THURS-016 - Photovoice: Examining the Intersection of Structural Racism, Rurality, and Childhood Obesity

Brief Abstract Summary: Wilcox County is among the least healthy counties in Alabama, with 50% obesity rates. A disproportionate burden of child obesity is experienced by Black people and those in rural areas and from low-income families. The purpose of this study was to describe the intersection of structural racism, rurality and childhood obesity in Wilcox County through the lens of county youth to inform community-led solutions. We worked with ~20 Wilcox County youth in a photovoice project which was exhibited during 3 community events. Surveys were collected from exhibit participants to gauge impact. Over 100 photos were collected and analyzed; 28 photos were exhibited. Photovoice participants saw beyond the only grocery store in the county to recognize community gardens, local farms, and convenience stores as options to buy and produce healthy food options. Moreover, the photovoice exhibit was a source of inspiration for others in the community to act to achieve solutions to issues identified.

Detailed abstract description:

Background: A long history of racism in rural Wilcox County, Alabama, has made a significant impact on residents’ quality of life. About 30% of people living in the county live in poverty; of these, 92% are Black. The county is among the least healthy counties in Alabama, with 50% obesity rates. Only 6% of residents have adequate physical activity access. Nearly 2 out of 3 people in the county live in a food desert.

A disproportionate burden of child obesity is experienced by Black people and those in rural areas and from low-income families. Systemic racism may be one cause of racial disparities in obesity rates and in rural health. Inequities in access to health care and distribution of healthy foods are among factors attributed to disparate obesity rates.

The purpose of this study was to describe the intersection of structural racism, rurality, and childhood obesity in Wilcox County through the lens of county youth to inform community-led solutions to identified issues. Photovoice is especially useful in dismantling traditional and historically harmful power dynamics between institutions and communities. Researchers have used this approach for a variety of health-related projects to evoke advocacy, community change, and policy making.


Methods: We worked with ~20 Wilcox County adolescents in a photovoice project that included 2 orientation sessions, 3 photo training sessions, independent and group photography sessions, and 3 group analysis meetings over 6 months. Participants used prompts to guide their photo taking: how (1) racism, (2) living in a rural place, and (3) equity/lack of equity in Wilcox County may affect eating habits, availability of food options, and ability to be physically active. The SHOWED method was used as a framework to help participants create narratives to accompany photos. Photos were grouped by emergent themes. Photos and narratives were exhibited during 3 community events and surveys were collected from exhibit participants to gauge impact.

Results: Over 100 photos were collected and analyzed; 28 photos were exhibited. Five themes emerged: Economics, Access, Social, Historical, and Intentionality. Seven people completed the exhibit survey; 6 agreed/strongly agreed that they wanted to do something to address structural racism, food access, access to physical activity and living in a rural community because of attending the photovoice exhibit. Specifically, 5 indicated they wanted to work with officials to improve food/recreational programs for youth.

Conclusion: Photovoice participants identified major sources of food access, looking beyond the only grocery store in the county to recognize community gardens, local farms, and convenience stores as options to buy and produce healthy food options. Moreover, the photovoice exhibit was a source of inspiration for others in the community to act to achieve solutions to the issues identified.