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Borders TF, Hammerslag L. Discussions of Cancer Survivorship Care Needs: Are There Rural Versus Urban Inequities? Med Care 2024; 62:473-480. [PMID: 38775667 PMCID: PMC11155275 DOI: 10.1097/mlr.0000000000002014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
BACKGROUND Rural cancer survivors may face greater challenges receiving survivorship care than urban cancer survivors. PURPOSE To test for rural versus urban inequities and identify other correlates of discussions about cancer survivorship care with healthcare professionals. METHODS Data are from the 2017 Medical Expenditure Panel Survey (MEPS), which included a cancer survivorship supplement. Adult survivors were asked if they discussed with a healthcare professional 5 components of survivorship care: need for follow-up services, lifestyle/health recommendations, emotional/social needs, long-term side effects, and a summary of treatments received. The Behavioral Model of Health Services guided the inclusion of predisposing, enabling, and need factors in ordered logit regression models of each survivorship care variable. RESULTS A significantly lower proportion of rural than urban survivors (42% rural, 52% urban) discussed in detail the treatments they received, but this difference did not persist in the multivariable model. Although 69% of rural and 70% of urban ssurvivors discussed in detail their follow-up care needs, less than 50% of both rural and urban survivors discussed in detail other dimensions of survivorship care. Non-Hispanic Black race/ethnicity and time since treatment were associated with lower odds of discussing 3 or more dimensions of survivorship care. CONCLUSIONS This study found only a single rural/urban difference in discussions about survivorship care. With the exception of discussions about the need for follow-up care, rates of discussing in detail other dimensions of survivorship care were low among rural and urban survivors alike.
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Affiliation(s)
| | - Lindsey Hammerslag
- Division of Biomedical Informatics, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY
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Hearn M, Pinto C, Moss JL. Evaluating the Connection Between Rural Travel Time and Health: A Cross-Sectional Analysis of Older Adults Living in the Northeast United States. J Prim Care Community Health 2024; 15:21501319241266114. [PMID: 39051657 PMCID: PMC11273699 DOI: 10.1177/21501319241266114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION To characterize the impact of rural patients' travel time to obtain healthcare on their reported utilization of preventive healthcare services and personal health outcomes. METHODS Online survey data from rural adults ages 50+ years living in the Northeastern United States were collected from February to August 2021. Study measures included self-reported travel time to obtain healthcare, use of preventive healthcare, and health outcomes. The associations between travel time with use of preventive care and health outcomes were assessed using linear, Poisson, and logistic regression analyses controlling for demographic variables. RESULTS Our study population included 1052 rural adults, with a mean travel time of 18.5 min (range: 0-60). Travel time was greater for racial/ethnic minority participants and for higher-income participants (both P < .05), but it was not associated with use of preventive healthcare. Greater travel time was associated with poorer mental health and more comorbidities, including cancer and diabetes (all P < .05). CONCLUSIONS Travel time varied by patient demographic factors, and it was associated with mental health and comorbidities. There was no association between travel time and preventive care use, suggesting that other barriers likely contribute to suboptimal use of these services within rural communities. Further research is needed to elucidate the causal pathways linking travel time to mental health and comorbidities within rural communities, as increased travel may exacerbate intrarural health disparities.
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Affiliation(s)
| | - Casey Pinto
- Penn State College of Medicine, Hershey, PA, USA
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Guest MA, Hunter EG, Schoenberg NE. Making Home: The Role of Social Networks on Identity, Health, and Quality of Life Among Rural Lesbian and Gay Older Adults. Innov Aging 2023; 7:igad082. [PMID: 37727599 PMCID: PMC10506171 DOI: 10.1093/geroni/igad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Indexed: 09/21/2023] Open
Abstract
Background and Objectives Gay and lesbian older persons face a host of health inequalities related to their identity as they age. Challenges to health access and appropriate social support may be even more exacerbated for those living in rural environments; this may be due to the lack of supportive and affirming social connections. This project aimed to explore and describe the social networks and the relationship of these social networks to identity, health, and quality of life of gay and lesbian individuals in rural communities. Research Design and Methods Social network data on network type, size, and social capital were collected and supplemented by quantitative questionnaires relating to health, quality of life, marginalization, and identity. Results Participants (N = 25) were recruited from three states. Thirteen participants self-identified as gay and 12 as lesbian. All but one identified as non-Hispanic White. The average age of all participants was 60.32 years. Findings indicate that rural gay and lesbian individuals develop networks with little consideration for network members' acceptance of their identity. Participants reported an average network size of 9.32 individuals. Gay men reported higher perceptual affinity (.69) than lesbian participants (.62). Lesbian networks showed significantly (p = .0262) greater demographic similarity (.58) than aging gay men's networks (.55). Aging gay men (.89) reported statistically stronger (p = .0078) network ties than aging lesbian females (.78). Among participants in this study, network size is not correlated with the health and quality of life of rural aging lesbian and gay individuals. Still, personal identity congruence does appear to relate to health and quality of life. Discussion and Implications The findings highlight the collective need to continue research into sexual minority aging and rural sexual minority aging, particularly employing novel methods.
