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Childs EM, Boyas JF, Blackburn JR. Off the beaten path: A scoping review of how 'rural' is defined by the U.S. government for rural health promotion. Health Promot Perspect 2022; 12:10-21. [PMID: 35854849 PMCID: PMC9277290 DOI: 10.34172/hpp.2022.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/08/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Given the recognition that the U.S. government lacks a consensus definition of the word rural, the purpose of this scoping review was to uncover how the federal government defines the term and to establish a nuanced understanding of what criterion is used to designate an area as rural. Methods: Arksey and O’Malley’s framework was used to synthesize, analyze, and summarize the existing literature. A multi-system search was conducted, and articles were screened for eligibility by two independent reviewers using pretested forms. Results: Initially, 929 articles were screened that used the search terms rural and some variation of the word definition. After eliminating all ineligble studies, 49 documents were included in the final analysis. These documents revealed 33 federal definitions of rural. The majority of definitions centered on either population, population density, or urban integration provisions. Additionally, the analysis showed that the literature could be separated into two categories: how rural was defined in a particular industry or for a specific population and the multiple adverse effects of having multiple definitions of rural. Conclusion: The discrepancies found in current classification systems reveal the need for a standardized definition of rural. Ultimately, policies centered on securing health care services for rural populations are impacted by whatever definition of rural is used. Failing to establish a gold standard definition of rural could have harmful consequences to the health and wellbeing of the many people living in rural communities across the U.S.
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Affiliation(s)
- Elisa M Childs
- School of Social Work, University of Georgia, 279 Williams St., Athens, GA, 30602, USA
| | - Javier F Boyas
- School of Social Work and Human Services, Troy University, 112-D Wright Hall, Troy, AL, 36082, USA
| | - Julianne R Blackburn
- School of Social Work, University of Georgia, 279 Williams St., Athens, GA, 30602, USA
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Brainson CF, Huang B, Chen Q, McLouth LE, He C, Hao Z, Arnold SM, Zinner RG, Mullett TW, Bocklage TJ, Orren DK, Villano JL, Durbin EB. Description of a Lung Cancer Hotspot: Disparities in Lung Cancer Histology, Incidence, and Survival in Kentucky and Appalachian Kentucky. Clin Lung Cancer 2021; 22:e911-e920. [PMID: 33958300 DOI: 10.1016/j.cllc.2021.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Kentucky is recognized as the state with the highest lung cancer burden for more than 2 decades, but how lung cancer differs in Kentucky relative to other US populations is not fully understood. PATIENTS AND METHODS We examined lung cancer reported to the Surveillance, Epidemiology, and End Results (SEER) Program by Kentucky and the other SEER regions for patients diagnosed between 2012 and 2016. Our analyses included histologic types, incidence rates, stage at diagnosis, and survival in Kentucky and Appalachian Kentucky relative to other SEER regions. RESULTS We found that both squamous cell carcinomas and small-cell lung cancers represent larger proportions of lung cancer diagnoses in Kentucky and Appalachian Kentucky than they do in the SEER registries. Furthermore, age-adjusted cancer incidence rates were higher in Kentucky for every subtype of lung cancer examined. Most notably, for Appalachian women the rate of small-cell carcinomas was 3.5-fold higher, and for Appalachian men the rate of squamous cell carcinoma was 3.1-fold higher, than the SEER rates. In Kentucky, lung cancers were diagnosed at later stages and lung cancer survival was lower for adenocarcinoma and neuroendocrine carcinomas than in SEER registries. Squamous cell carcinomas and small-cell carcinomas were most lethal in Appalachian Kentucky. CONCLUSION Together, these data highlight the considerable disparities among lung cancer cases in the United States and demonstrate the continuing high burden and poor survival of lung cancer in Kentucky and Appalachian Kentucky. Strategies to identify and rectify causes of these disparities are discussed.
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Affiliation(s)
- Christine F Brainson
- Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky, Lexington, KY; Markey Cancer Center, University of Kentucky, Lexington, KY.
