West Virginians Research Articles

State-Level Action for Health

Health is certainly one of most critical components when measuring quality of life and prosperity for a state. As governor of West Virginia, I am committed to doing what it takes to make certain every citizen is aware of the importance of daily exercise and healthy eating. Further, I am dedicated to changing our state’s culture with respect to good nutrition and physical activity. I believe the burden of obesity and related diseases in West Virginia requires a strong state infrastructure with a specific focus on physical activity, nutrition, and obesity prevention. Fortunately, West Virginia has a solid ethic of collaboration, and our people share a sense of pride, tradition, culture, and customs. The cohesive and protective nature of the state fosters a service philosophy and West Virginia citizens embrace the opportunity to help their own. When I became governor in 2005, I realized there were many ongoing efforts, both formal and informal and under myriad organizations, aimed at promoting healthy lifestyles for West Virginians. I strongly believe it is my responsibility to not only provide a framework in which local, state, and institutional policymakers can work collaboratively to create and support environments that make it easier for West Virginians to choose healthy foods and to be physically active, but also to create state policy that would support existing efforts. I am very pleased that in 2005 the West Virginia Legislature, upon my request, passed the West Virginia Healthy Lifestyles Act. This act signified that the leadership in West Virginia not only acknowledged that we were truly facing a public health epidemic, but that we also were prepared to be both bold and innovative in our efforts to reduce West Virginia’s prevalence of obesity. The West Virginia Healthy Lifestyles Act created a 13-member coalition as well as a clinical advisory committee, appointed by the governor. The Healthy Lifestyle Coalition and its Clinical Advisory Committee focus on establishing and supporting public policy specific to promoting physical activity and nutrition. This legislation also recognized that children and adolescents spend the majority of their time in schools; therefore it is critical that schools incorporate healthful eating and physical activity as part of a total learning environment. Therefore, the legislation specifically targeted the following public school issues:

West Virginia residents' attitudes and opinions toward American black bear hunting

American black bear (Ursus americanus) hunting has come under close scrutiny over the past decade. As black bear populations have increased and expanded, wildlife agencies have been faced with new challenges on how to set population and harvest goals. Wildlife agencies have altered proposed regulations or have had seasons entirely stopped because of public opposition, necessitating a proactive approach to wildlife management based on a scientific understanding of public opinion rather than reactive decision-making in response to public resistance. In November–December 2006, we conducted a telephone survey of 1,206 West Virginia residents to determine their opinions and attitudes toward black bear populations and hunting seasons and to help strengthen the state's black bear management strategies. Although the majority of West Virginians, nearly 3 of 4 respondents in this study, indicated they know at least something about black bears in West Virginia, there were significant regional differences in the public's assessment of their knowledge of the species. Although most respondents thought the black bear population size was “about right,” again, there were regional differences among respondents. In general, most respondents supported black bear hunting if the population was carefully monitored, if they knew the population was stable, or both; however, a number of regional and sociodemographic characteristics appeared to influence public opinion on black bear hunting and hunting seasons in the state, and support for specific seasons varied considerably according to hunting method. Interestingly, our study found that even among hunters, public opposition exceeded support for the current, year-round training season of black bear hunting dogs without harvesting animals in the state. Although it is important for wildlife managers to consider human dimensions and public opinion data in conjunction with biological data when making management decisions, we demonstrate that it also is important for managers to consider regional and sociodemographic differences with respect to attitudes and opinions when making management decisions and population objectives.

Campaign Support, Conflicts of Interest, and Judicial Impartiality: Can the Legitimacy of Courts Be Rescued by Recusals?

