Rural Hispanics Research Articles

Investigating the Relationship Between Marital Status and Ethnicity on Neurocognitive Functioning in a Rural Older Population: A Project FRONTIER Study.

Research indicates being married is related to better physical and psychological health. Little is known regarding the relationship between marital status and neurocognitive functioning and whether it differs based on ethnicity (Hispanic vs non-Hispanic). This is the first study to examine this relationship in a sample of aging adults in rural Texas. Data from 1,864 participants (Mage = 59.68, standard deviation [SD]age = 12.21), who were mostly Hispanic (n = 1,053), women (n = 1,295), and married (n = 1,125) from Project Facing Rural Obstacles to Healthcare Now Through Intervention, Education, & Research were analyzed. Neuropsychological testing comprised Repeatable Battery for the Assessment of Neuropsychological Status, Trails Making Test, and Clock Drawing. Participants were dichotomized, married, and unmarried. There was a significant interaction between Hispanic identity and marital status on overall neurocognitive functioning (F(1, 1,480) = 4.79, p < .05, ηp2 = 0.003). For non-Hispanic individuals, married individuals had higher overall neurocognitive functioning compared to unmarried individuals, whereas neurocognitive functioning for Hispanic individuals did not significantly differ between married and unmarried individuals. There were significant main effects as married individuals (M = 84.95, SD = 15.56) had greater overall neurocognitive functioning than unmarried individuals (M = 83.47, SD = 15.86; F(1, 1,480) = 14.67, p < .001, ηp2 = 0.01), Hispanic individuals (M = 78.02, SD = 14.25) had lower overall neurocognitive functioning than non-Hispanic individuals (M = 91.43, SD = 15.07; F(1, 1,480) = 284.99, p < .001, ηp2 = 0.16). Hispanics living in rural areas experience additional stressors that could lead to worse neurocognitive functioning, which is supported by the Lifespan Biopsychosocial Model of Cumulative Vulnerability and Minority Health, which postulates that race/ethnicity/socioeconomic-status-related stressors exacerbate the impact of other life stressors. Reduction of stress on rural Hispanics should be a priority as it could positively affect their neurocognitive functioning.

Differences in Chronic Pain Care among Veterans from Differing Racial and Ethnic Groups: Primary Care, Pain Clinic, Physical Therapy and Emergency/urgent Care Visits

An abundance of research provides evidence for racial and ethnic minorities receiving less effective chronic pain treatment. As chronic pain disproportionately impacts US Military Veterans and has substantial physical, psychological, and societal consequences, the purpose of the current study was to identify differences in chronic pain care for African Americans, Asian Americans, and Hispanics, compared to Whites in the Veterans Health Administration. A chronic pain cohort was examined (N = 2,135,216) using VA administrative data from 2018. For each health care utilization variable, multivariate log binomial regression models compared differences between racial/ethnic groups and interactions with rural/urban residence. Additionally, an a priori definition of clinical significance was established due to the large sample size. Clinical significance was achieved if the aRR point estimate was < 0.91 or > 1.10 and was statistically significant. The current study found no differences in pain-related primary care visits among all racial/ethnic groups but did find that African Americans and Asian Americans were less likely to visit pain clinics. Rurality further decreased the likelihood of African Americans receiving pain clinic visits. African Americans were most likely to have pain-related physical therapy visits (aRR = 1.17, 95% CI: 1.16-1.18), followed by Hispanics (aRR = 1.10, 95% CI: 1.08-1.11), relative to Whites. However, this did not hold true with rural Hispanics (aRR = 0.97, 95% CI: 0.92-1.02). For emergency or urgent care visits, African Americans and Hispanics were both more likely to have chronic pain-related visits (aRR = 1.32 and 1.10). All interactions concerning rurality and emergency and urgent care were significant except for rural Hispanics who were less likely to receive emergency room or urgent care visits. The findings from the current study may be useful in further improving the Stepped Care Model of Pain Care to address differences in pain clinic and emergency/urgent care visits. Grant support from the Office of Rural Health grant #16023.

Disparities in Care Experienced by Older Hispanic Medicare Beneficiaries in Urban and Rural Areas.

