Rural Classification Research Articles

Building a medical workforce in Tasmania: A profile of medical student intake

To identify under-represented groups in a medical school intake. Descriptive analysis of student demographic characteristics. One state-wide medical school. All students enrolled between 2010 and 2016. Proportion of students from regional and rural areas, state versus independent schools, highest parental qualification, Aboriginal or Torres Strait Islander students. Of 819 students, 472 (57.6%) were from Tasmania, five (1.1%) identified as Aboriginal or Torres Strait Islanders, 335 (71.0%) completed their secondary education at independent schools and 137 (29.0%) at government schools. The overall median Modified Monash Model was 2 (range 1-6) and median Australia Statistical Geography Standard Remoteness Area was 2 (inner regional: range 1-4), reflecting that a majority came from one of the two main cities. Over two-thirds (69.5%) had a parent with a Bachelor degree or higher qualification, regardless of the school attended. Just under half (225, 47.7%) of all Tasmanian students attended a secondary school with a parental contribution of ≥$5000 per annum. These students attended a small number of independent schools, with the proportion relatively stable over the period from 2010 to 2016. Widening participation and widening access initiatives to graduate doctors who understand and want to work in communities in need might not be working as well in Tasmania as elsewhere in Australia. Social accountability might be improved by adapting a rural classification that reflects the demographic profile of Tasmania.

The impact of rural classification systems on a comparison of risky drug-related behaviors in Kentucky and Ohio counties

ABSTRACTTo analyze county-level differences in injection drug use (IDU) behaviors and overdoses in Kentucky and Ohio, and to assess the impact of using different models to classify counties as rural.Existing clinical data were pooled from three regional programs: 1) an opioid overdose prevention program (OOPP) within a residential addiction treatment program (n=163), 2) a regional evaluation of four OOPPs (n=655), and 3) a mobile syringe services program (n=1,379), representing 17 counties each in Kentucky (n=516) and Ohio (n=1,618). Pearson chi-square tests were used for dichotomous variables and an analysis of variance (ANOVA) was used to compare continuous variables. A Tukey HSD posttest was used to identify statistically significant comparisons.Age at first IDU was consistently younger in rural counties. However, findings changed based on the classification scheme used. This was also true for the prevalence of methamphetamine use.The rurality classification applied at the county level may be an important consideration in the analysis of research studies.

Multilevel Regression for Small-Area Estimation of Mammography Use in the United States, 2014.

The U.S. Preventive Services Task Force recommends biennial screening mammography for average-risk women aged 50-74 years. County-level information on population measures of mammography use can inform targeted intervention to reduce geographic disparities in mammography use. County-level estimates for mammography use nationwide are rarely presented. We used data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS; n = 130,289 women), linked it to the American Community Survey poverty data, and fitted multilevel logistic regression models with two outcomes: mammography within the past 2 years (up-to-date), and most recent mammography 5 or more years ago or never (rarely/never). We poststratified the data with U.S. Census population counts to run Monte Carlo simulations. We generated county-level estimates nationally and by urban-rural county classifications. County-level prevalence estimates were aggregated into state and national estimates. We validated internal consistency between our model-based state-specific estimates and urban-rural estimates with BRFSS direct estimates using Spearman correlation coefficients and mean absolute differences. Correlation coefficients were 0.94 or larger. Mean absolute differences for the two outcomes ranged from 0.79 to 1.03. Although 78.45% (95% confidence interval, 77.95%-78.92%) of women nationally were up-to-date with mammography, more than half of the states had counties with >15% of women rarely/never using a mammogram, many in rural areas. We provided estimates for all U.S. counties and identified marked variations in mammography use. Many states and counties were far from the 2020 target (81.1%). Our results suggest a need for planning and resource allocation on a local level to increase mammography uptake.

Characteristics of Territories-in-between

Much of physical territory of the Europe does not fit classic ‘urban–rural’ typologies but can best be described as ‘territories-in-between’ (TiB). There is considerable agreement that TiB is pervasive and very significant. However, typologies of territory or spatial development continue to employ only degrees of either urban or rural. Similarly, spatial planning and territorial development policies rarely make use of the notion of in-between areas but tend instead to divide the territory into urban and rural zones. Questions have been raised therefore about the lack of understanding of territories-in-between and their negligence in planning policy. This paper contributes to a better understanding of TiB, by proposing a method for their characterisation and mapping. It asks if there can be a common definition of TiB that reflects consistent and distinctive characteristics across the great variety of spatial development contexts in Europe. It proposes spatial and demographic criteria for their definition, mapping and comparison. The comparison with widely used urban–rural classifications shows that the presented classification of TiB has three advantages: (i) it maps the complexity of the spatial structure of urbanised areas on a regional scale, and thereby helps to overcome the prevalent idea that urbanised regions are characterised by a spatial gradient from urban centre(s) to rural periphery; (ii) it emphasises the network structure of territories-in-between and the underlying connectivity of places with different functions and (iii) it raises awareness that in some parts of Europe a settlement pattern has developed that cannot be understood as either urban or rural.

