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J Public Health Manag Pract. 2013 Nov-Dec;19(6):503-10. doi: 10.1097/PHH.0b013e3182893bbb.

Addressing rural health disparities through policy change in the stroke belt.

Author information

  • 1Department of Public Health, East Carolina University, Greenville, North Carolina (Dr Jilcott Pitts); and Department of Nutrition, Gillings School of Global Public Health and UNC Center for Health Promotion and Disease Prevention (Mss Smith, Thayer, Drobka, and Miller and Dr Ammerman), and Department of Medicine, School of Medicine (Dr Keyserling), University of North Carolina at Chapel Hill.



Obesity-prevention policies are needed, particularly in low-income rural areas of the southern United States, where obesity and chronic disease prevalence are high. In 2009, the Centers for Disease Control and Prevention issued the "Common Community Measures for Obesity Prevention" (COCOMO), a set of 24 recommended community-level obesity-prevention strategies.


A variety of stakeholders in Lenoir County, North Carolina, were surveyed and interviewed, ranking the winnability, defined as feasibility and acceptability, of each of the 24 COCOMO-recommended strategies based on local culture, infrastructure, funding, and community support.




This study was part of the Heart Healthy Lenoir project, a community-based project to reduce cardiovascular disease risk and disparities in risk in Lenoir County, North Carolina.


COCOMO assessments were conducted with 19 Community Advisory Council members and in-depth interviews were conducted with 11 community stakeholders. Heart Healthy Lenoir lifestyle intervention participants (n = 366) completed surveys wherein they ranked their support for 7 obesity-prevention strategies (based on the COCOMO strategies).


Ranking of obesity-prevention strategies.


Policies to improve physical activity opportunities were deemed the most winnable, whereas policies that would limit advertisement of unhealthy food and beverages were deemed the least winnable. The most winnable food-related strategy was improving mechanisms to procure food from local farms. Stakeholders perceived the public as unfavorably disposed toward government mandates, taxes, and incentives. Among Heart Healthy Lenoir participants, males indicated lower levels of support for COCOMO-related strategies than females, and African Americans indicated higher levels of support than white participants.


The formative work presented here provides insight into the winnability of proposed obesity-prevention policy change strategies in Lenoir County, North Carolina.

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