicit and otherwise. Data for the region indicate that the substances of choice include alcohol, tobacco, prescription drugs, methamphetamine, marijuana, and newer versions of drugs as they become available.1, 2 Anecdotal evidence also indicates the presence of rolling addictions in Appalachia, such as from OxyContin to hydrocodone to Acomplia.3, 4.

The purpose of this study was to evaluate a conference based program designed to enable 26 Appalachian teams to create intervention plans to address substance abuse in their communities. In March 2006, 26 Appalachian teams attended a conference to address substance abuse in their region. Teams of four to seven stakeholders generated community plans. The teams were evaluated 8 months later using a framework based on an adaptation of the Health Belief Model. Team leaders participated in structured telephone interviews. Results of this study found that the most common benefit to promulgating plans was community support. The most indicated barrier was time. The majority of teams believed that their community was susceptible to substance abuse problems. The cues that were most responsible for action were public awareness campaigns that emphasized the problems associated with substance abuse. The common denominator for team success was the ability to recruit key stakeholders and the ability to integrate with other organizations. The results of this study suggest that substance abuse is a threat to the health of the region. More effort on the part of communities will be needed to solve this problem. It will not be solved by a single agency, philosophy or program strategy, but must include multiple stakeholder participation.

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Background: Context and purpose of the study. To examine (1) associations between county-level zoning to support farmers' market placement and county-level farmers' market availability, rural/urban designation, percent African American residents, and percent of residents living below poverty and (2) individual-level associations between zoning to support farmers' markets; fruit and vegetable consumption and body mass index (BMI) among a random sample of residents of six North Carolina (NC) counties. Methods: Zoning ordinances were scored to indicate supportiveness for healthy food outlets. Number of farmers' markets (per capita) was obtained from the NC-Community Transformation Grant Project Fruit and Vegetable Outlet Inventory (2013). County-level census data on rural/urban status, percent African American, and percent poverty were obtained. For data on farmers' market shopping, fruit and vegetable consumption, and BMI, trained interviewers conducted a random digit dial telephone survey of residents of six NC counties (3 urban and 3 rural). Pearson correlation coefficients and multilevel linear regression models were used to examine county-level and individual-level associations between zoning supportiveness, farmers' market availability, and fruit and vegetable consumption and BMI. Results: At the county-level, healthier food zoning was greater in more urban areas and areas with less poverty. At the individual-level, self-reported fruit and vegetable consumption was associated with healthier food zoning. Conclusions: Disparities in zoning to promote healthy eating should be further examined, and future studies should assess whether amending zoning ordinances will lead to greater availability of healthy foods and changes in dietary behavior and health outcomes.

Using data from the Third National Health and Nutrition Examination Survey, we assessed measures of puberty in U.S. girls in relation to blood lead levels to determine whether sexual maturation may be affected by current environmental lead exposure. The study sample included 1,706 girls 8-16 years old with pubic hair and breast development information; 1,235 girls 10-16 years old supplied information on menarche. Blood lead concentrations (range = 0.7-21.7 pg/dL) were categorized into three levels: 0.7-2.0, 2.1-4.9, and 5.0-21.7 μg/dL. Sexual maturation markers included self-reported attainment of menarche and physician determined Tanner stage 2 pubic hair and breast development. Girls who had not reached menarche or stage 2 pubic hair had higher blood lead levels than did girls who had. For example, among girls in the three levels of blood lead described above, the unweighted percentages of 10-year-olds who had attained Tanner stage 2 pubic hair were 60.0, 51.2, and 44.4%, respectively, and for girls 12 years old who reported reaching menarche, the values were 68.0, 44.3, and 38.5%, respectively. The negative relation of blood lead levels with attainment of menarche or stage 2 pubic hair remained significant in logistic regression even after adjustment for race/ethnicity, age, family size, residence in metropolitan area, poverty income ratio, and body mass index. In conclusion, higher blood lead levels were significantly associated with delayed attainment of menarche and pubic hair among U.S. girls, but not with breast development.

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Swimming is a very popular sport among adolescents in the US. Little is known about the diet of competitive adolescent swimmers in the US but data from other countries indicate several inadequacies, including excessive intake of fat and lower than recommended intake of carbohydrate and several micronutrients that may affect athletic performance and bone accrual. We assessed usual diet, using a food frequency questionnaire and calcium checklist, among 191 adolescent males and females [91 swimmers (mean 13.7, s = 2.5 years) and 100 non-athletes (mean 14.4, s = 2.8 years)]. For both males and females, swimmers and non-athletes generally had similar average intakes of macro- and micro-nutrients, including higher than recommended amounts of total fat (36%) and saturated fat (12%), and inadequate amounts of calcium, vitamin D, and daily servings of fruits, vegetables, grains, and dairy products. This first study of nutritional intake among adolescent swimmers in the US suggests that dietary habits of adolescents who swim competitively may jeopardize optimal athletic performance and place them at risk for future chronic diseases, including osteoporosis.

Objective Because farmers' markets include a variety of fruits and vegetables, shopping at farmers' markets would likely improve diet quality among low-income consumers, as well as promote sustainable direct farm-to-consumer business models. However, not much is known about how to promote farmers' market shopping among low-income consumers. Therefore, the purpose of the present paper was to examine barriers to and facilitators of shopping at farmers' markets and associations between shopping at farmers' markets and self-reported dietary behaviours (fruit and vegetable, sugar-sweetened beverage and fast-food consumption) and BMI. Design Cross-sectional analyses of associations between farmers' market shopping frequency, awareness of markets, access to markets, dietary behaviours and BMI. Setting Department of Social Services, Pitt County, eastern North Carolina, USA. Subjects Between April and July 2013, Supplemental Nutrition Assistance Program (SNAP) participants (n 205) completed a quantitative survey. Results Barriers to shopping at farmers' markets included does not accept SNAP/electronic benefit transfer, out of the way and lack of transportation. Farmers' market shopping was associated with awareness of farmers' markets (estimate =0·18 (se 0·04), P<0·001). Fruit and vegetable consumption was positively associated with farmers' market shopping (estimate =1·06 (se 0·32), P=0·001). Conclusions Our study is one of the first to examine SNAP participants' farmers' market shopping, distance to farmers' markets and dietary behaviours. Barriers to shopping at farmers' markets and increasing awareness of existing markets should be addressed in future interventions to increase SNAP participants' use of farmers' markets, ultimately improving diet quality in this high-risk group.