Rural Ohio Research Articles

Evaluating fentanyl test strips as a harm reduction strategy in rural and urban counties: study protocol for a randomized controlled trial

BackgroundOpioid-related fatalities are a leading cause of death in Ohio and nationally, with an increasing number of overdoses attributable to fentanyl. Rapid fentanyl test strips can identify fentanyl and some fentanyl analogs in urine samples and are increasingly being used to check illicit drugs for fentanyl before they are used. Fentanyl test strips are a promising harm reduction strategy; however, little is known about the real-world acceptability and impact of fentanyl test strip use. This study investigates fentanyl test strip distribution and education as a harm reduction strategy to prevent overdoses among people who use drugs.MethodsThe research team will recruit 2400 individuals ≥ 18 years with self-reported use of illicit drugs or drugs purchased on the street within the past 6 months. Recruitment will occur at opioid overdose education and naloxone distribution programs in 16 urban and 12 rural Ohio counties. Participating sites will be randomized at the county level to the intervention or non-intervention study arm. A brief fentanyl test strip educational intervention and fentanyl test strips will be provided to participants recruited from sites in the intervention arm. These participants will be eligible to receive additional fentanyl test strips for 2 years post-enrollment. Participants recruited from sites in the non-intervention arm will not receive fentanyl test strip education or fentanyl test strips. All participants will be followed for 2 years post-enrollment using biweekly, quarterly, and 6-month surveys. Primary outcomes include (1) identification of perceived barriers and facilitating factors associated with incorporating fentanyl test strip education and distribution into opioid overdose education and naloxone distribution programs; (2) differences in knowledge and self-efficacy regarding how to test drugs for fentanyl and strategies for reducing overdose risk between the intervention and non-intervention groups; and (3) differences in non-fatal and fatal overdose rates between the intervention and non-intervention groups.DiscussionFindings from this cluster randomized controlled trial will contribute valuable information about the feasibility, acceptability, and impact of integrating fentanyl test strip drug checking in rural and urban communities in Ohio and help guide future overdose prevention interventions.Trial registrationClinicalTrials.gov NCT05463341. Registered on July 19, 2022. https://clinicaltrials.gov/study/NCT05463341

From Jamestown to Bethlehem: Local connections of geopolitical violence

In this visual intervention, I demonstrate connections between Israel’s military occupation of the West Bank and rural Jamestown, Pennsylvania, USA, through 14 photos of surrounding landscapes. This intervention demonstrates how local geopolitical landscapes between two settler colonial nations perpetuate violence in the occupied Palestinian Territory (oPT), specifically through photos of “less-lethal munitions” in the West Bank and the site near the Pennsylvania manufacturer. While many scholars have demonstrated how US media and broader geopolitical discourses shape violence in everyday, intimate ways on bodies and people, this photo essay demonstrates how geopolitical violence and rhetoric manifest in everyday, local landscapes. Photos in this essay come from Aida Camp in the occupied West Bank outside of Bethlehem and rural Ohio and Pennsylvania, USA, on the route to where Combined Systems, Inc. manufactures rubber bullets, tear gas canisters, and other “less-lethal munitions and launching systems” deployed by the Israeli Security Force (ISF) in Aida.

Primary care professionals' perspectives on tailoring buprenorphine training for rural practice.

Buprenorphine is a highly effective medication for opioid use disorder (OUD) that remains substantially underutilized by primary care professionals (PCPs). This is particularly true in rural communities, which have fewer prescribers and significant access disparities. The Drug Enforcement Administration removed the X-waiver requirement in December 2022, yet many rural clinicians still report barriers to prescribing buprenorphine. In this study, we examined rural PCPs' experiences with buprenorphine to identify tailored training strategies for rural practice. Physicians, nurse practitioners, and physician associates practicing in rural Ohio counties were recruited through contacts at statewide health associations and health professions training programs. Twenty-three PCPs were interviewed about their perspectives on prescribing buprenorphine, including their training history. PCPs self-reported being motivated to respond to OUD. However, they also reported that current training efforts failed to equip them with the knowledge and resources needed to prescribe effectively, and that urban-focused training often alienated rural clinicians. Participants suggested tailoring training content to rural settings, using rural trainers, and bolstering confidence in navigating rural-specific barriers, such as resource deficits and acute opioid fatigue. Our study found that current training on buprenorphine prescribing is inadequate for meeting the needs of rural PCPs. Tailored buprenorphine training is needed to improve accessibility and acceptability, and to better support the clinical workforce in communities disproportionately impacted by the opioid epidemic.

