Rural Healthy People 2030

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http://hdl.handle.net/1969.1/1581900

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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.
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.
Rural Health Issues in Child and Adolescent Development
(Texas A&M University, 2023) Wilson, Kelly
The Rural Healthy People 2030 survey ranked “Child and Adolescent Development” as a top 20 health priority, emphasizing the need for specialized attention to rural youth. This demographic faces higher health and developmental risks than urban peers. Key areas requiring targeted efforts include education, literacy, healthcare access, and mental health services. These are vital for improving the health and development of rural children and adolescents. Ongoing monitoring of health trends and the effectiveness of evidence-based programs in rural settings is essential. Such surveillance will enhance health outcomes and provide insights into the utilization of resources by rural youth. Understanding the complex challenges faced by rural children, particularly those with multiple risk factors, is crucial as they transition into adulthood. This knowledge is imperative for shaping interventions that cater to the evolving needs of this growing population.
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.
Rural Education Access and Quality
(Texas A&M University, 2023) Kipp, Andrew
There are encouraging trends in rural schools when compared to nonrural schools. For example, rural schools outperform urban schools in graduation rates. They outperform nonrural schools in the NAEP 4th and 8th grade math and reading achievement test scores. However, other trends are less encouraging, such as higher poverty rates in rural schools compared to suburban schools, fewer students attending college the first October after high school graduation, fewer course offerings and interactions with colleges, larger learning losses during the summer months compared to nonrural schools as a result of fewer summer learning opportunities, higher rates of mental health crises compared to their urban counterparts, and fewer opportunities to access technology when compared to nonrural schools. There are disparities with students of color compared to White students in rural regions as students of color experience higher rates of poverty, lower educational attainment, and lower student achievement compared to rural White students. Finally, the South and West regions in the U.S. tend to have higher rates of rural poverty compared to the other U.S. regions, which compromises educational attainment and student achievement. Rural barriers, such as isolation, high rates of poverty, and fewer funds to recruit/ retain quality teachers and address the school’s deficits, create difficulties to reverse the problematic trends in student achievement and attainment. The interventions and community models aim to overcome these barriers to ensure that our rural students have better educational access and quality. In turn, these improvements may result in a healthier rural community
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.
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.
Public Health Infrastructure in Rural America: Elevating Quality Improvement, Accreditation, and Core Competencies
(Texas A&M University, 2023) Rochford, Hannah I.; Marthey, Daniel; Ferdinand, Alva O.
Understanding community needs and preferences is essential for effective public health. This applies to access to services and other challenges faced by rural local health departments (LHDs). Rural areas lack public sector investments, workforce support, and economic recovery seen in urban counterparts. Overcoming reliance on declining state and federal funding is crucial for rural LHDs. Collaborations and resource pooling can enhance capacity. Social connectedness and self-reliance provide a foundation for effective partnerships and tailored solutions in rural public health.
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.
Transportation in Rural America
(Texas A&M University, 2023) Akinlotan, Marvellous; Eboreime, Emesomhi; Kolade, Fiyinfolu; Udeh, Mercy
Motor vehicle crashes (MVC) remain a public health threat. Public policies and programs that improve rural road infrastructure, enforce speed limit laws, ensure alternative means of transportation, especially for the intoxicated, and make targeted public education campaigns are critical to reducing MVCs and saving lives. As private and governmental entities work to improve public transportation that will support rural residents’ well-being by providing transportation to employment, schools, as well as social and recreational destinations, efforts must be made to encourage ridership. Public transportation systems are critical for those who are historically considered racial/ethnic minorities, those who earn less, and for the elderly. The consequences of poor access to public transit might mean residents forgo economic, educational, recreational, and healthcare opportunities. Maintaining viable community transportation services will involve the input of federal, state, local and not-for-profit organizations. Technological advancements may reduce the need for commuting as more rural residents are able to work and receive healthcare remotely, thus reducing the need for more frequent transportation.
Rural Economic Stability
(Texas A&M University, 2023) Andreyeva, Elena; Wang, Brad
Recognition that economic stability has a significant impact on individual health status has become more pronounced over the last decade, especially since the COVID-19 pandemic and its disruption to the household finances of many Americans. While residents of inner cities have historically been affected by economic instability, rural residents have not been exempt from unique challenges accessing safe housing, nutritious foods, healthcare services, stable schooling, and other necessities. In fact, some of the challenges may be more striking in rural communities due to pockets of persistent poverty, limited employment opportunities, food insecurity, aging population, limited housing stock, lack of transportation, and underfunded schools. As recognition of the importance of economic stability continues to strengthen, future research should examine the impact current policy initiatives have not only on the financial health of rural Americans, but also on their physical and mental health. The relationship between rural poverty and health is multifaceted, further complicated by regional disparities in economic stability, concentrated in the U.S. South, and racial disparities concentrated among non-White rural residents. To succeed, policymakers, public health professionals, researchers, businesses, community groups, and other stakeholders should continue to work together to implement interventions directed at addressing disparities in access to employment opportunities, affordable housing, nutritious foods, and schooling in rural communities.
