Rural Midwestern Community Research Articles

Vaccine Uptake and Perspectives Among Latina Immigrant Mothers in Rural Communities in a Midwestern State.

Examine the prevalence of and characteristics related to COVID-19 vaccine uptake. Quantitative and qualitative data collected at two-time points via phone interviews. Rural Midwestern communities. 109 Latina mothers with incomes < 185% FPL, at least one child < age 12 recruited from a Midwestern state based on two previous studies. Mothers responded to the following variables through a survey: Vaccine uptake measured by responses to, Have you received a vaccination shot for COVID-19. Tested predictors of vaccine uptake included: income, gender, education, immigration status, confidence in vaccine, belief the pandemic is over). Mothers' perspectives regarding the vaccine explored via responses to Why haven't you received COVID-19 vaccine?. Binary logistic regression analysis was conducted. Demographic variables and attitudes toward the vaccine served as predictors of mothers' vaccine uptake. Qualitative data were analyzed to shed light on mothers' perspectives on receiving the vaccine. Mother's confidence in the vaccine predicted vaccine uptake in 2021 (aOR=1.332, 95% CI: 1.07-1.65) and 2022 (aOR=1.48, 95%CI: 1.11-1.97). In 2021, income also predicted vaccine uptake (aOR=1; 95% CI: 1-1.002). Overarching themes: "vaccination is not necessary","mistrust of the vaccine", and "vaccine as protector". Vaccinated mothers viewed the vaccine as a protection from being infected or gravely ill. For unvaccinated mothers, messages are needed that communicate the vaccine can protect them from virus transmission from household members who unknowingly are infected, as well as from different virus strains.

Building Healthy Families: Outcomes of an Adapted Family Healthy Weight Program Among Children in a Rural Mid-Western Community.

Background: This study aimed to evaluate the effectiveness of implementing an adapted, evidence-based 12-week Family Healthy Weight Program (FHWP), Building Healthy Families, on reducing BMI metrics and clinical health indicators in a real-world community setting. Methods: Ninety child participants with a BMI percentile greater or equal to the 95th percentile for gender and age and their parents/guardians (n = 137) enrolled in the program. Families attended 12 weekly group-based sessions of nutrition education, family lifestyle physical activity, and behavior modification. A pre-post study design with a 6-month follow-up was used. Results: Nine cohorts of families between 2009 and 2016 completed the program with 82.1% retention at 12 weeks and 53.6% at 6 months. Participants had statistically significant improvements at 12 weeks in BMI z-score, %BMIp95, body mass, body fat, fat mass, fat-free mass, and systolic blood pressure with greater improvement at 6 months in body mass, BMI metrics, body fat, fat mass, fat-free mass, and systolic blood pressure. Parents/guardians of the participants had similar statistically significant body composition and blood pressure improvements (p < 0.05). In addition, children had significant improvements in high-density lipoprotein (HDL) cholesterol and aspartate aminotransferase (AST) liver enzymes at 6 months. Conclusions: Overall, this study demonstrated that an evidence-based FHWP can result in statistically meaningful declines in BMI z-score and accompanied clinically meaningful changes in health risk. Participants lost ∼4% of their body mass in 12 weeks, while their parents/guardians lost closer to 7% of their body mass, which supports previous literature suggesting body mass changes influence health.

Navigating health and well‐being during the COVID‐19 pandemic: Experiences of Latina immigrant mothers in rural Midwestern communities

