Rural United States Research Articles

Barriers in Office-Based Opioid Treatment in Rural United States

Barriers in Office-Based Opioid Treatment in Rural United States

Assessment of an inpatient dermatology service line in the rural United States.

Assessment of an inpatient dermatology service line in the rural United States.

Implementation of a heart failure disease management program in the rural southern United States: a best practice implementation project.

Heart failure affects thousands of patients annually, often resulting in hospitalization, emergency room visits, and decreased quality of life. The scientific evidence indicates that disease management programs using a multidisciplinary approach improve outcomes for heart failure patients. The overarching aim of this evidence implementation project was to establish a disease management program for heart failure patients. Specifically, the project sought to promote compliance with best practices for the early identification of heart failure exacerbation symptoms to prevent emergency room visits and hospitalizations, thereby reducing morbidity and mortality. This project was guided by the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit strategy. A baseline audit was conducted, revealing the need for a heart failure disease management program. A policy was developed to implement a disease management program and virtual relationships were established to create a multidisciplinary team. A follow-up audit was conducted to determine whether the implemented interventions closed the gap in practice identified by the baseline audit. The baseline audit revealed 0% compliance with best practices for the management of patients with heart failure, while the follow-up audit revealed 93.3% compliance. This project enhanced best practices by implementing a protocol in a rural health clinic to ensure that all heart failure patients were enrolled in a disease management program. Recommendations include using the electronic health record to quickly identify heart failure patients and their status in a disease management program. Chart audits should be performed every 6 months to ensure the program's sustainability and to determine heart failure patients' enrollment status. http://links.lww.com/IJEBH/A270.

Gleaning Rural Journalism: Rural Journalists' Agricultural and Environmental Reporting Utilizing Community Storytelling Networks☆

AbstractEnvironmental concerns are growing in parts of the rural United States as drinking water wells become contaminated with agrichemicals, and climate change impacts such as drought and extreme rain events disrupt farming practices. Analyzing in‐depth interviews with 29 U.S. rural journalists, we explore the role rural journalists play when reporting on the environment as it relates to agricultural issues. Findings show that reporting about the environment—such as weather, climate change, water shortages, and droughts—appear in rural journalists' stories given those topics' relevance to their rural communities and the social systems forces exerting influence on journalists, yet rural journalists often do not perceive themselves as doing environmental reporting. Rural journalists also report lacking training and resources to do environmental reporting. This study points to the need for more support for rural journalists' environmental reporting as one way to build social change and maintain local community.

51089 A critical assessment of inpatient dermatology service line in the rural United States

51089 A critical assessment of inpatient dermatology service line in the rural United States

Sepsis as a driver of excess severe maternal morbidity and mortality in the rural United States

Obstetric sepsis is a leading cause of preventable maternal morbidity and mortality. Pregnant and postpartum patients in rural settings experience disproportionate rates of sepsis and other forms of severe maternal morbidity. Although there have been recent advances in addressing preventable morbidity and mortality from sepsis in the general adult population, combating excess rates of sepsis in the obstetric population, particularly among rural patients, will require targeted clinical and policy interventions.

Additive Benefits of Individual, Relational, and Community Factors on Physical- and Mental-Health Trajectories Among Black Americans

Black Americans have demonstrated significant resilience in the face of stress caused by systemic oppression. This resilience is likely to stem from several factors across socioecological levels, including those internal to the individual (assets) and those external to the individual (resources), but existing work has yet to consider these within an integrated framework. To address this gap, in the current study, we used longitudinal data from 692 Black adults living in the rural southeastern United States to examine the univariate and multivariate effects of individual (religiosity and spirituality), relational (romantic partner support, general social support), and community (neighborhood support) factors on trajectories of depressive symptoms, sleep problems, and general health. Findings revealed univariate and multivariate effects on health, providing evidence of additive benefits from these assets and resources. Greater consideration of strengths and supports across socioecological systems may help inform enhanced preventive interventions for and promote health equity among Black Americans.

The Association between Urinary Metal Levels and Cognitive Decline in a Rural United States Aging Population

The Association between Urinary Metal Levels and Cognitive Decline in a Rural United States Aging Population

The Availability of Midwifery Care in Rural United States Communities.