Food insecurity, fruit and vegetable consumption, and use of the Supplemental Nutrition Assistance Program (SNAP) in Appalachian Ohio.

Food insecurity and inadequate nutrition are two major challenges that contribute to poor health conditions among U.S. households. Ohioans continue to face food insecurity, and rates of food insecurity in rural Southeast Ohio are higher than the state average. The main purpose of this project is to evaluate the associations between Supplemental Nutrition Assistance Program (SNAP) participation and food security in rural Ohio, and to explore the association between SNAP participation and fruit/vegetable consumption. We control for food shopping patterns, such as shopping frequency, because previous research reports a significant relationship between shopping patterns and food security. To achieve our purpose, we use novel household-level data on food insecurity and SNAP participation in rural Southeast Ohio, collected during the COVID-19 pandemic. We find that people who experience higher levels of food insecurity than others are more likely to participate in SNAP, though this is likely a function of selection bias. To correct for the bias, we employ the nearest neighbor matching method to match treated (SNAP participant) and untreated (similar SNAP nonparticipant) groups. We find that participating in SNAP increases the probability of being food secure by around 26 percentage points after controlling for primary food shopping patterns. We do not find any significant association between SNAP participation and estimated intake of fruits and vegetables. This study provides policymakers with suggestive evidence that SNAP is associated with food security in rural Southeast Ohio during the pandemic, and what additional factors may mediate these relationships.

Geographic Distribution of Social Service Resources for Stroke Survivors in Ohio Varies by Rurality.

Both social service resources and stroke prevalence vary by geography, and health care resources are scarcer in rural areas. We assessed whether distributions of resources relevant to stroke survivors were clustered around areas of the highest stroke prevalence in Ohio and whether this is varied by rurality using an ecological study design. Census tract (CT)-level self-reported stroke prevalence estimates (Centers for Disease Control and Prevention PLACES-2019 Behavioral Risk Factor Surveillance System) were linked with sociodemographic and rurality data (2019 American Community Survey) and geographic density of resources in Ohio (2020 findhelp data). Resources were grouped into categories: housing, in-home, financial, transportation, education, and therapy. Negative binomial regression models estimated the mean number of resources within 25 miles and 30 minutes of a CT centroid and quartiles of stroke prevalence for each resource group by rurality status (rural, urban, and suburban). Models were sequentially adjusted for total population and CT demographics. In Ohio, stroke prevalence was 3.9% (0.4%-14.2%). The highest stroke prevalence quartile (versus lowest) was associated with fewer resources within 25 miles overall (resource ratio [RR], 0.57-0.98). The most pronounced disparities were in rural CT; rural CTs with the highest quartile stroke prevalence had fewer housing (RR, 0.49 [95% CI, 0.32-0.75]), in-home (RR, 0.31 [95% CI, 0.20-0.49]), and therapy (RR, 0.23 [95% CI, 0.13-0.43]) resources compared with those with the lowest quartile stroke prevalence (reference: mean, 1.2 housing, 5.1 in-home, and 4.9 therapy resources, respectively). Rural disparities no longer persisted after adjustment for federal poverty limit (rural: housing [RR, 0.69 (95% CI, 0.40-1.20)], in-home [RR, 0.65 (95% CI, 0.34-1.23)], and therapy [RR, 0.66 (95% CI, 0.33-1.32)]). Stroke social service resources are inversely distributed relative to stroke prevalence in Ohio, particularly in rural areas. This inverse link in rural Ohio is likely explained by geographic differences in poverty. Stroke-specific resource-related interventions may be needed and should consider the roles of rurality and poverty.

Engaging, empowering, and evaluating farm-to-school projects with photovoice

This case study describes how we used photovoice as an engagement, empowerment, and evaluation tool in a farm-to-school project with food service staff in rural Ohio. We explain why we chose the visual narrative approach, working in a school set­ting, addressing institutional review board proto­cols, training, building trust with participants, and the outcomes. We provide lessons learned and suggestions for how other farm-to-school projects can use this tool for broader engagement, empow­erment, and evaluation, especially when working with hard-to-reach or vulnerable populations.

