title: Trends in cigarette smoking and obesity in Appalachian Kentucky.
abstract: OBJECTIVE
  The southern region of the United States, particularly central and southern Appalachia, has long been identified as an area of health inequities. An updated and more complete understanding of the association among the leading risk factors for such health inequities allows researchers, clinicians, and policymakers to focus their efforts on the most effective strategies to minimize these risks.
  
  
  METHODS
  Using the most recent survey data from the Behavioral Risk Factor Surveillance System, we examined 10-year trends in rates of cigarette smoking and obesity in Appalachian Kentucky, comparing these trends with national and non-Appalachian Kentucky rates.
  
  
  RESULTS
  Women and men from Appalachian Kentucky smoke cigarettes at rates 1.8 times and 1.6 times higher, respectively, than their national counterparts. Although rates of smoking in Appalachian Kentucky, non-Appalachian Kentucky, and the United States have decreased, such decreases among Appalachian Kentucky women have been minimal. Adding to these concerning trends, obesity rates in Appalachian adults are much higher than in non-Appalachian Kentucky or the United States overall, although Appalachian Kentucky smokers are less likely to be obese than nonsmokers. Low socioeconomic status and impeded access to health care characterize the Appalachian communities in which these risk behaviors occur and likely account for the prevalence of these most risky behaviors.
  
  
  CONCLUSIONS
  A continuum of approaches to address smoking and obesity is warranted. Such approaches range from ensuring access to smoking cessation programs to implementing community- and state-level policies to curb smoking and unhealthy energy balance (eg, smoke-free policies and increases in tobacco and "junk food" taxes) and culturally appropriate individual-level interventions (evidence-based smoking cessation and weight-loss programming).
authors.affiliation: From the Department of Behavioral Science and the Markey Cancer Center, University of Kentucky, Lexington, and the Barren River District Health Department, Bowling Green, Kentucky.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Schoenberg
authors.affiliation: From the Department of Behavioral Science and the Markey Cancer Center, University of Kentucky, Lexington, and the Barren River District Health Department, Bowling Green, Kentucky.
authors.forename: Bin
authors.initials: B
authors.lastname: Huang
authors.affiliation: From the Department of Behavioral Science and the Markey Cancer Center, University of Kentucky, Lexington, and the Barren River District Health Department, Bowling Green, Kentucky.
authors.forename: Srihari
authors.initials: S
authors.lastname: Seshadri
authors.affiliation: From the Department of Behavioral Science and the Markey Cancer Center, University of Kentucky, Lexington, and the Barren River District Health Department, Bowling Green, Kentucky.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Tucker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001061:Appalachian Region / Q000453:epidemiology; D005260:Female; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000209:etiology; D062486:Public Health Surveillance; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data*; D012907:Smoking / Q000453:epidemiology*; D055815:Young Adult