Maternal and Child Health Journal

, Volume 16, Supplement 2, pp 238–249 | Cite as

Preconception Health Indicators: A Comparison Between Non-Appalachian and Appalachian Women

  • Vanessa L. Short
  • Reena Oza-Frank
  • Elizabeth J. Conrey


To compare preconception health indicators (PCHIs) among non-pregnant women aged 18–44 years residing in Appalachian and non-Appalachian counties in 13 U.S. states. Data from the 1997–2005 Behavioral Risk Factor Surveillance System were used to estimate the prevalence of PCHIs among women in states with ≥1 Appalachian county. Counties were classified as Appalachian (n = 36,496 women) or non-Appalachian (n = 88,312 women) and Appalachian counties were categorized according to economic status. Bivariate and multivariable logistic regression models examined differences in PCHIs among women by (1) Appalachian residence, and (2) economic classification. Appalachian women were younger, lower income, and more often white and married compared to women in non-Appalachia. Appalachian women had significantly higher odds of reporting <high school education (adjusted odds ratio (AOR) 1.19, 95 % confidence interval (CI) 1.10–1.29), fair/poor health (AOR 1.14, 95 % CI 1.06–1.22), no health insurance (AOR 1.12, 95 % CI 1.05–1.19), no annual checkup (AOR 1.12, 95 % CI 1.04–1.20), no recent Pap test (AOR 1.20, 95 % CI 1.08–1.33), smoking (AOR 1.08, 95 % CI 1.03–1.14), <5 daily fruits/vegetables (AOR 1.11, 95 % CI 1.02–1.21), and overweight/obesity (AOR 1.05, 95 % CI 1.01–1.09). Appalachian women in counties with weaker economies had significantly higher odds of reporting less education, no health insurance, <5 daily fruits/vegetables, overweight/obesity, and poor mental health compared to Appalachian women in counties with the strongest economies. For many PCHIs, Appalachian women did not fare as well as non-Appalachians. Interventions sensitive to Appalachian culture to improve preconception health may be warranted for this population.


Preconception health Appalachia Disparities Socioeconomic status Behavioral Risk Factor Surveillance System Rural populations 



We thank Drs. Ruben Smith and Charlan Kroelinger (Division of Reproductive Health, Centers for Disease Control and Prevention); Dr. Larry Smith (Mississippi State Department of Health); Drs. Deborah Rosenberg and Kristin Rankin (University of Illinois, Chicago) for technical assistance and expertise. This study was supported in part by an appointment to the Applied Epidemiology Fellowship Program administered by the Council for State and Territorial Epidemiologists (CSTE) and funded by the Centers for Disease Control and Prevention (CDC) Cooperative Agreement Number 5U38HM000414.


