Rural and Minority Health Research Center

Completed Projects

Listed by project completion date. You can also view these projects alphabetically.


  • Identification of High-Need Rural Counties Lacking an FQHC Presence
    Federally Qualified Health Centers (FQHCs) have been key safety net providers since the program was initiated. However, many rural communities lack this resource. Expanding on the index of relative rural deprivation developed by the SCRHRC, we identified high-need rural counties that currently are not served by an FQHC or similar provider.
    Topics: Critical Access Hospitals, Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs)
  • Identifying Obesogenic Communities in the U.S.: An Urban-Rural Comparison
    In this study, we created an obesogenic environment score for all U.S. counties and Census tracts, explored urban versus rural differences in obesogenic environment scores, and examined associations between obesogenic environments and childhood obesity overall and by level of rurality.
    Topics: Children and adolescents, Obesity
  • Perceived Facilitators and Barriers to Rural Ambulatory Care Practice Among Registered Nurses
    Although a quarter of all registered nurses work in ambulatory care settings, little research has addressed the factors associated with their remaining in the profession and current job settings. The study surveyed a sample of rural and urban nurses to ascertain perceived facilitators and barriers to remaining in rural practice.
    Topics: Nurses and nurse practitioners, Workforce
  • Promotion of Rural Health Research Center Attendance at Cancer-Related Meetings
    This project will promote attendance at cancer-related meetings by Rural Health Research Centers by facilitating the dissemination of information regarding important cancer meetings and handling the travel arrangements for Rural Health Research Center personnel.
    Topics: Cancer, Minority health
  • Rural Nursing Workforce: Current Educational Characteristics and Options for Improvement
    This project examined the current distribution of nurses, subset by educational attainment, across the rural U.S. using data from Census Public-Use Microdata files. Then surveyed approximately 750 registered nurse to bachelor of science in nursing (RN-to-BSN) educational programs across the U.S. identifying the proportion of programs offering rural content or facilitating rural placement.
    Topics: Nurses and nurse practitioners, Workforce
  • Social Determinants of Health Among Minority Populations in Rural America
    This project compiled information from the U.S. Census, the Area Health Resource File, and the Robert Wood Johnson Foundation County Rankings data set into a comprehensive summary of key social determinants of health among rural populations: demographic characteristics, economic characteristics, health facility availability, and selected health outcomes.
    Topics: American Indians and Alaska Natives, Hispanics, Minority health, Rural statistics and demographics, Social determinants of health



  • Disparities in Access to Oral Health Care Among Rural Children: Current Status and Models for Innovation
    The ACA contains key provisions on addressing oral health disparities among vulnerable populations. This project will provide baseline information on trends in rural health and describe the experiences of four states taking innovative approaches to implementation of key ACA oral health provisions.
    Topics: Children and adolescents, Oral health
  • Potential Impact of ESRD Payment Reform on Rural Dialysis Patients
    This study will estimate the potential implications of rural dialysis facility loss for rural patients. Specifically, we will identify low-volume dialysis facilities in rural areas, profile the patients they serve, and estimate the additional travel burden that these patients would experience if facilities close.
    Topics: Health services, Hospitals and clinics
  • Rural-Urban Differences in Medicare Service Use and Expenditures in the Last Six Months of Life
    Patterns of end-of-life care are known to vary by rurality and by minority status, and the availability of facilities such as hospice also vary with rurality. This study will examine the relationship between level of service use during the last six months of life and facility availability in county of residence (hospital, SNF, IRF, home health, hospice), as well as minority status of the beneficiary and whether the beneficiary is also eligible for Medicaid ("dual eligible").
    Topics: Aging, Medicaid and CHIP, Medicare, Minority health
  • Transitions of Care Among Rural Medicare Beneficiaries: The Care Continuum
    Because they are often hospitalized outside their home community, rural Medicare beneficiaries may experience a different sequence of services after discharge than do urban beneficiaries. This study will follow beneficiaries across the continuum of post-hospital care to determine if rural beneficiaries, particularly minority beneficiaries, are more likely to experience care disruption and adverse outcomes, such as re-hospitalization.
    Topics: Medicare, Minority health
  • Trends in Rural Children's Health and Access to Care
    The past ten years have seen positive trends in the availability of health insurance coverage for children, coupled with worsening trends for poverty. This project will examine data from three iterations of the National Survey of Children' Health (2003, 2007, 2012) to see whether rural children have benefited equally from any improvements in health insurance, healthcare use, and health status.
    Topics: Children and adolescents, Private health insurance



