Abstract Body (Do not enter title and authors here): Background: Residents of rural socioeconomic distressed counties, such as Appalachian Kentucky, experience disproportionately high cardiovascular disease (CVD) risk, compounded by sedentary behavior and poor self-reported physical health. This study investigates whether sedentary behavior and poor self-reported physical health serially mediate the relationship between years of residence in rural socioenconomic distressed counties and CVD risk.
Methods: This secondary analysis included 309 adults residing in rural Appalachian counties. Sedentary behavior was measured as daily minutes in sedentary activity using Actiwatch. Self-reported physical health was assessed using the Short-Form Health Survey-12, and CVD risk was measured using the Framingham risk score. Serial mediation analysis with two mediators was conducted using the PROCESS macro, controlling for sociodemographic and lifestyle covariates.
Results: The participants’ mean age was 57.3 (±15) years, with an average residence duration of 42.7 (±22.2) years. Participants spent an average of 751.6 (±215.3) minutes per day in sedentary activity, and the mean CVD risk was 15.3% (±10.4%). Years of residence were directly associated with increased CVD risk (direct effect = .168; 95% Boot CI [.117, .219]), acounting for 85.3% of the total effect; and indirectly associated through sedentary activity (indirect effect = .016; 95% Boot CI [.006, .039]). An additional indirect effect emerged through sedentary activity leading to poorer self-reported physical health (indirect effect = .002; 95% Boot CI [.001, .004]).
Conclusion:
Although interventions targeting CVD risk reduction in rural socioeconomic distressed counties that included strategies to reduce sedentary lifestyles may improve self-reported physical health status and decrease CVD risk burden, understanding and adressing neighborhood characteristics relevant to cardiovascular health in these areas is curical in effort to achieve cardiovascular health equity.