Alva Ferdinand, DrPH, JD

Director, Southwest Rural Health Research Center

Phone: 979.436.9434
Fax: 979.436.9598
Email: aferdinand@tamu.edu

Texas A&M University
212 Adriance Lab Rd.
1266 TAMU
College Station, TX 77843-1266

Current Projects - (7)
Completed Projects - (6)
Publications - (21)

Current Projects - (7)

Evaluating the Federal Office of Rural Health Policy's Community-Based Division Funding Programs: Does the Performance Improvement and Measurement Systems (PIMS) Database Adequately Capture Impact
This project will examine three types of Federal Office of Rural Health Policy Community-Based Division programs to determine whether the Performance Improvement and Measurement Systems captures the programs' impact and goals as set forth in their respective notices of funding opportunities.
Research center: Southwest Rural Health Research Center
Topic: Legislation and regulation
Federal Agencies' Recent Collaboration and Innovation in Rural Cancer Control: A Model for Practice
The investigators will conduct an examination of the multi-year effort by the National Cancer Institute to focus on rural cancer issues and its collaboration with the Federal Office of Rural Health Policy. The project will explore the key pieces of evidence that served as the impetus for the emphasis on rural America in cancer control efforts.
Research center: Southwest Rural Health Research Center
Topics: Cancer, Health disparities and health equity
Racial and Ethnic Disparities Shouldered by Rural Americans: Evidence from the Peer-Reviewed and Grey Literature on the Five Leading Causes of Death
A systematic review of peer-reviewed and grey literature will explore the role of racial and ethnic disparities in the five leading causes of death. The project will provide historical and context setting perspectives on the contributors to the five leading causes of death, particularly as they involve the intersection of rurality and non-majority demographic identities.
Research center: Southwest Rural Health Research Center
Topics: Cancer, Chronic diseases and conditions, Health disparities and health equity, Minority health
The Intersection of Race/Ethnicity and Rurality in Pediatric Asthma: Trends and Predictors
Little is known about the extent to which the intersection of race/ethnicity and rurality plays a role in the disparities associated with asthma outcomes, particularly among children. Using the National Inpatient Sample from 2015 – 2019, this project will identify trends in pediatric asthma-related hospitalizations and the significant predictors of them, particularly by considering interaction terms.
Research center: Southwest Rural Health Research Center
Topics: Children and adolescents, Chronic diseases and conditions, Health disparities and health equity
Trends and Predictors of Urban-Rural and Racial/Ethnic Disparities in Hospitalizations Associated with the Top Five Cancers
This project will serve to update the Federal Office of Rural Health Policy's cancer research portfolio. Using recent nationally representative hospital discharge data, the researchers will examine trends and predictors of hospitalizations associated with the top five cancers in the U.S.: skin, lung, prostrate, breast, and colorectal.
Research center: Southwest Rural Health Research Center
Topics: Cancer, Health disparities and health equity
Trends and Predictors of Urban-Rural and Racial/Ethnic Disparities in Hospitalizations Tied to Acute Myocardial Infarction
This project will update the Federal Office of Rural Health Policy's research portfolio on hospital-based disparities associated with acute myocardial infarctions (AMIs). Very little is known about variances in hospital-based outcomes for AMIs along the urban-rural continuum and among diverse sub-populations in the U.S.
Research center: Southwest Rural Health Research Center
Topic: Health disparities and health equity
Updating and Exploring the Burden of Potentially Avoidable Emergency Department Visits in Rural U.S. Communities
This project will update the Federal Office of Rural Health Policy's research portfolio on potentially avoidable emergency department (ED) visits among rural residents across the U.S., particularly as they relate to ambulatory care sensitive conditions (ACSCs). Data on ACSC-related ED visits will be drawn from the State Emergency Department Databases, and findings will be stratified by census region, patient's place along the urban-rural continuum, and by race/ethnicity.
Research center: Southwest Rural Health Research Center
Topics: Emergency medical services and trauma, Healthcare access, Medicaid and CHIP, Uninsured and underinsured

