Research Objective: On behalf of the Appalachian Funders Network, with funding from the Robert Wood Johnson Foundation, East Tennessee State University and NORC at the University of Chicago documented the current burden of obesity, diabetes, and chronic disease mortality in central Appalachia. An analysis of county-level data was conducted in order to provide a comprehensive picture of the health condition of the region. Contributing factors, such as physical inactivity and food environment, were also investigated to determine how the built environment impacts obesity. Study Design: Several secondary data sources were utilized, including the County Health Rankings, CDC Diabetes Interactive Atlas, USDA Food Environment Atlas, and mortality data from the CDC National Center for Health Statistics, National Vital Statistics System. Variables analyzed included: adult obesity prevalence, adult diabetes prevalence, food insecurity, access to exercise opportunities, physical inactivity, and premature chronic disease mortality. The mortality analyses focused on four of the leading causes of death: heart disease, stroke, diabetes, and chronic lower respiratory disease, for persons age 25 to 64 from 2009 to 2013. When available, county-level estimates were used to create maps of the region, documenting the disparities compared to the rest of the nation. Population Studied: Health disparities were documented within the counties of central Appalachia, consisting of parts of Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia. Principal Findings: More than two-thirds (68.6%) of the 234 counties in central Appalachia have an adult obesity prevalence above the national median of 30.9% (defined as BMI over 30). Over 85% of the counties in central Appalachia have a percentage of physically inactive adults higher than the national median of 26.4% (defined as not participating in physical activity or exercise in the past 30 days). When analyzing the combined chronic disease mortality for heart disease, stroke, diabetes and chronic lower respiratory disease, the combined national mortality rate is 93.0 deaths per 100,000 population. Nearly 90% of central Appalachian counties have a higher combined morality rate, and the state mortality rate for the Appalachian region of all six states is higher than the national rate. The disparity is more pronounced in rural communities, as the rural counties of central Appalachia have a higher mortality rate than urban counties within central Appalachia and rural counties across the United States. The combined mortality rate for these four diseases is 74% higher in rural central Appalachia than urban counties nationally. Conclusions: Compared to the rest of the country, people in central Appalachia are more likely to experience and prematurely die from obesity-related chronic disease, including diabetes and heart disease. Residents of rural central Appalachia face even more significant disparities as compared to urban residents within the region and nationally. Implications for Policy or Practice: Obesity and chronic disease in central Appalachia are significant public health concerns that must be addressed in order to improve the health of the region.

No description available.

Background: Compared to other regions of the United States, people living in Appalachia bear a heavier burden from obesity related chronic conditions such as cardiovascular disease, stroke, diabetes, fibromyalgia, and sleep apnea as well as higher rates of premature mortality for those diseases. Childhood obesity in particular poses a burgeoning and understated threat to the public health system. Objectives: The purpose of this study was, working with the Appalachian Funders Network, identify the policies and practices that have a positive impact on the reduction of childhood obesity and chronic disease in central Appalachia (TN, VA, KY, WV, NC, and OH). Methods: Mixed methods approach was utilized. Survey of practitioners and funders identified efforts to reduce childhood obesity including obesity prevention, healthy eating and/or physical activity. Focus groups conducted across the region provided participant generated strategies to address gaps and needs. Results: Over 400 practitioners and 40 funders completed the survey. Eight focus groups were conducted across central Appalachia. Based on the finding, a set of recommendations to inform future grant making strategies will be compiled. Preliminary results demonstrate some areas of disconnect between funders and practitioners. Programs were more sustainable if funded from within the community rather than from an outside source. Further, the success of a program seems to be based on need and the collaboration of the practioners and funders. Conclusions: Using a mixed-methods approach, an aggregate of data provides a comprehensive picture of the current health condition of central Appalachia. Working with the Appalachian Funders Network, a group of 80 funders, the findings from this study have the potential to impact the work on practitioners and funders in the region. This collaboration hopes to promote a sustainable healthy lifestyle within Tennessee and greater Appalachia.

