Southwest Rural Health Research Center

Permanent URI for this community

http://hdl.handle.net/1969.1/201246

Browse

Now showing 1 - 20 of 38

Addiction in Rural America
(Texas A&M University, 2023) Gary, Jodie C.; Burge, Destiny; Downing, Nancy R.; Hutchison, Linnae; Horel, Scott
Continued investigation, and interventions that emphasize environments which better conditions underpinning increased risk, are critical. In general, rural Americans are at-risk and understudied in relation to the opioid epidemic. This chapter highlights drug use in rural America, as the opioid epidemic is certainly on the forefront of addiction concerns. The need is great for stronger partnerships among the medical community, increased access to substance use treatments, and collaborative public health organizations to better support rural communities.
Analysis of an Innovative Approach to Target Rural Communities in Public Health Funding
(2023-03) Callaghan, Timothy H.; Falia, Gogoal; Greer, Earl; Ramy, Maya; Washburn, David J.
In 2021, the Centers for Disease Control (CDC) carved out $427 million in state funding to focus on combatting COVID-19 in rural communities as part of a multi-billion dollar national initiative to address COVID-19-related health disparities among at-risk and underserved populations. This brief explores the circumstances around this emphasis on rural America by interviewing relevant decision-makers and key stakeholders. The analysis indicated the funds were well supported by stakeholders and were being used in creative ways. It also allowed more rural stakeholders to be involved in public health decision making. Although it's too soon to evaluate the funds' impact on rural communities, and there have been some infrastructure and capacity challenges in using the funds, most stakeholders would encourage rural carve outs for future grant programs.
Are Rural Infants Benefiting from WIC Food Package Rule Changes? Breastfeeding and Infant Feeding Behaviors
(2020-02) Ishdorj, Ariun; Di, Hongyang; Samman, Elfreda; McKyer, E. Lisako J.
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides healthy foods and services to low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, as well as to infants and children up to age 5. In 2009, revisions were made to the WIC program to further improve the nutrition and health of infants by providing benefits to promote and support breastfeeding among those who are able and to improve infant feeding practices. This study compared breastfeeding initiation for rural and urban WIC participants, as well as changes in breastfeeding and infant feeding practices before and after the WIC Food Packages (WIC-FPs) revisions. Secondary data from the National Food and Nutrition Survey were used consisting of data from 58 WIC programs representing 38 states, two U.S. districts and territories, and 10 Indian/tribal organizations. Our results revealed breastfeeding for WIC participants continues to move in a positive direction with evidence showing a significant increase in fully breastfeeding post WIC-FP revisions in both rural and urban participants. Our findings for infant feeding revealed an improvement in feeding practices post WIC-FP revisions, such as a delay in the introduction of solid food. Rural participants, however, were still lagging behind their urban counterparts.
Cancer Mortality in Rural America
(2018-11) Callaghan, Timothy H.; Ferdinand, Alva O.; Towne Jr, Samuel D.; Akinlotan, Marvellous; Primm, Kristin; Bolin, Jane
For scholars and policymakers alike, understanding the burden of cancer on society is a critical topic for investigation. Cancer consistently ranks as the second leading cause of death in the U.S., and cancers of the prostate, breast, lung, and colorectal areas are particularly problematic. This policy brief works to understand the scope of cancer mortality in urban and rural areas of the U.S. and across census regions. It finds that age-adjusted mortality rates are higher for lung, prostate, and colon cancer in rural areas than in urban areas but also that mortality rates are lower for breast and cervical cancers in rural areas than in urban areas. In addition, this brief identifies important discrepancies in cancer mortality across regions, with lower rates in the West for all analyzed cancer types except prostate cancer, and higher rates for most cancers in the rural South.
The Co-occurrence of HIV and Opioid Mortality in Rural and Urban America from 1999-2018
(2021-06) Callaghan, Timothy H.; Primm, Kristin; Akinlotan, Marvellous; Khodakarami, Nima; Vadali, Meera; Bolin, Jane; Ferdinand, Alva O.
Previous research has noted that the U.S. is facing dual public health crises associated with opioid use disorder (OUD) and human immunodeficiency virus (HIV). Fatalities associated with OUD have been reported with increasing frequency, and researchers have posited that the injection of opioids could have implications for HIV rates and mortality. The current body of literature outlining connections between HIV and OUD does not account for differences in rural and urban areas. Using the Centers for Disease Control and Prevention Wide-ranging Online Date for Epidemiology Research mortality database, this brief finds no positive relationship between opioid mortality and HIV mortality over time. Instead, the results show a consistent decline in HIV mortality rates and a troubling rise in deaths from opioids across the time period analyzed.
Community Health Worker Roles and Responsibilities in Rural and Urban America
(2019-11) Callaghan, Timothy H.; Washburn, David J.; Schmit, Carson D.; Martinez, Denise; Thompson, Emily; Lafleur, Megan; Ruiz, Zuleyma
