The burden of obesity disproportionately influences poor health outcomes in rural communities in the United States. Various social and environmental factors contribute to inadequate food access and availability in rural areas, influencing dietary intakes and food insecurity rates. This study aims to identify patterns related to food insecurity and fruit and vegetable consumption within a SNAP-eligible and low-income, highly obese rural Appalachian community. A prospective cohort was implemented to identify gaps in resources addressing obesity and food insecurity challenges. SAS 9.4 software was used to examine differences in dietary intakes and shopping practices among SNAP participants. Among participants (n = 152), most reported an annual household income less than USD 20,000 (n = 90, 60.4%), 29.1% reported food insecurity, and 39.5% reported receiving SNAP benefits within the last month. The overall mean FV intake was 3.46 daily servings (95% CI: 3.06–3.91) among all participants. SNAP participation was associated with food insecurity (p = 0.007) and those participating in SNAP were two times more likely to report being food insecure (OR = 2.707, 95% CI: 1.317, 5.563), relative to non-participants. These findings further depict the need for intervention, as the burden of food insecurity persists. Tailoring health-promoting initiatives to consider rurality and SNAP participation is vital for sustainable success among these populations.

Rural communities are disproportionally affected by food insecurity, making them vulnerable to the consequences of supply disruptions caused by the COVID-19 pandemic. While access to food was initially diminished due to food supply disruptions, little is known about the mechanisms through which federal emergency assistance programs impacted food access in rural populations. Through a series of five focus groups in spring 2021, we examined the impact of the COVID-19 pandemic on food access in a rural Appalachian community in Kentucky. Data were analyzed using a Grounded Theory Approach. Findings revealed the following four primary themes: food scarcity in grocery stores; expanded federal food assistance; expanded community food resources; and expanded home gardening. Participants provided details regarding the way increased federal assistance, especially expanded benefits within the Supplemental Nutrition Assistance Program, allowed them to purchase greater quantities of nutritious food. This study unveils the specific impacts of the COVID-19 pandemic on one rural population, including the influence of some social determinants of health on food insecurity. Policymakers and stakeholders should recognize the layered protection of multiple federal emergency assistance programs against food insecurity and the potential for long-term population health promotion in rural areas.

Background: Health behaviors, like diet, are influenced by a person’s culture and the society where they reside, contributing to the presence of health disparities within a unique region. Such disparities are evident in Central Appalachia where a unique cultural identity exists. Culture-based initiatives focused on improving food security and other nutritional challenges have had success in other diverse groups, yet similar interventions considering geographically tied culture, like Appalachia, are limited. Aim: This study aims to identify specific aspects of Appalachian culture that address food insecurity to inform future initiatives that may improve adult dietary habits and food security status. Methods: Qualitative data were collected from five focus groups in one rural Central Appalachian community in 2021 (n=59). Data were analyzed using Grounded Theory Approach. Results: Four primary themes related to culture and food insecurity emerged: 1) Community decline and economic hardship 2) Shifts in multigenerational food traditions 3) Response to limited food access and 4) Value of social and familial units. Participants revealed adaptations they have made in the face of geographic isolation and poverty and the pride they take in providing for themselves and one another. Conclusion: These findings indicate the people of Appalachia are unknowingly leveraging cultural practices to address food insecurity, yet the impact of these practices on nutritional status remains unknown. These results have implications for future studies and interventions in Appalachia which may have greater success by accounting for cultural influences compared to traditional approaches for reducing food insecurity in the region.

• Sugar-sweetened beverage consumption differs among Appalachian adult age groups. • Appalachian Millennials consume more sugar-sweetened beverages than older adults. • Millennials consume 6 times more calories from non-soda SSB than older adults. • Identifying SSB choices and consumption patterns inform PSE interventions.

Several environmental level factors exacerbate poor health outcomes in rural populations in the United States, such as lack of access to healthy food and locations to be physically active, which support healthy choices at the individual level. Thus, utilizing innovative place-based approaches in rural locations is essential to improve health outcomes. Leveraging community assets, like Cooperative Extension, is a novel strategy for implementing community-driven interventions. This prospective cohort study (n = 152), recruited in 2019 and surveyed again in 2020 and 2021, examined individual level changes in diet and physical activity in one rural Appalachian county. During this time, multiple community-driven interventions were implemented alongside Cooperative Extension and several community partners. Across the three-year study, the cohort indicated increases in other vegetables and water and reductions in fruits and legumes. There were also reductions in less healthy items such as French fries and sugar-sweetened beverages. The cohort also reported being less likely to engage in physical activity. Our findings suggest that key community-driven programs may have indirect effects on dietary and physical activity choices over time. Outcomes from this study are relevant for public health practitioners and community organizations working within rural Appalachian communities to address health-related behaviors.