Many stereotypes and images are present about the Appalachian region and its residents, but little is known about how Appalachian residents view themselves. Due to the diversity in the region and migration of people into Appalachia, it is of interest to identify factors associated with Appalachian self-identity, as well as the relationship between Appalachian self-identity and health behaviors. The goals of this research were to determine the prevalence of Appalachian self-identity, to ascertain factors associated with Appalachian self-identity, and to examine the effect of Appalachian self-identity on factors related to cervical cancer, such as Pap smear screening habits and risky sexual behavior.
One of the aims of the Community Awareness Resources and Education (CARE) study was to investigate the interaction of environmental, societal, behavioral, and biological mechanisms as they contribute to understanding the causes and prevention of cervical cancer in Ohio Appalachia. Mixed regression models using baseline data on 571 women from the CARE study were utilized to construct multivariable models for identifying factors significantly associated with Appalachian self-identity, examining the relationship between Appalachian self-identity and Pap smear screening behaviors, and examining the relationship between Appalachian self-identity and past risky sexual behavior.
Appalachian self-identity was reported by more than 35% of participants from the Ohio Appalachian region. Multiple factors, including time spent in the current county of residence, religious affiliation, family ties to the area, and location within the Ohio Appalachian region, were associated with Appalachian self-identity. The prevalent Appalachian stereotypes of poverty and lack of education were not associated with Appalachian self-identity. In turn, Appalachian self-identity was shown to not be significantly associated with any of the measured health behaviors related to cervical cancer risk.
Overall, participants had poor health behaviors, including low Pap smear screening rates and high levels of risky sexual behavior. Thus, there is a need for future health intervention programs that address these poor health behaviors among women living in Ohio Appalachia. However, Appalachian self-identity, as measured, may not be an important characteristic to consider in targeting a population for such interventions designed to reduce cervical disease in Ohio Appalachia.