Understanding Geographic and Neighborhood Variations in Overdose Death Rates.

The current opioid epidemic continues to challenge us in new and potentially troubling ways. For example, research today finds more overdose deaths occurring in rural, rather than urban, geographic areas. Yet, studies have often ignored heterogeneities within these spaces and the neighborhood variations therein. Using geodemographic classification, we investigate neighborhood differences in overdose death rates by geographical areas to further understand where and among what groups the problem might be most concentrated. For deaths between 2013 and 2016, we find significant variation in rates among neighborhoods, defined by their socio-economic and demographic characteristics. For example, overdose death rates vary up to 13-fold among neighborhoods within geographic areas. Our results overall show that while the rural or urban classification of a geographic area is important in understanding the current overdose problem, a more segmented analysis by neighborhood's socio-economic and demographic makeup is also necessary.

Validation of a new continuous geographic isolation scale: A tool for rural health disparities research

The purpose of this study was to develop and test a new continuous measure for rural health disparities research that characterizes geographic areas according to a perspective of access to resources. We call the measure Isolation and anticipate it will be useful as an alternative to commonly used rural classification schemes (e.g., the Census Bureau's measure). Following the best known standards for measuring rurality, it captures the trade-off between access to resource-rich, high-population-density areas and the cost of travel to those areas; thus even intrinsically low-resource areas may have high access to nearby resources. Validity was tested with proxies such as distance to hospitals, physician availability, and access to high quality food. The Isolation scale demonstrated good construct validity (i.e., both convergent and criterion validity). Fit statistics indicated that, compared to other commonly-used urban/rural definitions, the Isolation scale was the best overall measure when predicting several proxies for rurality, even when categorized. We also show that the measure does a substantially better job at explaining national health outcome data at the state level. This new continuous Isolation scale shows considerable promise for improving our conceptualization, theorization, and measurement of the features of rurality that are pertinent to rural health disparities research, and can also be useful to policy makers who may find value in using isolation thresholds that are most relevant to their policy planning needs.

Rescaling social dynamics in climate change: The implications of cumulative exposure, climate justice, and community resilience

In this study, we explore cumulative exposure, climate justice, and flood risk with specific reference to community resilience, vulnerability, and social justice characteristics at the county-level within the U.S. Mississippi River basin from 1990 to 2009. Using a basic conceptual model of spatial resilience to climate risks, temporal lag effect of community capacity, urban and rural spatial classification, integrative cumulative exposure, and spatial clustering of risk, we examine spatial climate risk outcomes and the role of community resilience in reducing such risks. Our approach accounted for local social, economic, environmental, regulatory policy, and planning mitigation contexts. Results suggest that community social and ecological characteristics were influenced by flood losses and that social capital and climate justice characteristics combined with local proactive planning and policy measures lead to lower disaster losses and enhanced community resilience.

Using GIS Technology to Define and Assess a Rurality Scheme Suitable for Decision Support in Health and Patient Services

Labeling geographic areas into rural or urban classes has implications to public policy, distribution of funds and services, as well as analysis and research. Rural-Urban classifications are often limited to dichotomous, county-based comparisons on geographies that can be too large and diverse to effectively assess and resource health care needs and services. Using an existing census tract based classification system, a modified rurality classification layer is proposed and used as a foundation layer in support of research, mission and income programs at a National Non-profit Organization. This system is analyzed by integrating with health services and program data to better understand accessibility and availability of health services, to assess available program offerings, and to evaluate the geographic distribution of health care providers and facilities. The analysis illustrates how identifying intra-rural differences can play a pivotal role in understanding patient needs, assigning adequate resources and can further support public health programs and policy implementation.

