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Rural Counties (rural + county)

Distribution by Scientific Domains

Medical Sciences	84%

Selected Abstracts

Presence of a Community Health Center and Uninsured Emergency Department Visit Rates in Rural Counties

THE JOURNAL OF RURAL HEALTH, Issue 1 2009
FAAFP, FACPM, George Rust MD
ABSTRACT:,Context: Community health centers (CHCs) provide essential access to a primary care medical home for the uninsured, especially in rural communities with no other primary care safety net. CHCs could potentially reduce uninsured emergency department (ED) visits in rural communities. Purpose: We compared uninsured ED visit rates between rural counties in Georgia that have a CHC clinic site and counties without a CHC presence. Methods: We analyzed data from 100% of ED visits occurring in 117 rural (non-metropolitan statistical area [MSA]) counties in Georgia from 2003 to 2005. The counties were classified as having a CHC presence if a federally funded (Section 330) CHC had a primary care delivery site in that county throughout the study period. The main outcome measure was uninsured ED visit rates among the uninsured (all-cause ED visits and visits for ambulatory care sensitive conditions). Poisson regression models were used to examine the relationship between ED rates and the presence of a CHC. To ensure that the effects were unique to the uninsured population, we ran similar analyses on insured ED visits. Findings: Counties without a CHC primary care clinic site had 33% higher rates of uninsured all-cause ED visits per 10,000 uninsured population compared with non-CHC counties (rate ratio [RR] 1.33, 95% confidence interval [CI] 1.11-1.59). Higher ED visit rates remained significant (RR 1.21, 95% CI 1.02-1.42) after adjustment for percentage of population below poverty level, percentage of black population, and number of hospitals. Uninsured ED visit rates were also higher for various categories of diagnoses, but remained statistically significant on multivariate analysis only for ambulatory care sensitive conditions (adjusted RR = 1.22, 95% CI 1.01-1.47). No such relationship was found for ED visit rates of insured patients (RR 1.06, 95% CI 0.92-1.22). Conclusions: The absence of a CHC is associated with a substantial excess in uninsured ED visits in rural counties, an excess not seen for ED visit rates among the insured. [source]

A National Study of Obesity Prevalence and Trends by Type of Rural County

THE JOURNAL OF RURAL HEALTH, Issue 2 2005
J. Elizabeth Jackson MA
ABSTRACT: Context: Obesity is epidemic in the United States, but information on this trend by type of rural locale is limited. Purpose: To estimate the prevalence of and recent trends in obesity among US adults residing in rural locations. Methods: Analysis of data from the Behavioral Risk Factor Surveillance System (BRFSS) for the years 1994,1996 (n = 342,055) and 2000,2001 (n = 385,384). The main outcome measure was obesity (body mass index [BMI] ,30), as determined by calculating BMI from respondents' self-reported height and weight. Results: In 2000,2001, the prevalence of obesity was 23.0% (95% confidence interval [CI] 22.6%-23.4%) for rural adults and 20.5% (95% CI 20.2%-20.7%) for their urban counterparts, representing increases of 4.8% (95% CI 4.2%-5.3%) and 5.5% (95% CI 5.1%-5.9%), respectively, since 1994,1996. The highest obesity prevalence occurred in rural counties in Louisiana, Mississippi, and Texas; obesity prevalence increased for rural residents in all states but Florida over the study period. African Americans had the highest obesity prevalence of any group, up to 31.4% (95% CI 29.1%-33.6) in rural counties adjacent to urban counties. The largest difference in obesity prevalence between those with a college education compared with those without a high school diploma occurred in urban areas (18.4% [95% CI 17.9%-18.9%] vs 23.5% [95% CI 22.5%-24.5%], respectively); the smallest difference occurred in small, remote rural counties (20.3% [95% CI 18.7%-21.9%] versus 22.3% [95% CI 20.7%-24.0%], respectively). Conclusions: The prevalence of obesity is higher in rural counties than in urban counties; obesity affects some residents of rural counties disproportionately. [source]

Domestic violence against women: Understanding social processes and women's experiences

JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY, Issue 2 2009
Jan Bostock
Abstract The prevalence of domestic abuse against women has been estimated as high as one in four. The risk is particularly high for women who are younger, economically dependent, unemployed and with children. Research about the factors that maintain situations of abuse has generally focused separately on the coping strategies of women, barriers to leaving the relationship and the perpetrators' means of abuse. In this study we used a community psychology perspective to seek a broader understanding of what maintains situations of abuse, in order to suggest interventions in a rural County in the North of England. Twelve women who had experienced domestic abuse and had used voluntary sector services agreed to be interviewed about their experiences and the resources and strategies available to them. Using grounded theory we generated four themes: (1) Commonalities and contradictions in the experience of abuse; (2) living with abuse; (3) the response of systems reinforced or challenged the abuse and (4) dealing with abuse beyond the relationship. These findings illustrate how situations of domestic abuse can be prolonged by limited options available to victims for support and protection, and a lack of active public acknowledgement that domestic abuse is unacceptable. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Comparing Household Listing Techniques in a Rural Midwestern Vanguard Center of the National Children's Study

