title: Disparities in underserved white populations: the case of cancer-related disparities in Appalachia.
abstract: There are meaningful cancer-related disparities in the Appalachian region of the U.S. To address these disparities, the Appalachia Community Cancer Network (ACCN), a collaboration of investigators and community partners in five states (Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia), is involved in increasing cancer education and awareness, conducting community-based participatory research (CBPR), and creating mentorship and training opportunities. The primary objective of this paper is to describe cancer-related disparities in the Appalachian region of the U.S. as an example of the disparities experienced by underserved, predominantly white, rural populations, and to describe ACCN activities designed to intervene regarding these disparities. An ACCN overview/history and the diverse activities of ACCN-participating states are presented in an effort to suggest potential useful strategies for working to reduce health-related disparities in underserved white populations. Strengths that have emerged from the ACCN approach (e.g., innovative collaborations, long-standing established networks) and remaining challenges (e.g., difficulties with continually changing communities, scarce resources) are described. Important recommendations that have emerged from the ACCN are also presented, including the value of allowing communities to lead CBPR efforts. Characteristics of the community-based work of the ACCN provide a framework for reducing health-related disparities in Appalachia and in other underserved white and rural populations.
authors.affiliation: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Columbus, Ohio, USA.
authors.forename: Electra D
authors.initials: ED
authors.lastname: Paskett
authors.forename: James L
authors.initials: JL
authors.lastname: Fisher
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Lengerich
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Schoenberg
authors.forename: Stephenie K
authors.initials: SK
authors.lastname: Kennedy
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Conn
authors.forename: Karen A
authors.initials: KA
authors.lastname: Roberto
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Dwyer
authors.forename: Darla
authors.initials: D
authors.lastname: Fickle
authors.forename: Mark
authors.initials: M
authors.lastname: Dignan
mesh_terms: D001061:Appalachian Region; D019058:Community Networks; D055812:Community-Based Participatory Research; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D008507:Medically Underserved Area; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D012424:Rural Population; D013221:State Health Plans; D044465:White People