Rural Appalachian Perspectives on Heart Health: Social Ecological Contexts

Mudd‐Martin, Gia; Biddle, Martha J; Chung, Misook L.; Lennie, Terry A.; Bailey, Alison L.; Casey, Baretta R.; Novak, M. John; Moser, Debra K.

doi:10.5993/ajhb.38.1.14

Cited by 20 publications

(18 citation statements)

References 60 publications

(50 reference statements)

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“…Compared to physical activity and dietary practices, even less is known about the social factors influencing tobacco use in rural settings. However, studies in rural Appalachian adults found encouragement from friends and family to be a primary motivator of smoking cessation, while frequent smoking in social circles hindered quitting efforts …”

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confidence: 99%

Support and Sabotage: A Qualitative Study of Social Influences on Health Behaviors Among Rural Adults

Sriram

Morgan

Graham

et al. 2017

The Journal of Rural Health

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Purpose Social environments exert an important influence on health behaviors, yet evidence from rural‐specific contexts is limited. This study explored how social relationships influence health‐related behaviors among midlife and older rural adults at increased risk of chronic disease. Methods Seventeen focus groups were conducted with 125 sedentary, overweight/obese adults (aged 40‐91 years) residing in “medically underserved” rural Montana towns in 2014. Groups were stratified by age (40‐64 and ≥65) and gender. Transcripts were examined thematically using NVivo software according to social influences on diet, physical activity, and tobacco use. Analyses were conducted in 2015‐2016. Results Attitudes and actions of family members and friends were key influences on health behaviors, in both health‐promoting and health‐damaging ways. In these small, isolated communities, support from and accountability to family and friends were common facilitators of behavior change and maintenance. However, expectations to conform to social norms and traditional gender roles (eg, caregiving duties) often hindered healthy lifestyle changes. Conclusions These findings suggest that health behavior interventions targeting adults in rural settings need to consider and, if possible, integrate strategies to address the impact of social relationships in both supporting and sabotaging behavior change and maintenance.

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mentioning

confidence: 99%

Support and Sabotage: A Qualitative Study of Social Influences on Health Behaviors Among Rural Adults

Sriram

Morgan

Graham

et al. 2017

The Journal of Rural Health

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“…Despite being socioeconomically disadvantaged and encountering numerous barriers to living healthy lives [16][17][18][19][20] , rural residents are more likely to be obese than urban residents, independent of diet, physical activity, and sociodemographic factors 2,3,21,22 . These studies support a growing body of research suggesting that broader neighborhood characteristics are associated with poor health outcomes independent of individual-level factors.…”

Section: Introductionmentioning

confidence: 99%

“…However, increasing education attainment is reported to be more strongly associated with declining obesity prevalence in urban compared to rural areas 2,63 . This may be due to challenges faced by rural residents to access affordable, high-quality healthy foods and opportunities for physical activity 17,[64][65][66] . Higher education may therefore be overshadowed by financial constraints and limited opportunities to engage in healthy behaviors among rural residents.…”

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confidence: 99%

Residing in economically distressed rural Appalachia is independently associated with excess body weight in college students