AbstractObjectiveIn this study, we sought to gain insight into the challenges Latina immigrant mothers in rural Midwest communities encountered during the pandemic, strategies they employed to avoid infection of the virus, and impacts of the pandemic on family health and well‐being.BackgroundIn rural Midwestern communities, the pandemic disproportionately affected immigrants, many of whom are Latino and worked in meatpacking and food processing plants. Latina mothers are commonly viewed as caretakers of the family. This prescribed role placed mothers at the center of safeguarding their families' health during the pandemic.MethodIn this descriptive study, we conducted individual interviews with 124 Latina immigrant mothers across six rural Midwestern communities who participated in one of two previous studies in the communities. Thematic analyses was used to identify themes that aligned with three areas of interest: challenges experienced, strategies employed to avoid virus infection, and impacts of the pandemic on family health and well‐being.ResultsMothers enacted behaviors (e.g., sanitation practices, wore masks, stayed home) to lessen negative impacts of the pandemic on family health and well‐being. Factors beyond their control (e.g., public policies, work policies and practices) placed families at greater risk for poor health and well‐being. Eleven themes were identified that aligned with the three areas of interest.ConclusionFindings build upon and extend prior research that reexposed unjust employment conditions, inadequate health‐care systems, and an anti‐immigrant context during the pandemic that perpetuated health disparities among Latino immigrants and other minoritized populations.ImplicationsEthnographic and longitudinal studies that give voice to populations underrepresented in COVID‐19 research and at high risk for poor health are warranted to inform policies and practices to protect health during public health crises.

Using enclave groups to discuss workplace cultural diversity and community inclusion

AbstractWorkplace cultural diversity and community inclusion are two facets of a complex public issue that require a deliberative community-based problem-solving approach. This article reports findings from a qualitative analysis of fourteen focus groups (N = 83 participants) held in a rural Midwestern community that centered on community members’ experiences with workplace cultural diversity and community inclusion. Three themes emerged: (a) racism and micro-aggressions; (b) discomfort talking about and across cultural differences; and (c) lack of belonging. Of the 14 focus groups, five represented enclave groups with culturally diverse employees. By engaging with historically excluded groups, researchers communicated with affected stakeholders when framing the public issue and convening public meetings to discuss that issue. This use of enclave groups to make the initial stages of the deliberative cycle more inclusive has implications for practitioners of public deliberation, scholars of human communication, and citizens and their communities.

Parenting Pre-teens During COVID-19 in a Rural Midwestern Community: An Interpretive Phenomenological Study.

The online version contains supplementary material available at 10.1007/s40653-022-00507-9.

Multilevel correlates of domain-specific physical activity among rural adults – a cross-sectional study

BackgroundIncreasing physical activity (PA) in rural communities is a vital prevention tactic in multiple chronic diseases; however, little is known on the multilevel correlates of PA rural areas. A better understanding of domain-specific PA adds context for promoting PA in rural communities. The current study sought to determine factors associated with domain-specific and overall moderate-vigorous physical activity (MVPA) in rural communities.MethodsSurveys were conducted across 14 rural mid-Western communities, with the final analytical sample including 1241 adults (ages 19–96, M = 57.0 [SD = 16.7], 67.8% female, 83.8% white). Generalized linear models with negative binomial distributions examined the relation between demographics, trail use, and perceptions of the neighborhood environment, with domain-specific and overall MVPA, measured via the Global Physical Activity Questionnaire.ResultsRural residents reported an average of 617 total minutes of weekly MVPA (SD = 1141), with 58.5% meeting MVPA guidelines. Higher age, female gender, and higher educated individuals had lower levels of overall and occupational MVPA. Females, higher education, and perceived indoor recreational access were associated with lower levels of transportation-related MVPA, while trail use was associated with increased transportation MVPA. Higher age and female gender respondents had lower levels of recreational MVPA, while trail users and those who perceived favorable indoor recreational access had higher levels of recreational MVPA.ConclusionsPA primarily occurred in the occupational domain among this sample of rural mid-Western adults. Findings highlight the need for multilevel interventions to address PA across multiple domains in rural communities, especially among females and older adults.

COVID-19, "A Gift and a Curse" in Unsettling Times: A Qualitative Study.

