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Janice C. Probst, PhD

Director, South Carolina Rural Health Research Center

Phone: 803.251.6317
Fax: 803.777.1836
E-mail: jprobst@mailbox.sc.edu

South Carolina Rural Health Research Center
University of South Carolina
220 Stoneridge Drive, Suite 204
Columbia, SC 29210  


Current Projects (7)

Adequacy of Home Health Care Availability in Rural Counties
Research center: South Carolina Rural Health Research Center
Topics: Aging, Home health
This project will describe current distribution of HHC agencies, by Zip Code and county of facility location and of service provision, across levels of rurality. Second, the project will estimate whether rural populations at risk for inadequate access to HHC, based on projected population need population / provider ratios.

Characteristics and Utilization Patterns of Rural Dual-eligible Medicare Beneficiaries
Research center: South Carolina Rural Health Research Center
Topics: Medicaid and S-CHIP, Medicare
Persons who are eligible for both Medicare and Medicaid insurance coverage (dual eligible) represent 21% of total Medicare enrollment, but account for more than 36% of Medicare expenditures. The purpose of this study is to ascertain whether dual-eligible beneficiaries living in rural areas differ from their urban counterparts in demographic characteristics and Medicare expenditures.

Intensity of Service Provision for Medicare Beneficiaries Utilizing Home Health Services
Research center: South Carolina Rural Health Research Center
Topics: Chronic diseases and conditions, Home health, Medicare
This study will assess whether Medicare beneficiaries in rural areas receive a lower intensity of home health (HH) services compared to their urban counterparts. Specifically, the study will examine (1) the distribution of levels of HH services for four conditions: joint (hip and knee) replacement, stroke, end-stage renal disease (ESRD), and diabetes; (2) the distribution of type of provider for each condition across the levels of rurality; and (3) the median charge and payment per beneficiary for these services across the levels of rurality.

Post-Hospital Transitions in Care Among Dually-Eligible Medicare Beneficiaries
Research center: South Carolina Rural Health Research Center
Topics: Health policy, Hospitals and clinics, Medicare
This project will examine the hospitalization rates, post-discharge physician follow-up, and subsequent readmission rates among Medicare beneficiaries who are also enrolled in Medicaid. We will examine these dual-eligible beneficiaries by level of rurality to determine if residence is a significant factor in these rates. We will also control for co-morbidities, county characteristics, and other factors related to readmission rates.

Profiling Health and Health Resource Availability in U.S. – Mexico Border Counties
Research center: South Carolina Rural Health Research Center
Topics: Border and international health, Minority health
This project will augment a previous SCRHRC chartbook on Border health with additional information on health resources and health outcomes in US counties adjacent to Mexico.

Rural and Urban Differences in Case-Mix Among Recipients of Home Health Care
Research center: South Carolina Rural Health Research Center
Topics: Health disparities, Home health, Medicare
We will examine current patient case-mix for the Medicare population receiving skilled health care from a home health agency to determine if there are rural or race/ethnicity-based disparities with regards to receipt of services and clinical acuity indicators.

Rural Area Deprivation and Hospitalizations Among Children for Ambulatory Sensitive Conditions
Research center: South Carolina Rural Health Research Center
Topics: Children, Health disparities, Hospitals and clinics
Rural areas with reduced social and economic resources may be particularly vulnerable to inadequate primary care for children.

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Completed Projects (19)

Adequacy of Ambulatory Care among Rural African Americans with Congestive Heart Failure, Diabetes or Asthma, Lead researcher
Research center: South Carolina Rural Health Research Center
Topics: African Americans, Chronic diseases and conditions, Minority health

Characteristics and Educational Needs of Rural Acute Care Hospital Boards of Directors, Lead researcher
Research center: South Carolina Rural Health Research Center
Topic: Hospitals and clinics
Rural hospital boards face challenges in an environment of increasing legal and financial complexity. This study will characterize rural hospital Board of Directors' backgrounds, perceptions of board function, and perceived need of training and development.

Chartbook: Racial and Ethnic Disparities in the Health of Rural Populations , Lead researcher
Research center: South Carolina Rural Health Research Center
Topics: Health disparities, Minority health, Rural statistics and demographics
This study will provide a cross-sectional, descriptive study that uses large, nationally representative data sets to illustrate health and health care among rural populations. The data sets to be used include the 2005 Behavioral Risk Factor Surveillance Survey, the 2005 National Health Interview Survey, and the Area Resource File.

