Individuals living in rural Appalachian food deserts have among the highest cardiovascular disease (CVD) rates in the nation. Nine risk factors account for 90% of all CVD risk and eight of those factors, excluding smoking, are influenced by nutritional habits. Diet is dependent upon individual and environmental factors, particularly in rural food deserts where socioeconomic factors contribute to poor eating habits. Few researchers have developed and tested strategies aimed at improving dietary patterns in rural food deserts and there has been no significant improvement in the dietary behaviors of most rural Appalachians over the past several decades. Given the disproportionate CVD rates and economic disadvantage in this region, it is vital to develop and test cost-effective interventions that target the individual and environmental barriers to healthy eating that are specific to this region. Through a training plan that includes mentoring by a team of nursing and nutritional scientists, and formal course work, seminars and a research study, this K23 Award will engender the skills to develop and test novel interventions aimed at increasing consumption of CVD risk- reducing foods in rural Appalachia. The applicant completed her doctorate in nursing in 2011 and has since conducted preliminary studies that inform the need to develop and test individualized nutritional interventions that address the unique barriers to healthy eating in rura Appalachia. The broad hypothesis of this program of research is that nutritional behavior change interventions individualized to each participant's specific motivation and ability are more likely to yield long-term behavior change than standardized interventions delivered en masse. A pilot study will be conducted in six Appalachian food desert counties with participants in three counties serving as controls and participants in the other three counties receiving an individualized intervention.
The specific aims of the study are to: 1) test the outcome of an individualized intervention aimed at increasing consumption of CVD-risk reducing foods and 2) determine whether health literacy, financial status and risk of food insecurity moderate the effect of the intervention. Outcome variables will be measured using a food frequency questionnaire, food security survey and by monitoring monthly grocery purchases. The combination of a structured training plan and the research project will support the applicant's long-term goal of becoming an independent investigator in primary CVD prevention focused on improving nutrition. Specifically, the applicant will obtain training in the principles of a) conducting rigoous trials of individualized dietary interventions in the context of austere environments, b) assessing nutritional status and c) improving scientific productivity (grant-writing and publishing). The research study will provide the preliminary data, research skills and expertise needed to apply for R01 grant funding to conduct controlled trials of individualized interventions aimed at improving dietary patterns of individuals living in rural food deserts and other austere environments with similar barriers to healthy eating.

Public Health Relevance

The knowledge gained from this project will help fulfill the need for developing and testing individualized interventions aimed at improving eating habits and thereby, lowering risk and cost burden of heart disease in rural Appalachian food deserts. Currently, there has been little research on the effectiveness of dietary behavior change strategies aimed at reducing cardiovascular disease risk for this region, which has the country's highest heart disease rates and is one of the most economically disadvantaged areas. This research has the potential to significantly impact short and long-term heart disease rates in this and similar regions.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Mentored Patient-Oriented Research Career Development Award (K23)
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Nursing Science Review Committee (NRRC)
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Roary, Mary
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University of Kentucky
Schools of Nursing
United States
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Hardin-Fanning, Frances; Ricks, JaNelle M (2017) Attitudes, social norms and perceived behavioral control factors influencing participation in a cooking skills program in rural Central Appalachia. Glob Health Promot 24:43-52
Hardin-Fanning, Frances; Wiggins, Amanda T (2017) Food Costs Are Higher in Counties With Poor Health Rankings. J Cardiovasc Nurs 32:93-98
Hardin-Fanning, Frances; Rayens, Mary Kay (2015) Food cost disparities in rural communities. Health Promot Pract 16:383-91
Hardin-Fanning, Frances; Gokun, Yevgeniya (2014) Gender and age are associated with healthy food purchases via grocery voucher redemption. Rural Remote Health 14:2830