Adults In Counties Research Articles

County-Level Cardiac Rehabilitation and Broadband Availability: Opportunities for Hybrid Care in the United States.

Cardiac rehabilitation (CR) improves patient outcomes and quality of life and can be provided virtually through hybrid CR. However, little is known about CR availability in conjunction with broadband access, a requirement for hybrid CR. This study examined the intersection of CR and broadband availability at the county level, nationwide. Data were gathered and analyzed in 2022 from the 2019 American Community Survey, the Centers for Medicare & Medicaid Services, and the Federal Communications Commission. Spatially adaptive floating catchments were used to calculate county-level percent CR availability among Medicare fee-for-service beneficiaries. Counties were categorized: by CR availability, whether lowest (ie, CR deserts), medium, or highest; and by broadband availability, whether CR deserts with majority-available broadband, or dual deserts. Results were stratified by state. County-level characteristics were examined for statistical significance by CR availability category. Almost half of US adults (n = 116 325 976, 47.2%) lived in CR desert counties (1691 counties). Among adults in CR desert counties, 96.8% were in CR deserts with majority-available broadband (112 626 906). By state, the percentage of the adult population living in CR desert counties ranged from 3.2% (New Hampshire) to 100% (Hawaii and Washington, DC). Statistically significant differences in county CR availability existed by race/ethnicity, education, and income. Almost half of US adults live in CR deserts. Given that up to 97% of adults living in CR deserts may have broadband access, implementation of hybrid CR programs that include a telehealth component could expand CR availability to as many as 113 million US adults.

Migration of young adults in micropolitan counties

ABSTRACT Nonmetropolitan U.S. counties have historically lagged metropolitan areas in population and employment growth. Population projections indicate that they will face a shrinking workforce in the future, although, immigration and domestic migration by young adults could help offset this trend. The number of young adults (ages 25 to 44) is projected to increase in the next several decades and thus will be a growing proportion of the workforce. However, whether they will be attracted to rural areas such as micropolitan counties and how these counties can attract them has not received much attention in the community development literature. This article uses OLS regression to examine the determinants of the net migration rate for the 25–44 age group in micropolitan counties between 2000 and 2010, adjusting for geographic, economic, and county-level demographic factors.. The discussion then examines approaches that micropolitan areas can use to attract this age cohort.

Geographical characteristics and influencing factors of the health level of older adults in the Yangtze River Economic Belt, China, from 2010 to 2020.

The health of older adults is crucial for the overall health of the entire life cycle. Based on population sampling survey data and census data from 131 prefecture level units in the Yangtze River Economic Belt (YREB) during 2010-2020, this study used exploratory spatial data analysis, geographical detector, stepwise regression analysis, and GTWR model to analyze the spatiotemporal pattern and influencing factors of the health level of older adults in the YREB. The results show that the health level of older adults in the YREB slightly increased from 2010 to 2020, with the most significant improvement in the upstream region and the most significant decline in the midstream region. The older adults' health level in the YREB displays a gradient decreasing pattern of the downstream, midstream, and upstream regions. The health level of older adults in the YREB is influenced by a combination of natural and social environment factors. Areas with lower altitude and moderate humidity climates are more conducive to the health of older adults. The increase in influencing factors such as population migration rate, per capita GDP, average years of education, per capita housing construction area, per capita park green area, and green coverage rate in built-up areas is conducive to improving the health level of older adults, while lower number of health institutions per 1,000 people and higher household support rate are not conducive to improving the health level of older adults. In addition, over time, the health-promoting effect of natural environmental factors is enhanced from 2010 to 2020, and the influence of annual precipitation on shaping the spatial pattern of older adults' health level became more obvious. Although the promoting effect of population migration on the health level of older adults tends to weaken, it remains the primary factor affecting the spatiotemporal differentiation of older adults' health level in the YREB. The impact of social development on the health level of older adults has changed from a positive health effect (improvement) to a negative health effect (loss). The health-promoting effect of living environment factors is enhanced. The health-inhibitory effect of household support rate increased, and showed a gradient decreasing pattern from downstream to midstream to upstream. The findings of this study can provide a more in-depth understanding of the spatiotemporal pattern of the health level of older adults in the YREB and the factors influencing it, improve the health level of older adults in the region, and promote the development of healthy and active aging in the YREB, and improve the human health. At the same time, this study also supplements the related research on aging and the health level of the elderly. Firstly, it can provide reference for the research on the health of old adults in other countries and regions around the world. Secondly, it can also provide a basis for research on aging and the health of old adults in cities and counties under YREB.

