Rural-urban Continuum Research Articles

Incidence trends of early-onset colorectal cancer (EOCRC) in the United States, by age, sex, race and ethnicity, and urbanicity (2000-2021).

26 Background: Research is needed to understand the extent to which the incidence of early onset colorectal cancer (EOCRC)is rising across population sub-groups, including by age, sex, race/ethnicity, and urbanicity, to inform hypotheses regarding its causes and strategies for screening and prevention. Methods: We used data on colorectal cancer cases diagnosed among adults 20-49 years (yr) between 2000-2021 in the delay-adjusted Surveillance, Epidemiology, and End Results (SEER) database (April 2024). We calculated delay- and age-adjusted annual incidence rates (IR) per 100,000, overall and by age, sex, race/ethnicity, and urbanicity. Urbanicity was defined using USDA Rural-Urban Continuum Codes for county; 1-3 were classified as urban and 4-9, 98, and 99 were classified as non-urban. We used NCI’s Joinpoint regression models (Joinpoint version 5.2.0.0) to estimate annual percent change (APC) and 95% confidence intervals (CI). We also calculated IRs for the most recent 5-year period (2017-2021) and used incidence rate ratios (IRR) to compare across groups; IRs and IRRs were calculated using SEER*Stat version 8.4.3. Results: Analyses included 155,500 cases of EOCRC. Most cases (72%) occurred among adults 40-49 yr; 22% occurred among those 30–39 yr and 6% in people 20-29 yr. Among adults 40-49 yr, the incidence of EOCRC increased 4.4% / yr on average between 2018-2021 (95%CI: 2.5, 5.6). Among adults 30-39 yr, incidence of EOCRC increased 3.0% / yr, on average, starting in 2010 (95%CI: 2.4, 4.5). For adults ages 20-29 yr, there were large increases in incidence from 2000-2016 (2000-2013, APC: 3.5; 95%CI: 2.4, 4.1; 2013-2016, APC: 11.2; 95%CI: 6.8, 13.5) but no change from 2016-2021. For the most recent 5-yr period (2017-2021), females had lower IR compared to males (IRR: 0.90; 95%CI: 0.88, 0.91), but trends over time were similar by sex. The incidence of EOCRC increased across races and ethnicities between 2000-2021, albeit at different rates. In the most recent period (2017-2021), the IR per 100,000 was 22.0 for Non-Hispanic American Indian and Alaskan Native (AIAN), 15.0 for Non-Hispanic White, 14.9 for Non-Hispanic Black, 12.4 for Hispanic or Latino, and 11.2 for Non-Hispanic Asian American or Pacific Islander adults. People in non-urban areas had a higher incidence of EOCRC compared to those in urban areas (IRR: 1.18; 95%CI: 1.14, 1.22), with similar trends over time. Conclusions: The incidence of EOCRC is highest among adults 40-49 yr, males, Non-Hispanic AIAN adults, and in non-urban areas. Trend analyses generally showed similar increases in incidence (3-5%/yr) in recent periods across sex, race/ethnicity, and urbanicity.

Reply to Editorial Comment on "Male Factor Infertility and the Rural-Urban Continuum".

Reply to Editorial Comment on "Male Factor Infertility and the Rural-Urban Continuum".

Geographic distance to Commission on Cancer-accredited and nonaccredited hospitals in the United States.

The Commission on Cancer (CoC) establishes standards to support multidisciplinary, comprehensive cancer care. CoC-accredited cancer programs diagnose and/or treat 73% of patients in the United States. However, rural patients may experience diminished access to CoC-accredited cancer programs. Our study evaluated distance to hospitals by CoC accreditation status, rurality, and Census Division. All US hospitals were identified from public-use Homeland Infrastructure Foundation-Level Data, then merged with CoC-accreditation data. Rural-Urban Continuum Codes (RUCC) were used to categorize counties as metro (RUCC 1-3), large rural (RUCC 4-6), or small rural (RUCC 7-9). Distance from each county centroid to the nearest CoC and non-CoC hospital was calculated using the Great Circle Distance method in ArcGIS. Of 1,382 CoC-accredited hospitals, 89% were in metro counties. Small rural counties contained a total of 30 CoC and 794 non-CoC hospitals. CoC hospitals were located 4.0, 10.1, and 11.5 times farther away than non-CoC hospitals for residents of metro, large rural, and small rural counties, respectively, while the average distance to non-CoC hospitals was similar across groups (9.4-13.6 miles). Distance to CoC-accredited facilities was greatest west of the Mississippi River, in particular the Mountain Division (99.2 miles). Despite similar proximity to non-CoC hospitals across groups, CoC hospitals are located farther from large and small rural counties than metro counties, suggesting rural patients have diminished access to multidisciplinary, comprehensive cancer care afforded by CoC-accredited hospitals. Addressing distance-based access barriers to high-quality, comprehensive cancer treatment in rural US communities will require a multisectoral approach.