Hispanic older adults face substantial health disparities compared with non-Hispanic-White (hereafter "White") older adults. To the extent that these disparities stem from cultural and language barriers faced by Hispanic people, they may be compounded by residence in rural areas. The objective of this study was to investigate possible interactions between Hispanic ethnicity and rural residence in predicting the health care experiences of older adults in the United States, and whether disparities in care for rural Hispanic older adults differ in Medicare Advantage versus Medicare Fee-for-Service. Medicare beneficiaries age 65 years and older who responded to the 2017-2018 nationally representative Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. We fit a series of linear, case-mix-adjusted models predicting Medicare CAHPS measures of patient experience (rescaled to a 0-100 scale) from ethnicity, place of residence, and Medicare coverage type. In all residential areas, Hispanic beneficiaries reported worse experiences with getting needed care (-3 points), getting care quickly (-4 points), and care coordination (-1 point) than White beneficiaries (all P's<0.001). In rural areas only, Hispanic beneficiaries reported significantly worse experiences than White beneficiaries on doctor communication and customer services (-3 and -9 points, respectively, P<0.05). Tests of a 3-way interaction between ethnicity, rural residence, and coverage type were nonsignificant. There is a need to improve access to care and care coordination for Hispanic beneficiaries overall and doctor-patient communication and customer service for rural Hispanic beneficiaries. Strategies for addressing deficits faced by rural Hispanics may involve cultural competency training and provision of language-appropriate services for beneficiaries (perhaps as telehealth services).

Preferred HPV and HPV Vaccine Learning Methods to Guide Future HPV Prevention Interventions Among Rural Hispanics

PurposeHPV vaccination among United States's rural Hispanic youth is suboptimal to the Healthy People 2030 goal. Rural Hispanic parents' HPV vaccine (HPVV) perceptions have influenced these low rates. Furthermore, few effective interventions for increasing HPV vaccination among rural Hispanic populations exist. This study aimed to determine rural Hispanic parent's preferred HPV and HPVV learning methods to guide future HPV prevention interventions. Design and methodsA descriptive qualitative design was used. A total of 23 rural Hispanic parents from South Florida participated in four focus groups. Conventional content analysis was used to analyze the transcripts. ResultsThree overcharging themes were identified: 1) Learning method preferences for parents, 2) Learning method preferences for youth, and 3) Learning method preferences for families. Sub-themes included participants' preferences on their interest for an intervention, target audiences, teaching methods, availability of community members, intervention facilitators, and content. ConclusionsAddressing HPV vaccination by developing culturally tailored programs for rural Hispanic parents is urgently needed to prevent HPV and HPV-related cancers among this disproportionately affected population. Findings highlight essential elements that should be considered when designing an intervention for increasing HPV vaccination among Hispanics in rural settings. Practice implicationsPediatric nurses must offer culturally appropriate HPVV education and literature and proactively recommend the HPVV at every opportunity. Pediatric nurses can administer the HPVV at schools and community health fairs while clinics can play educational clips in waiting and examination rooms.

1400-P: Rural/Urban Residence and Race/Ethnicity Differences in All-Cause Mortality Trends among Medicare Beneficiaries with Diabetes, 2001-2016

To examine rural/urban and racial/ethnic differences in all-cause mortality from 2001-2016 among older U.S. adults with diabetes, we used Medicare claims data linked to the National Death Index. We identified beneficiaries aged ≥67y who were enrolled in fee-for-service (FFS) plans with diabetes. Rural/urban residence was based on the 2016 Medicare core-based statistical area classification. Race/ethnicity was classified as: non-Hispanic white (NHW), non-Hispanic black (NHB), Asian/Pacific Islander (API), and Hispanic (HISP). Rates were age-/sex-standardized to the 2001 FFS population. From 2001 to 2016, there were absolute declines in mortality in all rural/urban and racial/ethnic subgroups (all p&amp;lt;0.001; Figure). By 2016, mortality rates were higher among rural residents (vs. urban) for all racial/ethnic groups (rate ratios: NHW [1.07 (1.06-1.08)]; NHB [1.05 (1.03-1.08)]; API [1.20 (1.09-1.32)], HISP [1.09 (1.05-1.13)]). Reductions in mortality were relatively consistent among rural HISP and API residents (p-trend&amp;lt;0.05); while rates plateaued after 2007 for NHW and after 2011 for NHB rural residents. Among urban residents, reductions in mortality slowed (NHB [2010]; API [2007]) or stalled (NHW [2009]; HISP [2010]) at varying times. Future research may be helpful in addressing mortality disparities in this diverse, aging population. Disclosure K.M. Bullard: None. L.J. Andes: None. S. Saydah: None. D.B. Rolka: None. C. Mercado: None. G. Imperatore: None. S.R. Benoit: None.

