Disparities in Underserved White Populations: The Case of Cancer-Related Disparities in Appalachia

Abstract

There are meaningful cancer-related disparities in the Appalachian region of the U.S. To address these disparities, the Appalachia Community Cancer Network (ACCN), a collaboration of investigators and community partners in five states (Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia), is involved in increasing cancer education and awareness, conducting community-based participatory research (CBPR), and creating mentorship and training opportunities. The primary objective of this paper is to describe cancerrelated disparities in the Appalachian region of the U.S. as an example of the disparities experienced by underserved, predominantly white, rural populations, and to describe ACCN activities designed to intervene regarding these disparities. An ACCN overview/history and the diverse activities of ACCN-participating states are presented in an effort to suggest potential useful strategies for working to reduce health-related disparities in underserved white populations. Strengths that have emerged from the ACCN approach (e.g., innovative collaborations, long-standing established networks) and remaining challenges (e.g., difficulties with continually changing communities, scarce resources) are described. Important recommendations that have emerged from the ACCN are also presented, including the value of allowing communities to lead CBPR efforts. Characteris-

Cancer Incidence in Appalachia, 2004–2011

“…For all sites combined, Appalachia has higher rates of cancer regardless of sex, race, or region, consistent with previously reported findings (11,16,(18)(19)(20)(21)(22)(23). However, our data show that the gap has narrowed over time, with the exception of oral cavity and pharynx, larynx, lung and bronchus, and thyroid cancers.…”

“…Additional tobacco-related cancers that were elevated in Appalachia regions are urinary bladder, esophagus (men only), colon and rectum, cervix, and kidney and renal pelvis (women only). Other studies have shown varying results (16,18,19,23). CDC data show that among both males and females, the average smoking prevalence is higher for states in each Appalachian region compared with the United States (20% among males and 16% among females): 27% and 20% Southern region; 25% and 20% Central region; and 22% and 20% Northern region, among males and females, respectively (27).…”

“…Other studies were limited to specific cancer sites and states, implied cancer incidences based on hospitalizations, or were limited to cancer mortality rates (11,(13)(14)(15)(16)(18)(19)(20)(21)(22)(23)(24). This analysis improved upon the article by Wingo and colleagues by using a broader time period (eight versus three years) and having complete population coverage (100% vs. 88%; ref.…”

Risk Factors for Smoking in Rural Women: The Role of Gender-Based Sexual and Intimate Partner Violence

“…[1][2][3][4] Although cancer of the lung and bronchus is elevated in Ohio Appalachia, the greatest disparity in incidence and mortality for smoking-attributable cancer is observed for cancer of the cervix. 4 Among Ohio Appalachian women, from 2000 to 2004, the average annual age-adjusted cervical cancer incidence rate was 9.7 per 100,000 and mortality rate was 3.4 per 100,000-rates 24.4% and 41.7% higher, respectively, than among non-Appalachian residing women.…”

“…(2) What is the distribution of smoking status (never, former, and current) by intimate partner and/or sexual GBV exposure among Ohio Appalachian women? (3) What is the association between cumulative exposure to a spectrum of intimate partner and/or sexual GBV abuse types and current smoking behavior among Ohio Appalachian women, accounting for other known risk factors for smoking among women in this region, including depression, age, and adult socioeconomic position?…”