The objectives of this study were to rapidly explore the perceptions of female-headed African American families on "stressors," "stress reactions," and "opportunities" amid the COVID-19 pandemic lockdown mandates. Semistructured telephone interviews were conducted with 9 African American women in a rural Midwestern (US) community, who were single parents/grandparents and cared for at least one child/grandchild aged 5 to 17 years. A thematic analytical approach was used to review, code, and analyze phone interview transcripts. Coding schemes were developed through an interactive iterative process. Three main themes emerged-pandemic as a curse, de-stressors and coping mechanisms, and the pandemic as a gift. Most participants reported increased stress for themselves and their children and adopted several coping strategies. However, for most mothers, COVID-19 was paradoxical because it also provided opportunities for families to bond despite these stressors. Public health actions such as social and physical distancing infringe on personal freedoms and can have negative effects on the health of those affected. There is a need to proactively address important areas such as health education and economic and social support to mitigate common sociopsychological effects of a pandemic.

Abstract P070: Individual And Environmental Correlates Of Objectively Assessed Physical Activity Levels In Rural Residents

Introduction: Rural communities in the US face disproportionately higher rates of physical inactivity as well as coronary heart disease mortality, when compared to their urban and suburban counterparts. As such, increasing physical activity (PA) and reducing barriers to PA is critical in improving population health. Neighborhood characteristics have been shown to influence PA, but are understudied in rural communities. The current analysis: (1) describes PA patterns in rural mid-western communities, and (2) examines the associations of and interactions between individual and environmental correlates of objectively assessed weekly moderate to vigorous physical activity (MVPA) minutes. Hypotheses: Overall, we expected low levels of weekly MVPA in rural residents; with lower levels anticipated in female, older, and low-income participants. We also expected positive associations of favorable perceptions of the neighborhood environment, trail use, and self-efficacy for PA with weekly MVPA. Finally, the test of interactions between intrapersonal and perceived environmental factors in relation to weekly MVPA is exploratory. Methods: Telephone surveys were conducted with 280 adults in 14 rural southeast Missouri communities, who were also asked to wear accelerometer devices for seven days. Participants were recruited via address-based sampling, and at local community events. Participants self-reported demographic information (age, sex, income), individual level behavioral factors (self-efficacy for PA, trail use) and neighborhood environment perceptions (indoor recreational access, safety from traffic, home neighborhood environment). Weekly MVPA minutes were assessed using the accelerometry data. Generalized linear mixed models using a negative binomial distribution were used examining associations of and interactions between individual characteristics and environmental correlates with weekly MVPA (Analyses were conducted using STATA V15). Results: Participants had a weekly average of 97 minutes MVPA, with 21% meeting PA guidelines. Increased age and being female were significantly associated with lower weekly MVPA. Additionally, increased self-efficacy and trail use were significantly associated with higher weekly MVPA. When exploring interaction effects, there was a significant interaction between gender and safety from traffic. For females, increased perceived safety from traffic was associated with lower MVPA. Conclusions: Rural residents have low levels of PA with less than a quarter meeting PA guidelines (75 minutes of vigorous and/or 150 minutes of moderate PA per week). Specifically, female residents face disproportionately lower levels of MVPA, with only 75 weekly minutes compared to 135 weekly minutes in males. Promoting trail use and targeting self efficacy for PA, may be effective strategies for increasing PA in rural residents.

Reducing 30-Day All-Cause Acute Exacerbation of Chronic Obstructive Pulmonary Disease Readmission Rate With a Multidisciplinary Quality Improvement Project.

Our objective was to implement a comprehensive quality improvement project to decrease the 30-day readmission rate for all-cause acute exacerbation of chronic obstructive pulmonary disease (AECOPD) at a rural Midwestern community hospital in the United States. Prospective data were collected from January 1 to December 31, 2017. A total of 77 patients met the study criteria and were included for analysis. Baseline data analysis involved data for 72 patients from September 1, 2015, to October 1, 2016, and showed a 30.6% all-cause 30-day AECOPD readmission rate. The Define, Measure, Analyze, Improve, and Control (DMAIC) model was used for this quality improvement project. All aspects of this project were successfully implemented, and the resulting 30-day all-cause AECOPD readmission rate decreased to 16.9% during the study time frame. Through this comprehensive quality improvement project, the 30-day all-cause AECOPD readmission rate was reduced by 23.7%.