This project investigated the Community Health Worker (CHW) field in rural and urban environments using a series of focus groups of CHWs in four states. Our findings suggest that there is not a "typical" CHW. Despite this, our results show that CHWs in rural and urban areas share two commonalities—their role as bridge figures between communities and needed resources and their unique position in helping the healthcare industry address social determinants of health. An important difference we observed is that rural CHWs took on a more "generalist" role due to lack of resources, programs, and services, whereas urban CHWs took on a more "specialist" role because of the sometimes substantial amount of available resources, programs, and services.
The Development of Telehealth Laws in the U.S. from 2008 to 2015: A Legal landscape
(2019-11) Schmit, Carson D.; Ferdinand, Alva O.; Callaghan, Timothy H.; Kageyama, Mariko; Khodakarami, Nima; Morrisey, Michael A.
Rapid technological advances make telehealth a moving target for regulators. This study examines the scope and evolving nature of telehealth statutes (i.e., laws passed by state legislatures) and regulations (i.e., laws promulgated by state executive agencies) in the U.S. Our research aims to understand changes in telehealth laws over time (2008-2015), variations in legal frameworks established across the U.S., and the extent that state laws regulate the primary care delivery through the use of telehealth. We found that the number of states with broadly worded laws that authorize a variety of healthcare professional to provide care via telehealth more than tripled between 2008 and 2015 (from 3 to 10). A legal analysis suggests that enabling regulations on telehealth payment for Medicaid are relatively rare in the eastern U.S. and that laws governing private insurance telehealth payments are more geographically defused. Examining differences in the adoption of telehealth laws by state proportions on rurality and urbanicity indicates that states with large urban populations also see the utility of a regulatory environment supports telehealth as an avenue for increased access to care for rural residents.
Diabetes and Forgone Medical Care due to Cost in the U.S. (2011-2015): Individual-level and Placed-based Disparities
(2017-08) Towne Jr, Samuel D.; Bolin, Jane; Ferdinand, Alva O.; Nicklett, Emily Joy; Smith, Matthew Lee; Callaghan, Timothy H.; Ory, Marcia G.
Diabetes, particularly Type 2 diabetes, affects millions of Americans with a particular burden placed on more vulnerable populations. Underlying factors (e.g., residing in low-resource rural areas) may contribute to poor health-related outcomes for persons with diabetes. This study used 2011-2015 data from the Behavioral Risk Factor Surveillance System (BRFSS), to investigate trends in diabetes rates and forgone medical care among persons with diabetes in the U.S. and to identify geographic determinants (i.e., place-based) and other social determinants of health disparities. Results indicate that both the southern U.S. and rural areas faced a greater burden of diagnosed diabetes. Areas that failed to expand Medicaid through the Affordable Care Act may face a greater burden of both diabetes and forgone medical care due to cost among those with diagnosed diabetes. This study highlighted the critical role that both individual-level and place-based (i.e., geospatial factors), namely region and rurality, play in diabetes and forgone medical care. Practical applications of this study include a call for increased focus on prevention, diagnosis, and diabetes self-care education and proper maintenance of diabetes among at-risk populations.
Diabetes Mortality in Rural America: 1999-2015
(2017-08) Callaghan, Timothy H.; Towne Jr, Samuel D.; Bolin, Jane; Ferdinand, Alva O.
One of the most important tasks for rural scholars and policymakers is to better understand the causes and consequences of diabetes, as diabetes prevalence is generally higher in rural areas than urban areas. This study explores diabetes-related mortality, comparing urban-versus-rural mortality over a sixteen-year period, and investigating the influence of race and rurality. The study uses data from the Centers for Disease Control and Prevention Wonder Database. Results demonstrated that as rurality increases in America, so too does diabetes-related mortality. Mortality attributable to diabetes is dramatically higher for Black Americans than Whites in both rural and urban areas, although rural-urban disparities follow similar trends for both groups. Hispanics, despite having lower diabetes-related mortality than Whites, also demonstrated higher rural rates of mortality than urban. Resources should be devoted to better understanding the causes and consequences of these findings, and to developing effective interventions aimed at eliminating disparities in diabetes mortality based on rurality and race.
Diabetes-Related Hospital Mortality in Rural America: A Significant Cause for Concern
(2018-03) Ferdinand, Alva O.; Akinlotan, Marvellous; Callaghan, Timothy H.; Towne Jr, Samuel D.; Bolin, Jane
It has been reported that diabetes prevalence is higher in rural areas than in urban areas. Other studies have shown that rural persons with diabetes have higher morbidity from diabetes-related complications than urban persons with diabetes. This study used data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (2009-2014) to examine hospital-based diabetes-related mortality and whether there were urban-rural differences across census regions. On average 2.63% of all diabetes-related urban hospital admissions resulted in death, while 2.73% of all diabetes-related rural hospital admissions resulted in death (p<0.001). Mortality rates were highest within rural areas of the South and Midwest (21.0 and 15.1 deaths per 100,000 population, respectively) compared to other areas in both regions. The noncore, micropolitan, and small metropolitan areas of the South had the highest average diabetes-related hospital mortality rates (21.0, 20.3, and 14.0 deaths per 100,000 population, respectively) compared to corresponding areas in the Northeast, Midwest, and West regions. Results suggest that substantial differences exist between rural and urban diabetes-related hospital mortality. Furthermore, the burden is especially pronounced for rural residents in the South and Midwest census regions.