Effects Of A Telephone-based Lifestyle Intervention On Mobility Performance And Mobility-related Self-efficacy Among Rural Ohio Residents

Effects Of A Telephone-based Lifestyle Intervention On Mobility Performance And Mobility-related Self-efficacy Among Rural Ohio Residents

Changes In Weight, Body Composition, And Biomarkers After A Lifestyle Intervention Among Rural Ohio Residents

Changes In Weight, Body Composition, And Biomarkers After A Lifestyle Intervention Among Rural Ohio Residents

Physical Activity And Dietary Changes Following A Telephone-based Lifestyle Intervention Among Rural Ohio Residents

Physical Activity And Dietary Changes Following A Telephone-based Lifestyle Intervention Among Rural Ohio Residents

Implementing the Better Starts For All Pilot Mobile and Telehealth Intervention in Ohio Appalachia: Improving Access to Maternal Healthcare

Abstract: Introduction. Women in Ohio Appalachia experience greater maternal health disparities relative to the general U.S. population, resulting in poorer health outcomes. This paper describes the Ohio Better Starts for All (BSFA) program that provides mobile maternal health services in rural Ohio. Methods. This three-year intervention was delivered through a community-clinical partnership in Ohio Appalachia. The program's preliminary evaluation and opportunities were informed by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Results. Over six months, 86 patients were referred to the BSFA program, 54 (62.8 %) were seen by the maternal care team, and 14 out of 19 scheduled clinic days were held. Five clinics were canceled due to inclement weather, mobile unit breakdown, or provider COVID-19 infection. Discussion. Maternal care providers must provide equitable care to patients, with particular attention to those who face substantial challenges accessing obstetric services. The BSFA program offers one promising solution to help women overcome barriers to accessing care.

5 Questions for Idra Novey

5 Questions for Idra Novey Michelle Johnson (bio) and Idra Novey (bio) IN TAKE WHAT YOU NEED, Idra Novey's third novel, a woman who fled her childhood in the Allegheny Mountains endures an uneasy return when her stepmother, Jean, dies. There in her Rust Belt hometown, Leah is astonished to find Jean's metal sculptures, what Jean called her Manglements. In this novel of ideas with a propulsive plot, characters take what's discarded—from a desolate landscape and damaged relationships—and make something meaningful. Click for larger view View full resolution Q Take What You Need is set in the southern Allegheny Mountains, in a town painted in desolation with its boarded-up storefronts and empty, condemned houses, "the hulking emptiness of the mills." The airport is long-gone, the hospital closed, but political polarization is present. I read the novel as, among other things, a Rust Belt novel. Why did you decide to write a novel set in the Rust Belt? A One in four people in this country is estranged from a close relative. During the previous administration, I had an intense disagreement with one of my siblings that led to a prolonged, painful estrangement. I couldn't find any novels that addressed the psychic cost of cutting off communication with a sibling or parent over a political divide. As I have in all my novels, I decided to write the scenes I longed to read. This novel takes place in the Rust Belt region of western Pennsylvania where parts of my family have lived for over a century, and still live. I've come to see the upsides of that rural reality with new eyes, returning now with my children, playing with them in the same creek where I played as a kid. Yet some of the statements on billboards around town, on the signs in people's yards, are terrifying. This novel became a way to think more deeply about that dissonance, how the [End Page 19] ongoing experience of political polarization is impacting me and my children in ways we may not realize for years to come. Click for larger view View full resolution Q What other Rust Belt literature would you recommend? A Hanif Abdurraqib is a superb writer from Columbus, Ohio. I loved the poems in his collection The Crown Ain't Worth Much. One of my favorite novels set in the Rust Belt, During the Reign of the Queen of Persia, by Joan Chase, came out in the 1980s. It's a quietly radical novel about women's stifled lives in rural Ohio, the covert ways they seek pleasures denied to them. Q Louise Bourgeois and Agnes Martin appear throughout the novel, with Jean quoting them, relying on their wisdom for guidance. How did these two artists come to feature so prominently in the novel? A Louise Bourgeois entered the novel after finding a beat-up book of her writing at a flea market. Bourgeois's insights on sexuality and power, on her father, aligned potently with Jean's artistic drive. Bourgeois recognized the libidinal forces fueling her sense of defiance. Agnes Martin's writing aligned with Jean's process in other aspects. Martin chose to retreat and work in complete solitude in her later years. While writing Jean's chapters, I also immersed myself in the writing of Anne Truitt, Celia Paul, Hilma af Klint, and many other women artists. They were all repeatedly dismissed and written off, and yet somehow still found the conviction to keep taking their art seriously. Writing about Jean's nerve to keep getting on her ladder, stacking her Manglements as high as her room allowed, was a deeply joyful and rewarding process. Q In specific moments with both Jean and Leah, we see reflections that could apply broadly to a polarized society. For example, Jean reflects on how isolation takes away the pressure to explain things, to make sense to other people or yourself, and when she and Leah are hurtling down the mountain, arguing about the local men they met on the cliff, Leah imagines them crashing while "arguing over them with such intensity that we lost all sense of our own...

