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Let Me Show You What Keeps Me From Being Healthy

What do you see in your community that helps you be heart healthy, and what gets in your way? People who live in the "stroke belt," an area in the Southeast with high rates of heart disease and stroke, can show you.

"The idea was to have community residents take photos of their individual take on the topic of barriers to heart health," says Sarah Kowitt, a study author and graduate student in public health at the University of North Carolina, Chapel Hill.

The teen and adult volunteers took photos of what they think creates barriers to good heart health in Lenoir County, N.C., where they live. The study, published Thursday in Preventing Chronic Disease, is part of Heart Healthy Lenoir, a community-based project aimed at creating long-term strategies to reduce heart disease in a community at high risk.

Lenoir County is rural, low-income and mostly African-American. While cardiovascular disease is the leading cause of death in the U.S., there are "big disparities in income and disease among African-Americans" when compared with people of other races and ethnicities, Kowitt says.

This was a tiny study, just nine adolescents and six adults. But just look at some of these photos, and what people have to say about them.

Barriers To Good Health

  • Family Influences

    "He wasn't raised where health was an issue in the household. There was nobody talkin' about health, probably nobody talking about not smoking or drinking or unhealthy practices, what it could lead to. There was nobody talkin' about that." i

    "He wasn't raised where health was an issue in the household. There was nobody talkin' about health, probably nobody talking about not smoking or drinking or unhealthy practices, what it could lead to. There was nobody talkin' about that." National Center for Chronic Disease Prevention and Health Promotion hide caption

    toggle caption National Center for Chronic Disease Prevention and Health Promotion
    "He wasn't raised where health was an issue in the household. There was nobody talkin' about health, probably nobody talking about not smoking or drinking or unhealthy practices, what it could lead to. There was nobody talkin' about that."

    "He wasn't raised where health was an issue in the household. There was nobody talkin' about health, probably nobody talking about not smoking or drinking or unhealthy practices, what it could lead to. There was nobody talkin' about that."

    National Center for Chronic Disease Prevention and Health Promotion
  • No Safe Place To Play

    "We live on a busy road ... but if you branch off there's little neighborhoods like this. There's a branch where you can go ride your bike. But where we live at, you walk out [laughter] you won't be walkin' no more."

    "We live on a busy road ... but if you branch off there's little neighborhoods like this. There's a branch where you can go ride your bike. But where we live at, you walk out [laughter] you won't be walkin' no more." National Center for Chronic Disease Prevention and Health Promotion hide caption

    toggle caption National Center for Chronic Disease Prevention and Health Promotion
  • Candy At The Front Of The Store

    "Have you ever noticed, like when you walk in the store, like most of the time right upfront where the cash registers are it's candy, candy. All the healthy stuff is in the back, and right upfront is the candy, so it's the first thing you see 'cause everybody knows you're gonna buy it 'cause it's good. It's advertised good. People like it!" i

    "Have you ever noticed, like when you walk in the store, like most of the time right upfront where the cash registers are it's candy, candy. All the healthy stuff is in the back, and right upfront is the candy, so it's the first thing you see 'cause everybody knows you're gonna buy it 'cause it's good. It's advertised good. People like it!" National Center for Chronic Disease Prevention and Health Promotion hide caption

    toggle caption National Center for Chronic Disease Prevention and Health Promotion
    "Have you ever noticed, like when you walk in the store, like most of the time right upfront where the cash registers are it's candy, candy. All the healthy stuff is in the back, and right upfront is the candy, so it's the first thing you see 'cause everybody knows you're gonna buy it 'cause it's good. It's advertised good. People like it!"

    "Have you ever noticed, like when you walk in the store, like most of the time right upfront where the cash registers are it's candy, candy. All the healthy stuff is in the back, and right upfront is the candy, so it's the first thing you see 'cause everybody knows you're gonna buy it 'cause it's good. It's advertised good. People like it!"

    National Center for Chronic Disease Prevention and Health Promotion
  • Fast-Food Avenue

    "What I'm showing here is the amount of fast-food places on [omitted] Avenue within a mile. I would say less than a half a mile! Four pizza joints ... you got Moons, then you got a steakhouse right next to it. So you get your Chinese food and then your greasy sub sandwiches here; Burger King's ... you have Bojangles; the Mexican joint." i

    "What I'm showing here is the amount of fast-food places on [omitted] Avenue within a mile. I would say less than a half a mile! Four pizza joints ... you got Moons, then you got a steakhouse right next to it. So you get your Chinese food and then your greasy sub sandwiches here; Burger King's ... you have Bojangles; the Mexican joint." National Center for Chronic Disease Prevention and Health Promotion hide caption

    toggle caption National Center for Chronic Disease Prevention and Health Promotion
    "What I'm showing here is the amount of fast-food places on [omitted] Avenue within a mile. I would say less than a half a mile! Four pizza joints ... you got Moons, then you got a steakhouse right next to it. So you get your Chinese food and then your greasy sub sandwiches here; Burger King's ... you have Bojangles; the Mexican joint."

    "What I'm showing here is the amount of fast-food places on [omitted] Avenue within a mile. I would say less than a half a mile! Four pizza joints ... you got Moons, then you got a steakhouse right next to it. So you get your Chinese food and then your greasy sub sandwiches here; Burger King's ... you have Bojangles; the Mexican joint."

    National Center for Chronic Disease Prevention and Health Promotion

In discussion groups following the photo sessions, adults and teens dug into these and other stressors in the community. Adults often pointed to racial prejudice and the stress it causes, saying that "as a people, this whole stress thing is new; we just think this is how it is."

Bottom line, the photos and discussion sessions started a conversation about the importance of heart health and the difficulties many people face in maintaining it. According to co-investigator Alexandra Lightfoot, participants saw this as an opportunity to explore barriers to good health and rally the community to bring about needed changes.

Some great ideas emerged, says Lightfoot, including ways to "entice residents toward the healthy food" section in grocery stores and fast-food establishments, initiate nutrition education in the schools and even encourage rap stars to incorporate positive health messages in lyrics. All a great beginning, they say, in getting the community involved in helping make positive changes that are good for the heart.

What hurts or helps your health? Show us. Post your photos on Twitter or Instagram with the hashtag #NPRmyhealth.

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