Place, Power, and Premature Mortality: A Rapid Scoping Review on the Health of Women in Appalachia

Abstract

Objective: Appalachian women continue to die younger than in other US regions. We performed a rapid scoping review to summarize women’s health research in Appalachia from 2000 to 2019, including health topics, study populations, theoretical frameworks, methods, and findings. Data Source: We searched bibliographic databases (eg, PubMed, PsycINFO, Google Scholar) for literature focusing on women’s health in Appalachia. Study Inclusion and Exclusion Criteria: Included articles were: (1) on women’s health in Appalachia; (2) published January 2000 to June 2019; (3) peer-reviewed; and (4) written in English. We excluded studies without reported data findings. Data Extraction: Two coders reviewed articles for descriptive information to create summary tables comparing variables of interest. Data Synthesis: Two coders co-reviewed a sub-sample to ensure consensus and refine data charting categories. We categorized major findings across the social-ecological framework. Results: A search of nearly 2 decades of literature revealed 81 articles, which primarily focused on cancer disparities (49.4%) and prenatal/pregnancy outcomes (23.5%). Many of these research studies took place in Central Appalachia (eg, 42.0% in Kentucky) with reproductive or middle-aged women (82.7%). Half of the studies employed quantitative methods, and half used qualitative methods, with few mixed method or community-engaged approaches (3.7%). Nearly half (40.7%) did not specify a theoretical framework. Findings included complex multi-level factors with few articles exploring the co-occurrence of factors across multiple levels. Conclusions: Future studies should: 1) systematically include Appalachian women at various life stages from under-represented sub-regions; 2) expand the use of rigorous methods and specified theoretical frameworks to account for complex interactions of social-ecological factors; and 3) build upon existing community assets to improve health in this vulnerable population.

The importance of family relationships for the health of underserved Appalachians: An application and extension of the biobehavioral family model.

“…Specifically, the geographic isolation of rural Appalachia, exacerbated by the mountainous topography, creates worsened physical barriers to accessing healthcare resources (i.e., longer distance to hospital; Thompson et al, 2021). Additionally, with the increased hospital closures and 39% of Appalachian communities lacking consistent access to primary care providers, rural Appalachians have limited local healthcare options (Thompson et al, 2021). The high proportion of rural communities in Appalachia is approximately double that of the national average (42% vs. 20%; Thompson et al, 2021), magnifies the disparities in access to healthcare resulting in poorer health outcomes (Krometis et al, 2017; Reif et al, 1999).…”

The impact of rural structural and community health factors on postmastectomy complications among south central Appalachian breast cancer patients

“…The Appalachian region is marked by significant public health obstacles including the region's largely rural population that is double that of the national average (42% vs. 20%), 11,12 along with low socioeconomic status and educational attainment, high rates of unemployment, 13 poverty, 2 and food insecurity 14 . To compound the issue, these rural populations reside largely in mountainous regions that create added geographic barriers and isolation from health care and transportation services 2 .…”

“…To compound the issue, these rural populations reside largely in mountainous regions that create added geographic barriers and isolation from health care and transportation services 2 . These geographic disparities magnify the disproportionate lack of access to health care personnel and resources with 39% of Appalachian counties overall lacking the standard minimal amount of primary care providers and 20% without access to a local/nearby hospital 11 . The geographic and financial barriers also cause a lack of access to and availability of nutritionally adequate foods, leaving approximately 14% of Appalachians food insecure compared to 12.5% of the United States 15,14 .…”

“…2 These geographic disparities magnify the disproportionate lack of access to health care personnel and resources with 39% of Appalachian counties overall lacking the standard minimal amount of primary care providers and 20% without access to a local/nearby hospital. 11 The geographic and financial barriers also cause a lack of access to and availability of nutritionally adequate foods, leaving approximately 14% of Appalachians food insecure compared to 12.5% of the United States. 15,14 Overall, low socioeconomic status, poverty, educational attainment, 16 high rates of food insecurity, 17 transportation barriers, lack of insurance and accessibility to health care 18 have historically been associated with poorer overall health and oncologic outcomes.…”

Family Caregivers in Rural Appalachia Caring for Older Relatives With Dementia: Predictors of Service Use

“…In summary, residents of Appalachia are not generally considered when discussing health disparities. Nevertheless, rural residents of Appalachia continue to experience economic distress, with concentrated areas of high poverty, unemployment, poor health, and low education ( Thompson et al, 2021 ; Vanderpool & Huang, 2010 ). While some researchers have recognized the importance of examining health-related perceptions, beliefs, and behaviors within the cultural context of Appalachia (e.g., ARC, 2018 ; Behringer & Friedell, 2006 ; Della, 2011 ; Goins et al, 2011 ; Schoenberg et al, 2011 ), studies explicitly focused on caregiving for relatives with dementia in this region are scarce ( Wiese & Williams, 2018 ).…”