Rural American Communities Research Articles

Building partnerships to improve clinical trial accrual in rural and Native American communities through community health educator interventions.

180 Background: Rural populations and racial minorities are often underrepresented in cancer clinical trials. The low representation is determined by multilevel factors, including lack of geographic access to facilities in rural locations and mistrust in the medical and scientific community. Presented here are partial results of an educational intervention to improve clinical trials-related knowledge among rural residents and racial minorities. Methods: The Center to Reduce Cancer Health Disparities (CRCHD) from the National Cancer Institute (NCI) developed the study materials, that were available in English or Spanish, to be utilized according to participants' preferences. The University of Wisconsin Carbone Cancer Center implemented this intervention in northern Wisconsin, which consisted of a baseline questionnaire, a recorded educational intervention, and a post-educational questionnaire. The chosen community is largely rural and Native. The questionnaires consisted of 11-knowledge- and 6-intention-related questions. After being screened by the rural Community Health Educator (CHE), subjects self-administered the intervention online or received the intervention from the CHE during tribal or other educational group events in rural communities. Results: Between January and May 2024, 62 participants started the intervention. Participants’ mean age was 45.1 (±15.36) years, 64.5% (40/62) were female, and 53.2% (33/62) self-identified as American Indian/ Alaska Native. All resided in rural community, defined as Rural-Urban Continuum Codes 7 or 8. Three participants did not respond to the post-educational questionnaire, and one skipped its intentions section. Although the two questions about informed consent presented the highest percent of correct answers post-intervention, the median total knowledge score pre and post-intervention remained the same (p>0.05). Post-intervention, participants more often agreed it is important for minority groups to participate in clinical trials, reported being likely to search for a clinical trial they might be eligible for, join a clinical trial, and talk to family/friends about joining a clinical trial (p<0.05). Conclusions: The CHE successfully engaged rural community members to participate in the intervention. In addition, the intervention facilitated building trust and partnerships for future cancer-related community driven work.

The Epidemic of Congenital Syphilis in the Indigenous and Rural Populations of South Dakota.

From 2020 to 2023, South Dakota witnessed a substantial increase in cases of congenital syphilis (CS), with the highest rates identified in rural and Native American (NA) communities. Here, we discuss 3 severe cases of CS in premature infants born to NA individuals and communities in South Dakota with poor access to prenatal care. The infants in these 3 cases presented with varying clinical conditions, including respiratory failure, persistent pulmonary hypertension of the newborn, severe direct hyperbilirubinemia, feeding intolerance, and necrotizing enterocolitis. Lack of prenatal care and other systemic health disparities likely contributed to the increased disease burden. For NA communities, rurality, limited resources, systemic racism, historical trauma, and lack of trust in medical institutions likely contribute to inadequate prenatal care. All 3 of these cases also occurred in pregnant people with a present or history of substance use disorders, which may have led to further hesitancy to seek care because of fear of prosecution. To combat the rising number of syphilis and CS cases, we advocate for new and continued outreach that provides education about and testing for sexually transmitted diseases to NA and rural populations, increased care coordination, the integration of point-of-care testing and treatment strategies in lower resource centers, and legislative allocation of additional resources to engage pregnant people with or at risk for substance use disorders.

Rural American farmers’ perceptions of crime, safety and policing

PurposeThe purpose is to understand how farmers in rural American communities perceive crime, safety and policing.Design/methodology/approachAn online survey, adapted from a version used in Victoria, Australia (Harkness, 2017), was modified and administered through social media and farming organizations throughout three US states. The survey covers topics relating to crime and victimization, feelings of safety or fear in rural areas, policing practices and trust in police in their areas and any crime prevention practices that respondents use.FindingsWith nearly 1,200 respondents and four scales investigated, results indicate that those respondents with more favorable views of law enforcement and the criminal justice system had the highest fear of crime, those who had been prior victims of crime had a higher fear of crime than those who did not, those with higher community involvement had higher fear of crime, and those from Nebraska compared to Colorado had higher fear of crime.Research limitations/implicationsA better understanding of the agricultural community’s perceptions of crime, safety and policing will aid law enforcement in community policing efforts and in farm crime investigation and prevention. Limitations of the study, including the distribution method will be discussed.Originality/valueFarm- and agriculture-related crimes have serious financial and emotional consequences for producers and local economies. Stereotypes about rural areas being “safe with no crime” are still prevalent. Rural American farmers’ perceptions of crime, safety and police are largely absent from the literature and are important for improving farm crime prevention.

A Rural Native American Community Experiences Related to Emotional and Mental Health Well-Being during the COVID19 Pandemic.

