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Rural Residents (rural + resident)
Selected AbstractsAssociations of Rural Residence With Timing of HIV Diagnosis and Stage of Disease at Diagnosis, South Carolina 2001-2005THE JOURNAL OF RURAL HEALTH, Issue 2 2010Kristina E. Weis PhD Abstract Context: Rural areas in the southern United States face many challenges, including limited access to health care services and stigma, which may lead to later HIV diagnosis among rural residents. Purpose: To investigate the associations of rural residence with timing of HIV diagnosis and stage of disease at diagnosis. Methods: Timing of HIV diagnosis was categorized as a diagnosis of acquired immune deficiency syndrome within 1 year of a first positive HIV test or HIV-only. Stage of disease was based on initial CD4+ T-cell count taken within 1 year of diagnosis. County of residence at HIV diagnosis was classified as urban if the population of the largest city was at least 25,000; it was classified as rural otherwise. Logistic regression was used to analyze timing of HIV diagnosis, and analysis of covariance was used to analyze stage of disease. Findings: From 2001 to 2005, 4,137 individuals were diagnosed with HIV infection. Of these, 1,129 (27%) were rural and 3,008 (73%) were urban residents. Among rural residents, 533 (47%) were diagnosed late, compared with 1,258 (42%) urban residents. Rural residents were significantly more likely to be diagnosed late (OR 1.19 [95% CI, 1.02-1.38]). Rural residence was associated with lower initial CD4+ T-cell count in crude analysis (P= .01) but not after adjustment (P > .05). Conclusions: Rural residence is a risk factor for late HIV diagnosis. This may lead to reduced treatment response to antiretroviral medications, increased morbidity and mortality, and greater HIV transmission risks among rural residents. New testing strategies are needed that address challenges to HIV testing and diagnosis specific to rural areas. [source] Perceived Barriers to Nurse Practitioner Practice in Rural SettingsTHE JOURNAL OF RURAL HEALTH, Issue 2 2005Linda Lindeke PhD ABSTRACT: Context: Rural residents experience the same incidence of acute illness as urban populations and have higher levels of chronic illness. Overall, access to adequate rural health care is limited. Nurse practitioners (NPs) have been identified as safe, cost-effective providers in meeting these challenges in rural settings. Purpose: This replication study was conducted to examine NP perceptions of barriers to rural practice in Minnesota. Findings were compared to earlier studies to examine issues that have persisted over time. Methods: A Barriers to Practice checklist was mailed to NPs from the database of the Board of Nursing of a midwestern state. Rural NPs (n = 191) identified and described barriers to practice and rated the overall restrictiveness of their practice. Findings: Barriers to practice were perceived to be prevalent. Persisting barriers continued to stand in the way of full utilization of NP roles. Lack of understanding of NP roles on the part of the public and other health professionals has been particularly problematic over time. Key issues in 2001 were low salaries, lack of adequate office space, and a limited peer network. Perceived restrictiveness of the practice climate, gauged as somewhat restrictive, remained unchanged between 1996 and 2001. Conclusions: NPs have an excellent history of meeting rural primary health care needs. Enhancing the NP work environment could prove instrumental to retaining these professionals in the work force and thereby contribute to improved access and quality of care in underserved rural communities. [source] Obesity and Physical Inactivity in Rural AmericaTHE JOURNAL OF RURAL HEALTH, Issue 2 2004Paul Daniel Patterson MPH ABSTRACT: Context and Purpose: Obesity and physical inactivity are common in the United States, but few studies examine this issue within rural populations. The present study uses nationally representative data to study obesity and physical inactivity in rural populations. Methods: Data came from the 1998 National Health Interview Survey Sample Adult and Adult Prevention Module. Self-reported height and weight were used to calculate body mass index. Physical inactivity was defined using self-reported leisure-time physical activity. Analyses included descriptive statistics, x2 tests, and logistic regression. Findings: Obesity was more common among rural (20.4%, 95% CI 19.2%,21.6%) than urban adults (17.8%, 95% CI 17.2%,18.4%). Rural residents of every racial/ethnic group were at higher risk of obesity than urban whites, other factors held equal. Other predictors of obesity included being male, age 25,74, lacking a high school diploma, having physical limitations, fair to poor health, and a history of smoking. Proportionately more rural adults were physically inactive than their urban peers (62.8% versus 59.3%). Among rural residents, minorities were not significantly more likely to be inactive than whites. Males and younger adults were less likely to be inactive. Rural adults who were from the Midwest and South, had less than a high school education, had fair to poor health, and currently smoked were more likely to be inactive compared to their respective referent group. Conclusions: The high prevalence of obesity and inactive lifestyles among rural populations call for research into effective rural interventions. [source] Southern Rural Access Program: An OverviewTHE JOURNAL OF RURAL HEALTH, Issue 5 2003Michael Beachler MPH ABSTRACT: Rural residents