bluuebunny/crossref_metadata_2025 huggingface dataset:
Bolivian Mothers Clubs as Media: Building on Community‐Based Networks*
Authors: Aguilar Ana Maria , Schaeffer Curt , Spain Peter L.
Published: April 2008

ABSTRACT: Because of the high infant mortality rate in Bolivia, health officials sought an effective method of distributing information about oral‐rehy‐dration therapy (ORT). Capitalizing on the existence of a network of “mothers clubs” throughout the country, an attempt was made to transform these units from passive recipients of surplus food to active agents of health education. These efforts to disseminate information and supplies through the education of local community leaders were combined with mass media strategies to form a coordinated information and delivery system. Preliminary evaluations suggest that the effort was successful in increasing the awareness of the ORT therapy among participants, their knowledge about the consequences of ORT use, and the availability of ORT supplies. Moreover, informed club members were found to be sharing their knowledge with non‐member mothers. The implications of this strategy for other health education efforts are discussed.
Impact of Federal Primary Health Care Policy in Rural Areas: Empirical Evidence from the Literature*
Authors: Horner Ronnie D.
Published: April 2008

This review examines the equity, efficiency and effectiveness of federal rural primary care policy as documented by the existing literature. The focus is on the Community Health Center and National Health Service Corps programs which have constituted the major components of the policy. The literature relating to the policy is limited in the number of studies available and in the quality of the research. The available evidence indicates that the policy is associated with an improvement in the distribution of health resources between rural and urban areas, and among rural areas. There is also partial evidence that the policy has been cost‐efficient. For federally subsidized practices, the cost of delivering a similar quality of health care is shown to be up to 50 percent less in rural than in urban areas. Rural private practitioners, though, may be more cost‐efficient than federally subsidized rural practitioners, at least under certain conditions which have yet to be fully delineated. Program effectiveness is the least well documented, but the literature does suggest that the policy has had a positive effect on the health status of rural populations. Substantially more research on the efficiency, and particularly the effectiveness, of federal rural primary care policy is required for the development of a rational basis for the policy.
Patterns of Travel for Rural Individuals Hospitalized in New York State: Relationships Between Distance, Destination, and Case Mix.*
Authors: Hogan Christopher
Published: April 2008

The travel patterns of individuals living in rural areas of New York State who were discharged from short‐term general hospitals in New York State in 1983 are examined. Counties are used as the geographical unit, and rural individuals who cross geographic boundaries to obtain inpatient hospital care are compared with those who receive such care in their own geographic area. Hospitals serving the rural population of New York are classified into three types: urban, consisting of all hospitals located in MSAs; rural referral centers; and other rural hospitals. Next, the rural patients who are admitted to each of these three types of hospitals are characterized in terms of distance traveled, case mix, length of stay, and age. Individuals who travel beyond the counties adjacent to their county of residence had a higher case mix index but were less likely to be more than 75 years old. Distance traveled and the expected cost of care were strongly positively related for patients admitted to urban and rural referral center hospitals, but were only weakly related for other rural hospitals. Finally, comparisons of rural patients in these three types of hospitals were performed adjusting for DRG mix, a comparison which is relevant to hospital reimbursements under the Medicare Prospective Payment System. Using several measures of illness severity, rural patients in urban hospitals and rural referral center hospitals were more severely ill than rural patients in other rural hospitals after adjusting for DRG mix. We conclude that somewhat higher payments to urban hospitals and rural referral center hospitals in New York are justified based on the more severely ill patients which they treat.
Stress on the Farm: A Test of the life‐Events Perspective Among Iowa Farm Operators*
Authors: Geller Jack M. , Bultena Gordon , Lasley Paul
Published: April 2008

Although a great deal is known about the nature and severity of the recent financial crisis in agriculture, there has been little systematic study of the social and psychological effects of this crisis upon farm operators and their families. Using data from a statewide sample of Iowa farmers, this study tests some hypotheses about correlates of psychological stress. The findings suggest that many farm operators find their situations to be stressful and that such stress is related to the severity of their financial problems. In addition, the life‐events perspective is examined in its utility to explain how adverse economic changes impact psychological well‐being.
Organizational Characteristics, Occupational Stress, and Depression in Rural Emergency Medical Technicians
Authors: Revicki Dennis A. , Whitley Theodore W. , Landis Sandra S. , Allison E Jackson
Published: April 2008

