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McCulloh RJ, Kerns E, Abresch C, Warren M, Sanchez F, Marfileno G, Rivera L, Broadhurst MJ. Reach, Adoption, Implementation, and Sustainability of the Mobile Health for Migrant Health (mHealth-4-Mhealth) Program: Nebraska, 2022‒2023. Am J Public Health 2024:e1-e5. [PMID: 39173092 DOI: 10.2105/ajph.2024.307746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
Migrant families face challenges to health and well-being from COVID-19. We deployed Mobile Health for Migrant Health (mHealth-4-Mhealth) to migrant families, a household-based program with mHealth-assisted at-home testing and linkages to community resources. We assessed the reach, adoption, and implementation of the program among rural migrant families enrolled in the Title IC Nebraska Migrant Education Program from February 2022 to July 2023. We describe successful adoption and longitudinal use of mHealth screening tools for severe acute respiratory syndrome coronavirus 2 infection risk and social determinants of health. (Am J Public Health. Published online ahead of print August 22, 2024:e1-e5. https://doi.org/10.2105/AJPH.2024.307746).
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Affiliation(s)
- Russell J McCulloh
- Russell J. McCulloh and Ellen Kerns are with the Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha. Chad Abresch is with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center. Michelle Warren is with the Department of Modern Languages, College of Arts and Sciences, University of Nebraska Kearney. Fernando Sanchez and Gisela Marfileno are with the Child Health Research Institute, University of Nebraska Medical Center. Lisvey Rivera is with the Nebraska Migrant Education Program, Hastings. M. Jana Broadhurst is with the Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center
| | - Ellen Kerns
- Russell J. McCulloh and Ellen Kerns are with the Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha. Chad Abresch is with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center. Michelle Warren is with the Department of Modern Languages, College of Arts and Sciences, University of Nebraska Kearney. Fernando Sanchez and Gisela Marfileno are with the Child Health Research Institute, University of Nebraska Medical Center. Lisvey Rivera is with the Nebraska Migrant Education Program, Hastings. M. Jana Broadhurst is with the Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center
| | - Chad Abresch
- Russell J. McCulloh and Ellen Kerns are with the Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha. Chad Abresch is with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center. Michelle Warren is with the Department of Modern Languages, College of Arts and Sciences, University of Nebraska Kearney. Fernando Sanchez and Gisela Marfileno are with the Child Health Research Institute, University of Nebraska Medical Center. Lisvey Rivera is with the Nebraska Migrant Education Program, Hastings. M. Jana Broadhurst is with the Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center
| | - Michelle Warren
- Russell J. McCulloh and Ellen Kerns are with the Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha. Chad Abresch is with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center. Michelle Warren is with the Department of Modern Languages, College of Arts and Sciences, University of Nebraska Kearney. Fernando Sanchez and Gisela Marfileno are with the Child Health Research Institute, University of Nebraska Medical Center. Lisvey Rivera is with the Nebraska Migrant Education Program, Hastings. M. Jana Broadhurst is with the Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center
| | - Fernando Sanchez
- Russell J. McCulloh and Ellen Kerns are with the Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha. Chad Abresch is with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center. Michelle Warren is with the Department of Modern Languages, College of Arts and Sciences, University of Nebraska Kearney. Fernando Sanchez and Gisela Marfileno are with the Child Health Research Institute, University of Nebraska Medical Center. Lisvey Rivera is with the Nebraska Migrant Education Program, Hastings. M. Jana Broadhurst is with the Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center
| | - Gisela Marfileno
- Russell J. McCulloh and Ellen Kerns are with the Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha. Chad Abresch is with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center. Michelle Warren is with the Department of Modern Languages, College of Arts and Sciences, University of Nebraska Kearney. Fernando Sanchez and Gisela Marfileno are with the Child Health Research Institute, University of Nebraska Medical Center. Lisvey Rivera is with the Nebraska Migrant Education Program, Hastings. M. Jana Broadhurst is with the Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center
| | - Lisvey Rivera
- Russell J. McCulloh and Ellen Kerns are with the Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha. Chad Abresch is with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center. Michelle Warren is with the Department of Modern Languages, College of Arts and Sciences, University of Nebraska Kearney. Fernando Sanchez and Gisela Marfileno are with the Child Health Research Institute, University of Nebraska Medical Center. Lisvey Rivera is with the Nebraska Migrant Education Program, Hastings. M. Jana Broadhurst is with the Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center
| | - M Jana Broadhurst
- Russell J. McCulloh and Ellen Kerns are with the Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha. Chad Abresch is with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center. Michelle Warren is with the Department of Modern Languages, College of Arts and Sciences, University of Nebraska Kearney. Fernando Sanchez and Gisela Marfileno are with the Child Health Research Institute, University of Nebraska Medical Center. Lisvey Rivera is with the Nebraska Migrant Education Program, Hastings. M. Jana Broadhurst is with the Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center
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Nair M, Fokom Domgue J, Joseph CLM, Alleman ER, Williams AM, Abouelella DK, Babatunde OA, Osazuwa-Peters N, Adjei Boakye E. Disparities in HPV Vaccination Among Adolescents by Health Care Facility Type. JAMA Pediatr 2024:2821644. [PMID: 39073824 PMCID: PMC11287439 DOI: 10.1001/jamapediatrics.2024.2383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 05/21/2024] [Indexed: 07/30/2024]
Abstract
Importance Approximately 31 000 cases of human papillomavirus (HPV)-associated cancers are diagnosed annually in the US. The HPV vaccine can prevent more than 90% of these cancers, yet national uptake remains lower than the Healthy People 2030 target of 80% completion. To devise targeted interventions to increase the uptake of HPV vaccines, it is crucial to understand the vaccination rates across various health care settings. Objective To examine the association between health care facility type and adolescent HPV vaccine uptake and clinician recommendation for the vaccine in the US. Design, Setting, and Participants This cross-sectional study uses a complex sampling design of data from the 2020 National Immunization Survey-Teen. The study included adolescents aged 13 to 17 years. The data analysis was completed between March 1 and May 31, 2022. Exposure Health care facility type classified as public, hospital-based, private, mixed (more than 1 type), and other facilities (eg, military health care facility; Women, Infants, and Children clinic; school-based health center; pharmacy). Main Outcomes and Measures Initiation of HPV vaccination was defined as the receipt of at least 1 dose of the HPV vaccine and completion as receipt of at least 2 or 3 doses, depending on age of initiation. Parent or guardian self-reported clinician recommendation was categorized as yes or no. Weighted, multivariable logistic regression models were used to estimate the odds of initiating and completing the HPV vaccine series and receiving clinician recommendation by health care facility type adjusted for adolescent and maternal characteristics. Results A total of 20 162 adolescents (mean [SD] age, 14.9 [1.4] years; 51.0% male) were included. Clinician recommendation for the HPV vaccine was received by 81.4% of adolescents, and 75.1% initiated and 58.6% completed the HPV vaccine series. In the adjusted analyses, adolescents who received recommended vaccinations at public facilities had lower odds of initiating (adjusted odds ratio [AOR], 0.71; 95% CI, 0.58-0.88) and completing (AOR, 0.62; 95% CI, 0.51-0.76) HPV vaccination compared with those who received recommended vaccinations at private facilities. Similarly, adolescents who received recommended vaccinations at public facilities (AOR, 0.62; 95% CI, 0.51-0.77) had lower odds of receiving a clinician recommendation for the HPV vaccine compared with those who received recommended vaccinations at private facilities. Conclusions and Relevance These findings reveal health disparities in HPV vaccination among adolescent populations served by public health care facilities, suggesting that a greater focus is needed on vaccine recommendations and uptake in public facilities.
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Affiliation(s)
- Mrudula Nair
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Joël Fokom Domgue
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston
- Division of Cancer Prevention and Population Science, The University of Texas MD Anderson Cancer Center, Houston
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | | | - Elizabeth R. Alleman
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Amy M. Williams
- Office of Physician Well-Being and Professionalism, Corewell Health, Southfield, Michigan
| | - Dina K. Abouelella
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Eric Adjei Boakye
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
- Henry Ford Health + Michigan State University Health Sciences, Detroit
- Department of Otolaryngology–Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan
- Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, East Lansing
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Kilmer G, Jones SE, Rico A, Houston A, Lim C, Leon-Nguyen M, Asher AK. Changes in Illicit Drug Use Among High School Students in Southeastern U.S. States-2009 to 2019. JOURNAL OF PREVENTION (2022) 2024:10.1007/s10935-024-00791-1. [PMID: 38967862 DOI: 10.1007/s10935-024-00791-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/06/2024]
Abstract
To determine if decreasing lifetime use of methamphetamines, cocaine, ecstasy, and inhalants among high school students occurring from 2009 to 2019 in the U.S. also occurred in five southeastern states, Youth Risk Behavior Survey data representative of high school students in grades 9-12 in 2009 and 2019 were analyzed. In a classroom setting, lifetime use of methamphetamines, cocaine, ecstasy, and inhalants were self-reported. Students nationwide (n = 30,087) were compared to students in Alabama, Georgia, Louisiana, Mississippi, and South Carolina (n = 18,237). Lifetime methamphetamine use significantly increased from 4.8% in 2009 to 6.2% in 2019 in the southeast but decreased from 4.1 to 2.2% nationwide. Use of cocaine, ecstasy, and inhalants remained stable in the southeast while decreasing significantly nationwide from 2009 to 2019. During a period when use of methamphetamines, cocaine, ecstasy, and inhalants among high school students in the U.S. decreased, use in southeastern states did not change. Culturally specific programs and interventions may be needed to prevent illicit drug use in communities of southeastern states where youth remain at risk.
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Affiliation(s)
- Greta Kilmer
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, USA.
| | - Sherry Everett Jones
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Adriana Rico
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Aaron Houston
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Connie Lim
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Michelle Leon-Nguyen
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Alice K Asher
- Division of Overdose Prevention, National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, USA
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Vestal E, Newman S, Phillips S. Barriers and facilitators to accessing pediatric specialty care for rural-dwelling children with complex chronic conditions: An integrative review. J Pediatr Nurs 2024; 77:e385-e393. [PMID: 38777676 DOI: 10.1016/j.pedn.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 05/01/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024]
Abstract
PROBLEM Pediatric specialty services are often geographically concentrated in urban areas, leaving up to 1 in 5 rural-dwelling children in the United States without access to advanced care. The purpose of this review was to identify and review extant literature related to barriers and facilitators to accessing specialty care for rural-dwelling children with complex chronic conditions. ELIGIBILITY CRITERIA The Whittemore and Knafl (2005) integrative review method guided the review which included a critical appraisal and analysis of relevant articles published between 2012 and 2023. SAMPLE Twenty-three studies were identified for inclusion in the integrative review. RESULTS Using the domains of the Levesque et al. (2013) conceptual framework, findings were categorized according to the access to care continuum. Barriers included broadband access, transportation, and inadequate care coordination. Facilitators included telehealth, social support, and outreach clinics. CONCLUSIONS To improve access to pediatric specialty care for rural-dwelling children, nurses, physicians, and policymakers will need to consider how the social determinants of health impact the healthcare access continuum from diagnosis to continuing healthcare. IMPLICATIONS The findings of this integrative review will aid researchers in developing interventions to improve access to pediatric specialty care for rural-dwelling children.
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Affiliation(s)
- Elisabeth Vestal
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160 Charleston, SC 29425 United States.
| | - Susan Newman
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160 Charleston, SC 29425 United States
| | - Shannon Phillips
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160 Charleston, SC 29425 United States
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Kim GH, Song JS, Nam JW, Lee WR, Yoo KB. Trajectory of medical expenditure and regional disparities in hypertensive patients in South Korea. Front Public Health 2024; 12:1294045. [PMID: 38975357 PMCID: PMC11225734 DOI: 10.3389/fpubh.2024.1294045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 06/03/2024] [Indexed: 07/09/2024] Open
Abstract
The aim of this study is to understand how different regions influence the management and financial burden of hypertension, and to identify regional disparities in hypertension management and medical expenditure. The study utilized data from the Korean Health Panel Survey conducted between 2014 and 2018, focusing on individuals with hypertension. Medical expenditures were classified into three trajectory groups: "Persistent Low," "Expenditure Increasing," and "Persistent High" over a five-year period using trajectory analysis. Inverse Probability Weighting (IPW) analysis was then employed to identify the association between regions and medical expenditure trajectories. The results indicate that individuals residing in metropolitan cities (Busan, Daegu, Incheon, Gwangju, Daejeon, and Ulsan) and rural areas were more likely to belong to the "Expenditure Increasing" group compared to the "Persistent Low Expenditure" group (OR = 1.07; 95% CI; p < 0.001), as opposed to those in the capital city (Seoul) (OR = 1.07; 95% CI; p < 0.001). Additionally, residents of rural areas were more likely to be in the "High Expenditure" group compared to the "Persistent Low Expenditure" group than those residing in the capital city (OR = 1.05; 95% CI; p = 0.001). These findings suggest that individuals in rural areas may be receiving relatively inadequate management for hypertension, leading to higher medical expenditures compared to those in the capital region. These disparities signify health inequality and highlight the need for policy efforts to address regional imbalances in social structures and healthcare resource distribution to ensure equitable chronic disease management across different regions.
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Affiliation(s)
- Gi-Hyun Kim
- Institute of Health and Welfare, Yonsei University, Wonju, Republic of Korea
| | - Ji-Soo Song
- Institute of Health and Welfare, Yonsei University, Wonju, Republic of Korea
- Department of Health Administration, Yonsei University Graduate School, Wonju, Republic of Korea
| | - Ji-Woong Nam
- Institute of Health and Welfare, Yonsei University, Wonju, Republic of Korea
- Department of Health Administration, Yonsei University Graduate School, Wonju, Republic of Korea
| | - Woo-Ri Lee
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - Ki-Bong Yoo
- Institute of Health and Welfare, Yonsei University, Wonju, Republic of Korea
- Division of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
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Heitkemper E, Hulse S, Bekemeier B, Schultz M, Whitman G, Turner AM. The Solutions in Health Analytics for Rural Equity Across the Northwest (SHARE-NW) Dashboard for Health Equity in Rural Public Health: Usability Evaluation. JMIR Hum Factors 2024; 11:e51666. [PMID: 38837192 PMCID: PMC11187519 DOI: 10.2196/51666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 03/24/2024] [Accepted: 04/18/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Given the dearth of resources to support rural public health practice, the solutions in health analytics for rural equity across the northwest dashboard (SHAREdash) was created to support rural county public health departments in northwestern United States with accessible and relevant data to identify and address health disparities in their jurisdictions. To ensure the development of useful dashboards, assessment of usability should occur at multiple stages throughout the system development life cycle. SHAREdash was refined via user-centered design methods, and upon completion, it is critical to evaluate the usability of SHAREdash. OBJECTIVE This study aims to evaluate the usability of SHAREdash based on the system development lifecycle stage 3 evaluation goals of efficiency, satisfaction, and validity. METHODS Public health professionals from rural health departments from Washington, Idaho, Oregon, and Alaska were enrolled in the usability study from January to April 2022. The web-based evaluation consisted of 2 think-aloud tasks and a semistructured qualitative interview. Think-aloud tasks assessed efficiency and effectiveness, and the interview investigated satisfaction and overall usability. Verbatim transcripts from the tasks and interviews were analyzed using directed content analysis. RESULTS Of the 9 participants, all were female and most worked at a local health department (7/9, 78%). A mean of 10.1 (SD 1.4) clicks for task 1 (could be completed in 7 clicks) and 11.4 (SD 2.0) clicks for task 2 (could be completed in 9 clicks) were recorded. For both tasks, most participants required no prompting-89% (n=8) participants for task 1 and 67% (n=6) participants for task 2, respectively. For effectiveness, all participants were able to complete each task accurately and comprehensively. Overall, the participants were highly satisfied with the dashboard with everyone remarking on the utility of using it to support their work, particularly to compare their jurisdiction to others. Finally, half of the participants stated that the ability to share the graphs from the dashboard would be "extremely useful" for their work. The only aspect of the dashboard cited as problematic is the amount of missing data that was present, which was a constraint of the data available about rural jurisdictions. CONCLUSIONS Think-aloud tasks showed that the SHAREdash allows users to complete tasks efficiently. Overall, participants reported being very satisfied with the dashboard and provided multiple ways they planned to use it to support their work. The main usability issue identified was the lack of available data indicating the importance of addressing the ongoing issues of missing and fragmented public health data, particularly for rural communities.