experience significant disparities in health status and access to care. These disparities and access barriers are particularly prevalent in rural communities in the South. The Southern Rural Access Program, a national program of the Robert Wood Johnson Foundation, was designed as a long-term effort to improve access to basic health care in 8 of the most underserved states in the country. The program was launched in 1998 with 3 goals: (1) to increase the supply of providers in underserved areas, (2) to strengthen the health care infrastructure, and (3) to build capacity at the state and community level to solve problems. The first 3-year phase of the program made $23.8 million available to communities in the 8 target states, and a January 2002 reauthorization of the program will make an additional $18.9 million available in the next 4 years. This article will provide an overview of the Southern Rural Access Program, focusing on the development and evolution of the program during its first 3-year phase. The article will also highlight some of the refinements that the foundation has made during the 2002,2006 second phase of the program. [source] Reading the Rural Modern: Literacy and Morality in Republican China1HISTORY COMPASS (ELECTRONIC), Issue 1 2009Kate Merkel-Hess This essay was runner-up in the 2007 History Compass Graduate Essay Prize, Asia Section. In the mid-1920s many education reformers turned their attention away from the urban illiterates who had been the focus of recent mass education efforts and toward the countryside and rural residents instead. In order to engage rural readers, reformers created a body of literature that addressed rural issues, articulating a reformed vision of a modern countryside as they did so. As the most prominent of the mass education programs, the Mass Education Movement's publications reached millions of Chinese. On the pages of their 1920s publications, the MEM constructed a vision of a ,rural modern' that emphasized a literate citizenry as the basis of a reformed countryside and modern nation. In this way, even while reformers attempted to democratize access to knowledge, they affirmed a Confucian relationship of education to morality. [source] Urban residents' subtle prejudice towards rural-to-urban migrants in China: The role of socioeconomic status and adaptation stylesJOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY, Issue 3 2010Huadong Yang Abstract The household registration system (Hukou) implemented by the Chinese government divides the Chinese society into two groups: urban residents and rural residents. Since the 1980s, millions of rural residents have migrated to cities without official permission. In this paper, we investigate urban residents' subtle prejudice towards rural-to-urban migrants. Specifically, the impacts of urban residents' socioeconomic status (SES) and their perception of migrants' adaptation styles are examined. A sample including 457 Chinese urban residents is taken from four cities in China. Educational and occupational levels are used to indicate urban residents' SES. Four adaptation styles (integration, assimilation, separation and marginalization) are manipulated by using vignettes. The results show that SES has a negative impact on urban residents' subtle prejudice. This link is further moderated by urban residents' perceptions of migrants' adaptations: the negative effect of SES on subtle prejudice holds only under a perception of integration or assimilation and disappears under a perception of separation or marginalization. Copyright © 2010 John Wiley & Sons, Ltd. [source] Exploring social capital in rural settlements of an islander region in GreeceJOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY, Issue 2 2010Anastasia Zissi Abstract This paper reports on a large scale cross-sectional study examining subjective perceptions of community social life held by a randomly selected sample of residents (n,=,428) in all small rural settings (n,=,89) of the region of North Aegean Sea. The notion of social capital was used as a conceptual tool in order to explore different aspects of the relational life of contemporary rural communities. This study has two aims: First to provide an account of rural residents' perceptions of village life in terms of interpersonal support, mutual aid, trust, social cohesion and community competence, and second to examine the suitability of the social capital notion within the specific cultural context. A combination of data collection procedures and a range of sources were employed, such as key informants, rural residents and researchers' field observations. The findings indicate that small farming communities of high devotion with deep roots and strong sense of belonging face severe demographic imbalance and experience low civic power given the limited links with external agents. The mainstream notion of social capital as an unconditionally beneficial factor is thus questioned. The findings call for revisiting its relevance across communities with varying capacities and needs. Copyright © 2009 John Wiley & Sons, Ltd. [source] Ascertainment of birth defects: The effect on completeness of adding a new source of dataJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2000C Bower Background: The Western Australian (WA) Birth Defects Registry aims for complete ascertainment of birth defects in WA, but the proportions of birth defects in rural areas and in Aboriginal children are lower than in metropolitan and non-Aboriginal children. The effect on ascertainment of adding data from the Rural