Depression and Generalized Anxiety Disorder across Rural Populations, Lead researcher
Research center: South Carolina Rural Health Research Center
Topics: Health disparities, Mental health, Minority health

Effect of Safety Net Providers on Ambulatory Care Sensitive Hospitalization Rates in Rural Counties, Lead researcher
Research center: South Carolina Rural Health Research Center
Topics: Chronic diseases and conditions, Federally Qualified Health Centers (FQHCs), Health services, Poverty, Rural Health Clinics (RHCs)
This project will determine if the presence of a community health center or rural health clinic in a county reduces ambulatory care sensitive hospitalizations for children, working age adults, and older adults.

Effects of Alcohol Use on Educational Attainment and Employment in Rural Youth, Lead researcher
Research center: South Carolina Rural Health Research Center
Topics: Children, Substance abuse
This study will examine the effects of alcohol use during the teen years on subsequent educational attainment and employment in a panel of rural residents.

Effects of Uninsurance during the Preceding 10 Years on Health Status Among Rural Working Age Adults, Lead researcher
Research center: South Carolina Rural Health Research Center
Topic: Health insurance and the uninsured
Utilizing data from the 1979 National Longitudinal Survey of Youth, the effects of long-term, continuous uninsurance on health status will be analyzed through a comparison of rural and urban populations who were between the ages of 14-22 in 1979.

Emergency Department Use by Medically Indigent Rural Residents, Lead researcher
Research center: South Carolina Rural Health Research Center
Topics: Emergency medical services (EMS), Health insurance and the uninsured, Hospitals and clinics

Mode of Travel and Actual Distance Traveled for Medical or Dental Care by Rural Residents, Lead researcher
Research center: South Carolina Rural Health Research Center
Topics: Dental health, Health disparities, Health services, Minority health
This project examined the influence of race and rural isolation on distance traveled to receive medical or dental care, and how the potential interaction of these factors might exacerbate disparities in access to care.

Premature Mortality: Potential Role of Health Insurance in Moderating Race/Ethnicity and Rural/Urban Disparities, Lead researcher
Research center: South Carolina Rural Health Research Center
Topics: Health insurance and the uninsured, Minority health
This project will explore the degree to which lack of health insurance may contribute to high mortality rates among rural minority men and women aged 45-64.

Racial and Rural Differences in Cervical Cancer Screening Practices
Research center: South Carolina Rural Health Research Center
Topics: Health promotion and disease prevention, Minority health, Women
The purpose of this study is to describe and compare racial and rural differences in cervical cancer screening practices using data from the National Ambulatory Medical Care Survey. The findings will inform policies to increase appropriate access to quality cancer-preventive services.

Rapid Research Response on Health Care Reform Issues, Lead researcher
Research center: South Carolina Rural Health Research Center
Topics: Health care financing, Health policy
The focus of the SC Rural Health Research Center is on investigating persistent inequities in health status within the population of the rural US, with an emphasis on inequities stemming from socioeconomic status, race and ethnicity, and access to healthcare services. Building on existing expertise, the SC Rural Health Research Center will create an internal process that allows for rapid turnaround of analysis on race/ethnicity and rural-based health disparity inquiries from policymakers.

Rural Border Chartbook
Research center: South Carolina Rural Health Research Center
Topics: Border and international health, Hispanics, Minority health
This chartbook is the first study to examine the health status of residents living in US counties that border Mexico as a single region rather than as four distinct state areas. We examined select health status indicators among residents of the four border states, Arizona, California, New Mexico, and Texas, comparing indicators by ethnicity (Hispanic vs. non-Hispanic), rurality (rural vs. urban), and proximity to border (border vs. non-border).

Rural EMS Infrastructure, Lead researcher
Research center: South Carolina Rural Health Research Center
Topics: Emergency medical services (EMS), Frontier health

Rural Health Center Expansion and Recruitment Survey, Lead researcher
Research centers: South Carolina Rural Health Research Center, WWAMI Rural Health Research Center
Topics: Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Workforce
This collaborative project between WWAMI and the South Carolina Rural Health Research Centers examined and described the current staffing needs of rural health centers (HC), ascertained the staffing, recruitment, and retention issues that HC CEOs regard as most critical; distinguish edhow issues differ between CEOs contemplating development of expansion sites versus those who are not; and described how these findings correlate with the literature and current national supply projections for the categories of health professions needed by the HCs.