Prevalence of Meeting Aerobic, Muscle-Strengthening, and Combined Physical Activity Guidelines During Leisure Time Among Adults, by Rural-Urban Classification and Region — United States, 2020

The healthful effects of physical activity on a multitude of physical and mental health outcomes are well documented (1). Despite promising increases in the percentage of U.S. adults meeting aerobic and muscle-strengthening physical activity guidelines (guidelines)* (1) during leisure time in nearly all demographic and regional subgroups 1998-2018 (2,3), differences by rurality and U.S. Census Bureau region (Northeast, Midwest, South, and West), persist (4). Before 2020, analyses of rural-urban differences were dichotomized into nonmetropolitan (rural) versus metropolitan (urban) areas; however, in 2020 a four-category rural-urban variable† to classify rural-urban status was included in the National Health Interview Survey (NHIS) public-use dataset. NHIS 2020 data were used to conduct multivariate logistic regression analyses by rural-urban status and U.S. Census Bureau region of the prevalence of meeting the aerobic, muscle-strengthening, and combined aerobic and muscle-strengthening guidelines during leisure time among adults aged ≥18 years, controlling for demographic characteristics. Prevalence of meeting the aerobic, muscle-strengthening, and combined aerobic and muscle-strengthening guidelines was consistently the lowest in Nonmetropolitan counties (38.2%, 21.1%, and 16.1%, respectively) and highest in the West region (52.1%, 35.3%, and 28.5%, respectively). Regardless of rural-urban classification and region, no more than 28% of adults met combined aerobic and muscle-strengthening guidelines. Adults in the most rural category were significantly less likely to meet aerobic, muscle-strengthening, and combined guidelines than were adults in each of the three other categories (adjusted odds ratio [aOR] range = 0.68-0.89). In addition, adults in medium and small metropolitan counties were less likely to meet guidelines than were adults in the two most urban categories (aOR range = 0.85-0.89). Adults in the Northeast, Midwest, and South U.S. Census Bureau regions were less likely to meet guidelines than were adults in the West region (aOR range = 0.75-0.82). These analyses identify geographic disparities in leisure-time physical activity where focused population-level intervention efforts could help reduce or eliminate the consequent disparities in chronic conditions (e.g., cardiovascular diseases) and the resulting mortality (5,6).

Age‐race‐ethnicity segregation in the United States: Where do minority older adults stand?

AbstractA recent study shows that among the three age groups of youth, adult and older adult, youth‐older adult has the highest age segregation while youth‐adult has the lowest. Similar to many previous age segregation studies, racial‐ethnic differences, an important population axis in segregation studies, were not considered. Prior studies are also limited to using two‐group measures, failing to compare multiple groups together. We explore the complexity in measuring intersectional segregation focusing on the two axes of age and race‐ethnicity and propose a conditional approach to measure age segregation by racial‐ethnic groups, and racial‐ethnic segregation by age groups. Using this approach, we empirically study the 2010 age‐race‐ethnic segregation at the county and state levels in the United States, using census tracts as the basic units. Both the two and multigroup dissimilarity indices were used. Results show that the racial‐ethnic axis had been a stronger force in segregation than the age axis. Results also show disparities of racial‐ethnic segregation across age groups with the highest levels present among older adults and in urban counties. For all three age groups, segregation levels involving Natives and Asians tend to be higher than those without them. In contrast, age segregation was the highest between youths and older adults, and the levels varied across racial‐ethnic groups with Natives at the highest levels. Although age segregation was significantly different between urban and rural counties, higher segregation in urban areas were mostly involving Whites as opposed to higher segregation in rural counties involving minority racial groups. Studying age segregation should not be colour blinded, as nonwhite older adults in rural counties were more likely to experience higher levels of age segregation than other groups.

Ageing in place - exploring the safety of the environment of Slovenian older adults.