Completed Projects - (6)

Examining the Legal Landscape in Rural America: Implications for the Healthcare Workforce, Access to Care, and Population Health
This project explores potential rural/urban differences in the prevalence of malpractice claims, clinical privilege actions, and state licensure actions among health care providers. We will also examine whether variations in nurse practitioner scope of practice laws affect rural residents differentially, especially with respect to preventive care.
Research center: Southwest Rural Health Research Center
Topics: Allied health professionals, Health services, Legislation and regulation, Nurses and nurse practitioners, Workforce
How Well are We Doing Meeting Healthy People 2020 Mortality Objectives at Midterm? Rural v. Urban Differences
The purpose of this project was to conduct a midterm examination of urban versus rural disparities in meeting Healthy People 2020 mortality objectives for the top 10 leading causes of death in the U.S. utilizing existing secondary databases.
Research center: Southwest Rural Health Research Center
Topics: Chronic diseases and conditions, Health disparities and health equity
Malpractice Claims Among Rural and Urban Providers: Do State Telehealth Laws Make a Difference?
This project examines trends in state telehealth laws and whether they have affected the rural and urban malpractice environments differentially. Data from the National Practitioner Data Bank are used to determine whether changes in telehealth laws are associated with increased malpractice claims and other adverse actions against providers.
Research center: Southwest Rural Health Research Center
Topics: Allied health professionals, Legislation and regulation, Nurses and nurse practitioners, Telehealth, Workforce
The Burden of Diabetes in Rural America
The purpose of this project was to determine rural versus urban differences in type 2 diabetes prevalence, morbidity and mortality in the U.S. Diabetes complications, disparities and associated demographics were reported. A comparison of Mexican-American border versus non-border states was also included.
Research center: Southwest Rural Health Research Center
Topics: Chronic diseases and conditions, Diabetes, Health disparities and health equity, Minority health
Trends and Predictors of Human Immunodeficiency Virus (HIV) in Light of the Opioid Crisis Along the Urban-Rural Continuum
This project explored trends in the burden of HIV and predictors of HIV-related mortality and morbidity. The study examined how the opioid crisis has changed the nature of the burden of HIV, especially considering differential disease burdens between residents of rural areas relative to their urban counterparts.
Research center: Southwest Rural Health Research Center
Topics: Chronic diseases and conditions, Pharmacy and prescription drugs, Substance use and treatment
Variations in Travel Burdens Associated with Access to Care Between Rural and Urban Residents
This project focused on geographic access to medical and dental care, recognizing that travel time and distances can hinder individuals from obtaining necessary care. The study explored the travel time and distances to care for specific sub-populations and in specific geographic settings, particularly urban versus rural residence and region.
Research center: Southwest Rural Health Research Center
Topics: Health services, Healthcare access, Transportation

Publications - (21)

2023

Rural Healthy People 2030: Common Challenges, Rural Nuances
Policy Brief
Southwest Rural Health Research Center
Date: 05/2023
This study analyzes the most important Healthy People 2030 priorities for rural America. Data collected from a survey found mental health, substance use, health care access, and economic stability were among the most important priorities. This information could be used to accelerate health improvements in rural America.
Rural Healthy People 2030: New Decade, New Challenges
Journal Article
Southwest Rural Health Research Center
Date: 03/2023
This study reports the findings of Rural Healthy People 2030, a companion piece to the Healthy People 2030 initiative with a focus on health priorities of rural populations. Data was collected from a survey given to rural stakeholders. Mental health, substance use, health care access, and economic stability were among the most important priorities.