Rural Minority Health: A Comprehensive Assessment, Lead researcher
Research center: South Carolina Rural Health Research Center
Topics: African Americans, Health disparities, Minority health, Rural statistics and demographics
This study will profile demographics of rural African Americans by region of the U.S.; describe clinical problems prevalent in rural African American populations; explore available health care facilities and practitioners in rural areas; investigate outpatient treatment provided to rural African American populations by type of practitioner; explore expenditures for health care among rural African Americans by region of the U.S.; and determine barriers to care such as insurance, provider availability, and health beliefs and behaviors.

Rural Minority Health: A Comprehensive Assessment of Health Status, Health Care Utilization and Barriers to Care among Rural Minorities, Lead researcher
Research center: South Carolina Rural Health Research Center
Topics: Health disparities, Minority health, Rural statistics and demographics

Transitions in Care for Rural Medicare Beneficiaries with Diabetes, Lead researcher
Research center: South Carolina Rural Health Research Center
Topics: Chronic diseases and conditions, Health disparities, Medicare, Minority health
Hospital readmission rates among persons with diabetes, as well as absolute admission rates, may be used to study health disparities among rural and minority populations. This project will use data from the Medicare Chronic Conditions Data Warehouse to explore residence- and race-based disparities in diabetes admission rates, effective transitions to outpatient care, and re-admission rates, to help guide rural policy-makers and health care providers.

Trends in Uninsurance Among Rural Minority Children, Lead researcher
Research center: South Carolina Rural Health Research Center
Topics: Children, Health insurance and the uninsured
This project analyzed trends in health insurance coverage and health services utilization among rural children, in order to ascertain whether the S-CHIP program has positively affected rural children, and whether all rural children, including minority children, have benefited equally.

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Publications (50)

