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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Introduction: Over 420,000 women aged 13-44 in Tennessee depend on publicly funded contraceptive services, yet only 42.9% receive them. Lack of access to contraception leads to unintended pregnancies, which are associated with higher rates of maternal and neonatal morbidity and mortality. This study explores perceived barriers to contraception and patient awareness of preexisting resources to mitigate such barriers in a rural region. Methods: Women with a confirmed pregnancy establishing obstetric care at East Tennessee State University’s resident clinic were offered a 20-question survey assessing demographic variables and perspectives to contraceptive care. Results: 141 survey respondents met inclusion criteria. 95.7% denied using contraception prior to conception. Of these, 24.8% reported their pregnancy was unintended. Only 59.6% reported knowing where they could access free long-acting, reversible contraception (LARC) in the community. 50.4% agreed it would be helpful to have a free community clinic providing reproductive health care. Specifically, 73.7% of participants reported they would benefit from free LARCs; 61.0% expressed need for evening hours and 67.4% for weekend hours. Conclusions: One in four women experienced an unintended pregnancy. The known risks of unintended pregnancies to the mother and fetus will likely increase secondary to recent changes in abortion policies. Two in five women reported no awareness of resources for free LARCs in our community, suggesting that knowledge about and access to contraception is lacking at a time which women need autonomy over reproductive choices the most. Initiatives which aim to educate women regarding contraceptive care and to eliminate barriers which hinder access are warranted.

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The goal of this study is to determine issues rural Appalachian residents consider most important, their perceived environmental health risk, and how community engagement can potentially improve those issues. The University of Kentucky Superfund Research Center held the Appalachian Community Health and Well-being Forum at the Letcher County Cooperative Extension Office in Eastern Kentucky. A four-member panel consisted of two local health officials, a nutrition expert, and a federal scientist; answered questions from community members. The expert panel and audience members shared concerns, success stories, and highlighted efforts to promote health in the region. Community members completed a questionnaire collecting information on perceived environmental health risk, fruit and vegetable intake, and basic demographic information. The concerns raised by community members were chronic disease, poverty, pollution, mental health, and wellness. Proposed solutions were compliance, nutrition, physical activity, education, empathy, funding, community engagement, awareness, holistic health, prevention, and insurance/policy change. The programs in place to combat these issues are FARMACY, Community Health Workers, transportation services, mobile dental vans, Kentucky River Watershed Watch, research, policy changes, and the CLIK program. The questionnaire showed that residents are aware of the types of pollution in their community and believe that illness is caused by pollution in their environment. Community residents feel that pollution is not something they should have to live with, they act to protect themselves from pollution, and likely to engage in community efforts to stop pollution in their community.