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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Wewers ME, Katz M, Fickle D, Paskett ED. Risky behaviors among Ohio Appalachian adults. Prev Chronic Dis [serial online] 2006 Oct. Available from: http://www.cdc.gov/pcd/issues/2006/oct/06_0032.htm.
Wilde PE, Peterman JN. Individual weight change is associated with household food security status. J Nutr. 2006;136(5):1395-400
Williams KJ, Taylor CA, Wolf KN, Lawson RF, Crespo R. Cultural perceptions of healthy weight in rural Appalachian youth. Rural and Remote Health. 2008; 8: 932. (Online). Available from: http://www.rrh.org.au.
Willi C, Bodenmann P, Ghali W, Faris P, Cornuz J. Active Smoking and the Risk of Type 2 Diabetes: A Systematic Review and Meta-analysis. JAMA. 2007;298(22):2654-2664.
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