A model of organizational characteristics, occupational stress and mental health in emergency medical technicians (EMTs) is developed and tested. Supervisor behavior and work group support are used as predictors of negative role perception. Negative role perception is specified as intervening between the organizational variables and occupational stress. Occupational stress is hypothesized to directly influence depression. Data collected from 250 EMTs is used in a structural equation analysis to estimate model parameters. The sample is mostly male (74%), white (94%), and married (68%). Results suggest that there is a direct relationship between perceived occupational stress and increased depression. Role perception is a critical intervening variable between supervisor behavior, work group support, and occupational stress. The findings suggest that EMTs are more satisfied when supervisory practices result in an environment which encourages open expression and group problem solving. This work environment leads to more supportive relationships among squad members, reduced role ambiguity, and decreased occupational stress and depression.
Fatal Unintentional Injuries Among Kentucky Farm Children: 1979 to 1985*
Authors: Stallones Lorann
Published: April 2008

ABSTRACT: The hazards of farming among adults have been well described, but less has been published regarding the nature of farm injuries among children. Fatal farm injuries in Kentucky among children under 14 years of age usually have involved agricultural equipment, primarily tractors. The average annual age specific rates for fatal injuries in Kentucky among farm children ranged from 14.8 per 100,000 to 28.5 per 100,000 for boys, and from 11.8 per 100,000 to 3.1 per 100,000 for girls. Many of these deaths could have been prevented by not allowing children to ride on tractors, or by using infant and child restraints in motor vehicles. In the older age group (10 to 14 years of age), many deaths were due to drowning, so drowning prevention programs could reduce the number of fatal injuries. Exposure to environmental hazards differ for farm children and prevention programs in this population need to target those special hazards.
A Subsidized Perinatal Care Program in a Rural Colorado County*
Authors: Main Deborah S. , Tressler Carolyn J. , Calonge Ned , Joffe Lynn , Robichaux Andre
Published: April 2008

ABSTRACT: A large number of medically indigent women in rural areas currently receive little or no prenatal care, raising major concerns regarding perinatal health. In Colorado, subsidized prenatal and labor/delivery programs have been instituted to address this problem. This article describes the implementation of two programs in one rural county. In these rural programs, private physicians, health department personnel, and social work staff at the local hospital collaborate to provide financial assistance, comprehensive health education, and quality medical care for eligible pregnant women. The identified benefits and barriers unique to the provision of quality perinatal care in rural settings are discussed.
Maternity Care as an Essential Public Service: A Proposed Role for State Government*
Authors: Gavin Kathleen , Leong Darryl
Published: April 2008

ABSTRACT: This paper describes some of the current problems in assuring basic maternity care as an essential community service in the rural state of Vermont. Solving the cost of care problem will still leave large gaps in the ability of our maternity care system to provide continuous and high‐quality maternity care for all pregnant women. The problem of access is not only a temporary aberration of the current medical care system, but a central and identifying characteristic of it. Maternity care services are as essential as other community services such as utilities and education. The authors propose that the state should assure the availability and quality of maternity care services as it would other essential services. The development of a statewide care system using a nurse midwife model of services is suggested.
Determinants of Primary Caregiver Stress and Burden: Area of Residence and the Caregiving Networks of Frail Elders*
Authors: Dwyer Jeffrey W. , Miller Michael K.
Published: April 2008

This research examines the association among characteristics of the caregiving network, primary caregiver stress and burden, and area of residence. The purpose is two‐fold: to determine whether the structure of the relationship between the caregiving network, and stress and burden is uniform across rural, small city, and urban samples; and, to assess whether stress and burden are explained by a similar set of variables within area of residence categories. The data are drawn from a matched sample of 1,388 impaired elders and their primary caregivers from the 1982 National Long‐Term Care Survey and the National Survey of Informal Caregivers. In general, the analysis shows that several characteristics of the care‐receiver and the primary caregiver have a differential effect on stress and burden across residential categories, and that, within rural, small city, and urban samples, the determinants of stress and burden are not homogeneous. When the frail elder is able to reciprocate by doing chores, babysitting, or providing some other type of assistance for the primary caregiver, however, both stress and burden are reduced in all three residential categories. Similarly, the increased provision of assistance with instrumental activities of daily living by the primary caregiver uniformly increases stress and burden. These findings suggest that interventions designed to alleviate primary caregiver stress and burden may be able to have some common components, but may also need to be tailored in some ways to specific residential environments.
Availability and Accessibility of Rural Health Care*
Authors: Hicks Lanis L.
Published: April 2008

ABSTRACT: The 1980s saw a retrenchment of the ideology that government intervention could solve the problems of inadequate access to health services in rural areas. Increased emphasis was placed on an ideology that promoted deregulation and competitive market solutions. During the 1980s, the gap in the availability of physicians in metropolitan versus nonmetropolitan areas widened. Also during that time period, the gap between metropolitan and nonmetropolitan populations' utilization of physician services widened. In addition, many indicators of the health status of nonmetropolitan residents versus metropolitan residents worsened during the 1980s. As we enter the 1990s, concern about equitable access to needed health care services and for the vulnerability and fragility of rural health systems has resurfaced. A number of national policies and a research agenda to improve accessibility and availability of health services in rural areas are being considered.
Prolonged Travel Time to Neonatal Intensive Care Unit Does Not Affect Content of Parental Visiting: A Controlled Prospective Study*
Authors: Callahan Edward J. , Brasted William S. , Myerberg David Z. , Hamilton Sharon
Published: April 2008