  • Access to Care among Rural Minorities: Children
    Date: 11/2002
    Profiles the characteristics of non-metro children, their health insurance coverage, and their health care visits. Recommends a multi-faceted approach to ensure that non-metro children obtain appropriate levels of health care. Facets including retaining and expanding provision of care to indigent and low-income families, expanding insurance coverage, and addressing rural poverty.
  • Access to Care Among Rural Minorities: Children (Appendix - Methods, Data Sources, and Detailed Tables)
    Date: 11/2002
    Appendix of report on rural minority children and the factors affecting their health insurance coverage and health services use.
  • Access to Care Among Rural Minorities: Older Adults
    Date: 10/2002
    Profiles health status of, and use of physicians by, non-metro older adults. Programmatic recommendations based on the findings: maintain programs that encourage providers to practice in non-metro areas, pay particular attention to the problems of the near-poor African-American elderly, and foster coalitions linking providers with voluntary community-based organizations to increase support services to elderly non-metro populations.
  • Access to Care Among Rural Minorities: Older Adults (Appendix - Methods, Data, and Detailed Tables)
    Date: 10/2002
    Appendix of report on health status and health services use among poor and minority older adults in non-metro areas.
  • Access to Care among Rural Minorities: Working Age Adults
    Date: 01/2003
    Examines the prevalence of health insurance and the use of physician services in rural areas. Findings include that rural minorities are handicapped by poverty and lack of education; low income and low education levels in non-metro areas translate into jobs that do not offer health insurance; and although non-metro adults were less likely to have insurance than metropolitan residents, they were not less likely to see a physician, with some exceptions.
  • Assessment Of Barriers To The Delivery Of Medicare Reimbursed Diabetes Self-Management Education In Rural Areas
    Date: 09/2004
    Explores the barriers that rural practitioners face in providing diabetes education services to Medicare beneficiaries. Survey results from a random sample of ADA-recognized diabetes education facilities indicated that insufficient Medicare reimbursement, staffing, institutional support as well as the ADA recognition process all constituted barriers to diabetes self-management education in rural areas.
  • Barriers Associated With the Delivery of Medicare Reimbursed Diabetes Self-Management Education
    Date: 2005
    Describes the results of a study to explore the barriers that practitioners face in providing diabetes self-management education (DSME) to Medicare beneficiaries, with a special focus on barriers faced by rural providers. Barriers identified for rural providers include costs, reporting requirements, the shortage of designated specialists, fewer resources, high application fees for ADA recognition, staffing/institutional support, amount of Medicare reimbursement, lack of hours covered, and transportation.
  • Chartbook: Dental Health and Access to Care among Rural Children: A National and State Portrait (Full Report)
    Date: 03/2008
    Although children's dental health in the U.S. has improved over recent decades, a subset of children continues to suffer dental disease severe enough to constitute a public health problem. This Chartbook examines dental health status, use of preventive services, and dental insurance among rural and urban children. The Chartbook provides information specific to rural children, and in particular rural minority children, not available in similar detail from other sources. This information can be used at the state level for program planning and assessment.
  • Community Health Center and Rural Health Clinic Presence Associated with Lower County-Level Hospitalization Rates for Ambulatory Care Sensitive Conditions (Full Report)
    Date: 08/2009
    Examines the effect of the presence of a Federally Qualified Community Health Center (CHC) or Rural Health Clinic (RHC) within a county on population rates of hospitalization for ambulatory care sensitive (ACS) conditions, using data from eight states.
  • Delivery Complications Associated With Prenatal Care Access for Medicaid-Insured Mothers in Rural and Urban Hospitals
    Date: 2005
    Examined access to health care during pregnancy for mothers insured by Medicaid as well as the risks of potentially avoidable maternity complications among rural and urban hospital deliveries for groups of mothers defined by race or ethnicity. Within groups defined by race or ethnicity, unadjusted rates for potentially avoidable maternity complications did not differ significantly by hospital location. Holding other factors constant, potentially avoidable maternity complications were less common in rural hospitals than in urban hospitals. In rural hospitals, African Americans had notably higher risk for potentially avoidable maternity complications than did non-Hispanic whites. The authors conclude that providers and policymakers should work to reduce the risks of potentially avoidable maternity complications for African American women in rural areas who are insured by Medicaid.
  • Dental Sealant Utilization Among Rural and Urban Children
    Date: 03/2013
    Examines the proportion of rural children who have received dental sealants applied to the surface of their teeth to prevent or delay the development of dental decay.
  • Depression in Rural Populations: Prevalence, Effects on Life Quality, And Treatment-Seeking Behavior
    Date: 05/2005
