Perspectives on physical activity and exercise among Appalachian youth.

BACKGROUND: Most children in the United States receive far less physical activity (PA) than is optimal. In rural, under resourced areas of Appalachian Kentucky, physical inactivity rates are significantly higher than national levels. We sought to understand children's perceptions of PA, with the goal of developing culturally appropriate programming to increase PA. METHODS: During 11 focus groups, we explored perspectives on PA among 63 Appalachian children, ages 8-17. Sessions were tape recorded, transcribed, content analyzed, and subjected to verification procedures. RESULTS: Several perspectives on PA emerged among these rural Appalachian youth, including the clear distinction between PA (viewed as positive) and exercise (viewed as negative) and an emphasis on time and resource factors as barriers to adequate PA. Additional PA determinants expressed in the focus groups are similar to those of other populations. We include children's recommendations for appealing PA programs. CONCLUSIONS: Appalachian and other rural residents contend with the loss of rural health advantages (due to declines in farming/other occupational and avocational transitions). At the same time, Appalachian residents have not benefitted from urban PA facilitators (sidewalks, recreational facilities, clubs and organized leisure activities). Addressing low PA levels requires extensive community input and creative programming.

Perceptions of smoking cessation programs in rural Appalachia.

OBJECTIVES: To identify perspectives on smoking cessation programs in Appalachian Kentucky, a region with particularly high smoking rates and poor health outcomes. METHODS: Insufficient existing research led us to conduct 12 focus groups (smokers and nonsmokers) and 23 key informant interviews. RESULTS: Several findings previously not described in this high-risk population include (1) transition from pro-tobacco culture toward advocacy for tobacco cessation approaches, (2) region-specific challenges to program access, and (3) strong and diverse social influences on cessation. CONCLUSIONS: To capitalize on changes from resistance to support for smoking cessation, leaders should incorporate culturally appropriate programs and characteristics identified here.

Formative research conducted in rural Appalachia to inform a community physical activity intervention.

PURPOSE: Despite the well-established benefits of physical activity (PA), most Americans, especially those in rural, traditionally underserved areas, engage in considerably less PA than recommended. This study examines perceived barriers to and facilitators of PA and promising organized PA programs among rural Appalachians. DESIGN: Eight focus groups and seven group key informant interviews were conducted. SETTING: This study was conducted in eastern Kentucky, in central Appalachia. SUBJECTS: One hundred and fourteen rural Appalachian residents (74% female, 91% white) participated. MEASURES: Open-ended, semistructured, and structured questions regarding perceptions of, barriers to/facilitators of, and examples of successful/failed PA programs were asked. ANALYSIS: Qualitative data analysis was conducted, including codebook development and steps taken to ensure rigor and transferability. Interrater reliability was over 94%. RESULTS: In addition to barriers that are consistent with those found in other populations, rural Appalachian residents indicated that travel time, family commitments, and inadequate community resources undermine PA. Suggested avenues to increase PA include partnership with churches and the U.S. Department of Agriculture's Cooperative Extension Service; programs that include families, are well advertised, and focus on health rather than appearance; and, underlying all suggestions, culturally relevant yet nonstereotyping activities. CONCLUSIONS: When developing PA interventions in rural Appalachia, it is important to employ community-based participatory approaches that leverage unique assets of the population and show potential in overcoming challenges to PA.