Many legal scholars and observers perceive elected state courts in the U.S. as under siege by the politicization of judicial elections – by candidates for judicial office making policy pronouncements and promises, using ads attacking their opponents (often scurrilously), and, most important, by accepting campaign contributions and support from organizations litigating before the very judges these groups helped elect. Since no form of political capital is more valuable to courts than institutional legitimacy, the hypothesis that campaign activities undermine judicial legitimacy must be taken quite seriously.Our purpose in this paper is to investigate citizen perceptions of the impartiality and legitimacy of courts. We focus on the residents of West Virginia, because that state has recently been a battleground for intense conflict over campaign support and perceived conflicts of interest and loss of impartiality. We employ an experimental vignette embedded within a representative sample of West Virginians to test hypotheses about several factors that might affect perceived judicial impartiality: (1) campaign contributions and support; (2) the size of such support; (3) whether the judge accused of holding a conflict of interest withdraws from the case; and (4A) if not, whether that judge’s vote was crucial to the outcome, and (4B) if so, whether the party providing the campaign support wins or loses the lawsuit. Our theoretical objectives in this paper are to assess the determinants of citizens’ views of judicial impartiality, following earlier research on how campaigning affects such perceptions. More practically, we test the hypothesis that recusals can rehabilitate a judge and/or court from perceptions of a conflict of interest. In almost every respect, our findings are not as expected. Perhaps most important, contributions offered but rejected by the candidate have similar effects to contributions offered and accepted. And, although recusal can rehabilitate a court/judge to some degree, the effect of recusal is far from the complete restoration of the impartiality and legitimacy of the institution. We are also surprised that about one-third of the respondents are unfazed by the most conflicted circumstance our vignette imagines. We attribute that finding to the “reservoir of goodwill” enjoyed by courts and to the framing effects flowing from pre-existing loyalty to the judiciary. The processes by which citizens form and update their opinions of judges and courts are certainly complicated, but seem at least to involve pre-existing attitudes, expectations of judges, and perceptions of contextual factors, as our analysis of conditional influences demonstrates. Finally, our findings indicate that several of the assumptions of the majority in the recently decided Caperton v. Massey are empirically inaccurate, at least from the viewpoint of the citizens of West Virginia.

Assessing BMI in West Virginia schools: parent perspectives and the influence of context.

West Virginia is a state at the forefront of the obesity epidemic and one that is experiencing immense health and economic costs as a result. The childhood obesity research discussed in this article was conducted over the past 10 years through 4 projects that range from a school-based cardiovascular risk screening program to an evaluation of state legislation targeting childhood obesity via modifications in the school environment. In the course of these projects, we have collected BMI and other health indices on students, provided feedback to students and their parents, and assessed the obesity and health-related beliefs of West Virginians through individual and focus-group interviews and questionnaires. Our work has been accomplished by using an active-consent process, and BMI has typically been only 1 component of the comprehensive health data we collect and feedback we provide. Collaboration with state and local partners and regular dissemination of our findings have been key elements of the approach taken. The research and policy implications of our findings and approach are discussed.

Remembering Fairmont during World War II: An Interview with Lysbeth Huster and Joyce Ann Irons

Remembering Fairmont during World War II: An Interview with Lysbeth Huster and Joyce Ann Irons Kashka Nelson and C. Belmont Keeney “World War II has warped our view of how we look at things today. We see things in terms of that war.”1 Certainly no other event in the twentieth century has changed American society more than World War II. Millions of young American men who had never traveled far beyond their hometowns found themselves whisked away to foreign continents and oceans, not knowing if or when they would ever return. Meanwhile the tasks of producing goods for the war effort, aiding troop morale, and single-handedly raising families fell on the shoulders of those who were left behind–particularly the women. While they awaited news from loved ones abroad and hoped for their safe and swift return, American women aided the war effort in every way they could, whether by employment in the workforce, through the USO, or merely by donating household goods and scraps for war production. The following oral history was conducted by Kashka Nelson, an undergraduate student at West Virginia University, as a research project for the West Virginia History course that I taught in the spring of 2006. The research project, in conjunction with the West Virginia Veterans’ Project,2 intended to capture the experience not only of veterans, but of any West Virginians who have been directly affected by any American military conflict. In this case, Lysbeth Huster and Joyce Ann Irons, two natives of Fairmont, West Virginia, recall their experiences on the home front during World War II. Based on their recollections of the bombing of Pearl Harbor, rationing, civilian defense, and the psychological impact of the conflict, we find that, even in a small Appalachian town, the war dominated every facet of daily life. Kashka Nelson: How old were you when the war started? Lysbeth Huster: Well, then I was twenty-one. Joyce Irons: Oh, I would have only been about four years old in 1941 when the war started. [End Page 83] Kashka: Where were you both living when the war started? Joyce: Umm, at that time on the east side of Fairmont. We lived there the first nine years of my life in town. Then we moved out into the county on the East Grafton Road and I lived out here and in this area until I got married. Kashka: Do you remember hearing about Pearl Harbor when the attack happened? Lysbeth: Oh yes. I was bowling that day and they had the radio on and it was announced on the radio and I couldn’t bowl worth a darn after that. I mean, I knew my husband would have to go. He was the right age and we didn’t have any children then. Joyce: How did you hear about it? The radio? Lysbeth: The radio at the bowling alley. It was devastating. It was in the middle of the afternoon when we heard it. We always bowled on Sunday. It was the middle of the afternoon. Joyce: Course, in those days everybody gathered at the radio. Lysbeth: Yeah. Joyce: But a side note my husband talks about–he lived over here [Colfax, WV] by the school and he was seven and he was on his way down to visit his aunt and a neighbor called out to another neighbor screaming, “They bombed Pearl Harbor!” Scared my husband to death. He thought maybe that was over the hill or over in town. He was seven. He went running down to his aunt’s and he said, “They’ve bombed Pearl Harbor!” And he was terrified and he said, “Where’s Pearl Harbor?” He had no idea. Kashka: You were married at the time? Lysbeth: Yes. Kashka: How old was your husband? Lysbeth: He was twenty-two. Kashka: And he wasn’t in the service? Lysbeth: Not yet, but he went later. Kashka: Where did he get shipped to? Lysbeth: He spent most of his duties in California. The ship he was scheduled to go overseas on was a big aircraft carrier, but for the first time in his life he came down with a fever and he stayed...

