Health In Rural Communities Research Articles

Enhancing the Awareness of Modifiable Risk Factors for Cancer Prevention in the Alabama Black Belt Region: A Follow-up Study.

We determined the profile of participants in the multi-level annual marathons held in Alabama Black Belt counties in terms of lifestyle characteristics and considered how these characteristics relate to a family history of cancer. Data on socioeconomic, health, and lifestyle characteristics of respondents were collected during the Annual Healthy Lifestyle Marathons of 2013-2019. These events were five miles in length and allowed participants to walk, bike, or run. Characteristics of respondents were compared using frequencies, percentages, and cross-tabulations. Most of the respondents with a family history of cancer were within the 18 to 24-year age category; had an annual income in the range of under U.S. $10,000; had received some college training; reported their overall health as good; and were African American. Although low consumption of fruits and vegetables has a demonstrated association with being diagnosed with cancer, in 2019 only 43% of respondents reported frequent intake of fruits and vegetables. Community-based health programs are critically needed to improve health in rural Black Belt communities.

Long-Term Drought Harms Mental Health in Rural Communities

In rural and remote communities in Australia, psychological distress worsened during the first few years of a prolonged drought. Other signs of poor mental health persisted beyond that time.

Distribution of Physician Specialties by Rurality.

Physicians of all specialties are more likely to live and work in urban areas than in rural areas. Physician availability affects the health and economy of rural communities. This study aimed to measure and update the availability of physician specialties in rural counties. This analysis included all counties with a Rural-Urban Continuum Code (RUCC) between 4 and 9. Geographically identified physician data from the 2019 American Medical Association Masterfile was merged with 2019 County Health Rankings, the Census Bureau's 2010 county-level population data, and 2010 Topologically Integrated Geographic Encoding and Referencing shapefiles. Multivariate logistic regression was performed to assess the availability of physicians by specialty in rural counties. Of the 1,947 rural counties in our sample, 1,825 had at least 1 physician. Specialties including emergency medicine, cardiology, psychiatry, diagnostic radiology, general surgery, anesthesiology, and OB/GYN were less available than primary care physicians (PCPs) in all rural counties. The probability of a rural county having a PCP was the highest in RUCC 4 (1.0) and lowest in RUCC 8 (0.93). Of all primary care specialties, family medicine was the most evenly distributed across the rural continuum, with a probability of 1.0 in RUCC 4 and 0.88 in RUCC 9. Family medicine is the physician specialty most likely to be present in rural counties. Policy efforts should focus on maintaining the training and scope of practice of family physicians to serve the health care needs of rural communities where other specialties are less likely to practice.

Climate change and rural mental health: a social geographic perspective.

The objective of this commentary is to suggest ways in which current and future research on climate change and rural mental health can be enhanced by social geographic perspectives. As the effects of climate change escalate, the mental health of rural and remote communities will be placed at increasing risk. As such, it is imperative that academics and practitioners recognise the value of multidisciplinary approaches to tackling this issue. As social geographers, the authors of this commentary outline concepts from their field that they find helpful in understanding the relationship between people and places, and how these relations give rise to emotions that are responsive to environmental conditions. Ultimately, the authors would like to prompt a re-thinking of 'social' as a category, which is usually confined to interpersonal interactions between humans and suggest a broadening of the concept to include both human and non-human worlds.

Pipelines to Pathways: Medical School Commitment to Producing a Rural Workforce.

Despite the efforts of numerous medical schools to produce rural physicians, many rural communities in the United States still experience physician shortages. This study describes the current landscape of rural efforts in US undergraduate medical education and catalogs medical school characteristics and activities that evidence has suggested, and that many experts in rural medical education believe, may result in more graduates choosing rural practice. This is a descriptive study of publicly available and rurally relevant characteristics of all 182 allopathic and osteopathic medical schools operating in the 50 states and the District of Columbia in 2016, with rural program information for these schools updated in 2019. The authors constructed a "rural program" definition in order to systematically catalog coordinated and strategic medical school efforts to produce a rural physician workforce. Few (8.2%) medical schools expressed an explicit commitment to producing rural physicians in public mission statements. However, most (64.8%) provided rural clinical experiences and many demonstrated their commitment in other ways. Only 39 (21.4%) did so through a formal rural program. In establishing an explicit rural program definition and documenting other markers of rural commitment, this paper provides a baseline for future studies of rural workforce production and medical school investment in these programs, activities, and personnel. Demonstrating the effectiveness of schools' rural physician education efforts will require collaboration across institutions and more intensive evaluations of programs involving students who, though relatively few in number, have great potential for contributing to the health of rural communities across the nation.

