Residents of Distressed Appalachian Counties are at a Substantial Risk For Diabetes
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Introduction: Appalachia is a 205,000-square-mile region of the Unites States that follows the Appalachian Mountains from southern New York to northern Mississippi [Appalachian Regional Commission (ARC), 2009a]. (Figure 1) Appalachia includes all of West Virginia and parts of Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, and Virginia. Appalachia consists of 420 counties. It has a population of approximately 24 million; 42 percent of the region's population is rural, while 20 percent of the national population is. [ARC, 2009a]. Appalachia's population in 2000 was 88% non-Hispanic white, as opposed to around 70% for the rest of the United States. [ARC, 2009b].
In the early days of westward expansion, settlers of Appalachia's mountainous, often steep-sloped terrain found land adequate to support their small farms. However, as flatter, richer western land opened, Appalachia became increasingly economically marginalized. The region was slow to develop substantial urban centers, in part because of rough terrain and a shortage of roads and navigable rivers. Instead of exhibiting the mobility that characterized much of the rest of the United States, the people of Appalachia often remained on ancestral land. This resulted in a degree of isolation from the mainstream, and Appalachia became culturally distinct from the rest of the nation.
Today, Appalachia suffers from high rates of poverty, low education, high unemployment, an aging population, limited access to health care, high rates of cigarette smoking and generally poor health status [Appalachia Leadership Initiative on Cancer, 1994; Wewers et al., 2000]. Poverty and low education [Robbins et al., 2001], c...
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