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Affiliation(s)
| | - Scott Hulse
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Betty Bekemeier
- School of Nursing, University of Washington, Seattle, WA, United States
- School of Public Health, University of Washington, Seattle, WA, United States
| | - Melinda Schultz
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Greg Whitman
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Anne M Turner
- School of Public Health, University of Washington, Seattle, WA, United States
- School of Medicine, University of Washington, Seattle, WA, United States
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Ward JA, Cepeda JA, Jackson DB, Crifasi CK. Characteristics of Injurious Shootings by Police Along the Urban-Rural Continuum. Am J Prev Med 2024:S0749-3797(24)00180-6. [PMID: 38844147 DOI: 10.1016/j.amepre.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Much research on shootings by police has focused on urban jurisdictions, but most U.S. law enforcement agencies are not located in cities. Prior research suggests that rates of fatal shootings by police are comparable between urban and nonurban areas. Yet, shooting characteristics across the urban-rural continuum are unknown. This study describes and compares fatal and nonfatal injurious shootings by officers in U.S. urban, suburban, and rural areas from 2015 to 2020. METHODS Characteristics of fatal and nonfatal injurious shootings by police were abstracted from Gun Violence Archive. In 2023-2024, using ZIP-code and county-based rurality designations, the national distribution, incidence, and characteristics of injurious shootings by police were compared across urban, suburban, and rural areas of the U.S. RESULTS Rates of injurious shootings in rural areas approached or exceeded those of urban rates. As rurality increased, proportionately more injurious shootings involved single responders, sheriffs, or multiple agency types. Across the urban-rural continuum, characteristics of precipitating incidents were similar. Injurious shootings were most frequently preceded by domestic violence incidents, traffic stops, or shots-fired reports; co-occurring behavioral health needs were common. After accounting for local demographic differences, Black, indigenous, and Hispanic residents were injured at higher rates than White residents in all examined areas. CONCLUSIONS Shootings by police represent an overlooked and inequitable source of injury in rural areas. Broadly similar incident characteristics suggest potential for wide-reaching reforms. To prevent injuries, crisis prevention, dispatch, and response systems must assure proportionate rural-area coverage. In addition, legislative prevention and accountability measures should include sheriffs' offices for optimal rural-area impact.
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Affiliation(s)
- Julie A Ward
- Department of Medicine, Health, and Society, Vanderbilt College of Arts and Science, Nashville, Tennessee; Program in Public Policy Studies, Vanderbilt College of Arts and Science, Nashville, Tennessee.
| | - Javier A Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Cassandra K Crifasi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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García MC, Rossen LM, Matthews K, Guy G, Trivers KF, Thomas CC, Schieb L, Iademarco MF. Preventable Premature Deaths from the Five Leading Causes of Death in Nonmetropolitan and Metropolitan Counties, United States, 2010-2022. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2024; 73:1-11. [PMID: 38687830 PMCID: PMC11065459 DOI: 10.15585/mmwr.ss7302a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Problem/Condition A 2019 report quantified the higher percentage of potentially excess (preventable) deaths in U.S. nonmetropolitan areas compared with metropolitan areas during 2010-2017. In that report, CDC compared national, regional, and state estimates of preventable premature deaths from the five leading causes of death in nonmetropolitan and metropolitan counties during 2010-2017. This report provides estimates of preventable premature deaths for additional years (2010-2022). Period Covered 2010-2022. Description of System Mortality data for U.S. residents from the National Vital Statistics System were used to calculate preventable premature deaths from the five leading causes of death among persons aged <80 years. CDC's National Center for Health Statistics urban-rural classification scheme for counties was used to categorize the deaths according to the urban-rural county classification level of the decedent's county of residence (1: large central metropolitan [most urban], 2: large fringe metropolitan, 3: medium metropolitan, 4: small metropolitan, 5: micropolitan, and 6: noncore [most rural]). Preventable premature deaths were defined as deaths among persons aged <80 years that exceeded the number expected if the death rates for each cause in all states were equivalent to those in the benchmark states (i.e., the three states with the lowest rates). Preventable premature deaths were calculated separately for the six urban-rural county categories nationally, the 10 U.S. Department of Health and Human Services public health regions, and the 50 states and the District of Columbia. Results During 2010-2022, the percentage of preventable premature deaths among persons aged <80 years in the United States increased for unintentional injury (e.g., unintentional poisoning including drug overdose, unintentional motor vehicle traffic crash, unintentional drowning, and unintentional fall) and stroke, decreased for cancer and chronic lower respiratory disease (CLRD), and remained stable for heart disease. The percentages of preventable premature deaths from the five leading causes of death were higher in rural counties in all years during 2010-2022. When assessed by the six urban-rural county classifications, percentages of preventable premature deaths in the most rural counties (noncore) were consistently higher than in the most urban counties (large central metropolitan and fringe metropolitan) for the five leading causes of death during the study period.During 2010-2022, preventable premature deaths from heart disease increased most in noncore (+9.5%) and micropolitan counties (+9.1%) and decreased most in large central metropolitan counties (-10.2%). Preventable premature deaths from cancer decreased in all county categories, with the largest decreases in large central metropolitan and large fringe metropolitan counties (-100.0%; benchmark achieved in both county categories in 2019). In all county categories, preventable premature deaths from unintentional injury increased, with the largest increases occurring in large central metropolitan (+147.5%) and large fringe metropolitan (+97.5%) counties. Preventable premature deaths from CLRD decreased most in large central metropolitan counties where the benchmark was achieved in 2019 and increased slightly in noncore counties (+0.8%). In all county categories, preventable premature deaths from stroke decreased from 2010 to 2013, remained constant from 2013 to 2019, and then increased in 2020 at the start of the COVID-19 pandemic. Percentages of preventable premature deaths varied across states by urban-rural county classification during 2010-2022. Interpretation During 2010-2022, nonmetropolitan counties had higher percentages of preventable premature deaths from the five leading causes of death than did metropolitan counties nationwide, across public health regions, and in most states. The gap between the most rural and most urban counties for preventable premature deaths increased during 2010-2022 for four causes of death (cancer, heart disease, CLRD, and stroke) and decreased for unintentional injury. Urban and suburban counties (large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan) experienced increases in preventable premature deaths from unintentional injury during 2010-2022, leading to a narrower gap between the already high (approximately 69% in 2022) percentage of preventable premature deaths in noncore and micropolitan counties. Sharp increases in preventable premature deaths from unintentional injury, heart disease, and stroke were observed in 2020, whereas preventable premature deaths from CLRD and cancer continued to decline. CLRD deaths decreased during 2017-2020 but increased in 2022. An increase in the percentage of preventable premature deaths for multiple leading causes of death was observed in 2020 and was likely associated with COVID-19-related conditions that contributed to increased mortality from heart disease and stroke. Public Health Action Routine tracking of preventable premature deaths based on urban-rural county classification might enable public health departments to identify and monitor geographic disparities in health outcomes. These disparities might be related to different levels of access to health care, social determinants of health, and other risk factors. Identifying areas with a high prevalence of potentially preventable mortality might be informative for interventions.
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Yousufuddin M, Mahmood M, Barkoudah E, Badr F, Khandelwal K, Manyara W, Sharma U, Abdalrhim AD, Issa M, Bhagra S, Murad MH. Rural-urban Differences in Long-term Mortality and Readmission Following COVID-19 Hospitalization, 2020 to 2023. Open Forum Infect Dis 2024; 11:ofae197. [PMID: 38698896 PMCID: PMC11065360 DOI: 10.1093/ofid/ofae197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/03/2024] [Indexed: 05/05/2024] Open
Abstract
Background We compared long-term mortality and readmission rates after COVID-19 hospitalization based on rural-urban status and assessed the impact of COVID-19 vaccination introduction on clinical outcomes by rurality. Methods The study comprised adults hospitalized for COVID-19 at 17 hospitals in 4 US states between March 2020 and July 2022, followed until May 2023. The main analysis included all patients, whereas a sensitivity analysis focused on residents from 4 states containing 17 hospitals. Additional analyses compared the pre- and postvaccination periods. Results The main analysis involved 9325 COVID-19 hospitalized patients: 31% were from 187 rural counties in 31 states; 69% from 234 urban counties in 44 states; the mean age was 65 years (rural, 66 years; urban, 64 years); 3894 women (rural, 41%; urban, 42%); 8007 Whites (rural, 87%; urban, 83%); 1738 deaths (rural, 21%; urban, 17%); and 2729 readmissions (rural, 30%; urban, 29%). During a median follow-up of 602 days, rural residence was associated with a 22% higher all-cause mortality (log-rank, P < .001; hazard ratio, 1.22; 95% confidence interval, 1.10-1.34, P < .001), and a trend toward a higher readmission rate (log-rank, P = .038; hazard ratio, 1.06; 95% confidence interval, .98-1.15; P = .130). The results remained consistent in the sensitivity analysis and in both pre- and postvaccination time periods. Conclusions and Relevance Patients from rural counties experienced higher mortality and tended to be readmitted more frequently following COVID-19 hospitalization over the long term compared with those from urban counties, a difference that remained even after the introduction of COVID-19 vaccines.
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Affiliation(s)
- Mohammed Yousufuddin
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota, USA
| | - Maryam Mahmood
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ebrahim Barkoudah
- Department of Internal Medicine/Hospital Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Fatimazahra Badr
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota, USA
| | - Kanika Khandelwal
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota, USA
| | - Warren Manyara
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota, USA
| | - Umesh Sharma
- Division of Hospital Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Ahmed D Abdalrhim
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Meltiady Issa
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sumit Bhagra
- Department of Endocrine and Metabolism, Mayo Clinic Health System, Austin, Minnesota, USA
| | - Mohammad H Murad
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
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10
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Modula MJ, Chipu MG. Exploring information needs among family caregivers of children with intellectual disability in a rural area of South Africa: a qualitative study. BMC Public Health 2024; 24:1139. [PMID: 38658872 PMCID: PMC11040777 DOI: 10.1186/s12889-024-18606-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Globally, families experience challenges caring for and raising children with intellectual disability (ID). Family caregivers in rural states are mostly known for lacking support resources, including information on understanding the care of ID. Lack of adequate information on understanding of ID compromises the provision of life-long care and support of the children with ID's physical, emotional, psychological and social developmental well-being. The study aimed to explore the information needs of family caregivers regarding the care of children with ID in rural areas of Limpopo Province, South Africa. METHODS This qualitative explorative research conducted 16 in-depth individual interviews and one focus group discussion with ten family members. The participants shared their experiences of raising children with ID in rural communities. Inductive thematic analysis using Atlas Ti software categorised emerging themes and subthemes of this study from merged data sets on information needs regarding the care of children with ID among family caregivers. RESULTS The findings highlighted the need for information regarding ID care among family caregivers raising children with ID in the home environment. The information challenges experienced by family caregivers include caring for the challenging behaviour of children with ID and available support resources and services for the children and their families. These challenges impact the care and support required to meet the developmental needs of children with ID. Furthermore, inadequate information on ID among family caregivers in rural communities with a lack of resources restricts the children from accessing required support services. CONCLUSIONS Given the information challenges these families face on ID, the stakeholders must develop continuous training programmes that will equip, empower, and further monitor ID care and management among family caregivers to enhance care and the raising of children with dignity.
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Affiliation(s)
- Mantji Juliah Modula
- School of Nursing, Faculty of Health Sciences, University of Free State, Nelson Mandela Drive, 9301, Bloemfontein, Free State Province, South Africa.
| | - Mpho Grace Chipu
- School of Nursing, Faculty of Health Sciences, University of Free State, Nelson Mandela Drive, 9301, Bloemfontein, Free State Province, South Africa
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11
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Bauer KL, Mitchell AL, Mays GP. Examining Characteristics of Local Public Health Systems With Exceptional Tribal Organization Participation. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:274-284. [PMID: 38030145 PMCID: PMC10833201 DOI: 10.1097/phh.0000000000001840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To learn feasible ways to increase multisector community partnership with tribal organizations, meaning tribal health authorities or American Indian and Alaska Native (AI/AN)-serving organizations, by examining characteristics of local public health systems with exceptional tribal organization participation. DESIGN, SETTING, AND PARTICIPANTS In total, 728 local public health departments were surveyed in 2018 to generate a nationally representative sample of local public health systems in the United States. A positive deviance approach using logistic regression helped identify local public health systems that had tribal organization participation despite characteristics that make such participation statistically unlikely. Local public health systems with exceptional tribal organization participation were compared with systems with conventional participation, examining measures known to impact the formation of public health partnerships. MAIN OUTCOME MEASURE This study used an exploratory logistic regression approach to identify unique characteristics of local public health systems with exceptional tribal organization participation. RESULTS Of 728 health systems surveyed, 21 were identified as having exceptional tribal organization participation. Across varying thresholds to identify exceptional participation, having a higher network density and prioritizing equity in public health activities were found to consistently distinguish exceptional tribal organization participation in both nonrural and rural areas. CONCLUSIONS Public health partnerships with tribal organizations are possible even in circumstances that make them unlikely. Efforts to build denser networks of collaborating organizations and prioritize equity may help public health systems achieve success with tribal organization partnerships.
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Affiliation(s)
- Kyla L. Bauer
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Amelia L. Mitchell
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Glen P. Mays
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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12
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Frugé AD, Robinson LA, Strickland KP, Watts SO, Tuggle FJ, Slay JL, Sewell J, Helms K, Ellison KJ. Race and gender disparities in preventive health activity engagement of older adults in the southeastern United States. Geriatr Nurs 2024; 56:184-190. [PMID: 38359738 DOI: 10.1016/j.gerinurse.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/17/2024] [Accepted: 02/01/2024] [Indexed: 02/17/2024]
Abstract
A cross-sectional study was conducted to determine preventive-health-activity engagement in community-dwelling older adults participating in student-led health screenings in east Alabama. From 2017-2019, health professions students conducted health screenings at 23 community and independent living sites to assess medical and social needs of adults. Clients' responses to questions regarding vaccinations (flu/pneumonia/shingles), cancer screenings (colon/sex-specific), and other (dental/vision) screenings were aggregated to create a preventive health behavior (prevmed) score. Chi-square, t-tests, and regression analyses were conducted. Data from 464 adults ages 50-99 (72.9±10.1) years old were analyzed. The sample was 71.3% female, 63.1% Black/African American (BA), and 33.4% rural. Linear regression indicated BA race (p=0.001), currently unmarried (p=0.030), no primary care provider (p<0.001) or insurance (p=0.010), age <65 years (p=0.042) and assessment at a residential site (p=0.037) predicted lower prevmed scores. Social factors predict preventive health activity engagement in community-dwelling adults in east Alabama, indicating several opportunities to improve health outcomes.