PUBLIC HEALTH NURSING, Issue 2 2009
Katie Dreiling
ABSTRACT The National Children's Study (NCS) is a longitudinal study that will examine the influence of environmental and social factors on the health and development of 100,000 children, following them from before birth until age 21. Proposed participant recruitment methods call for locating and listing all dwelling units (DUs) located within randomly selected segments within the 105 NCS sites. One of seven Vanguard Centers of the NCS includes four rural counties that span approximately 2,500 square miles. The size of this sampling area presents unique geographic challenges. In order to determine the most efficient method for listing DUs within this large area, a study was undertaken to investigate the differences in the percent of DUs identified and the cost of four different approaches. It compared the on-site listing method of physically identifying each DU with three other methods: plat maps, postal listings, and Geographic Information Systems (GIS)/satellite imagery techniques. The on-site method had the strongest , (.85) in terms of identifying true DUs. There was a moderate agreement (.59) with the plat map method, fair agreement (.34) with the postal method, and only a slight agreement (.14) with the GIS/satellite imagery method. The plat map, postal listing, and GIS/satellite methods were less time-consuming than the on-site method. [source]

Are There Enough Doctors in My Rural Community?

THE JOURNAL OF RURAL HEALTH, Issue 2 2009
Perceptions of the Local Physician Supply
ABSTRACT:,Purpose: To assess whether people in the rural Southeast perceive that there is an adequate number of physicians in their communities, assess how these perceptions relate to county physician-to-population (PtP) ratios, and identify other factors associated with the perception that there are enough local physicians. Methods: Adults (n = 4,879) from 150 rural counties in eight southeastern states responded through a telephone survey. Agreement or disagreement with the statement "I feel there are enough doctors in my community" constituted the principal outcome. Weighted chi-square analysis and a generalized estimating equation (GEE) assessed the strength of association between perceptions of an adequate physician workforce and county PtP ratios, individual characteristics, attitudes about and experiences with medical care, and other county characteristics. Findings: Forty-nine percent of respondents agreed there were enough doctors in their communities, 46% did not agree, and 5% were undecided. Respondents of counties with higher PtP ratios were only somewhat more likely to agree that there were enough local doctors (Pearson's correlation coefficient = 0.09, P < .001). Multivariate analyses revealed that perceiving that there were enough local physicians was more common among men, those 65 and older, whites, and those with lower regard for physician care. Perceptions that the local physician supply was inadequate were more common for those who had longer travel distances, problems with affordability, and little confidence in their physicians. Perceptions of physician shortages were more common in counties with higher poverty rates. Conclusions: County PtP ratios only partially account for rural perceptions that there are or are not enough local physicians. Perceptions of an adequate local physician workforce are also related to how much people value physicians' care and whether they face other barriers to care. [source]

Presence of a Community Health Center and Uninsured Emergency Department Visit Rates in Rural Counties

Home Health Care Agency Staffing Patterns Before and After the Balanced Budget Act of 1997, by Rural and Urban Location

THE JOURNAL OF RURAL HEALTH, Issue 1 2008
William J. McAuley PhD
ABSTRACT:,Context:The Balanced Budget Act (BBA) of 1997 and other recent policies have led to reduced Medicare funding for home health agencies (HHAs) and visits per beneficiary. Purpose: We examine the staffing characteristics of stable Medicare-certified HHAs across rural and urban counties from 1996 to 2002, a period encompassing the changes associated with the BBA and related policies. Methods: Data were drawn from Medicare Provider of Service files and the Area Resource File. The unit of analysis was the 3,126 counties in the United States, grouped into 5 categories: metropolitan, nonmetropolitan adjacent, and 3 nonmetropolitan nonadjacent groups identified by largest town size. Only relatively stable HHAs were included. We generated summary HHA staff statistics for each county group and year. Findings: All staff categories, other than therapists, declined from 1997 to 2002 across the metropolitan and nonmetropolitan county groupings. There were substantial population-adjusted decreases in stable HHA-based home health aides in all counties, including remote counties. Conclusions: The limited presence of stable HHA staff in certain nonmetropolitan county types has been exacerbated since implementation of the BBA, especially in the most rural counties. The loss of aides in more rural counties may limit the availability of home-based long-term care in these locations, where the need for long-term care is considerable. Future research should examine the degree to which the presence of HHA staff influences actual access and whether other paid and unpaid sources of care substitute for Medicare home health care in counties with limited supplies of HHA staff. [source]

Perspectives on Health Among Adult Users of Illicit Stimulant Drugs in Rural Ohio

