The National Institutes of Health has acknowledged that residents of rural Appalachia experience among the nation's worst health and economic profiles, including disability and premature mortality stemming from elevated rates of heart disease and stroke, various cancers, diabetes, all of which are closely associated with suboptimal dietary intake, obesity, and overweight. Community members are particularly concerned about their children, who have among the highest rates of obesity, overweight, and suboptimal dietary intake in the nation. Eliminating these health disparities requires scientificaly informed community-engaged research to develop and evaluate innovative and sustainable programs and policies. For the proposed application, our community-research team will (1) use an innovative information technology CBPR method - Structured Public Involvement - to refine and tailor a package of pilot tested healthy eating interventions; (2) conduct and evaluate this package of interventions that were found to be feasible, culturally consonant, and promising during R24MD008018 and (3) build community capacity in social marketing, an innovative approach to enhance sustainability of the intervention. Our partners include the Community Farm Alliance, local school districts, the Cooperative Extension Service, and other community organizations. For the first aim, the innovative CBPR approach Structured Public Involvement will allow us to tailor the intervention while maintaining project fidelity. For the second aim, we will administer and evaluate three interrelated interventions to transform access to and intake of healthy foods for Appalachian children; (1) a school-based water campaign to decrease sugar sweetened beverage consumption (2) healthy cooking classes to encourage healthy cooking on a budget; and (3).a farmer's market-based healthy summer feeding program. Finally, in Aim 3, we will administer a CBPR-oriented approach, social marketing, to enhance sustainability, a challenge for all behavioral interventions. Through the schools, we will train teachers and administrators to teach social marketing to students, who will be encouraged to develop marketing campaigns supporting healthy diets. All of these efforts will be developed, implemented, and evaluated in conjunction with our Community Advisory Boards. As one of our local stakeholders told us, If you really are what you eat, it's no wonder so many of us are unhealthy. By developing sustainable, evidence-based programming, we aim to transform consumption patterns and the eating environment so the next generation of rural residents can overcome pernicious health disparities.
Appalachians Together Restoring the Eating Environment (Appal-TREE) uses a new CBPR technology to solicit community input, delivers a tested package of healthy diet interventions (water promotion, cooking classes, and expansion of the Summer Food Service Program via farmers markets) to Appalachian communities. Social marketing techniques will be taught to area youth as a means of promoting sustainable support for this intervention.