The feasibility of a telephone-based weight loss intervention in rural Ohio: A pilot study.

Weight loss through lifestyle modification can produce health benefits and may reduce cancer risk. The goal of this study was to examine the feasibility of and adherence to a 15-week telephone-based weight loss intervention in rural Ohio, an area with high rates of obesity. This pilot 2-arm randomized controlled study was designed for rural Ohio residents who were overweight or obese. Eligible participants were 2:1 randomly assigned to either a 15-week weight loss intervention group or active control group. The weight loss intervention group received weekly telephone sessions to improve healthy diet and increase physical activity. The active control group received education brochures with information on physical activity and dietary guidelines. Feasibility was defined as at least 80% of participants completing the follow-up surveys, and acceptable adherence was defined as the percentage of participants in the weight loss group who attend ≥75% of weekly telephone sessions. A total of 423 individuals entered the online screening survey, 215 (50.8%) completed the survey, and 98 (45.6%) of those were eligible. Forty eligible individuals were enrolled and randomly assigned to the weight loss group (n = 27) or active control group (n = 13). The average age of the weight loss group was 49 (SD = 10) years, and 89% were female. The average age of the active control group was 51 (SD = 9) years, and 92% were female. Feasibility was demonstrated: 90% of participants completed the online follow-up surveys at 15-weeks. Among participants in the weight loss group, 22 out of 27 (81.5%) completed the 15-week intervention, the average number of sessions attended was 9.7 (64.9%). Adherence to the intervention was rated as acceptable among almost half of the group (48.1%). Feasibility of a 15-week telephone-based weight loss study among rural residents with overweight/obesity were determined. A future study will test this intervention for weight loss efficacy.

Abstract 45: Geographic Distribution Of Social Service Resources For Stroke Survivors In Ohio Varies By Rurality

Introduction: The availability of social services resources and stroke prevalence vary by geography. We assessed whether distributions of resources relevant to stroke survivors were clustered around areas of highest stroke prevalence in Ohio and if this varied by rurality. Methods: Census tract (CT) level self-reported stroke prevalence estimates (CDC PLACES-2019 Behavioral Risk Factor Surveillance System) was linked with sociodemographic and rurality data (2019 American Community Survey) and geographic density of resources in Ohio (2020 findhelp—search engine connecting individuals to a network of area social services). Resources were grouped into categories: housing, in-home, financial, transportation, education, and therapy. Negative binomial regression models estimated mean number of resources within 25 miles of a CT centroid and quartiles of stroke prevalence for each resource group and stratified by rurality status (rural, urban, and suburban). Models were sequentially adjusted for total population and CT level demographics. Results: The highest stroke prevalence quartile was associated with fewer resources within 25 miles compared to the lowest quartile overall (Prevalence Ratios (PR): 0.57-0.98), but this varied by rurality with the most pronounced disparity in rural CT ( p <0.05 for all resource categories). Rural CTs with the highest quartile stroke prevalence had fewer housing PR: 0.49 (95% CI: 0.32, 0.75), in-home PR: 0.31 (0.20, 0.49), and therapy PR: 0.23 (0.13, 0.43) resources compared to those with the lowest quartile stroke prevalence. Rural disparities became null after adjustment for federal poverty limit (FPL), supporting FPL as a mediator of this association. Conclusions: The inverse link between stroke prevalence and resource availability in rural Ohio is likely explained by geographic differences in poverty. Stroke-specific resource-related interventions are likely needed and should consider the role poverty.