Medicare telehealth utilization by Rural Health Clinics and Federally Qualified Health Centers prior to and during the COVID-19 pandemic.

To address the extent to which Federally Qualified Health Centers (FQHCs) and independent and provider-based Rural Health Clinics (RHCs) were using telehealth prior to and during the COVID-19 pandemic. A nationally representative 5% sample of Medicare Fee-for-Service beneficiaries who used outpatient services at FQHCs and RHCs were identified within the 2019-2021 5% Medicare Limited Data Set Outpatient and Carrier files. Rural-Urban Continuum Codes were used to identify rural-urban clinic locations. Logistic regression included three-way interaction terms for time, rurality, and clinic type. Telehealth use curbed the decline in outpatient visits for all clinic types during the pandemic. Telehealth use declined as the pandemic continued in 2021 yet remained higher than pre-pandemic levels. FQHCs had higher telehealth use (18%-31%) than RHCs (8%-14%) in 2020-2021. Across all years, tele-behavioral health was the primary venue for originating and distant site providers.Overall, 19%-34% of originating site providers were psychiatrists and 10%-31% were primary care providers. Likely due to patients sheltering-in-place (at home), 2020-2021 distant site providers were largely primary care providers. Urban FQHCs experienced the largest increase in telehealth use during the pandemic (24.6% increase in urban, 14.4%-15.8% in rural) followed by rural ID_RHCs (10.2%-11.7%). RHCs were less likely to provide telehealth services than FQHCs during the pandemic. Telehealth played a key role in facilitating access to health services during the height of the pandemic (2020-2021). Telehealth flexibilities were associated with greater telehealth use among FQHCs and RHCs but did not make up for the overall decline in health service use.

A descriptive examination of rurality in the Environmental influences on Child Health Outcomes Cohort: Implications, illustrations, and future directions.

The Environmental influences on Child Health Outcomes (ECHO) Cohort has enrolled over 60,000 children to examine how early environmental factors (broadly defined) are associated with key child health outcomes. The ECHO Cohort may be well-positioned to contribute to our understanding of rural environments and contexts, which has implications for rural health disparities research. The present study examined the outcome of child obesity to not only illustrate the suitability of ECHO Cohort data for these purposes but also determine how various definitions of rural and urban populations impact the presentation of findings and their interpretation. This analysis uses data from children in the ECHO Cohort study who had residential address information between January 2010 and October 2023, including a subset who also had height and weight data. Several rural-urban classification schemes were examined with and without collapsing into binary rural/urban groupings (ie, the Rural-Urban Continuum Codes, 2010 Rural-Urban Commuting Area [RUCA] Codes, and Urban Influence Codes). Various rural/urban definitions and classification schemes produce similar obesity prevalence (17%) when collapsed into binary categories (rural vs urban) and for urban participants in general. When all categories within a classification scheme are examined, however, the rural child obesity prevalence ranges from 5.8% to 24%. Collapsing rural-urban classification schemes into binary groupings erases nuance and context needed for interpreting findings, ultimately impacting health disparities research. Future work should leverage both individual- and community-level datasets to provide context, and all categories of classification schemes should be used when examining rural populations.

The effect of spatial variation on linkage to care and treatment rates among patients with hepatitis C: A Canadian population-based study

