Britteny M. Howell

Picturing health: a photovoice pilot of Latina girls' perceptions of health.

The purpose of this study was to conduct a pilot participatory needs assessment, using Photovoice to engage in a critical dialogue with preadolescent Latina girls about their perceptions of health and immediate health concerns. Seven Latina girls participated in the Photovoice study and held a photography exhibition for the community to display their photographs and quotes from their discussions. Eight themes about being healthy emerged. Conducting a needs assessment, which concentrates on the voices and needs of these girls, can be the first step to creating successful and cost-efficient programs and interventions specifically suited to this group.

Community strategies to address cancer disparities in Appalachian Kentucky.

Central Appalachian residents suffer disproportionate health disparities, including an all-cancer mortality rate 17% higher than the general population. During 10 focus groups and 19 key informant interviews, 91 Appalachian residents identified cancer screening challenges and strategies. Challenges included (1) inadequate awareness of screening need, (2) insufficient access to screening, and (3) lack of privacy. Strategies included (1) witnessing/storytelling, (2) capitalizing on family history, (3) improving publicity about screening resources, (4) relying on lay health advisors, and (5) bundling preventive services. These insights shaped our community-based participatory research intervention and offered strategies to others working in Appalachia, rural locales, and other traditionally underserved communities.

What Motivates Older Adults to Improve Diet and Exercise Patterns

Dietary intake and physical activity are lifestyle behaviors that are learned, developed, and practiced throughout an individual’s lifetime. These lifestyle behaviors have a profound role on health and quality of life—with late-life changes still resulting in notable improvements. Despite well documented benefits of behavior change, such changes are extremely challenging. The purpose of this study is to better understand from the perspective of older adults themselves, the factors that may influence their likelihood of making lifestyle changes. Participants were recruited two primary care clinics. 104 older adults ranging in age from 65 to 95 were included. Participants were interviewed about their motivations and plans to change diet and physical activity behaviors following a routine primary care visit. All interviews were transcribed and transcripts were analyzed using a line-by-line coding approach. Older adults reported that their likelihood of making a lifestyle change related to perceptions of old age, personal motivation, and perceived confidence in the ability to make effective changes. These findings suggest the importance of creating more positive images of old age and tailoring health promotion efforts to older adults’ motivations and confidence in their ability to make behavior changes.

Perceptions of Smoking Cessation Programs in Rural Appalachia

OBJECTIVES To identify perspectives on smoking cessation programs in Appalachian Kentucky, a region with particularly high smoking rates and poor health outcomes. METHODS Insufficient existing research led us to conduct 12 focus groups (smokers and nonsmokers) and 23 key informant interviews. RESULTS Several findings previously not described in this high-risk population include (1) transition from pro-tobacco culture toward advocacy for tobacco cessation approaches, (2) region-specific challenges to program access, and (3) strong and diverse social influences on cessation. CONCLUSIONS To capitalize on changes from resistance to support for smoking cessation, leaders should incorporate culturally appropriate programs and characteristics identified here.

The Long-Term Effects of a Coal Waste Disaster on Social Trust in Appalachian Kentucky

In October 2000, a coal impoundment structure emptied more than 300 million gallons of toxic coal waste into the streams of Martin County, Kentucky. This study compares surveys conducted in the months following the disaster with surveys administered 10 years later to determine the long-term impacts of the disaster on trust in government, corporations, and experts. We find that the social trust levels in Martin County partially recovered in the 10 years since the impoundment rupture. This suggests that technological disasters, including those that result in toxic contamination, do not always permanently damage the social fabric of the communities that experience them. However, some factors suggest that Martin County’s recovery in trust may be unwarranted, which, in turn, raises concerns about this community’s susceptibility to environmental hazards and possible future disasters.

Older Patients’ Recall of Lifestyle Discussions in Primary Care

Despite the known benefits of engaging in healthy diet and physical activity across the life span, suboptimal diet and physical inactivity are pervasive among older adults. While health care providers can promote patients’ engagement in health behaviors, patient recall of recommendations tends to be imperfect. This study sought to better understand older adults’ recall of dietary and physical activity discussions in primary care. One hundred and fifteen adults aged 65 and older were interviewed immediately following a routine primary care visit on whether and what they recalled discussing pertaining to diet and physical activity. Compared against transcripts, most patients accurately recalled their diet and physical activity discussions. The inclusion of a recommendation, and for diet discussions longer duration, increased the likelihood of patient recall for these health behavior discussions. These findings suggest that specific recommendations and an extra minute of discussion, at least for dietary discussions, increase the likelihood of accurate patient recall.

Acceptability and Feasibility of Physical Activity Assessment Methods for an Appalachian Population

Nowhere is improving understanding and accurate assessment of physical activity more important for disease prevention and health promotion than among health disparities populations such as those residing in rural and Appalachian regions. To enhance accurate assessment of physical activity and potentially improve intervention capacity, we conducted a mixed-methods study examining the acceptability and feasibility of self-report physical activity questionnaires, pedometers, and accelerometers among rural Appalachian children, adolescents, and adults. Most participants reported positive experiences with all three physical activity assessment tools. Several acceptability ratings differed by age group and by sex within each age group. With very few exceptions, no significant differences in acceptability were found by race, education, employment status, health status, BMI categories, income levels, or insurance status within age groups or overall. Several factors may impact the choice of the physical activity assessment method, including target population age, equipment cost, researcher burden, and potential influence on physical activity levels. Children and adolescents appear to have more constraints on when they can wear pedometers and accelerometers. While pedometers are inexpensive and convenient, they may influence physical activity levels, rather than simply measure them. Accelerometers, while less influential on behavior, consume extensive resources, including high purchase costs and researcher burden.

Yaqui Homeland And Homeplace: The Everyday Production of Ethnic Identity

Yaqui Homeland and Homeplace is the result of more than sixteen months of ethnographic fieldwork spread out over ten years among the Yaqui of northern Mexico. The book, written by anthropologist Kirstin Erickson, consists of eight chapters arranged into two parts—“Narrating Place, Articulating Identity” and “The Articulation of Gender and Ethnicity.” The book also contains a SpanishEnglish glossary, a Yaqui-English glossary, and an appendix of selected narrative transcriptions.