Higher-than-average cervical cancer incidence and mortality rates occur in Ohio Appalachia. Little is known, however, about societal norms and social determinants that affect these rates. To examine county-level sociocultural environments to plan a cervical cancer prevention program, the authorsinterviewed key informants from 17 of 29 Ohio Appalachia counties. Findingsinclude the perceived offensiveness of the term Appalachia, the importance of long-standing family ties, urban and rural areas within counties, use and acceptability of tobacco, the view that cancer is a death sentence, and the stigmatization of people with cancer. Barriers to screening included cost, lack of insurance, transportation problems, fear, embarrassment, and privacy issues. These findings highlight the important role of geography, social environment, and culture on health behaviors and health outcomes. The interviews provided information about the unique characteristics of this population that are important when developing effective strategies to address cancer-related health behaviors in this medically underserved population.
Algeo, K. (2003). Locals on local color: Imaging identity in Appalachia. Southern Cultures, 9(4), 27-54.
2.
American Cancer Society. (2005). Cancer prevention and early detection: Facts and figures, 2005. Atlanta, GA: Author.
3.
American Cancer Society. (2006). Cancer prevention and early detection: Facts and figures, 2006. Atlanta, GA: Author.
4.
Amonkar, M. M., & Madhavan, S. (2003). Compliance rates and predictors of cancer screening recommendations among Appalachian women. Journal of Health Care for the Poor and Underserved, 13, 443-460.
5.
Blackman, D. K., Bennett, E. M., & Miller, D. S. (1999). Trends in self-reported use of mammograms (1989-1997) and Papanicolaou tests (1991-1997): Behavioral risk factor surveillance system. Morbidity and Mortality Weekly Report, 48(SS-6), 1-22.
6.
Centers for Disease Control (CDC). (2002). Cancer death rates—Appalachia, 1994-1998. Morbidity and Mortality Weekly Report, 51(24), 527-529.
7.
Denham, S. A., Meyer, M. G., Toborg, M. A., & Mande, M. J. (2004). Providing health education to Appalachia populations. Holistic Nursing Practice, 18(6), 293-301.
8.
Elnicki, D. M., Morris, D. K., & Shockcor, W. T. (1995). Patientperceived barriers to preventive health care among indigent, rural Appalachian patients. Archives of Internal Medicine, 155(4), 421-424.
9.
Friedell, G. H., Tucker, T. C., McManmon, E., Moser, M., Hernandez, C., & Nadel, M. (1992). Incidence of dysplasia and carcinoma of the uterine cervix in an Appalachian population. Journal of the National Cancer Institute, 84(13), 1030-1032.
10.
Glasmeier, A. K., & Farrigan, T. L. (2003). Poverty, sustainability, and the culture of despair: Can sustainable development strategies support poverty alleviation in America's most environmentally challenged communities?Annals of the American Academy, 590, 131-149.
11.
Gosschalk, A., & Carozza, S. (2003). Cancer in rural areas. In L. D. Gamm, L. L. Hutchinson, B. J. Dabney, & A. M. Dorsey (Eds.), Rural Healthy People 2010: A companion document to Healthy People 2010(Vol. 2, pp. v-vi). College Station: Texas A&M University System Health Science Center, School of Rural Public Health, Southwest Rural Health Research Center.
12.
Hall, H. I., Rogers, J. D., Weir, H. K., Miller, D. S., & Uhler, R. J. (2000). Breast and cervical carcinoma mortality among women in the Appalachian Region of the U.S., 1976-1996. Cancer, 89(7), 1593-1602.
13.
Hall, H. I., Uhler, R. J., Coughlin, S. S., & Miller, D. S. (2002). Breast and cervical cancer screening among Appalachian women. Cancer Epidemiology, Biomarkers, and Prevention, 11(1), 137-142.
14.
Jemal, A., Murray, T., Ward, E., Samuels, A., Tiwari, R. C., Ghafoor, A., et al. (2005). Cancer Statistics, 2005. CA—A Cancer Journal for Clinicians, 55(1), 10-30.
15.
Lannin, D. R., Mathews, H. F., Mitchell, J., Swanson, M. S., Swanson, F. H., Edwards, M. S. (1998). Influence of socioeconomic and cultural factors on racial differences in latestage presentation of breast cancer. Journal of the American Medical Association, 279(22), 1801-1807.
16.
Lengerich, E. J., Tucker, T. C., Powell, R. K., Colsher, P., Lehman, E., Ward, A. J., et al. (2005). Cancer incidence in Kentucky, Pennsylvania, and West Virginia: Disparities in Appalachia. Journal of Rural Health, 21(1), 39-47.
17.
Leyden, W. A., Manos, M., Geiger, A. M., Weinmann, S., Mouchawar, J., Bischoff, K., et al. (2005). Cervical cancer in women with comprehensive health care access: Attributable factors in the screening process. Journal of the National Cancer Institute, 97(9), 675-683.
18.
Marmot, M., & Wilkinson, R. G. (1999). (Eds.). Social determinants of health. Oxford, UK: Oxford Press.
19.
Moritz, F., Farber, F. L., Bristow, R. E., & Cornelison, T. (2001). Impact of increasing Papanicolaou test sensitivity and compliance: a modeled cost and outcomes analysis. Obstetrics and Gynecology, 97(5), 781-788.
20.
Munoz, H., & Bosch, F. X. (1992). HPV and cervical neoplasia: Review of case-control and cohort studies. In N. Munoz, F. X. Bosch, K.V. Shah, & A. Meheus (Eds.), The epidemiology of cervical cancer and human papillomavirus (pp. 251-261). Lyon, France: Oxford University Press.
21.
National Cancer Institute. (2002, April 1). Centers for population health and health disparities (RFA: ES-02-009). Washington, DC: Author.
22.
Newmann, S. J, & Garner, E. O. (2005). Social inequities along the cervical cancer continuum: A structured review. Cancer Causes and Control, 16(1), 63-70.
23.
Obermiller, P. J. (1981). Labeling urban Appalachians: The role of stereotypes in the formation of ethnic group identity. Unpublished doctoral dissertation, Union Graduate School, Cincinnati, Ohio.
24.
Ohio Cancer Incidence Surveillance System. (2003). Cervical cancer in Ohio, 1996-2000. Columbus: Ohio Department of Health.
25.
Rissel, C., & Bracht, N. (1999). Assessing community needs, resources, and readiness: Building on strengths. In N. Bracht (Ed.), Health promotion at the community level: New advances (pp. 59-69). Thousand Oaks, CA: Sage.
26.
Shell, R., & Tudiver, F. (2004). Barriers to cancer screening by rural Appalachian primary care providers. Journal of Rural Health, 20(4), 368-373.
27.
Tobacco Risk Reduction Program. (2004). Comprehensive tobacco use prevention: Strategic plan 2004-2008. Columbus: Ohio Department of Health.
28.
Vellozzi, C. J., Romans, M., & Rothenberg, R. B. (1996). Delivering breast and cervical cancer screening services to underserved women, Part I: Literature review and telephone survey. Women's Health Issues, 6(2), 65-73.
29.
Wewers, M. E., Ahijevych, K. L., Chen, M. S., Dresbach, S., Kihm, K. E., & Kuun, P. A. (2000). Tobacco use characteristics among rural Ohio Appalachians. Journal of Community Health, 25(5), 377-388.
30.
Yabroff, K. R., Lawrence, W. F., King, J. C., Mangan, P., Washington, K. S.,Yi, B., et al. (2005) Geographic disparities in cervical cancer mortality: What are the roles of risk factor prevalence, screening, and use of recommended treatment?Journal of Rural Health, 21(2), 149-157.
