CREEEK Project Examines Risk Factors Related to Respiratory Disease in Appalachia


LEXINGTON, Ky. (June 15, 2015) ­– Researchers in the University of Kentucky College of Public Health were recently awarded a $2.5 million grant to investigate respiratory health inequities in Appalachia from the National Institutes of Health’s National Institute of Environmental Health Sciences.

During the five-year project titled “Community-Engaged Research and Action to Reduce Respiratory Disease in Appalachia,” public health researchers will work with Kentucky’s Appalachian communities to develop strategies for improving respiratory and environmental public health. The project calls for the creation of a Community Response to Environmental Exposures in Eastern Kentucky (CREEEK).

Residents of Kentucky’s central Appalachian counties experience the highest rates of serious respiratory illness and disease of any region in the nation. Adults in Appalachian Kentucky are 50 percent more likely to develop asthma or chronic obstructive pulmonary disease (COPD) than the overall U.S. population.  As many as one in five adults in the region have received a diagnosis of asthma and rates of COPD are nearly two-and-a-half fold the incidence of the disease in other parts of the country.

“Faculty and staff are intently engaged on the questions of our day – pioneering solutions in – and with – communities that help transform lives,” UK President Eli Capilouto said.  “Moving the needle in Eastern Kentucky on important health issues is part of our land grant and flagship mission.”

Studies suggest associations between respiratory health inequities and environmental contaminants. However, data on this topic has not included individual-level assessments or accounted for behavioral risk factors frequently observed in the area, such as smoking, poor diet and insufficient physical activity, or social determinants such as socioeconomic status or occupation. The CREEEK Project strives to holistically examine factors that contribute to this elevated risk.

To address the need for a reduction in respiratory health disparities, the project will involve three interrelated steps. The first step will be a community-based assessment designed to identify the relationships between indoor air pollutants, behavioral and social determinants and the effects these factors have on risk of respiratory disease.  The project will involve community members in the collection of information and contaminants.

“Respiratory diseases impact not only individuals, but their families, and affect their way of living. This project is significant because it addresses a problem that is important to our Appalachian communities and works with the communities to identify causes and find innovative solutions," UK Provost Tim Tracy said.

As a second step, the information collected from the community-based assessment will be shared with local stakeholders in an effort to increase understanding of the environmental exposures present in the region.  The dissemination of information will take place through reports, community forums and meetings of a community advisory board (CAB).

Finally, the project will implement an environmental public health action strategy (EPHAS) and will evaluate that strategy’s ability to impact short-and long-term outcomes for respiratory health. The goal of the EPHAS is to inform, consult and collaborate with the community in reaching the goal of improved respiratory health. Specific outcomes that will be measured include improvement in pulmonary function, reduction of respiratory symptoms, increased knowledge of respiratory illness and health care availability, improved quality of life, and the extent and satisfaction of community participation.

The interdisciplinary research team is led by Steven Browning, associate professor of epidemiology, and Nancy Schoenberg, Marion Pearsall Professor in the Department of Behavioral Science in the College of Medicine and associate dean for research in the College of Public Health. Other members include David Mannino, chair of the Department of Preventive Medicine and Environmental Health; Wayne Sanderson, interim dean of the College of Public Health and professor of epidemiology; Jay Christian, assistant professor of epidemiology; and Heather Bush, associate professor of biostatistics.

The project management will be led by Beverly May, a lifelong Appalachian resident and doctoral candidate in the College of Public Health, and Nell Fields, also a lifelong Appalachian resident, who has directed two community-engaged smoking cessation projects.

MEDIA CONTACT: Elizabeth Adams,