Paediatric Service (RPS) was investigated. Method: A file of all cases of birth defects for children born 1980,1997 and recorded on the RPS database was linked to the Registry. Results: The addition of this new data source had little effect on the overall prevalence of birth defects (an increase from 5.38 to 5.41%). There was a slightly greater effect on the prevalence of birth defects in rural residents (4.67%,4.76%) and Aboriginal children (4.55,4.78%), although the prevalence for each of these groups is still less than for metropolitan residents and non-Aboriginal infants, respectively. All major categories of birth defects were represented in the new cases and, in general, their addition made little difference to the prevalence of each category. The exception was fetal alcohol syndrome, which increased from 0.13 per 1000 to 0.18 per 1000 once the 21 new cases from the RPS were added. Conclusion: Complete ascertainment of birth defects is important in developing and evaluating preventive programs, and in investigating clusters of birth defects. [source] Trends in Diet, Nutritional Status, and Diet-related Noncommunicable Diseases in China and India: The Economic Costs of the Nutrition TransitionNUTRITION REVIEWS, Issue 12 2001Dr. Barry M. Popkin Ph.D Undernutrition is being rapidly reduced in India and China. In both countries the diet is shifting toward higher fat and lower carbohydrate content. Distinct features are high intakes of foods from animal sources and edible oils in China, and high intakes of dairy and added sugar in India. The proportion of overweight is increasing very rapidly in China among all adults; in India the shift is most pronounced among urban residents and high-income rural residents. Hypertension and stroke are relatively higher in China and adult-onset diabetes is relatively higher in India. Established economic techniques were used to measure and project the costs of undernutrition and diet-related noncommunicable diseases in 1995 and 2025. Current WHO mortality projections of diet-related noncommunicable diseases, dietary and body composition survey data, and national data sets of hospital costs for healthcare, are used for the economic analyses. In 1995, China's costs of undernutrition and costs of diet-related noncommunicable diseases were of similar magnitude, but there will be a rapid increase in the costs and prevalence of diet-related noncommunicable diseases by 2025. By contrast with China, India's costs of undernutrition will continue to decline, but undernutrition costs did surpass overnutrition diet-related noncommunicable disease costs in 1995. India's rapid increase in diet-related noncommunicable diseases and their costs projects similar economic costs of undernutrition and overnutrition by 2025. [source] Prevalence and time trends in obesity among adult West African populations: a meta-analysisOBESITY REVIEWS, Issue 4 2008A. R. Abubakari Summary The objective of this study was to determine the distribution of and trends in obesity in adult West African populations. Between February and March 2007, a comprehensive literature search was conducted using four electronic databases. Journal hand searches, citations and bibliographic snowballing of relevant articles were also undertaken. To be included, studies had to be population-based, use well-defined criteria for measuring obesity, present data that allowed calculation of the prevalence of obesity and sample adult participants. Studies retrieved were critically appraised. Meta-analysis was performed using the DerSimonian-Laird random effect model. Twenty-eight studies were included. Thirteen studies were conducted in urban settings, 13 in mixed urban/rural and one in rural setting. Mean body mass index ranged from 20.1 to 27.0 kg2. Prevalence of obesity in West Africa was estimated at 10.0% (95% CI, 6.0,15.0). Women were more likely to be obese than men, odds ratios 3.16 (95% CI, 2.51,3.98) and 4.79 (95% CI, 3.30,6.95) in urban and rural areas respectively. Urban residents were more likely to be obese than rural residents, odds ratio 2.70 (95% CI, 1.76,4.15). Time trend analyses indicated that prevalence of obesity in urban West Africa more than doubled (114%) over 15 years, accounted for almost entirely in women. Urban residents and women have particularly high risk of overweight/obesity and obesity is rising fast in women. Policymakers, politicians and health promotion experts must urgently help communities control the spread of obesity in West Africa. [source] Impact of Rural Residence on Survival of Male Veterans Affairs Patients After Age 65THE JOURNAL OF RURAL HEALTH, Issue 4 2010Todd A. MacKenzie PhD Abstract Objectives: More than 1 in 5 Veterans Affairs (VA) users lives in a rural setting. Rural veterans face different barriers to health care than their urban counterparts, but their risk of death relative to their urban counterparts is unknown. The objective of our study was to compare survival between rural and urban VA users. Methods: We linked the Large Health Survey of Veteran Enrollees conducted in 1999 to the Veterans Administration vital status registry. We used time-to-event regression models controlling for patient race, education, ZIP-code median income, and marital and smoking status. Findings: Of the 372,463 male veterans of age 65 or greater, 80,931 lived in rural settings. Age-adjusted mortality was 5.9% higher (95% CI, 4.5%-7.2%) in rural residents compared to urban residents. After adjusting for age, education, and ZIP-code median income, rural residents had 3.0% lower mortality (95% CI, 