East and west of main street: racism in rural America

Ethnic Identity Attachment and Motivation for Weight Loss and Exercise Among Rural, Overweight, African-American Women

Rural and minority women are disproportionately impacted by the obesity epidemic; however, little research has studied the intersection of these disparity groups. The purpose of this study was to examine the influence of racial identity on motivation for weight loss and exercise among rural, African-American women with an obesity-linked chronic disease. A total of 154 African-American women were recruited from the patient population of a Federally Qualified Health Center in the rural South to complete a questionnaire battery including the Multigroup Ethnic Identity Measure and separate assessments of motivation for weight loss and exercise. Multivariate analyses, controlling for age, education status, insurance status, and body mass index revealed that attachment to ethnic identity was predictive of motivation for exercise but not for weight loss. Our findings suggest that attachment to ethnic identity may be an important factor in motivation for change among African-American women, particularly with respect to exercise, with direct implications for the development of culturally and geographically tailored weight loss interventions.

Mental Health, Racial Discrimination, and Tobacco Use Differences Across Rural-Urban California

OBJECTIVE

Disparities in tobacco use persist despite successful policies reducing use within the United States. In particular, the prevalence of tobacco use in rural and certain minority communities is significantly higher compared to that of their counterparts. In this work, we examine the impact of rurality, mental health, and racial discrimination on tobacco use.

METHODS

Data come from the 2003 California Health Interview Survey (n = 42,044). Modified Poisson regression models were adjusted for age, sex, race/ethnicity, birth origin, education, income, insurance, and marital status.

RESULTS

Compared to urban residents, rural residents had a significantly higher risk for smoking after adjustment (RR = 1.10, 95% CI: 1.01-1.19). Those who reported having experienced racial discrimination also had a significantly greater risk for smoking compared to those who did not (RR = 1.17, 95% CI: 1.07-1.27). Additionally, those who reported higher stress had a significantly greater risk for smoking (RR = 1.61, 95% CI: 1.07-1.67). There was evidence of interaction between rurality and race/ethnicity, and rurality and gender (P < .05).

CONCLUSION

Residing in rural areas was associated with an increased risk for smoking, above and beyond sociodemographics. There were no significant differences across rural-urban environments for the relationship between stress and tobacco use-an indication that the impact of stress and discrimination is not buffered or exacerbated by environmental characteristics potentially found in either location. Mechanisms that explain rural-urban tobacco use disparities need to be explored, and smoking cessation programs and policies should be tailored to target these factors within rural communities.

Identifying underserved ethnic populations within a community: the first step in eliminating health care disparities among racial and ethnic minorities

As set forth by the United States Department of Health and Human Services in Healthy People 2010, the primary goal of the national health promotion and disease prevention plan is to eliminate the health care disparities among racial and ethnic groups. This disparity is due, in part, to unequal health access. However, equal access to health care alone would not eliminate the difference. The health care provided must be culturally competent to be effective. Before providers can effectively begin strategizing ways to provide culturally sensitive health care for the people they serve, they first need to identify the groups of people in their service areas. A clinical example will be used to demonstrate public health nursing's role in accessing and advocating for uncounted populations as a fundamental beginning for eliminating disparity in health care delivery.