Introduction: Despite significant global efforts towards eliminating hepatitis C virus (HCV) infection, multiple challenges remain in achieving this goal. In this study, we assessed the impact of geographical variation on HCV diagnosis and treatment rates in Alberta, Canada. Methods: Adults aged ≥20 years with a positive HCV antibody were identified from the provincial administrative sources from the fiscal years 2012 through 2017. To assess the differences across Alberta's rural-urban continuum, high-resolution spatial analyses using global and local spatial autocorrelation were applied to the HCV age- and sex-standardized prevalence rate at the sub-local geographic area level. We compared and tested differences in HCV RNA tests, HCV RNA positivity rates, and HCV treatment status across the different areas. Results: Between 2012 and 2017, we identified 18,768 patients who had tested positive for HCV Ab. Within this cohort, only 63.1% had HCV RNA repetitive. The HCV RNA positivity rate was 42.1%, and 65.3% had received HCV treatment after testing as HCV RNA positive. HCV Ab positive case counts exhibited a spatial distribution consistent with that of the population at risk: 67.5% in metro, 11.1% in urban, 19.7% in rural, and 1.8% in remote areas. The metropolitan area of Edmonton's age-and sex-standardized prevalence of 8.2 (95% CI 8.0–8.4) per 1,000 persons was higher than Calgary's standardized prevalence of 5.0 (95% CI 5.1–5.4) per 1,000 persons ( p < 0.001). HCV RNA and HCV treatment rates demonstrated significant spatial variation. Conclusions: HCV prevalence, diagnosis, and treatment exhibit significant spatial variation across rural-urban Alberta. Implementation of geographically oriented screening and treatment interventions would result in a time- and cost-efficient HCV elimination strategy.

Demographic analysis of survival trends in squamous cell carcinoma of the upper 1/3 of the esophagus: a population-based study.

Esophageal malignancies, constituting 3% of global cancers, pose significant health challenges with poor survival rates. Squamous Cell Carcinoma (SCC) and Adenocarcinoma (AC) are predominant subtypes, with shifting incidences globally. This analysis will focus primarily on the demographics of survival trends for Squamous cell carcinoma of esophagus (SCCE). This retrospective study, utilizing the SEER database, examined demographic factors influencing survival trends in SCC of the upper esophagus. Variables included age, sex, race, income, and rurality. Statistical analyses included chi-square tests and multivariable models, specifically logistic regression and conditional inference tree models. A total of 2821 patients were included in this study. Demographic disparities were evident with race (p<0.001), age (p=0.002), and sex (p=0.048) significantly impacting survival when holding other variables constant, with Non-Hispanic Black individuals exhibiting the greatest odds of mortality compared to other racial groups. Median household income (p=0.344) and Rural-Urban Continuum (p=0.100) were not significantly associated with improved survival rates when controlling for other demographics. Our findings align with previous research on sex-based survival disparities and racial variations in SCCE incidence and outcomes. Socioeconomic and biological factors contribute to these disparities, highlighting the need for tailored interventions and equitable healthcare access. Understanding demographic determinants in SCCE survival is crucial for personalized treatment and policy reforms to address disparities. Future research should focus on prospective, diverse cohorts to further elucidate these complex interactions and improve esophageal SCCE management and outcomes.

Editorial Comment on "Male Factor Infertility and the Rural-urban Continuum".

Editorial Comment on "Male Factor Infertility and the Rural-urban Continuum".

Rurality and pediatric cancer survival in the United States: An analysis of SEER data from 2000 to 2021

BackgroundCancer is the leading cause of death by disease among children in the United States. Residing in rural areas may impact cancer outcomes as rural areas tend to have fewer available healthcare resources. Few population-based studies have investigated rural/urban disparities in pediatric cancer outcomes. The objective of this study was to examine rural/urban differences in (1) five-year relative survival and (2) cancer-specific survival among children in the United States. MethodsThe study is a population-based longitudinal study using data from the Surveillance, Epidemiology, and End Results (SEER) 17 registries database (2000–2021). We included data for individuals aged 0–19 with a first primary malignant cancer diagnosed from 2000 to 2016. Rurality was measured by Rural-Urban Continuum Codes (RUCCs). Five-year relative survival rates, Kaplan-Meier curves, and Cox regression analysis were used to determine the differences in pediatric cancer survivorship between rural and urban areas. ResultsBoth five-year relative survival rates and log-rank tests of survival probabilities over time by rurality showed no statistically significant difference between individuals living in urban versus rural counties. However, after adjusting for age, sex, race/ethnicity, cancer type, median household income, and region, children diagnosed in rural counties had a 9 % higher risk of death compared to children diagnosed in urban counties (95 % CI 1.02–1.17), with the highest increased risk observed for children with retinoblastoma (aHR: 6.12, 95 % CI 2.01–18.59). A higher increased risk of death was observed for children living in the most rural counties (aHR: 1.18, 95 % CI 1.07–1.32). ConclusionIn this study, residing in rural areas was associated with an increased risk of death from pediatric cancer, especially for children residing in rural areas not adjacent to urban areas. Our findings warrant further investigation to determine the rural/urban disparities in pediatric cancer outcomes and to develop interventions to deliver high-quality cancer care to rural children.