Prevalence of endoparasitors in rural communities in Central Brazil: a cross-sectional study

Abstract Background Studies show that the magnitude is high in regions lacking basic sanitation, such as rural areas. Despite this, there is little evidence on the prevalence of endoparasitosis in rural communities in developing countries. The aim of this study was to estimate the prevalence of endoparasitosis in residents of rural communities in Central Brazil. Methods Cross-sectional study conducted within the scope of the Sanrural Project that aims to assess the health and sanitation conditions of rural communities in 2019. The target population of this study consisted of residents of 17 settlements, 24 quilombola and 7 riverside communities in Central Brazil. By listing the total number of residents of each household in the communities, residents were selected by simple random probability sampling. Then, stool samples were collected in sterile plastic containers and identified. After collection, the samples were transported for analysis by direct examination of the feces. The descriptive analysis was made. The study was approved by the Research Ethics Committee of the Federal University of Goiás. Results Data from 680 individuals (children and adults) who had stool samples collected were analyzed. The prevalence's of the endoparasites found were: Entamoeba coli (13.5%; 90%CI: 11.5-15.8%); Giardia lamblia (2.8%; 90%CI: 1.9-4.4); Ascaris lumbricoides (1.5%; 90%CI: 0.9-2.4); Ancyslotoma (0.9%; 90%CI: 0.5-1.7); Enterobius vermicularis (0.7%; 90%CI: 0.4-1.5%); Taenia (0.6%; 90%CI: 0.3-1.3); Hymenolepis nana (0.6%; 90%CI: 0.3-1,3); Itamoeba (0.4; 90%CI: 0.2-1.1); Hymenolepis diminuta (0.3%; 90%CI: 0.1-0.9), Strongiloides (0.0%); Trichuris (0.0%) and, Schistosoma mansoni (0.0%). Conclusions An intermediate prevalence for principal endoparasites was observed. This result may suggest the persistence of precarious sanitation conditions. Thus, the implications of the study include the need for systematic action by managers and health professionals in improving sanitation conditions. Key messages A current diagnosis will be made on the health and sanitation situation of rural communities in Goiás, based on the analysis of clinical samples and water quality, among other conditions. Based on this diagnosis, together with the community, we will seek solutions for sanitation and health through a Rural Sanitation Security Plan (PSSR).

Western University Schulich School of Medicine & Dentistry.

Western University Schulich School of Medicine & Dentistry.

Cooperative Extension as a Force for Healthy, Rural Communities: Historical Perspectives and Future Directions.

Cooperative Extension (Extension), part of the land-grant university system, has been engaged in rural communities for more than a century. While the focus of Extension's efforts has largely centered on agriculture, there is an important thread of work that has similarities to public health.As Extension settles into its second century, we are working to be even more engaged in efforts that improve the health and well-being of rural communities in particular. Extension faculty and staff are accomplishing this through direct-to-the-population education and through partnerships with more classically oriented public health organizations able to leverage Extension's networks and positive reputation in communities to engage them and improve their health. A component of these partnerships includes Extension faculty and staff increasingly engaging in policy, systems, and environment work and other initiatives that help ensure longer-term, systemic changes more likely to improve health outcomes.In short, Extension clearly changed the agricultural system of the United States, and because of its reach into rural communities, it has the capacity to do for health in rural communities in this second century what it did for agriculture in the first century.