Colorectal cancer screening: Understanding the health literacy needs of hispanic rural residents.

PurposeHispanics residing in rural areas are among those who are least likely to be screened for colorectal cancer (CRC) and more likely to present with late stage CRC than other racial or ethnic groups. We conducted a pilot study utilizing a mixed-method approach to explore perceptions of CRC and CRC screening among Hispanic adults residing in South Texas rural communities and to identify health literacy needs associated with CRC screening uptake.MethodsA convenience sample of 58 participants, aged 35–65, were recruited to complete questionnaires and participate in focus groups, ranging in size from 4 to 13 participants. Six focus groups were conducted across 3 adjacent rural counties. A semi-structured moderator's guide was designed to elicit discussion about participants' experiences, knowledge, and perceptions of CRC and CRC screening.FindingsLack of knowledge of CRC and CRC screening as cancer prevention was a common theme across focus groups. A majority, 59%, reported never been screened. Thirty-nine percent reported they had been screened for colon cancer and 5% reported they did not know if they had been screened. Participants with lower educational levels perceived themselves at high risk for developing CRC polyps, would not want to know if they had CRC, and if they did have CRC, would not want to know until the very end. Limited information about CRC and CRC screening, a lack of specialized providers, limited transportation assistance, and compromised personal privacy in small-town medical facilities were perceived to be barriers to CRC screening.ConclusionsLow screening rates persist among rural Hispanics. Improving CRC screening literacy and addressing factors unique to rural Hispanics may be a beneficial strategy for reducing screening disparities in this at-risk population.

Risk of Colorectal Polyps and Malignancies Among Predominantly Rural Hispanics

Colorectal cancer is the fourth most frequently diagnosed cancer. However, due to variations in diet, it was hypothesized that risk of adenomatous or hyperplastic polyps or malignancies would be lower among Hispanics. Participants (n = 1671) underwent a colonoscopy. Results were grouped into one of four groups: normal, hyperplastic polyps only, adenomatous polyps, and malignancies. As expected, Hispanics had a lower risk of hyperplastic (p = .031, OR = 0.47) and adenomatous polyps (p = .031, OR = 0.66) than non-Hispanic Whites. Comparison between malignancies was not possible as no Hispanics had a malignancy. Contrary to expectations, risk of hyperplastic and adenomatous polyps and malignancies were no different between non-Hispanic Blacks and Whites. Among rural and mostly rural populations, Hispanics had a lower risk of hyperplastic and adenomatous polyps.

Bridging the Distance: Common Issues of the Rural West ed. by David B. Danbom

Reviewed by: Bridging the Distance: Common Issues of the Rural West ed. by David B. Danbom J. L. Anderson David B. Danbom, ed., Bridging the Distance: Common Issues of the Rural West. Salt Lake City: University of Utah Press, 2015. 312 pp. $30.00. Bridging the Distance brings together scholars from multiple disciplines to reckon with the issue of the vast space of the rural West. The authors in the collection represent fields as diverse as journalism, law, geography, public health, and history, to name just a few. They engage the history of energy industry, broadband access, small town economies, the Sagebrush Rebellion and more. The collection was born at a conference sponsored by the Bill Lane Center for the American West at Stanford University. To his credit, editor David Danbom has forged those widely divergent approaches and disciplines into a collection that delivers on its promise to show how the expansiveness of the rural West has been a challenge not only for westerners but also for scholars who attempt to make sense of it. Each of the essays engage the topic of bridging physical or cultural distance. Of course, it is impossible to convey a full sense of the ten essays in the book, so a few highlights will suffice. Jon Lauck demonstrates how the West has figured in the historical imagination as well as the importance of regionalism. Historian David Rich Lewis traces the divide between Utah [End Page 89] officials and the Goshute as well as among Goshutes over the suitability and desire for economic development a temporary storage facility for nuclear waste in Skull Valley. State officials went to great lengths to undermine the native decision to bring hazardous waste into Skull Valley even as the state welcomed other toxic waste, some of it more toxic than that proposed by the Goshutes. In an essay on the reporting of a small-town scandal in Colorado, journalism professor Judy Miller describes the importance of the distance between insider and outsider in news reporting. In other essays, readers learn how water and wolves divide communities as well as how rural Hispanics have disproportionately poor health outcomes compared to their urban counterparts and the general population. The collection succeeds in large part because the multidiscipline case-study approach effectively conveys the complexity of the region. Furthermore, every one of the essays directly relates to the issue of distance. Readers learn how rural westerners overcame some problems associated with distance and how they failed to resolve many other problems. Scholars interested in addressing the common issues of the Midwest should pay close attention to Bridging the Distance and draw inspiration from its success. J. L. Anderson Mount Royal University Calgary, Alberta Copyright © 2018 Paul Mokrzycki Renfro