Identifying Measures for Understanding and Addressing County-Level Disparities in Adolescent HPV Vaccination Coverage in North Carolina.

Human papillomavirus (HPV) vaccination coverage is characterized by geographic disparities in the United States, with national studies finding lower coverage in rural versus nonrural areas. To direct quality improvement efforts in North Carolina, we sought to understand how different rurality measures characterize these disparities. We used separate negative binomial regression models to test associations between five dichotomized county-level rurality measures and HPV vaccination coverage (≥1 dose) among North Carolina adolescents, aged 11 to 12 years (n = 326,345). Rurality measures were derived from: Office of Management and Budget's Metropolitan Statistical Areas, Rural-Urban Continuum Codes, Index of Relative Rurality, US Census Bureau classifications, and North Carolina Rural Center classifications. Models controlled for Social Vulnerability Index (SVI) percentile and rate of pediatricians per county. Vaccination data came from the North Carolina Immunization Registry. HPV vaccination coverage was 29% across North Carolina's 100 counties (range: 13%, 46%). Agreement between rurality measures ranged from 54% to 93% of counties. In adjusted analyses, none of the five rurality measures were correlated with HPV vaccination coverage, but higher SVI and higher rate of pediatricians were positively associated with coverage (P < 0.01). Exploratory moderation analyses suggested regional variation in the relationship between rurality and coverage, with a positive association in one region, a negative association in one region, and no association in four regions. County-level rurality measures did not identify disparities in HPV vaccination coverage in North Carolina. Measures related to social vulnerability and access to pediatricians may be better suited for understanding and addressing the state's substantial county-level vaccination disparities.

Male Factor Infertility and the Rural-Urban Continuum

OBJECTIVETo examine the association between male factor infertility and the Rural—Urban continuum. MATERIALS AND METHODSSingle institution retrospective cohort study using the Utah Population Database (UPDB), which combines demographic, medical, and residential data for patients residing in Utah and links to the Subfertility Health Assisted Reproduction and Environment (SHARE) database, which houses fertility data from 1998-2017. The data was divided by metropolitan (metro-) [large, medium, small], and non-metropolitan (non-metro-) [urban, rural] status, based on United States Department of Agriculture (USDA) rural-urban continuum codes (RUCC). RESULTSNon-metro urban/rural males were less likely to be a racial/ethnic minority (91.3% non-Hispanic white vs 85.7%), or use assisted reproductive technology (ART) (13.4% vs 18.5%). Multivariate regression controlling for race/ethnicity, age, semen analysis category (oligozoospermic vs normozoospermic), previous successful fertility outcome, and use of ART, demonstrated complete rurality was associated with decreased likelihood of successful fertility outcome (Hazard Ratio [HR] 0.63, 95% CI 0.44–0.91, n=65). Non-metro urban individuals trended towards lower likelihood of successful fertility outcome ([HR] 0.93, 95% CI 0.85–1.01). Complete rurality was associated with longer time for 50% cohort successful fertility outcome (>60 months vs approximately 34 months both metro). All comparisons p<0.001. CONCLUSIONSAcross the rural—urban continuum, residing in a metro area was associated with higher rates of racial/ethnically diversity, fertility treatment utilization, and successful fertility outcomes (live births). Given approximately 18% of the United States resides with a rural community (12% in Utah), these findings can provide more informed infertility care.

Bridging digital divides in Wisconsin: an examination of policy efforts and effectiveness over the past five years

ABSTRACT The digital divide, generally characterized by unequal Internet access, represents the gap between individuals who benefit from the use of digital technologies and those who do not. Many social inequalities are associated with the prevalence of the digital divide, particularly across the rural-urban divide. This research seeks to characterize the status of the digital divide, and related sociodemographic variables, within the context of the US state of Wisconsin. In addition, this research investigates the effectiveness of broadband expansion grants, within the state of Wisconsin, on bridging the digital divide. The findings indicate that, at the county level, variations in education, household income, age, and location on a rural-urban continuum are all associated with variations in county broadband adoption rates. Also, despite increasing broadband funding, the amount of money sent to a county is not associated with the need of that county or the change in county level broadband adoption rates from the year 2017–2021. The findings of this study have theoretical implications as they add to our understanding of how broadband adoption is related to social aspects of life. In addition, there are political implications in terms of how grant funding allocation is determined.