Namesake

Namesake Remi Recchia (bio) Named after a medieval French bishop, a transgender poet and essayist reflects on the inheritances we’re born with and those we fashion for ourselves. Click for larger view View full resolution TRANSFER OF SAINT REMI RELICS, STAINED GLASS WINDOW IN THE BASILICA OF SAINT CLOTILDE IN PARIS, FRANCE A blinding light filled the sanctuary as the two vials, once empty, filled with chrism and oil of the catechu-mens. Candles dimmed in the wake of the sharp white light. The onlookers watched the vials with disbelief, but the moribund pagan had eyes only for Remigius, archbishop of Reims. Documentation of the legend of the Baptism of the Moribund Pagan, also known as Remigius and the Holy Ampulla, does not include description of white light, a shocked congregation, or a mesmerized pagan. In truth, the sixth-century baptism of a dying man may have been a nonevent with the exception of the miraculously filled baptismal artifacts. In his early twenties, Remigius was ordained as the archbishop of Reims in 459. He is most known for converting Clovis, king of the Franks, to Christianity in 496, along with three thousand of the king’s followers. Theologians credit the canonized archbishop with the miracle performed in the Baptism of the Moribund Pagan, a [End Page 18] miracle confirmed upon the discovery of the same vials emitting an “unworldly” fragrance when his tomb was opened during the reign of Charles the Bald. _______ My own connection to France runs deep. My mom, a French professor and medievalist, went on sabbatical in 2000 in pursuit of Saint Martial, taking my dad, my twin sister, and me with her to Bretagne, or Brittany. Brittany is a rainy province in northern France, primarily dairy country, that draws much of its revenue from the local farming industry. Neither my sister nor I spoke French; it was a quick learning curve. By the end of our fourteen months there—at the end of which we would be eight years old—we would be fluent. After spending our seventh birthday in Paris, we arrived in Brittany for what would be my sister’s and my second-grade year. My parents had rented what had once been an old chateau called Tréhorenteuc, or Tregarantec, which was now a dairy farm, except we weren’t staying in the chateau proper—we lived in a section of the property that was just outside the big house. On the phone years later, my mom describes the grand chateau as shaped like a huge semicircle, or something U-shaped. Our part of the property was at the end of one of the hedges of the semicircle. Our own French haven. Tregarantec was in the small village of Mellionec. Mellionec’s geographical landscape is similar to rural Ohio or Michigan in soft rain with cows and abandoned wells and tractors. Tregarantec was a seventeenth-century chateau; my mom tells me now that it was rumored to have been a gift to one of Louis XIV’s mistresses. Our living space had two floors with the kitchen on the first floor and one or two bedrooms on the second floor. A clothesline ran through my parents’ bedroom, safe inside because it rained so frequently in Brittany. The kitchen was a claustrophobia of walls and cupboards. My sister and I went to a Catholic school in the nearby town of Rostrenen called L’École Notre Dame. Though Catholic in name, it was run fairly secularly according to my mom, and it cost a mere ten euros, or eleven US dollars, a month. Our dad drove us down the long dirt driveway from Tregarantec each day. We had to time our arrival and departure perfectly so as not to get stuck behind the cows on their way to the milking parlor at regular intervals throughout the day. Sometimes if we were running late, we had to duck beneath the electric wire to get in the car. It was my favorite game. I do not think I can offer anything new on the trope of foreboding nuns at Catholic school, but I will try. I remember that the nuns did not preside over...

‘Doomscrolling’ in my backyard: Corrosive online communities and contested wind development in rural Ohio

Wind energy development in the rural U.S. remains locally contentious across geographies and social groups. These development decisions are often debated on social media sites, where individuals seek out information and share ideas related to risks and benefits of development. This research examines content from two anti-wind Facebook Community Pages (FCPs) focused on northwestern Ohio. We apply the corrosive community framework to categorize discourse around the framework's three major themes of health risk, recreancy, and litigation, and observe differences in numbers and types of social media activity before and after development and among local and non-local actors. We describe the role social media plays in mediating public discourse in local siting decisions and acts to situate online networks within physical places. We find the corrosive community framework a useful lens to analyze online-community conflicts around wind energy and categorize discourse around wind energy opposition. As public discourse moves increasingly to social media networks, understanding FCPs as a form of community can provide a framework for organizing and analyzing social conflicts and their local-nonlocal connections.