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Affiliation(s)
- Andrew D Frugé
- College of Nursing, Auburn University, Auburn, AL 36849, USA.
| | - Laura A Robinson
- College of Nursing, Auburn University, Auburn, AL 36849, USA; Department of Nutritional Sciences, Auburn University, Auburn, AL 36849, USA
| | | | - Sarah O Watts
- College of Nursing, Auburn University, Auburn, AL 36849, USA
| | - Felicia J Tuggle
- Department of Sociology, Anthropology, and Social Work, Auburn University, Auburn, AL 36849, USA
| | - Jennifer L Slay
- Department of Sociology, Anthropology, and Social Work, Auburn University, Auburn, AL 36849, USA
| | - Jeanna Sewell
- Harrison College of Pharmacy, Auburn University, Auburn, AL 36849, USA
| | - Kristen Helms
- Alabama College of Osteopathic Medicine, Dothan, AL 36303, USA
| | - Kathy J Ellison
- College of Nursing, Auburn University, Auburn, AL 36849, USA
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Cohen A, Vikesland P, Pruden A, Krometis LA, Lee LM, Darling A, Yancey M, Helmick M, Singh R, Gonzalez R, Meit M, Degen M, Taniuchi M. Making waves: The benefits and challenges of responsibly implementing wastewater-based surveillance for rural communities. WATER RESEARCH 2024; 250:121095. [PMID: 38181645 DOI: 10.1016/j.watres.2023.121095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/08/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
The sampling and analysis of sewage for pathogens and other biomarkers offers a powerful tool for monitoring and understanding community health trends and potentially predicting disease outbreaks. Since the early months of the COVID-19 pandemic, the use of wastewater-based testing for public health surveillance has increased markedly. However, these efforts have focused on urban and peri‑urban areas. In most rural regions of the world, healthcare service access is more limited than in urban areas, and rural public health agencies typically have less disease outcome surveillance data than their urban counterparts. The potential public health benefits of wastewater-based surveillance for rural communities are therefore substantial - though so too are the methodological and ethical challenges. For many rural communities, population dynamics and insufficient, aging, and inadequately maintained wastewater collection and treatment infrastructure present obstacles to the reliable and responsible implementation of wastewater-based surveillance. Practitioner observations and research findings indicate that for many rural systems, typical implementation approaches for wastewater-based surveillance will not yield sufficiently reliable or actionable results. We discuss key challenges and potential strategies to address them. However, to support and expand the implementation of responsible, reliable, and ethical wastewater-based surveillance for rural communities, best practice guidelines and standards are needed.
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Affiliation(s)
- Alasdair Cohen
- Department of Population Health Sciences, Virginia Tech, Blacksburg, VA 24061, USA; Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA 24061, USA.
| | - Peter Vikesland
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA 24061, USA
| | - Amy Pruden
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA 24061, USA
| | - Leigh-Anne Krometis
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, VA 24061, USA
| | - Lisa M Lee
- Department of Population Health Sciences, Virginia Tech, Blacksburg, VA 24061, USA; Division of Scholarly Integrity and Research Compliance, Virginia Tech, Blacksburg, VA 24061, USA
| | - Amanda Darling
- Department of Population Health Sciences, Virginia Tech, Blacksburg, VA 24061, USA; Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA 24061, USA
| | - Michelle Yancey
- Virginia Department of Health, Office of Environmental Health Services, Richmond, VA 23219, USA
| | - Meagan Helmick
- Virginia Department of Health, Mount Rogers Health District, Marion, VA 24354, USA
| | - Rekha Singh
- Virginia Department of Health, Office of Environmental Health Services, Richmond, VA 23219, USA; Department of Civil and Environmental Engineering, Old Dominion University, Norfolk, VA 23529, USA
| | - Raul Gonzalez
- Hampton Roads Sanitation District, Virginia Beach, VA 23455, USA
| | - Michael Meit
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN 37614, USA
| | - Marcia Degen
- Virginia Department of Health, Office of Environmental Health Services, Richmond, VA 23219, USA
| | - Mami Taniuchi
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908, USA; Department of Civil and Environmental Engineering, University of Virginia, Charlottesville, VA 22908, USA; Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA 22908, USA
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14
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Reynolds Kueny C, Price A, Canfield C. Measure Twice, Change Once: Using Simulation to Support Change Management in Rural Healthcare Delivery. Adv Health Care Manag 2024; 22:29-53. [PMID: 38262009 DOI: 10.1108/s1474-823120240000022002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Barriers to adequate healthcare in rural areas remain a grand challenge for local healthcare systems. In addition to patients' travel burdens, lack of health insurance, and lower health literacy, rural healthcare systems also experience significant resource shortages, as well as issues with recruitment and retention of healthcare providers, particularly specialists. These factors combined result in complex change management-focused challenges for rural healthcare systems. Change management initiatives are often resource intensive, and in rural health organizations already strapped for resources, it may be particularly risky to embark on change initiatives. One way to address these change management concerns is by leveraging socio-technical simulation models to estimate techno-economic feasibility (e.g., is it technologically feasible, and is it economical?) as well as socio-utility feasibility (e.g., how will the changes be utilized?). We present a framework for how healthcare systems can integrate modeling and simulation techniques from systems engineering into a change management process. Modeling and simulation are particularly useful for investigating the amount of uncertainty about potential outcomes, guiding decision-making that considers different scenarios, and validating theories to determine if they accurately reflect real-life processes. The results of these simulations can be integrated into critical change management recommendations related to developing readiness for change and addressing resistance to change. As part of our integration, we present a case study showcasing how simulation modeling has been used to determine feasibility and potential resistance to change considerations for implementing a mobile radiation oncology unit. Recommendations and implications are discussed.
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15
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Gansa WH, Kleijwegt H, Aldridge M, Ankuda C. Individual Socioeconomic Factors Have a Greater Impact on End-of-Life Care Outcomes Than Regional Factors. J Palliat Med 2024; 27:160-167. [PMID: 37699248 PMCID: PMC11265611 DOI: 10.1089/jpm.2023.0163] [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] [Accepted: 07/25/2023] [Indexed: 09/14/2023] Open
Abstract
Background: End-of-life (EoL) care provided to Americans in urban and rural settings is distinct in terms of both available and delivered services. However, much less is known about which geographic, demographic, and health indicators are associated with disparities in EoL care and how individual versus regional characteristics influence quality of care (QoC). Objective: This study aimed to assess how regionality, rurality, and individual socioeconomic factors are associated with QoC in the last month of life (LML). Design: Nationally representative cross-sectional study using the proxy-completed LML questionnaire as part of the National Health and Aging Trends Study (NHATS). The data were linked at the zip code level to geographic and economic indicators. Settings/Subjects: A total of 2778 NHATS enrollees who died from 2012 to 2020. Measurements: Measurements included population density, socioeconomic indicators, health factors, and health outcomes. The primary independent variable was proxy-reported QoC during the LML (excellent vs. not excellent). Results: In our sample, 52.1% (n = 1447) reported not excellent care and 47.9% (n = 1331) reported excellent care. These populations varied in their demographic and socioeconomic characteristics. After accounting for survey weighting and design, decedents in the top (odds ratio [OR]: 1.58; 95% confidence interval [CI]: 1.08-2.32) income quartile had significantly greater odds of receiving excellent care than decedents in the bottom quartile. Decedents in zip codes with top quartile health outcome metrics had significantly greater odds of receiving excellent care (OR: 1.64; 95% CI: 1.17-2.29) than decedents in zip codes with bottom quartile health outcomes. County rurality index and county health factors were not correlated with QoC in the LML. Conclusions: High QoC at the EoL may be more associated with individual socioeconomic factors than regional indicators, including degrees of rurality. Clinicians should strive to recognize the interplay of individual characteristics and regional indicators to provide more personalized care.
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Affiliation(s)
- William H. Gansa
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hannah Kleijwegt
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Melissa Aldridge
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Claire Ankuda
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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16
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Weiss NM, Martin S, Onal SO, McDaniel N, Leider JP. Public health workforce survey data (2016-2021) related to employee turnover: proposed methods for harmonization and triangulation. Front Public Health 2024; 11:1306274. [PMID: 38249360 PMCID: PMC10796527 DOI: 10.3389/fpubh.2023.1306274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Public health workforce numbers are unsustainable at best and dire at worst: based on 2017 and 2019 data, 80,000 FTEs needed to be hired by health departments to provide basic public health foundational services before COVID-19 hit, suggesting that the situation is worse after the mass exodus of public health officials due to the pandemic. As such, a better understanding of public health workforce turnover is critical to improving recruitment and retention in the discipline. Methods This methods report details how the authors harmonized four public health workforce surveys-the Public Health Workforce Interests and Needs Survey (PH WINS), the National Association of County and City Health Officials (NACCHO) Profile, the NACCHO Forces of Change survey, and the Association of State and Territorial Health Officials (ASTHO) Profile-in order to examine employee turnover. Results We found that 31% of the public health workforce reported considering leaving their positions at some time in the future. Furthermore, the majority of agencies reported that zero vacancies had been filled in both 2018 and 2019. Discussion These findings suggest that retention, recruitment, and onboarding may be areas upon which to focus evaluation and quality improvement endeavors, allowing public health organizations to better attract and retain the most qualified candidates.
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Affiliation(s)
- Nicole M. Weiss
- Center for Public Health Systems, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, United States
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17
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Gill G, Fahnestock L, DeVito R, Somaiya CK, Streuli S, Ramirez D, Baker R, Johnstone A, Dyjack D, Randhawa M. Investing in Retail Food Safety: Assessing the NEHA-FDA Retail Flexible Funding Model Grant Program's Distribution Through an SDOH Lens. J Food Prot 2023; 86:100181. [PMID: 37839554 DOI: 10.1016/j.jfp.2023.100181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/13/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Abstract
Social Determinants of Health (SDOH) have a major impact on community health and quality of life. Healthy People 2030 has an increased focus on SDOH, given their contribution to health disparities and inequalities as a social phenomenon. Despite advances in food hygiene and sanitation, structural disparities related to SDOH leave food systems vulnerable. The Voluntary National Retail Food Regulatory Program Standards (VNRFRPS), otherwise known as the Retail Program Standards initiative is part of the Food and Drug Administration (FDA)'s strategy for prevention-based food safety to reduce foodborne illness. The National Environmental Health Association (NEHA) and the U.S. Food and Drug Administration (FDA) work in partnership to administer the NEHA-FDA Retail Flexible Funding Model (RFFM) Grant Program. The program provides funding to State, Local, Tribal, and Territorial (SLTT) retail food regulatory agencies as they achieve and advance conformance with the VNRFRPS. In its first year (Calendar Year 2022) of the 3-year cycle, the grant program awarded $6.87M in funding to over 200 jurisdictions nationwide. The research note shares preliminary findings of utilizing Geographic Information Systems (GIS) to map the first-year SLTT grant program awardees, with a selection of their jurisdiction's Social Determinants of Health (SDOH) metrics. Integration and analysis of program-specific grant funding and mapping with the relevant health determinants provide an opportunity to understand further the need for comprehensive program investments for greater impact and improvements in public health.
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Affiliation(s)
| | | | | | | | | | | | - Rance Baker
- National Environmental Health Association, USA
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18
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Gupta N, Cookson SR. Double Disparity of Sexual Minority Status and Rurality in Cardiometabolic Hospitalization Risk: A Secondary Analysis Using Linked Population-Based Data. Healthcare (Basel) 2023; 11:2854. [PMID: 37957999 PMCID: PMC10650143 DOI: 10.3390/healthcare11212854] [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: 09/25/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
Studies have shown separately that sexual minority populations generally experience poorer chronic health outcomes compared with those who identify as heterosexual, as do rural populations compared with urban dwellers. This Canadian national observational study explored healthcare patterns at the little-understood intersections of lesbian, gay, or bisexual (LGB) identity with residence in rural and remote communities, beyond chronic disease status. The secondary analysis applied logistic regressions on multiple linked datasets from representative health surveys, administrative hospital records, and a geocoded index of community remoteness to examine differences in the risk of potentially avoidable cardiometabolic-related hospitalization among adults of working age. Among those with an underlying cardiometabolic condition and residing in more rural and remote communities, a significantly higher hospitalization risk was found for LGB-identified persons compared with their heterosexual peers (odds ratio: 4.2; 95% confidence interval: 1.5-11.7), adjusting for sociodemographic characteristics, behavioral risk factors, and primary healthcare access. In models stratified by sex, the association remained significant among gay and bisexual men (5.6; CI: 1.3-24.4) but not among lesbian and bisexual women (3.5; CI: 0.9-13.6). More research is needed leveraging linkable datasets to better understand the complex and multiplicative influences of sexual minority status and rurality on cardiometabolic health to inform equity-enhancing preventive healthcare interventions.
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Affiliation(s)
- Neeru Gupta
- Department of Sociology, University of New Brunswick, Fredericton, NB E3B 5A3, Canada
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19
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Fritz CD, Khan J, Kontoyiannis PD, Cao EM, Lawrence A, Love LD. Analysis of a Community Health Screening Program and the Factors Affecting Access to Care. Cureus 2023; 15:e41907. [PMID: 37588327 PMCID: PMC10425604 DOI: 10.7759/cureus.41907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction Free community health fairs and screening initiatives can be effective in broadening access to care and improving health outcomes in historically marginalized communities. UTHealthCares is a community health-focused organization developed at the University of Texas Health Science Center in Houston. At the beginning of 2023, UTHealthCares oversaw a free community health fair in the Eastex-Jensen Area - a medically underserved area in Northeast Houston. The health fair consisted of four stations - vitals and body mass index collection, vision screening, blood glucose screening, and dental screening. Participants also received coronavirus disease 2019 vaccinations, referrals, and health education. The purpose of this study is to evaluate the effectiveness of the UTHealthCares community health fair while assessing the factors that influence participants' access to medical care. Methods After completing the health fair, participants filled out an optional questionnaire. The questionnaire contained items that assessed satisfaction with the health fair, improvements in managing health, and access to resources. We calculated descriptive statistics, including mean response and 95% confidence intervals for rating scale questions. We used the chi-squared test to evaluate the independence of categorical variables and the Mann-Whitney U test to evaluate differences in means between distributions. Results A total of 111 people participated in the health fair, 91 of which completed a questionnaire. When participants rated their satisfaction with the health fair, the average response was 4.62 out of five. Participants also reported that they were more comfortable managing areas of health related to the stations offered at the fair. Many participants reported limited access to fresh food and long travel times to the physician. Participants that traveled further to reach one resource also tended to have significantly higher travel times for the other: X2 (4, N=78)=28.04, p<0.0001. However, 77.8% of respondents reported that the lack of insurance or cost was their greatest barrier to seeing a medical provider, while only 2.47% reported the lack of transportation as their greatest barrier. Participants who reported having health insurance also had a significantly higher probability of visiting a medical provider when they had a health issue: U=928.5, p=0.0006. Conclusion Overall, participants reported high satisfaction with the health fair. Participants also gave valuable feedback for improving future community health initiatives. Although many participants reported travel times greater than 30 minutes to reach community resources, very few participants indicated that transportation was their largest barrier to accessing medical care. Instead, the lack of insurance and high costs seem to be participants' most significant hindrances. Therefore, interventions in the Eastex-Jensen area focused on expanding access to care should also include components that improve access to insurance.
