title: Self-rated health in rural Appalachia: health perceptions are incongruent with health status and health behaviors.
abstract: BACKGROUND
  Appalachia is characterized by poor health behaviors, poor health status, and health disparities. Recent interventions have not demonstrated much success in improving health status or reducing health disparities in the Appalachian region. Since one's perception of personal health precedes his or her health behaviors, the purpose of this project was to evaluate the self-rated health of Appalachian adults in relation to objective health status and current health behaviors.
  
  
  METHODS
  Appalachian adults (n = 1,576) were surveyed regarding health behaviors - soda consumer (drink ≥ 355 ml/d), or non-consumer (drink < 355 ml/d), fast food consumer (eating fast food ≥ 3 times/wk) or healthy food consumer (eating fast food < 3 times/wk), smoking (smoker or non-smoker), exercise (exerciser > 30 min > 1 d/wk) and sedentary (exercise < 30 min 1 d/wk), blood pressure medication (yes, no), and self-rated health. Blood pressure was measured through auscultation and serum cholesterol measured via needle prick. Weight status was based on BMI: normal weight (NW ≥ 18.5 and < 25.0), overweight (OW ≥ 25.0 and < 30.0), and obese (OB ≥ 30.0). Jaccard Binary Similarity coefficients, odds ratios, chi-square, and prevalence ratios were calculated to evaluate the relationships among self-rated health, objective health status, and health behaviors. Significance was set at p < 0.05.
  
  
  RESULTS
  Respondents reported being healthy, while being sedentary (65%), hypertensive (76%), overweight (73%), or hyperlipidemic (79%). Between 57% and 66% of the respondents who considered themselves healthy had at least two disease conditions or poor health behaviors. Jaccard Binary Similarity coefficients and odds ratios showed the probability of reporting being healthy when having a disease condition or poor health behavior was high.
  
  
  CONCLUSIONS
  The association between self-rated health and poor health indicators in Appalachian adults is distorted. The public health challenge is to formulate messages and programs about health and health needs which take into account the current distortion about health in Appalachia and the cultural context in which this distortion was shaped.
authors.affiliation: Department of Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, WV 24901, USA. wmiller@osteo.wvsom.edu
authors.forename: Brian N
authors.initials: BN
authors.lastname: Griffith
authors.forename: Gretchen D
authors.initials: GD
authors.lastname: Lovett
authors.forename: Donald N
authors.initials: DN
authors.lastname: Pyle
authors.forename: Wayne C
authors.initials: WC
authors.lastname: Miller
mesh_terms: D000328:Adult; D001061:Appalachian Region / Q000453:epidemiology; D059026:Diagnostic Self Evaluation; D005260:Female; D015438:Health Behavior; D006305:Health Status Indicators; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000453:epidemiology; D012423:Rural Health / Q000706:statistics & numerical data*; D057185:Sedentary Behavior