Health promotion and disease prevention: Rural Health Research Products & Journal Articles

2023

Rural Population Health in the United States: A Chartbook
Chartbook
North Carolina Rural Health Research and Policy Analysis Center
Date: 02/2023
This chartbook uses a range of indicators to describe population health in rural America and document health disparities between rural and urban areas. This report includes 33 measures of population health, organized into five domains: Access to Care, Health Outcomes and Risks, Mortality, Social Determinants of Health, and Socioeconomics.

2022

Disparities in Prenatal Immunization Rates in Rural and Urban U.S. Areas by Indicators of Access to Care
Journal Article
Southwest Rural Health Research Center
Date: 02/2022
This study evaluates variations in immunization rates among pregnant women across the urban-rural continuum. Results indicate pregnant women in rural areas more commonly rely on Medicaid to fund prenatal care but are less likely to have full or expanded access to Medicaid. This finding may contribute to immunization uptake disparities.

2021

The Association of Rurality and Breast Cancer Stage at Diagnosis: A National Study of the SEER Cancer Registry
Policy Brief
WWAMI Rural Health Research Center
Date: 10/2021
Patients from rural areas have lower breast cancer screening rates and poorer cancer outcomes than urban patients and received initial breast cancer diagnosis at a later stage compared with urban patients. Black race and being uninsured were also associated with late stage at diagnosis. Patterns have persisted and suggest areas for policy change.
"They're Not Leaving Their Home; This Is Where They Were Born, This Is Where They Will Die.": Key Informant Perspectives From the U.S. Counties With the Greatest Concentration of the Oldest Old
Journal Article
University of Minnesota Rural Health Research Center
Date: 07/2021
Researchers share interview results with key informants from 50 rural U.S. counties with the highest percentage of the residents ages 85 and older or the "oldest old." Respondents shared unique challenges to serving this population, as well as positive attributes of rural communities that make them attractive places for growing older.
Disparities in Maternal Immunization Among Women Residing in Rural and Urban Areas of the United States
Journal Article
Southwest Rural Health Research Center
Date: 06/2021
This study evaluates disparities in urban-rural influenza vaccination rates of women prior to and during pregnancy using 2016-2018 Pregnant Risk Assessment Monitoring System data. Findings indicate women residing in rural areas have lower vaccination rates with the greatest differences seen in Hispanic women and women with no health insurance.
Disparities in Meeting USPSTF Breast, Cervical, and Colorectal Cancer Screening Guidelines Among Women in the United States
Journal Article
Rural and Minority Health Research Center
Date: 04/2021
The US Preventive Services Task Force provides recommendations for breast, cervical, and colorectal cancer screening. This manuscript examines the sociodemographic characteristics associated with women meeting these recommendations.
Influenza and Pertussis Vaccination Rates Among Pregnant Women in Rural and Urban Areas
Policy Brief
Southwest Rural Health Research Center
Date: 04/2021
This policy brief evaluates the receipt of influenza and pertussis vaccines from 2012-2018 among pregnant women in rural and urban areas of the U.S. Furthermore, it examines whether pregnant women during this this same period received influenza vaccine recommendations from their healthcare providers.
Advancing Population Health in Rural Places: Key Lessons and Policy Opportunities
Report
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 01/2021
This paper advances policy discussion of population health in rural places, focusing on the role of rural healthcare organizations. Lessons from ongoing programs provide policy considerations. Medicare and Medicaid programs should prioritize staff and infrastructure development, flexibility in covered benefits, and further expansion of telehealth.