    Using the National Health Interview Survey and the NHIS-administered depression scale from the Comprehensive International Diagnostic Interview to explore depression among rural versus urban residents, the authors found that the prevalence of major depression was significantly higher among rural (6.11%) than among urban (5.16%) populations. However, nearly all individuals scoring positive for depression reported that their symptoms interfered with their life or activities (46.67% rural, 44.25% urban). Persons without any health insurance were less likely to have communicated with a physician than were the privately or publicly insured. Additionally, the likelihood that an individual with depression would have communicated with a practitioner rose as the person's self reported health declined.
  • Development of a Research Agenda on the Issues of Access to Care and Reduction of Health Status Disparities of Rural African Americans in South Carolina
    Date: 01/2001
    Explores disparities in health among rural African Americans and rural white South Carolina residents. Introductory, descriptive study. Key findings include: Mortality, use of hospital and emergency department services, and outpatient visits among Medicaid recipients.
  • Dialysis Availability in Rural America
    Date: 01/2013
    Explores the availability of dialysis services in rural America including the prevalence of dialysis use across urban and rural counties, travel distance for services, and dialysis quality outcomes.
  • Diet, Physical Activity, and Sedentary Behaviors as Risk Factors for Childhood Obesity: An Urban and Rural Comparison (Final Report)
    Date: 11/2010
    Nearly 20% of the U.S. population resides in non-metropolitan areas, yet our knowledge about the prevalence of obesity in rural America is very limited. Previous research by the South Carolina Rural Health Research Center found that rural children, paradoxically, were both more likely to be overweight or obese and more likely to be physically active than urban children.
  • Diffusion of Preventive Innovation: Racial and Rural Differences in Cervical Cancer Prevention and Control Practices
    Date: 05/2013
    Examines differences in receipt of cervical cancer screening and HPV vaccination associated with residence and race/ethnicity.
  • Early Alcohol Use, Rural Residence, and Adulthood Employment
    Date: 10/2005
    Findings indicate that drinking during youth and early adulthood was common in the early 1980's. Nearly half (47.6%) of respondents reported drinking before age 18, and 55.3% reported binge drinking. Drinking behaviors did not differ significantly between rural and urban residents, and rural youth surveyed in 1979-1983 were as likely as their urban counterparts to start drinking before the age of 18, binge drink before 18, and report that work or school was impacted by drinking.
  • Effects of Race and Poverty on Perceived Stress Among Rural Women
    Date: 2005
  • Effects of Uninsurance during the Preceding 10 Years on Health Status among Rural Working Age Adults
    Date: 09/2005
    In a population just reaching age 40, continuous health insurance coverage across the preceding 8 to 10 years was not associated with better self-perceived health than interrupted coverage. However, continuous insurance coverage was significantly related to better mental health, with the effect persisting in multivariable analysis controlling for residence, race, and demographic characteristics. Rural residents reaching age 40 in 1998 or 2000 were less likely to have been continuously insured between 1989-2000 than were their urban peers.
  • Emergency Department Use By Medically Indigent Rural Residents
    Date: 07/2003
    Examined emergency department (ED) use, combining national data and South Carolina state data to estimate the uncompensated charges in rural EDs nationally and the ameliorating effects of rural community health centers on ED use by rural residents.
  • Expected Annual Emergency Miles per Ambulance: An Indicator for Measuring Availability of Emergency Medical Services Resources
    Date: 2006
    Proposes a county-level indicator of emergency medical services (EMS) resource availability that takes into consideration existing EMS resources (ambulances), population health and demographics, and geographic factors. The indicator, the EXpected annual emergency miles per AMBulance (EXAMB), provides a basis for comparing ambulance availability across counties within states. A method for calculating the EXAMB indicator is demonstrated using data from 5 states.
  • Handling the Handoff: Rural and Race-Based Disparities in Post Hospitalization Follow-up Care Among Medicare Beneficiaries with Diabetes
    Date: 09/2011
    Diabetes is one of the most common chronic diseases, affecting an estimated 23.6 million people in the United States (7.8% of the total population). Rural African American and Hispanic residents with diabetes are less likely to exhibit good control of their condition, putting them at greater risk for the consequences of this disease, such as kidney failure, blindness and amputation. Effective outpatient care is key to diabetes management. Absence of such care, conversely, may play a role in poorer diabetes control in rural areas. The present report uses information regarding Medicare beneficiaries with diabetes to examine the provision of care in rural America. It provides estimates of hospital admission rates for rural Medicare beneficiaries with diabetes, tracks the proportion of patients who receive adequate outpatient care post discharge, and assesses subsequent readmissions to the hospital. It also explores the potential for race-based disparities in care for diabetes.
  • Health Disparities: A Rural-Urban Chartbook (Full Report)
    Date: 06/2008
