The world in our backyard

January 16, 2015 by Tessie Pollock

appalachia landscape

How research and service in Appalachia translates into underrepresented and underserved populations across the globe

With rolling hills, flowing rivers and winding roads, Ohio’s Appalachian area provides some of the most scenic settings of the state. But that geography and socioeconomic landscape becomes a challenge when it comes to health and wellness in these 32 Ohio counties. 

“People in this region suffer a disproportionate disease burden because of where they live, including less access to healthy foods, lower socioeconomic status, transportation barriers, and increased stress,” noted Electra Paskett, who serves as the Associate Director for Population Sciences at the Comprehensive Cancer Center at Ohio State.

In Appalachian Ohio, poor health determinants are significantly impacting health outcomes. Increasing rates of smoking, frequent smokeless tobacco use, lower consumption of fruits and vegetables and low physical activity rates translate into higher incidence of premature births, cancer and other chronic diseases.

“The cancer burden is significant among the residents of this geographic region,” said Mira Katz. “There are many factors that contribute to the increase in cancer rates, including risky health behaviors and fewer people using preventive healthcare services.”

“In addition, a significant portion of the population does not identify themselves as being Appalachian. They think the term has significant negative stereotypes. Many of the Ohio Appalachian residents that we have interviewed refer to themselves as Ohioans,” Katz said.

Drs. Katz and Paskett have worked together using community-engaged research strategies to develop and test interventions to increase cancer screening rates throughout Ohio’s Appalachian region to address the increased cancer mortality rates.

The other missing piece of the puzzle? Access to healthcare. Amy Ferketich focuses on behavior health interventions for Medicaid populations. She says there is a clear lack of providers in Appalachia.

“Medicaid providers in general are hard to find in Ohio, and in Appalachia, it’s even more difficult because there are not providers in every county who are willing to take new patients. There’s not even a hospital in every county,” said Ferketich.  “It’s extremely difficult for them to find a dentist who will take Medicaid. Often they’ll have to travel two counties to find a dentist who will see them. So access issues are tough, even if you have insurance-- and good insurance-- it can be difficult to find a provider.” 

Despite the greater burden and lack of resources, Appalachian populations aren’t often selected for national intervention programs.

“When we think about disparity, we generally in this country think about racial and ethnic differences,” said Mary Ellen Wewers whose research specialty is tobacco cessation with special interests in underserved populations. “The Appalachian population is 95 percent white, but there is a lot of economic distress and burden and a lack of structural resources available. Unfortunately, Appalachians are often overlooked in a lot of initiatives.”

Community Engaged Research
So how can you implement effective interventions into communities that often times are not aware of the challenges but often feel the impact? By using a collaborative research approach, referred to as community-engaged research.

“Engaging community partners in our research strengthens the relevance of the research by making the developed interventions more culturally appropriate. Over time, this collaborative approach builds trust and a long-term partnership is formed that is able to focus on emerging health issues,” said Katz.

Giving Back
“The advantage of doing community-engaged research is that there are communities all over the country that want to have a voice in the research that’s being done in their neighborhood. And that can apply to any population. There are things that people care deeply about and want to be involved in when setting the research agenda,” Wewers observed.

“We have heard stories that academic researchers have arrived in a community, completed their research, and never provide study results back to the community members. This type of behavior makes it more difficult to conduct research with certain communities. To avoid this problem, we participate in community forums to provide study results to the community and many of our community members attend an annual research seminar that Electra Paskett organizes and sponsors,” said Katz.

Another issue that community members raise is that they do not want to be in the control arm of a study. To address this concern, in a recent Ohio State study to improve colon cancer screening rates, the control counties were provided with an intervention to increase fruit and vegetable consumption. “We try to address the concern of the community, and when we know if an intervention is effective, then we disseminate the intervention to other Appalachian communities,” added Katz.

Partnerships Continue
As the State of Ohio continues its work in Appalachia, trying to address underlying problems like jobs and economic distress, the College of Public Health will continue to work on successful interventions. Plans are in place to turn small pilot programs and interventions into larger, multi-faceted research projects.

One piece of the future is certain, the strong partnerships will only continue to grow in this at-risk population. “We may look at all the terrible health outcomes, but on the other hand, many of the communities are close-knit.” says Amy Ferketich. “People look out for their neighbors, and families are important.”

 

 

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About The Ohio State University College of Public Health

The Ohio State University College of Public Health is a leader in educating students, creating new knowledge through research, and improving the livelihoods and well-being of people in Ohio and beyond.  The College's divisions include biostatistics, environmental health sciences, epidemiology, health behavior and health promotion, and health services management and policy.   It is ranked 22nd among all colleges of public health in the U.S. by U.S. News and World Report, and also includes the top 8-ranked MHA degree program.  The college’s epidemiology specialty was ranked 19th. The College provides leadership and expertise for Ohio and the world through its Center for Health Outcomes and Policy Evaluation Studies (HOPES) and Center for Public Health Practice (CPHP).