THE JOURNAL OF RURAL HEALTH, Issue 2 2006
Harvey A. Siegal PhD
ABSTRACT:,Context: Although the nonmedical use of stimulant drugs such as cocaine and methamphetamine is increasingly common in many rural areas of the United States, little is known about the health beliefs of people who use these drugs. Purpose: This research describes illicit stimulant drug users' views on health and health-related concepts that may affect their utilization of health care services. Methods: A respondent-driven sampling plan was used to recruit 249 not-in-treatment, nonmedical stimulant drug users who were residing in 3 rural counties in west central Ohio. A structured questionnaire administered by trained interviewers was used to collect information on a range of topics, including current drug use, self-reported health status, perceived need for substance abuse treatment, and beliefs about health and health services. Findings: Participants reported using a wide variety of drugs nonmedically, some by injection. Alcohol and marijuana were the most commonly used drugs in the 30 days prior to the interview. Powder cocaine was used by 72.3% of the sample, crack by 68.3%, and methamphetamine by 29.7%. Fair or poor health status was reported by 41.3% of the participants. Only 20.9% of the sample felt they needed drug abuse treatment. Less than one third of the sample reported that they would feel comfortable talking to a physician about their drug use, and 65.1% said they preferred taking care of their problems without getting professional help. Conclusions: Stimulant drug users in rural Ohio are involved with a range of substances and hold health beliefs that may impede health services utilization. [source]

A National Study of Obesity Prevalence and Trends by Type of Rural County

Transforming the Delivery of Rural Health Care in Georgia: State Partnership Strategy for Developing Rural Health Networks

THE JOURNAL OF RURAL HEALTH, Issue 5 2003
Karen J. Minyard PhD
ABSTRACT: Since 1996, 19 networks covering 74 of the 127 rural counties in Georgia have emerged. This grassroots transformation of rural health care occurred through a series of partnerships launched by state government officials. These partnerships brought together national and state organizations to pool resources for investment in an evolving long-term strategy to develop rural health care networks. The strategy leveraged resources from partners, resulting in greater impact. Change was triggered and accelerated using an intensive, flexible technical assistance effort amplified by developmental grants to communities. These grants were made available for structural and organizational change in the community that would eventually lead to improved access and health status. Georgia's strategy for developing rural health networks consisted of 3 elements: a clear state vision and mission; investment partnerships; and proactive, flexible technical assistance. Retrospectively, it seems that the transformation occurred as a result of 5 phases of investment by state government and its partners. The first 2 phases involved data gathering as well as the provision of technical assistance to individual communities. The next 3 phases moved network development to a larger scale by working with multiple counties to create regional networks. The 5 phases represent increasing knowledge about and commitment to the vision of access to care and improved health status for rural populations. [source]

Determinants of Economic Growth and Spread,backwash Effects in Western and Eastern China

ASIAN ECONOMIC JOURNAL, Issue 2 2010
Article first published online: 20 MAY 2010, Shanzi Ke
O18; P25; R11; R12 This paper comparatively assesses the major contributors to economic growth and spread,backwash effects in Western and Eastern China over the period 2000,2007. The empirical findings indicate that economies in both regions increasingly agglomerated in large cities; the marginal products of domestic capital and labor in the western region were, respectively, two-thirds and half of those in the eastern region; FDI was more productive than domestic capital. Spatial econometric analysis reveals that the central cities in Western China had mild spread effects on each other and backwash effects on the nearby rural counties and, in contrast, the central cities in the eastern region competed with each other and had backwash effects on nearby rural counties but spread effects on neighboring county-level cities. The paper draws several policy implications in relation to the improvement of factor inputs and construction of growth centers in the western region. [source]

Evaluating the impact of integrated health and social care teams on older people living in the community

HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2003
Louise Brown CQSW BSc(Hons) MSc
Abstract Although it is perceived wisdom that joint working must be beneficial, there is, even at this stage, little evidence to support that notion. The present study is an evaluation of two integrated co-located health and social care teams which were established in a rural county to meet the needs of older people and their carers. This study does identify that patients from the ,integrated teams' may self-refer more and are assessed more quickly. This might indicate that the ,one-stop shop' approach is having an impact on the process of service delivery. The findings also suggest that, in the integrated teams, the initial stages of the process of seeking help and being assessed for a service may have improved through better communication, understanding and exchange of information amongst different professional groups. However, the degree of ,integration' seen within these co-located health and social care teams does not appear to be sufficiently well developed to have had an impact upon the clinical outcomes for the patients/service users. It appears unlikely from the available evidence that measures such as co-location go far enough to produce changes in outcomes for older people. If the Department of Health wishes to see benefits in process progress to benefits to service users, then more major structural changes will be required. The process of changing organisational structures can be enhanced where there is evidence that such changes will produce better outcomes. At present, this evidence does not exist, although the present study does suggest that benefits might be forthcoming if greater integration can be achieved. Nevertheless, until the social services and National Health Service trusts develop more efficient and compatible information systems, it will be impossible to evaluate what impact any further steps towards integration might have on older people without significant external resources. [source]