Cultural Norms in Conflict: Breastfeeding Among Hispanic Immigrants in Rural Washington State.

Objectives To examine perceptions, experiences, and attitudes towards breastfeeding among Hispanic women living in rural Washington State. Methods Twenty parous Hispanic women of low acculturation, aged 25-48years and residents in rural Washington State participated in an exploratory, face-to-face interview. Interviews were audio-recorded, translated and transcribed, and analyzed using a thematic content analysis approach. Results Nine emergent themes were grouped into three overarching categories: (1) Breast is best; (2) Hispanic cultural and familial expectations to breastfeed; and (3) Adapting to life in the United States: cultural norms in conflict. Women said they were motivated to breastfeed because of their knowledge and observations of its health benefits for mother and child. They said breastfeeding is ingrained in their Hispanic cultural heritage, and infant feeding choices of female family members were particularly influential in women's own decision to breastfeed. Women said they experienced embarrassment about breastfeeding in the United States and as a result, often chose to initiate formula feeding as a complement so as to avoid feelings of shame. Additionally, they faced economic pressure to work, key barriers for continued breastfeeding among Hispanics in the United States. Conclusions for Practice Knowledge of the benefits of breastfeeding for mother and child and longstanding cultural practices of breastfeeding are not enough to encourage exclusive breastfeeding to 6months among this rural Hispanic population. Continued support through family-level interventions as well as work place policies that encourage breastfeeding are needed for rural Hispanics to reach optimal breastfeeding rates.

Rural Hispanic Health Care Utilization

Background and Research Objective : Minority populations living in rural areas are often disadvantaged in their abilities to access healthcare in their community. To further understand the scope of this problem a sample of adult Hispanics residing in three north central Texas rural counties was studied. Sample and Method: A convenience sample of 386 adult Hispanic residents of three rural counties in north central Texas completed surveys about their utilization of health care services in their communities. Results and Conclusions: 74.4 % were uninsured, 72.3% did not have a primary care physician and 63.6% reported they needed access to more health care. Over the past year 23.3 % reported 1-3 visits to the hospital emergency room for health care. Over half (51.3%) reported the need for a translator when going to the doctor. My conclusion is, rural Hispanics are disadvantaged to health care utilization by a lack of health insurance, language barriers and access to a primary care physician. Key Words : Rural, Access to Health Care, Hispanic

A Qualitative Investigation of Cancer Survivorship Experiences Among Rural Hispanics

Cancer survivorship experiences were explored among Hispanic men and women with cancer and family members of cancer survivors, recruited from two rural Washington communities in the Lower Yakima Valley. Five focus groups were conducted from February 2006 to October 2007 with 31 women and 10 men. Disbelief, fear, sadness, strength, courage, faith, and hope were common reactions to diagnosis. Concerns about family/children, losing medical coupons, and feelings of depression/isolation were identified as challenges faced after diagnosis. Participants identified smoking and environmental exposures as causes of cancer, but many believed operating on tumors caused cancer to spread. Participants used conventional treatments but identified herbal/natural remedies as cures. Most participants reported negative experiences with physicians and believed their community would benefit from language-appropriate information regarding prevention and treatment. The importance of linking survivors through support groups was emphasized and information elicited from sessions has been used to organize survivor support groups in these two communities.