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Affiliation(s)
- Connor D Fritz
- Public Health, University of Texas Health Science Center at Houston John P. and Katherine G. McGovern Medical School, Houston, USA
| | - Jeanana Khan
- Public Health, University of Texas Health Science Center at Houston John P. and Katherine G. McGovern Medical School, Houston, USA
| | - Panayiotis D Kontoyiannis
- Public Health, University of Texas Health Science Center at Houston John P. and Katherine G. McGovern Medical School, Houston, USA
| | - Emily M Cao
- Dermatology, University of Texas Health Science Center at Houston John P. and Katherine G. McGovern Medical School, Houston, USA
| | - Alexandria Lawrence
- Pediatrics, University of Texas Health Science Center at Houston John P. and Katherine G. McGovern Medical School, Houston, USA
| | - LaTanya D Love
- Pediatrics, University of Texas Health Science Center at Houston John P. and Katherine G. McGovern Medical School, Houston, USA
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Lundberg DJ, Wrigley-Field E, Cho A, Raquib R, Nsoesie EO, Paglino E, Chen R, Kiang MV, Riley AR, Chen YH, Charpignon ML, Hempstead K, Preston SH, Elo IT, Glymour MM, Stokes AC. COVID-19 Mortality by Race and Ethnicity in US Metropolitan and Nonmetropolitan Areas, March 2020 to February 2022. JAMA Netw Open 2023; 6:e2311098. [PMID: 37129894 PMCID: PMC10155069 DOI: 10.1001/jamanetworkopen.2023.11098] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/10/2023] [Indexed: 05/03/2023] Open
Abstract
Importance Prior research has established that Hispanic and non-Hispanic Black residents in the US experienced substantially higher COVID-19 mortality rates in 2020 than non-Hispanic White residents owing to structural racism. In 2021, these disparities decreased. Objective To assess to what extent national decreases in racial and ethnic disparities in COVID-19 mortality between the initial pandemic wave and subsequent Omicron wave reflect reductions in mortality vs other factors, such as the pandemic's changing geography. Design, Setting, and Participants This cross-sectional study was conducted using data from the US Centers for Disease Control and Prevention for COVID-19 deaths from March 1, 2020, through February 28, 2022, among adults aged 25 years and older residing in the US. Deaths were examined by race and ethnicity across metropolitan and nonmetropolitan areas, and the national decrease in racial and ethnic disparities between initial and Omicron waves was decomposed. Data were analyzed from June 2021 through March 2023. Exposures Metropolitan vs nonmetropolitan areas and race and ethnicity. Main Outcomes and Measures Age-standardized death rates. Results There were death certificates for 977 018 US adults aged 25 years and older (mean [SD] age, 73.6 [14.6] years; 435 943 female [44.6%]; 156 948 Hispanic [16.1%], 140 513 non-Hispanic Black [14.4%], and 629 578 non-Hispanic White [64.4%]) that included a mention of COVID-19. The proportion of COVID-19 deaths among adults residing in nonmetropolitan areas increased from 5944 of 110 526 deaths (5.4%) during the initial wave to a peak of 40 360 of 172 515 deaths (23.4%) during the Delta wave; the proportion was 45 183 of 210 554 deaths (21.5%) during the Omicron wave. The national disparity in age-standardized COVID-19 death rates per 100 000 person-years for non-Hispanic Black compared with non-Hispanic White adults decreased from 339 to 45 deaths from the initial to Omicron wave, or by 293 deaths. After standardizing for age and racial and ethnic differences by metropolitan vs nonmetropolitan residence, increases in death rates among non-Hispanic White adults explained 120 deaths/100 000 person-years of the decrease (40.7%); 58 deaths/100 000 person-years in the decrease (19.6%) were explained by shifts in mortality to nonmetropolitan areas, where a disproportionate share of non-Hispanic White adults reside. The remaining 116 deaths/100 000 person-years in the decrease (39.6%) were explained by decreases in death rates in non-Hispanic Black adults. Conclusions and Relevance This study found that most of the national decrease in racial and ethnic disparities in COVID-19 mortality between the initial and Omicron waves was explained by increased mortality among non-Hispanic White adults and changes in the geographic spread of the pandemic. These findings suggest that despite media reports of a decline in disparities, there is a continued need to prioritize racial health equity in the pandemic response.
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Affiliation(s)
- Dielle J. Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
| | - Elizabeth Wrigley-Field
- Department of Sociology, University of Minnesota, Minneapolis
- Minnesota Population Center, University of Minnesota, Minneapolis
| | - Ahyoung Cho
- Center for Antiracist Research, Boston University, Boston, Massachusetts
- Department of Political Science, Boston University, Boston, Massachusetts
| | - Rafeya Raquib
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Elaine O. Nsoesie
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Center for Antiracist Research, Boston University, Boston, Massachusetts
| | - Eugenio Paglino
- Department of Sociology, University of Pennsylvania, Philadelphia
- Population Studies Center, University of Pennsylvania, Philadelphia
| | - Ruijia Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Alicia R. Riley
- Department of Sociology, University of California, Santa Cruz
| | - Yea-Hung Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Marie-Laure Charpignon
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge
| | | | - Samuel H. Preston
- Department of Sociology, University of Pennsylvania, Philadelphia
- Population Studies Center, University of Pennsylvania, Philadelphia
| | - Irma T. Elo
- Department of Sociology, University of Pennsylvania, Philadelphia
- Population Studies Center, University of Pennsylvania, Philadelphia
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
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21
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Kovach KA. Age-Adjusted All-Cause Mortality in Counties Served by PHAB-Accredited Local Health Departments Compared With Counties Served by Nonaccredited Local Health Departments: 1999 to 2020. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:446-455. [PMID: 37097187 DOI: 10.1097/phh.0000000000001744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
OBJECTIVES To analyze trends in the age-adjusted all-cause mortality rate (AAMR) from 1999 to 2020 between counties served by a Public Health Accreditation Board (PHAB)-accredited local health department and a nonaccredited local health department to determine whether accreditation impacted the AAMR and whether there were differences in the AAMR preceding the first health departments being accredited in 2013. DESIGN Descriptive time trends and difference-in-differences analysis was used to explore differences in the AAMR between accredited counties and nonaccredited counties. Propensity score matching was used to develop a control group matched on county characteristics to address confounding. SETTING A national observational study using data obtained from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research, the American Community Survey, and a PHAB data set on accreditation status. PARTICIPANTS All US counties with data on the AAMR and county characteristics. INTERVENTION Accreditation by the PHAB. MAIN OUTCOME MEASURE The AAMR. RESULTS Difference-in-differences in the AAMR between accredited and nonaccredited counties were stable following the launch of the accreditation program in 2013, except for an improvement in 2020 in the total sample (32.2 deaths per 100 000 people, 95% confidence interval: 3.8-60.6, P = .03). Age-adjusted all-cause mortality rates were lower in accredited counties across the 22-year period. This was statistically significant every year in the total sample but only statistically significant in 2020 in the matched sample (P < .05). Prior to accreditation, the AAMR improved by 24.7 deaths per 100 000 people (P = .05) and 18.0 deaths per 100 000 people (P = .24) more among accredited counties between 1999 and 2008, among the total and matched samples, respectively. CONCLUSION Currently, PHAB accreditation has not had a substantial impact on the AAMR, and the AAMR was higher among nonaccredited counties preceding the first health departments being accredited in 2013.
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Rudolphi JM, Cuthbertson C, Kaur A, Sarol JN. Agricultural Producers' and Stakeholders' Perceived Effectiveness and Participation in COVID-19 Protective Behaviors. J Agromedicine 2023; 28:105-115. [PMID: 36310383 DOI: 10.1080/1059924x.2022.2142347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study was designed to identify the perceived effectiveness of COVID-19 protective behaviors and participation in COVID-19 protective behaviors among agricultural producers and stakeholders in the Midwest, United States. A questionnaire was disseminated online to agricultural producers and stakeholders in April-July 2020. Respondents (N = 1,876) shared their perceptions of the effectiveness of COVID-19 protective behaviors and participation in those behaviors. Respondents were primarily agricultural producers (85.5%), aged 64 or younger (66.4%), male (81.2%), white (98.3%), and rural residents (88.7%). About three-quarters of respondents thought washing hands with soap and water and covering a cough or sneeze is very effective at preventing the spread of COVID-19, however, only 30% thought wearing a face mask when in contact with others or in public is very effective. Similarly, over 80% reported washing hands with soap regularly every day and covering their cough or sneeze every day in the past two weeks. In contrast, less than 40% reported staying home as much as possible and wearing a face mask when in public every day in the past two weeks. Rural residents were less likely than urban or suburban residents to report wearing a face mask when in public or with people outside their household. Agricultural producers and stakeholders were found to be at risk of getting COVID-19 due to the perceptions and practices, especially those related to protective social measures. Understanding engagement in protective behaviors and perceptions of their effectiveness is critical to developing effective public health interventions for agricultural communities.
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Affiliation(s)
- Josie M Rudolphi
- Department of Agricultural and Biological Engineering, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Courtney Cuthbertson
- Department of Human Development and Family Studies, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Amandeep Kaur
- Biostatistics, Epidemiology, and Research Design Core, Interdisciplinary Health Sciences Institute, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Jesus Natividad Sarol
- Biostatistics, Epidemiology, and Research Design Core, Interdisciplinary Health Sciences Institute, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
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23
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Kegler MC, Hermstad A, Haardörfer R, Arriola KJ, Gauthreaux N, Tucker S, Nelson G. Evaluation Design for The Two Georgias Initiative: Assessing Progress Toward Health Equity in the Rural South. HEALTH EDUCATION & BEHAVIOR 2023; 50:268-280. [PMID: 35306908 DOI: 10.1177/10901981211060330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As persistent inequities in health gained increased attention nationally due to COVID-19 and racial justice protests in 2020, it has become increasingly important to evaluate both the process and outcomes associated with coalition-based efforts to address health inequities. The Two Georgias Initiative supports coalitions in 11 rural counties to (1) achieve greater health equity, (2) improve health and health care, (3) build healthier rural communities and improve social conditions that impact the health of rural populations, and (4) build community, organizational, and individual leadership capacity for health equity. Rural communities suffer significant health disparities relative to urban areas, and also experience internal inequities by race and poverty level. The evaluation framework for The Two Georgias Initiative provides a comprehensive mixed methods approach to evaluating both processes and outcomes. Early results related to community readiness and capacity to address health inequities, measured through a coalition member survey (n = 236) conducted at the end of the planning phase, suggest coalitions were in the preparation stage, with higher levels of readiness among coalition members and organizations/groups similar to the coalition members' own, lower levels among public officials and other leaders, and the lowest levels among county residents. In addition, coalition members reported more experience with downstream drivers (e.g., access to care) of health than upstream drivers (e.g., affordable housing, environmental or racial justice). By providing a logic model, evaluation questions and associated indicators, as well as a range of data collection methods, this evaluation approach may prove practical to others aiming to evaluate their efforts to address health equity.
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Affiliation(s)
| | | | | | | | | | | | - Gary Nelson
- Healthcare Georgia Foundation, Atlanta, GA, USA
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Staton M, Pike E, Tillson M, Lofwall MR. Facilitating factors and barriers for use of medications to treat opioid use disorder (MOUD) among justice-involved individuals in rural Appalachia. JOURNAL OF COMMUNITY PSYCHOLOGY 2023:10.1002/jcop.23029. [PMID: 36930568 PMCID: PMC10505241 DOI: 10.1002/jcop.23029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
The purpose of this qualitative study is to assess facilitating factors and barriers for medications to treat opioid use disorder (MOUD) initiation among justice-involved individuals in one rural Appalachian community, as well as how those factors may differ across the three types of Food and Drug Administration (FDA) approved medications. Qualitative interviews were conducted with rural justice-involved individuals (N = 10) with a history of opioid use in the target community. Overall, participants demonstrated knowledge of the different types of MOUD and their pharmacological properties, but limited overall health literacy around opioid use disorder and MOUD treatment. Treatment access was hampered by transportation, time burdens, and costs. Findings call for research into improving health literacy education, training, and resources to decrease stigma and increase access to MOUD, particularly in light of the ongoing opioid crisis. State policies also need to increase access to all FDA medications among justice-involved individuals, as well as supporting a care continuum from facility entry, release, and community re-entry.
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Affiliation(s)
- Michele Staton
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY 40536-0086, USA
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY 40508, USA
| | - Erika Pike
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY 40536-0086, USA
| | - Martha Tillson
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY 40508, USA
- Department of Sociology, University of Kentucky College of Arts and Sciences, Lexington, KY 40506-0027, USA
| | - Michelle R. Lofwall
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY 40536-0086, USA
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY 40508, USA
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25
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Salerno EA, Gao R, Fanning J, Gothe NP, Peterson LL, Anbari AB, Kepper MM, Luo J, James AS, McAuley E, Colditz GA. Designing home-based physical activity programs for rural cancer survivors: A survey of technology access and preferences. Front Oncol 2023; 13:1061641. [PMID: 36761969 PMCID: PMC9907024 DOI: 10.3389/fonc.2023.1061641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023] Open
Abstract
Background While technology advances have increased the popularity of remote interventions in underserved and rural cancer communities, less is understood about technology access and preferences for home-based physical activity programs in this cancer survivor population. Purpose To determine access, preferences, and needs, for a home-based physical activity program in rural cancer survivors. Methods A Qualtrics Research Panel was recruited to survey adults with cancer across the United States. Participants self-reported demographics, cancer characteristics, technology access and usage, and preferences for a home-based physical activity program. The Godin Leisure Time Exercise Questionnaire (GLTEQ) assessed current levels of physical activity. Descriptive statistics included means and standard deviations for continuous variables, and frequencies for categorical variables. Independent samples t-tests explored differences between rural and non-rural participants. Results Participants (N=298; mean age=55.2 ± 16.5) had a history of cancer (mean age at diagnosis=46.5), with the most commonly reported cancer type being breast (25.5%), followed by prostate (16.1%). 74.2% resided in rural hometowns. 95% of participants reported accessing the internet daily. On a scale of 0-100, computer/laptop (M=63.4) and mobile phone (M=54.6) were the most preferred delivery modes for a home-based physical activity intervention, and most participants preferred balance/flexibility (72.2%) and aerobic (53.9%) exercises. Desired intervention elements included a frequency of 2-3 times a week (53.5%) for at least 20 minutes (75.7%). While there were notable rural disparities present (e.g., older age at diagnosis, lower levels of education; ps<.001), no differences emerged for technology access or environmental barriers (ps>.08). However, bias due to electronic delivery of the survey should not be discounted. Conclusion These findings provide insights into the preferred physical activity intervention (e.g., computer delivery, balance/flexibility exercises) in rural cancer survivors, while highlighting the need for personalization. Future efforts should consider these preferences when designing and delivering home-based interventions in this population.