Background: The prevalence of diabetes is disproportionately distributed in Central Appalachia compared with other regions in the U.S. Previous research reveals that nearly 65% and 17% of patients with diabetes reported having history of cardiovascular heart disease (CHD) and coronary artery disease (CAD) respectively. This study examined the prevalence of factors associated with subclinical atherosclerosis (measured as coronary artery calcium) in patients with diabetes in geographic locations of rural Central Appalachia. Methods: The study population consisted of 2479 asymptomatic individuals from the rural Central Appalachian region of Kentucky, North Carolina, Tennessee, and Virginia between August 2012 and November 2016. Descriptive analysis was completed for the total sample size with sub analysis of individuals with diabetes. T-test was used for comparison of categorical (example: hypertension and physical inactivity) and continuous variables (example: age and BMI), respectively. In addition, multinomial logistic regression was conducted to assess the association between multiple risk factors including CAC scores, and geographic locations of patients with diabetes in rural Central Appalachia. Results: There was no significant difference between ages for diabetic and non-diabetic patients. Individual factors which are associated with diabetes include current CAC score (p<0.001, CI: 45.90 – 189.98), BMI (p<0.001, CI: 3.01 – 5.64), sedentary lifestyle (p<0.005, CI: 0.039 – 0.215), history of CAD (p<0.001, CI: 0.08 - 0.19), hypercholesterolemia (p<0.001, CI: 0.64 – 0.23), and hypertension (p<0.001, CI: 0.18 – 0.34). There was no significant correlation between geographic locations and diabetes. Among male and female genders, hypertension, hypercholesterolemia, history of CAD, sedentary lifestyle, current CAC score, and BMI have a significant positive correlation with diabetes except for self-reported obesity which only has a significant positive correlation with the female gender. Conclusion: Individual factors remain associated with diabetes across the male and female genders regardless of the geographic locations of the diabetic patients in rural Appalachia. There is strong evidence that cardiovascular related factors could be associated with diabetes across both genders in rural Central Appalachia. We suggest the implementation of evidence-based public health strategies to address the modifiable behaviors that can improve the health of people in rural Central Appalachia.

No description available.

Navigating personal identity changes through the cancer journey can be challenging, especially for women in a culture that places emphasis on traditional gender roles and values close-knit families. Drawing on a story circule approach, this study examined the intersecting identities of female cancer survivors in southern Appalachia. Stories of 29 female Appalachian cancer survivors from Northeast Tennessee and Southwest Virginia were collected via a mixed methods approach in either a day-long story circule (N-26) or an in-depth interview (N=3). Transcripts from both phases were audio-recorded and transcribed verbatim; NVivo 8.0 facilitated qualitative content analysis of the data. Inductive analysis revealed that women in this study appeared in struggle with (1) maintaining place in the family, (2) mothering, and (3) navigating physical changes. Ideas of family versus self appeared to overlap and intertwine with how women in Appalachia navigate personal identify changes through the cancer journey.

This study examines the illness narratives of female cancer survivors living in Southern Central Appalachia. Stories of 29 female Appalachian cancer survivors from northeastern Tennessee and southwcstmn Virginia were collected via a mixed methods approach in either a day-long story circle (n=26) or an in-depth interview (n=3), Qualitative content analysis was used to guide an inductive analysis of the tTanscript<;, What emerged was that as participants survived cancer, they also survived other health conditions, their intorsccting stories yielding an omnibus survivorship narrative.

Informed by a mothering-disruption framework, our study examines the illness narratives of women cancer survivors living in Southern Central Appalachia. We collected the stories of twenty-nine women cancer survivors from northeast Tennessee and southwest Virginia using a multi-phasic qualitative design. Phase I consisted of women cancer survivors participating in a day-long story circle (n=26). Phase II consisted of women cancer survivors who were unable to attend the story circle ; this sample sub-set participated in in-depth interviews (n=3) designed to capture their illness narratives. Participants' illness narratives revealed the presence of: (1) mothering-disruption whereby cancer adversely impacted the mothering role ; and (2) mothering-connection , whereby the cancer experience motivatedmother-survivors. Participants' illness narratives reflected thatthe role of mother was the preeminent role for mother-survivor and whenever there was oppositional tension between the roles of mother and survivor , the women-survivors seemed to linguistically relocate away from the survivor role and toward the mothering role. As a result , women-survivors seemingly rejected medicalization of their identities by emphasizing their mothering responsibilities , something we term motherizing.

Book Summary: Scholars of southern Appalachia have largely focused their research on men, particularly white men. While there have been a few important studies of Appalachian women, no one book has offered a broad overview across time and place. With this collection, editors Connie Park Rice and Marie Tedesco redress this imbalance, telling the stories of these women and calling attention to the varied backgrounds of those who call the mountains home.The essays of Women of the Mountain South debunk the entrenched stereotype of Appalachian women as poor and white, and shine a long-overdue spotlight on women too often neglected in the history of the region. Each author focuses on a particular individual or group, but together they illustrate the diversity of women who live in the region and the depth of their life experiences. The Mountain South has been home to Native American, African American, Latina, and white women, both rich and poor. Civil rights and gay rights advocates, environmental and labor activists, prostitutes, and coal miners—all have lived in the place called
 the Mountain South and enriched its history and culture.

No description available.