    Rural minorities experience disparities in health and health care delivery. Previous studies have illustrated many of the health disparities experienced by rural residents, such as poorer health status, higher obesity prevalence, more with activity limitations, and higher mortality rates. The Chartbook seeks to expand the work of the National Healthcare Disparities Reports, issued annually by the Agency for Healthcare Research and Quality. These Reports are limited in their discussion of disparities experienced by rural residents and present little data regarding disparities among rural minority populations. The present Chartbook expands upon prior work by examining potential disparities among rural populations in health, health behaviors, preventive services and diabetes care.
  • HIV/AIDS in Rural America: Prevalence and Service Availability
    Date: 01/2013
    Examines the prevalence of HIV/AIDS in rural counties across 28 states in 2008 and the rural-versus-urban distribution of Ryan White providers.
  • Hospitalization for Ambulatory Care Sensitive Conditions: Asthma, Diabetes, and Congestive Heart Failure in South Carolina
    Date: 05/2003
    Hospitalization rates for ambulatory care sensitive conditions, diseases for which primary care in the preceding six months could have reduced or eliminated the need for hospitalization, are a commonly used indicator of disparities in access to care.
  • Hypertension, Diabetes, Cholesterol, Weight, and Weight Control Activities Among Non Metro Minority Adults
    Date: 12/2002
    The 1998 National Health Interview Survey (NHIS) included a detailed examination of preventive health problems and behaviors. This report uses data from the 1998 NHIS to examine the prevalence of selected problems among rural populations, with an emphasis on rural minorities. ?Rural? was defined, following NHIS guidelines, as living in a non-MSA county.
  • Impact Of Medicaid Managed Care, Race/Ethnicity, and Rural/Urban Residence On Potentially Avoidable Maternity Complications: A Five-State Multi-Level Analysis
    Date: 12/2004
    Complications of pregnancy affect the lives of many women and infants. This study examines pregnancy-related complications using Potentially Avoidable Maternity Complications (PAMCs) as an indicator of access. Findings include: 1) Mothers delivering in rural hospitals had lower PAMC risks than those with urban deliveries.; 2) In rural hospitals, African American women had greater PAMC risks than white women.; and 3) In urban hospitals, adjusted PAMC risks were substantially lower for Hispanics and Asians than for whites.
  • Investigating Rural EMS Infrastructure: A Developmental Methodology For Measuring The Availability Of EMS Resources
    Date: 08/2004
    Explores a potential indicator of EMS availability, the Expected Annual Emergency Miles per Ambulance (EXAMB). The ambulance is used as the core unit of availability due to its importance for safe transport and the initiation of medical services. The EXAMB measure calculates expected annual emergency miles per ambulance beginning with the number of ambulances, the land area of a county as a proxy for distance, and county population. Findings showed that in three of the five states studied, EXAMB values varied in parallel with other measures of resource availability, and in all states, the EXAMB was positively related to the proportion of the county population in poverty.
  • Is Your Hospital's Board Prepared to Govern? Rural Acute Care Hospital Boards Of Directors: Education and Development Needed
    Date: 06/2010
    Examined the structural, leadership, and educational needs of rural hospital boards, as viewed by rural hospital board chairs and chief executive officers (CEOs).
  • Mental Health Risk Factors, Unmet Needs, and Provider Availability for Rural Children
    Date: 09/2005
    The study used the 2001 National Health Interview Survey to assess the prevalence of sub-clinical mental health problems among children, the degree to which children with potential problems use mental health and general providers for these problems, and the degree of unmet need. Key findings include: 1) Nearly 1 of every 4 rural children has a potential mental health problem as derived from the Strengths and Difficulties Questionnaire (SDQ).; 2) Age, sex, family income, parental education, living situation, health insurance status, and previously diagnosed developmental disorder were all associated with sub-clinical mental health problems in children.; 3) Less than 1 out of 5 parents of rural or urban children with sub-clinical mental health problems had seen or talked to a mental health professional about the child in the past 12 months.; and 4) Characteristics associated with mental health care utilization were race/ethnicity, insurance status, level of education in the child's family, living situation, and previous diagnosis of a developmental disorder. Among roughly 2.9 million rural children with a potential mental health problem as defined by the SDQ score, two thirds (68.1%) are living in a HPSA-mental health designated area. This translates to over 1.9 million children with mental health problems but living in areas where very minimal to no resources are available for their care.
  • Minorities in Rural America: An Overview of Population Characteristics
    Date: 01/2002
    Presents an overview of demographic and economic statistics pertaining to rural minority populations and addresses the following questions: Where do rural minorities live? How is the rural minority population distributed across ages and sexes? What is the economic structure of rural, minority communities? What health resources are available in rural, minority communities? Findings pertaining to each minority group are presented in separate chapters. Based on the findings, the authors make several recommendations regarding issues ranging from program participation to infrastructure to research.
  • Minorities in Rural America: Appendix A Description of Method and Supporting Tables Tables Ordered by Chapter
    Date: 2002
    Appendix of a report that gives an overview of demographic and economic statistics pertaining to rural minority populations.
