Appalachian communities are disproportionately affected by the leading causes of morbidity and mortality. Specifically, cancer and diabetes mortality rates are 17 percent and 33 percent above national rates. The Appalachian region also has the nation's highest cardiovascular death rates with 328.9 to 405.9 deaths per 100,000 population. A leading risk factor implicated in all of these health disparities is problematic energy balance;BRFSS data indicate that only 22 percent of Appalachian Kentuckians receive the RDI for fruit and vegetable intake, between 62-76 percent are overweight or obese, and between 45-62 percent report sedentary lives. Nationally, Kentucky ranks third in not meeting fruit and vegetable intake, #3 in overweight, #9 in obesity, and #3 for sedentary behavior. Of particularly elevated concern, the obesity rate has doubled since 1990 and Kentucky youth rank #1 in overweight and significantly lower than their national counterparts in fruit/vegetable intake and physical activity. Despite the pervasiveness of these risk factors and disease burdens, Appalachian culture contains many characteristics and structures that offer locally based solutions, including strong intergenerational ties, faith-based activism, and healthy traditional activities. Drawing on epidemiologic evidence and informed by our current successful faith-based, trained lay health advisor tailored intervention (R01CA108696), we propose to administer and evaluate an intergenerational, culturally appropriate CBPR energy balance intervention that has the potential of greatly preventing and reducing cancer, CVD, and diabetes morbidity and mortality by increasing fruit and vegetable intake, lowering BMI, and increasing physical activity. Working in partnership with 70 faith-based institutions in Appalachian Kentucky, the proposed project has three phases: Phase I (Developmental phase) will use ethnographic methods (socio-ecological inventories, key informant interviews, participant observation) to assess the barriers to and facilitators of healthy diet, weight, and physical activity;develop culturally appropriate instruments;and modify existing interventions (Healthy Body/ Healthy Spirit and We Can!) to be responsive to local culture. During Phase II, we will administer the group randomized, staggered CBPR intervention based on Healthy Body/ Healthy Spirit and NHLBI's We Can! Theoretically informed by the SCT, TTM, and socio-ecological determinants of health, the intervention will include culturally appropriate workshops (with locally relevant activities, like square dance, community gardening, story telling, and cooking classes), tailored lay health adviser visits, and motivational interviewing. Throughout the project, the RE-AIM model will inform our evaluation. During Phase III, we will undertake qualitative process evaluation interviews and evaluate consistency with CBPR principles.

Public Health Relevance

Rural Appalachian communities suffer some of the highest rates of the most common causes of death;cancer, heart disease, and diabetes. These conditions are strongly associated with being overweight and having a substandard diet and inadequate physical activity, risk factors that are pervasive in Appalachia. The proposed project works in partnership with 70 faith-based institutions in Appalachian Kentucky to develop, administer, and evaluate an intergenerational intervention that uses culturally appropriate activities and workshops to reduce overweight and increase physical activity and fruit and vegetable intake.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project (R01)
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Special Emphasis Panel (ZRG1-RPHB-K (50))
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Hunter, Christine
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University of Kentucky
Schools of Medicine
United States
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Swanson, Mark; Schoenberg, Nancy E; Davis, Rian et al. (2013) Perceptions of healthful eating and influences on the food choices of Appalachian youth. J Nutr Educ Behav 45:147-53
Schoenberg, Nancy E; Howell, Britteny M; Swanson, Mark et al. (2013) Perspectives on healthy eating among Appalachian residents. J Rural Health 29 Suppl 1:s25-34
Swanson, Mark; Schoenberg, Nancy E; Erwin, Heather et al. (2012) Perspectives on Physical Activity and Exercise among Appalachian Youth. J Phys Act Health :
Kruger, Tina M; Swanson, Mark; Davis, Rian E et al. (2012) Formative research conducted in rural Appalachia to inform a community physical activity intervention. Am J Health Promot 26:143-51
Swanson, Mark; Studts, Christina R; Bardach, Shoshana H et al. (2011) Intergenerational energy balance interventions: a systematic literature review. Health Educ Behav 38:171-97