Disparities and Opportunities Across the Cancer Continuum in Rural America
(Texas A&M University, 2023) Bloom, Rosaleen D.; Bolin, Jane; Brandford, Arica; Callaghan, Timothy H.; Fahrenwald, Nancy; Mullens, Sophie; Primm, Kristin; Wang, Brad
Rural cancer health disparities persist in the U.S. Barriers exist across the cancer continuum from primary prevention to cancer screening and cancer control. As cancer costs continue to grow, effective primary prevention should target interventions to reduce pollution and toxins, obesity, smoking and alcohol disparities. Continued implementation and development of secondary prevention screening strategies that improve access to providers and screening services are needed. Tertiary cancer control interventions need to be created and piloted for rural communities. Rather than a small subset of states, all fifty states need rural-specific cancer strategies in their comprehensive cancer control plans.
An Examination of the Workforce in Rural America
(Texas A&M University, 2023) Brandford, Arica; Falia, Gogoal; Fahrenwald, Nancy; Clark, Heather; Bolin, Jane; Rigsby, Matilin; Kolade, Fiyinfolu
It is important to leverage the healthcare workforce in new and innovative ways, with more care taking place outside of traditional settings. Flexibility in the way individuals connect with and engage in care is critical. Relationships are central to the development, forward progress, and collective action of community-based partnerships and collaborations. Often, evaluation of partnerships or community collaborative efforts focuses on achieving outcomes and effectiveness; however, community capacity building has many dimensions including: skills and resources, nature of social relations, structures and mechanisms for community dialogue, civic participation, value systems, and learning culture. Continued expansion of telehealth as a means of healthcare provision means identifying evidence-based practices and policy changes to address challenges. There is a need to improve the quality and standardization of data to fully demonstrate and understand the impact of telehealth and identify where disparities persist. Telehealth plays a key role in helping to address workforce issues by enhancing access and reducing burnout.
Health Insurance for Rural Americans
(Texas A&M University, 2023) Ukert, Benjamin; Chakraborty, Susmita; Giannouchos, Theodoros
The ACA expansion increased access to health insurance and led to the historically lowest rate of uninsured people in the United States. However, access issues remain, especially in states that did not expand Medicaid and which have much larger rural populations. Thus, many low-income and rural residents still face insurance access/uptake/enrollment issues. At the same time, improving access to primary care remains a challenge, especially for rural communities, as the number of primary care providers is not growing fast enough to provide access to urban and rural residents. New technologies and state licensure law changes have expanded the opportunity to improve access to care; however, whether these changes will meaningfully increase primary care access remains unknown. Finally, dental coverage rates are relatively low compared to health insurance rates, but dental needs remain high.
Healthy People 2020 Progress for Leading Causes of Death in Rural and Urban America: A Chartbook
(2020-03) Callaghan, Timothy H.; Ferdinand, Alva O.; Akinlotan, Marvellous; Primm, Kristin; Lee, Ju Sung; Macareno, Blanca; Bolin, Jane
Rural Americans have historically faced significant challenges in accessing healthcare and preventive healthcare services, including ambulatory care, dental care, emergency services, and pharmaceutical services. Rural Americans are more likely to die from conditions generally considered self-manageable or preventable. This study examines rural versus urban differences in how the U.S. is meeting the Healthy People 2020 mortality objectives for many of the leading causes of death. Our analyses use national vital statistics mortality data available through the Centers for Disease Control and Prevention's Wonder website. Overall, our findings indicate rural America is lagging behind urban America in achieving these objectives. Furthermore, key findings indicate men have been less likely than women to achieve these objectives, the rural South has seen less progress than other regions toward many of the objectives, and suicide mortality has increased across all levels of rurality.
Hospital and Emergency Services in Rural Areas
(Texas A&M University, 2023) Côté, Murray J.; Shrestha, Aakriti
Rural America continues to face significant challenges in accessing hospital and emergency services. Through various combinations of policy and technology, considerable progress has been made in the breadth and delivery of services in rural communities. Ironically, the barriers that persist are consequences of being associated with rural regions. The pursuit of improving rural-based hospital and emergency services is made more difficult by limited healthcare resources, low population density, and residents with limited or no health insurance who also tend to have generally poorer health status relative to those in other, primarily urban, geographic areas. Optimistically, the growing and persistent attention being paid to rural America may ultimately lead to lower disparities and fewer challenges. The recognition of the rural-urban gaps coupled with innovations in delivery, such as REHs and telehealth, represent important and significant progress.
