We Can Still Feed Ourselves: Food Sovereignty, Aid, Sickness, and Health in Eastern Kentucky

Over forty percent of eastern Kentucky residents are classified as obese. From a biomedical perspective, obesity is linked to a range of chronic diseases, including heart disease, diabetes, and high blood pressure and is caused by particular lifestyle behaviors that lead to an increase in calorie consumption and decrease in calorie expenditure. However, these links – individual behavior leads to obesity which leads to chronic disease - do not take into account a wide range of personal, social, environmental, political, and economic conditions. In addition to the assumptions of what it means to become and be obese, Kentucky is regularly ranked among the unhealthiest states in the country. In other words, assumptions are made about how people live based on their bodies as well as their geographical location. This project explores some basic questions that form the bedrock of these assumptions. I discuss three food aid programs that developed in response to the Covid-19 pandemic in the spring and summer of 2020. Participants received boxes of (mostly processed) foods and expressed both gratitude and frustration. Standardized, shelf stable food, after all, is not the most nutrient dense and often contains one or more allergens. Boxes provided food during a time of fear and uncertainty but undercut the agency of families to determine their own food needs. Next, I dive into the metabolic and anthropometric data collected over three years (2017-2019) from twenty-five participants in a fruit and vegetable walking program. Positive patterns emerged from the data, specifically concerning measures related to diabetes and heart disease. Biology is influenced by cultural products, such as access to medical care and a living wage. To contextualize the walking program and its suggestive but limited findings, I present key concerns from walking program participants and other members of the community. Then I present another factor that contributes to health and disease – disordered eating. Disordered eating is a non-standardized term and phenomenon that affectively moves between bodies. Through a combination of a validated survey (the Eating Attitudes Test) and in-depth interviews, I explore what disordered eating is, how it affects individuals and those around them, and from the various cultural and relational places it emerges. Finally, this project contests the narrative of absence that often overshadows nutritional studies of eastern Kentucky, specifically when it comes to food. Through interviews and farm visits, I paint an alternative portrait of eastern Kentucky as overflowing with gardens and fresh produce in order to encourage a turn towards food sovereignty in program development and implementation

Breastfeeding Practices Among Native Hawaiians and Pacific Islanders

Background. Breastfeeding is associated with a decreased risk of obesity in the early and adult years. Native Hawaiians and Pacific Islanders (NHPI) experience high rates of obesity which is often obfuscated with aggregated data. Using disaggregated data, we examined breastfeeding practices among NHPI. Methods. Seven databases and reference lists were searched. Two independent researchers extracted relevant studies based on predetermined criteria. Nine studies met our inclusion criteria and a meta-analysis was conducted using random-effects, inverse-various weighted models. Results. Few studies disaggregated NHPI populations when examining breastfeeding practices. Most studies were cross-sectional and our search yielded no randomized or quasirandomized control trials. The results of the meta-analysis indicated that 46.5% NHPI women initiated breastfeeding with 40.8% breastfeeding exclusively. These pooled analyses show that NHPI breastfeeding practices are below the recommended national and international goals and guidelines. Conclusion. Breastfeeding practices among NHPI are heterogeneous and critical disparities exist among certain NHPI subgroups and additional research needs to be conducted to determine the reasons for the disparity. Future studies should work to disaggregate data for NHPI and the various subpopulations. Multicomponent, multilevel strategies are needed to support breastfeeding practices among NHPI

Appalachian Environmental Health Literacy: Building Knowledge and Skills to Protect Health

Environmental health literacy (EHL) is an emerging, multidisciplinary field that promotes understanding of how environmental exposures can affect human health. After discussing the regional relevance of environmental health knowledge and skills, this article describes three ongoing Appalachian projects that are focused on measuring and building EHL