1.5%-4.4%). Compared to urban and suburban VA users, rural VA users' mortality at age 65 was 12% lower, but this advantage gradually diminished by age 75. Conclusion: Mortality after the age of 65 for male VA users is higher in rural dwellers than in urban dwellers. However, among veterans of the same socioeconomic characteristics, rural-dwelling veterans have up to 15% better mortality than urban-dwelling veterans until the age of 75. [source] Associations of Rural Residence With Timing of HIV Diagnosis and Stage of Disease at Diagnosis, South Carolina 2001-2005THE JOURNAL OF RURAL HEALTH, Issue 2 2010Kristina E. Weis PhD Abstract Context: Rural areas in the southern United States face many challenges, including limited access to health care services and stigma, which may lead to later HIV diagnosis among rural residents. Purpose: To investigate the associations of rural residence with timing of HIV diagnosis and stage of disease at diagnosis. Methods: Timing of HIV diagnosis was categorized as a diagnosis of acquired immune deficiency syndrome within 1 year of a first positive HIV test or HIV-only. Stage of disease was based on initial CD4+ T-cell count taken within 1 year of diagnosis. County of residence at HIV diagnosis was classified as urban if the population of the largest city was at least 25,000; it was classified as rural otherwise. Logistic regression was used to analyze timing of HIV diagnosis, and analysis of covariance was used to analyze stage of disease. Findings: From 2001 to 2005, 4,137 individuals were diagnosed with HIV infection. Of these, 1,129 (27%) were rural and 3,008 (73%) were urban residents. Among rural residents, 533 (47%) were diagnosed late, compared with 1,258 (42%) urban residents. Rural residents were significantly more likely to be diagnosed late (OR 1.19 [95% CI, 1.02-1.38]). Rural residence was associated with lower initial CD4+ T-cell count in crude analysis (P= .01) but not after adjustment (P > .05). Conclusions: Rural residence is a risk factor for late HIV diagnosis. This may lead to reduced treatment response to antiretroviral medications, increased morbidity and mortality, and greater HIV transmission risks among rural residents. New testing strategies are needed that address challenges to HIV testing and diagnosis specific to rural areas. [source] Practical and Policy Implications of Using Different Rural-Urban Classification Systems: A Case Study of Inpatient Service Utilization Among Veterans Administration UsersTHE JOURNAL OF RURAL HEALTH, Issue 3 2009Ethan M. Berke MD ABSTRACT:,Context: Several classification systems exist for defining rural areas, which may lead to different interpretations of rural health services data. Purpose: To compare rural classification systems on their implications for estimating Veterans Administration (VA) utilization. Methods: Using 7 classification systems, we counted VA health care enrollees who lived in each category, and number admitted to VA hospitals or non-VA hospitals under Medicare. For dual VA-Medicare enrollees over age 65, we compared VA and private sector hospitalizations on numbers of admissions and bed-days of care. We compared VA enrollees' relative proportions across rural to urban categories for each classification system and evaluated discordance between systems at the veterans-integrated service networks (VISN) level. Findings: Enrollment and inpatient utilization counts for rural veterans vary considerably from one classification system to another, though the systems generally agree that admission rates, length of stay, and reliance on the VA for care are lower for rural veterans. Among older dual VA and Medicare enrollees, rural residents rely on non-VA facilities more, though this effect also varies widely depending on the classification scheme. VISNs vary greatly in the proportions of patients who are rural residents, and in the degree to which classification systems are discordant in designating patients as rural. Conclusions: Decisions about allocating VA health care resources to target "rural" patients may be affected greatly by the rural classification system chosen, and the impact of this choice will affect some hospital networks much more than others. [source] Medicare Hospital Charges in the Last Year of Life: Distribution by Quarter for Rural and Urban Nursing Home Decedents With Cognitive ImpairmentTHE JOURNAL OF RURAL HEALTH, Issue 2 2008Charles E. Gessert MD ABSTRACT:,Background:Medicare beneficiaries incur 27%-30% of lifetime charges in the last year of life; most charges occur in the last quarter. Factors associated with high end-of-life Medicare charges include less advanced age, non-white race, absence of advance directive, and urban residence. Methods: We analyzed Medicare hospital charges in the last year of life for nursing home residents with severe cognitive impairment, focusing on rural,urban differences. The study population consisted of 3,703 nursing home residents (1,882 rural, 1,821 urban) in Minnesota and Texas who died in 2000-2001. Data on Medicare hospital charges were obtained from 1998-2001 Centers for Medicare and Medicaid Services MedPAR files. Results: During the last year of life, unadjusted charges averaged $12,448 for rural subjects; $31,780 for urban. The charges were distributed across the last 4 quarters similarly for the 2 populations, with 15%-20% of charges incurred in each of the first 3 quarters, and 47% (rural) and 52% (urban) in the last quarter. At the individual level, a higher percentage of hospital charges were incurred in the last 90 days by urban