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Affiliation(s)
- Elizabeth A. Salerno
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Rohana Gao
- Academic Program of Medical Education, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Jason Fanning
- Department of Gerontology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Neha P. Gothe
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Lindsay L. Peterson
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Allison B. Anbari
- Sinclair School of Nursing, University of Missouri, Columbia, MO, United States
| | - Maura M. Kepper
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Jingqin Luo
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Aimee S. James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Edward McAuley
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Graham A. Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
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Anzalone AJ, Sun J, Vinson AJ, Beasley WH, Hillegass WB, Murray K, Hendricks BM, Haendel M, Geary CR, Bailey KL, Hanson CK, Miele L, Horswell R, McMurry JA, Porterfield JZ, Vest MT, Bunnell HT, Harper JR, Price BS, Santangelo SL, Rosen CJ, McClay JC, Hodder SL. Community risks for SARS-CoV-2 infection among fully vaccinated US adults by rurality: A retrospective cohort study from the National COVID Cohort Collaborative. PLoS One 2023; 18:e0279968. [PMID: 36603014 DOI: 10.1371/journal.pone.0279968] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND While COVID-19 vaccines reduce adverse outcomes, post-vaccination SARS-CoV-2 infection remains problematic. We sought to identify community factors impacting risk for breakthrough infections (BTI) among fully vaccinated persons by rurality. METHODS We conducted a retrospective cohort study of US adults sampled between January 1 and December 20, 2021, from the National COVID Cohort Collaborative (N3C). Using Kaplan-Meier and Cox-Proportional Hazards models adjusted for demographic differences and comorbid conditions, we assessed impact of rurality, county vaccine hesitancy, and county vaccination rates on risk of BTI over 180 days following two mRNA COVID-19 vaccinations between January 1 and September 21, 2021. Additionally, Cox Proportional Hazards models assessed the risk of infection among adults without documented vaccinations. We secondarily assessed the odds of hospitalization and adverse COVID-19 events based on vaccination status using multivariable logistic regression during the study period. RESULTS Our study population included 566,128 vaccinated and 1,724,546 adults without documented vaccination. Among vaccinated persons, rurality was associated with an increased risk of BTI (adjusted hazard ratio [aHR] 1.53, 95% confidence interval [CI] 1.42-1.64, for urban-adjacent rural and 1.65, 1.42-1.91, for nonurban-adjacent rural) compared to urban dwellers. Compared to low vaccine-hesitant counties, higher risks of BTI were associated with medium (1.07, 1.02-1.12) and high (1.33, 1.23-1.43) vaccine-hesitant counties. Compared to counties with high vaccination rates, a higher risk of BTI was associated with dwelling in counties with low vaccination rates (1.34, 1.27-1.43) but not medium vaccination rates (1.00, 0.95-1.07). Community factors were also associated with higher odds of SARS-CoV-2 infection among persons without a documented vaccination. Vaccinated persons with SARS-CoV-2 infection during the study period had significantly lower odds of hospitalization and adverse events across all geographic areas and community exposures. CONCLUSIONS Our findings suggest that community factors are associated with an increased risk of BTI, particularly in rural areas and counties with high vaccine hesitancy. Communities, such as those in rural and disproportionately vaccine hesitant areas, and certain groups at high risk for adverse breakthrough events, including immunosuppressed/compromised persons, should continue to receive public health focus, targeted interventions, and consistent guidance to help manage community spread as vaccination protection wanes.
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Affiliation(s)
| | - Jing Sun
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | | | - William B Hillegass
- University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Kimberly Murray
- Maine Health Institute for Research, Portland, Maine, United States of America
| | - Brian M Hendricks
- West Virginia University, Morgantown, West Virginia, United States of America
| | - Melissa Haendel
- University of Colorado Anschutz Medical School, Aurora, CO, United States of America
| | - Carol Reynolds Geary
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Kristina L Bailey
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Corrine K Hanson
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Lucio Miele
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Ronald Horswell
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Julie A McMurry
- Oregon State University, Corvallis, Oregon, United States of America
| | | | - Michael T Vest
- Christiana Care Health System, Newark, Delaware, United States of America
| | - H Timothy Bunnell
- Nemours Children's Health, Wilmington, Delaware, United States of America
| | - Jeremy R Harper
- Owl Health Networks, Indianapolis, Indiana, United States of America
| | - Bradley S Price
- West Virginia University, Morgantown, West Virginia, United States of America
| | - Susan L Santangelo
- Maine Health Institute for Research, Portland, Maine, United States of America
- Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Clifford J Rosen
- Maine Health Institute for Research, Portland, Maine, United States of America
| | - James C McClay
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Sally L Hodder
- West Virginia University, Morgantown, West Virginia, United States of America
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Kulik PKG, Leider JP, Rogers M, Karnik H, Power LE, Schaffer K, Bekemeier B. PH WINS for All: The Critical Role of Partnerships for Engaging All Local Health Departments in the Public Health Workforce Interests and Needs Survey. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:S48-S53. [PMID: 36223512 PMCID: PMC10573110 DOI: 10.1097/phh.0000000000001635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The 2021 "PH WINS for All" pilot sought to address a rural research gap by including small local health departments in the Public Health Workforce Interests and Needs Survey (PH WINS) for the first time. To do so, the de Beaumont Foundation partnered with the Public Health Training Centers in Health and Human Services Regions V and X. This article describes the collaborative efforts that made the PH WINS for All pilot successful, presents respondent demographics by agency size, and discusses the importance of gathering such data to address the unique needs of the workforce in small local health departments.
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Affiliation(s)
- Phoebe K. G. Kulik
- Region V Public Health Training Center and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan (Ms Kulik and Dr Power); Region V Public Health Training Center and Center for Public Health Systems, University of Minnesota School of Public Health, Minneapolis, Minnesota (Drs Leider and Karnik); de Beaumont Foundation, Bethesda, Maryland (Ms Schaffer); and Northwest Center for Public Health Practice, University of Washington School of Public Health, Seattle, Washington (Ms Rogers and Dr Bekemeier)
| | - Jonathon P. Leider
- Region V Public Health Training Center and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan (Ms Kulik and Dr Power); Region V Public Health Training Center and Center for Public Health Systems, University of Minnesota School of Public Health, Minneapolis, Minnesota (Drs Leider and Karnik); de Beaumont Foundation, Bethesda, Maryland (Ms Schaffer); and Northwest Center for Public Health Practice, University of Washington School of Public Health, Seattle, Washington (Ms Rogers and Dr Bekemeier)
| | - Megan Rogers
- Region V Public Health Training Center and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan (Ms Kulik and Dr Power); Region V Public Health Training Center and Center for Public Health Systems, University of Minnesota School of Public Health, Minneapolis, Minnesota (Drs Leider and Karnik); de Beaumont Foundation, Bethesda, Maryland (Ms Schaffer); and Northwest Center for Public Health Practice, University of Washington School of Public Health, Seattle, Washington (Ms Rogers and Dr Bekemeier)
| | - Harshada Karnik
- Region V Public Health Training Center and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan (Ms Kulik and Dr Power); Region V Public Health Training Center and Center for Public Health Systems, University of Minnesota School of Public Health, Minneapolis, Minnesota (Drs Leider and Karnik); de Beaumont Foundation, Bethesda, Maryland (Ms Schaffer); and Northwest Center for Public Health Practice, University of Washington School of Public Health, Seattle, Washington (Ms Rogers and Dr Bekemeier)
| | - Laura E. Power
- Region V Public Health Training Center and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan (Ms Kulik and Dr Power); Region V Public Health Training Center and Center for Public Health Systems, University of Minnesota School of Public Health, Minneapolis, Minnesota (Drs Leider and Karnik); de Beaumont Foundation, Bethesda, Maryland (Ms Schaffer); and Northwest Center for Public Health Practice, University of Washington School of Public Health, Seattle, Washington (Ms Rogers and Dr Bekemeier)
| | - Kay Schaffer
- Region V Public Health Training Center and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan (Ms Kulik and Dr Power); Region V Public Health Training Center and Center for Public Health Systems, University of Minnesota School of Public Health, Minneapolis, Minnesota (Drs Leider and Karnik); de Beaumont Foundation, Bethesda, Maryland (Ms Schaffer); and Northwest Center for Public Health Practice, University of Washington School of Public Health, Seattle, Washington (Ms Rogers and Dr Bekemeier)
| | - Betty Bekemeier
- Region V Public Health Training Center and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan (Ms Kulik and Dr Power); Region V Public Health Training Center and Center for Public Health Systems, University of Minnesota School of Public Health, Minneapolis, Minnesota (Drs Leider and Karnik); de Beaumont Foundation, Bethesda, Maryland (Ms Schaffer); and Northwest Center for Public Health Practice, University of Washington School of Public Health, Seattle, Washington (Ms Rogers and Dr Bekemeier)
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Maddock JE, Demment M, Graham M, Folta S, Strogatz D, Nelson M, Ha SY, Eldridge GD, Seguin-Fowler RA. Changes in physical activity outcomes in the Strong Hearts, Healthy Communities (SHHC-2.0) community-based randomized trial. Int J Behav Nutr Phys Act 2022; 19:159. [PMID: 36578002 PMCID: PMC9795747 DOI: 10.1186/s12966-022-01401-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/15/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Physical inactivity is a risk factor for numerous adverse health conditions and outcomes, including all-cause mortality. Aging rural women are at particular risk for physical inactivity based on environmental, sociocultural, and psychosocial factors. This study reports on changes in physical activity and associated factors from a multicomponent community-engaged intervention trial. METHODS Strong Hearts, Healthy Communities 2.0 (SHHC-2.0) was a 24-week cluster (community) randomized controlled trial building on the results from the previous trial of SHHC-1.0. Rural women (n = 182) aged 40 and over living in 11 rural communities in upstate New York were recruited. The intervention consisted of twice-weekly experiential classes focused on exercise, nutrition, and civic engagement. Physical activity outcomes included accelerometry and self-report as well as related psychosocial measures at midpoint (12 weeks) and post-intervention (24 weeks). Data were analyzed using multilevel linear regression models with the community as the random effect. RESULTS Compared to participants from the control communities, participants in the intervention communities showed a significant increase in objectively measured moderate to vigorous intensity physical activity: at 12 weeks (increase of 8.1 min per day, P < 0.001) and at 24 weeks (increase of 6.4 min per day; P = 0.011). Self-reported total MET minutes per week also increased: at 12 weeks (increase of 725.8, P = 0.003) and 24 weeks (increase of 955.9, P = 0.002). Several of the psychosocial variables also showed significant positive changes. CONCLUSIONS The SHHC-2.0 intervention successfully increased physical activity level and related outcome measures. Modifications made based upon in-depth process evaluation from SHHC-1.0 appear to have been effective in increasing physical activity in this at-risk population. TRIAL REGISTRATION Clinicaltrials.gov: NCT03059472. Registered 23 February 2017.
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Affiliation(s)
- Jay E. Maddock
- grid.264756.40000 0004 4687 2082School of Public Health, Texas A&M University, College Station, TX 77843 USA
| | - Margaret Demment
- grid.264756.40000 0004 4687 2082Texas A&M AgriLife Research and Extension Center, Dallas, TX 75252 USA
| | - Meredith Graham
- grid.264756.40000 0004 4687 2082Texas A&M AgriLife Research and Extension Center, Dallas, TX 75252 USA
| | - Sara Folta
- grid.429997.80000 0004 1936 7531Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02155 USA
| | - David Strogatz
- grid.427850.cBassett Healthcare Network, Cooperstown, NY 13326 USA
| | - Miriam Nelson
- grid.467528.a0000 0004 5905 7925Newman’s Own Foundation, Westport, CT 06880 USA
| | - Seong-Yeon Ha
- grid.264756.40000 0004 4687 2082Department of Statistics, Texas A&M University, College Station, TX 77843 USA
| | - Galen D. Eldridge
- grid.264756.40000 0004 4687 2082Texas A&M AgriLife Research and Extension Center, Dallas, TX 75252 USA
| | - Rebecca A. Seguin-Fowler
- Institute for Advancing Health Through Agriculture, Texas A&M AgriLife, College Station, TX 77843 USA
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James WL, Brindley C, Purser C, Topping M. Conceptualizing rurality: The impact of definitions on the rural mortality penalty. Front Public Health 2022; 10:1029196. [PMID: 36408010 PMCID: PMC9669957 DOI: 10.3389/fpubh.2022.1029196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Background In the U.S., inequality is widespread and still growing at nearly every level conceivable. This is vividly illustrated in the long-standing, well-documented inequalities in outcomes between rural and urban places in the U.S.; namely, the rural mortality penalty of disproportionately higher mortality rates in these areas. But what does the concept of "rural" capture and conjure? How we explain these geographic differences has spanned modes of place measurement and definitions. We employ three county-level rural-urban definitions to (1) analyze how spatially specific and robust rural disparities in mortality are and (2) identify whether mortality outcomes are dependent on different definitions. Methods We compare place-based all-cause mortality rates using three typologies of "rural" from the literature to assess robustness of mortality rates across these rural and urban distinctions. Results show longitudinal all-cause mortality rate trends from 1968 to 2020 for various categories of urban and rural areas. We then apply this data to rural and urban geography to analyze the similarity in the distribution of spatial clusters and outliers in mortality using spatial autocorrelation methodologies. Results The rural disadvantage in mortality is remarkably consistent regardless of which rural-urban classification scheme is utilized, suggesting the overall pattern of rural disadvantage is robust to any definition. Further, the spatial association between rurality and high rates of mortality is statistically significant. Conclusion Different definitions yielding strongly similar results suggests robustness of rurality and consequential insights for actionable policy development and implementation.
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Affiliation(s)
- Wesley L. James
- Department of Sociology, Center for Community Research and Evaluation, University of Memphis, Memphis, TN, United States,*Correspondence: Wesley L. James
| | - Claire Brindley
- Department of Sociology, Center for Community Research and Evaluation, University of Memphis, Memphis, TN, United States
| | - Christopher Purser
- Department of Politics, Justice, Law, and Philosophy, University of North Alabama, Florence, AL, United States
| | - Michael Topping
- Department of Sociology, Center for Demography and Ecology, University of Wisconsin-Madison, Madison, WI, United States
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Vo MV, Ebi KL, Busch Isaksen TM, Hess JJ, Errett NA. Addressing Capacity Constraints of Rural Local Health Departments to Support Climate Change Adaptation: Action Is Needed Now. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13651. [PMID: 36294229 PMCID: PMC9602968 DOI: 10.3390/ijerph192013651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
Looming climate change health impacts among rural communities will require a robust health system response. To reduce health inequities and promote climate justice, rural local health departments (LHDs) must be adequately resourced and supported to engage in climate change mitigation and adaptation policy and program development and implementation. In the United States, small local tax bases, overreliance on revenue from fee-based services, and limited federal funding to support climate change and health programming, have left rural LHDs with limited and inflexible human, financial, and political capital to support engagement in local climate change activities. Because of the urgent demands stemming from climate change, additional investments and supports are needed to rapidly build the capacity and capability of rural LHDs. Federal and state approaches to public health funding should consider the unique climate change and health risks of rural communities. Further, cross-jurisdictional shared service arrangements and state-level support to build rural LHDs' technical capacity, and research on local impacts and culturally appropriate solutions, must be prioritized.