Geometric classification method of rural residences at regional scale

With the rapid growth of construction area, residential energy consumption has sharply increased in China. Under this background, energy consumption estimation and energy performance assessment for rural residences at regional scale has become a significant issue that needs to be solved. Bottom-up approach is widely used to establish the representative residence models for estimating building energy consumption. However, there are some difficulties when applying bottom-up method to estimate energy consumption for residential building stock in rural region of China. For instance, the rural residences classification, which is a fundamental step of bottom-up approach cannot be finished by the typology and classification approaches that have been proposed. In order to solve this problem, a new classification method for rural residences of China is presented in this article. This method includes four steps. Firstly, the remote sensing image of target region is checked whether the application conditions are met. Secondly, the target region can be divided into several sub-regions and the villages are randomly selected by stratified sampling from each sub-region. Thirdly, the 3D data of residences in each selected village is obtained with Google Earth. Lastly, based on the obtained 3D data, the residential buildings are classified and the representative geometric models for each group can be established. In order to further illustrate this method with more details, the municipal region of Hangzhou in Zhejiang province of China is taken as an example. The new method is significant to establish representative model for rural residences at municipal scale, which supports not only energy consumption estimation and energy performance assessment of residential building stock, but also the evaluation of energy saving potential and the impact of retrofit measures from the perspective of regional scale.

Examining changes in the equity of physician distribution in Japan: a specialty-specific longitudinal study

ObjectivesIn this longitudinal study, we examined changes in the geographical distribution of physicians in Japan from 2000 to 2014 by clinical specialty with adjustments for healthcare demand based on population...

Prevalence of and Differences in Salad Bar Implementation in Rural Versus Urban Arizona Schools

BackgroundRural children consume more calories per day on average than urban children, and they are less likely to consume fruit. Self-service salad bars have been proposed as an effective approach to better meet the National School Lunch Program’s fruit and vegetable recommendations. No studies have examined how rural and urban schools differ in the implementation of school salad bars. ObjectiveTo compare the prevalence of school-lunch salad bars and differences in implementation between urban and rural Arizona schools. DesignSecondary analysis of a cross-sectional web-based survey. Participants/settingSchool nutrition managers (N=596) in the state of Arizona. Main outcomes measuredNational Center for Education Statistics locale codes defined rural and urban classifications. Barriers to salad bar implementation were examined among schools that have never had, once had, and currently have a school salad bar. Promotional practices were examined among schools that once had and currently have a school salad bar. Statistical analyses performedGeneralized estimating equation models were used to compare urban and rural differences in presence and implementation of salad bars, adjusting for school-level demographics and the clustering of schools within districts. ResultsAfter adjustment, the prevalence of salad bars did not differ between urban and rural schools (46.9%±4.3% vs 46.8%±8.5%, respectively). Rural schools without salad bars more often reported perceived food waste and cost of produce as barriers to implementing salad bars, and funding was a necessary resource for offering a salad bar in the future, as compared with urban schools (P<0.05). No other geographic differences were observed in reported salad bar promotion, challenges, or resources among schools that currently have or once had a salad bar. ConclusionsAfter adjustment, salad bar prevalence, implementation practices, and concerns are similar across geographic settings. Future research is needed to investigate methods to address cost and food waste concerns in rural areas.

Weight Loss Success of Participants Residing in Rural and Urban Areas.

Rural residents are significantly more likely to be overweight and obese than are urban residents. However, few data have compared weight control program responses in these population groups. Therefore, the primary aim of this study was to evaluate the weight loss outcomes of participants in a multisite, online behavioral intervention by residential location (rural vs urban) and, second, assess any possible differences in adherence to treatment goals. A total of 492 adult participants (mean BMI = 35.7 kg/m2 ; 90% female; 24% minority) were categorized based on their home ZIP code and the 2010 US Census Urban and Rural Classification criteria (58.3% rural; 41.7% urban). Weight (kg) was measured in-person at baseline and 6 months after participating in a behavioral weight control intervention. Adherence to physical activity and calorie and fat intake goals was assessed based on weekly self-monitoring journals. Weekly online chat attendance and completion of weekly online self-monitoring journals were recorded. Presence of obesogenic foods in the home was self-reported at baseline and 6 months. There were no statistically significant differences in weight loss between rural and urban participants (-6.1 kg vs -5.3 kg, P = .16), nor were there differences in chat attendance, self-monitoring journals, self-reported physical activity, calorie intake, or obesogenic foods reported in the household. Overall, there was no difference in weight loss and adherence to treatment goals for rural and urban participants. Further research on rural and urban residents is necessary to explore the factors responsible for the disparity in obesity prevalence.

Building a local medical workforce in Tasmania: where are international fee-paying medical graduates likely to work?