Exposure of Hausa Women to Mass Media Messages: Health and Risk Perception of Cultural Practices affecting Maternal Health in Rural Communities of Bauchi State, Nigeria

This study aims to determine the exposure of Hausa women in rural areas of Bauchi state to health messages from the Mass Media, with a view to ascertaining if these messages have a bearing on their perception of risk regarding prevalent cultural practices relating to maternal health. A review of the literature indicates that the mass media promote the communication of health messages, and have contributed to health promotion and disease prevention; thus, dissemination of health messages through public education campaigns via the mass media can seek to change the social climate, to encourage healthy behaviours, create awareness, change attitudes, as well as motivate individuals to adopt recommended behaviours, such as lowering risk perceptions. A Focus Group Discussion was used to gather data from women of child-bearing age in the study area. Findings showed that some cultural practices detrimental to maternal health are still prevalent and such practices are mostly not perceived as risky. Also, although women encounter health messages (mostly through radio and posters) that are contextually relevant in addressing problems associated with maternal health, none of these are centred specifically on harmful cultural practices. Based on the aforementioned, it is recommended that relevant authorities concerned with the welfare of women prioritise the dissemination of mass media messages/campaigns that could contribute to the improvement of women’s health, to minimize the problems affecting maternal health. Also, cultural practices that persist in these areas should be researched with a view to ascertaining their strengths, to emphasize the assimilation of the positive aspects into the packaging of mass media messages/campaigns.

Rural gerontological health: Emergent questions for research, policy and practice.

This article explores what can be learned from the evolution of rural gerontology as a field of study to inform a more critical approach to the health of rural older adults. To counter the prevailing essentialism of highlighting the rural health disparities faced by older adults, there is a need to expand rural gerontological health research beyond deficit and medicalized understandings of health in rural communities. We argue that appreciating the interplay between unique health experiences, the complexity of the rural context and the continuum of older adult care is an important next step to foster advances in the field. Emergent questions for research, policy and practice are discussed and new directions for rural gerontological health are proposed.

The Future of Smallholder Farming in India: Some Sustainability Considerations

The biodiverse, predominantly crop-livestock mixed-farming in India is key to ensuring resilience to climate change and sustainability of smallholder farming agroecologies. Farmers traditionally grow diverse crops as polyculture, and agriculture is mainly organic/biodynamic with spirituality in food systems deeply ingrained. Job-driven out-migration of rural youths, the family labor force, and globalization of contemporary food choices under corporate industrial agriculture both adversely affect sustainability of traditional farming landscapes and compromise the nutrition and health of rural farming communities. Besides documenting information on general agri-food system policy inputs, our paper presents the results of an exploratory study of four crucial community-level initiatives conducted in four distinct agroecological landscapes of India, aimed at bringing sustainability to traditional farming and food systems. The driving force for fundamental change in agri-food system, and in society, is the question of sustainability. The organic and local food movements are but specific phases of the larger, more fundamental sustainable agri-food movement. While it is very critical to increase farmer livelihood, it is even more important to increase overall rural economy. It was found that four important interventions viz. linking organic agriculture to community-supported agriculture (CSA) initiatives; linking small-holder farming to school meal (MDM) programmes; enhanced market access and value chain development for local agricultural produce; and creation of employment opportunities at community level for rural youths and reducing over-dependence of rural population on agriculture as source of income can make traditional farming more profitable and sustainable. The transition to more sustainable methods of farming by selling the farm produce “locally” helps both consumers and farmers alike and is considered a future strength of smallholder Indian agriculture.

Factors influencing the perceived importance of oral health within a rural Aboriginal and Torres Strait Islander community in Australia

BackgroundIndigenous Australians suffer from higher rates of oral disease and have more untreated dental problems and tooth extractions than the general population. Indigenous Australians also have lower rates of accessing oral health services and are more likely to visit for a problem rather than a check-up. Multiple issues effect health service and prevention programs including: characteristics of health services such as distances to health services; existence of social and cultural barriers; available wealth and social support; and, characteristics of the individual and community including the importance given to the disease. This paper seeks to explore the perceived importance of oral health within a rural Indigenous community in Australia and the factors influencing this perception.MethodsThe study used a phenomenology research design incorporating focus group discussions and in-depth interviews. It was undertaken in partnership with communities’ Health Action Group who guided the focus, implementation and reporting of the research. A convenience sample was recruited from established community groups. Thematic analysis on the transcripts was completed.ResultsTwenty-seven community members participated in three focus groups and twelve in-depth interviews. The study found that the community gives high priority to oral health. Factors influencing the importance include: the perceived severity of symptoms of oral disease such as pain experienced due to tooth ache; lack of enabling resources such as access to finance and transport; the social impact of oral disease on individuals including impact on their personal appearance and self-esteem; and health beliefs including oral health awareness. Participants also noted that the importance given to oral health within the community competed with the occurrence of multiple health concerns and family responsibilities.ConclusionThis paper highlights the high importance this rural Indigenous community gives to oral health. Its findings suggest that under-utilisation of oral health services is influenced by both major barriers faced in accessing oral health services; and the number and severity of competing health and social concerns within the community. The study results confirm the importance of establishing affordable, culturally appropriate, community-based oral health care services to improve the oral health of rural Indigenous communities.