Access to pregnancy-related and childbirth-related health care for rural residents is limited by health workforce shortages in the United States. Although midwives are key pregnancy and childbirth care providers, the current landscape of the rural midwifery workforce is not well understood. The goal of this analysis was to describe the availability of local midwifery care in rural US communities. We developed and conducted a national survey of rural US hospitals with current or recently closed childbirth services. Maternity unit managers or administrators at 292 rural hospitals were surveyed from March to August 2021, with 133 hospitals responding (response rate 46%; 93 currently offering childbirth services, 40 recently closed childbirth services). This cross-sectional analysis describes whether rural hospitals with current or prior childbirth services had midwifery care with certified nurse-midwives available locally and whether rural communities with and without midwifery care differed by hospital-level and county-level characteristics. Among hospitals surveyed, 55% of those with current and 75% of those with prior childbirth services reported no locally available midwifery care. Of the 93 rural communities with current hospital-based childbirth services, those without midwifery care were more likely to have lower populations (37% vs 33%); majority populations that were Black, Indigenous, and people of color (24% vs 10%); and hospitals where at least 50% of births were Medicaid funded (77% vs 64%), compared with communities with midwifery care. Conversely, communities with midwifery care more often had greater than 30% of patients traveling more than 30 miles for hospital-based childbirth services (38% vs 28%). More than half of rural hospitals surveyed reported no locally available midwifery care, and availability differed by hospital-level and county-level characteristics. Efforts to ensure pregnancy and childbirth care access for rural birthing people should include attention to the availability of local midwifery care.

T149 - Motivation and Context of Concurrent Stimulant and Opioid Use Among Persons who Use Drugs in the Rural United States: A Multi-Site Qualitative Inquiry

T149 - Motivation and Context of Concurrent Stimulant and Opioid Use Among Persons who Use Drugs in the Rural United States: A Multi-Site Qualitative Inquiry

Community-Based Participatory Obesity Prevention Interventions in Rural Communities: A Scoping Review.

Child obesity is a worldwide public health concern. In America, children from rural areas have greater odds of obesity in comparison to those from urban areas. Community-engaged research is important for all communities, particularly under-represented communities. This paper reports the results of a scoping review investigating community-engaged research in obesity prevention programs tested with school-aged children in rural America. A literature search of Medline Ovid was conducted to identify interventions reporting the results of obesity prevention interventions that promoted a healthy diet or physical activity (PA) behaviors to school-age children in rural communities of the United States (US). After title and abstract review, potentially relevant citations were further examined by assessing the full text. Each stage of review was conducted by two independent reviewers. Twelve studies met the inclusionary criteria and are included in this review. Most of the studies focused on elementary school participants (n = 7) and improving both diet and PA (n = 9). Out of the twelve studies, only five included the target audience in intervention development or implementation. The most popular type of community engagement was community participation (n = 4). This review revealed that community-engaged research is under-utilized in obesity prevention interventions tested with school-aged children in rural US communities.

Regime shift in secondary inorganic aerosol formation and nitrogen deposition in the rural United States

Secondary inorganic aerosols play an important role in air pollution and climate change, and their formation modulates the atmospheric deposition of reactive nitrogen (including oxidized and reduced nitrogen), thus impacting the nitrogen cycle. Large-scale and long-term analyses of secondary inorganic aerosol formation based on model simulations have substantial uncertainties. Here we improve constraints on secondary inorganic aerosol formation using decade-long in situ observations of aerosol composition and gaseous precursors from multiple monitoring networks across the United States. We reveal a shift in the secondary inorganic aerosol formation regime in the rural United States between 2011 and 2020, making rural areas less sensitive to changes in ammonia concentrations and shortening the effective atmospheric lifetime of reduced forms of reactive nitrogen. This leads to potential increases in reactive nitrogen deposition near ammonia emission hotspots, with ecosystem impacts warranting further investigation. Ammonia (NH3), a critical but not directly regulated precursor of fine particulate matter in the United States, has been increasingly scrutinized to improve air quality. Our findings, however, show that controlling NH3 became significantly less effective for mitigating fine particulate matter in the rural United States. We highlight the need for more collocated aerosol and precursor observations for better characterization of secondary inorganic aerosols formation in urban areas.