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Affiliation(s)
- Marc Aaron Guest
- Center for Innovation in Healthy and Resilient Aging, Arizona State University, Phoenix, Arizona, USA
| | - Elizabeth G Hunter
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
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Bennett KJ, Borders TF, Holmes GM, Kozhimannil KB, Ziller E. What Is Rural? Challenges And Implications Of Definitions That Inadequately Encompass Rural People And Places. Health Aff (Millwood) 2020; 38:1985-1992. [PMID: 31794304 DOI: 10.1377/hlthaff.2019.00910] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Monitoring and improving rural health is challenging because of varied and conflicting concepts of just what rural means. Federal, state, and local agencies and data resources use different definitions, which may lead to confusion and inequity in the distribution of resources depending on the definition used. This article highlights how inconsistent definitions of rural may lead to measurement bias in research, the interpretation of research outcomes, and differential eligibility for rural-focused grants and other funding. We conclude by making specific recommendations on how policy makers and researchers could use these definitions more appropriately, along with definitions we propose, to better serve rural residents. We also describe concepts that may improve the definition of and frame the concept of rurality.
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Affiliation(s)
- Kevin J Bennett
- Kevin J. Bennett ( kevin. bennett@uscmed. sc. edu ) is an associate professor of family medicine and director of the Research Center for Transforming Health, both at the University of South Carolina School of Medicine, in Columbia
| | - Tyrone F Borders
- Tyrone F. Borders is a professor of health management and policy and the Foundation for a Healthy Kentucky Endowed Chair in Rural Health Policy, both at the University of Kentucky, in Lexington
| | - George M Holmes
- George M. Holmes is a professor in the Department of Health Policy and Management and director of the Cecil G. Sheps Center for Health Services Research, both at the University of North Carolina at Chapel Hill
| | - Katy Backes Kozhimannil
- Katy Backes Kozhimannil is an associate professor in the Division of Health Policy and Management, University of Minnesota School of Public Health, in Minneapolis
| | - Erika Ziller
- Erika Ziller is an assistant professor of public health and director of the Maine Rural Health Research Center, both at the University of Southern Maine, in Portland
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Dwyer M, Rehman S, Ottavi T, Stankovich J, Gall S, Peterson G, Ford K, Kinsman L. Urban-rural differences in the care and outcomes of acute stroke patients: Systematic review. J Neurol Sci 2018; 397:63-74. [PMID: 30594105 DOI: 10.1016/j.jns.2018.12.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/14/2018] [Accepted: 12/16/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To describe literature pertaining to urban-rural differences in both the quality of care and outcomes of acute stroke patients. METHODS We systematically searched CINAHL, PubMed, ProQuest Dissertations & Theses, and Scopus for published and unpublished literature until 9th December 2017. Studies were included if they compared the acute care provided to, or outcomes of, patients hospitalised for stroke in urban versus rural settings. Abstract, full-text review, and data extraction were conducted in duplicate. Findings are presented in the form of narrative syntheses. RESULTS A total of 28 studies were included in the review (16 on care, 12 on outcomes). With few exceptions, studies addressing the provision of care suggested that rural patients have less access to most aspects of acute stroke care. Studies reporting urban-rural differences in patient outcomes were inconsistent in their findings, however, few of these studies were primarily focused on the issue of urban-rural disparities. Overall, study findings did not appear to differ in line with study quality ratings, stroke subtypes included, or how inter-facility patient transfers were accounted for. CONCLUSIONS There is convincing, albeit not unanimous, evidence to suggest that stroke patients in rural areas receive less acute care than their urban counterparts. Despite this, the available data and methodology have largely not been used to study urban-rural differences in patient outcomes. PROSPERO registration information: URL: https://www.crd.york.ac.uk/prospero. Unique identifier: CRD42017073262.