Can we manage mental health and cardiovascular risk in rural communities?

Can we manage mental health and cardiovascular risk in rural communities?

Limited dietary interventions in rural Australian communities: A systematic review.

This review aimed to synthesise the evidence on the effectiveness of dietary interventions targeting adolescents (>13 years) and adults living in rural or remote Australia. Six electronic databases were searched to identify dietary interventions undertaken in rural or remote communities. Studies were included if they utilised intervention and control comparisons or pre and post assessment of diet-related outcomes. If studies included metropolitan populations, dietary outcome measures had to be provided separately for rural data. In total, 14 articles from 12 unique studies met the criteria for inclusion and together provided incomplete coverage across all states of Australia, included intervention studies targeted diet to address obesity, cardiovascular disease, and high blood pressure or diabetes. No studies were focussed on reducing community malnutrition. All studies, with one exception, focussed specifically on rural adults, no interventions specifically targeted adolescents in rural areas. Only two studies documented the involvement of a dietitian in intervention development or delivery. All studies produced a significant outcome for either dietary intake, body mass index, waist circumference, or diet related biomedical risk factors for individuals located in rural or remote areas of Australia. Dietary interventions in rural Australia are under-studied, especially among the adolescent population. This is despite the high level of preventable diet-related disease burden in rural and remote Australia. Existing evidence shows promise in improving dietary intakes, but further, large scale intervention research, with the involvement of dietitians, is urgently needed to improve the health of rural communities.

Household air pollution in India and respiratory diseases: current status and future directions.

Combustion of solid cooking fuels employed by more than 3 billion people globally, contributes to approximately one third of ambient air pollution. In the recent past, the issue has drawn global attention because of its threat to the health of rural communities, particularly women and children. This review is focused on the evidence from India on effects of household air pollution (HAP) on respiratory health and interventions to replace the solid fuels. HAP exposure is a major risk factor for increased respiratory symptoms, respiratory infections, and chronic obstructive pulmonary disease. In most studies, the odds ratio for the risk of development of respiratory disorders is more than one in HAP exposed individuals. HAP is also associated with increased risk of tuberculosis, asthma, mortality from cardio-respiratory illnesses, and nonrespiratory problems such as adverse pregnancy outcomes, prematurity, and low birth weight. Household air pollution is a common but preventable risk factor for respiratory diseases. Replacement of solid cooking fuels with clean fuels such as LPG gas as exemplified by the 'Ujjwala' program of India is likely to be most effective intervention to reduce the HAP related disease burden.

Thermal comfort and cooling strategies in the Brazilian Amazon. An assessment of the concept of fuel poverty in tropical climates.

Fuel poverty has increasingly been associated with thermal discomfort, health related issues and winter deaths in the Global North because it can force families to choose between food and a warmer environment. Juxtaposing the concept of fuel poverty in rural tropical areas of the Global South, it is likely that a similar pattern between fuel poverty and heat related illnesses can be found. A recent study shows that between 1.8 and 4.1 billion people, especially in India, Southeast Asia and Sub-Saharan Africa will need indoor cooling to avoid heat related health issues. This paper aims to address a blind spot in the literature on the links between fuel poverty, thermal comfort and cooling strategies in the Brazilian Amazon.This study draws from current definitions and indicators of fuel poverty in the Global North and juxtaposes it in the context of tropical areas to understand how fuel poverty affects human health, livelihood strategies and social justice in rural communities that live in hot climates. To do so, this paper uses qualitative methods and a conceptual framework to guide the analysis. I call the intersection between vernacular architecture and sustainable cooling practices ‘energy relief’.