Relations Between Health Indicators and Residential Proximity to Coal Mining in West Virginia

We used data from a survey of 16493 West Virginians merged with county-level coal production and other covariates to investigate the relations between health indicators and residential proximity to coal mining. Results of hierarchical analyses indicated that high levels of coal production were associated with worse adjusted health status and with higher rates of cardiopulmonary disease, chronic obstructive pulmonary disease, hypertension, lung disease, and kidney disease. Research is recommended to ascertain the mechanisms, magnitude, and consequences of a community coal-mining exposure effect.

Moving mountains: how one woman and her community won justice from big coal

In late 1994, wells in Pie, West Virginia, began to go dry, leaving many residents of the small coal-mining town without potable water. When local housewife Trish Bragg made a few phone calls in an effort to solve this problem, she had no idea that her inquiries would eventually lead to her becoming the named plaintiff in a major lawsuit, a summa cum laude college graduate, and a hero of her community. Moving Mountains recounts the struggle of Trish Bragg and other ordinary West Virginians for fair treatment by the coal companies that dominate the local economies of southern West Virginia. The collateral effects of mountaintop removal, deep mining, and other mining practices are felt most profoundly in the communities that supply much of the labor for these mining operations, which results in divided loyalties among families that have made their living from coal mining for generations. Author Penny Loeb spent nine years chronicling the triumphs and setbacks of people in the West Virginia coal-fields - people caught between the economic opportunities provided by coal and the detriments to health and to quality of life that are so often the by-products of the coal industry. The result of her work is an account of the human and environmental costs of coal extraction, and the inspirational grassroots crusade to mitigate those costs.

Factors Influencing Interstate Variation in Tooth Loss

The term for the loss of all natural permanent teeth is edentulism. In 2004, the Centers for Disease Control and Prevention (CDC) released data on the edentulism rate by state (2004 Behavioral Risk Factor Surveillance System Survey). Measured as a percentage of state residents over 65, the edentulism rate for the average state was 22.1%. West Virginia had the highest rate of complete tooth loss at 42.8% and Connecticut had the lowest rate at 13.5%. The high edentulism rate in West Virginia is surprising given that the state has fluoridation rates well above the national average. According to the CDC, 91.5% of West Virginians live in areas with fluoridated water compared to 70% in the average state. This suggests that other factors besides access to fluoridated water must be contributing to the high rate of edentulism in West Virginia. The medical literature points to several possible reasons for tooth loss in addition to water fluoridation. Income, poverty status, limited access to dental care due to geography, poor attitudes towards dental care and smoking have all been linked to tooth loss. A review of the literature found no studies examining the determinants of interstate variation in edentulism. To better investigate the role of each of these factors in determining why some states have high rates of tooth loss and others do not, I regressed the edentulism rate by state against the following variables: the percentage of adults with a bachelor’s degree or higher, the elderly poverty rate, state per capita personal income, urban population percentage, percentage of residents that are everyday smokers, and the percentage of the population with fluoridated water (Data, sources, and results at: http://joshua.c.hall.googlepages.com/papers/). Int Adv Econ Res (2008) 14:262–263 DOI 10.1007/s11294-008-9139-x

