Appalachian Health and Well-Being

3. The Quest for an Appalachian Health Lifestyle

67 3 The Quest for an Appalachian Health Lifestyle Evelyn A. Knight Is there a distinctive Appalachian health lifestyle? This chapter explores the concept of health lifestyles and how research on this concept has been applied to the Appalachian region. It concludes with recommendations for researchers and practitioners engaged in addressing health issues from a lifestyle perspective. Although there is no universal definition of the term lifestyle as it is applied to health research, in the most general sense, it refers to the behaviors and life course choices individuals and groups of individuals make that have the potential to impact their health status. Based on extensive epidemiological study over the past sixty to seventy years, these behaviors and life course choices can be categorized as follows: (1) behaviors that promote improved health and lower the risks for certain diseases, such as engaging in physical activity, consuming a diet that conforms to recommended guidelines, and choosing not to use tobacco products; (2) behaviors that prevent specific health problems or identify them early, when they may be more easily treatable, such as getting immunizations or undergoing blood pressure checks or mammograms; and (3) protective behaviors that reduce the exposure to health threats, such as using a seat belt or avoiding toxic exposures in the workplace.1 A wide variety of factors,or determinants,influence individuals’health behavior choices. These include knowledge, attitudes, and beliefs regarding the behavior itself and the relationship between the behavior and one’s own health; the social norms and supports that influence beliefs and behavior; the structural or environmental factors that influence one’s perception of 68 Evelyn A. Knight what is possible; and the elements in one’s societal and physical environment that either support or hinder the behavior. The approach to the study of health behavior based on these determinants is known as the socioecological model, and it is broadly applied in research and in practice.2 Given the breadth of influences on a wide variety of health behaviors , asking whether there is an Appalachian health lifestyle implies that there are broad cultural and structural commonalities in the region that result in widespread (perhaps even unique) Appalachian lifestyle patterns that can be observed and understood in relation to those commonalities. This chapter explores the information available to support or refute this assumption by examining regionwide studies of lifestyle behaviors. Then, using the example of tobacco-related behavior research, the chapter explores what has been learned about Appalachian lifestyle patterns at a subregional level. Studying Health Lifestyle In the United States, lifestyle information is most often collected through self-reports from random samples of the population or through convenience samples of well-defined local groups, such as users of specific health facilities. These key research tools are useful for describing general population trends or specific situations, but one must exercise care when using them to draw conclusions about health disparities or unique lifestyle characteristics of a subset of the U.S. population, including Appalachia, that encompasses subregions with different histories and diverse populations. Vital Statistics. Records of vital statistics—which capture “official” events in the lives of American citizens, including birth and death—are the most complete, valid, and reliable data available for studying the health of the U.S. population. Analyses of mortality data, which are compiled from death certificates by the states and then combined into national data sets, have played a major role in highlighting regional health disparities.3 For example, cardiovascular disease is the major cause of death among adults over age 35 in every state and among all ethnic and racial groups. Yet rates of death from cardiovascular disease vary greatly across the country, even when differences in the age distribution of various populations are taken into account. Similar disparities can be observed nationally for cancer mortality rates. When looking for explanations of these differences, The Quest for an Appalachian Health Lifestyle 69 health lifestyle comes under scrutiny. For example, extensive epidemiological research has found that specific health behaviors (though not the only determinants of these disparities) contribute to high rates of death from cardiovascular disease. These include smoking, sedentary lifestyle, and diet, with smoking considered the greatest preventable cause of death among the competing lifestyle risks.4 Data on the health behaviors that contribute to death are not available from death certificates, so researchers must depend...