Concerns about climate change among rural residents in Australia

Abstract Climate change impacts human health and there is growing recognition of the explicit consequences for mental health and wellbeing. Rural communities are recognised as one of the most vulnerable populations to climate change. The majority of research to date is quantitative and has a focus on farmers specifically, with the impacts of climate change on the wider rural community considered to a lesser extent. Our study addresses this gap by analyzing qualitative data from the Australian Rural Mental Health Study (ARMHS), a longitudinal study conducted in non-metropolitan New South Wales (NSW), Australia, during the Millennium Drought. Free text responses from 823 participants to the open-ended question “What is your biggest concern about climate change?” were analysed to determine what the qualitative data from ARMHS reveals about the mental health and wellbeing of rural communities. Four themes were identified: (i) suffering under climate change; (ii) causes of climate change; (iii) extremes of climate change; and (iv) leadership and action to address climate change. The environmental, financial, health and social impacts of climate change were of greatest concern to rural residents. Many participants also had concerns relating to climate change attribution, with many believing climate change was a natural, cyclical process not caused by human actions. Other major concerns were the financial consequences of extreme events and the adequate communication of climate change information. Analysis of qualitative data such as that presented here gives context and breadth of understanding to issues identified via quantitative analysis. Importantly, insights emerging from qualitative data, and the personal/community context that is not always available from quantitative data, can lead to more informed community-based approaches to addressing climate change issues experienced by vulnerable populations.

Social Networks and Mental Health of Rural Latino Adolescents in North Florida

AbstractThere is limited research on mental health in rural Latino communities, particularly with adolescents. The aims of this study were to: 1) describe the evidence of social networks and mental health research in rural Latino communities and 2) illustrate themes related to the social networks and mental health depicted by rural Latino adolescents. A secondary data analysis study was performed, using data collected through semi-structured interviews (N=59) with adolescents, 11-17 years-old, living in three rural counties of North Florida. The interviews were conducted by community health workers (promotoras), in either Spanish or English; exploring family and community relations. NVivo 12 was used to aid in managing and thematically analyzing the data. Major themes were analyzed as Protective and Risk factors for mental health. A social network framework was then created under these themes including Family, School, Outside Community and Immigration Policy as main categories. The findings of this study highlight the need for mental health promotion interventions with rural Latino adolescents and can be used to influence future studies of social networks and mental health.

Creating place-based health and wellbeing networks in rural and remote communities.

Creating place-based health and wellbeing networks in rural and remote communities.

A Tale of Two Parasites: Statistical Modelling to Support Disease Control Programmes in Africa

Vector-borne diseases have long presented major challenges to the health of rural communities in the wet tropical regions of the world, but especially in sub-Saharan Africa. In this paper, we describe the contribution that statistical modelling has made to the global elimination programme for one vector-borne disease, onchocerciasis. We explain why information on the spatial distribution of a second vector-borne disease, Loa loa, is needed before communities at high risk of onchocerciasis can be treated safely with mass distribution of ivermectin, an antifiarial medication. We show how a model-based geostatistical analysis of Loa loa prevalence survey data can be used to map the predictive probability that each location in the region of interest meets a WHO policy guideline for safe mass distribution of ivermectin and describe two applications: one is to data from Cameroon that assesses prevalence using traditional blood-smear microscopy; the other is to Africa-wide data that uses a low-cost questionnaire-based method. We describe how a recent technological development in image-based microscopy has resulted in a change of emphasis from prevalence alone to the bivariate spatial distribution of prevalence and the intensity of infection among infected individuals. We discuss how statistical modelling of the kind described here can contribute to health policy guidelines and decision-making in two ways. One is to ensure that, in a resource-limited setting, prevalence surveys are designed, and the resulting data analysed, as efficiently as possible. The other is to provide an honest quantification of the uncertainty attached to any binary decision by reporting predictive probabilities that a policy-defined condition for action is or is not met.