Much of regional Australia continues to face challenges in recruitment and retention of medical practitioners, despite the apparently successful rural medical education initiatives funded by the Commonwealth Government. International fee-paying (IFP) medical students are a significant component of Australian medical education, contributing additional income and more diverse learning environments for universities. Their contribution to the Australian medical workforce is harder to determine. After obtaining registration, IFP graduates may apply to remain in Australia as skilled migrants. Since 1999 there has been a 325% increase in the number of international medical students in Australia, with approximately 73% of IFP graduates remaining in Australia for at least some postgraduate training. Recognising the potential contribution of IFP students to the Tasmanian medical workforce, the authors sought better understanding of the career intentions and work locations of IFP graduates from the medical program in Tasmania, Australia, through two studies. Firstly, a quantitative study was conducted of the locations of all IFP graduates from the Tasmanian medical program, and then a qualitative study exploring graduating students' intentions and factors that contribute to their decisions about work location choices. This was a cohort study of IFP students who graduated from the University of Tasmania School of Medicine over the period 2000-2015. Work locations for 2016 were mapped to a Modified Monash rurality classification. Semi-structured interviews were held with 15 final year IFP medical students, exploring career intentions and location preferences. There were 261 IFP graduates, 54.4% male. The most common country of origin was Malaysia (55.2%). In 2016, 189 (72.4 %) were working in Australia, 42 (16.1%) in Tasmania and 126 (66.7%) in areas categorised as Modified Monash 1. Recent graduates in postgraduate year 1/2 (71.3%) were more likely to be working in Tasmania but most left for specialty training. All 15 interview participants intended to remain in Australia for at least their intern year, although at enrolment only six had planned to remain. Factors influencing workplace location decisions were (1) 'professional': greater appeal of Australian medical workplaces, intention to pursue a speciality, and to complete this at an Australian metropolitan hospital; (2) 'social': proximity to family/partner or opportunity to meet a prospective partner, family obligations, positive rural experiences; and (3) 'location': direct travel access to family. IFP graduates from the Tasmanian medical program make an important contribution to the Australian mainland metropolitan medical workforce, but play only a small role in workforce development for both Tasmania and the broader Australian rural and remote context. Most IFPs do not choose to work rurally. Rurally focused medical programs need to consider how they place IFP students to meet both the learning and career needs of IFP students and the goal of the rural medical programs in developing a rural workforce.

Сельский туризм: классификации и особенности организации

The article is focused on the rural tourism. It is type of tourism with specific features of development and organization. The article considers approaches to the concept of "rural tourism". The authors elaborate a hierarchy of signs of the rural tourism classification by the type and category of tourism, as well as by the types and functional form of tourism. As part of the study of agricultural tourism classifications, a complex system of basic and additional services of rural tourism is presented. The authors propose the system of rural tourism organization based on rural tourism development models. They include creation of special large and medium-sized rural tourism facilities, organization and creation of rural tourist networks, creation of public and private agricultural facilities. The article descript in detail the organization of rural tourism features, namely the personnel selection, the organization of the tourists reception, the organization of accommodation and food for tourists, the entertainment and additional services, ensuring the safety of tourists, conflict mitigation. The authors also consider services marketing peculiarities of rural tourism, among them the organization of the promotion system of rural tourism services, the study of consumer preferences, the development of an optimal pricing mechanism, etc. The advantages and disadvantages of the rural tourism development in the Russian Federation are revealed, and prospects for the development of this type of tourism are determined. The article present the features of the rural tourism organization that can be useful for representatives of the tourist business, regional and municipal authorities, as well as for researchers studying rural tourism from the organizational and economic sides. A further prospect of the research is the creating a development mechanism of rural tourism at the local level, and the socio-economic efficiency assessment of the development of this type of tourism.

O18 Internet testing for chlamydia reported through national surveillance in england

IntroductionTo support and monitor growth of online testing, the National Chlamydia Screening Programme published guidance on commissioning online testing services. Coding was amended in national surveillance systems to differentiate tests requested online from testing in other venues.MethodsNational surveillance data from January 2015–September 2016 were linked to the IMD 2015 and ONS urban rural classification indices to analyse the trends in online testing and test positivity by gender for 15–24 year olds. Patterns of repeat testing were explored.Results163,062 tests and 13,422 diagnoses were reported from online services covering 89% of local authorities in England. Test positivity was higher in men (10% vs. 7.6% women; RR 0.80,p&lt;0.0005), residents of urban areas (8.4% vs. 7.4% rural; RR 1.08,p=0.002) and those living in the most deprived areas of England (9.6% vs 7.0% least deprived; RR 0.79,p&lt;0.0005). Test positivity online was higher than in general practice (8.2% vs GP 6.1% p&lt;0.0005) and lower than in specialised sexual health services (8.2% vs 9.9% GUM and 9.5% SRH p&lt;0.0005). In 2015, 18% of online testers had a subsequent online test within 6 months. Test positivity was higher at first than subsequent test (8.5% vs 7.3%).DiscussionPatterns in online test positivity were comparable with those found in other services suggesting that they are used by the population at risk not just the ‘worried well’. Around 1-in-5 of those testing online had subsequent online tests. These findings support the provision of online testing services as well as face-to-face venues.