ABSTRACT: Decreased local obstetric care appears to be increasing the rate of premature births to rural populations. With increased numbers of premature and complicated births in rural populations, understanding the impact of the Neonatal Intensive Care Unit (NICU) environment on the development of parent‐child relationships becomes critical. NICU infants appear to be at increased risk for failure to thrive, child abuse, and neglect. Some reports suggest that the frequency of parental visits to the NICU can predict infants likely to be at risk. Because rural parents visiting infants hospitalized in urban centers are likely to visit less often, understanding this possible relationship is critical. In this controlled prospective study, three groups of parents were observed visiting their hospitalized infants: (1) those visiting “in house” while the mother was still hospitalized; (2) those whose visits required one hour or less in travel time; and (3) those whose visits required more than one hour in travel time. Results showed that travel time influences the frequency of visits, with fewer visits from those living furthest from the NICU. However, those visiting from greater distances stayed with their infants longer so that there was no difference in the total visiting time over a two‐week period. Direct observations of the visits by both mothers and fathers showed no differences in the content of parent‐child interactions among groups. Thus, visit frequency alone must be viewed cautiously as a potential indicator of failure to bond with a hospitalized infant, especially in settings serving rural populations.
Farm Safety and Federal Responses to Occupational Health
Authors: Kelsey Timothy W.
Published: April 2008

ABSTRACT: There is always a trade‐off in occupational safety policy between the right for one person to make decisions and the right for others to avoid the consequences of that person's decisions. This conflict has driven the federal response to agricultural safety. Agriculture was an integral part of the original Occupational Safety and Health Administration bill, but farm owner and farm group lobbying contributed to the granting in 1976 of an exemption for all farms with 10 or fewer workers.

Finding a proper balance between farm owners' and farm employers' interests is important, but copying the federal response to safety in other occupations will not lead to resolution. Comparing current federal safety expenditures on different federal occupational safety programs, such as to mine safety, slights fundamental differences between agriculture and other occupations, and improperly implies that agriculture is being discriminated against by federal safety efforts. The rights issue and the unavoidable value judgments they entail cannot be ignored. Because the people who would be protected by regulations are also largely the people who would be restricted by those regulations, the decision to create mandatory safety rules in agriculture is much more difficult than in other occupations.
Patterns of Illness Behavior Among Rural Elderly: Preliminary Results of a Health Diary Study
Authors: Stoller Eleanor Palo , Forster Lorna Earl
Published: April 2008

This paper summarizes the responses of rural elderly people to a variety of symptoms experienced during a three‐week period. Responses to symptoms included causal attributions, consultation patterns, and intervention strategies. Data recorded in diaries during a three‐week period highlight the importance of lay care in the illnesses of older people. Most symptoms were managed by older respondents themselves. When symptoms were discussed with someone else, the consultant was most likely a family member or friend rather than a health care professional. Only one third of the respondents contacted any formal provider about any of their symptoms. The majority of respondents combined medical and nonmedical explanations in interpreting their symptoms. The most frequent response to a symptom was doing nothing. The next two most commonly reported interventions were over‐the‐counter medications and activity limitation. Analyses revealed few differences among residential categories in patterns of illness behavior. Rural‐urban differences often disappeared when controlling for demographic and socioeconomic background which covarv with residence.
Maternal Care Coordination for Migrant Farmworker Women: Program Structure and Evaluation of Effects on Use of Prenatal Care and Birth Outcome
Authors: Larson Kim , McGuire Joan , Watkins Elizabeth , Mountain Karen
Published: April 2008

Nearly three fourths of the migrant farmworkers in the U.S. are Hispanic. Cultural and social barriers, along with constant travel, make coordination of care a significant concern for migrant health centers providing perinatal services to female farmworkers. As part of a demonstration project, a migrant‐specific maternal care coordination program was developed that used bilingual staff, outreach services, lay health advisers, and a multistate tracking system. Following the initiation of the project, first‐trimester entry into prenatal care and number of prenatal visits increased over a five‐year period among the target population. Successful tracking methods provided outcome data on more than 80 percent of participants during the project period.