Breastfeeding Practices among Native Hawaiians and Pacific Islanders

Background. Breastfeeding is associated with a decreased risk of obesity in the early and adult years. Native Hawaiians and Pacific Islanders (NHPI) experience high rates of obesity which is often obfuscated with aggregated data. Using disaggregated data, we examined breastfeeding practices among NHPI. Methods. Seven databases and reference lists were searched. Two independent researchers extracted relevant studies based on predetermined criteria. Nine studies met our inclusion criteria and a meta-analysis was conducted using random-effects, inverse-various weighted models. Results. Few studies disaggregated NHPI populations when examining breastfeeding practices. Most studies were cross-sectional and our search yielded no randomized or quasirandomized control trials. The results of the meta-analysis indicated that 46.5% NHPI women initiated breastfeeding with 40.8% breastfeeding exclusively. These pooled analyses show that NHPI breastfeeding practices are below the recommended national and international goals and guidelines. Conclusion. Breastfeeding practices among NHPI are heterogeneous and critical disparities exist among certain NHPI subgroups and additional research needs to be conducted to determine the reasons for the disparity. Future studies should work to disaggregate data for NHPI and the various subpopulations. Multicomponent, multilevel strategies are needed to support breastfeeding practices among NHPI

Nutrition and Environmental Pollution Extension Curriculum Improved Diet-Related Behaviors and Environmental Health Literacy

Kentucky experiences some of the nation’s worst health outcomes related to obesity, diabetes, high blood pressure, and other age-related chronic diseases linked with oxidative stress and inflammation, which in turn are associated with poor diet, lack of physical activity, and exposure to certain environmental pollutants. In the Commonwealth, deteriorating infrastructure, inappropriate waste disposal, and potential occupational injury related to mining, agriculture, and other regionally important industries exacerbate the need for residents to have basic knowledge of potential environmental health threats. Unfortunately, community-level understanding of the complex connections between environmental exposures and health is limited, with many Kentuckians unaware that the Commonwealth is home to 13 hazardous waste sites included in the United States Environmental Protection Agency Superfund National Priorities List (NPL). The NPL highlights priority sites for long-term remedial action to reduce environmental contaminants. To enhance the understanding of environmental health and protective actions, the University of Kentucky Superfund Research Center Community Engagement Core developed a 9-lesson extension curriculum “Body Balance: Protect Your Body from Pollution with a Healthy Lifestyle” (Body Balance) and partnered with Kentucky’s Family and Consumer Sciences (FCS) Cooperative Extension Service to pilot the curriculum in Kentucky communities. FCS agents in 4 Kentucky counties delivered the Body Balance pilot study (18-31 participants per lesson). Pre- and post-lesson questionnaires revealed increased knowledge and awareness of the effects of environmental pollution on health and the protective role of dietary strategies. Focus group participants (n = 18) self-reported positive behavior changes because of increases in knowledge and leadership from their FCS agent. The Body Balance curriculum appeared to be a promising mechanism for raising environmental health and diet knowledge, as well as for promoting positive behavior changes among white, middle/older-aged women in rural Kentucky communities

Breastfeeding Practices among Native Hawaiians and Pacific Islanders

Background. Breastfeeding is associated with a decreased risk of obesity in the early and adult years. Native Hawaiians and Pacific Islanders (NHPI) experience high rates of obesity which is often obfuscated with aggregated data. Using disaggregated data, we examined breastfeeding practices among NHPI. Methods. Seven databases and reference lists were searched. Two independent researchers extracted relevant studies based on predetermined criteria. Nine studies met our inclusion criteria and a meta-analysis was conducted using random-effects, inverse-various weighted models. Results. Few studies disaggregated NHPI populations when examining breastfeeding practices. Most studies were cross-sectional and our search yielded no randomized or quasirandomized control trials. The results of the meta-analysis indicated that 46.5% NHPI women initiated breastfeeding with 40.8% breastfeeding exclusively. These pooled analyses show that NHPI breastfeeding practices are below the recommended national and international goals and guidelines. Conclusion. Breastfeeding practices among NHPI are heterogeneous and critical disparities exist among certain NHPI subgroups and additional research needs to be conducted to determine the reasons for the disparity. Future studies should work to disaggregate data for NHPI and the various subpopulations. Multicomponent, multilevel strategies are needed to support breastfeeding practices among NHPI