This qualitative study was conducted as part of a larger nationwide study, the Aegis Project that investigated the impact of the COVID19 pandemic, infection and reinfection, and the potential long-term immunity to SARS-CoV-2 and will be reported in a future paper. The study is a collaborative effort among The University of Texas at Austin School of Nursing, Indiana University at Bloomington School of Public Health, and a rural-based Tribe located in the Midwest. The qualitative component of the study explored the experiences that impacted the emotional and mental health well-being during the COVID19 pandemic. Data were collected using open-ended interview questions regarding participants' experiences during the pandemic. Results were analyzed using the Consensual Qualitative Research (CQR) method which includes the process of categorizing data into specific themes by means of the research team's discourse, external auditing, and agreement. Four themes emerged related to emotional and mental health well-being experiences that include: 1) loss of connectedness, 2) increase in stress, 3) increase in anxiety, and 4) learning to cope. Understanding the lived experiences of Native Americans during the COVID19 pandemic is needed to help guide the development and testing of culturally based interventions to improve the emotional and mental health well-being of Native American communities during pandemics or other distressful incidences such as natural disasters.

The effect of proximity to grocery stores and the pandemic on parents' and youths' perceptions of eating habits in predominately African American rural communities.

Rural communities have a disproportionately high level of childhood obesity along with high rates of food insecurity. To assess the eating habits of youth in predominantly African American rural communities and assess the association between proximity to a grocery store and eating habits as well as how the COVID-19 pandemic may have impacted eating habits. 203 youth and parents completed a 16-item survey. Analyses were performed to assess the effect of having a neighborhood grocery store as well as to compare responses between youth and parents. Having a neighborhood grocery store was associated with increased consumption of vegetables (F(1,122) = 41.56) and fruits (F(1,121) = 65.05), decreased consumption of chips (F(1,125) = 79.51) and a smaller percentage of overweight youth (χ2(1,125) = 5.03). Parents underestimated the effect of the COVID-19 pandemic on youth eating habits (χ2 (1,198) = 17.88). Proximity to a grocery store significantly associated with eating habits and weight in the rural communities examined. Given the steady decrease in the number rural grocery stores over the past decade it is important to consider how to improve access to healthy foods in these communities.

Smoking Quit Attempts and Associated Factors Among Rural Adults Who Smoke Daily in the United States.

Rural American communities are heavily affected by tobacco-related health disparities. This study aims to evaluate the prevalence of quit attempts (QAs) and factors that promote or impede QA among rural adults who smoke daily. Data from Wave 5 of the Population Assessment of Tobacco and Health study were analyzed. Multivariable logistic regression was used to identify factors associated with QA. Backward selection was used to identify variables included in the final model with statistical significance set at p < .05. Among 1610 rural adults who smoked daily, the prevalence of a QA in the past 12 months was 25.6% (95% confidence interval [CI]: 23.2, 28.2). Factors associated with greater QA odds: having greater education (adjusted odds ratio [aOR] = 1.35, 95% CI: 1.03, 1.77), e-cigarette use (aOR = 1.35 95% CI: 1.03, 1.80), disapproval of smoking from friends/family (aOR = 1.46, 95% CI: 1.09-1.94), greater frequency of thinking about the harm of tobacco (aOR = 1.48, 95% CI: 1.28, 1.71), fair/poor physical health (aOR = 1.31, 95% CI: 1.00, 1.70), and being advised to quit by a doctor (aOR = 1.63, 95% CI:1.25, 2.13). Smokeless tobacco use (aOR = 0.67, 95% CI: 0.47, 0.96) and greater cigarettes per day (aOR = 0.67, 95% CI: 0.47, 0.96) were associated with QA lower odds. Only one in four rural adults who smoke made a past-year QA. Interventions that promote provider advice to quit smoking, tobacco health harms, and normative beliefs may increase QAs in rural communities. Along with higher smoking rates and lower QAs, rural communities face limited access to programs, medication, and health care professionals as tools to help them quit smoking. Public Health initiatives should focus on developing cultural sensitivity training targeting health care professionals to advise patients to quit smoking and the role of multiple tobacco product use. Furthermore, given the low rates of smoking QAs, future mixed-methods research is needed to inform policies and interventions targeted at eliminating tobacco-related health disparities.

HIV Knowledge, Risk Factors, and Utilization of Services in the US Rural Deep South.