More-than-land: conserving the social fabrics of the Kat O coastal settlements in Hong Kong

This article examines the unique self-organised spatial and social structure of the Kat O coastal settlements in Hong Kong. By problematising the identity politics between built forms and landscapes, this paper analyses the village’s deep-rooted history within the land‒water dichotomies, which have been shaped by government survey methods and conservation-development policies. Specifically, it presents the peri-urban condition of Kat O’s coastal settlements as a departure from the traditional urban‒rural continuum perspectives. Empirically, the field documentation of the self-built additions presents critical perspectives into the static understanding of land ownership, addition and adaptation strategies and the building materialities embedded within the government survey methods and conservation-development policies. Theoretically, this study provides an understanding of these coastal settlements as cultural landscapes that are dynamically related to the environment, as well as the changing sociocultural relationships among different communities on the basis of their unique conceptions of habitation and living. By examining past and current conservation policies, this article advocates for a water-centric vision for countryside conservation in Hong Kong that transcends the commonly adopted terrecentric perspective.

Monitoring changes in walkability over time: An environmental exposure change detection framework with implications for equity and social justice

Evidence suggests that walkability and greenspace impact travel related activity patterns and vehicle emissions which affect sustainability, public health, and equity. Resulting levels of physical activity, active, or sedentary travel time impact obesity, diabetes, and heart disease which impact COVID-19 mortality. It is now possible to track changes in locally controlled land use characteristics known to impact sustainability and health. This information can provide decisionmakers with feedback required to spatially prioritize and better link state and nationally funded transportation investments with locally sanctioned land use actions. Linking the achievement of established benchmarks of health equity-based indicators with funding establishes a more performance-based approach connecting land use with transportation investment. This study longitudinally tracks neighborhood-level walkability features at the census tract level for 2013 and 2020 for the entire USA. Longitudinal volatility-based change detection models are developed to examine how changes in walkability over time correlate with racialization and social justice. Walkability tends to increase over time with significant variations across metro regions and the urban-rural continuum. Largest and smallest increases in walkability were observed in Western Pacific and Northwest states, respectively. Increased racial and social justice disparities were observed in access to more walkable infrastructure by marginalized populations (such as less-educated, older, unemployed, and black individuals). Significant heterogeneity in the spatial distribution of walkability was observed, over the variation captured by observed sociodemographic, regional, and urban/rural factors. The findings highlight the potential for an “environmental surveillance” system to support a “performance-based” approach to transportation funding that prioritizes resource allocation consistent with Justice40 and United Nation's Sustainable Development Goals.

A Demographic Description of Children and Adolescents With Concomitant Autism and Anxiety Along With a Comparison of Receipt of Psychological Services.

(1) Evaluate differences in demographic distributions between those with autism alone and those with autism concomitant with anxiety and (2) assess demographic factors associated with receipt of psychological therapy in patients with autism. Using deidentified health care claims data, we extracted all encounters among children with the International Classification of Diseases-10-CM for Autism Spectrum Disorder (F84) and flagged those with concomitant anxiety (F41.9). Extracted data included age, sex, race, ethnicity, insurance status, and Rural-Urban Continuum Codes. Current procedural terminology codes for psychological services were extracted. Data were analyzed using Mann-Whitney U tests, χ2 tests of association, and logistic regression. Demographic differences between children/adolescents with autism alone versus autism concomitant with anxiety were noted for age, sex, and race/ethnicity, with a greater prevalence of autism/anxiety identified in older-aged children and children identifying as female and non-Hispanic White residing in an urban area. While 21% of those included in this study had received psychotherapy, the percentages within the autism only and autism/anxiety groups were 12% and 50%, respectively (p < 0.001). Children/adolescents who were older age quartile, resided in an urban residence, and with a concomitant diagnosis of anxiety were more likely to receive psychological services, while non-Hispanic Other were less likely to, compared with the reference of non-Hispanic White. We identified demographic disparities in the diagnosis of autism versus autism with concomitant anxiety, including age, sex, race/ethnicity, and residence location. Age quartile, urban location, and concomitant anxiety were associated with increased likelihood of receipt of psychological services.

Association between obesogenic environments and childhood overweight/obesity across the United States: Differences by rurality.