2020

Risky Substance Use Behaviors Among Adolescents Residing in Nonmetropolitan and Metropolitan Counties in the United States, 2017-2018
Policy Brief
Rural and Underserved Health Research Center
Date: 11/2020
This brief uses nationally representative survey data to compare past-30 day and past-year risky substance use among adolescents 12 to 17 years of age residing in metropolitan and nonmetropolitan counties. Specifically, we compared consumption of alcohol, tobacco, and other illicit substances.
Risky Substance Use Behaviors Among Adults Residing in Nonmetropolitan and Metropolitan Counties in the United States, 2017-2018
Policy Brief
Rural and Underserved Health Research Center
Date: 11/2020
This brief uses nationally representative survey data to identify differences in past-30 day and past-year risky substance use among adults, including alcohol, tobacco, and illicit drugs. This data indicates some significant differences in substance use consumption.
Rural/Urban Disparities in the Utilization of Health and Behavioral Assessments/Interventions in the Fee-for-Service Medicare Population
Policy Brief
Rural and Underserved Health Research Center
Date: 06/2020
Identifying behaviors that contribute to disease and modifying them can be an important step in treatment. This study investigated geographic disparities and the availability of Health and Behavioral Assessments and Interventions services in rural and urban areas by examining fee-for-service Medicare beneficiaries in 2012-2016.
Rural/Urban Disparities in Utilization of Diabetes Self-Management Training to the Fee-for-Service Medicare Population
Policy Brief
Rural and Underserved Health Research Center
Date: 06/2020
Diabetes self-management training (DSMT) is recommended for all newly diagnosed patients with diabetes. However, the utilization rate of DSMT is low, and geographic disparities in availability exist. This study sought to identify the extent of the rural/urban disparity in the provision of DSMT to fee-for-service Medicare beneficiaries in 2012-2016.
Rural/Urban Disparities in Utilization of Medical Nutrition Therapy to the Fee-for-Service Medicare Population
Policy Brief
Rural and Underserved Health Research Center
Date: 06/2020
Medical Nutrition Therapy (MNT) is important in the treatment of many chronic conditions, but the availability of MNT in rural versus urban communities has not been examined. This study sought to identify the availability of MNT in rural and urban communities by examining Medicare fee-for-service beneficiaries in 2012-2016.

2019

Differences in Preventive Care Among Rural Residents by Race and Ethnicity
Policy Brief
University of Minnesota Rural Health Research Center
Date: 11/2019
Disparities in preventive care by rural and urban location and by race and ethnicity are well documented in the literature, but less is known about whether there are differences in healthcare use among rural residents by race and ethnicity. We address this gap by examining differences in preventive care among rural residents by race and ethnicity.
Investigating the Impact of Geographic Location on Colorectal Cancer Stage at Diagnosis: A National Study of the SEER Cancer Registry
Journal Article
WWAMI Rural Health Research Center
Date: 08/2019
Access to recommended cancer screening is more difficult for rural than urban residents. As a result, rural patients may present at later stages than urban patients due to delays in detection. This study compared the adjusted rates of and late colorectal cancer staging at diagnosis between patients residing in urban and rural counties.

2018

Update: Rural/Urban Disparities in Pneumococcal Vaccine Service Delivery Among the Fee-for-Service Medicare Population, 2012-2015
Policy Brief
Rural and Underserved Health Research Center
Date: 11/2018
Delivery of pneumococcal vaccines to fee-for-service Medicare beneficiaries increased 380% from 2014-2015 as a result of uptake of pneumococcal conjugate vaccine (PCV13). However, a significant rural-urban disparity remains. Pharmacy providers delivered a significantly greater proportion of vaccines in rural versus urban counties.
Key Informant Perspectives on Rural Social Isolation and Loneliness
Policy Brief
University of Minnesota Rural Health Research Center
Date: 10/2018
This policy brief uses data from interviews with 22 key informants in 12 states, all of whom were experts on the issue of social isolation and/or rural health, to describe key challenges and opportunities related to rural social isolation.
Rural Family Physicians Have a Broader Scope of Practice Than Urban Family Physicians
Policy Brief
Rural and Underserved Health Research Center
Date: 02/2018
While the scope of practice of family physicians has been shrinking, they still practice broadly, often due to fewer health care resources in rural areas. Using data from family physicians seeking continued board certification in 2014 and 2015, we found that a high percentage of rural family physicians provide nearly every clinical service queried.
Rural Family Physicians in Patient Centered Medical Homes Have a Broader Scope of Practice
Policy Brief
Rural and Underserved Health Research Center
Date: 02/2018
The Patient Centered Medical Home (PCMH) is supposed to provide accessible and comprehensive care. Using data from family physicians seeking to continue their American Board of Family Medicine certification in 2014 and 2015, we found that rural family physicians in PCMH practices generally provide more services than those in non-PCMH practices.
Rural/Urban Disparities in Pneumococcal Vaccine Service Delivery Among the Fee-for-Service Medicare Population
Policy Brief
Rural and Underserved Health Research Center
Date: 02/2018
Using 2014 Medicare data, we found a significant disparity in pneumococcal vaccine service delivery to fee-for-service Medicare beneficiaries. Although primary care providers delivered the majority of pneumococcal vaccines to this population, pharmacy providers delivered a significantly greater proportion of vaccines in rural versus urban counties.

