Appalachians Together Restoring the Eating Environment (APPAL-TREE)

As noted in the Biennial Report of the Director of the NIH Centers of Excellence, the NCMHD has identified Appalachian residents as a key priority population, “Conducting population-based studies for reducing the incidence and prevalence of health disparities among individuals living in different geographical regions of the United States—especially the Mississippi Delta, Appalachia, the U.S.-Mexico border region, and tribal communities—will continue to be important. 7 Appalachian Kentucky residents experience among the worst health inequities in the nation, with higher incidence and mortality from the leading causes of death than most other populations. 1-6 The main chronic health conditions-- diabetes, heart disease, certain cancers, obesity and overweight- are directly linked to suboptimal dietary intake. Between two-thirds and three quarters of Appalachian residents are considered overweight or obesity, and only one-fifth of residents consume the recommended RDI of fruits and vegetables .3 4 With the main partnership of three community-based organizations, Faith Moves Mountains (a community-based research team with ten years of culturally-based intervention experience); Community Farm Alliance (a community development organization designed to improve food production systems), and the Big Sandy Area Development District (a well-respected network that plans, promotes, and coordinates programs for regional economic, health, and social development of Appalachia) and with extensive input from our Community Advisory Board (CAB), faith partners, and Cooperative Extension, this community-academic partnership proposes to address the most modifiable risk factor for these main causes of morbidity and mortality, suboptimal diet. Through extensive input from these community partners and in Drs. Swanson and Schoenberg’s extensive community-engaged research in the Appalachian context5-7, limited access to healthy foods consistently has been mentioned as a main contributor to poor diet and many of the health inequities plaguing the region. In this three year planning grant, our community-academic collaboration will undertake three specific aims and associated activities. During Aim 1, we will conduct a community needs assessment and assets inventory, hold community forums to present this information, and meet regularly with our community partners and CAB. Our nutrition and agricultural economic research colleagues will partner with the Faith Moves Mountain community research team to use innovative and established methods, including GIS mapping, focus groups and nutritional and economic assessment techniques. During Aim 2, community forums, CAB meetings, and collaborative engagement sessions among our partners will facilitate the selection and initiation of an evidence-based pilot intervention to promote better nutrition, emphasizing food access, particularly fruits and vegetables. During Aim 3, our community-academic collaborative will implement and evaluate this pilot intervention, tracking nutritional outcomes, participant satisfaction, and costs and reporting results to Appalachian community members. We will establish an effective, culturally appropriate approach capable of dissemination to other rural, underserved areas that improved dietary intake and, ultimately, reduces pernicious health inequities in Appalachia.