Engaging Rural Community Members with Food Policy Councils to Improve Food Access: Facilitators and Barriers

ABSTRACT This study is a secondary assessment of data from a multi-state project called Voices for Food. The purpose was to determine facilitators and barriers to community stakeholders’ (n = 171) and food pantry clients’ (n = 612) engagement with food policy councils (FPCs) among rural Midwestern communities. Quantitative and qualitative data from surveys were examined across three data collection time points (baseline = 0, midpoint = 24, and post = 36 months). In addition to determining the sectors represented in council membership, barriers to and facilitators of participation in the council were identified. This information can be used to engage all types of community members in FPC work.

An Educator’s Excess of Language Around Latinx Students of Uncertain Legal Status: Creating Visibility or Invisibility?

This paper draws on data from a 2018 study that explored how K-12 educators in one rural Midwestern community were responding to the milieu of rapid changes in immigration policy and rhetoric. Participants’ discussion around immigration status commingled with other status-assigning labels or used labels that may be used to sort or categorize students (e.g., socioeconomic status). We theoretically examine an extended interview with one principal drawing on Derridian concepts of deconstruction and differánce. We question how the excess of an educator’s language around race/ethnicity, socioeconomic status, and cultural and/or linguistic heritage of immigrants render Latinx students of varying legal status visible and invisible in school. We located signifiers such as country of origin, economic worth, and legal status that made visible Latinx persons through identity indicators, also rendering them invisible through reducing all Latinx persons in the community into a monolithic category.

Sink or Swim: Virtual Life Challenges among African American Families during COVID-19 Lockdown.

This study explores African American parents’ experiences with using technology to engage their children in meaningful activities (e.g., e-learning) during COVID-19 and its impact on family health. Eleven African American families were recruited through a local health department program from a rural Midwestern community to participate in semi-structured interviews. Majority of participants reported stresses from feelings of “sink or swim” in a digital world, without supports from schools to effectively provide for their children’s technology needs. The COVID-19 pandemic underscored the importance of family-school collaborative engagement and empowerment. Digital technology needs to become part of our school education system so that technology use among African Americans is elevated and families protected against future outbreaks. Further research with a more diverse African American sample is needed.

Varying Experiences of Cyber Victimization among Middle and High School Students.

BackgroundAlthough cyber victimization (CV) occurs in both middle school (MS) and high school (HS)—and these experiences appear to differ between boys and girls—to our knowledge, no studies have directly examined these differences across specific acts of CV. Further, limited research has examined school environment factors, such as school safety and attachment, as they relate to CV.ObjectivesThe current study compared CV experiences reported by boys and girls in both MS and HS as well as examined CV’s association with perceived school safety and school attachment.MethodParticipants were 286 MS and 304 HS students (52% boys) from a small, rural Midwestern community in the United States. Self-reported measures were collected.ResultsHS girls reported experiencing more CV than MS girls on 5 of the 6 CV acts examined. Additionally, HS girls reported experiencing more CV on 3 of the acts compared to MS boys. In general, HS boys and HS girls report similar rates of CV, with the exception of HS girls experiencing higher levels of “people saying mean and nasty things about them.” Regression analyses indicated that youth who report higher CV feel less connected to school, but their CV experiences do not appear to be related their perceived school safety when also considering traditional forms of victimization.ConclusionsCV experiences are higher for HS girls for the majority of different types of CV acts compared to MS youth but similar to HS boys, and experiencing these acts is associated with less school connectedness.