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.
Preventive Care for Rural Populations and Providers: Routine Screenings, Prenatal Care, and Oral Health
(Texas A&M University, 2023) Bolin, Jane; Weston, Cynthia; Sanaullah, Syeda F.; Noureldin, Amal A. K.; Obeidat, Raghad; Page, Robin L.
Solutions to improve preventive healthcare services in rural areas include: (1) expanding Medicaid in states that have not adopted that provision of the ACA; (2) removing physician oversight requirements for nurse practitioners in the 23 remaining states that continue to place this financial burden and restriction on nurse practitioners; (3) utilizing school-based primary care clinics; (4) educating rural residents on the importance of and need for USPSTF-recommended screenings; and (5) providing continuing education for rural providers on updates in preventive guidelines. More than ever, rural health policymakers need to be monitoring potential gaps in access to health care, as well as providing support for social determinants of health, with the goal of improving access to routine health screenings for rural residents. By increasing access to regular preventive care, we can significantly improve the health of rural communities in America.
Rural Healthy People: Older Adults
(Texas A&M University, 2023) Towne Jr, Samuel D.; Ng, Boon Peng; Reres, Adam; Rigsby, Matilin; Lee, Chanam; Smith, Matthew Lee; Ory, Marcia G.
Older adults face distinct challenges related to aging, including social connectedness and isolation. Solutions, such as age-friendly community designs, can mitigate these issues. Older rural residents experience health disparities, compounded by factors like race, ethnicity, and socioeconomic status. Analyzing these experiences is complex due to intersecting factors (e.g., race, rurality). Tailored evidence-based programs and policies are essential. Embedding interventions sensitive to individual experiences and ongoing public health surveillance are crucial for improving outcomes among rural older adults.
Nutrition and Healthy Eating in Rural America
(Texas A&M University, 2023) Seguin-Fowler, Rebecca A.; Jilcott Pitts, Stephanie B.; Shanks, Carmen B.; Babatunde, Oyinlola T.; Maddock, Jay E.
Rural adults and youth consume fewer fruits and vegetables but more sugar-sweetened beverages than their urban counterparts. Food insecurity rates remain higher in rural areas, impacting physical and mental health. Food insecurity rates are elevated in the South, particularly among Black and Native American residents. Obesity-associated chronic diseases are also more prevalent in these regions. Poverty, limited access to healthy food, and higher food costs hinder healthy eating in rural areas. Longer travel times and lack of reliable transportation further exacerbate the issue. Successful strategies include incentives, produce prescription programs, mobile markets, and improved access to summer meals. Awareness campaigns, tailored labels, telehealth, and school-based programs have also shown promise. Research on rural-specific measurement tools and technologies is needed. Assumptions about nutrition, obesity, and health must be reconsidered for diverse populations. Innovations like online shopping, drone delivery, and mobile markets can enhance rural food access and healthy eating. Addressing rural disparities requires increased funding for sustainable projects and interventions tailored to local needs.
Rural Substance Misuse Trends in America
(Texas A&M University, 2023) Montemayor, Benjamin N.; Woodland, Gracie; Barry, Adam E.
Alcohol is the most commonly used substance among American school-aged youth. It is often the initial substance adolescents try, and its use is linked to subsequent illicit substance use later in life. Alcohol use is associated with poorer academic performance and engagement in risky behaviors, potentially affecting future work and educational opportunities. Rather than substance-specific interventions, policies and strategies should focus on enhancing prevention and treatment infrastructure. Rural areas consistently show higher rates of hazardous alcohol use or alcohol-related harm. Public health strategies tailored to rural communities’ unique needs are essential. In-depth assessments of individual, community, and familial factors (e.g., religiosity, social norms, family relationships) should be conducted to inform targeted intervention and prevention efforts. Addressing alcohol-related challenges in rural communities requires tailored approaches that consider local context and individual factor
Obesity and Physical Activity in Rural Settings
(Texas A&M University, 2023) Maddock, Jay E.; Seguin-Fowler, Rebecca A.; Shrestha, Aakriti; Ferdinand, Alva O.
Obesity and physical inactivity are risk factors for chronic disease throughout the U.S. However, rural adults are at a higher risk for both of these, with differences in obesity seen as early as three years old. Cultural norms and the built environment contribute to these disparities. However, in recent years several effective interventions have been developed that can improve the health of rural residents. Dissemination and widespread adoption of these interventions, along with changes to the food and physical activity environments, are needed to eliminate rural/urban disparities in obesity and physical inactivity.
Rural Healthcare Access and Quality
(Texas A&M University, 2023) Callaghan, Timothy H.; Trujillo, Kristen Lunz; Lockman, Alee; Falia, Gogoal
In the past decade, healthcare access and quality in the U.S. have improved significantly, largely due to the Affordable Care Act (ACA), which enabled millions to obtain affordable health insurance. This has facilitated increased access to healthcare services and reduced the burden of uncompensated care. Technological advancements have further enhanced access through telehealth, allowing more Americans to receive timely care. However, disparities in healthcare access and quality persist, particularly in rural areas. Rural Americans often lack health insurance, face travel barriers to care, experience health professional shortages, and are affected by hospital closures. Additionally, inadequate internet and device access limits telehealth’s potential. Similar challenges affect minority groups and those in states without Medicaid expansion. To bridge these gaps, policy changes are essential. Expanding Medicaid, improving internet coverage for telehealth, addressing health professional shortages, supporting rural hospitals, and reducing prescription drug costs are critical steps. Policies like the Inflation Reduction Act are underway, and their impact on rural health must be monitored over the coming decade.
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.
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.

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