Preconception Health Indicators: A Comparison Between Non-Appalachian and Appalachian Women

Abstract

To compare preconception health indicators (PCHIs) among non-pregnant women aged 18-44 years residing in Appalachian and non-Appalachian counties in 13 U.S. states. Data from the 1997-2005 Behavioral Risk Factor Surveillance System were used to estimate the prevalence of PCHIs among women in states with ≥1 Appalachian county. Counties were classified as Appalachian (n = 36,496 women) or non-Appalachian (n = 88,312 women) and Appalachian counties were categorized according to economic status. Bivariate and multivariable logistic regression models examined differences in PCHIs among women by (1) Appalachian residence, and (2) economic classification. Appalachian women were younger, lower income, and more often white and married compared to women in non-Appalachia. Appalachian women had significantly higher odds of reporting <high school education (adjusted odds ratio (AOR) 1.19, 95 % confidence interval (CI) 1.10-1.29), fair/poor health (AOR 1.14, 95 % CI 1.06-1.22), no health insurance (AOR 1.12, 95 % CI 1.05-1.19), no annual checkup (AOR 1.12, 95 % CI 1.04-1.20), no recent Pap test (AOR 1.20, 95 % CI 1.08-1.33), smoking (AOR 1.08, 95 % CI 1.03-1.14),<5 daily fruits/vegetables (AOR 1.11, 95 % CI 1.02-1.21), and overweight/obesity (AOR 1.05, 95 % CI 1.01-1.09). Appalachian women in counties with weaker economies had significantly higher odds of reporting less education, no health insurance, <5 daily fruits/vegetables, overweight/obesity, and poor mental health compared to Appalachian women in counties with the strongest economies. For many PCHIs, Appalachian women did not fare as well as non-Appalachians. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptInterventions sensitive to Appalachian culture to improve preconception health may be warranted for this population.

The Effect of Perceived Stress on Epstein-Barr Virus Antibody Titers in Appalachian Ohio Women

“…Appalachian populations generally have higher rates of smoking and obesity, along with higher rates of substance abuse and mental health problems such as depression and anxiety, than those living outside of the region [4,5] . These stressors and disparity are not unique or different from other low-income segments of the US population.…”

Correlates of risky alcohol use among women from Appalachian Ohio.

“…A study of 298 smokers from Appalachian Ohio (67% female) found that a significant proportion, 59.4% of the sample, reported heavy episodic drinking in the past two weeks (Davison, Shoben, Pasch, & Klein, 2016). Examination of a national sample of women found that heavy episodic drinking was less prevalent among Appalachian compared to non-Appalachian women (Short et al, 2012), and that it was more common among women with higher economic status. Additional research focused on rural populations has found that alcohol use is more common among those with lower economic status.…”

Making the Case: The Importance of Using 10 Key Preconception Indicators in Understanding the Health of Women of Reproductive Age

“…Although the 45 core PCH indicators were proposed based on valid and reliable sources, 3 no research had reported estimates for all 45 developed indicators. 4–6 In addition, due to heterogeneity of state policies and needs, and the multiple surveillance systems used to calculate PCH indicators, 7 condensing the large number of indicators to an integrated and comprehensive set was recommended. The PCHHC Initiative noted the need for more focused measurement of PCH and PCC and suggested that a short list of population-level indicators be identified from the 45 core indicators.…”

“…14 An assessment of PCH indicators comparing women’s health behaviors among Appalachian and non-Appalachian counties highlighted the impact of the economy on PCH. 6 Additional PCH indicator research focused on certain PCH conditions, including mental distress, 5 risky behaviors, and chronic conditions. 15 Still other research assessed the impact of maternal PCH behaviors on infant outcomes.…”