Preconception health indicators: a comparison between non-Appalachian and Appalachian women

Abstract

To compare preconception health indicators (PCHIs) among non-pregnant women aged 18-44 years residing in Appalachian and non-Appalachian counties in 13 U.S. states. Data from the 1997-2005 Behavioral Risk Factor Surveillance System were used to estimate the prevalence of PCHIs among women in states with ≥1 Appalachian county. Counties were classified as Appalachian (n = 36,496 women) or non-Appalachian (n = 88,312 women) and Appalachian counties were categorized according to economic status. Bivariate and multivariable logistic regression models examined differences in PCHIs among women by (1) Appalachian residence, and (2) economic classification. Appalachian women were younger, lower income, and more often white and married compared to women in non-Appalachia. Appalachian women had significantly higher odds of reporting <high school education (adjusted odds ratio (AOR) 1.19, 95 % confidence interval (CI) 1.10-1.29), fair/poor health (AOR 1.14, 95 % CI 1.06-1.22), no health insurance (AOR 1.12, 95 % CI 1.05-1.19), no annual checkup (AOR 1.12, 95 % CI 1.04-1.20), no recent Pap test (AOR 1.20, 95 % CI 1.08-1.33), smoking (AOR 1.08, 95 % CI 1.03-1.14), <5 daily fruits/vegetables (AOR 1.11, 95 % CI 1.02-1.21), and overweight/obesity (AOR 1.05, 95 % CI 1.01-1.09). Appalachian women in counties with weaker economies had significantly higher odds of reporting less education, no health insurance, <5 daily fruits/vegetables, overweight/obesity, and poor mental health compared to Appalachian women in counties with the strongest economies. For many PCHIs, Appalachian women did not fare as well as non-Appalachians. Interventions sensitive to Appalachian culture to improve preconception health may be warranted for this population.

Fig. 1

County economic status in Appalachia. Appalachian counties are classified as: (1) distressed (below the 10th percentile for the nation), (2) at-risk (between the 10th and 25th percentile), (3) transitional (between the 25th and 75th percentile, (4) competitive (between the 75th and 90th percentile), and (5) attainment (above the 90th percentile)