The Children of Appalachia Working toward success 2018 CELEBRATE KIDS! Conference CASA for Children, Ohio September 27, 2017, 1:15 to 2:45

Presenters Pamela Salsberry PhD, RN, Professor OSU, College of Public Health; Program Director, Community Engagement, OSU Center for Clinical and Translational Science Beverly Stringer, BS, Community Engagement Coordinator, OSU Center for Clinical and Translational Science

Learning Objectives Discuss importance of context and life course approaches for optimal child development Become familiar with Ohio Appalachian Region Identify barriers and facilitators to children’s success within Ohio Appalachian Region. Discuss programs and resources that are in place to improve child outcomes in the Ohio Appalachian region.

First …a few comments about optimizing child development Optimizing child development- thinking across the life course and within context

Optimizing a child’s development Think of as a trajectory that depends upon prior experiences, but always with the potential for change Some periods particularly critical for child’s development….early childhood, start of school, school transitions Family transitions and changes have significant long-term impact, importance of ‘buffers’

A Life Course Approach to Health Development Good health Poor Health Birth Adolescence Infancy Early Childhood Exclusive breastfeeding Bottle fed; rapid weight gain Safe Neighborhood; physical activity; sleep quality Good family routine; exercise; good stress management Lack of exercise; unsafe neighborhood; shortened sleep; disorganized family environment; poverty; stress Healthy prenatal period Prepregnancy health, genetic predisposition Development of type 2 diabetes in youth. Middle Childhood

One depiction of social ecological model

3 Principles to Improve Outcomes for Children and Families Support responsive relationships for children and adults. Strengthen core life skills, Reduce sources of stress in the lives of children and families. From www.developingchild.Harvard.edu

Context matters…Knowing about Appalachia Two …what are the contexts that matter? Context matters…Knowing about Appalachia

Source #1

Report available at : Appalachian Regional Commission Website, Source #2

The Appalachian region An overview…. The Appalachian region

The Appalachian Region States All of West Virginia Part of 12 other states: Alabama Georgia Kentucky Maryland Mississippi New York North Carolina Ohio Pennsylvania South Carolina Tennessee Virginia

Appalachian Sub regions

The Ohio Appalachian Region Counties in Ohio Adam Mahoning Ashtabula Meigs Athens Monroe Belmont Morgan Brown Muskingum Carroll Noble Clermont Perry Columbiana Pike Coshocton Ross Gallia Scioto Guernsey Trumbull Harrison Tuscarawas Highland Vinton Hocking Washington Holmes Jackson Jefferson Lawrence

Appalachian Region…The Geography and Demographics are Unique

Persons per Square Mile About ½ of the counties are less populated than US average. Population concentrations need large cities, Pittsburgh in Northeast, Cincinnati, southwest

Median Age of Persons in the Appalachian Region North east portion of Ohio Appalachia older than US and other Appalachian areas; Other counties at least at US median

% under 18 years, 2016 Much of the region has fewer children than the US Average.

Appalachian Region…The Social Determinants, that is the social and physical context that influence outcomes

Social Determinants: Per Capita Income Most of the Ohio Appalachian region has a per capital income below the Appalachian average

The Social Determinants Poverty by age group

An attempt to assess and delivery resources to those most challenged

The Social Determinants Education Total Pop. % < High School HS Plus HS Degree Assoc. Degree Bachelor + Ohio Appalachian has greater percent with less than high school, fewer with bachelor or higher degrees

Social Determinants: Employment

The Social Networks and Associations

Community Characteristics: Social Association Ohio Appalachian region has high social association rate, compared with other areas, specifically true of the north east.

Community Characteristics: Student-Teacher Ratio Higher student-teacher ratio

Community Characteristics Coalitions—all types! Public Health Departments Extension Offices Local hospital/health care initiatives Educational institutions

So in summary: Context matters: Rural, low resources, aging population Community Strengths: Connected, widespread efforts to work with communities in ways that they define

Lifestyle and Health

Lifestyle: Physical activity

Lifestyle: Smoking

Lifestyle: Obesity

Health: Diabetes

Health: Physical Health, unhealthy days per month per person

Health: Mental Health, unhealthy days per month per person

But there are “bright spots” where health is better than expected! Communities are working hard to turn things around.

A DEEPER LOOK AT THE BRIGHT SPOT COUNTIES Each of the ten Bright Spot counties has its own particular health-related challenges, available resources for dealing with them, and different responses. But there are similarities in the solutions and strategies they employed. These fall into six broad categories: Community leaders engaged in health initiatives Cross-sector collaboration Resource sharing of Transportation, Food, Shelter Local healthcare providers committed to public health Active faith community Initiatives to combat substance abuse

In summary….. Life style: Smoking, obesity, and physical activity reflect rates that need improved Adult health: diabetes, physical and mental health challenges….partially from an aging population

Community Engagement of Southeast Ohio Beverly Stringer, BS Community Engagement Coordinator OSU Center for Clinical and Translational Science Appalachian Translational Research Network Scioto County Welcome Center 342 Second Street, Portsmouth Ohio 45662

Community Engagement of Southeast Ohio: Encourage community involvement: Identifying and prioritizing problems; Providing input into relevant research questions; Contributing to research design and methods; Developing culturally sensitive and ethical proposals; Enhancing recruitment and retention of participants; Implementing and disseminating research findings.

Community Partners Communities have the capacity to participate as full partners…. Consulted about research priorities; All stakeholders respected, valued, rewarded; Effective implementation and dissemination strategies are developed; Increase in public support for research, and Ultimately, improved health and well-being of communities.

Research Collaboration Researchers encouraged to go into the communities of southeast Ohio Consult with community members Seek community input/feedback Support for researchers to be involved with communities Grow partnerships

Extended Collaboration Appalachian Translational Research Network – 9 universities OSU, OU, UC, UK, WVU, Marshall, Penn State, ETSU, Wake Forest SE-Ohio Community Advisory Board: meets quarterly Franklin County Community Advisory Board: meets quarterly Community Faculty Advisory Board: meets semi-annually Education efforts

Projects Community Engagement Sodabriety Educational Literature Assessment Hep C Study – mothers/babies Planning to Be Active My Plate Yoga for Children – summer program Training for professionals working with children Opioid Project

An example: Community Engagement in SE Ohio Problem identified from Community Advisory Board of SE Ohio—Hep C Reach into OSU to find researchers interested in this problem Researchers invited to Board meeting Collaborations began between Dr. Jennifer Syvertsen and Scioto Community R21 submitted, followed by larger U submission (Miller, PI)

Community Engagement of Southeast Ohio Beverly Stringer, BS Community Engagement Coordinator OSU Center for Clinical and Translational Science Appalachian Translational Research Network Scioto County Welcome Center 342 Second Street, Portsmouth Ohio 45662

So in sum… While the challenges for children in Appalachia are real, there are new efforts all across Appalachia to address these challenges with local efforts, that are community centric and sustainable.