A Note from the Editor

A Note from the Editor Virginia M. Brennan As the country watches the 2008 presidential campaign take shape, with health care prominent on the horizon, many people soldier on without any care or without adequate care, their health often compromised by structural factors, awaiting policy that truly addresses their needs. Among the cornerstones of public policy in this area are the constructs of Health Professional Shortage Area (HPSA) and Medically Underserved Area (MUA), first introduced by federal legislation during the 1970s. In an important paper in the present issue, Thomas Ricketts and colleagues from the Sheps Center of the University of North Carolina at Chapel Hill describe the development of a theory-based, data-driven replacement for the HPSA and MUA designation systems. The authors write in the article published here, "The proposed rule changes were approved by the Secretary of Health and Human Services on March 26, 2007 and a 'notice of proposed rulemaking' will appear in the Federal Register sometime in 2007. After a 6-month comment and review period, which may result in modifications to the proposal, the final rule is scheduled for publication in early 2008." We are proud to be publishing this important paper. In a related paper, Jiexin Liu asks whether, in addition to having fewer doctors, people in HPSAs suffer from worse health. Using survey data of 10,940 adult West Virginians, Liu finds that living in an HPSA is indeed associated with worse general health status, poor physical health, and less access to medical services (though not to inpatient care), confirming the intuitive rationale behind the construct of HPSAs. Another topic addressed in the present issue is what Joshua Yang and Marjorie Kagawa-Singer of UCLA call ethnicity-specific care. Their Commentary concerns the advisability and feasibility of creating ethnicity-specific subsystems of care as a strategy for increasing access to care for cultural and linguistic minorities. They recount in depth the historical experiences of the Chinese community in San Francisco on the basis of systematic exploration of archival documents and semi-structured interviews. In doing so, they reconstruct the evolution of that community's ethnicity-specific health care infrastructure, including the origin and evolution of Chinese Hospital, and create an organizational development model for ethnicity-specific health care organizations and infrastructures. The authors conclude by making policy recommendations for developing ethnicity-specific sub-systems of care. Nathan Consedine and colleagues from Long Island University in Brooklyn delve into a related question when they investigate whether the way a message concerning breast cancer screening is framed (in terms either of what one would gain by getting screened or of what one would lose by not getting screened) is associated in any clear way with the income level and/or ethnicity or race of the person to whom the message is directed. Contrary to expectation, they find no main effect for framing condition. Income proved an important moderator of framing effects, interacting with both condition and race to influence screening. [End Page vii] Also from New York, on the subject of care for immigrant populations as part of medical education, Robert Karp and colleagues from the State University of New York (SUNY) Downstate Medical Center in Brooklyn report on a program addressing pediatric residents' knowledge, awareness, and practices around patients' immigration status and eligibility for government funded health and nutrition benefits. After assessment and training of the residents, the faculty used posters to remind them and their clinic's largely immigrant population about immigrants' rights to care. Another report concerning health professional students comes from Carmen Patrick Mohan and Arun Mohan. They describe the HealthSTAT model of professional development, a student-run advocacy program that uses team-based leadership and peer-to-peer learning to cultivate inter-professional collaboration and community partnership in service to the poor and underserved of Georgia. Also in the area of medical education, Mina Silberberg and colleagues from Duke University report on a clinic run by a federally-qualified health center and Duke's medical center. Showing how the clinic expands the community's primary care capacity, combining advantages of big and small settings, and of its dual affiliation, the authors present a workable system that similar town...

Health Professional Shortage and Health Status and Health Care Access

Although areas designated as Health Professional Shortage Areas (HPSAs) have fewer primary care physicians than non-HPSAs, few studies have tested whether HPSA designation is related to health status and medical service access. This study examined whether residents living in HPSAs were more likely to report worse health status and to be more likely to have difficulty in getting access medical services than residents living in non-HPSAs, with survey data of 10,940 adult West Virginians. Multiple regression results indicate that HPSA is associated with worse general health status and poor physical health, and less access to medical services (measured by had usual place for medical care, experienced not getting needed health care and had outpatient care) but not to inpatient care. These findings indicate that the current HPSA designation system does capture the significant differences between residents of HPSAs and residents of non-HPSAs in health status and medical services access.

