Preconception Health Indicators: A Comparison Between Non-Appalachian and Appalachian Women
- 444 Downloads
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.
KeywordsPreconception 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.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
- 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.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.Henshaw, S. K. (1998). Unintended pregnancy in the United States. Family Planning Perspectives, 30(1), 24–29, 46.Google Scholar
- 8.Health, United. (2011). States, 2010: With Special Feature on Death and Dying. Hyattsville, MD: National Center for Health Statistics.Google Scholar
- 9.Appalachian Regional Commission. About ARC. Available at http://www.arc.gov/about/index.asp. Accessed October 10, 2010.
- 10.Behringer, B., & Friedell, G. H. (2006). Appalachia: where place matters in health. Prevention of Chronic Diseases, 3(4), A113.Google Scholar
- 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.Appalachian Regional Commission. (2010). County Economic Status and Distressed Areas in Appalachia. Available at http://www.arc.gov/research/SourceandMethodologyCountyEconomicStatusFY2007FY2012.asp. Accessed October 10, 2010.
- 19.Appalachian Regional Commission. (2010). Data Reports: Socioeconomic Data by County. Available at http://www.arc.gov/data. Accessed October 10, 2010.
- 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
- 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.Appalachian Regional Commission. Relative Unemployment Rates in Appalachia, 2009. Available at http://www.arc.gov/research/MapsofAppalachia.asp?MAP_ID=24. Accessed October 19, 2011.
- 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
- 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.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
- 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.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 ftp://ftp.cdc.gov/pub/Publications/dnpao/census-tract-level-state-maps-mrfei_TAG508.pdf. Accessed August 2, 2012.
- 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 http://cffpi.osu.edu/docs/RuralFoodAccessGaps.pdf. Accessed August 2, 2012.
- 36.Centers for Disease Control and Prevention. (2007). County-Specific diabetes and obesity prevalence. Available at http://www.cdc.gov/obesity/data/trends.html#County. Accessed March 29, 2011.
- 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.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