HIV prevalence in the rural South remains high among Black Americans due to limited access to prevention and treatment services and poverty. HIV care inequities for Black Americans living in the rural South are further intensified by high mortality rates, low HIV health literacy, stigma, and discrimination. Few studies have focused on HIV knowledge and risk factors within Black Americans in the rural South. This cross-sectional study examined the association between HIV risk factors, HIV knowledge, and utilization of HIV and/or sexually transmitted infection (STI) testing services among Black Americans (N = 200) living in the rural South. HIV knowledge, risk factors, and utilization of testing services were assessed via The HIV Knowledge Questionnaire, The HIV Risk Factor Questionnaire, and three investigator-generated questions, respectively. Linear regression was used to examine the relationship between demographic characteristics, HIV knowledge, utilization of testing services, and HIV risk factors. Among 200 participants, a smaller percentage (37.7%, n = 75) reported using HIV/STI testing services compared to non-users. Controlling for demographic covariates in the model, HIV knowledge (p < .0001) and marital status (p = .010) were significantly associated with HIV risk factors. HIV risk factors decreased as HIV knowledge increased. Individuals who reported being single also reported having fewer risk factors. Future research should examine the impact of HIV education tailored for individuals with greater HIV risk factors within rural Black Americans. Studies exploring barriers to the utilization of HIV/STI testing services within Black American rural communities are warranted.

An Economic History of Ellis County, Kansas

Like many American rural communities in the second decade of the twenty-first century, Ellis County faces tough decisions regarding economic development, population growth, and sustainable strategies. This paper examines the history of the region since the early twentieth century, tracing the evolution of various industries—from oil to farming—and the different ways the community responded to the area and nation’s economic shifts. This “big picture” view of Ellis County operates as a starting point for strategizing paths forward for area residents.

The Work of Pioneering Amish Studies Scholar Walter Kollmorgen: Annontations of His 1940s Amish Publications

Walter Kollmorgen’s two seminal contributions to Amish studies scholarship include the 1942 report “Culture of a Contemporary Rural Community: The Old Order Amish of Lancaster County, Pennsylvania” published by the U.S. Department of Agriculture’s Bureau of Agricultural Economics, and his 1943 article “The Agricultural Stability of the Old Order Amish and Old Order Mennonites of Lancaster County, Pennsylvania” published in the American Journal of Sociology. His 1942 report was one of six mixed-methods studies that analyzed the relative in/stability of rural American communities during the Great Depression. The six-part series concluded that the Amish of Lancaster County, PA, weathered the Great Depression with fortitude. In Kollmorgen’s subsequent 1943 AJS article, he consolidated key findings from field research, summarizing why the Old Order Amish and Old Order Mennonite people persist as a distinctive sect. Representing the very first substantial Amish studies scholarship (alongside Bachman’s 1942 The Old Order Amish of Lancaster County), Kollmorgen’s work merits ongoing re-examination, as it defined the conversation and trajectory of Amish studies scholarship. In this essay, I annotate both works, distilling his findings into summary essays that focus on presenting his research as a resource for readers and not necessarily engaging with it. Given the diffuseness of his report’s data, I provide both short summaries of each chapter and full chapter annotations. [Abstract by author.]

P120 Methods for Adapting Medical Clinic Referral to EFNEP to Serve Rural Native American Communities Via Telehealth

<h3>Objective</h3> The objective is to develop methods to adapt an in-person urban medical clinic-based intervention to a telehealth modality serving Native Americans in a rural setting where health disparities are more pronounced. <h3>Use of Theory or Research</h3> The Expanded Food and Nutrition Education (EFNEP) program intervention is based on Social Cognitive Theory and adult learning strategies. The adaptation methods are driven by the community-based participatory implementation science framework. <h3>Target Audience</h3> Native American families residing in rural California communities. <h3>Program Description</h3> Parents with young children are referred by physicians to attend an intervention (8-weekly sessions) delivered via telehealth by EFNEP educators. The intervention is focused on obesity prevention utilizing Guided Goal Setting, obesity risk assessments, storytelling, and food-related parenting topics. <h3>Evaluation Methods</h3> Meetings (n = 4) were convened over a four month period to develop a multi-phased community-based participatory approach to adapt the intervention. Members included the State EFNEP Director and County Program Advisors (n = 2), EFNEP educator, Indian Health Center Outreach Director, Pediatric Endocrinologist, Public Health Nurse, Nutrition Education Professor, Nutrition Specialist, and Human Development Specialist with over half having experience working with rural and Native American communities (n = 6). <h3>Results</h3> A three-phased approach was identified: formative, capacity bridging, and referral model implementation with each rooted in community-based participation. Community asset mapping will be conducted in the formative phase to outline healthcare partners serving Native American communities. A community advisory board consisting of Native American elders, Tribal chairs, parents, educators, and health care providers will be created for consultation on all phases including intervention content modification, identification of community/tribal health clinic partners, and inform referral and telehealth delivery strategies. <h3>Conclusions</h3> Adapting an intervention to a different target audience, location, and modality necessitates a thorough process to ensure relevance and sustainability. A three-phased approach with community-based participation was developed that can be used by other programs. <h3>Funding</h3> NIFA