The importance of subjective and objective living environment was investigated. A new questionnaire was developed, validated and distributed to community-dwelling adults in various Slovenian counties. Data were analysed using descriptive statistics and t-tests in SPSS Statistics 24. Older adults (N = 358), 33% men and 67% women, mean age 74.3 years, participated in the cross-sectional study. Statistically significant differences (at 5% significance level) in subjective opinions of older adults regarding views on appropriate design of the living environment between the group with and without risk factors exist only for the statement that a thermostat to regulate room temperature should be placed in a visible and accessible location (p = 0.014). The living environment has some risk factors, but they are not statistically significant between groups. The results may prompt occupational therapists to develop innovative strategies to facilitate occupational participation of users, increase participation in preventive services and obtain policy support.

Assessment of Disparities in Diabetes Mortality in Adults in US Rural vs Nonrural Counties, 1999-2018

US rural vs nonrural populations have striking disparities in diabetes care. Whether rurality contributes to disparities in diabetes mortality is unknown. To examine rates and trends in diabetes mortality based on county urbanization. In this observational, cross-sectional study, the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was searched from January 1, 1999, to December 31, 2018, for diabetes as a multiple cause and the underlying cause of death among residents aged 25 years or older in US counties. County urbanization was categorized as metro, medium-small, and rural. Weighted multiple linear regression models and jackknife resampling, with a 3-segment time component, were used. The models included exposures with up to 3-way interactions and were age standardized to the 2009-2010 population. The analyses were conducted from July 1, 2020, to February 1, 2022. County urbanization (metro, medium-small, or rural), gender (men or women), age group (25-54, 55-74, or ≥75 years), and region (Midwest, Northeast, South, or West). Annual diabetes mortality rate per 100 000 people. From 1999-2018, based on 4 022 238 309 person-years, diabetes was a multiple cause of death for 4 735 849 adults aged 25 years or older. As a multiple cause, diabetes mortality rates in 2017-2018 vs 1999-2000 were highest and unchanged in rural counties (157.2 [95% CI, 150.7-163.7] vs 154.1 [95% CI, 148.2-160.1]; P = .49) but lower in medium-small counties (123.6 [95% CI, 119.6-127.6] vs 133.6 [95% CI, 128.4-138.8]; P = .003) and urban counties (92.9 [95% CI, 90.5-95.3] vs 109.7 [95% CI, 105.2-114.1]; P < .001). In 2017-2018 vs 1999-2000, mortality rates were higher in rural men (+18.2; 95% CI, 14.3-22.1) but lower in rural women (-14.0; 95% CI, -17.7 to -10.3) (P < .001 for both). In the 25- to 54-year age group, mortality rates in 2017-2018 vs 1999-2000 showed a greater increase in rural counties (+9.4; 95% CI, 8.6-10.2) compared with medium-small counties (+4.5; 95% CI, 4.0-5.0) and metro counties (+0.9; 95% CI, 0.4-1.4) (P < .001 for all). Of all regions and urbanization levels, the mortality rate in 2017-2018 vs 1999-2000 was higher only in the rural South (+13.8; 95% CI, 7.6-20.0; P < .001). In this cross-sectional study, US rural counties had the highest overall diabetes mortality rate. The determinants of persistent rural disparities, in particular for rural men and for adults in the rural South, require investigation.

Rural-urban and within-rural differences in COVID-19 vaccination rates.

PurposeCOVID‐19 mortality rates are higher in rural versus urban areas in the United States, threatening to exacerbate the existing rural mortality penalty. To save lives and facilitate economic recovery, we must achieve widespread vaccination coverage. This study compared adult COVID‐19 vaccination rates across the US rural‐urban continuum and across different types of rural counties.MethodsWe retrieved vaccination rates as of August 11, 2021, for adults aged 18+ for the 2,869 counties for which data were available from the CDC. We merged these with county‐level data on demographic and socioeconomic composition, health care infrastructure, 2020 Trump vote share, and USDA labor market type. We then used regression models to examine predictors of COVID‐19 vaccination rates across the USDA's 9‐category rural‐urban continuum codes and separately within rural counties by labor market type.FindingsAs of August 11, 45.8% of adults in rural counties had been fully vaccinated, compared to 59.8% in urban counties. In unadjusted regression models, average rates declined monotonically with increasing rurality. Lower rural rates are explained by a combination of lower educational attainment and higher Trump vote share. Within rural counties, rates are lowest in farming and mining‐dependent counties and highest in recreation‐dependent counties, with differences explained by a combination of educational attainment, health care infrastructure, and Trump vote share.ConclusionLower vaccination rates in rural areas is concerning given higher rural COVID‐19 mortality rates and recent surges in cases. At this point, mandates may be the most effective strategy for increasing vaccination rates.

