Rural Appalachian residents experience the nation's highest rates of serious respiratory illnesses, with Appalachian Kentuckians twice as likely to be diagnosed with adult asthma and chronic obstructive pulmonary disease as their national counterparts. In response to community concern and to address the critical need to reduce respiratory health disparities in Appalachia, we draw on our decade-long community-academic partnership to undertake three aims and activities: (1) to investigate the extent, nature, and source of respiratory health inequities, we will implement a community-engaged assessment of environmental and individual-level exposures; (2) to enhance community knowledge about respiratory illness and refine a culturally appropriate environmental public health action strategy (EPHAS), we will disseminate results from the epidemiologic assessment and gather input to refine the EPHAS; and (3) to test the efficacy of the EPHAS, we will implement and evaluate a three arm RCT involving self-management and home modification. Outcomes include appropriate health care use; improvement in quality of life, pulmonary function, respiratory illness knowledge and self-efficacy; extent of community participation; and programmatic satisfaction. The proposed application is responsive to Research to Action: Assessing and Addressing Community Exposures to Environmental Contaminants (PA-12-153), encouraging community-engagement projects designed to investigate the potential health risks of environmental exposures of concern to a community and to implement an environmental public health action plan based on research findings. The proposed community-academic effort represents the first of its kind to undertake a comprehensive environmental, behavioral, and social determinants assessment, leading to a community-endorsed environmental public health action strategy to rectify Appalachian respiratory health inequities.
Residents of Rural Appalachia have the nation's highest rates of respiratory disease (asthma, chronic obstructive pulmonary disease, etc.). This project is the first to (1) study the many factors-environmental, social, and behavioral- that may account for this health inequity and (2) test an innovative approach to improve respiratory health. We draw on our long standing partnerships with several community groups-- a community research organization, a community coalition/advisory board, local media, and health, education, and faith organizations- to do an epidemiologic assessment, share the results, and then implement and evaluate an environmental public health strategy.