2017

Who Performs Colonoscopy? Workforce Trends Over Space and Time
Journal Article
Rural and Minority Health Research Center
Date: 11/2017
Using data from South Carolina from 2001-2010, this study looked at changes in the types of facilities doing colonoscopies as well as the any changes in who is performing them.

2010

Diet, Physical Activity, and Sedentary Behaviors as Risk Factors for Childhood Obesity: An Urban and Rural Comparison (Final Report)
Rural and Minority Health Research Center
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 limited. Previous research found that rural children, paradoxically, were more likely to be overweight or obese and more likely to be physically active than urban children.

2009

Rural Residents Lag in Preventive Services Use; Lag Increases With Service Complexity
Rural and Minority Health Research Center
Date: 06/2009
This research brief describes the receipt of preventive services among rural adults and explores the factors that are related to disparities in utilization.

2008

Trends in Cervical and Breast Cancer Screening Practices Among Women in Rural and Urban Areas of the United States
Policy Brief
WWAMI Rural Health Research Center
Date: 08/2008
This policy brief documents the receipt of timely breast and cervical cancer screening using a rural-urban classification system and nationally representative data.
Trends in Cervical and Breast Cancer Screening Practices Among Women in Rural and Urban Areas of the United States (Final Report)
WWAMI Rural Health Research Center
Date: 08/2008
This policy brief reports on trends in breast cancer screening practices. Participation in mammography improved nationally, but women living in rural locations remained less likely to receive the test than those living in urban settings.
Financing Rural Public Health Activities in Prevention and Health Promotion (Final Report)
NORC Walsh Center for Rural Health Analysis
Date: 06/2008
This is the final report of a study to determine whether the flow of federal resources, from federal agencies, through states, and to communities, is influenced by state- and local-level public health infrastructure.
Rural Public Health Financing: The Relationship Between Infrastructure and Local Program Funding
Policy Brief
NORC Walsh Center for Rural Health Analysis
Date: 06/2008
This study's purpose was to describe how federal funds for selected chronic disease prevention and health promotion activities are distributed to local health departments and non-governmental organizations at the local level and to identify infrastructure-related barriers that rural agencies may face in securing and using funds for such purposes.

2007

Use of Preventive Services Among Hispanic Sub-Groups: Does One Size Fit All?
Rural and Minority Health Research Center
Date: 07/2007
This executive summary includes results from the exploration of the use of preventive health services among Mexicans, Puerto-Ricans, Cubans, and other Latinos 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)
Fact Sheet
Rural and Minority Health Research Center
Date: 2007
This fact sheet provides key facts on preventive health services provided to rural Hispanics.

2006

Problem Drinking: Rural and Urban Trends in America, 1995/1997 to 2003
Journal Article
WWAMI Rural Health Research Center
Date: 03/2006
Assesses the prevalence of, and recent trends in, alcohol use among adults 18 years and older in rural areas of the United States. The paper finds that heavy drinking was highest and increasing in urban areas, but that binge drinking was greater in rural areas. It recommends tailoring interventions specifically to meet the needs of rural residents.
Prevalence and Trends in Smoking: A National Rural Study
Journal Article
WWAMI Rural Health Research Center
Date: 2006
Using data from the Behavioral Risk Factor Surveillance System, the prevalence of smoking between 1994-1996 and 2000-2001 did not change substantially for the United States as a whole. The prevalence of smoking for rural residents decreased by more than 2 percent in six states. However, it increased by 2 percent or more in ten states.

2005

A National Study of Obesity Prevalence and Trends by Type of Rural County
Journal Article
WWAMI Rural Health Research Center
Date: 2005
Analyzes data from the Behavioral Risk Factor Surveillance System for 1994-1996 and 2000-2001 to estimate the recent trends in obesity among U.S. adults residing in rural locations. In 2000-2001 the prevalence of obesity was 23.0% for rural adults and 20.5% for urban, representing increases of 4.8% and 5.5%, respectively, since 1994-1996.
Trends in Professional Advice to Lose Weight Among Obese Adults, 1994-2000
Journal Article
WWAMI Rural Health Research Center
Date: 2005

The authors studied whether rising obesity prevalence in the U.S. was accompanied by an increasing trend in professional advice to lose weight among obese adults, and found that disparities in professional advice to lose weight associated with income and educational attainment increased from 1994 to 2000. They concluded that there is a need for mechanisms that allow healthcare professionals to devote sufficient attention to weight control and to link with evidence-based weight loss interventions, especially those that target groups most at risk for obesity.