  1. 1.
    Johnson, K., Posner, S. F., Biermann, J., et al. (2006). Recommendations to improve preconception health and health care-United States. A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR Recommendation Reports, 55(RR-6), 1–23.Google Scholar
  2. 2.
    Kramer, M. S. (1987). Determinants of low birth weight: methodological assessment and meta-analysis. Bulletin of the World Health Organization, 65(5), 663–737.PubMedGoogle Scholar
  3. 3.
    The Health Consequences of Smoking. (2004). A Report of the Surgeon General, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Atlanta, GA: U.S. Department of Health and Human Services.Google Scholar
  4. 4.
    Mulrow, C. D., Chiquette, E., Ferrer, R. L., et al. (2000). Management of chronic hypertension during pregnancy. Evidence Report/Technology Assessment (Summary), 14, 1–4.Google Scholar
  5. 5.
    Henshaw, S. K. (1998). Unintended pregnancy in the United States. Family Planning Perspectives, 30(1), 24–29, 46.Google Scholar
  6. 6.
    Korenbrot, C. C., Steinberg, A., Bender, C., et al. (2002). Preconception care: A systematic review. Maternal and Child Health Journal, 6(2), 75–88.PubMedCrossRefGoogle Scholar
  7. 7.
    Broussard, D. L., Sappenfield, W. B., Fussman, C., et al. (2011). Core state preconception health indicators: a voluntary, multi-state selection process. Maternal and Child Health Journal, 15(2), 158–168.PubMedCrossRefGoogle Scholar
  8. 8.
    Health, United. (2011). States, 2010: With Special Feature on Death and Dying. Hyattsville, MD: National Center for Health Statistics.Google Scholar
  9. 9.
    Appalachian Regional Commission. About ARC. Available at Accessed October 10, 2010.
  10. 10.
    Behringer, B., & Friedell, G. H. (2006). Appalachia: where place matters in health. Prevention of Chronic Diseases, 3(4), A113.Google Scholar
  11. 11.
    Lu, M. C., Tache, V., Alexander, G. R., et al. (2003). Preventing low birth weight: Is prenatal care the answer? Journal of Maternal-Fetal & Neonatal Medicine, 13(6), 362–380.CrossRefGoogle Scholar
  12. 12.
    Baldwin, M., & Stevenson, Y. (2001). A model for providing prenatal health care to indigenous women living in remote areas. International Journal of Circumpolar Health, 60(4), 623–631.PubMedGoogle Scholar
  13. 13.
    Laditka, S. B., Laditka, J. N., Bennett, K. J., et al. (2005). Delivery complications associated with prenatal care access for Medicaid-insured mothers in rural and urban hospitals. Journal of Rural Health, 21(2), 158–166.PubMedCrossRefGoogle Scholar
  14. 14.
    Hillemeier, M. M., Weisman, C. S., Chase, G. A., et al. (2007). Individual and community predictors of preterm birth and low birthweight along the rural-urban continuum in central Pennsylvania. Journal of Rural Health, 23(1), 42–48.PubMedCrossRefGoogle Scholar
  15. 15.
    Jesse, D. E., Seaver, W., & Wallace, D. C. (2003). Maternal psychosocial risks predict preterm birth in a group of women from Appalachia. Midwifery, 19(3), 191–202.PubMedCrossRefGoogle Scholar
  16. 16.
    Smith, L. H., & Holloman, C. H. (2011). Health status and access to health care services: a comparison between Ohio’s rural non-Appalachian and Appalachian families. Family & Community Health, 34(2), 102–110.Google Scholar
  17. 17.
    Appalachian Regional Commission. (2010). County Economic Status and Distressed Areas in Appalachia. Available at Accessed October 10, 2010.
  18. 18.
    Bloomberg, L., Meyers, J., & Braverman, M. T. (1994). The importance of social interaction: a new perspective on social epidemiology, social risk factors, and health. Health Education Quarterly, 21(4), 447–463.PubMedCrossRefGoogle Scholar
  19. 19.
    Appalachian Regional Commission. (2010). Data Reports: Socioeconomic Data by County. Available at Accessed October 10, 2010.
  20. 20.
    Centers for Disease Control and Prevention. (1995). Health insurance coverage and receipt of preventive health services-United States. MMWR Recommendations and Reports, 44(11), 219–225.Google Scholar
  21. 21.
    Weissman, J. S., Stern, R., Fielding, S. L., et al. (1991). Delayed access to health care: risk factors, reasons, and consequences. Annals of Internal Medicine, 114(4), 325–331.PubMedGoogle Scholar
  22. 22.
    Eberhardt, M. S., Ingram, D. D., Makuc, D. M., Urban and Rural Health Chartbook. (2001) National Center for Health Statistics. Hyattsville, MD.Google Scholar
  23. 23.
    Appalachian Regional Commission. Relative Unemployment Rates in Appalachia, 2009. Available at Accessed October 19, 2011.
  24. 24.