than by rural residents (P < .001). A larger proportion of urban (43%) than rural (37%) residents were hospitalized in the final quarter. The charges for hospitalized residents (N = 1,994) were distributed similarly to those of the entire study population. Discussion: Medicare hospital charges during the last year of life were lower for rural nursing home residents with cognitive impairment than for their urban counterparts. Charges tend to be more concentrated in the last 90 days of life for urban residents. [source] The State of Diabetes Care Provided to Medicare Beneficiaries Living in Rural AmericaTHE JOURNAL OF RURAL HEALTH, Issue 4 2006Joseph P. Weingarten Jr PhD ABSTRACT:,Context: Diabetes poses a growing health burden in the United States, but much of the research to date has been at the state and local level. Purpose: To present a national profile of diabetes care provided to Medicare beneficiaries living in urban, semirural, and rural communities. Methods: Medicare beneficiaries with diabetes aged 18-75 were identified from Part A and Part B claims data from 1999 to 2001. A composite of 3 diabetes care indicators was assessed (annual hemoglobin A1c test, biennial lipid profile, and biennial eye examination). Findings: Over 77% had a hemoglobin A1c test, 74% a lipid profile, and 69% an eye examination. Patterns of care were considerably different across the urban-rural continuum at the state, Census division, and regional levels. States in the northern and eastern portions of the country had higher indicator rates for rural than for urban residents. States in the South had much lower rates for rural residents than their urban counterparts. Despite these within-state differences, across-state comparisons found that several states tended to have low indicator rates in every level of the urban-rural continuum. A common feature of these states was the relatively high concentration of nonwhite beneficiaries. For example, southern states had much higher concentrations of nonwhite beneficiaries relative to other areas in the country and demonstrated low rates in every level of the urban-rural continuum. Conclusions: Urban-rural quality of care differences may be a function not just of geography but also of the presence of a large nonwhite population. [source] A National Study of Obesity Prevalence and Trends by Type of Rural CountyTHE JOURNAL OF RURAL HEALTH, Issue 2 2005J. 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] Obesity and Physical Inactivity in Rural AmericaTHE JOURNAL OF RURAL HEALTH, Issue 2 2004Paul Daniel Patterson MPH ABSTRACT: Context and Purpose: Obesity and physical inactivity are common in the United States, but few studies examine this issue within rural populations. The present study uses nationally representative data to study obesity and physical inactivity in rural populations. Methods: Data came from the 1998 National Health Interview Survey Sample Adult and Adult Prevention Module. Self-reported height and weight were used to calculate body mass index. Physical inactivity was defined using self-reported leisure-time physical activity. Analyses included descriptive statistics, x2 tests, and logistic regression. Findings: Obesity was more common among rural (20.4%, 95% CI 19.2%,21.6%) than urban adults (17.8%, 95% CI 17.2%,18.4%). Rural residents of every racial/ethnic group were at higher risk of obesity than urban whites, other factors held equal. Other predictors of obesity included being male, age 25,74, lacking a high school diploma, having physical limitations, fair to poor health, and a history of smoking. Proportionately more rural adults were physically inactive than their urban peers (62.8% versus 59.3%). Among rural residents, minorities were not significantly more likely to be inactive than whites. Males and younger adults were less likely to be inactive. Rural adults who were from the Midwest and South, had less than a high school education, had fair to poor health, and currently smoked were more likely to be inactive compared to their respective referent group. Conclusions: The high prevalence of obesity and inactive lifestyles among rural populations call for research into effective rural interventions. [source] Rural-Urban Differences in the Social Climate Surrounding Environmental Tobacco Smoke: A Report From the 2002 Social Climate Survey of Tobacco ControlTHE JOURNAL OF RURAL HEALTH, Issue 1 2004Robert McMillen PhD ABSTRACT: Context: Although previous research has found smoking rates to be higher among residents of rural areas, few studies have investigated rural-urban differences in exposure to environmental tobacco smoke (ETS). Objective: This study contrasted the social climate surrounding ETS among Americans who resided in 5 levels of county urbanization. Design: Data were collected via telephone interviews administered to a representative sample of 3,009 civilian, noninstitutionalized adults over age 18 in the United States. Households were selected using random digit dialing procedures. Findings: Compared to residents of urban counties, rural residents reported fewer restrictions on smoking in the presence of children and lower incidences of smoking bans in households, family automobiles, work areas, convenience stores, fast-food restaurants, and restaurants. Interestingly, when rural-urban variations in knowledge and attitudes about ETS were examined, the magnitude of rural-urban differences was smaller or nonexistent for these indicators. Moreover, logistic regression models indicated that none of these rural-urban differences in knowledge