Appalachian self-identity and its effects on cervical cancer screening and risky sexual behavior among women in Ohio Appalachia

Background: Many stereotypes and images surround the Appalachian region and its residents, but little is known how Appalachian residents view themselves. Due to the region's diversity and migration of people into Appalachia, it is of interest to identify factors associated with Appalachian self-identity, as well as its effects on health behaviors.

Objective/Purpose: The purpose is to determine the prevalence of Appalachian self-identity, to ascertain factors associated with identifying oneself as being “Appalachian,” and to examine the effect of Appalachian self-identity on factors related to cervical cancer, such as Pap smear screening habits and risky sexual behavior.

Methods: Mixed regression models using interview data on 571 women from a cervical cancer prevention study in Ohio Appalachia were utilized to construct multivariable models for each of the stated goals.

Results: Multiple factors, including time spent in current county, religious association, family ties to the area, and location within the Ohio Appalachian region, were associated with a woman identifying as “Appalachian.” In turn, Appalachian self-identity has thus far been shown to have little effect on the examined health behaviors.

Discussion/Conclusions: Appalachian self-identity was most affected by time spent in the region and location within the region. The prevalent Appalachian stereotypes of poverty and lack of education were not associated with Appalachian self-identity. While a significant number of women self-identify as “Appalachian,” it may be of little importance in trying to improve health behaviors related to cervical cancer.