Stroke-Related Mortality in the United States-Mexico Border Area of the United States, 1999 to 2018.

BACKGROUNDThe United States (US)‐Mexico border is a socioeconomically underserved area. We sought to investigate whether stroke‐related mortality varies between the US border and nonborder counties.METHODS AND RESULTSWe used death certificates from the Centers for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research database to examine stroke‐related mortality in border versus nonborder counties in California, Texas, New Mexico, and Arizona. We measured average annual percent changes (AAPCs) in age‐adjusted mortality rates (AAMRs) per 100 000 between 1999 and 2018. Overall, AAMRs were higher for nonborder counties, older adults, men, and non‐Hispanic Black adults than their counterparts. Between 1999 and 2018, AAMRs reduced from 55.8 per 100 000 to 34.4 per 100 000 in the border counties (AAPC, −2.70) and 64.5 per 100 000 to 37.6 per 100 000 in nonborder counties (AAPC, −2.92). The annual percent change in AAMR initially decreased, followed by stagnation in both border and nonborder counties since 2012. The AAPC in AAMR decreased in all 4 states; however, AAMR increased in California’s border counties since 2012 (annual percent change, 3.9). The annual percent change in AAMR decreased for older adults between 1999 and 2012 for the border (−5.10) and nonborder counties (−5.01), followed by a rise in border counties and stalling in nonborder counties. Although the AAPC in AAMR decreased for both sexes, the AAPC in AAMR differed significantly for non‐Hispanic White adults in border (−2.69) and nonborder counties (−2.86). The mortality decreased consistently for all other ethnicities/races in both border and nonborder counties.CONCLUSIONSStroke‐related mortality varied between the border and nonborder counties. Given the substantial public health implications, targeted interventions aimed at vulnerable populations are required to improve stroke‐related outcomes in the US‐Mexico border area.

Knowledge, attitudes and practices (KAP) regarding Lassa fever disease among adults in endemic and non-endemic Counties of Liberia, 2018: A Cross-sectional study

Background: Lassa fever (LF) causes significant morbidity and mortality worldwide with estimated 3-5 million individuals being infected yearly. In West Africa, the disease is endemic in Nigeria, Sierra Leone, Guinea and Liberia. Liberia recorded its first outbreak in 1972. We determined knowledge, attitudes, and practices (KAP) toward LF disease, to identify practices related to LF transmission, determine differences in KAP and to identify factors associated with LF among adult populations in endemic and non-endemic counties of Liberia. Methods: We conducted a cross-sectional study among 858 respondents in all 15 counties in Liberia. A combination of probability sampling techniques were used to obtain the desired sample size. We used electronic semi-structured questionnaires for data collection. We summarized data using counts, proportions, 95%CI and Chi-square. Results: Of the 858 respondents from all 15 counties in Liberia, only 24(3%) had good knowledge generally about LF management (<i>P-value=0.02</i>), 250(29%) had a positive attitude towards LF (<i>P-value=0.6</i>), and 217(25%) carried out good LF-related practices (<i>P-value=0.1</i>). A higher level of education was associated with good knowledge and positive attitudes in endemic and non-endemic counties. (<i>P-value=0.01</i>). Conclusions: KAP of LF was low in both endemic and non-endemic counties. There was no difference seen in attitudes and practices among endemic and non-endemic counties. We recommended that Ministry of Health and National Public Health Institute of Liberia increase awareness of LF in Liberia and work with the Ministry of Education to introduce modules on LF in all schools.

Local variation in cannabis use patterns among young adults in the San Francisco Bay Area

This study evaluated whether neighborhood-level disorder, social cohesion, and perceived safety, were associated with days of cannabis use in the prior month in a representative sample of young adults in Alameda and San Francisco Counties in California (N = 1272). We used multiscale geographically weighted regression, modeled by county, to measure associations between cannabis use days and neighborhood attributes, adjusting for sociodemographic characteristics and self-rated health. Positive associations were found between number of cannabis use days and neighborhood disorder, and greater perceived safety. Higher levels of social cohesion predicted fewer cannabis use days. Racial/ethnic, sex and, socioeconomic compositions of participants residing in areas with significant neighborhood-level associations varied substantially, suggesting that risk factors for young adult cannabis use may be highly localized. Public health efforts in cannabis education and intervention should be tailored to fit the culture and composition of local neighborhoods.