| | - Bin Huang
- Markey Cancer Center, University of Kentucky, Lexington, KY; Division of Cancer Biostatistics, College of Medicine, University of Kentucky, Lexington, KY; Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Quan Chen
- Markey Cancer Center, University of Kentucky, Lexington, KY; Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Laurie E McLouth
- Markey Cancer Center, University of Kentucky, Lexington, KY; Department of Behavioral Science, Center for Health Equity Transformation, College of Medicine, University of Kentucky, Lexington, KY
| | - Chunyan He
- Markey Cancer Center, University of Kentucky, Lexington, KY; Department of Medicine, Division of Medical Oncology, College of Medicine, University of Kentucky, Lexington, KY
| | - Zhonglin Hao
- Markey Cancer Center, University of Kentucky, Lexington, KY; Department of Medicine, Division of Medical Oncology, College of Medicine, University of Kentucky, Lexington, KY
| | - Susanne M Arnold
- Markey Cancer Center, University of Kentucky, Lexington, KY; Department of Medicine, Division of Medical Oncology, College of Medicine, University of Kentucky, Lexington, KY
| | - Ralph G Zinner
- Markey Cancer Center, University of Kentucky, Lexington, KY; Department of Medicine, Division of Medical Oncology, College of Medicine, University of Kentucky, Lexington, KY
| | - Timothy W Mullett
- Department of Surgery, Division of Cardiothoracic Surgery, College of Medicine, University of Kentucky, Lexington, KY
| | - Therese J Bocklage
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Kentucky, Lexington, KY
| | - David K Orren
- Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky, Lexington, KY; Markey Cancer Center, University of Kentucky, Lexington, KY
| | - John L Villano
- Markey Cancer Center, University of Kentucky, Lexington, KY; Department of Medicine, Division of Medical Oncology, College of Medicine, University of Kentucky, Lexington, KY
| | - Eric B Durbin
- Markey Cancer Center, University of Kentucky, Lexington, KY; Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY; Division of Biomedical Informatics, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY
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Grineski S, Morales DX, Collins T, Wilkes J, Bonkowsky JL. Geographic and Specialty Access Disparities in US Pediatric Leukodystrophy Diagnosis. J Pediatr 2020; 220:193-199. [PMID: 32143930 PMCID: PMC7186149 DOI: 10.1016/j.jpeds.2020.01.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/05/2020] [Accepted: 01/29/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine disparities in the diagnosis of leukodystrophies including geographic factors and access to specialty centers. STUDY DESIGN Retrospective cohort study of pediatric patients admitted to Pediatric Health Information System hospitals. Patients with leukodystrophy were identified with International Classification of Diseases, Tenth Revision, Clinical Modification diagnostic codes for any of 4 leukodystrophies (X-linked adrenoleukodystrophy, Hurler disease, Krabbe disease, and metachromatic leukodystrophy). We used 3-level hierarchical generalized logistic modeling to predict diagnosis of a leukodystrophy based on distance traveled for hospital, neighborhood composition, urban/rural context, and access to specialty center. RESULTS We identified 501 patients with leukodystrophy. Patients seen at a leukodystrophy center of excellence hospital were 1.73 times more likely to be diagnosed than patients at non-center of excellence hospitals. Patients who traveled farther were more likely to be diagnosed than those who traveled shorter. Patients living in a Health Professionals Shortage Area zip code were 0.86 times less likely to be diagnosed than those living in a non-Health Professionals Shortage Area zip code. CONCLUSIONS Geographic factors affect the diagnosis of leukodystrophies in pediatric patients, particularly in regard to access to a center with expertise in leukodystrophies. Our findings suggest a need for improving access to pediatric specialists and possibly deploying specialists or diagnostic testing more broadly.
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Affiliation(s)
- Sara Grineski
- Department of Sociology, University of Utah, Salt Lake City, Utah
| | - Danielle X. Morales
- Department of Sociology & Anthropology. University of Texas at El Paso, El Paso, Texas
| | - Timothy Collins
- Department of Geography, University of Utah, Salt Lake City, Utah
| | | | - Joshua L. Bonkowsky
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah,Brain and Spine Center, Primary Children’s Hospital, Salt Lake City, Utah,Primary Children’s Center for Personalized Medicine, Salt Lake City, Utah,Address correspondence to: Josh Bonkowsky, Department of Pediatrics, 295 Chipeta Way/Williams Building, Salt Lake City, Utah 84108, , Phone: 801-581-6756, Fax: 801-581-4233
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Dean C, Fogleman AJ, Zahnd WE, Lipka AE, Malhi RS, Delfino KR, Jenkins WD. Engaging rural communities in genetic research: challenges and opportunities. J Community Genet 2017; 8:209-219. [PMID: 28477297 DOI: 10.1007/s12687-017-0304-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 04/27/2017] [Indexed: 12/13/2022] Open
Abstract
Statistical analyses of health and disease in rural communities is frequently limited by low sample counts. Still, some studies indicate increased risk for some diseases even after adjustment for known risk factors. It has been hypothesized that the context of community formation in rural areas facilitates the propagation of genetic founder effects-potentially impacting disease susceptibility. However, outright examination of genetic diversity in such communities has not been performed. Our objective was to engage otherwise research-inexperienced rural communities of largely European descent in genomic research in the context of cancer susceptibility. From September 2015 to February 2016, we implemented a systematic process of progressive community engagement. This iterative method sought project buy-in from first the town mayor, then village council. If approved by both, a focus group of community members examined how residents might view the research, informed consent and specimen collection, and issues of privacy. We were successful in engaging three of the four communities approached for the research project. There was universal enthusiasm for the project by all mayors and village councils. The focus groups' main point of discussion involved wording in the informed consent, with little concern regarding the research question or privacy. Perhaps contrary to popular thought, we found each community we approached to be both welcoming and enthusiastic about collaborating in research on genomic diversity. The systematic method of engagement did much to preserve community respect and autonomy and facilitated buy-in.
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Affiliation(s)
- Caress Dean
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62794-9664, USA
| | - Amanda J Fogleman
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62794-9664, USA
| | - Whitney E Zahnd
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62794-9664, USA
| | - Alexander E Lipka
- Department of Crop Sciences, University of Illinois, W-201B Turner Hall, 1102 S Goodwin Ave, Urbana, IL, 61801, USA
| | - Ripan Singh Malhi
- Departments of Anthropology & Animal Biology, Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign, 209F Davenport Hall, 607 Matthews Ave., Urbana, IL, 61801, USA
| | - Kristin R Delfino
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62794-9664, USA
| | - Wiley D Jenkins
- Population Health Science Program, Southern Illinois University School of Medicine, 201 E. Madison St, Springfield, IL, 62794-9664, USA.
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