and attitudes persisted after statistically controlling for region, smoking status, gender, race, age, and education factors. This suggests that the observed rural-urban differences in ETS bans could not be explained adequately by rural-urban differences in knowledge and attitudes about the dangers of ETS. Conclusions: The policy implications of this research point to a greater need in rural America for programs focusing on the restriction and elimination of ETS. They also suggest that programs focusing only on influencing the levels of ETS knowledge and attitudes among the general population may not be adequate in producing the desired change. [source] Insurance Coverage of Prescription Drugs and the Rural ElderlyTHE JOURNAL OF RURAL HEALTH, Issue 1 2004Curt Mueller PhD ABSTRACT: Context: Rural impacts of a Medicare drug benefit will ultimately depend on the number of elderly who are currently without drug coverage, new demand by those currently without coverage, the nature of the new benefit relative to current benefits, and benefit design. Purpose: To enhance understanding of drug coverage among rural elderly Medicare beneficiaries and their expenditures for pharmaceuticals. Methods: Estimates of the extent of coverage, expenditures, and sources of drugs were obtained using data are from the 1997 Medicare Current Beneficiary Survey and the Pharmacy Verification and Household Components of the 1996 Medical Expenditure Panel Survey. Findings: Three-quarters of the urban elderly had some type of drug coverage in 1997 versus 59% of the elderly in rural areas. Urban residents were more likely to have obtained their drug coverage from an employersponsored supplemental plan, and rural residents were more likely to have self-purchased Medigap drug coverage. Expenditures and use of drugs by Medicare beneficiaries are greater for those with than without coverage, and differences are invariant with respect to geographic location. Coverage under self-purchased supplemental plans appears less generous than under employer-sponsored plans in both rural and urban areas. Rural and urban elderly are more than twice as likely to receive at least 1 prescribed medication through the mail than the general population. Conclusion: A well-designed Medicare drug benefit would be especially beneficial to the rural elderly because relatively more rural elderly currently lack coverage or have less generous coverage than urban beneficiaries. Mail-order distribution may help contain future program expenditures. [source] Unmet Need Among Rural Medicaid Beneficiaries in MinnesotaTHE JOURNAL OF RURAL HEALTH, Issue 3 2002Sharon K. Long Ph.D. Given the vulnerabilities of rural residents and the health care issues faced by the Medicaid population generally, the combined effects of being on Medicaid and living in a rural area raise important questions about access to health care services. This study looks at a key dimension of health care access: unmet need for health care services. The study relies on data from a 1998 survey of rural Minnesota Medicaid beneficiaries. An overall response rate of 70% was obtained. For this study, the sample is limited to women who were on Medicaid for the full 12 months prior to the survey, resulting in 900 respondents. The study finds that the rural Medicaid beneficiaries face high levels of unmet need: more than 1 in 3 reported either delaying or not getting doctor, hospital, or specialist care that they felt they needed. Although the study lacks direct measures of the consequences of the high levels of unmet need, there is evidence that greater emergency room use is associated with unmet need. The survey data cannot necessarily be generalized to other rural areas, and like all surveys, this one is subject to nonresponse bias as well as potential biases because of respondent recall and self-assessment of medical needs. Nevertheless, these findings are suggestive of negative consequences of unmet need for both Medicaid beneficiaries and program costs. [source] Gender and Hmong Women's Handicrafts in Fenghuang's ,Tourism Great Leap Forward,' ChinaANTHROPOLOGY OF WORK REVIEW, Issue 3 2007Xianghong Feng Abstract Fenghuang County in rural Hunan Province started its "Tourism Great Leap Forward" in 2002, when the county government granted a 50-year lease for development rights over eight local major tourist sites to Yellow Dragon Cave Corporation (YDCC) headquartered in Changsha City, the capital of Hunan. Based on ethnographic research in 2002 and 2005,2006, this article explores the sociocultural impacts of Fenghuang's tourism development on local Hmong women's gender roles and their traditional handicrafts. According to the official state development discourse, local Hmong communities' traditional ethnic culture is associated with both poverty and the solution to poverty. Local Hmong women's handicraft practice in the context of tourism is used in this article to illustrate how local people react to this dilemma, and how ethnic minorities and rural residents are being drawn into the widening orbit of contemporary China's neoliberal economic development. [source] Costs of accessing surgical specialists by rural and remote residentsANZ JOURNAL OF SURGERY, Issue 9 2001Sarah L. Rankin Introduction: Access to surgical specialist services by rural and remote residents in Australia is limited. Little information is available on the cost to rural residents of accessing specialist treatment. The aim of the present study was to define the personal costs incurred by country patients in Western Australia when accessing