Abstract MP54: Increase in the Urban-Rural Divide in Cerebrovascular Mortality Among Middle-Aged Adults From 2013 to 2018

Introduction: Despite observed overall decline cerebrovascular mortality in the United States over the past 2 decades, geographic pockets of increasing cerebrovascular mortality among middle aged adults have been reported on county-level data; and factors driving this regional increase are poorly understood. Methods: We extracted cerebrovascular mortality rates (ICD tenth revision codes I60-I69) in middle aged adults (age 35-64) from Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research database from 1999 to 2018. Variations in annual age-adjusted mortality rates, assessed with Joinpoint regression modeling, are expressed as estimated Annual Percentage Change [APC (95% confidence interval)], stratified by urbanization. In regions with increasing stroke mortality, race-ethnicity and gender subgroups were compared. Results: Mid-age cerebrovascular mortality decreased across urbanization strata between 1999 and 2012. Since 2013, stroke mortality has been increasing in Rural counties [APC +1.8% (+1.0% to +2.6%)] and stagnating in Small-to-Medium Metro counties [APC +0.7% (-0.1% to +1.5%)] and Large Metro counties [APC +0.1% (-0.8% to +0.9%)]. Focusing on rural counties, the profound rate difference between non-Hispanic African Americans and non-Hispanic whites decreased between 1999-2012 at Average APC -1.7% (-2.3% to -1.2%) and since then persisted [Average APC -0.2% (-2.1% to 1.8%)]. Both genders were affected. Conclusion: Since 2013, increase in cerebrovascular mortality in middle-aged adults in rural counties contributes to growing urban-rural divide; while the high stroke mortality rate in non-Hispanic African Americans have ceased to converge with non-Hispanic whites. Upstream drivers of stroke mortality in young and middle-aged rural residents and non-Hispanic African Americans should be further elucidated and vigorously targeted by public health initiatives.

Achieving Population Health Impacts Through Health Promotion Programs Offered by Community-based Organizations.

Evidence-based health promotion programs can help older adults manage chronic conditions and address behavioral risk factors, and translating these interventions to population-scale impact depends on reaching people outside of clinical settings. Area Agencies on Aging (AAAs) have emerged as important delivery sites for health promotion programs, but the impacts of their expanded role in delivering these interventions remain unknown. The objective of this study was to test whether evidence-based health promotion programs implemented by AAAs from 2008 to 2016 influenced health care use and spending by older adults and to examine how agencies' organizational capacity for implementation influenced these population-level impacts. We used panel regression models to examine how the expansion of health promotion programs offered by AAAs over the course of 2008-2016 was associated with a change in health care use and spending by older adults in counties served by the AAAs. We examined impact separately for high capacity and low capacity agencies. Across the full sample of AAAs, beginning to offer any health promotion program in the AAA was associated a with 0.94% percentage point reduction in potentially avoidable nursing home use in counties covered by the AAA (95% confidence interval=-1.58, -0.29), equivalent to a 6.5% change. Expanding the breadth of programs offered by the AAA was also associated with a significant reduction in potentially avoidable nursing home use. Stratified analysis showed that reductions in potentially avoidable nursing home use were evident only in places where the AAA had high implementation capacity. Expansion of health promotion programs offered by AAAs was not associated with the change in county-level hospital readmission rates, ambulatory care sensitive hospitalizations, or Medicare spending per beneficiary. AAAs are an example of community-based organizations that can contribute to health care policy goals such as cost containment. Organizational development support may be needed to extend their ability to effect change in more regions of the country.

Socially-isolated neighborhoods and the risk of all-cause mortality among nursing home residents in the United States: A multilevel study.