The Clam Shell : Opening to Life with Resolute Passion

MARY LEE SETTLE'S LITERARY LEGACY The Clam Shell: Opening to Life with Resolute Passion____________________ Meredith Sue Willis Settle's strength as a novelist is fully displayed in The Clam Shell, published more than fifteen years after her first novel. Her characters are seen clearly and in the fullness of their humanity, her ensemble scenes are skillfully written, and her delineations of the layers of social standing are insightful and strong. The novel is narrated through one consciousness in the present tense. It is not that single narrators or present tense make the best novels, but rather that this strategy works extremely well for an eighteen year old's story. A lot happens in The Clam Shell as events are built up with psychological exactitude from inside this young woman. At the time I first read The Clam Shell, I was overwhelmed by its breathless full-speed-ahead Faulknerian style. Settle was a fan of Faulkner, perhaps never more obviously than in this novel. In her hands, the dense, impressionistic writing style works well to create the world as seen by a young woman making false starts and finally breaking for freedom. In Settle's hands, the style is about the information of the senses, the way the world comes at us as sensation, color, and sounds. That newness, that surprise at the familiar, is one of her main strategies in this novel. She writes near the beginning, before the coming-of-age story proper begins, how the narrator has come back to visit some of the people she grew up with. This is a Sunday afternoon in suburbia with some couples gathered around the televison. Except for the narrator, these are people who never left the old home town or the country club milieu. The couples were leaders of her society when she was a girl, and seeing them again, she feels finally free of them, and thus everything is different, everything is new- even the television and the flames in the fireplace: The fire, breathing pale blue from time to time, makes the light waver and tremble. Against the paleness, the television flings color, orange faces, color of comic books, cheap candy, plastic flowers, and reflects dancing white, maroon, and gold on the window-panes. 73 According to Settle in her introduction to the University of South Carolina edition of The Clam Shell, the novel grew out of a World War II discussion with the well-known literary man, Archibald MacLeish during a walk through Hyde Park in London. MacLeish did not take Settle seriously at first, but in the end, she proudly tells us, he confides in her that he has spent his life finding out that what he knew at eighteen was true. Settle says she held that remark in her mind and years later, made her own exploration of the idea in The Clam Shell. The point I want to make—aside from recommending that people read that essay as an excellent short introduction to Settle's creative process—is how she boasts of making a male literary figure take her seriously. By the time she finally writes her own study of an eighteenth year, she is very interested in power relations between men and women, as well as between social classes and between Appalachia and the Old South. The novel offers a striking portrait of a young woman coming of age between the World Wars by breaking out of the social setting she was trained for—a milieu that constricts young women, damages the moral fiber of young men, and turns old women into jailers of the young. The story line is that the narrator leaves her provincial West Virginia city to go to a women's college over the mountains in Virginia. The country club strivers she lives among look to the South, especially to Virginia, as the exemplar of the good life, and to the hollows of West Virginia as the thing to avoid. People in Virginia, however, look down on all West Virginians. There is painfully funny scene in which the young narrator makes fun of her own background to amuse her roommate: "West Virginia!" [the roommate] says, and that way...

Preventive Care in Appalachia: Use of the Theory of Planned Behavior to Identify Barriers to Participation in Cholesterol Screenings Among West Virginians

West Virginians are at increased risk for heart disease. Given that the process of atherosclerosis begins in childhood, the Coronary Artery Risk Detection in Appalachian Communities Project was developed to reduce this risk by implementing a cholesterol screening program in the schools. However, participation rates have been less than desired. This study examined the barriers to participation in preventive health screenings, specifically cholesterol screenings, in adults and children of West Virginia using the theory of planned behavior to guide conceptualization. A total of 14 community leaders, 36 parents, and 92 fifth-grade children from 6 West Virginia counties with predominately rural populations participated in individual and focus group interviews. Qualitative analysis was used to examine interview transcripts. Adult and child attitudes about preventive care were the largest barrier to cholesterol screenings. Adult attitudinal barriers included concerns with outcomes of testing, lack of knowledge about cholesterol and heart disease, concerns about needles, and traditional Appalachian cultural beliefs (resistance to change, denial, and fatalism). Children cited concerns about needles, outcomes of testing, privacy, and lack of concern about health and cholesterol. Adults also acknowledged environmental barriers to screenings. Finally, children reported a lack of social pressure to participate in prevention activities. Attitudinal, social normative, and environmental barriers to health screenings may be characteristic of impoverished rural Appalachians. Interventions are being designed to target these belief barriers to improve participation in cholesterol screenings for fifth graders.