specialist surgical services in a rural or metropolitan setting. Methods: A random sample of 50 patients who attended a visiting rural surgical service between December 1998 and February 1999 inclusive was recruited. In a structured telephone interview patients were asked 40 non-clinical questions relating to their recent specialist consultation. The cost of accessing these services was determined from time lost from work, distance and travel expenses. The same formula was then applied to estimate the cost of attending a base metropolitan hospital. The need for an accompanying person was determined from a subset of 16 patients who had transferred to metropolitan specialist consultation in the previous 12 months. Average waiting list times for consultations and common surgical procedures for the visiting service were compared with those for a metropolitan-based service. Results: An estimated saving of AU$1077 was made per specialist consultation when accessing a local rather than a metropolitan service. Savings were observed in travel time, distance travelled, lost income, provision of an escort and waiting time. Conclusion: The present study shows that the personal costs and difficulties incurred by rural and remote residents when accessing specialist treatment can be reduced if a visiting specialist service is available. [source] Distress among rural residents: Does employment and occupation make a difference?AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 1 2010Lyn Fragar Abstract Objective:,This study investigates the relationship between levels of mental health and well-being (in terms of self-reported levels of distress) with employment and occupational status of rural residents, to better inform the provision of mental health services to those in greatest need in rural communities. Method:,A stratified random sample of community residents in rural and remote New South Wales with over-sampling of remote areas as first stage of a cohort study. Psychological distress was measured using Kessler-10, inclusive of additional items addressing functional impairment (days out of role). Occupational data were classified using Australian and New Zealand Standard Classification of Occupations categories. Results:,A total of 2639 adults participated in this baseline phase. Among them, 57% were in paid employment, 30% had retired from the workforce, 6% were permanently unable to work and 2% were unemployed. The highest levels of distress and functional impairment were reported in those permanently unable to work and the unemployed group with rates of ,caseness' (likely mental health disorder) varying from 57% to 69%, compared with 34% of farmers and farm managers and 29% of health workers (P < 0.01). Conclusion:,The rural unemployed suffer considerable psychological distress and ,disability', yet they are not the target of specific mental health promotion and prevention programs, which are often occasioned by rural adversity, such as drought, and delivered through work-based pathways. Policy-makers and health service providers need to consider the needs of the rural unemployed and those permanently unable to work and how they might be addressed. [source] Health behaviours of young, rural residents: A case studyAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 2 2009Lisa Bourke Abstract Objective:,To analyse self-reported health behaviours of young people from a rural community and the factors influencing their behaviours. Methods:,Interviews were conducted with 19 young people, 11 parents and 10 key informants from a small rural Victorian community, asking about teenage health behaviours and the factors influencing these behaviours. Results:,Young people ate both healthy and unhealthy foods, most participated in physical activity, few smoked and most drank alcohol. The study found that community level factors, including community norms, peers, access issues and geographic isolation, were particularly powerful in shaping health behaviours, especially alcohol consumption. Smoking was influenced by social participation in the community and national media health campaigns. Diet and exercise behaviour were influenced by access and availability, convenience, family, peers and local and non-local cultural influences. Conclusion and implications:,The rural context, including less access to and choice of facilities and services, lower incomes, lack of transport and local social patterns (including community norms and acceptance), impact significantly on young people's health behaviours. Although national health promotion campaigns are useful aspects of behaviour modification, much greater focus on the role and importance of the local contexts in shaping health decisions of young rural people is required. [source] Rural health care in MalaysiaAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 2 2002Kamil Mohamed Ariff ABSTRACT: Malaysia has a population of 21.2 million of which 44% resides in rural areas. A major priority of healthcare providers has been the enhancement of health of ,disadvantaged' rural communities particularly the rural poor, women, infants, children and the disabled. The Ministry of Health is the main healthcare provider for rural communities with general practitioners playing a complimentary role. With an extensive network of rural health clinics, rural residents today have access to modern healthcare with adequate referral facilities. Mobile teams, the flying doctor service and village health promoters provide healthcare to remote areas. The improvement in health status of the rural