A Critical Assessment of Inpatient Dermatology Service Line in the Rural United States

Objective: We sought to classify dermatologic conditions presenting in rural inpatient hospitalization. Methods: Retrospective chart review. Conclusion: Limited rural dermatology care in the United States prompted the establishment of an inpatient dermatology consult line in rural Upstate New York. Over 3 years, 27.7% of consults were admitted for dermatologic concerns, 21.5% for both dermatologic and medical issues and, 50% for non-dermatologic reasons but later seen by dermatologists. Common conditions included eczematous rashes, infections, drug reactions, edematous skin conditions, and autoimmune diseases. Among patients admitted for dermatologic concerns, cellulitis (3) and rashes (3) were the most common. Interestingly, 74% of provisional dermatologic diagnoses matched final diagnoses before further workups. Approximately 58.5% of consults were deemed highly valuable. Followup showed 73.8% improvement, 23.1% deceased from different pathologies, and 3.1% stable. Understanding the rural dermatology landscape could enhance access, diagnostic accuracy, and the feasibility of inpatient consult services. Understanding the rural dermatology landscape may improve access to specialist care, increase diagnostic accuracy, reduce disease burden and associated costs, and communicate the feasibility of inpatient consult services either in-house or via teledermatology to rural hospital systems.

Influence of Karen Immigrant Students on Teachers’ Instructional Decisions in the Rural United States

Influence of Karen Immigrant Students on Teachers’ Instructional Decisions in the Rural United States

The plantation system and the roots of the southern rural mortality penalty in the northern Blackland Prairies of Texas

In recent decades, public health researchers have observed that the health of rural people has declined relative to the health of urban people in the United States. This disparity in health and life expectancy across the rural/urban divide has been described as the Rural Mortality Penalty. However, public health researchers have also noted that health and life expectancies are not uniform across the rural United States, but vary according to race, sex, gender, and other factors. Rural health disparities also vary geospatially and are especially pronounced in the American South, leading to recent calls for greater attention to the structural factors that shape the health of rural Southerners. In this study, we take an anthropological and historically explicit approach to study the impacts of systemic violence on rural health. Specifically, we focus on farm labor within the plantation system as a context where geospatial, racial, and sexual differences in mortality, often studied in isolation, find a common historical source. Here we analyze vital records data from the post-emancipation period in the Blackland Prairies ecoregion of Texas, a period when emerging forms of plantation labor such as tenant farming, convict leasing, and migrant labor were being developed to maintain the plantation economy after the abolishment of chattel slavery. We find that the plantation system remains a strong predictor of differential mortalities in rural Texas, accounting for nearly all the variation that exists across the rural/urban divide and elucidating the complex interactions of race, sex, labor, and health in the rural South.

Toward a Beloved Community: Facilitated Group Listening as a Tool for Community Development and Civic Engagement

Toward a Beloved Community: Facilitated Group Listening as a Tool for Community Development and Civic Engagement

What does it mean to be ‘left behind?’

Abstract This comment critiques the idea of geographic regions being “left behind.” It argues that the term frames the regions in question as passive experiencers of natural phenomena, in turn obfuscating the structural forces that have shaped those regions and local populations’ efforts to pursue better living conditions. The comment draws on three examples from the rural United States to illustrate how the designation of being “left behind” serves to mask subjugation and struggle.

Motivation and context of concurrent stimulant and opioid use among persons who use drugs in the rural United States: a multi-site qualitative inquiry

BackgroundIn recent years, stimulant use has increased among persons who use opioids in the rural U.S., leading to high rates of overdose and death. We sought to understand motivations and contexts for stimulant use among persons who use opioids in a large, geographically diverse sample of persons who use drugs (PWUD) in the rural settings.MethodsWe conducted semi-structured individual interviews with PWUD at 8 U.S. sites spanning 10 states and 65 counties. Content areas included general substance use, injection drug use, changes in drug use, and harm reduction practices. We used an iterative open-coding process to comprehensively itemize and categorize content shared by participants related to concurrent use.ResultsWe interviewed 349 PWUD (64% male, mean age 36). Of those discussing current use of stimulants in the context of opioid use (n = 137, 39%), the stimulant most used was methamphetamine (78%) followed by cocaine/crack (26%). Motivations for co-use included: 1) change in drug markets and cost considerations; 2) recreational goals, e.g., seeking stronger effects after heightened opioid tolerance; 3) practical goals, such as a desire to balance or alleviate the effects of the other drug, including the use of stimulants to avoid/reverse opioid overdose, and/or control symptoms of opioid withdrawal; and 4) functional goals, such as being simultaneously energized and pain-free in order to remain productive for employment.ConclusionIn a rural U.S. cohort of PWUD, use of both stimulants and opioids was highly prevalent. Reasons for dual use found in the rural context compared to urban studies included changes in drug availability, functional/productivity goals, and the use of methamphetamine to offset opioid overdose. Education efforts and harm reduction services and treatment, such as access to naloxone, fentanyl test strips, and accessible drug treatment for combined opioid and stimulant use, are urgently needed in the rural U.S. to reduce overdose and other adverse outcomes.

