Abstract
The 2016 US presidential election brought national visibility to prominent economic issues affecting rural America, yet little has been done to examine serious health or economic problems in rural communities from the perspectives of rural US adults themselves. To examine views on the most serious health and economic concerns and potential solutions in rural communities. This survey study used 2 cross-sectional probability-based telephone (cellular and landline) surveys of adults living in the rural United States. The first survey was conducted June 6 to August 4, 2018, and the second survey was conducted January 31 to March 2, 2019. All results were weighted to be nationally representative of rural US adults. Data analysis was conducted in April 2019. The primary study outcomes were the prevalence of rural adults reporting their biggest community problems, problems with health care access and costs, ratings of the local economy, views on opioid addiction, and views on solving major community issues. The 2018 survey included 1300 respondents (response rate, 12%; completion rate, 70%), and the 2019 survey included 1405 respondents (response rate, 8%; completion rate, 76%). Rural adults primarily identified as non-Hispanic white (78%), and more than half of respondents were 50 years or older (survey 1: 55%, survey 2: 53%). Rural adults identified opioid or other drug addiction or abuse (25%; 95% CI, 22%-28%) and economic concerns (21%; 95% CI, 19%-24%) as the most serious problems facing their local communities. Opioid or other drug addiction or abuse was reported as a serious problem in their local community by 57% (95% CI, 53%-60%) of rural adults, while 49% (95% CI, 46%-53%) of rural adults said they personally know someone who has had opioid addiction. Problems paying medical bills were reported by 32% (95% CI, 29%-36%) of rural adults, and recent issues with accessing health care were reported by 26% (95% CI, 23%-30%) of rural adults. Regarding financial and economic issues, 55% (95% CI, 52%-59%) of rural adults rated their local economy as only fair or poor, and 49% (95% CI, 44%-54%) of rural adults said they would have difficulty paying off an unexpected $1000 expense. On solving major community problems, 58% (95% CI, 54%-62%) of rural adults saw a need for outside help to solve major community problems, and among those who reported needing outside help, 61% (95% CI, 57%-66%) identified a major role for government. These findings suggest that in today's economically stretched rural United States, opioid or other drug addiction or abuse has emerged as an equal problem with economic concerns. One in 3 rural adults still have problems paying their medical bills even after the passage and implementation of the Patient Protection and Affordable Care Act. Although rural communities have traditionally been self-reliant, more than half of rural adults are open to outside help to solve serious problems facing their communities, including major help from government.
Highlights
The 2016 US presidential election brought national visibility to prominent economic issues affecting rural communities, including persistent poverty, limited job growth, and a slow economic recovery from the Great Recession of 2007 to 2009.1-3 economic issues and national security have historically been identified by the public as the most serious problems facing the nation,[4] US adults often have different views about serious problems facing their local communities
Rural adults identified opioid or other drug addiction or abuse (25%; 95% CI, 22%-28%) and economic concerns (21%; 95% CI, 19%-24%) as the most serious problems facing their local communities
Opioid or other drug addiction or abuse was reported as a serious problem in their local community by 57% of rural adults, while 49% of rural adults said they personally know someone who has had opioid addiction
Summary
The 2016 US presidential election brought national visibility to prominent economic issues affecting rural communities, including persistent poverty, limited job growth, and a slow economic recovery from the Great Recession of 2007 to 2009.1-3 economic issues and national security have historically been identified by the public as the most serious problems facing the nation,[4] US adults often have different views about serious problems facing their local communities. In 2016, more than 1.5 million people living in rural areas misused opioids, including prescription pain relievers and heroin, and nearly 5000 people in rural areas died of opioid overdose—the largest annual opioid-related death toll in US history.[5] Rates of drug overdose deaths in rural areas (17.0 deaths per 100 000 people) have surpassed those in urban areas (16.2 deaths per 100 000 people),[6] President Donald Trump has identified the opioid abuse epidemic as a public health emergency, and the Department of Health and Human Services recently awarded more than $1 billion in grants to combat the opioid crisis.[7] In this survey study, we conducted 2 original polls in 2018 and 2019. Our objective was to examine the views of rural US adults on serious health and economic problems facing their communities
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