(Mis)Recognizing Undocumented Students & Families in a Rural School

ABSTRACT School and educator responses to the immigration policy environment may depend on what educators know about who is in their school community. This paper examines whether and how educators in a rural Midwestern community recognize undocumented and mixed-legal status students in their school community. We utilize concepts from recognition theory to understand the mechanisms that may have facilitated or hindered an elementary school principal and two teams of 3rd and 4th grade teachers’ recognition. The findings present a picture of a school in the nascent stages of recognizing how the sociopolitical climate and enforcement of immigration law powerfully impact children and families.

Tapping into Community Resiliency in Rural Adolescent Pregnancy Prevention: An Implementation Sciences Approach

Although rural youth experience marked inequities in adolescent pregnancy, there is little guidance for implementing evidence-based programs (EBPs) in rural settings. When implementation occurs in rural communities, it frequently focuses on deficits, rather than strengths or capacity for growth. Using the consolidated framework for implementation research (CFIR), we describe a resiliency-focused implementation of two middle school EBPs in rural Midwestern communities, including the intervention, outer and inner settings, individuals, implementation processes and preliminary outcomes. Data included program staff interviews, feedback from local partners, community meetings notes, and participant surveys. Using the CFIR, we describe the engagement of rural communities themselves in a resilience-based implementation of adolescent pregnancy prevention EPBs. Communities self-described as rural, traditional and religious. They identified adolescent pregnancy, substance use, and academic success as priorities. To address infrastructure needs and build on local strengths, funds were used to hire local partners to implement the program. As small communities, stakeholders were closely networked and wanted to address local needs. Local partners selected the EBP based upon community values and priorities. Champions, including local partner organizations and schools were locally based and were well connected. Intensive training of local staff and piloting with adaptation assured fidelity and sustainability, while increasing community implementation skills and comfort. In Clinton County, enrollment was 1946 with students receiving the program in 6th, 7th, and/or 8th grades. In Southern Indiana, 7275 students received the program once in either 6th, 7th, or 8th. We conclude that the CFIR can facilitate the implementation of a community resilience-focused adolescent pregnancy prevention intervention in rural communities.

Multiliteracies in Rural Schools:

Multiliteracies is a paradigm for language and literacy, in which all languages and literacies are valuable, meaningful, and serve a purpose in meeting the needs of the learner within their social contexts. Multiliteracies are enacted and negotiated through different languages, technologies, and modalities and are represented in homes and communities of English Learners (ELs) or emergent bilinguals (EBs), representing their bi- or multilingual identities. Within rural communities, these family multiliteracies differ from the predominantly English-monolingual contexts found within schools, but have the potential to reshape rural educators’ conceptions of literacies. Redefining literacy holds significance in rural communities where resources, including highly qualified teachers, are often scarce or distant. Employing a collective-case study, our study explores the family-based literacy practices of 20 EB families from two rural Midwestern communities. Findings demonstrate that family’s home literacies are associated with complex multilingual and multimodal practices.

Impact of Enhanced Recovery in Cesarean Patients

Enhanced recovery (ER) programs have been shown to improve postoperative outcomes, including cesarean births. Our clinical goal was to determine the impact of the ER protocol for scheduled, elective cesarean patients on lengths of stay (LOS), opiate consumption, antiemetic consumption, readmission rates, and exclusive breastfeeding rates. In addition, we wanted to determine whether any of the patients’ demographic variables (smoker, diabetes, anemia, age, or prior cesarean) resulted in increased LOS, despite ER-protocol implementation. The study consisted of a quasi-experimental, nonequivalent control group, pretest–posttest design. For the pretest–control group, 90 random elective cesarean charts were reviewed from August 2017 through August 2018. For the posttest or experimental group, 90 random elective cesarean charts will be reviewed from August 2018 through August 2019. A magnet-designated hospital in a Midwestern rural community with a population of approximately 18,500. The hospital has a 12-bed maternity unit staffed with 17 nurses (RNs) and averages 400 births/year with an average cesarean rate of 120/year. All multiparous, elective cesarean patients. The study is a quasi-experimental, nonequivalent control group, pretest–posttest design. A paired t test is used to determine the impact of the new ER protocol for scheduled cesarean patients' lengths of stay, opiate consumption, antiemetic consumption, readmission rates, and exclusive breastfeeding rates. Logistic regression is used to determine if any of women’s demographic factors (smoker, diabetic, anemic, previous cesarean, age) influence lengths of stay, despite ER implementation. Emergency cesareams are excluded from the data due to the lack of preparatory time for the ER protocol to be fully implemented. The following trends have been observed (n-19Pre/n-19Post): decreased LOS, decreased length of Foley catheter use, decreased length of bedrest, decreased length of intravenous fluid administration, decreased opiate use, and increased times of breastfeeding in the first 24 hours. There was a significant decrease in postoperative opioid consumption with an increase in exclusive breastfeeding rates.