  • Minorities in Rural America: Appendix B Map Supplement
    Date: 2002
    Appendix to report on overview of demographic and economic statistics pertaining to rural minority populations. Maps.
  • Minorities in Rural America: Appendix C Economic Patterns in Non-Metro America
    Date: 2002
    Appendix to report on an overview of demographic and economic statistics pertaining to rural minority populations. Focuses on economic status and health services infrastructure.
  • Mode of Travel and Actual Distance Traveled For Medical or Dental Care By Rural and Urban Residents
    Date: 05/2006
    Discusses the cost and difficulty associated with travel for medical or dental care, which may serve as a barrier for rural populations.
  • More May Be Better: Evidence of a Negative Relationship Between Physician Supply and Hospitalization for Ambulatory Care Sensitive Conditions
    Date: 2005
    The authors conducted an empirical test of the relationship between physician supply and hospitalization for ambulatory care sensitive conditions (ACSH). Principal findings showed that in the urban models for ages 0-17 physician supply has the largest negative adjusted relationship with ACSH. For ages 18-39 and 40-64, physician supply has the second largest negative adjusted relationship with ACSH. Physician supply was not associated with ACSH in rural areas. The authors conclude that physician supply is positively associated with the overall performance of the primary health care system in a large sample of urban counties of the United States.
  • Overweight and Physical Inactivity among Rural Children Aged 10-17: A National and State Portrait
    Date: 05/2007
    Recent studies have found that the tide of child obesity is rising faster in rural communities in several states, including Pennsylvania, New Mexico, Michigan, West Virginia, and North Carolina. This report examines the presence of overweight and obesity among children in both rural and urban settings using the data from a recent national survey, the 2003 National Survey of Children's Health (NSCH). In 2003, 30.6% of children aged 10-17 years old were overweight, 14.8% of which were obese. Rural children (16.5%) were more likely to be obese than urban children (14.4%).
  • Poverty, Stress, and Violent Disagreements in the Home Among Rural Families
    Date: 08/2005
    This study used information from a large, nationally representative telephone survey of households with children, carried out by the National Center for Health Statistics, to explore the prevalence of violent disagreements in the home. "Violent" disagreements are those that involve hitting or throwing, as opposed to heated argument or calm discussion. Poverty and parenting stress also were examined as they are hypothesized to be associated with violent disagreement. Findings from the study showed that rural children, all things held equal, were less likely than urban children to live in households where disagreements are expressed violently. Similarly, rural children were less likely to live in households with high parenting stress or low reported neighborhood trust. Nonetheless, rural practitioners must still be sensitive to the possibility of exposure to violence. Key factors associated with parenting stress, and thus with violent disagreements, are more prevalent in rural areas. Poverty and low-income were more common among rural than urban children, and affected well over half of rural minority children, in particular.
  • Prevalence of Health Related Behavioral Risk Factors Among Non-Metro Minority Adults
    Date: 08/2003
    Data on tobacco use, seat belt use, and alcohol consumption among rural minority adults. Includes recommendations and detailed data tables.
  • Racial and Ethnic Disparities in Potentially Avoidable Delivery Complications Among Pregnant Medicaid Beneficiaries in South Carolina
    Date: 2006
    Examined access to health care during pregnancy for mothers insured by Medicaid as well as the risks of potentially avoidable maternity complications among rural and urban hospital deliveries for groups of mothers defined by race or ethnicity. Within groups defined by race or ethnicity, unadjusted rates for potentially avoidable maternity complications did not differ significantly by hospital location. Holding other factors constant, potentially avoidable maternity complications were less common in rural hospitals than in urban hospitals. In rural hospitals, African Americans had notably higher risk for potentially avoidable maternity complications than did non-Hispanic whites. The authors conclude that providers and policymakers should work to reduce the risks of potentially avoidable maternity complications for African American women in rural areas who are insured by Medicaid.
  • Recruitment and Retention of EMTs: A Qualitative Study
    Date: 2005
    Emergency medical technicians (EMTs) are critical to out-of-hospital care, but maintaining staff can be difficult. The study objective was to identify factors that contribute to recruitment and retention of EMTs and paramedics. Analysis of focus group responses showed that for a majority of respondents, emergency medical services was not a primary career path. Most respondents entered the industry as an alternate or replacement for a nursing career or as a second career following military medic service. The majority of respondents believed the job was stressful yet rewarding, and although it negatively affected their personal lives, the occupation gave them a sense of accomplishment and belonging. Respondents expressed a preference for EMT education resulting in college credit or licensure versus professional certification. Job-related stress produced by numerous factors appears to be a likely contributor to low employee retention.
  • Rural Border Health Chartbook
