Lay explanations for Kentucky's "Coronary Valley".

Kentucky and its neighboring states have some of the highest coronary heart disease (CHD) mortality rates in the United States, leading researchers to nickname the region "Coronary Valley." Currently, little is known about factors that account for "Coronary Valley"; however, understanding lay perspectives on CHD risk factors may provide insights into this high prevalence of CHD and may guide prevention efforts. In December 1999, a statewide telephone survey was administered to a random sample of Kentucky residents to elicit lay explanations for the high rates of CHD. Standard protocol for descriptive statistics was undertaken. Respondents (N = 624) identified most of the biomedically acknowledged risk factors, with an overwhelming majority acknowledging that high rates of smoking and poor diets contribute to CHD. Older respondents and those who reported having heart disease were more likely than others to identify factors beyond their control, including stress and pollution (p < .0005 and p < .00 1, respectively). After controlling for the presence of heart disease, age differences remained significant only among those who reported no heart disease. Education had marginal significance (p = .027) on explanations for CHD, while gender, racial or ethnic background, and type of community residence had no significant effects. Since most Kentuckians are aware of traditional risk factors underlying CHD, prevention efforts should be directed at removing structural and information barriers to behavior change (e.g., by providing smoking cessation programs) rather than limiting prevention efforts to traditional health education approaches (i.e., increasing knowledge of CHD risk factors).