The total number of Americans age 65 and older is expected to nearly double by 2060, and the number of Americans admitted to nursing homes is likewise anticipated to escalate. Studies have found living alone to be an important risk factor for mortality. Yet little is known about possible spillover health effects of living in a community where many elderly residents live alone. Even less is known about whether these risks persist after entering nursing homes. Our study population consisted of 874,162 US elderly adults newly admitted to nursing homes in 2011, as identified from the 3.0 Minimum Data Set. Data on these individuals were linked to Medicare claims and 2010 Census data. In this cohort study, we estimated multivariable-adjusted hazard ratios for the associations between the quartiles of county-level percentage of households with those age 65 or older living alone and the individual-level risks of all-cause mortality until December 31, 2013, controlling for county-, nursing home facility-, and individual-level factors. Older adults in counties belonging to the highest quartile of elderly single-occupancy households had a 8% higher risk of dying (HR = 1.08; 95% CI = 1.04–1.12, p < 0.001) after entering nursing homes compared to those in counties belonging to the lowest quartile. There was evidence of a linear trend (p for trend < 0.001). Should these findings be confirmed in future studies, it would suggest that living arrangements in elderly communities may have spillover health effects onto their residents. Programs and interventions that modify such living arrangements may yield more favorable health trajectories among older Americans, who are increasingly aging in place and at growing risk of entering nursing homes.

Engaging the disengaged: Examining the domestication of mobile telephony among older adults in Trans-Nzoia and Bungoma Counties in Western Kenya

The world is growing older. Considering the increasing number of older adults, it is imperative to consider how technology design can meet the needs and wants of these important user groups. Mobile phones offer great potential in improving quality of life for older adults in areas of, healthcare, independent living, communication and reduced isolation. There have been numerous studies on technology design for older adults (Fisk, Rogers, Charness, Czaja, &amp; Sharit, 2004), but much of the work has focused on indoor and stationary applications such as desktop computers (Zajicek &amp; Brewster, 2004). Although older people need support beyond stationary situations inside and outside their homes (Goodman, Brewster, &amp; Gray, 2004), limited number of mobile functions are used by older adults due to high cost associated with mobile phones (Lee: 2007). Conversely, Nimrod (2015), argues older people use mobile phones extensively but little is known about relevant domestication processes involved and the extent to which older adults adopt and use mobile phones. This study interviewed 40 older retired civil servants aged 60 years and above in Western Kenya. Using domestication theory, this study examined the appropriation (Possession and ownership), Objectification (meaning and symbols), incorporation of mobile phones in older people’s everyday life and conversion (unintended uses) process of the domestication of mobile technology by the said group. Findings showed that mobile phones both enhanced closeness with their children and isolated them from them too. Majority felt mobile phones had become their ‘extended family members’ bringing the news of the world to them via mobile phone calls and texts. However, the small font size of texts and the fact that phones were getting smaller in size made it difficult to use. Their favourite mobile phone application was the mobile money locally dubbed Mpesa as they could now receive cash transfers from the government.&#x0D; Key words: older adults, mpesa, isolation, connection, e-inclusion, domestication, Kenya

Adult Food Security and the Relationship with Adverse Childhood Experiences Among Residents of Appalachian North Carolina.

IntroductionThe Appalachian region has worse health outcomes than the remainder of the United States. These disparities are often linked to the underlying social and environmental determinants of health. Adverse childhood experiences (ACEs) are associated with poor health outcomes across the lifespan and have a significant impact on future social determinants as an adult, including food security status.PurposeTo explore the relationships between ACEs and food security among adults in the Appalachian counties of North Carolina and make comparisons with the rest of the state.MethodsResearchers used North Carolina’s 2012 Behavioral Risk Factor Surveillance System data; namely, the ACEs optional module which includes 11 items related to experiences respondents had before the age of 18 and a single item from the Social Context optional module to classify food security status. The sample was divided into three age categories (18–44, 45–64, and 65 and older) for statistical comparisons as well as by the indicator for Appalachian county. Using Stata 15, weighted logistic regression was utilized for examining relationships between variables.ResultsACEs were a statistically significant predictor of food insecurity across all respondents; each additional ACE was associated with a 13–21% increase in the odds of food insecurity, depending on age group. However, living in an Appalachian county was only a predictor for those age 45–64.ImplicationsThese findings highlight the long-term effects of childhood experiences on food security generally, and in Appalachia particularly for middle-aged adults. Reducing ACEs could reduce food insecurity and improve health in the region.