Childhood obesity is more prevalent in rural compared to urban communities and may be related to urban-rural differences in environmental factors known to affect obesity. However, understanding of how environmental factors impact childhood obesity in rural settings remains limited. This study aimed to address this gap by exploring the relationship between obesogenic environments and childhood overweight/obesity rates, including variations across the urban-rural continuum. This study analyzed data for counties in the United States (N = 3140). Linear regression models were employed to examine the relationship between the Childhood Obesogenic Environment Index, which consisted of ten variables from a variety of sources associated with physical activity and healthy eating, and childhood overweight/obesity rates estimates derived from the 2016 National Survey of Children's Health. County rurality was categorized using Rural-Urban Continuum Codes and a moderation analysis was conducted to identify potential variations by rurality. There was a significant positive association between the COEI and childhood overweight/obesity rates nationally, with notable variations across the urban-rural continuum for specific index components. Neighborhood walkability showed a significant positive association across rurality, indicating that childhood overweight/obesity rates were higher in less walkable communities. Full-service restaurants exhibited an inverse relationship with childhood overweight/obesity rates across all RUCC levels. These results underscore the obesogenic environmental factors associated with childhood overweight/obesity rates nationally and how they vary across the urban-rural continuum. This study highlights the importance of considering these variations when designing interventions to address childhood obesity.

Urban–Rural Continuum in the Gonda District, India: Quantifying Rurality Using Modified Fuzzy AHP

Urban–Rural Continuum in the Gonda District, India: Quantifying Rurality Using Modified Fuzzy AHP

Unveiling Kerala’s Distinct Urbanisation: A Comparative Analysis within India

Urbanisation is a pivotal demographic transformation that characterised the twentieth century, serving as a crucial indicator of modernisation intimately intertwined with economic growth and development. Significantly, in its journey as a developing nation, India is witnessing a rapid surge in urbanisation, a trend that surpassed expectations, as evidenced by the 2011 Census. The surge in India’s urban population is primarily attributed to a combination of net rural–urban reclassification and rural-to-urban migration. It is essential to recognise the distinctive nature of Kerala in this context, as the state diverges significantly from the patterns observed in other regions. The urbanisation unfolding in Kerala is not confined solely to designated towns and cities; instead, the entire state portrays a nuanced urban–rural continuum. In this study, an exploration is undertaken to dissect the trends and patterns of urbanisation in Kerala, delving into its unique characteristics and associated challenges based on data provided by the Census of India. Regression analysis is used to determine the factors that contribute to Kerala’s urbanisation, which shows that urbanisation process is influenced by a complex interplay of financial, economic and demographic factors. Over the decade, banking has become a crucial driver of urbanisation, highlighting its growing role in supporting urban growth and development. In contrast, the significance of investment in small-scale industries/micro, small and medium enterprises has diminished by 2011, suggesting shifts in the economic landscape and pointing to the rising importance of services and remittances as sources of urban expansion. Household dynamics, consistently significant in both years, emphasise the critical role of population changes and family structures in shaping urbanisation trends. Despite the continuous rise in urbanisation rates, there persists a noticeable sluggishness in development, especially regarding the provision of essential amenities. This aspect necessitates focused policy attention to address the challenges accompanying Kerala’s evolving urban landscape. JEL Codes: O18, R23, R12

An Analysis of the Otolaryngology Workforce in Pennsylvania.

This study aims to analyze the distribution of otolaryngologists between urban and rural counties in Pennsylvania. Retrospective database. American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) database and Centers for Medicare and Medicaid Services (CMS) Database. The AAO-HNS database (Entnet.org) and the CMS Database were used to identify otolaryngologists, their primary location, and their state of training. The 2023 Rural-Urban Continuum Codes were used to classify metropolitan (codes 1-3) and nonmetropolitan counties (codes 4-9) and determine county populations. A total of 388 otolaryngologists were identified across 67 Pennsylvania counties (33 metropolitan, 34 nonmetropolitan), 80% of which were male. There were 354 otolaryngologists in metropolitan counties serving 11.2 million people, with an average of 2.4 otolaryngologists per 100,000 people (/100 k). The majority of otolaryngologists (n = 235, 60.6%) are located in counties designated by code 1. There were 34 otolaryngologists in nonmetropolitan counties serving 1.8 million people, with an average of 2.4 otolaryngologists/100 k. Montour County (code 6) is home to a large academic center and accounts for 14/34 otolaryngologists in the nonmetropolitan counties. With the exception of Montour County, the remaining nonmetropolitan counties averaged 1.0 otolaryngologist/100 k. Only 3 metropolitan counties did not have otolaryngologists compared to 19 nonmetropolitan counties without otolaryngologists. Most otolaryngologists received their residency training in Pennsylvania (n = 177). New York (n = 35) and Maryland (n = 24) were the second most common states for training. There is a lack of otolaryngologists in rural counties of Pennsylvania, except in counties home to large academic centers.

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

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