Having a Diagnosis of Diabetes Is Not Associated With General Diabetes Knowledge in Rural Hispanics

The prevalence of diabetes among Hispanics in Washington State is 30% greater than it is for non-Hispanic whites. Hispanics also have higher rates of diabetes-related complications and mortality due to the disease. Although interventions have been developed for the Hispanic community, studies in rural settings are limited. To address this we conducted a study to identify factors associated with general diabetes knowledge in a rural Hispanic population. This study was conducted as part of a larger project in partnership with a local community hospital in Washington State's Lower Yakima Valley. Diabetes knowledge was assessed as part of a screening survey using 5 statements selected from the Diabetes Knowledge Questionnaire. Men and women (N = 1,297) between the ages of 18 and 92 attending community-oriented events took part in the survey. Gender, education, age, birthplace, diabetic status, and family history of diabetes were tested as predictors of diabetes knowledge. Overall, general knowledge was high with 71%-84% of participants responding correctly to 4 of 5 statements, while only 17% of participants responded correctly to a fifth statement. Although no variable was associated with all statements, family history, gender, and education were most frequently associated with knowledge. Diabetic status, age, and birthplace were less often or not associated with the knowledge statements. Contrary to expectations, having a diagnosis of diabetes was not among the factors most frequently associated with diabetes knowledge. Future research should investigate the roles of family history, gender, and diabetic status as conduits of diabetes education among rural Hispanics.

Type 2 Diabetes Among Rural Hispanics in Washington State: Perspectives From Community Stakeholders

During February-March 2006, elicitation interviews were conducted with 23 community stakeholders in the Yakima Valley, Washington State, to examine concerns about diabetes and to obtain recommendations for how to address concerns among Hispanics in this rural community. Using a snowball approach, stakeholders were identified from organizations providing care and outreach for Hispanics with diabetes. Interviews were guided by a social ecology approach and were conducted as part of a larger parent study using principles of community-based participatory research. Audiotaped interviews were transcribed and then coded by three staff members who identified common themes independently before meeting to reach consensus. Stakeholders represented health care delivery or social service organizations, churches, or local radio stations. Diabetes was perceived as an important problem among community members, who often underwent delayed diagnosis of the disease. Lack of disease knowledge, access to appropriate information or services, health insurance, and personal responsibility were perceived as barriers. Stakeholders recommended using exiting organizations and businesses as intervention channels, promoting cultural sensitivity of health professionals and volunteers, creating and distributing appropriate information, and organizing activities to promote awareness and disease management. Recommendations have informed the design of community interventions to lessen the impact of diabetes in the Yakima Valley.

Breast Cancer Screening Program Targeting Rural Hispanics in Southeastern Indiana: Program Evaluation

Breast Cancer Screening Program Targeting Rural Hispanics in Southeastern Indiana: Program Evaluation

Listening to Rural Hispanic Immigrants in the Midwest: A Community-Based Participatory Assessment of Major Barriers to Health Care Access and Use

Hispanic immigrants are increasingly residing in rural communities, including in the midwestern United States. Limitations in the ability of rural Hispanics to access and utilize health care contribute to patterns of poor health and health disparity. A conceptual model of "vulnerability" guides this community-based participatory assessment project designed to explore rural Hispanics' perceived barriers to accessing and utilizing health care. Findings from a series of 19 focus groups with 181 participants from three communities in the upper Midwest identified perceived barriers at the individual and health care system levels. The most commonly perceived barriers were the lack of and limitations in health insurance coverage, high costs of health care services, communication issues involving patients and providers, legal status/discrimination, and transportation concerns. Findings imply that these barriers could be addressed using multiple educational and health service delivery policy-related strategies that consider the vulnerable nature of this growing population.

Conflict over forest resources in Northern New Mexico: Rethinking cultural activism as a strategy for environmental justice

Through an examination of a conflict over the management of forest resources in northern New Mexico between rural Hispanics and white environmentalists, this paper sketches a critique of the use of cultural activism on the part of environmental justice activists as they seek to maintain and diversify their political support base. Using resource mobilization and frame alignment perspectives as a lens on collective action, the central point derived from this analysis is that environmental activism which presumes shared interests on the basis of cultural values runs the considerable risk of losing sight of the structural factors that strongly influence the way ethnic and racial minorities will view environmental issues.