Implementation and initial evaluation of falls risk reduction resources in a rural Native American Community

BackgroundAlthough falls are common and can cause serious injury to older adults, many health care facilities do not have falls prevention resources available. Falls prevention resources can reduce injury and mortality rates. Using the Centers for Disease Control and Prevention’s (CDC) Stopping Elderly Accidents, Deaths & Injuries (STEADI) model, a falls risk clinic was implemented in a rural Indian Health Service (IHS) facility.MethodsA Fall Risk Questionnaire was created and implemented into the Provider’s Electronic Health Records system interface to streamline provider screening and referral of patients who may be at risk for falls to a group falls risk reduction class.ResultsParticipants exhibited average improvements in the Timed Up and Go (6.8 s) (P = 0.0001), Five-Time Sit-to-Stand (5.1 s) (P = 0.0002), and Functional Reach (3.6 inches) (P = 1.0) tests as compared to their own baseline. Results were analyzed via paired t test. 71% of participants advanced out of an “increased risk for falls” category in at least one outcome measure. Of the participants to complete the clinic, all were successfully contacted and three (18%) reported one or more falls at the 90-day mark, of which one (6%) required a visit to the Emergency Department but did not require hospital admission.ConclusionsIn regards to reducing falls in the community, per the CDC STEADI model, an integrated approach is best. All clinicians can play a part in reducing elder falls.

High-Risk Outreach for COVID-19 Mortality Reduction in an Indigenous Community.

Indigenous populations have been disproportionally affected by COVID-19, particularly those in rural and remote locations. Their unique environments and risk factors demand an equally unique public health response. Our rural Native American community experienced one of the highest prevalence outbreaks in the world, and we developed an aggressive management strategy that appears to have had a considerable effect on mortality reduction. The results have implications far beyond pandemic response, and have reframed how our community addresses several complicated health challenges. (Am J Public Health. 2021;111(11):1939-1941. https://doi.org/10.2105/AJPH.2021.306472).

University of North Dakota School of Medicine and Health Sciences.

University of North Dakota School of Medicine and Health Sciences.

Culturally Responsive Teacher Education for Rural and Native Communities

This article explores the marginalized contexts of rural and Native American communities that have made recruitment and retention in teacher education inequitable in remote areas. Through facilitating a Culturally Responsive Pedagogy workshop series with schools in a neighboring rural county, having a large Native population and a very low student academic achievement rate, we discovered strong resistance from local educators to the notion of “culture” influencing student achievement. Our disappointment in the outcomes of the workshops caused us to examine the services our university provided to rural and Native place-based pre-service educators. As a result, we created a Satellite program to more responsively meet rural teachers’ unique needs and circumstances. By providing greater access to higher education and teacher licensing for students in remote locations, and by embedding equity, diversity, inclusion, and culturally relevant curriculum in all Satellite coursework, we hope to produce teachers who will return to their communities committed to improving schools and promoting equity and social-emotional and academic success for their future students.

Cross-border Communication and the Enregisterment of Collective Frameworks for Care

ABSTRACT Communication plays an important role in the non-copresent care that is increasingly prevalent today. Drawing on long-term research with transnational Salvadoran families, I explore how one multigenerational kin network managed a health crisis: a family member had been diagnosed with a new form of chronic kidney disease that is epidemic in rural Central American communities. The family used cross-border communication to simultaneously enact care and consolidate a particular register of care. I suggest that everyday communication is a powerful force that works both within and beyond immediate care work encounters in ways that have far-reaching consequences for ethical and moral life.

Feasibility of Managing Traditional Knowledge from the Culture on the Territory.

In the context of globality, there has been a sustained migration from the countryside to the city, which has generated a loss of traditional knowledge of rural and indigenous Latin American communities. Faced with the need to recover this knowledge, and in this requirement to efficiently manage resources, the objective was to create an initial strategy for evaluating the feasibility of managing this knowledge. For this, two “case studies” were carried out, the “Construction System of mud and straw houses, in the commune of Colchane, Tarapaca region, northern Chile.”, And the “Rural Women’s Table in the commune of Licanten, Maule region, southern Chile. In these cases, it was verified if there is still a system of activities and interconnection between knowledge, which allowed us to corroborate the feasibility of managing this knowledge, as heritage and resource for the sustainable development of the communities in its territory.