Calendar effects to forecast influenza seasonality: A case study in Milwaukee, WI

Calendar effects to forecast influenza seasonality: A case study in Milwaukee, WI

Determinants of oil-spill cleanup participation following the Deepwater Horizon oil spill

BackgroundOn April 20, 2010, the Deepwater Horizon oil rig exploded, spilling over 4.9 million barrels of oil in the Gulf of Mexico over an 87-day period and developing into a long-term environmental disaster that affected people living in Gulf Coast states. Engagement of community members in recovery efforts is important for mitigating adverse effects of disasters and accelerating the rebuilding process for impacted communities; however, few studies have explored factors that determine participation in oil spill cleanups. MethodsWe analyzed data from the Gulf States Population Survey (GSPS) to study the determinants of participating in the Deepwater Horizon Oil Spill cleanup. The GSPS was a random-digit dialing survey conducted on 38,361 adults in counties and parishes in Alabama, Florida, Louisiana, and Mississippi impacted by the oil spill. Using survey estimation to account for the complex survey design, we estimated the probability of cleanup participation and used logistic regression to examine the association between sociodemographic factors and cleanup participation. ResultsApproximately 4.7% of residents in affected Gulf communities participated in the cleanup. Most participants were young, men, non-Hispanic white, and employed. Living in an affected coastal county was associated with higher odds of participation (unadjusted odds ratio [OR]: 1.69; 95% confidence interval [CI]: 1.28–2.24), as was having excellent or very good physical health (OR: 2.05; 95% CI: 1.11–3.81). Older persons were less likely to participate in the cleanup (OR for 65+ age group vs. 18–24 age group: 0.14; 95% CI: 0.05–0.36). ConclusionsUnderstanding the demographics of cleanup participants may help inform civilian recruitment for future oil spill responses.

Barriers and Facilitators for Fruit and Vegetable Consumption Among Adults in Rural Counties

Research exploring factors affecting fruit and vegetable intake in rural populations is lacking. The purpose of this study was to identify barriers to and facilitators for eating fruits and vegetables among a convenience sample of rural‐dwelling adults in North Carolina. Twenty‐three women and men from five counties provided information in focus groups and completed demographic questionnaires. Analyses revealed barriers that included cost, time, schedule limitations, lack of options, food safety concerns, and inconvenience. Facilitators included having gardens, lower prices, having local and in‐season produce, and accessibility. Solutions to barriers were planning ahead and convenience. Facilitators included behavior changes and environmental supports.

\u201cAvailability of healthcare providers for rural veterans eligible for purchased care under the veterans choice act\u201d

BackgroundMilitary Veterans in the United States are more likely than the general population to live in rural areas, and often have limited geographic access to Veterans Health Administration (VHA) facilities. In an effort to improve access for Veterans living far from VHA facilities, the recently-enacted Veterans Choice Act directed VHA to purchase care from non-VHA providers for Veterans who live more than 40 miles from the nearest VHA facility. To explore potential impacts of these reforms on Veterans and healthcare providers, we identified VHA-users who were eligible for purchased care based on distance to VHA facilities, and quantified the availability of various types of non-VHA healthcare providers in counties where these Veterans lived.MethodsWe combined 2013 administrative data on VHA-users with county-level data on rurality, non-VHA provider availability, population, household income, and population health status.ResultsMost (77.9%) of the 416,338 VHA-users who were eligible for purchased care based on distance lived in rural counties. Approximately 16% of these Veterans lived in primary care shortage areas, while the majority (70.2%) lived in mental health care shortage areas. Most lived in counties that lacked specialized health care providers (e.g. cardiologists, pulmonologists, and neurologists). Counterintuitively, VHA played a greater role in delivering healthcare for the overall adult population in counties that were farther from VHA facilities (30.7 VHA-users / 1000 adults in counties over 40 miles from VHA facilities, vs. 22.4 VHA-users / 1000 adults in counties within 20 miles of VHA facilities, p < 0.01).ConclusionsInitiatives to purchase care for Veterans living more than 40 miles from VHA facilities may not significantly improve their access to care, as these areas are underserved by non-VHA providers. Non-VHA providers in the predominantly rural areas more than 40 miles from VHA facilities may be asked to assume care for relatively large numbers of Veterans, because VHA has recently cared for a greater proportion of the population in these areas, and these Veterans are now eligible for purchased care.