Adapting a youth suicide prevention program for rural communities in the United States: a feasibility study

Rural youth suicide represents a major source of mental health inequity in the United States (US). School-based suicide prevention programs may provide an effective avenue to address this mental health crisis among rural youth. This study’s primary goal is to demonstrate the feasibility and acceptability of a novel implementation approach (utilizing teachers from a neighboring school) for delivering the Youth Aware of Mental Health (YAM) program, an evidence-based, universal youth suicide prevention curriculum, to high school students in rural Montana. We will recruit approximately 1300 9th grade student in four Montana schools. Using a non-inferiority design, we will randomize classrooms in each school to be instructed by a teacher from another school (YAM-TE; experimental) or a traditional external instructor (YAM-EXT; control). We will assess program fidelity of both YAM training and implementation via independent observer and instructor-reporter ratings. Youth will complete measures of acceptability at post-YAM and outcome measures at pre-YAM, post-YAM, and 12 month follow-up. Standard and mixed linear and logistic regression models will be used to test the main hypothesis that the YAM-TE does not differ from YAM-EXT regarding fidelity (teachers) and acceptability (teachers and youth). Exploratory analyses will test moderation of the intervention effect (e.g., sex, poverty) and the mediating effect of mental health literacy, belongingness, and perceived burdensomeness on the intervention effect. Results of this pilot study will inform the development of subsequent, fully powered noninferiority trials. Our long-term goal is to scale YAM-TE for implementation across rural US communities or, if culturally appropriate, more globally.

Abstract P389: Prevalence, Awareness, Treatment, and Control of Major Cardiovascular Risk Factors in Rural Alabama

Background: CVD rates are high across the rural southern United States, but less is known about risk factor prevalence and control. Using data from two rural Alabama counties, we measured the prevalence, awareness, treatment, and control of hypertension, high cholesterol, and diabetes. Methods: The Risk Underlying Areas Longitudinal (RURAL) Heart and Lung Study began in 2021 to assess cardiopulmonary risk across 10 rural southern US counties. This analysis used data from two Alabama counties (N=942), 70% women, 79% non-Hispanic Black individuals, mean age 48.7 years. Hypertension was defined as SBP≥130 mmHg, DBP≥80 mmHg, and/or self-reporting hypertension medication use. High cholesterol was defined as TC≥200 mg/dL and/or cholesterol medication use. Diabetes was defined as fasting glucose≥126 mg/dL, non-fasting glucose>200 mg/dL, and/or diabetes medication use. Awareness, treatment, and control were assessed via self-reported physician diagnoses and medication use. All analyses applied sampling weights to produce representative estimates. Results: In the RURAL Alabama sample, the prevalence of hypertension was 73.7%, high cholesterol was 59.5%, and diabetes was 25.4%. The majority of individuals were aware of and taking medication for these risk factor conditions, but one-quarter of hypertension and less than half of diabetes was controlled (Figure). There were no significant sex differences observed. As compared with white individuals, Black individuals had a significantly higher prevalence of hypertension (79.2% vs 61.9%, p<0.001) and diabetes (29.9% vs 17.0%, p=0.005); however, there were no significant racial differences in risk factor control. Conclusion: There was a high prevalence of CVD risk factors in rural Alabama, with Black-white racial disparities for hypertension and diabetes, and control was low. This underscores the need for primary prevention of risk factors in the rural south and elucidating factors contributing to ‘treatment-control’ gaps for managing hypertension and diabetes.