Abshire

Lennie

Mudd‐Martin

et al. 2017

Rural Remote Health

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A B S T R A C TIntroduction: The prevalence of obesity is greater among adults living in rural compared to urban areas of the USA. Greater obesity risk among rural adults persists after adjusting for obesity-related behaviors and sociodemographic factors. With the ruralurban obesity disparity greatest among younger adults, it is important to examine the complexity of factors that may increase the risk for excess body weight in this population so that effective preventive interventions can be implemented. College students residing in economically deprived rural areas such as rural Appalachia may be particularly at risk for excess body weight from exposure to both rural and college obesogenic environments. The purpose of this study was to determine if living in economically distressed rural Appalachia is independently associated with excess body weight among college students. Methods: College students aged 18-25 years who were lifetime residents of either rural Eastern Appalachian Kentucky (n=55) or urban Central Kentucky (n=54) participated in this cross-sectional study. Students completed questionnaires on sociodemographics, depressive symptoms, and health behaviors including smoking, fruit and vegetable intake, and physical activity. Height and weight were obtained during a brief health examination to calculate body-mass index (BMI). Excess body weight was defined as being overweight or obese with a BMI of 25 kg/m 2 or greater. Binary logistic regression was used to determine if living in economically distressed rural Appalachia was independently associated with excess body weight. Results: The prevalence of excess body weight was higher in the rural Appalachian group than the urban group (50% vs 24%, p<0.001). Depressive symptom scores and smoking prevalence were also greater in the rural Appalachian group. © DA Abshire, TA Lennie, GT Mudd-Martin, DK Moser, 2016. A Licence to publish this material has been given to James Cook University, http://www.jcu.edu.au 2There were no differences in fruit and vegetable intake and vigorous physical activity between the groups. Residing in economically distressed rural Appalachia was associated with more than a six-fold increased risk of overweight or obesity, controlling for sociodemographics, depressive symptoms, and health behaviors (odds ratio=6.36, p=0.002). Conclusions: Living in economically distressed rural Appalachia was associated with excess body weight in college students independent of sociodemographic factors, depressive symptoms, and obesity-related behaviors. Further research is needed to determine other characteristics of this region that are associated with excess body weight so that effective programs to reduce obesity risk can be implemented.

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“…The Appalachia Regional Commission (ARC) reports that per capita personal income, real wages, salaries per job, and market income are significantly lower in all communities in Appalachian areas, compared with the respective state's averages . The Appalachian region has higher disease rates of stroke and cardiovascular disease . The Appalachian region has also been the subject of numerous other health‐related investigations including studies of healthcare access and utilization of services, diabetes, and relative rates of so‐called modifiable risk factors of disease and morbidity …”

mentioning

confidence: 99%

“…6 The Appalachian region has higher disease rates of stroke and cardiovascular disease. [7][8][9] The Appalachian region has also been the subject of numerous other health-related investigations including studies of healthcare access and utilization of services, diabetes, and relative rates of so-called modifiable risk factors of disease and morbidity. [10][11][12] There have been few studies comparing the prevalence of self reported hypertension between Appalachian residents and non-Appalachian residents.…”

mentioning

confidence: 99%

Comparing the Trends of Elevated Blood Pressure in Appalachian and Non‐Appalachian Regions

Shandera-Ochsner

Han

Rose

et al. 2014

J of Clinical Hypertension

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As an established risk factor for cardiovascular disease and stroke, hypertension risks are often thought to be more prevalent in Appalachian mountain ranges when compared with other neighboring counterpart regions. This study evaluated blood pressure (BP) readings among 2358 Kentucky residents attending community stroke risk screening events held in 15 counties, including nine Appalachian counties (n=1134) and six non‐Appalachian counties (n=1224). With high BP being operationally defined as ≥140/90 mm Hg, 41.5% of Appalachian county residents had elevated BP compared with 42.6% among those from non‐Appalachian counties. Although the counties with the highest rates of elevated BP did tend to reside in the Appalachian region, there was no significant difference between rates of elevated BP in Appalachia vs non‐Appalachian counties. This dataset is proposed as a pilot project to encourage further pursuit of a larger controlled project.

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Rural Appalachian Perspectives on Heart Health: Social Ecological Contexts

Abstract: Comprehensive intervention guided by a social ecological framework is needed to address CVD risk reduction in Appalachian Kentucky communities.

Cited by 20 publications

References 60 publications

Support and Sabotage: A Qualitative Study of Social Influences on Health Behaviors Among Rural Adults

Support and Sabotage: A Qualitative Study of Social Influences on Health Behaviors Among Rural Adults

Residing in economically distressed rural Appalachia is independently associated with excess body weight in college students

Comparing the Trends of Elevated Blood Pressure in Appalachian and Non‐Appalachian Regions

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