Housing and Homes: Implications for Rural Americans’ Housing Conditions, Mental Health Outcomes, and Overall Well-being
(Texas A&M University, 2023) Ferdinand, Alva O.; Eboreime, Emesomhi
Rural residents face housing challenges due to aging, limited repair abilities, lower incomes, and older housing stock. Insufficient investment in affordable rural housing affects mental health, lead exposure, and financial well-being. Children, the elderly, the homeless, and marginalized groups are profoundly affected. Despite these challenges, there are promising strategies that can be employed to achieve the overall goal of promoting healthy and safe home environments in rural contexts in the upcoming decade. These strategies include: Wraparound services to identify and address housing needs; partnerships with trusted service organizations for repairs and lead abatement; educate clinicians about housing-related social support programs; consider policies that protect rural multiunit residents from second-hand smoke exposure. These strategies can promote healthier and safer home environments in rural areas.
The Impact of Diabetes on Rural Americans
(Texas A&M University, 2023) Huang, Ya-Ching; Bolin, Jane; Brandford, Arica; Sanaullah, Syeda F.; Shrestha, Aakriti; Ory, Marcia G.
While modest gains have been made, challenges associated with preventing Type 2 diabetes mellitus (T2DM) or managing it well persist. Key to the prevention of diabetes, as well as appropriate management of diabetes, is an active lifestyle, access to primary health care, community-based approaches for prevention of diabetes, and assistance with appropriate management of diabetes for those people with T2DM in rural areas. However, a person’s demographic status, such as rurality, age, sex, and income play a role. Access to health care, including appropriate monitoring supplies, insulin, and nutrition education, as well as access to healthy food resources must be addressed and prioritized by state and national policy makers for diabetes care in rural areas.
Influenza and Pertussis Vaccination Rates Among Pregnant Women in Rural and Urban Area
(2021-04) Regan, Annette; Kaur, Ravneet; Callaghan, Timothy H.
This study evaluates the receipt of influenza and pertussis vaccines among pregnant women from 2012-2018 in the U.S. using data from the Pregnancy Risk Assessment Monitoring System. The data showed the percentage of influenza vaccination among rural pregnant women was lower than their urban counterparts with significant differences in certain subgroups. The data, however, for pertussis vaccination in pregnant women across the urban-rural continuum showed similar percentages overall but with some differences observed in subgroups. This study suggests important gains have been made in maternal vaccination, but significant differences persist across the urban-rural continuum.
The Issue of Chronic Pain in Rural America
(Texas A&M University, 2023) Williamson, Brandon; Woodland, Gracie
Chronic pain remains a devastatingly common disease in the U.S., with higher prevalence and greater severity in rural areas. Treatment of chronic pain in rural settings presents many challenges, including patient demographics, a lack of available medical resources, a lack of multidisciplinary options, and limitations on current epidemiologic knowledge related to rurality and chronic pain. Future directions should focus on training providers to not initiate opioid medications inappropriately and to avoid abrupt cessation in patients who have been on opioids for long periods of time without careful counseling and follow up. Availability of multimodality treatment options should be developed in rural areas and additional research related to chronic pain will help elucidate prevention strategies and care solutions effective for rural communities as a vulnerable patient population.
Mental Health and Mental Disorders: A Rural Challenge
(Texas A&M University, 2023) McCord, Carly E.; Phillips Reindel, Kala M.; Sopchak, Kelly; Stickley, Mariah; Williamson, Meredith
Addressing mental health needs is a clear priority for rural constituents. Issues of accessibility, availability, and acceptability of mental health care in rural areas are well documented. There are viable solutions for improvement as evidenced by the percentage of federally designated MHPSAs in rural or partially rural areas dropping from more than 85% to just under 68% since the 2015 publication of RHP 2020. The use of screening tools for anxiety and depression and the continued integration of mental/behavioral health care within primary care, coupled with intentional focus on training health professionals across disciplines in these models will positively benefit rural areas. Telehealth has a critical role in addressing the mental health crisis and can be used across the lifespan in a variety of settings including homes, schools, community centers, and medical facilities. Thinking outside the medical system by including peer support, utilizing evidence-based models for suicide prevention and mental health awareness, and capitalizing on extended support from community mental health workers will further increase access. Particular attention should be paid to those experiencing the greatest disparities in access and outcomes such as youth, LGBT individuals, and individuals with disabilities.

Browse

Browsing Southwest Rural Health Research Center by Title

Results Per Page

Sort Options