Unravelling urban–rural health disparities in England

AbstractPrevious research shows significant health and mortality variations by residential context. Numerous studies report better health and lower mortality among rural populations in comparison to urban residents, whereas other research shows the opposite, with poor health and high mortality in rural areas. This study investigates health variations in England by residential contexts and the causes of such differences. Further, it examines the sensitivity of results to different rural–urban classifications. Applying logistic regression models to individual‐level data from the 2001 UK census we demonstrate significant health variation by residential context. A clear urban–rural positive health gradient is apparent, with levels of ill health increasing parallel to levels of urbanisation. Briefly, people living in rural areas have better health than those living in cities and other urban contexts. However, the capital city (London) provides an exception to the gradient, with its inhabitants having better health than anticipated. Once we control for individual sociodemographic characteristics, including occupational status and educational level, the urban–rural health variations are reduced, but significant differences still persist. Most notably, Outer London residents have health expectations similar to those residing in the most rural locations. Clearly, our results support the existence of a positive urban–rural health gradient, with the exception of a protective “capital city” effect. These findings persist regardless of the precise urban–rural classification used. Finally we show that, having accounted for composition and the rural–urban context, there still remains a North–South divide in health outcomes.

Examining sufficiency and equity in the geographic distribution of physicians in Japan: a longitudinal study

ObjectivesThe objective of this study was to longitudinally examine the geographic distribution of physicians in Japan with adjustment for healthcare demand according to changes in population age structure.MethodsWe examined trends...

Methodological Review of Sampling Procedures for Rural Dwelling Sexual and Gender Minority People

Purpose : The purpose of this paper was to review the methodological sampling and recruitment decisions of extant studies that included rural dwelling sexual and gender minority populations. Design and Sample : This review searched PubMed, CINAHL, and SCOPUS for papers using the following inclusion criteria: a) English language; b) primary quantitative research published in the last 10 years, and; c) included a rural adult sexual or gender minority sample from the United States. Exclusion criteria included: a) duplicate studies; b) datasets older than 10 years; c) secondary data, and; d) did not differentiate between rural and non-rural samples. Thirteen articles were included in the final review. Results : This review identified the data collection approaches, rural classification systems, recruitment strategies, and sample demographics. Five areas were identified as needing further discussion, including the lack of dissimilar research topics, predominant focus on men, missed opportunity to identify transgender people, using social networks and smartphone applications as data collection strategies, and inconsistent rural classification systems. Conclusions : Researchers should capitalize on social networking and smartphone platforms. Future research should include sexual minority women, transgender people, more racial and ethnic minorities, and expand beyond sexual health topics. Researchers should also use objective rural classification systems. Keywords : Review; Homosexuality; Sexual Minorities; Transgender Persons; GLBT; Rural Population DOI: http://dx.doi.org/10.14574/ojrnhc.v17i2.448

The Relationship between of Rural Accessibility and Development

Rural accessibility has been an important issue for development. As wider accessibility allow people to increase their living standard, there is an urgency to compose a single indicator to measure accessibility. The World Bank has been produced Rural Access Index (RAI). That index measure the percentage of rural population living within two kilometers from all-season road. Even though this index is useful to compare among countries, there are obstacles experienced especially in developing countries like Indonesia. The first barrier is data availability. Then, the second barrier is the unequal population distribution in Indonesia. However, the index is still needed to solve many problems in Indonesia, e.g. health and lack of infrastructure. Keywords : Rural Access Index (RAI), accessibility, rural area JEL Classification : O18, R11, R12

The Relationship between of Rural Accessibility and Development

Rural accessibility has been an important issue for development. As wider accessibility allow people to increase their living standard, there is an urgency to compose a single indicator to measure accessibility. The World Bank has been produced Rural Access Index (RAI). That index measure the percentage of rural population living within two kilometers from all-season road. Even though this index is useful to compare among countries, there are obstacles experienced especially in developing countries like Indonesia. The first barrier is data availability. Then, the second barrier is the unequal population distribution in Indonesia. However, the index is still needed to solve many problems in Indonesia, e.g. health and lack of infrastructure. Keywords : Rural Access Index (RAI), accessibility, rural area JEL Classification : O18, R11, R12