Links Between Appalachian Culture & Links Between Appalachian Culture &

Diabetes prevention Diabetes prevention
Links Between Appalachian Culture & Links Between Appalachian Culture &
Diabetes prevention Diabetes prevention
Sharon A. Denham, DSN, RN Sharon A. Denham, DSN, RN
Professor Emerita, Ohio University School of Nursing Professor Emerita, Ohio University School of Nursing
Project Director, Strengthening Communities in Appalachia to Prevent Project Director, Strengthening Communities in Appalachia to Prevent
Diabetes Diabetes
Sharon A. Denham, DSN, RN Sharon A. Denham, DSN, RN
Professor Emerita, Ohio University School of Nursing Professor Emerita, Ohio University School of Nursing
Project Director, Strengthening Communities in Appalachia to Prevent Project Director, Strengthening Communities in Appalachia to Prevent
Diabetes Diabetes
Appalachia Appalachia Appalachia Appalachia
W W SeveraI famiIy generations? SeveraI famiIy generations?
W W Born and raised in the region? Born and raised in the region?
W W Years of residence in the region? Years of residence in the region?
W W One parent versus both parents? One parent versus both parents?
resident of an ppaIachian region? resident of an ppaIachian region?
ow income ow income
High poverty High poverty
imited education imited education
Poor Iiving standards Poor Iiving standards
Job deficits Job deficits
High unempIoyment High unempIoyment
Out Out- -migration migration
Stagnation Stagnation
DecIine DecIine
ppaIachian RegionaI DeveIopment: ppaIachian RegionaI DeveIopment:
11 states (360 counties) 11 states (360 counties)
1967: 13 states/393 counties 1967: 13 states/393 counties
1991: 399 counties 1991: 399 counties
1998: 402 counties 1998: 402 counties
2002: 410 counties 2002: 410 counties
2008: 420 counties 2008: 420 counties
Some homogenous, others diverse. Some homogenous, others diverse.
ack of urbanization in some areas. ack of urbanization in some areas.
RuraI area Iags behind ruraI merica. RuraI area Iags behind ruraI merica.
Distressed vs non Distressed vs non- -distressed. distressed.
entaI heaIth entaI heaIth
OraI heaIth OraI heaIth
CardiovascuIar disease/strokes CardiovascuIar disease/strokes
Diabetes Diabetes
Obesity epidemic Obesity epidemic
Cancer Cancer
EnvironmentaI risks EnvironmentaI risks
Substance abuse Substance abuse
ind ind
Outgoing Outgoing
Openhearted Openhearted
HeIpfuI HeIpfuI
SpirituaI beIiefs or faith in God SpirituaI beIiefs or faith in God
FamiIy vaIues FamiIy vaIues
Strong moraI vaIues Strong moraI vaIues
sense of community sense of community
Commitment & dedication to work Commitment & dedication to work
utuaI respect utuaI respect
HospitaIity HospitaIity
Pride Pride

ationaI Obesity (2008)
Obesity Obesity Obesity Obesity
ighest obesity prevalence was found in Alabama,
Kentucky, Louisiana, Mississippi, South Carolina,
and West Virginia. Ìn those states, 70% of counties
had obesity prevalence of 30.% or greater.

