Appalachians Together Restoring the Eating Environment (Appal-TREE): Advancing Sustainable CBPR Interventions to Improve Healthy Diet in Rural Appalachian Children

The National Institutes of Health has acknowledged that residents of rural Appalachia experience among the nation’s worst health and economic profiles, including disability and premature mortality stemming from elevated rates of heart disease and stroke, various cancers, diabetes, all of which are closely associated with suboptimal dietary intake, obesity, and overweight. Community members, acutely aware of the toll that these conditions take on their lives, are particularly concerned about children, who have the highest rates of obesity, overweight, and suboptimal dietary intake in the nation. Eliminating these most significant and intractable health disparities first requires scientifically informed community- engaged research to develop and evaluate innovative and sustainable programs and policies. Over the past decade and with the support of R24MD008018, we established the community priority of increasing access to and consumption of healthy food among vulnerable rural children; developed an intervention framework and mapping tool; and pilot tested a package of culturally appropriate interventions. For the proposed application, our community-research team will (1) use an innovative information technology CBPR method—Structured Public Involvement- to refine and tailor the package of pilot tested healthy eating interventions; (2) conduct and evaluate this package of interventions that were found to be feasible, culturally consonant, and promising during R24MD008018 and (3) administer an innovative approach to enhance sustainability of the intervention. Our partners include Community Farm Alliance as well as with several local school districts, the Cooperative Extension Service, and several community organizations (federally qualified health clinics, faith-based institutions, local food activists). For the first aim, we will apply an innovative CBPR approach to culturally tailor these interventions to our target rural communities. Although the county in which we pilot tested the intervention package is similar culturally, economically, and demographically, the Structured Public Involvement approach, an information technology application that allows us to precisely incorporate local assets into the intervention and avoid problems. For the second aim, we will administer and evaluate three interrelated interventions to transform access to and intake of healthy foods for Appalachian children; (1) a school-based water campaign to decrease sugar sweetened beverage consumption (2) healthy cooking classes to encourage healthy cooking on a budget; and (3).a farmer’s market-based healthy summer feeding program. Finally, in Aim 3, we will administer a CBPR-oriented approach, social marketing, to enhance sustainability, a challenge for all behavioral interventions. Through the schools, we will train teachers and administrators to teach social marketing to students, who will be encouraged to develop and update social media approaches to encourage consumption of healthy food. All of these efforts will be developed, implemented, and evaluated in conjunction with our Community Advisory Board, as shown in our intervention map. As one of our local stakeholders told us, “If you really are what you eat, it’s no wonder so many of us are unhealthy.” Working for sustainable, evidence-based programming, we aim to transform consumption patterns and the eating environment so the next generation of rural residents can overcome pernicious health disparities