"Youth Are More Aware and Intelligent than Imagined": The Mountain Air Youth Photovoice Project.

Kathryn M Cardarelli,Steven Browning,Marcy Paul,Nancy Schoenberg,Beverly May,Madeline Dunfee

doi:10.3390/ijerph16203829

Abstract

Appalachian Kentucky reports some of the highest rates of respiratory illness in the United States, including chronic obstructive pulmonary disease and asthma. While smoking rates are high in the region, unexplained variation remains, and community-engaged research approaches are warranted to identify contributing factors. The Mountain Air Project’s community advisory board recommended that investigators invite youth to provide their perspectives on possible contributing factors to respiratory illness, and we undertook an exploratory study to determine the utility of photovoice to elicit such perspectives with this population. While photovoice has been employed for other youth-focused health studies in Appalachia, to our knowledge, this work represents the region’s first environmental study using photovoice among youth. Over eight weeks, ten participants (age 12–18) represented their perspectives through photographs and accompanying narratives. A brief thematic content analysis of the youth narratives that accompanied the photos revealed three primary themes of environmental determinants of respiratory illness. These themes included compromises community members make regarding respiratory health in order to secure a livelihood; tension between cultural legacies and respiratory health; and consequences of geographic forces. This study demonstrates the value of incorporating youth perspectives in environmental health research, and that photovoice was a valuable approach to elicit such perspectives.

Highlights

Respiratory illness rates in southeastern Kentucky are among the highest in the United States (US)
This paper provides findings from an exploratory study in which youth identified factors that they perceived as important environmental determinants of respiratory illness in their community
According to Wang, photovoice has three main goals that enable participants to: “(1) record and represent their everyday realities; (2) promote critical dialogue and knowledge about personal and community strengths and concerns; and (3) reach policy makers” to achieve social change (p. 146, [5]). These three goals guided our research focus: to encourage youth living in an Appalachian community in which respiratory illness is common to explore what they perceive as contributing to respiratory burdens in their environments

Summary

Introduction

Respiratory illness rates in southeastern Kentucky are among the highest in the United States (US). According to the Centers for Disease Control and Prevention (CDC), the national asthma prevalence among adults in the US is 7.7%, compared to 10.7% in Kentucky [1]. Smoking is a significant contributing factor to respiratory morbidity and mortality. Kentucky has the second highest smoking prevalence among adults, 24.6%, compared to the US prevalence, 14.0% [2]. This higher prevalence of smoking in Kentucky contributes to the excess respiratory morbidity, a great deal of unexplained variation in respiratory disease remains. Res. Public Health 2019, 16, 3829; doi:10.3390/ijerph16203829 www.mdpi.com/journal/ijerph

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