2022

Meeting the Behavioral Health Needs of Farm Families in Times of Economic Distress
Policy Brief
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 02/2022
Economic fluctuations and periods of distress in farming cannot be eliminated, however, their impact on communities and individuals can be mitigated. Strategies for meeting the behavioral health needs of farm families by supporting community-based services, and expanding behavioral health services in rural contexts are highlighted in this work.
High-Performing Rural Health System
Policy Brief
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 01/2022
This document updates the RUPRI Health Panel's framework, for a high-performing rural health system, originally published in 2011. It offers a revised vision statement and updates the high-performing rural health system pillars (access, affordability, community health, and quality) and describes an underlying base of equity considerations.

2021

Rural Urban Variation in Travel Burdens for Care: Findings From the 2017 National Household Travel Survey (Executive Summary)
Supplement
Southwest Rural Health Research Center
Date: 12/2021
This project focuses on geographic access to medical and dental care, knowing that travel distances can keep people from getting necessary care. The study examines how rural residents' travel behaviors vary by socio-demographic and geographic characteristics and evaluates factors associated with a higher travel burden for medical and dental care.
Racial, Rural, and Regional Disparities in Diabetes-Related Lower-Extremity Amputation Rates, 2009–2017
Journal Article
Southwest Rural Health Research Center
Date: 09/2021
This study examines race, rurality, and regional disparities in diabetes-related lower-extremity amputations (LEA) among adult hospitalizations from 2009-2017. Findings indicate rising minor LEA rates among Asians/Pacific Islanders and rising major LEA rates among hospitalized diabetes patients in the Midwest.
Rural-Urban Variations in Travel Burdens for Care: Findings From the 2017 National Household Travel Survey (Policy Brief)
Policy Brief
Southwest Rural Health Research Center
Date: 07/2021
This project focuses on geographic access to medical and dental care, knowing that travel distances can keep people from getting necessary care. The study examines how rural residents' travel behaviors vary by socio-demographic and geographic characteristics and evaluates factors associated with a higher travel burden for medical and dental care.
The Co-occurrence of HIV and Opioid Mortality in Rural and Urban America From 1999-2018
Policy Brief
Southwest Rural Health Research Center
Date: 06/2021
This project evaluates trends in mortality from human immunodeficiency virus (HIV) and opioid use in rural and urban areas of the U.S. It explores whether HIV and opioid deaths appear to be related over time in rural and urban areas.

2020

Factors Affecting the Likelihood of a Hospitalization Following a Diabetes-Related Emergency Department Visit: A Regional and Urban-Rural Analysis
Journal Article
Southwest Rural Health Research Center
Date: 05/2020
This study examines place-based and individual-level predictors of diabetes-related hospitalizations using 2009-2014 data from the National Inpatient Sample. Our findings indicate a higher incidence of these hospitalizations in residents of noncore areas in the South and Midwest, racial and ethnic minorities, and the uninsured population.
Healthy People 2020 Progress for Leading Causes of Death in Rural and Urban America: A Chartbook
Chartbook
Southwest Rural Health Research Center
Date: 03/2020
The purpose of this project is to conduct a midterm examination of urban versus rural disparities in meeting Healthy People 2020 mortality objectives for the top 10 leading causes of death in the U.S.