Personal Responsibility and Physician Responsibility — West Virginia's Medicaid Plan

West Virginia is planning to ask residents who are eligible for Medicaid because of low income to sign documents outlining “member responsibilities and rights.” Drs. Gene Bishop and Amy Brodkey explain that the plan has implications far beyond its effects on needy West Virginians.

Genetics and Cardiovascular Disease Risk Factors in Obese West Virginians.

Genetics and Cardiovascular Disease Risk Factors in Obese West Virginians.

A comparison of low vision patients from a clinic and a random sample of West Virginians: Demographics; treatment patterns; vision problems; and activities of daily living

We wished to compare the low vision patients seen in the Appalachian Center for Vision Rehabilitation with those identified in previous statewide survey to determine if those who access low vision treatment are different than those who do not access treatment. We compared the two groups in four specific areas: demographics, treatment pattern, expectations of vision, and activities of daily living. We conducted a telephone survey of two samples, one of 417 patients seen in the clinic and one of 1026 randomly selected households in WV. Based on a stated difficulty in reading, ordinary newsprint 330 of the clinical group and 107 of the random sample were identified as having low vision. Income levels between the two samples appear to be similar with the majority earning less than $20,000. Statistically significant differences were found in the patients' vision health ratings (p=0.002). Differences were observed in the amount of pain (p=0.031); confidence in future vision (p=0.014) and on all 20 questions related to activities of daily living (p<0.0001). Compared to the random group, the clinical group showed higher rates of being insured, a higher average age, and a lower employment rate. The clinical group rated their vision as poorer; they were referred to specialist more often and received more treatment. The clinical group had more difficulty with activities of daily living, however, the random group experienced more pain.

West Virginia survey of visual health: Low vision and barriers to access

The West Virginia Survey of Visual Health was conducted to determine the types and frequency of barriers to vision treatment experienced by persons with visual health problems and low vision in West Virginia. The study used a Random Digit Dial (RDD) sample to gather information from 1026 households. Cross-tabulation of two variables were used to classify respondents or their family members as having low vision. Among the 1026 homes surveyed, 233 households reported having at least one or more persons with vision health problems. Out of the 233 households, 57 individuals were classified as having low vision. West Virginians who report vision health problems are older and tend to rate their physical health lower compared to those with normal vision. Treatment patterns illustrate that a large number of respondents see an eye doctor on an irregular basis. Economic barriers for the vision health population appear substantial. Transportation barriers are common among the low vision population. The impact of vision health problems on people's lives is substantial causing pain and frustration. Knowledge of rehabilitation is also a major barrier to treatment. No more than 18% of the vision health population reported knowledge of low vision rehabilitation. Vision health problems are frequent in West Virginia affecting about 23% of households. Economic, transportation, and psychosocial barriers affect the patterns and type of treatment sought and services obtained among West Virginia residents with low vision problems.

World's largest steerable radio telescope opens for business

U.S. Senator Robert C. Byrd, white‐maned, and alternately searching either the heavens or his prepared text for each phrasing, orated on stage to an adoring flock of about 1000 West Virginians and out‐of‐staters.In the backgrond and tucked amid verdant mountains in the midst of the 33,700 square kilometer National Radio Quiet Zone in Pocahontas County (where cell phones go dead and fixed radio transmitters have limitations on power use, to keep the air clear for receiving extraterrestrial frequencies), a white paintedradio telescope simultaneously squatted and reached for the sky.

