The Importance of Family Relationships for the Health of Underserved Appalachians: an Application and Extension of the Biobehavioral Family Model.

Introduction: Appalachia is characterized by many contextual stressors, including geographic, economic, and cultural barriers to healthcare. Guided by the biobehavioral family model (BBFM), an understanding of the influence of interpersonal relationships (i.e., marital and nonmarital relationships) on health outcomes could be critical to mitigating the region's contextual stressors.Method: Data were collected from 2018 to 2019 among 243 participants across seven pop-up medical clinics in central and southern Appalachia 59% from rural Appalachian counties (rural M-age = 41, 66% women, 90% White; urban M-age = 36, 74% women, 82% White). A series of multivariate regression models were conducted for outcome measures (i.e., depression, pain, physical symptoms, number of conditions, and perceived health).Results: The results suggest that family quality was significantly related to all outcome measures except for perceived health, whereas marital satisfaction was only significantly linked to physical symptoms. Rurality was not significantly associated with any outcome measures and only moderated the association between family quality and a number of conditions.Discussion: These findings demonstrate the importance of nonmarital family relationships on health outcomes for people in Appalachia. Given the limited direct impact rurality in this sample, close relationships may be important for the health and well-being of all economically marginalized Appalachians regarding where they live. Given the cultural tendency for Appalachians to rely on family and kinship networks for healthcare support and the findings in this study, medical professionals should develop innovative programs to incorporate family into healthcare visits, and disease management interventions for people living in Appalachia.