Diabetes (2008)
%he "Diabetes Belt¨ %he "Diabetes Belt¨ %he "Diabetes Belt¨ %he "Diabetes Belt¨
%wo paths-
One strung through
%ennessee, entucky and
West Virginia, and
nother running eastward
from ouisiana through
ississippi, Iabama,
Georgia and South CaroIina.
BRFSS O 7.8±0.6%
BRFSS US 7.2±0.6%
Diabetes Management Diabetes Management Diabetes Management Diabetes Management
Appalachia & Diabetes Appalachia & Diabetes
Risks Risks
Appalachia & Diabetes Appalachia & Diabetes
Risks Risks
W W ccess & affordabiIity issues ccess & affordabiIity issues
W W Few heaIth care Few heaIth care
providers/speciaIists providers/speciaIists
W W Uninsured or under Uninsured or under- -insured insured
W W Wait & see attitudes Wait & see attitudes
W W UnheaIthy IifestyIe behaviors UnheaIthy IifestyIe behaviors
Who is at Risk? Who is at Risk? Who is at Risk? Who is at Risk?
W %hose that consume unhealthy
foods.
W %hose that fail to get enough
activity.
W %hose with a family history.
W %hose living in the Appalachian
region.
W Women.
ost vaIuabIe asset owned. ost vaIuabIe asset owned.
Promotes responsibiIity & provides a stabIe Iiving environment. Promotes responsibiIity & provides a stabIe Iiving environment.
CriticaI source of weaIth accumuIation & economic security. CriticaI source of weaIth accumuIation & economic security.
ChiIdren often more IikeIy to thrive in homes that are owned rather than ChiIdren often more IikeIy to thrive in homes that are owned rather than
rented. rented.
Benefits communities by promoting good citizenship, civic participation, & Benefits communities by promoting good citizenship, civic participation, &
stabIe sociaI networks. stabIe sociaI networks.
Security in pIace. Security in pIace.
It's God's creation and a Ioved pIace. It's God's creation and a Ioved pIace.
CoIIective meaning. CoIIective meaning.
Why wouId anyone wouId ever want to Why wouId anyone wouId ever want to
Ieave? Ieave?
Some hesitancy about seeking medicaI Some hesitancy about seeking medicaI
care in other pIaces. care in other pIaces.
Gain information from famiIy & friends Gain information from famiIy & friends
Get famiIy input before decision Get famiIy input before decision- -making making
arratives & story arratives & story- -teIIing teIIing
"Stuck in the Story" "Stuck in the Story"
Woman often primary decision Woman often primary decision- -makers makers
imited choices in IocaI markets imited choices in IocaI markets
Concerns about food insecurity Concerns about food insecurity
utritionaI wasteIands for the poor utritionaI wasteIands for the poor
Enjoy food as part of sociaI experiences Enjoy food as part of sociaI experiences
Exercise is not naturaI Exercise is not naturaI
ack knowIedge about energy baIance ack knowIedge about energy baIance
"BibIe BeIt" "BibIe BeIt"
Women IikeIy more active church Women IikeIy more active church
goers goers
Sense of purpose Sense of purpose
DiscipIined Iives DiscipIined Iives
Faith & medicaI care Faith & medicaI care
SkepticaI about "systems" or SkepticaI about "systems" or
outsiders. outsiders.
CuIturaI differences of foreign CuIturaI differences of foreign- -born born
providers. providers.
FamiIy roIe as decision FamiIy roIe as decision- -maker. maker.
arge distances from regionaI arge distances from regionaI
centers. centers.
ack speciaIists. ack speciaIists.
Fear of medications causing Fear of medications causing
addictions. addictions.
any underinsured & uninsured. any underinsured & uninsured.
BuiId trust reIationships. BuiId trust reIationships.
Both parents often work outside the Both parents often work outside the
home. home.
Becoming more egaIitarian: Becoming more egaIitarian:
generationaI differences. generationaI differences.
PatriarchaI decision PatriarchaI decision- -making more making more
stereotype than reaIity. stereotype than reaIity.
other is orchestrator's of famiIy other is orchestrator's of famiIy
heaIth. heaIth.
FamiIies want to care for their own. FamiIies want to care for their own.
any Iack medicaI knowIedge. any Iack medicaI knowIedge.
eed heaIth messages in cIear eed heaIth messages in cIear
Ianguage. Ianguage.
eed to know about prevention & eed to know about prevention &
heaIthy IifestyIes. heaIthy IifestyIes.
Not Monolithic Not Monolithic
Most raise children properly Most raise children properly
Most have well Most have well- -kept homes kept homes
One One- -sided exploitation (tell the whole sided exploitation (tell the whole
story) story)
'Difference between being poor and being 'Difference between being poor and being
'Sorry'" 'Sorry'"
Avoid Stereotypes Avoid Stereotypes Avoid Stereotypes Avoid Stereotypes
Great strides have
repIaced the
conditions faced by
many ppaIachian
peopIe in the past.
Citizen Action Citizen Action Citizen Action Citizen Action
No One is Coming No One is Coming
to Help us... We to Help us... We
must help must help
ourselves! ourselves!
www.diabetesfamily.net www.diabetesfamily.net
Kentucky, Ohio, Kentucky, Ohio,
Mississippi, and Mississippi, and
Virginia Virginia
11 distressed 11 distressed
counties counties
5 year $2.5 million 5 year $2.5 million
project project
Sharon A. Denham Sharon A. Denham
denham@ohio.edu denham@ohio.edu
Sharon A. Denham Sharon A. Denham
denham@ohio.edu denham@ohio.edu