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Affiliation(s)
- Matthew V. Vo
- Public Health–Global Health, University of Washington School of Public Health, Seattle, WA 98195, USA
| | - Kristie L. Ebi
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA 98105, USA
- Department of Global Health, University of Washington School of Public Health, Seattle, WA 98195, USA
- Center for Health and the Global Environment (CHanGE), University of Washington School of Public Health, Seattle, WA 98195, USA
| | - Tania M. Busch Isaksen
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA 98105, USA
- Center for Health and the Global Environment (CHanGE), University of Washington School of Public Health, Seattle, WA 98195, USA
| | - Jeremy J. Hess
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA 98105, USA
- Department of Global Health, University of Washington School of Public Health, Seattle, WA 98195, USA
- Center for Health and the Global Environment (CHanGE), University of Washington School of Public Health, Seattle, WA 98195, USA
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Nicole A. Errett
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA 98105, USA
- Center for Health and the Global Environment (CHanGE), University of Washington School of Public Health, Seattle, WA 98195, USA
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Giroux S, Waldman K, Burris M, Valliant JCD, Babb AM, Stafford P, Fobi D, Czebotar K, Knudsen DC. Food security and well-being among older, rural Americans before and during the COVID-19 pandemic. PLoS One 2022; 17:e0274020. [PMID: 36054130 PMCID: PMC9439215 DOI: 10.1371/journal.pone.0274020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
The COVID-19 pandemic has impacted many aspects of our lives. Older adults, those with less income or fewer resources, and those living in rural parts of the United States are potentially more vulnerable. To understand the negative impact of COVID-19 on perceived food security, physical and mental health, and loneliness in a sample of older, rural, low-income adults in the United States, we use results from a mailed survey in which residents of four Indiana counties contrasted their status during the early period of the pandemic to their typical pre-pandemic status. We test for significant changes in status and what predicts negative impacts to food security, health, and loneliness. We asked respondents to report on both pre-pandemic and since-pandemic experiences in the instrument, which was administered after the pandemic had begun, in May 2020. We measure food security using the U.S. Household Food Security Survey Module (six-item short form; HFSSM), physical and mental health using the Centers for Disease Control’s Healthy Days Measures (HRQOL-4), and loneliness using the UCLA Revised Loneliness Scale. A binomial test identified significant declines in status for all three measures. Logistic regressions identified factors associated with each of the measures worsening. Fear of going to the store or food pantry was associated with all three measures. Decreased store hours and closed food pantries were associated with lower food security. More education, fewer years of age, being female, decreased income, and stockpiling were associated with more reported days of poor physical or mental health. Fewer years of age, lack of transportation, and eating less often with others were associated with perceived increased loneliness. The pandemic had a negative impact on respondents’ food security, unhealthy days, and loneliness, but different factors were associated with each measure for this population. Our findings provide insight for targeted recovery efforts.
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Affiliation(s)
- Stacey Giroux
- Ostrom Workshop, Indiana University, Bloomington, Indiana, United States of America
- * E-mail:
| | - Kurt Waldman
- Department of Geography, Indiana University, Bloomington, Indiana, United States of America
| | - Mecca Burris
- Department of Anthropology, Indiana University, Bloomington, Indiana, United States of America
| | - Julia C. D. Valliant
- Ostrom Workshop, Indiana University, Bloomington, Indiana, United States of America
| | - Angela M. Babb
- Ostrom Workshop, Indiana University, Bloomington, Indiana, United States of America
| | - Philip Stafford
- CoDesign Commons, Bloomington, Indiana, United States of America
| | - Daniel Fobi
- Department of Geography, Indiana University, Bloomington, Indiana, United States of America
| | - Kamila Czebotar
- Department of Geography, Indiana University, Bloomington, Indiana, United States of America
| | - Daniel C. Knudsen
- Department of Geography, Indiana University, Bloomington, Indiana, United States of America
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Rudolphi JM, Cuthbertson C, Kaur A, Sarol JN. From believers to skeptics: Latent class analysis of COVID-19 protective practices and perceptions among agricultural community members. J Rural Health 2022; 39:5-17. [PMID: 35841296 PMCID: PMC9349713 DOI: 10.1111/jrh.12692] [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] [Indexed: 02/01/2023]
Abstract
PURPOSE This cross-sectional study aimed to identify homogenous groups of agricultural producers and stakeholders based on their perceptions of effectiveness and use of COVID-19 protective behaviors. METHODS We conducted an online survey of agricultural producers and stakeholders through Qualtrics. Participants responded to 7 statements about COVID-19 protective behavior effectiveness and 7 statements about participation in COVID-19 protective behaviors in the previous 2 weeks. These statements included handwashing, disinfecting, refraining from touching one's face, covering one's face when coughing/sneezing, staying at home, social distancing, and wearing a face mask. Additional survey sections included demographics and health history. We performed separate latent class analysis (LCA) to identify clusters of agricultural producers' and stakeholders' perceptions and participation in COVID-19-related protective behaviors based on their pattern of responses. FINDINGS Based on LCA, participants were distributed as universal believers (33%), social believers (16%), personal believers (26%), moderate believers (17%), and social skeptics (85%) of effectiveness and as low (15%), moderate (40%), and high (45%) adherents of COVID-19 protective behaviors. Those who were female, older, or had underlying health conditions were more likely to be universal believers and highly adherent. High adherence was also more likely among those who lived in urban areas or were not self-employed. CONCLUSIONS Results suggest that groups of agricultural producers and stakeholders based on perception of effectiveness and participation in COVID-19 protective behaviors are associated with demographic and health characteristics. Public health campaigns that increase or maintain motivation to comply with protective behaviors should be developed and implemented specific for agricultural populations.
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Affiliation(s)
- Josie M. Rudolphi
- Department of Agricultural and Biological EngineeringUniversity of Illinois Urbana‐ChampaignUrbanaIllinoisUSA
| | - Courtney Cuthbertson
- Department of Human Development and Family StudiesUniversity of Illinois Urbana‐ChampaignUrbanaIllinoisUSA
| | - Amandeep Kaur
- Interdisciplinary Health Science InstituteUniversity of Illinois Urbana‐ChampaignUrbanaIllinoisUSA
| | - Jesus N. Sarol
- Interdisciplinary Health Science InstituteUniversity of Illinois Urbana‐ChampaignUrbanaIllinoisUSA
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Kegler MC, Gauthreaux N, Hermstad A, Arriola KJ, Mickens A, Ditzel K, Hernandez C, Haardörfer R. Inequities in Physical Activity Environments and Leisure-Time Physical Activity in Rural Communities. Prev Chronic Dis 2022; 19:E40. [PMID: 35797473 PMCID: PMC9336193 DOI: 10.5888/pcd19.210417] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Differential access to environments supportive of physical activity (PA) may help explain racial and socioeconomic disparities in leisure-time physical activity (LTPA) in rural communities. METHODS We used baseline data from a mailed survey (N = 728) conducted in 2019 as part of an evaluation of The Two Georgias Initiative to examine the relationships among LTPA, sociodemographic characteristics, and perceived access to supportive PA environments (eg, areas around the home/neighborhood, indoor and outdoor exercise areas, town center connectivity) in 3 rural Georgia counties. RESULTS More than half of respondents (53.5%) engaged in LTPA in the previous month. Perceptions of PA environments were generally neutral to somewhat negative. In multivariable models, overall PA environment was associated with LTPA (OR, 1.58; 95% CI, 1.06-2.35), as was annual household income >$50,000 relative to ≤$20,000 (OR, 2.72; 95% CI, 1.53-4.83) and race, with Black respondents less likely to engage in LTPA than White respondents (OR, 0.49; 95% CI, 0.29-0.85). Of the 5 PA environment domains examined, town center connectivity was significantly associated with LTPA (OR, 1.68, 95% CI, 1.20-2.36). Both the overall PA score (β = -0.014; 95% CI, -0.029 to -0.002) and town center connectivity (β = -0.020; 95% CI, -0.038 to -0.005) partially mediated associations between annual household income and LTPA. Areas supportive of PA around the home/neighborhood partially mediated the association by race (β = 0.016; 95% CI, 0.001-0.034). CONCLUSION Findings lend support for investing in town centers and racially diverse neighborhoods to increase walkability and PA infrastructure as potential strategies to reduce inequities in LTPA.
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Affiliation(s)
- Michelle C. Kegler
- Department of Behavioral, Social and Health Education Sciences, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Nicole Gauthreaux
- Department of Behavioral, Social and Health Education Sciences, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - April Hermstad
- Department of Behavioral, Social and Health Education Sciences, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kimberly Jacob Arriola
- Department of Behavioral, Social and Health Education Sciences, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Kelley Ditzel
- Public Administration, Georgia College & State University, Milledgeville, Georgia
| | - Clarisa Hernandez
- Department of Behavioral, Social and Health Education Sciences, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Regine Haardörfer
- Department of Behavioral, Social and Health Education Sciences, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Perceptions of Barriers: An Examination of Public Health Practice in Kansas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095513. [PMID: 35564905 PMCID: PMC9102560 DOI: 10.3390/ijerph19095513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 02/05/2023]
Abstract
Public health and healthcare professionals perform a wide variety of services for their communities, and serve in important and often overlapping roles, particularly in rural communities. In this qualitative study, public health practitioners in Kansas were asked about their perceptions of barriers to public health and vulnerable people in their communities. Participants from across Kansas were interviewed via teleconferencing, telephone, or email, and emergent themes were identified using qualitative thematic analysis. While asked about public health specifically, during interviews, many participants discussed barriers to healthcare as well. The top barriers to effective public health practice identified in this study were funding, education, accessibility, and affordability. Others included politics, transportation, and the need to expand Medicare and Medicaid. The populations believed most vulnerable in their communities were community members living in poverty, elderly people, and other marginalized populations. Our findings suggest public health practitioners in Kansas observe a lack of understanding and knowledge in their communities about public health, along with the recognition that a lack of accessibility and affordability to health services are barriers to effective public health practice.
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Steeves-Reece AL, Totten AM, Broadwell KD, Richardson DM, Nicolaidis C, Davis MM. Social Needs Resource Connections: A Systematic Review of Barriers, Facilitators, and Evaluation. Am J Prev Med 2022; 62:e303-e315. [PMID: 35078672 PMCID: PMC9850790 DOI: 10.1016/j.amepre.2021.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/20/2021] [Accepted: 12/01/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Healthcare organizations increasingly are screening patients for social needs (e.g., food, housing) and referring them to community resources. This systematic mixed studies review assesses how studies evaluate social needs resource connections and identifies patient- and caregiver-reported factors that may inhibit or facilitate resource connections. METHODS Investigators searched PubMed and CINAHL for articles published from October 2015 to December 2020 and used dual review to determine inclusion based on a priori selection criteria. Data related to study design, setting, population of interest, intervention, and outcomes were abstracted. Articles' quality was assessed using the Mixed Methods Appraisal Tool. Data analysis was conducted in 2021. RESULTS The search identified 34 articles from 32 studies. The authors created a taxonomy of quantitative resource connection measures with 4 categories: whether participants made contact with resources, received resources, had their social needs addressed, or rated some aspect of their experience with resources. Barriers to resource connections were inadequacy, irrelevancy, or restrictiveness; inaccessibility; fears surrounding stigma or discrimination; and factors related to staff training and resource information sharing. Facilitators were referrals' relevancy, the degree of support and simplicity embedded within the interventions, and interventions being comprehensive and inclusive. DISCUSSION This synthesis of barriers and facilitators indicates areas where healthcare organizations may have agency to improve the efficacy of social needs screening and referral interventions. The authors also recommend that resource connection measures be explicitly defined and focus on whether participants received new resources and whether their social needs were addressed.
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Affiliation(s)
- Anna Louise Steeves-Reece
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon; Oregon Rural Practice-based Research Network, School of Medicine, Oregon Health & Science University, Portland, Oregon.
| | - Annette Marie Totten
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon; Oregon Rural Practice-based Research Network, School of Medicine, Oregon Health & Science University, Portland, Oregon; Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon; Department of Medical Informatics & Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Katherine DuBose Broadwell
- Oregon Rural Practice-based Research Network, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Dawn Michele Richardson
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon
| | - Christina Nicolaidis
- School of Social Work, Portland State University, Portland, Oregon; Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Melinda Marie Davis
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon; Oregon Rural Practice-based Research Network, School of Medicine, Oregon Health & Science University, Portland, Oregon; Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
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Afifi RA, Parker EA, Dino G, Hall DM, Ulin B. Reimagining Rural: Shifting Paradigms About Health and Well-Being in the Rural United States. Annu Rev Public Health 2022; 43:135-154. [PMID: 34910581 PMCID: PMC11295601 DOI: 10.1146/annurev-publhealth-052020-123413] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Rural health disparities have attracted increased national attention, compelling an expanded focus on rural health research. In this article, we deconstruct the definitions and narratives of "rural" communities and suggest that a paradigm shift is needed that centers the complexity and strength of rural places. We discuss the relevance of health equity frameworks, implementation science, and community-engaged approaches to promote rural well-being. Focusing on rural in its own right will lead to intervention innovations and reinvention with implications beyond rural areas. We conclude with suggestions for research and practice to inspire renewed interest in partnering with rural communities to promote health equity.
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Affiliation(s)
- R A Afifi
- Department of Community and Behavioral Health, and Prevention Research Center for Rural Health, College of Public Health, University of Iowa, Iowa City, Iowa, United States; ,
| | - E A Parker
- Department of Community and Behavioral Health, and Prevention Research Center for Rural Health, College of Public Health, University of Iowa, Iowa City, Iowa, United States; ,
| | - G Dino
- Department of Social and Behavioral Sciences, and West Virginia Prevention Research Center, School of Public Health, West Virginia University, Morgantown, West Virginia, United States;
| | - D M Hall
- Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia, United States;
| | - B Ulin
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States;
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Haliwa I, Layman H, Coffman J, Snodgrass A, Santer P, Barlett B, Long K, Mason A, Pfost G, Harden J, Dino G, Jarrett T. Perceptions and Expectations of School-Based Professionals Surrounding School-Based Mindfulness Training in Appalachia During the COVID-19 Pandemic: A Qualitative Study. Front Public Health 2022; 10:816494. [PMID: 35186847 PMCID: PMC8854180 DOI: 10.3389/fpubh.2022.816494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background School-based professionals often report high burnout, particularly in geographic areas like Appalachia, where school-aged children are exposed to high levels of adverse childhood experiences, which may be exacerbated by the COVID-19 pandemic. While school-based mindfulness trainings can reduce burnout, their efficacy is influenced by the expectations of intervention personnel ahead of implementation. The present study assessed expectations and perceptions of a school-based mindfulness training among school personnel in 21 Appalachian schools during the COVID-19 pandemic. Methods Upon enrollment in the training, staff (N = 191) responded to open ended survey questions regarding perceived impacts of COVID-19 on students, expected benefits and barriers to school-based mindfulness, and perceived community acceptance of mindfulness. Results School personnel identified social isolation and lack of structure as negative impacts of COVID-19 on students. Expected benefits of classroom mindfulness included improved coping skills, focus, and emotion regulation, whereas barriers included lack of time and student ability level (e.g., age, attention). While most respondents indicated that their community was accepting of mindfulness practices, some noted resistance to and misperceptions of mindfulness, which may illustrate the influence of local cultural norms and values on the acceptability of mental health interventions. Conclusions Overall, these findings suggest positive expectations and relative perceived support for mindfulness practices within these Appalachian communities, including in response to negative impacts of the COVID-19 pandemic on students. Adapting practices and language to accommodate barriers such as time, student ability, and cultural misconceptions of mindfulness may increase the feasibility and efficacy of these interventions.