    Hatcher, J., Dignan, M. B., Turner, L. M., & Schoenberg, N. E. (2011). Predictors of cervical cancer screening for rarely or never screened rural Appalachian women. Journal of Health Care for the Poor and Underserved, 22(1), 176–193.PubMedGoogle Scholar
  25. 25.
    Paskett, E. D., McLaughlin, J. M., Lehman, A. M., et al. (2011). Evaluating the efficacy of lay health advisors for increasing risk-appropriate Pap test screening: a randomized controlled trial among Ohio Appalachian women. Cancer Epidemiology Biomarkers Prevention, 20(5), 835–843.CrossRefGoogle Scholar
  26. 26.
    Murin, S., Rafil, R., & Bilello, K. (2011). Smoking and smoking cessation in pregnancy. Clinics in Chest Medicine, 32(1), 75–91.PubMedCrossRefGoogle Scholar
  27. 27.
    Wewers, M. E., Katz, M., Fickle, D., et al. (2006). Risky behaviors among Ohio Appalachian adults. Preventing Chronic Disease, 3(4), A127.PubMedGoogle Scholar
  28. 28.
    Centers for Disease Control and Prevention. (2009). Sociodemographic differences in binge drinking among adults-14 states, 2004. MMWR Recommendations and Reports, 58(12), 301–304.Google Scholar
  29. 29.
    Centers for Disease Control and Prevention. (2010). Vital signs: Binge drinking among high school students and adults-United States, 2009. MMWR Recommendations and Reports, 59(39), 1274–1279.Google Scholar
  30. 30.
    Diala, C. C., Muntaner, C., & Walrath, C. (2004). Gender, occupational, and socioeconomic correlates of alcohol and drug abuse among U.S. rural, metropolitan, and urban residents. American Journal of Drug and Alcohol Abuse, 30(2), 409–428.PubMedCrossRefGoogle Scholar
  31. 31.
    Gardiner, P. M., Nelson, L., Shellhaas, C. S., et al. (2008). The clinical content of preconception care: nutrition and dietary supplements. American Journal of Obstetrics and Gynecology, 199(Suppl 2), S345–S356.PubMedCrossRefGoogle Scholar
  32. 32.
    Dubowitz, T., Heron, M., Bird, C. E., et al. (2008). Neighborhood socioeconomic status and fruit and vegetable intake among whites, blacks, and Mexican Americans in the United States. American Journal of Clinical Nutrition, 87(6), 1883–1891.PubMedGoogle Scholar
  33. 33.
    Lin, B., United States Department of Agriculture. (2005). Nutrition and health characteristics of low-income populations. Healthy Eating Index Agriculture Information Bulletin (No. 796-1) pp. 1–4.Google Scholar
  34. 34.
    Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention. Census tract level state maps of the modified retail food environment index (mrfei). Available at Accessed August 2, 2012.
  35. 35.
    Muamba, F., Clark, J. K., Betz, N., Food Access Gaps in Rural Ohio. (2010). Center for farmland policy innovation department of agricultural, environmental and development economics. Research Brief #2010-1 May 24, 2010. Available at Accessed August 2, 2012.
  36. 36.
    Centers for Disease Control and Prevention. (2007). County-Specific diabetes and obesity prevalence. Available at Accessed March 29, 2011.
  37. 37.
    Baum, A., Garofalo, J. P., & Yali, A. M. (1999). Socioeconomic status and chronic stress. Does stress account for SES effects on health? Annals of the New York Academy of Sciences, 896, 131–144.PubMedCrossRefGoogle Scholar
  38. 38.
    Nelson, D. E., Holtzman, D., Bolen, J., et al. (2001). Reliability and validity of measures from the Behavioral Risk Factor Surveillance System (BRFSS). Sozial- und Praventivmedizin, 46(Suppl 1), S3–S42.PubMedGoogle Scholar
  39. 39.
    Martin, J. A., Hamilton, B. E., Sutton, P. D., Ventura, S. J., Mathews, T. J., Osterman M. J. K., Division of Vital Statistics, National Center for Health Statistics. (2010). Births: Final data for 2008. National vital statistics reports. Hyattsville, MD 59(1).Google Scholar
  40. 40.
    Denham, S. A., Meyer, M. G., Toborg, M. A., & Mande, J. M. (2004). Providing health education to Appalachia populations. Journal of Holistic Nursing Practice, 18(6), 293–301.Google Scholar

Copyright information

© Springer Science+Business Media Newyork (Outside the USA) 2012

Authors and Affiliations

  • Vanessa L. Short
    • 1
  • Reena Oza-Frank
    • 2
    • 5
  • Elizabeth J. Conrey
    • 3
    • 4
  1. 1.Mississippi State Department of HealthJacksonUSA
  2. 2.Research Institute at Nationwide Children’s HospitalColumbusUSA
  3. 3.Ohio Department of HealthState Maternal and Child Health EpidemiologistColumbusUSA
  4. 4.Centers for Disease Control and PreventionAtlantaUSA
  5. 5.Department of PediatricsThe Ohio State UniversityColumbusUSA

Personalised recommendations