population using universal health status indicators has been remarkable. However, differentials in health status continue to exist between urban and rural populations. Malaysia's telemedicine project is seen as a means of achieving health for all rural people. [source] MEDIA REPORTS OF RURAL HEALTH AND SAFETY: A REVIEW OF ARTICLES PUBLISHED IN THE LAND NEWSPAPERAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 5 2001Robyn Shea ABSTRACT: The Land is one of the main newspapers that service Australia's rural community. A content analysis of reports on health issues in The Land was undertaken for the period April 1998 to October 1999 (76 editions, 10 336 pages). Fifty-four articles were published, with most being about causes of farm injury. Very few articles concerning non-injury health issues facing rural residents were published. People working in health promotion should consider The Land to be an under-utilised vehicle for news and commentary on rural health and safety issues. [source] Does Education Still Pay Off in Rural China: Revisit the Impact of Education on Off-farm Employment and WagesCHINA AND WORLD ECONOMY, Issue 2 2008Haiqing Zhang I21; J24; O15 Abstract The present study considers how education affects off-farm job participation and wages. We use a nationally representative dataset from a survey conducted in 5 provinces, 101 villages and 808 households by the authors in early 2005. The empirical results show that educational attainment, skill training and years of experience of rural residents have positive, statistically significant effects on off-farm employment. The average return to a year of education is 7 percent, which is higher than those observed in previous studies. We also find the return to an additional year of schooling to be higher for post-junior high schooling than for junior high and below schooling: 11.8 versus 3.2 percent. We conclude that not only does education still pays off in rural China, but also the rate of return to education is increasing over time. [source] Operated and unoperated cataract in AustraliaCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 2 2000Catherine A McCarty PhD MPH ABSTRACT Purpose: To quantify the prevalence of cataract, the outcomes of cataract surgery and the factors related to unoperated cataract in Australia. Methods: Participants were recruited from the Visual Impairment Project: a cluster, stratified sample of more than 5000 Victorians aged 40 years and over. At examination sites interviews, clinical examinations and lens photography were performed. Cataract was defined in participants who had: had previous cataract surgery, cortical cataract greater than 4/16, nuclear greater than Wilmer standard 2, or posterior subcapsular greater than 1 mm 2. Results: The participant group comprised 3271 Melbourne residents, 403 Melbourne nursing home residents and 1473 rural residents. The weighted rate of any cataract in Victoria was 21.5%. The overall weighted rate of prior cataract surgery was 3.79%. Two hundred and forty-nine eyes had had prior cataract surgery. Of these 249 procedures, 49 (20%) were aphakic, 6 (2.4%) had anterior chamber intraocular lenses and 194 (78%) had posterior chamber intraocular lenses. Two hundred and eleven of these operated eyes (85%) had best-corrected visual acuity of 6/12 or better, the legal requirement for a driver's license. Twenty-seven (11%) had visual acuity of less than 6/18 (moderate vision impairment). Complications of cataract surgery caused reduced vision in four of the 27 eyes (15%), or 1.9% of operated eyes. Three of these four eyes had undergone intracapsular cataract extraction and the fourth eye had an opaque posterior capsule. No one had bilateral vision impairment as a result of cataract surgery. Surprisingly, no particular demographic factors (such as age, gender, rural residence, occupation, employment status, health insurance status, ethnicity) were related to the presence of unoperated cataract. Conclusions: Although the overall prevalence of cataract is quite high, no particular subgroup is systematically under-serviced in terms of cataract surgery. Overall, the results of cataract surgery are very good, with the majority of eyes achieving driving vision following cataract extraction. [source] Lifetime urban/rural residence, social support and late-life depression in KoreaINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 9 2004Jae-Min Kim Abstract Background Population ageing and rural,urban migration are accelerating in many non-Western nations. This study aimed to investigate: (i) the association between lifetime urban/rural residence and late-life depression in Korea and (ii) modification of associations between depression and social support by lifetime residence. Methods 1204 urban/rural residents aged 65+were interviewed and GMS-AGECAT diagnoses made. Previous areas of residence were recorded and social support deficits quantified. Results Depression was present in 9% and 21% of the rural and urban samples respectively. For the urban sample, depression was not associated with earlier urban/rural residence. Social support deficits were most strongly associated with depression in people with a lifetime rural residence, followed by urban residents with a rural birthplace. Conclusions Prevalence rates of depression were increased in the urban sample regardless of previous urban/rural residence. Reduced social support was particularly strongly associated with depression in people with a rural upbringing. Copyright © 2004 John Wiley & Sons, Ltd. [source] | ||||||||||||||||