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Affiliation(s)
- Ilana Haliwa
- Department of Psychology, West Virginia University, Morgantown, WV, United States
- *Correspondence: Ilana Haliwa
| | - Hannah Layman
- WVU School of Public Health, West Virginia Prevention Research Center, Morgantown, WV, United States
| | - Jessica Coffman
- WVU School of Public Health, West Virginia Prevention Research Center, Morgantown, WV, United States
| | - Amy Snodgrass
- Department of Rural Health, West Virginia University, Morgantown, WV, United States
| | - Pamela Santer
- Wellness Center, WVU Parkersburg, Parkersburg, WV, United States
| | | | - Kate Long
- Try This West Virginia, Charleston, WV, United States
| | - Ashley Mason
- School of Physical Therapy, Marshall University, Huntington, WV, United States
| | - Gretchen Pfost
- School of Physical Therapy, Marshall University, Huntington, WV, United States
| | - Jenny Harden
- Greenbrier County Schools, Rupert, WV, United States
| | - Geri Dino
- WVU School of Public Health, West Virginia Prevention Research Center, Morgantown, WV, United States
| | - Traci Jarrett
- WVU School of Public Health, West Virginia Prevention Research Center, Morgantown, WV, United States
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Cohen SA, Nash CC, Byrne EN, Mitchell LE, Greaney ML. Black/White Disparities in Obesity Widen with Increasing Rurality: Evidence from a National Survey. Health Equity 2022; 6:178-188. [PMID: 35402770 PMCID: PMC8985531 DOI: 10.1089/heq.2021.0149] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Steven A. Cohen
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Caitlin C. Nash
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Erin N. Byrne
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Lauren E. Mitchell
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Mary L. Greaney
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
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Jain B, Paguio JA, Yao JS, Jain U, Dee EC, Celi LA, Ojikutu B. Rural-Urban Differences in Influenza Vaccination Among Adults in the United States, 2018-2019. Am J Public Health 2022; 112:304-307. [PMID: 35080958 PMCID: PMC8802596 DOI: 10.2105/ajph.2021.306575] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To provide adjusted rates of self-reported receipt of the influenza vaccine in the 2018-2019 flu season among adults in large metropolitan, medium and small metropolitan, and nonmetropolitan areas of the United States by age group, gender, and race. Methods. We queried the 2019 National Health Interview Survey for respondents aged 18 years and older. To provide national estimates of influenza vaccination coverage, we performed sample-weighted multivariable logistic regressions and predicted marginal modeling while adjusting for age, gender, race/ethnicity, and urban-rural household designation. Results. After weighting, 48.1%, 46.2%, and 43.6% of adults from large metropolitan, small and medium metropolitan, and nonmetropolitan areas, respectively, received the influenza vaccine. Additionally, there was a trend toward declining influenza vaccination status from large metropolitan to rural areas in all age groups, both genders, and multiple racial/ethnic groups. Conclusions. Self-reported influenza vaccination rates were lower in rural than in urban areas among adults of all age groups and both genders. Using community leaders for health promotion, augmentation of the community health care workforce, and provision of incentives for providers to integrate influenza vaccination in regular visits may expand influenza vaccine coverage. (Am J Public Health. 2022;112(2):304-307. https://doi.org/10.2105/AJPH.2021.306575).
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Affiliation(s)
- Bhav Jain
- Bhav Jain and Leo Anthony Celi are with the Laboratory of Computational Physiology, Massachusetts Institute of Technology, Cambridge. Joseph Alexander Paguio and Jasper Seth Yao are with the Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA. Urvish Jain is with the Department of Computational & Systems Biology, University of Pittsburgh, Pittsburgh, PA. Edward Christopher Dee is with the Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY. Bisola Ojikutu is with the Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | - Joseph Alexander Paguio
- Bhav Jain and Leo Anthony Celi are with the Laboratory of Computational Physiology, Massachusetts Institute of Technology, Cambridge. Joseph Alexander Paguio and Jasper Seth Yao are with the Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA. Urvish Jain is with the Department of Computational & Systems Biology, University of Pittsburgh, Pittsburgh, PA. Edward Christopher Dee is with the Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY. Bisola Ojikutu is with the Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | - Jasper Seth Yao
- Bhav Jain and Leo Anthony Celi are with the Laboratory of Computational Physiology, Massachusetts Institute of Technology, Cambridge. Joseph Alexander Paguio and Jasper Seth Yao are with the Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA. Urvish Jain is with the Department of Computational & Systems Biology, University of Pittsburgh, Pittsburgh, PA. Edward Christopher Dee is with the Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY. Bisola Ojikutu is with the Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | - Urvish Jain
- Bhav Jain and Leo Anthony Celi are with the Laboratory of Computational Physiology, Massachusetts Institute of Technology, Cambridge. Joseph Alexander Paguio and Jasper Seth Yao are with the Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA. Urvish Jain is with the Department of Computational & Systems Biology, University of Pittsburgh, Pittsburgh, PA. Edward Christopher Dee is with the Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY. Bisola Ojikutu is with the Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | - Edward Christopher Dee
- Bhav Jain and Leo Anthony Celi are with the Laboratory of Computational Physiology, Massachusetts Institute of Technology, Cambridge. Joseph Alexander Paguio and Jasper Seth Yao are with the Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA. Urvish Jain is with the Department of Computational & Systems Biology, University of Pittsburgh, Pittsburgh, PA. Edward Christopher Dee is with the Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY. Bisola Ojikutu is with the Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | - Leo Anthony Celi
- Bhav Jain and Leo Anthony Celi are with the Laboratory of Computational Physiology, Massachusetts Institute of Technology, Cambridge. Joseph Alexander Paguio and Jasper Seth Yao are with the Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA. Urvish Jain is with the Department of Computational & Systems Biology, University of Pittsburgh, Pittsburgh, PA. Edward Christopher Dee is with the Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY. Bisola Ojikutu is with the Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | - Bisola Ojikutu
- Bhav Jain and Leo Anthony Celi are with the Laboratory of Computational Physiology, Massachusetts Institute of Technology, Cambridge. Joseph Alexander Paguio and Jasper Seth Yao are with the Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA. Urvish Jain is with the Department of Computational & Systems Biology, University of Pittsburgh, Pittsburgh, PA. Edward Christopher Dee is with the Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY. Bisola Ojikutu is with the Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
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Watson SE, Smith P, Snowden J, Vaughn V, Cottrell L, Madden CA, Kong AS, McCulloh R, Stack Lim C, Bledsoe M, Kowal K, McNally M, Knight L, Cowan K, Jimenez EY. Facilitators and Barriers to Pediatric Clinical Trial Recruitment and Retention in Rural and Community Settings: A Scoping Review of the Literature. Clin Transl Sci 2022; 15:838-853. [PMID: 35037409 PMCID: PMC9010274 DOI: 10.1111/cts.13220] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/07/2021] [Accepted: 12/11/2021] [Indexed: 11/30/2022] Open
Abstract
Children in rural settings are underrepresented in clinical trials, potentially contributing to rural health disparities. We performed a scoping review describing available literature on barriers and facilitators impacting participation in pediatric clinical trials in rural and community-based (non-clinical) settings. Articles identified via PubMed, CINAHL, Embase, and Web of Science were independently double-screened at title/abstract and full-text levels to identify articles meeting eligibility criteria. Included articles reported on recruitment or retention activities for U.S.-based pediatric clinical studies conducted in rural or community-based settings and were published in English through January 2021. Twenty-seven articles describing 31 studies met inclusion criteria. Most articles reported on at least one study conducted in an urban or suburban or unspecified community setting (n=23 articles; 85%); fewer (n=10; 37%) reported on studies that spanned urban and rural settings or were set in rural areas. More studies discussed recruitment facilitators (n=25 studies; 81%) and barriers (n=19; 61%) versus retention facilitators (n=15; 48%) and barriers (n=8; 26%). Descriptions of recruitment and retention barriers and facilitators were primarily experiential or subjective. Recruitment and retention facilitators were similar across settings and included: contacts/reminders, community engagement and relationship-building, consideration of participant logistics, and incentives. Inadequate staff and resources were commonly cited recruitment and retention barriers. Few studies have rigorously examined optimal ways to recruit and retain rural participants in pediatric clinical trials. To expand the evidence base, future studies examining recruitment and retention strategies should systematically assess and report rurality and objectively compare relative impact of different strategies.
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Affiliation(s)
- Sara E Watson
- Department of Pediatrics, University of Louisville, and Norton Children's Hospital, Louisville, KY
| | | | | | | | | | - Christi A Madden
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Alberta S Kong
- University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Russell McCulloh
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE and Children's Hospital & Medical Center, Omaha, NE
| | - Crystal Stack Lim
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
| | | | - Karen Kowal
- Nemours Children's Health System, Wilmington, DE
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Tempelaar W, Kozloff N, Crawford A, Voineskos A, Addington D, Alexander T, Baluyut C, Bromley S, Brooks S, de Freitas L, Jindani S, Kirvan A, Morizio A, Polillo A, Roby R, Sosnowski A, Villanueva V, Durbin J, Barwick M. The quick pivot: Capturing real world modifications for the re-implementation of an early psychosis program transitioning to virtual delivery. FRONTIERS IN HEALTH SERVICES 2022; 2:995392. [PMID: 36925835 PMCID: PMC10012808 DOI: 10.3389/frhs.2022.995392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/28/2022] [Indexed: 02/05/2023]
Abstract
Background Team-based Early Psychosis Intervention (EPI) services is standard of care for youth with psychosis. The COVID-19 pandemic required most EPI services to mount an unplanned, rapid pivot to virtual delivery, with limited guidance on how to deliver virtual clinical services or whether quality of re-implementation and treatment outcomes would be impacted. We used a structured approach to identify essential modifications for the delivery of core components and explored facilitators and barriers for re-implementation and fidelity of a virtually delivered EPI intervention. Materials and methods NAVIGATE is a structured approach to team-based EPI. It provides detailed modules to guide delivery of core components including medication management, psychoeducation and psychotherapies, supported employment/education, and family education. Having initially implemented NAVIGATE at the Centre for Addiction and Mental Health (CAMH) in 2017, the EPI service transitioned to virtual delivery amid the COVID pandemic. Using a practice profile developed to support implementation, we detailed how core components of NAVIGATE were rapidly modified for virtual delivery as reported in structured group meetings with clinicians. The Framework for Reporting Adaptations and Modifications for Evidence-Based Interventions (FRAME) was used to describe modifications. Fidelity to the EPI standards of care was assessed by the First Episode Psychosis Fidelity Scale (FEPS-FS). Re-implementation barriers and facilitators and subsequent mitigation strategies were explored using structured clinician interviews guided by the Consolidated Framework for Implementation Research (CFIR). Results Identified modifications related to the intervention process, context, and training. We identified contextual factors affecting the re-implementation of virtually delivered NAVIGATE and then documented mitigating strategies that addressed these barriers. Findings can inform the implementation of virtual EPI services elsewhere, including guidance on processes, training and technology, and approaches to providing care virtually. Discussion This study identified modifications, impacts and mitigations to barriers emerging from rapid, unplanned virtual delivery of EPI services. These findings can support delivery of high-quality virtual services to youth with psychosis when virtual care is indicated.
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Affiliation(s)
- Wanda Tempelaar
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nicole Kozloff
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Allison Crawford
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Aristotle Voineskos
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Don Addington
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | | | - Crystal Baluyut
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sarah Bromley
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sandy Brooks
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Lauren de Freitas
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Seharish Jindani
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Anne Kirvan
- Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Andrea Morizio
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexia Polillo
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rachel Roby
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexandra Sosnowski
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Janet Durbin
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Melanie Barwick
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
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Valentine JA, Delgado LF, Haderxhanaj LT, Hogben M. Improving Sexual Health in U.S. Rural Communities: Reducing the Impact of Stigma. AIDS Behav 2022; 26:90-99. [PMID: 34436713 PMCID: PMC8390058 DOI: 10.1007/s10461-021-03416-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 11/27/2022]
Abstract
Sexually transmitted infections (STI), including HIV, are among the most reported diseases in the U.S. and represent some of America's most significant health disparities. The growing scarcity of health care services in rural settings limits STI prevention and treatment for rural Americans. Local health departments are the primary source for STI care in rural communities; however, these providers experience two main challenges, also known as a double disparity: (1) inadequate capacity and (2) poor health in rural populations. Moreover, in rural communities the interaction of rural status and key determinants of health increase STI disparities. These key determinants can include structural, behavioral, and interpersonal factors, one of which is stigma. Engaging the expertise and involvement of affected community members in decisions regarding the needs, barriers, and opportunities for better sexual health is an asset and offers a gateway to sustainable, successful, and non-stigmatizing STI prevention programs.
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Affiliation(s)
- Jo A Valentine
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA.
| | - Lyana F Delgado
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA
| | - Laura T Haderxhanaj
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA
| | - Matthew Hogben
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA
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Ingman BC, Loecke C, Belansky ES. A Partnership Among Local Public Health Agencies, Elementary Schools, and a University to Address Childhood Obesity: A Scalable Model of the Assess, Identify, Make It Happen Process. FRONTIERS IN HEALTH SERVICES 2022; 2:816536. [PMID: 36925837 PMCID: PMC10012628 DOI: 10.3389/frhs.2022.816536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/27/2022] [Indexed: 11/13/2022]
Abstract
Background One pathway to addressing childhood obesity is through implementing evidence-based practices (EBPs) shown to promote nutrition and physical activity in K-12 school settings. Assess, Identify, Make it happen (AIM) is a strategic planning process to engage stakeholders in implementing EBPs in their K-12 schools. Local Public Health Agencies (LPHAs) are a potential partner to facilitate this process to a broader audience of rural school communities. Methods A process and outcome evaluation design was applied in this study to examine the extent to which LPHAs effectively implemented AIM with rural/frontier schools in comparison to university staff. Data collection included post-meeting surveys completed by facilitators, a post-intervention interview with facilitators, a survey of school task force members at the end of the AIM process, and systematic documentation of the intervention. Results Reach -Among the 26 eligible elementary schools, 18 (69%) agreed to participate. Effect -In total, schools facilitated by LPHAs fully implemented an average of 4.0 changes per school, while schools facilitated by the university staff fully implemented an average of 3.7 changes. Adoption -Among the five LPHAs in the target region, all five agreed to partner on the initiative, but some agencies were unable to identify sufficient personnel to facilitate all schools in their catchment area. Implementation -(1) In total, 89 of 94 (95%) meetings scheduled by LPHA facilitators occurred. 47 of 48 (98%) meetings scheduled by the university staff occurred. (2) The university staff self-reported 93% of agenda items in the AIM process as "completely" followed while LPHA facilitators reported 41% of agenda items as "completely" followed. (3) Task force satisfaction with the AIM process and facilitator showed limited variance across LPHAs and university-facilitated schools. Maintenance -Of the 16 school districts that agreed to participate in the school-based version of AIM, 9 (56%) also participated in a district-wide version of AIM 2 years later. Conclusion AIM is an effective process for implementing EBPs in elementary schools when facilitated by LPHAs. Effective partnerships, a nuanced approach to fidelity, scalability considerations, and the role of technical assistance and training all contributed to the successful implementation of this LPHA-Elementary school partnership.