Pediatric Trauma System Evaluation before and after Level II Verification

ACS-verified trauma centers show higher survival and improved mortality rates in states with ACS-verified Level I pediatric trauma centers. However, few significant changes are appreciated in the first two years after verification. Minimal research exists examining verification of ACS Level II pediatric trauma centers. We analyzed ACS Level II pediatric trauma verification at our institution. In 2014, Sanford Medical Center Fargo became the only Level II pediatric trauma center in North Dakota, as well as the only center between Spokane and Minneapolis. A retrospective review of the institution's pre-existing trauma database one year pre- and postverification was performed. Patients aged <18 years were included in the study (P < 0.05). Patient number increased by 23 per cent, from 167 to 205 patients. A statistically significant increase occured in the three to six year old age group (P = 0.0002); motorized recreational vehicle (P = 0.028), violent (P = 0.009), and other (P = 0.0374) mechanism of injury categories; ambulance (P = 0.0124), fixed wing (P = 0.0028), and personal-owned vehicle (P = 0.0112) modes of transportation. Decreased public injuries (P = 0.0071) and advanced life support ambulance transportation (P = 0.0397). The study showed a nonstatistically significant increase in mean Injury Severity Score (from 6.3 to 7) and Native American trauma (from 14 to 20 per cent). Whereas prolonged ACS Level I pediatric trauma center verification was found to benefit patients, minimal data exist on ACS Level II verification. Our findings are consistent with current Level I ACS pediatric trauma center data. Future benefits will require continued analysis because our Level II pediatric trauma center continues to mature and affect our rural and large Native American community.

A Case Study of Transitions in Farming and Farm Labor in Southwestern Idaho

Farm labor in the U.S. is undergoing significant transitions. First, fewer farmworkers are migrating in the traditional sense, and more are settling in to rural American communities. Second, more women are working in agriculture—a process referred to as the feminization of agriculture. Third, there has been an increase in so-called “recreational” crops” like marijuana and hops grown for craft microbrew beers. This paper discusses these three transitions in Southwestern Idaho. These transitions were observed during pilot research conducted in Idaho during 2017–2018. We present this paper as a case study of current transitions in American agriculture. See the press release for this article.

Infusing Health Disparities Awareness Into Public Health Curricula at a Rural Midwestern University

Preventable differences in health outcomes between U.S. population subgroups, related to factors such as race or ethnicity, income, and geographic location, are troubling. Geographically, rural American communities experience higher rates of adverse health conditions when compared with urban areas, further widening disparities in health outcomes. Such disparities necessitate the creation of effective curricula to enable students to address the health needs of underserved populations. By intentionally incorporating health disparities awareness content into the curricula, undergraduate and graduate public health programs can play an integral role in developing conscious health practitioners to help close gaps in health outcomes. Moreover, rural health courses may increase students’ interest in rural health careers. This article presents the process and results of faculty efforts to design and deliver health disparities–related education in undergraduate and graduate public health courses at a rural Midwestern U.S. university. Various teaching development programs inspired faculty to use intentional instructional approaches to teach students about health disparities. Consequently, faculty incorporated a variety of assessment methods and teaching styles to infuse health disparities awareness content into public health courses. Results from students’ course evaluations and reflections are discussed along with lessons learned and implications for future pedagogical directions.

From Systematic Review to Call for Action.

Intimate partner violence (IPV) is a global public health and criminal justice concern with significant impacts; especially high rates are seen among rural Hispanic American (HA) communities, the fastest growing population in the United States. They experience additional barriers to care including extreme poverty, lesser education, gender norms, and language and immigration issues. A systematic literature review was conducted using Cooper's framework to identify evidence supporting associations between interventions and prevention, reduction, and elimination of IPV among rural HA women. Searches conducted on databases including CINAHL, PubMed, Medline, Women's Studies International, MedicLatina, and JSTOR used the MeSH terms Hispanic Americans (Latino/a and Hispanic), domestic violence, and intimate partner violence. Selected studies were published between January 1, 2000, and January 1, 2014. Of the 617 yielded articles, only 6 met the inclusion criteria. Of these, none closely examined rurality or provided valid and reliable measures of outcomes, instead reporting program descriptions and suggested interventions. We identify key findings to guide program, screening, and tool development. Our study identifies a gap in knowledge, research, and effective practices and issues a call for action to create evidence-based tools to prevent, reduce, and eliminate IPV in these underserved populations.