  • Post-Acute Stroke Care Delivery for Rural Medicare Beneficiaries
    Post-stroke rehabilitation has been shown to improve outcomes among patients, but the limited available evidence suggests that rural residents and African Americans are less likely to receive this care. Our analysis will determine whether residence or race-based disparities exist in post-stroke care, after taking into consideration differences in patient status.
    Topics: Medicare, Minority health, Post-acute care
  • Post-Hospital Transitions in Care Among Dually-Eligible Medicare Beneficiaries
    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.
    Topics: Diabetes, Hospitals and clinics, Medicare
  • Role of Free Clinics in the Rural Safety Net
    This two-part study will combine a mapping project that documents the location of free clinics across the US with a telephone survey of the 21 state and 2 regional free clinic associations.
    Topics: Hospitals and clinics, Rural Health Clinics (RHCs)
  • Rural Area Deprivation and Hospitalizations Among Children for Ambulatory Sensitive Conditions
    Rural areas with reduced social and economic resources may be particularly vulnerable to inadequate primary care for children.
    Topics: Children and adolescents, Health disparities and health equity, Hospitals and clinics


  • Adequacy of Home Health Care Availability in Rural Counties
    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.
    Topics: Aging, Home health
  • Characteristics and Utilization Patterns of Rural Dual-eligible Medicare Beneficiaries
    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.
    Topics: Cancer, Diabetes, Medicaid and CHIP, Medicare
  • Intensity of Service Provision for Medicare Beneficiaries Utilizing Home Health Services
    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.
    Topics: Chronic diseases and conditions, Diabetes, Home health, Medicare
  • Profiling Health and Health Resource Availability in U.S. – Mexico Border Counties
    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.
    Topic: Minority health
  • Rural and Urban Differences in Case-Mix Among Recipients of Home Health Care
    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.
    Topics: Health disparities and health equity, Home health, Medicare


  • Racial and Rural Differences in Cervical Cancer Screening Practices
    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.
    Topics: Cancer, Health promotion and disease prevention, Minority health, Women


  • Analysis of State Dental Hygiene Practice Acts and Medicaid Policies for Children's Dental Care: Services Covered and Practitioners Reimbursed
    The purpose of this qualitative analysis will be to obtain a clear picture of the degree to which (1) state SCHIP and Medicaid programs are implementing waivers, or other programs, to improve access to dental care for vulnerable populations including children and pregnant women; and (2) dental hygienists impact the dental safety net for rural America.
    Topics: Children and adolescents, Health disparities and health equity, Maternal health, Medicaid and CHIP, Oral health
  • Dental Sealant Utilization Among Rural and Urban Children
    Dental sealants can prevent or reduce dental caries among children, but only about a third of children currently have sealants. This project will explore the dissemination of sealants among rural children, identifying characteristics of children and communities with low sealant use.
    Topics: Children and adolescents, Oral health
  • Dialysis Availability in Rural America
    Working from Medicare Dialysis Compare files and the Standard Analysis File of the US Renal Data System, we will evaluate the current availability of dialysis services across rural America. We will examine general availability of services, service to population ratios, and patient outcome measures across levels of rurality.
    Topics: Chronic diseases and conditions, Diabetes, Medicare
  • Rural Border Chartbook
    This chartbook is the first study to examine the health status of residents living in U.S. 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).
    Topics: Hispanics, Minority health
  • Rural HIV: Estimated Prevalence of Persons Living with HIV/AIDS (PLWHA) in Rural America
    This study will describe the prevalence of HIV/AIDS by county, or when county-level data are not available, by sub-state region or state, together with information on the availability of health services, including Ryan White Clinics. A sub-study will develop models identifying rural counties at highest risk for increases in the population of PLWHA.
    Topic: Chronic diseases and conditions


  • Premature Mortality: Potential Role of Health Insurance in Moderating Race/Ethnicity and Rural/Urban Disparities
    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.
    Topics: Minority health, Uninsured and underinsured
  • Rapid Research Response on Health Care Reform Issues
    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.
    Topic: Healthcare financing
  • Transitions in Care for Rural Medicare Beneficiaries with Diabetes
    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 healthcare providers.
    Topics: Chronic diseases and conditions, Diabetes, Health disparities and health equity, Medicare, Minority health



  • Chartbook: Racial and Ethnic Disparities in the Health of Rural Populations
    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.
    Topics: Health disparities and health equity, Minority health, Rural statistics and demographics
  • Effect of Safety Net Providers on Ambulatory Care Sensitive Hospitalization Rates in Rural Counties
    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.
    Topics: Chronic diseases and conditions, Federally Qualified Health Centers (FQHCs), Health services, Poverty, Rural Health Clinics (RHCs)