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Affiliation(s)
- Benjamin C Ingman
- Center for Rural School Health and Education, Morgridge College of Education, University of Denver, Denver, CO, United States
| | - Carla Loecke
- Center for Rural School Health and Education, Morgridge College of Education, University of Denver, Denver, CO, United States
| | - Elaine S Belansky
- Center for Rural School Health and Education, Morgridge College of Education, University of Denver, Denver, CO, United States
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West RL, Margo J, Brown J, Dowley A, Haas S. Convergence of Service Providers and Managers' Perspectives on Strengths, Gaps, and Priorities for Rural Health System Redesign: A Whole-Systems Qualitative Study in Washington County, Maine. J Prim Care Community Health 2022; 13:21501319221102041. [PMID: 35603501 PMCID: PMC9130803 DOI: 10.1177/21501319221102041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction: Both rural residents and state government leaders describe a need to redesign
rural health care systems. Community members should be at the center of this
effort. Methods: We conducted 46 in-depth interviews of direct service providers between
September and November 2020 in Washington County, Maine. Data were analyzed
using a thematic analysis approach. Results: Existing strengths included collaboration between government and health
systems, and community-based services. Gaps included insufficient workforce,
restricted scope of licensing and poor reimbursement, lack of coordination
between health systems, and limited paramedicine capacity. Strategies for
health system redesign included addressing maldistribution of services and
resource optimization, changing federal and state legislation around
insurance and scope of practice, and moving toward value-based purchasing
models. Conclusions: Participants provided pragmatic recommendations based on their deep
understanding of the community context. Lessons learned are likely to be
salient in areas with similar profiles regarding rurality and poverty.
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Affiliation(s)
- Rebecca L West
- Ariadne Labs, Boston, MA, USA.,Boston University School of Public Health, Boston, MA, USA
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Collett D, Temple KM, Wells RD. The Challenges of Providing Preventive Health Care in Rural America. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tempelaar W, Barwick M, Crawford A, Voineskos A, Addington D, Addington J, Alexander T, Baluyut C, Bromley S, Durbin J, Foussias G, Ford C, de Freitas L, Jindani S, Kirvan A, Kurdyak P, Pauly K, Polillo A, Roby R, Sockalingam S, Sosnowski A, Villanueva V, Wang W, Kozloff N. Adapting Evidence-Based Early Psychosis Intervention Services for Virtual Delivery: Protocol for a Pragmatic Mixed Methods Implementation and Evaluation Study. JMIR Res Protoc 2021; 10:e34591. [PMID: 34806990 PMCID: PMC8653974 DOI: 10.2196/34591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Timely and comprehensive treatment in the form of early psychosis intervention (EPI) has become the standard of care for youth with psychosis. While EPI services were designed to be delivered in person, the COVID-19 pandemic required many EPI programs to rapidly transition to virtual delivery, with little evidence to guide intervention adaptations or to support the effectiveness and satisfaction with virtual EPI services. OBJECTIVE This study aims to explore the adaptations required to deliver NAVIGATE, a model of coordinated specialty care used in EPI, in a virtual format. This study will evaluate implementation of the NAVIGATE model delivered virtually by describing the nature of the adaptations to the intervention, assessing fidelity to the EPI model and the satisfaction of clients, family members, and care providers. We will investigate barriers and facilitators to virtual NAVIGATE implementation, service engagement, and health equity impacts of this work. METHODS The Centre for Addiction and Mental Health (Toronto, Ontario, Canada) transitioned to delivering NAVIGATE virtually early in the COVID-19 pandemic. The Framework for Reporting Adaptations and Modifications for Evidence-Based Interventions will be used to describe the adaptations required to deliver NAVIGATE virtually. Fidelity to the EPI model will be measured using the First Episode Psychosis Services Fidelity Scale and fidelity to NAVIGATE will be assessed by investigating adherence to its core components. Implementation facilitators and barriers will be explored using semistructured interviews with providers informed by the Consolidated Framework for Implementation Research. Satisfaction with virtually delivered NAVIGATE will be assessed with virtual client and provider experience surveys and qualitative interviews with clients, family members, and providers. Service engagement data will be collected through review of medical records, and potential impacts of virtually delivered NAVIGATE on different population groups will be assessed with the Health Equity Impact Assessment. RESULTS Virtual clinical delivery of NAVIGATE started in March 2020 with additional adaptations and data collection is ongoing. Data will be analyzed using descriptive statistics and survival analysis for quantitative data. Qualitative data will be analyzed using thematic content analysis. Integration of qualitative and quantitative data will occur at the data collection, interpretation, and reporting levels following a convergent design. CONCLUSIONS This study will provide information regarding the type of intervention adaptations required for virtual delivery of NAVIGATE for youth with early psychosis, ensuring access to high-quality care for this population during the pandemic and beyond by guiding future implementation in similar contexts. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/34591.
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Affiliation(s)
- Wanda Tempelaar
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Melanie Barwick
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Allison Crawford
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Aristotle Voineskos
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Donald Addington
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jean Addington
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Crystal Baluyut
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Bromley
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Janet Durbin
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - George Foussias
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Catherine Ford
- Mental Health Addiction, Ontario Ministry of Health, Toronto, ON, Canada
| | - Lauren de Freitas
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Seharish Jindani
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Anne Kirvan
- Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Paul Kurdyak
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
| | - Kirstin Pauly
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexia Polillo
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rachel Roby
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sanjeev Sockalingam
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexandra Sosnowski
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- College of Public Health, University of South Florida, Tampa, FL, United States
| | - Nicole Kozloff
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Kiang MV, Barnett ML, Wakeman SE, Humphreys K, Tsai AC. Robustness of estimated access to opioid use disorder treatment providers in rural vs. urban areas of the United States. Drug Alcohol Depend 2021; 228:109081. [PMID: 34600256 PMCID: PMC8595811 DOI: 10.1016/j.drugalcdep.2021.109081] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/21/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Effective, evidence-based treatments for opioid use disorder are not equally accessible to Americans. Recent studies have found urban/rural disparities in the driving times to the nearest opioid treatment providers. These disparities may be even worse than currently reported in the literature because patients may not be able to obtain appointments with their nearest provider. We examine the robustness of the opioid treatment infrastructure by estimating how driving times to treatment change as provider availability decreases. METHODS We used public data from the federal government to estimate the driving time from each census tract centroid to the nearest 15 treatment providers. We summarized the median and interquartile range of driving times to increasingly distant providers (i.e., nearest, second nearest, etc.), stratified by urban/rural classification. RESULTS The median driving time to the nearest provider was greater in rural areas than urban areas for both opioid treatment programs (12 min vs 61 min) and buprenorphine-waivered prescribers (5 min vs 21 min). Importantly, driving times in rural areas increased more steeply as nearer providers became unavailable. For example, the increase in driving time between the nearest provider and the fifth nearest provider was much greater in rural areas than in urban areas for both buprenorphine-waivered prescribers (23 min vs 4 min) and for opioid treatment programs (54 min vs 22 min). CONCLUSIONS Access to treatment for opioid use disorder is more robust in urban areas compared with rural areas. This disparity must be eliminated if the opioid overdose crisis is to be resolved.
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Affiliation(s)
- Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA,Correspondence: Mathew V. Kiang, ScD, Stanford University School of Medicine, Center for Population Health Sciences, 1701 Page Mill Road, Palo Alto, California 94304,
| | - Michael L. Barnett
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah E. Wakeman
- Harvard Medical School, Boston, Massachusetts, USA,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA,Veterans Affairs Health Care System, Palo Alto, California, USA
| | - Alexander C. Tsai
- Harvard Medical School, Boston, Massachusetts, USA,Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts USA
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Higgins ST. Behavior change, health, and health disparities 2021: Rural addiction and health. Prev Med 2021; 152:106834. [PMID: 34626647 PMCID: PMC9258004 DOI: 10.1016/j.ypmed.2021.106834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
This Special Issue of Preventive Medicine (PM) is the 8th in a series on behavior change, health, and health disparities. This is a topic of critical importance to improving U.S. population health. There is broad consensus that personal behavior patterns or lifestyle such as substance abuse, poor food choices, physical inactivity, and non-adherence with medical regimens are among the most important modifiable causes of chronic disease and premature death and contributors to recent decreases in U.S. longevity. While no U.S region is free of these problems, they disproportionately impact rural communities. As in prior Special Issues in this series, we devote considerable space to the ongoing U.S. opioid epidemic while also examining selected issues in rural health disparities involving tobacco use, cancer, and cardiovascular disease. Across each of these topics we have recruited contributions from accomplished investigators, clinicians, and policymakers to acquaint readers with recent advances while also noting knowledge gaps and unresolved challenges.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, Departments of Psychiatry and Psychological Science, University of Vermont, USA.
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Abildso CG, Perry CK, Jacobs L, Umstattd Meyer MR, McClendon M, Edwards MB, Roemmich JN, Ramsey Z, Stout M. What Sets Physically Active Rural Communities Apart from Less Active Ones? A Comparative Case Study of Three US Counties. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10574. [PMID: 34682319 PMCID: PMC8535724 DOI: 10.3390/ijerph182010574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rural US communities experience health disparities, including a lower prevalence of physical activity (PA). However, "Positive Deviants"-rural communities with greater PA than their peers-exist. The purpose of this study was to identify the factors that help create physically active rural US communities. METHODS Stakeholder interviews, on-site intercept interviews, and in-person observations were used to form a comparative case study of two rural counties with high PA prevalence (HPAs) and one with low PA prevalence (LPA) from a southern US state, selected based on rurality and adult PA prevalence. Interview transcripts were inductively coded by three readers, resulting in a thematic structure that aligned with a Community Capital Framework, which was then used for deductive coding and analysis. RESULTS Fifteen stakeholder interviews, nine intercept interviews, and on-site observations were conducted. Human and Organizational Capital differed between the HPAs and LPA, manifesting as Social, Built, Financial, and Political Capital differences and a possible "spiraling-up" or cyclical effect through increasing PA and health (Human Capital), highlighting a potential causal model for future study. CONCLUSIONS Multi-organizational PA coalitions may hold promise for rural PA by directly influencing Human and Organizational Capital in the short term and the other forms of capital in the long term.
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Affiliation(s)
- Christiaan G. Abildso
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV 26506, USA;
| | - Cynthia K. Perry
- School of Nursing, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Lauren Jacobs
- School of Kinesiology and Physical Education, College of Education and Human Development, University of Maine, Orono, ME 04469, USA;
| | - M. Renée Umstattd Meyer
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA; (M.R.U.M.); (M.M.)
| | - Megan McClendon
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA; (M.R.U.M.); (M.M.)
| | - Michael B. Edwards
- Department of Parks, Recreation and Tourism Management, College of Natural Resources, North Carolina State University, Raleigh, NC 27695, USA;
| | - James N. Roemmich
- US Department of Agriculture, Agricultural Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, ND 58201, USA;
| | - Zachary Ramsey
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV 26506, USA;
| | - Margaret Stout
- Department of Public Administration, West Virginia University, Morgantown, WV 26506, USA;
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50
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Dunne EM, Maxwell T, Dawson-Skuza C, Burns M, Ball C, Turner K, Hahn CG, Bowyer M, Carter KK, Hudson L. Investigation and public health response to a COVID-19 outbreak in a rural resort community-Blaine County, Idaho, 2020. PLoS One 2021; 16:e0250322. [PMID: 33882112 PMCID: PMC8059800 DOI: 10.1371/journal.pone.0250322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/05/2021] [Indexed: 12/04/2022] Open
Abstract
Blaine County, Idaho, a rural area with a renowned resort, experienced a COVID-19 outbreak early in the pandemic. We undertook an epidemiologic investigation to describe the outbreak and guide public health action. Confirmed cases of COVID-19 were identified from reports of SARS-CoV-2-positive laboratory test results to South Central Public Health District. Information on symptoms, hospitalization, recent travel, healthcare worker status, and close contacts was obtained by medical record review and patient interviews. Viral sequence analysis was conducted on a subset of available specimens. During March 13-April 10, 2020, a total of 451 COVID-19 cases among Blaine County residents (1,959 cases per 100,000 population) were reported, with earliest illness onset March 1. The median patient age was 51 years (interquartile range [IQR]: 37-63), 52 (11.5%) were hospitalized, and 5 (1.1%) died. The median duration between specimen collection and a positive laboratory result was 9 days (IQR: 4-10). Forty-four (9.8%) patients reported recent travel and an additional 37 cases occurred in out-of-state residents. Healthcare workers comprised 56 (12.4%) cases; 33 of whom worked at the only hospital in the county, leading to a 15-day disruption of hospital services. Among 562 close contacts monitored by public health authorities, laboratory-confirmed COVID-19 or compatible symptoms were identified in 51 (9.1%). Sequencing results from 34 specimens supported epidemiologic findings indicating travel as a source of SARS-CoV-2, and identified multiple lineages among hospital workers. Community mitigation strategies included school and resort closure, stay-at-home orders, and restrictions on incoming travelers. COVID-19 outbreaks in rural communities can disrupt health services. Lack of local laboratory capacity led to long turnaround times for COVID-19 test results. Rural communities frequented by tourists face unique challenges during the COVID-19 pandemic. Implementing restrictions on incoming travelers and other mitigation strategies helped reduce COVID-19 transmission early in the pandemic.
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Affiliation(s)
- Eileen M Dunne
- Division of Public Health, Idaho Department of Health and Welfare, Boise, Idaho, United States of America
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tanis Maxwell
- South Central Public Health District, Twin Falls, Idaho, United States of America
| | | | - Matthew Burns
- Division of Public Health, Idaho Department of Health and Welfare, Boise, Idaho, United States of America
| | - Christopher Ball
- Division of Public Health, Idaho Department of Health and Welfare, Boise, Idaho, United States of America
| | - Kathryn Turner
- Division of Public Health, Idaho Department of Health and Welfare, Boise, Idaho, United States of America
| | - Christine G Hahn
- Division of Public Health, Idaho Department of Health and Welfare, Boise, Idaho, United States of America
| | - Melody Bowyer
- South Central Public Health District, Twin Falls, Idaho, United States of America
| | - Kris K Carter
- Division of Public Health, Idaho Department of Health and Welfare, Boise, Idaho, United States of America
- Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Logan Hudson
- South Central Public Health District, Twin Falls, Idaho, United States of America
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