Health Behavior Resources Available to Farmers in Rural Ohio

ABSTRACT Poor health habits correlate with morbidity and mortality. Rural communities often have decreased access to prevention programs and health care. As a state highly dependent on agriculture, this study identifies rural health services for Ohio farmers. This cross-sectional, descriptive study surveys key informants in Ohio at rural health clinics, critical access hospitals, health departments, Ohio State University (OSU) Extension offices, migrant clinics, and Federally Qualified Health Centers about the types of services available to address eight health behaviors. Key informants were invited via email and U.S. Postal Service to complete an electronic survey. After service types were identified, additional information to describe format, barriers to delivery and perceived importance of the service was asked. Of Ohio’s 75 rural counties, 51 counties are represented in the data by at least one participating organization. Nutrition/healthy eating-related health services are provided most often by organizations (95.8%) and sleep services were least often reported (49.5%). The other health behaviors services (sun/UV exposure, physical activity, mental health, tobacco cessation, alcohol/substance abuse, and opioid abuse) fell in-between. Organizations are most likely to offer health education resources in print or web-based format across all health behaviors except for sleep, where social media promotion are the most common. The largest barrier to providing any type of health service is a lack of personnel. Providing health behavior services to farmers and farm families is important for improving their overall health. Documenting available services will assist the rural health community in future collaborative wellness projects.

High School Students as Citizen Scientists to Decrease Radon Exposure

Residents in rural Kentucky (KY) and suburban Ohio (OH) expressed concerns about radon exposure and lung cancer. Although 85% of lung cancer cases are caused by tobacco smoke, radon exposure accounts for 10–15% of lung cancer cases. Academic and community members from the University of KY and the University of Cincinnati developed and pilot-tested a family-centered, youth-engaged home radon testing toolkit. The radon toolkit included radon information, and how to test, interpret, and report back findings. We educated youth as citizen scientists and their teachers in human subjects protection and home radon testing using the toolkit in the classroom. Youth citizen scientists explained the study to their parents and obtained informed consent. One hundred students were trained in human subjects protection, 27 had parental permission to be citizen scientists, and 18 homeowners completed surveys. Radon values ranged from < 14.8 Bq/m3 to 277.5 Bq/m3. Youth were interested and engaged in citizen science and this family-centered, school-based project provided a unique opportunity to further the healthy housing and quality education components of the Sustainable Development Goals for 2030. Further research is needed to test the impact of student-led, family-centered citizen science projects in environmental health as part of school curricula.

COVID-19 Outbreak in an Amish Community - Ohio, May 2020.

In the United States, outbreaks of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), were initially reported in densely populated urban areas (1); however, outbreaks have since been reported in rural communities (2,3). Rural residents might be at higher risk for severe COVID-19-associated illness because, on average, they are older, have higher prevalences of underlying medical conditions, and have more limited access to health care services.* In May, after a cluster of seven COVID-19 cases was identified in a rural Ohio Amish community, access to testing was increased. Among 30 additional residents tested by real-time reverse transcription-polymerase chain reaction (RT-PCR; TaqPath COVID-19 Combo Kit),† 23 (77%) received positive test results for SARS-CoV-2. Rapid and sustained transmission of SARS-CoV-2 was associated with multiple social gatherings. Informant interviews revealed that community members were concerned about having to follow critical mitigation strategies, including social distancing§ and mask wearing.¶ To help reduce the ongoing transmission risk in a community, state and county health department staff members and community leaders need to work together to develop, deliver, and promote culturally responsive health education messages to prevent SARS-CoV-2 transmission and ensure that access to testing services is timely and convenient. Understanding the dynamics of close-knit communities is crucial to reducing SARS-CoV-2 transmission.

Fiscal Stress, Small Towns, and Professionalism: An Analysis of Post-Recessionary Budgetary Retrenchment Policy among Rural Ohio Rustbelt Towns

This conference paper pertaining to the study of small Ohio town budgetary policy focuses on the challenges related to fiscal stress of rust belt twilight communities. It was found that smaller, less professionalized towns facing higher property delinquency rates, with high concentrations of elderly and minority populations were unwilling to depart from conventional budgetary behavior to offset budgetary shortfalls. Such twilight towns were less politically resilient than those with access to skilled professional staffing. This knowledge of access to in-house professionalism can be helpful in future policy guidance needed to offset fiscal imbalances faced by small town officials.

Nuclear Reaction: The History of Financing a Rural Ohio School District Heavily Exposed to Nuclear Power Plant Valuation from 1970-2020

Nuclear Reaction: The History of Financing a Rural Ohio School District Heavily Exposed to Nuclear Power Plant Valuation from 1970-2020