  • Chartbook: Oral Health and Unmet Needs for Dental Care Among Children
    This study will characterize oral health status, dental care utilization, and unmet dental care needs among U.S. children by urban/rural residence. It will provide a descriptive analysis, using cross-sectional data from the 2003 National Survey of Children's Health.
    Topics: Children and adolescents, Health disparities and health equity, Oral health, Rural statistics and demographics



  • Mode of Travel and Actual Distance Traveled for Medical or Dental Care by Rural Residents
    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.
    Topics: Health disparities and health equity, Health services, Minority health, Oral health, Transportation
  • Rural Health Center Expansion and Recruitment Survey
    This collaborative project between WWAMI and the South Carolina Rural Health Research Centers examined and described the current staffing needs of rural health centers (RHCs), ascertained the staffing, recruitment, and retention issues that RHC CEOs regard as most critical; distinguished how 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 RHCs.
    Topics: Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Workforce


  • Depression and Generalized Anxiety Disorder across Rural Populations
    Topics: Health disparities and health equity, Mental and behavioral health, Minority health
  • Diabetes and Hypertension in Rural Hispanics
    The project will examine the similarities and differences between rural and urban Hispanics and Caucasian adults diagnosed with diabetes mellitus and hypertension.
    Topics: Chronic diseases and conditions, Diabetes, Health disparities and health equity, Hispanics, Minority health
  • Disability Burdens Among Rural and Urban Older Americans
    This project will use the 1994-2000 Second Longitudinal Study of Aging to develop detailed estimates of healthy, disabled, and total life expectancy among rural and urban populations. We will develop and compare the estimates between women and men, by race/ethnicity, and across differing levels of education.
    Topics: Aging, Disabilities, Health disparities and health equity, Long-term care, Rural statistics and demographics
  • Effects of Alcohol Use on Educational Attainment and Employment in Rural Youth
    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.
    Topics: Children and adolescents, Substance use and treatment
  • Effects of Uninsurance during the Preceding 10 Years on Health Status Among Rural Working Age Adults
    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.
    Topics: Diabetes, Uninsured and underinsured
  • How Rural Hospitals Are Meeting the Needs of Low-English Proficiency Patients
    This study will determine the extent to which rural hospitals have implemented plans for compliance with the DHHS Low-English Proficiency regulations, describe the difficulties rural hospitals must overcome in order to provide health care to Hispanic clients, ascertain the translation techniques most commonly used by rural hospitals, and describe the most effective approaches in the provision of culturally competent health care to Hispanic clients.
    Topics: Hispanics, Legislation and regulation, Minority health
  • Mental Health Risk Factors, Unmet Needs and Provider Availability for Rural Children
    The study will examine the prevalence of subclinical problems in rural children, assess risk factors associated with problems in children, and assess the influence of local provider availability on healthcare provider contact.
    Topics: Children and adolescents, Health services, Mental and behavioral health
  • Poverty, Parental Stress, and Violent Disagreements in the Home Among Rural Families
    Using the National Survey of Children's Health, this study will address the prevalence of poverty, parental stress and violent disagreements in the home in rural and urban families. Associations among economic hardships, parent stress, violent disagreements in the home and mental health problems in children will also be investigated.
    Topics: Children and adolescents, Poverty, Violence and abuse, Women
  • Rural Minority Health: A Comprehensive Assessment
    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.
    Topics: Health disparities and health equity, Minority health, Rural statistics and demographics


  • Impact of Medicaid Managed Care, Race/Ethnicity, and Rural/Urban Residence on Avoidable Maternity Complications: A Five-State Multi-level Analysis
    This project will examine differences in access to care for pregnant women enrolled in Medicaid Managed Care (MMC) and Medicaid fee-for-service, and examine differences in the impact of MMC on access among rural and minority persons.
    Topics: Maternal health, Medicaid and CHIP, Minority health, Women
  • Teen Violence
    This study will use national data to assess the prevalence of violence among rural youth, define risk factors for violence exposure among rural youth, and assess the current ability of rural school systems to provide appropriate mental health care and/or referrals for youth exposed to violence.
    Topics: Children and adolescents, Mental and behavioral health, Violence and abuse
  • Trends in Uninsurance Among Rural Minority Children
    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.
    Topics: Children and adolescents, Uninsured and underinsured