2019

Congestive Heart Failure-Related Hospital Deaths Across the Urban-Rural Continuum in the United States
Journal Article
Southwest Rural Health Research Center
Date: 12/2019
This study examines congestive heart failure (CHF)-related, in-hospital mortality across six levels of rurality and four census regions. Results indicated CHF-related hospital admissions in small metropolitan, micropolitan, and noncore areas, compared to large central metropolitan areas, were more likely to result in death.
Healthy People 2020: Rural Areas Lag in Achieving Targets for Major Causes of Death
Journal Article
Southwest Rural Health Research Center
Date: 12/2019
For the period 2007-2017 rural death rates were higher than urban rates for the seven major causes of death analyzed, and disparities widened for five of the seven. In 2017 urban areas had met national targets for three of the seven causes, while rural areas had met none of the targets.
The Development of Telehealth Laws in the U.S. from 2008 to 2015: A Legal Landscape
Policy Brief
Southwest Rural Health Research Center
Date: 11/2019
This study examines the scope and evolving nature of telehealth statutes and regulations in the U.S. Our research aims to understand changes in telehealth laws over time (2008-2015), variations in legal frameworks established across the U.S., and the extent that state laws regulate the primary care delivery through the use of telehealth.
Prevalence and Mortality of Heart Disease and Related Conditions: Disparities Affecting the South, Rural Areas, and American Indian and Alaska Natives
Policy Brief
Southwest Rural Health Research Center
Date: 11/2019
This policy brief identifies trends in the prevalence of stroke, heart disease, and heart attack while also assessing trends in mortality for heart disease and related conditions across the nation. The study examined whether disease-related mortality and prevalence varied across place and time.
The Changing Landscape of Diabetes Mortality in the United States Across Region and Rurality, 1999-2016
Journal Article
Southwest Rural Health Research Center
Date: 02/2019
This brief report examines place-based differences in diabetes mortality to understand whether disparities in diabetes mortality have changed across U.S. Census regions and levels of rurality over time. Reductions in diabetes mortality are lagging in rural areas, and the rural South in particular, relative to other areas of the country.
Diabetes-Related Hospital Mortality in the U.S.: A Pooled Cross-Sectional Study of the National Inpatient Sample
Journal Article
Southwest Rural Health Research Center
Date: 02/2019
This study examined place-based and individual-level variations in diabetes-related hospital deaths using the 2009-2015 National Inpatient Sample. Results show that place-based disparities exist. Targeted focus should be placed on the control of diabetic complications in the South, West, and Midwest census regions and among rural residents.

2018

Cancer Mortality in Rural America: 1999-2016
Policy Brief
Southwest Rural Health Research Center
Date: 11/2018
This policy brief details the differences in mortality from cancer at various levels of rurality in America. The primary aim of this study was to understand the scope of cancer mortality in urban and rural areas of the U.S. Common cancer types—breast, cervical, lung, prostate, and colon—were analyzed over an 18-year period from 1999-2016.
Diabetes-Related Hospital Mortality in Rural America: A Significant Cause for Concern
Policy Brief
Southwest Rural Health Research Center
Date: 03/2018
This brief is the third in a series prepared by the Southwest Rural Health Research Center on the topic of diabetes. The aim of this study was to examine trends and rates of diabetes-related deaths for persons hospitalized in the U.S., with emphasis on differences across the urban-rural continuum and across census regions.

2017

Diabetes and Forgone Medical Care Due to Cost in the U.S. (2011-2015): Individual-level and Place-Based Disparities
Policy Brief
Southwest Rural Health Research Center
Date: 08/2017
This brief is the first in a series prepared by the Southwest Rural Health Research Center on the topic of diabetes. The two aims of this study were to identify trends in diabetes rates and forgone medical care among persons with diabetes in the U.S. and to identify geographic determinants and other social determinants of health disparities.
Diabetes Mortality in Rural America: 1999-2015
Policy Brief
Southwest Rural Health Research Center
Date: 08/2017
This brief is the second in a series prepared by the Southwest Rural Health Research Center on the topic of diabetes. The primary aim of this study was to understand the scope of diabetes-related mortality in urban and rural America. We analyzed mortality caused by diabetes over a 16-year period and explored the roles played by rurality and race.
Assessing Diabetes and Factors Associated With Foregoing Medical Care Among Persons With Diabetes: Disparities Facing American Indian/Alaska Native, Black, Hispanic, Low Income, and Southern Adults in the U.S. (2011-2015)
Journal Article
Southwest Rural Health Research Center
Date: 04/2017
The purpose of this project was to identify individual- and place-based factors associated with diagnosed diabetes and foregone medical care among those diagnosed with diabetes. Diabetes prevalence and foregone medical care were found to be higher for those with lower incomes, for several racial/ethnic groups, and in the South versus other regions.