Rural Residents' Depressive Symptoms and Help-Seeking Preferences: Opportunities for Church-Based Intervention Development.

This study examines rural residents' depressive symptoms, helps seeking preferences and perceptions of a church-based group depression intervention, informing feasibility of adapting evidence-based treatment for delivery in rural churches. A cross-sectional survey was administered to 100 members of 2 churches in a rural Midwestern community; 63 congregants responded. Depression was assessed via the Patient Health Questionnaire-9. Descriptive analyses were performed, and 12.9% of respondents screened positive for depression. Another 25% reported mild symptomatology. Respondents preferred informal help seeking, although reported more openness to formal providers to address others' depression. Results suggest receptivity to church-based treatment. Almost two-third of respondents reported they would consider attending a church-based group depression intervention, 80% would recommend it to a friend in need, and 60% indicated it would benefit their community. Delivering evidence-based depression treatment within church settings may provide a viable option for increasing access to care in this rural community.

‘…Darn Thing Just Kind of Fell Together by Itself after a While’: Exploring the Role of Official and Tactical Communication in Siting a Rural Wind Farm

The growth of wind energy in the United States has created widespread access to renewable energy for citizens in many parts of the country. But while wind holds promise for meeting 21st-century energy demands, the question of how and where to locate wind farms poses significant technical and rhetorical challenges for wind energy companies seeking access to wind resources. Securing such access typically requires companies to work closely with municipalities and private landowners through a blizzard of “official genres”—e.g., letters, contracts, emails, maps—that are developed and authorized by wind power companies in order to inform and persuade. However, the construction of a wind farm presents the possibility of significant disruption of local values and identities, economies and aesthetics. Citing research from rhetorical genre studies and interviews with landowners and stakeholders in a rural Midwestern rural community, this chapter outlines a sampling of the official discourse utilized by wind energy companies to secure wind farm siting agreements and explores the pressures this rhetoric places upon local stakeholders. I then use interview data to illustrate how these official forms of documentation exist within a broader ecology of unofficial communication that includes citizen-curated sites of what Miles Kimball has called “tactical technical communication.” These sites, including informal meetings, citizen-initiated research, and local leadership activity, accommodate official wind energy discourse into the local rhetorical ecology, highlighting, in part, the scope of rhetorical activity needed to integrate wind into a local economy of values and beliefs.

Establishing a Community-Based Participatory Research Partnership in a Rural Community in the Midwest.

Rural health disparities are well-documented. "New destination" communities in predominantly rural states have emerged in recent years, with immigrants moving into these communities for better opportunities. Few reports of community-based participatory partnerships with these communities have been previously described in the literature. We report on the formation and implementation of a community-academic partnership to reduce health disparities in a rural Midwestern community. We describe the creation of a partnership between the University of Iowa (UI) Prevention Research Center (PRC) and the Ottumwa, Iowa community. We describe the partnership formation, activities, and results of the implementation of the partnership, and challenges encountered, including balancing attention to different health disparities populations and ensuring mechanisms for hearing from the different voices in the community. Our experience suggests the importance and challenge of considering the multiple dimensions of health disparities in rural new destination Midwestern communities.