The Changing Spatial Concentration of America's Rural Poor Population*

Abstract This paper documents changing patterns of concentrated poverty in nonmetro areas. Data from the Decennial U.S. Census Summary Files show that poverty rates—both overall and for children—declined more rapidly in nonmetro than metro counties in the 1990s. The 1990s also brought large reductions in the number of high‐poverty nonmetro counties and declines in the share of rural people, including rural poor people, who were living in them. This suggests that America's rural pockets of poverty may be “drying up” and that spatial inequality in nonmetro America declined over the 1990s, at least at the county level. On a less optimistic note, concentrated poverty among rural minorities remains exceptionally high. Roughly one‐half of all rural blacks and one‐third of rural Hispanics live in poor counties. Poor minorities are even more highly concentrated in poor areas. Rural children—especially rural minority children—have poverty rates well above national and nonmetro rates, the concentration of rural minority children is often extreme (i.e., over 80% lived in high‐poverty counties), and the number of nonmetro counties with high levels of persistent child poverty remains high (over 600 counties). Rural poor children may be more disadvantaged than ever, especially if measured by their lack of access to opportunities and divergence with children living elsewhere. Patterns of poverty among rural children—who often grow up to be poor adults— suggest that recent declines in concentrated rural poverty may be short‐lived.

Low-Skill Employment and the Changing Economy of Rural America

This study reports trends in rural low-skill employment in the 1990s and their impact on the rural workforce. The share of rural jobs classified as low-skill fell by 2.2 percentage points between 1990 and 2000, twice the decline of the urban low-skill employment share, but much less than the decline of the 1980s. Employment shifts from low-skill to skilled occupations within industries, rather than changes in industry mix, explain virtually all of the decline in the rural low-skill employment share. The share decline was particularly large for rural Black women, many of whom moved out of low-skill blue-collar work into service occupations, while the share of rural Hispanics who held low-skill jobs increased.

Rural Residence and Hispanic Ethnicity: Doubly Disadvantaged for Diabetes?

Hispanics are at increased risk for diabetes, while rural residents have historically had decreased access to care. To determine whether living in a rural area and being Hispanic confers special risks for diagnosis and control of diabetes. We analyzed the Third National Health and Nutrition Examination Survey (1988-1994). Hispanics and non-Hispanic white adults were classified according to rural/urban residence to create 4 ethnicity-residence groups. Investigated outcomes were previously diagnosed and undiagnosed diabetes. Among those with diagnosed diabetes, we investigated control of glucose, hypertension, and lipids. The prevalence of diagnosed diabetes was greatest for rural residents, especially for rural Hispanics (8.2%) versus that for urban whites (4.6%), rural whites (6.5%), or urban Hispanics (4.5%), (P < .01). However, urban Hispanics were most likely to have undiagnosed diabetes at 3.7%, versus 2.3% of rural whites, 2.8% of urban whites, and 2.7% of rural Hispanics (P = .04). Among people with diagnosed diabetes, there was no difference in glycemic control between the 4 groups. Rural Hispanics with diagnosed diabetes had the greatest prevalence of elevated systolic blood pressure at 45%, compared to 37% of urban whites, 29% of rural whites, 28% of urban Hispanics (P = .01). In regression models controlling for potential confounders, there were no differences among urban and rural whites and Hispanics in the likelihood of undiagnosed diabetes or in glycemic control for those with diagnosed diabetes. Initiatives that target Hispanic health, and especially diabetes, should acknowledge rural/urban Hispanic health differences.

Issues Affecting Utilization of Hospice Services by Rural Hispanics

As the population of Hispanics in the U.S. is growing, their utilization of hospice care remains low. In a study of 110 rural His-panics, most (88%) were not familiar with hospice, but did report willingness to accept such service in their homes. The most important possible barrier to receiving hospice care was language, along with poverty, lack of health insurance, and low levels of education. Hospice social workers can contribute greatly to an effort to increase access to hospice by offering education to the Hispanic community and promoting cultural awareness among hospice staff.