The quantity and quality of physical activity among those trying to lose weight

Background: Regular exercise to elicit caloric expenditure is an important component for achieving weight loss. The Healthy People 2000 objectives recommend regular sustained physical activity lasting 30 minutes, five days per week (Objective 1.3) particularly for weight loss. Moreover, this recommendation has been restated for weight loss and overall health benefits in the Centers for Disease Control and Prevention / American College of Sports Medicine (CDC/ACSM) statement and Surgeon General’s Report (SGR) on Physical Activity and Health. Thus, we sought to identify the relative quality and quantity of physical activity among people trying to lose weight. Design: Cross-sectional self-reported data from the West Virginia Behavioral Risk Factor Surveillance System (BRFSS) were used. The BRFSS is a state-based telephone survey of adults that uses a multistage cluster design based on the Waksberg method of random-digit dialing. Data from 2769 men and 4490 women were obtained from the 1992, 1994, and 1996 surveys. Results: Half (49.6%) of individuals trying to lose weight did not engage in any physical activity. Further, only 15% of respondents trying to lose weight reported exercising regularly. Nevertheless, those trying to lose weight were more likely (OR [odds ratio] = 1.3; 95% CI [confidence interval], 1.14, 1.51, p < 0.001) to exercise regularly than those not trying to lose weight. In particular, women trying to lose weight were significantly more likely (OR = 1.45; 95% CI, 1.22,1.74, p < 0.001) to exercise regularly than women not trying to lose weight. Conversely, men trying to lose weight were no more likely to exercise regularly ( p = .23) than men not trying to lose weight. Among respondents who were using exercise for weight loss, only 14.7% were expending ≥1000 kcal/week and 18.2% were expending ≥500 kcal/week. Weekly expenditure rates of ≥1000 kcal/week were more likely to occur among men (17%) than women (13.8%), in younger age groups, and among those with higher educational attainment. Conclusion: These data suggest that while certain individuals trying to lose weight are more likely to engage in regular physical activity, most persons trying to lose weight have not adopted regular physical activity as part of their weight loss practice. These results suggest that public health efforts to effectively integrate physical activity into weight control practices of West Virginians have been minimally successful.

Nutritional Adequacy of Self–Selected Low–Fat Diets

To identify areas for nutrition interventions, nutrient intakes were examined in a cross-sectional sample of West Virginians. A random sample of adults (N=788, ages 18–74) completed one 24-hour recall over the telephone. Trained interviewers, using the University of Minnesota Nutrition Data System (vs.2.9), conducted the recalls. Forty-two percent of the sample had consumed a lower fat diet (≤30% of Calories) on the day recalled. Consumption of a lower fat diet resulted in significantly lower caloric intakes (1677 kcal lowfat vs. 2130 kcal high fat, p=.002) due to carbohydrate substitution for fats. Lower–fat eaters consumed significantly more carbohydrate, 63% of kcal lowfat vs. 45% of kcal high fat and less fat, 22% of kcal lowfat vs. 39% of kcal high fat, than higher fat eaters, p <.0005. The sources of carbohydrates was probably due to higher consumption of fruits and vegetables since fiber (18 gm lowfat vs. 16 gm high fat. P=.01), vitamin C (103mg lowfat vs. 84mg high fat p=.02), and folate intakes (299 μg lowfat vs. 251 μg high fat, p=.001) were the only nutrients that were higher in persons consuming a low fat diet. Nutrients that were significantly less in the lower–fat eaters were saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, cholesterol, sodium, vitamin E, vitamin B12, calcium, and zinc. Only vitamin E was below the RDA in lower fat eaters. Calcium and zinc intakes were below the RDA in both higher fat and lower fat eaters. There were no differences between the groups for vitamin A, B-6, or iron. Overall, consumption of a low fat diet was associated with positive increases in nutrients except for vitamin E, calcium, and zinc. The latter two were problematic in both groups regardless of fat intake. Progress has been made toward reducing the population fat intake; however, over half still do not meet recommendations. As lower fat diets are adopted, food sources of vitamin E, calcium, and zinc need reinforced in our low fat diet messages.

Characteristics of West Virginians having myocardial infarction.

Prevalence of risk factors in patients having myocardial infarction (MI) have been reported in large US and international studies, but little is known about the prevalence of risk factors in West Virginians having MI. Risk factors for MI were identified by ICD-9 codes. Logistic regression analysis was used to compute odds ratios and 95% confidence intervals. In this cohort (n = 727), 72% of men less than 65 years old were current smokers. Women were older and had a lower frequency of smoking and a higher frequency of diabetes mellitus and obesity than men. Women less than 65 years old had significantly more hypertension than men. In West Virginia, women who have MI are more likely to be nonsmoking diabetics with hypertension.