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Gay C, Clements-Nolle K, Packham J, Ackerman G, Lensch T, Yang W. Community-Level Exposure to the Rural Mining Industry: The Potential Influence on Early Adolescent Alcohol and Tobacco Use. J Rural Health 2018; 34:304-313. [PMID: 29388274 DOI: 10.1111/jrh.12288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Rural youth have higher rates of alcohol and tobacco use compared to their urban counterparts. However, the economic dependence of rural communities may differentially influence risk behaviors. While research has shown that adults working in mining have elevated rates of alcohol and tobacco use, the influence of living in a mining community on early adolescent substance use is unknown. METHODS Using data from a representative sample of 4,535 middle school students in a state with heavy reliance on mining, we conducted weighted logistic regression to investigate whether community-level mining economic dependence influences rural-urban differences in adolescent alcohol and tobacco use. All models adjusted for sociodemographics, military family involvement, parental monitoring, and length of residence. FINDINGS Over one quarter of the sampled students lived in rural counties and approximately half of these counties met the USDA mining economic typology. After stratifying rural counties by mining and nonmining economic dependence, students in rural mining counties had significantly higher odds of all measures of alcohol use (AORs ranged from 1.83 to 3.99) and tobacco use (AORs ranged from 1.61 to 5.05) compared to students in urban counties. Only use of smokeless tobacco was higher among students in rural nonmining counties. CONCLUSIONS Our findings demonstrate rural-urban disparities in adolescent substance use that are particularly pronounced among youth living in counties with economic dependence on mining. Future research on this subject should include a wider range of community-level factors that may have specific relevance in rural settings to inform the development of population-level interventions.
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Affiliation(s)
- Christopher Gay
- School of Community Health Sciences, University of Nevada, Reno, Nevada
| | | | - John Packham
- Nevada Office of Statewide Initiatives, University of Nevada, Reno School of Medicine, Reno, Nevada
| | - Gerald Ackerman
- Nevada State Office of Rural Health, University of Nevada, Reno School of Medicine, Reno, Nevada
| | - Taylor Lensch
- School of Community Health Sciences, University of Nevada, Reno, Nevada
| | - Wei Yang
- School of Community Health Sciences, University of Nevada, Reno, Nevada
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Masterson S, Teljeur C, Cullinan J, Murphy AW, Deasy C, Vellinga A. The Effect of Rurality on Out-of-Hospital Cardiac Arrest Resuscitation Incidence: An Exploratory Study of a National Registry Utilizing a Categorical Approach. J Rural Health 2017; 35:78-86. [PMID: 28842929 DOI: 10.1111/jrh.12266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/30/2017] [Accepted: 07/27/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Variation in incidence is a universal feature of out-of-hospital cardiac arrest (OHCA). One potential source of variation is the rurality of the location where the OHCA incident occurs. While previous work has used a simple binary approach to define rurality, the purpose of this study was to use a categorical approach to quantify the impact of urban-rural classification on OHCA incidence in the Republic of Ireland. METHODS The observed versus expected ratio of OHCA incidence where resuscitation was attempted for the period January 1, 2012, to December 31, 2014, was calculated for each of the 3,408 electoral divisions (ED). EDs were then classified into 1 of 6 urban-rural classes. Multilevel modeling was used to test for variation in incidence ratios (IR) across the urban-rural classes. FINDINGS A total of 4,755 cases of adult OHCA, not witnessed by Emergency Medical Services, where resuscitation was attempted were included in the study. The number of EDs in each category was as follows: city (n = 477); town (n = 293); near village (n = 182); remote village (n = 84); near rural (n = 1,479); remote rural (n = 893). The IR per ED varied from 0 to 18.38 (EDs, n = 3,408). Multilevel modeling showed that 2.36% of variation in IR was due to urban-rural classification. This dropped to 0.45% when adjusted for ED deprivation score and median distance to an ambulance station. The addition of other explanatory variables did not improve the model. CONCLUSION OHCA variation in Ireland is limited and almost fully explained by area-level deprivation and proximity to ambulance stations.
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Affiliation(s)
- Siobhán Masterson
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Conor Teljeur
- Public Health and Primary Care, Trinity College, University of Dublin, Dublin, Ireland
| | - John Cullinan
- School of Business & Economics, National University of Ireland Galway, Galway, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Conor Deasy
- Health Service Executive, National Ambulance Service, Dublin, Ireland
| | - Akke Vellinga
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland
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