2004

Rural Healthy People 2010: A Companion Document to Healthy People 2010. Volume 3
Southwest Rural Health Research Center
Date: 04/2004
This report includes the overview of research and accompanying models for practice on five new focus areas in Rural Healthy People 2010, along with the more detailed literature reviews for each.
Development of a Methodology for Assessing the Effect of a Lay Home Visitation Program for Rural High-Risk Women and Infants
Rural and Minority Health Research Center
Date: 02/2004
This pilot study successfully demonstrated that a retrospective, population-based, comparative design is a feasible method for evaluating the effectiveness of a community health worker program for women at risk for poor pregnancy and birth outcomes.
Obesity Prevalence in Rural Counties: A National Study
WWAMI Rural Health Research Center
Date: 01/2004
Using a telephone survey of adults ages 18 and older residing in states participating in the Behavioral Risk Factor Surveillance System in 1994-96 and 2000-01, researchers found that the prevalence of obesity was 23% for rural adults and 20.5% for urban adults.
Rural Minority Children's Access to and Timeliness of Immunizations
Fact Sheet
Rural and Minority Health Research Center
Date: 2004
This fact sheet examined whether rural children ages 3-71 months are keeping up with urban children in the receipt of needed vaccinations.

2003

Rural Minority Children's Access to and Timeliness of Immunizations: 1993-2001
Rural and Minority Health Research Center
Date: 11/2003
The purpose of this study is to assess the quality of pediatric healthcare provided to rural minorities using timeliness of immunization receipt as a marker for quality.
Prevalence of Health Related Behavioral Risk Factors Among Non-Metro Minority Adults
Rural and Minority Health Research Center
Date: 08/2003
Data is shared on tobacco use, seat belt use, and alcohol consumption among rural minority adults. It includes recommendations and detailed data tables.
Breast and Cervical Cancer Screening: Is It Reaching Rural and Rural Minority Women?
Southwest Rural Health Research Center
Date: 04/2003
This study examines whether the Texas Breast and Cervical Cancer Control Program is reaching rural women in general and rural minority women in particular.
Behavioral Risk Factors Among Rural African Americans
Fact Sheet
Rural and Minority Health Research Center
Date: 2003
This fact sheet discusses seat belt use, tobacco use, and alcohol use among rural African Americans.
Behavioral Risk Factors Among Rural Hispanics
Fact Sheet
Rural and Minority Health Research Center
Date: 2003
This fact sheet discusses seat belt use, tobacco use, and alcohol use among rural Hispanics.
Rural Healthy People 2010: A Companion Document to Healthy People 2010. Volume 1
Southwest Rural Health Research Center
Date: 2003
This report offers brief overviews of the top rural health concerns and objectives associated with Healthy People 2010 focus areas. Also included are references to key literature about these concerns and descriptions of models for practice that rural communities can draw upon to achieve key Healthy People 2010 objectives.
Rural Healthy People 2010: A Companion Document to Healthy People 2010. Volume 2
Southwest Rural Health Research Center
Date: 2003
This report detailed literature reviews and associated references for the top rural health concerns addressed in Vol. 1 of Rural Healthy People 2010.

2000

Influence of Rural Residence on the Use of Preventative Health Care Services
University of Minnesota Rural Health Research Center
Date: 11/2000
This paper details a study of the utilization of specific preventive healthcare services by rural women and men to assess the impact of rural residence, the availability of healthcare providers and technology, demographic factors, and health insurance status on the likelihood of obtaining several preventive healthcare services.
Race and Place: Urban-Rural Differences in Health for Racial and Ethnic Minorities
North Carolina Rural Health Research and Policy Analysis Center
Date: 03/2000
This findings brief investigates urban-rural disparities for racial and ethnic minorities in six health areas: infant mortality, cancer screening and management, cardiovascular disease, diabetes, HIV infection, and child and adult immunizations.