    Date: 01/2013
    Examines potential geographic and ethnic disparities among U.S. border residents and describes select indicators related to access to care, women's preventive services, oral health, infectious and communicable diseases and mental health that have been identified as disparities.
  • Rural Hospitals and Spanish Speaking Patients with Limited English Proficiency
    Date: 10/2005
    Reports that 40 million Latinos in the United States, 14.2% of the population, have limited English proficiency (LEP), which can lead to poor health outcomes in the absence of effective medical interpretation or translation services.
  • Rural-Urban Differences in Depression Prevalence: Implications for Family Medicine
    Date: 10/2006
    Reports results of a study that examined the prevalence of depression in rural versus urban areas. An estimated 2.6 million rural adults suffer from depression. The unadjusted prevalence of depression was significantly higher among rural than urban populations (6.1% versus 5.2% ). After adjusting for rural/urban population characteristics, however, the odds of depression did not differ by residence. Depression risk was higher among persons likely to be encountered in a primary care setting: those with fair or poor self-reported health, hypertension, with limitations in daily activities, or whose health status changed during the previous year.
  • State Policy Levers for Addressing Preventive Dental Care Disparities for Rural Children: Medicaid Reimbursement to Non-Dental Clinicians for Fluoride Varnish and Dental Hygiene Supervision in Primary Care Safety Net Settings (Full Report)
    Date: 03/2012
    Addresses preventive dental care disparities for rural children by studying access to fluoride varnish applications and the extent that dental hygienists can provide select preventive dental services in primary care safety net settings.
  • Trends in Uninsurance among Rural Minority Children
    Date: 10/2005
    Disparities in health insurance coverage for both minority and rural children persist, with children who are simultaneously minority race/ethnicity and living in rural areas being particularly disadvantaged. Using twenty-one years of data from the National Health Interview Survey to explore trends in health insurance and health services utilization for children between 1980 and 2001, and focusing on non-Hispanic white, non-Hispanic African American, and Hispanic children, the authors found that rural children have been consistently less likely to have insurance than urban children, and minority status adds to the disparity. Several factors consistently influenced the odds that a child would lack health insurance, measured in 1980, 1986, 1994 and 2001. Compared to urban white children, rural white children and Hispanic children, both urban and rural, were more likely to lack insurance. Factors consistently associated with lack of health insurance, such as poverty, low education, and non-parental households, have been more prevalent among minority children since 1979, and remained so in 2001. Rural disadvantages for minority children are marked.
  • Update: Health Insurance and Utilization of Care Among Rural Adolescents
    Date: 2005
    Using data from the 1999-2000 National Health Interview Survey, the authors found that across races, rural adolescents were as likely to have insurance but less likely to report a preventive visit than urban children; residence did not affect the likelihood of a visit or a usual source of care. Minority rural adolescents were less likely than whites to be insured, report a visit, or have a usual source of care. The authors conclude that most barriers to care among rural and minority youth are attributable to factors originating outside the health care system, such as language, living situation, caretaker education, and income. A combination of outreach activities and programs to enhance rural schools and economic opportunities will be needed to improve coverage and utilization among adolescents.
  • Use of Preventive Services Among Hispanic Sub-Groups: Does One Size Fit All?
    Date: 07/2007
    The Hispanic population, the largest and fastest growing minority group in the nation, is generally under-served with regard to health services. This executive summary includes results from the exploration of the use of preventive health services among Mexicans, Puerto-Ricans, Cubans, and "other" Latinos (persons from all other Spanish-speaking countries such as Spain, Central and South America) and examined how the use of preventive services was influenced by nation of origin and by rural versus urban residence.
  • Use of Preventive Services Among Hispanic Sub-Groups: Does One Size Fit All? (Fact Sheet)
    Date: 2007
    This Fact Sheet provides key facts on preventive health services provided to rural Hispanics.
  • Violence And Rural Teens: Teen Violence, Drug Use, And School-Based Prevention Services In Rural America
    Date: 03/2005
    Describes a study which had three main purposes: (1) to explore the prevalence of violence-related exposures and drug use among rural teens, (2) to investigate the effects of race and gender on the risk of exposure to violence and drug use, and (3) to compare the policies and mental health care services of rural and urban schools. This study found no evidence to support the common assumption that rural youth are protected from exposure to violence. Rural teens are equally or more likely than suburban and urban teens to be exposed to violent activities, including weapons carrying, fighting, fear of violence, and suicide behaviors. Rural teens are at significantly greater risk of using cigarettes, chewing tobacco, crack/cocaine, and steroids than both suburban and urban teens. Of important note is the high prevalence of "crystal-meth" use among rural teens.

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