The results of this study suggest that migrant health centers should focus on employing public health‐oriented bilingual or bicultural health professionals and that an outreach strategy must be an integral part of a health care delivery system serving migrant farmworkers. Without these key ingredients, health care services will not be accessible or acceptable for this hard‐to‐reach population. Collaboration among the National Migrant Resource Program, the Migrant Clinicians Network, and the National Perinatal Association can facilitate development of a regionwide perinatal service system for female migrant farmworkers.
The Rural Hospital as a Provider of Health Promotion Programs
Authors: Dorresteyn‐Stevens Christine
Published: April 2008

Abstract: Although patient education has always been recognized as an essential function of a hospital, it was not until the health concerns of the nation focused on prevention that hospitals began to develop activities aimed at primarily healthy individuals. Hospital health promotion evolved from patient education about specific diseases to programs focused on modifying of lifestyle practices to prevent future debilitating conditions.

Studies conducted in the early 1980s show hospital‐based health promotion programs increasing in number and including such target populations as senior citizens, children, business people, and hospital employees. However, the extent of involvement of the rural hospital in offering health promotion programs has not been clearly established. The current study was conducted to determine the status of health promotion programs in rural North Carolina hospitals. Elements considered were types of programs, target audiences, methods of financing, staff use, and availability of specialized facilities for health promotion programs.

The results indicate rural hospitals do offer health promotion programs, but their primary focus is on hospital employees. Most programs are offered at low or no cost, making those offered for the community readily accessible. If input from the community is used and programming is aimed at specific health needs of rural populations, the rural hospital could make a significant contribution to an overall primary prevention strategy, lowering community health care costs.
The North Carolina Obstetrics Access and Professional Liability Study: A Rural‐Urban Analysis
Authors: Fondren Lise K. , Ricketts Thomas C.
Published: April 2008

Abstract: During the 1980s a rapid rise in the costs of malpractice coverage for obstetrical services caused many practitioners to stop delivering babies. Other factors also influenced the decision by physicians to exclude obstetrics from their practices, including: increases in malpractice claims made against obstetrical providers and the subsequent fear of being sued; closures of hospital obstetrics units; issues involving Medicaid; and the daily stresses inherent in providing obstetrical care. Rural areas were particularly vulnerable to these factors.

North Carolina was not unlike other states in recognizing a severe drop in access to obstetrical services in many communities, and policies were proposed to address this problem through tort reform, malpractice subsidies, and Medicaid program expansion. The exodus of obstetrical providers seemed especially critical in rural areas, and this article presents a metro‐politan‐nonmetropolitan analysis of the results of a survey of all obstetricians and gynecologists active and licensed to practice in North Carolina.

The analysis is focused on provider responses to proposed policies and also examines the clinical support networks for these physicians to determine if this might also be an area for future policy activity. Important differences were found between rural and urban providers in terms of intensity of obstetrical practice, adequacy of backup, Medicaid participation and caseload, ideas about tort reform, and recent changes in obstetrical practice. The results indicate that policies to increase demand or income can help solve the rural obstetrical access problem but that states should pay equal attention to the clinical support system for practitioners.
Predicting the Receipt of Employer‐Sponsored Health Insurance: The Role of Residence and Other Personal and Workplace Characteristics
Authors: Coward Raymond T. , Clarke Leslie L. , Seccombe Karen
Published: April 2008

Abstract: Americans without health insurance constitute a significant public policy concern. Previous research has demonstrated that rural Americans are more likely to be without coverage. Beyond documenting this comparative disadvantage, however, current research has two specific deficiencies: studies have not examined whether the factors that predict the receipt of employer‐sponsored health insurance are equivalent across residence categories, and few studies have used a multivariate framework to examine the predictors of the receipt of health insurance, Using data from the 1987 National Medical Expenditure Survey, the influence of residence is examined along with other variables known to be associated with an increased likelihood of receiving health insurance from an employer (specifically, seven employee and six workplace characteristics). At a bivariate level, an individual's place of residence did affect the probability of receiving health insurance from an employer, with nonmetropolitan workers least likely to receive such benefits. The influence of the employee and workplace characteristics on receipt of insurance, however, did not vary significantly by place of residence. In a multivariate model, six employee and six workplace characteristics were identified as significant predictors. These findings do not refute the existence of important residential differences in health insurance coverage, rather, they suggest that the differences are due to identifiable population and workplace characteristics that vary in their distribution by residence.
Geographic Imbalances of Physician Supply: An International Comparison
Authors: Blumetithal Daniel S.
Published: April 2008

This study was undertaken to compare geographic imbalances of physician manpower in developed and developing countries and to evaluate the success of policies designed to alleviate the imbalances. Data were drawn from a mail survey of countries conducted by the World Health Organization, from national statistical summaries, and from published information on national policies and programs. Information was available from 26 developing countries and 15 developed countries. Among developing countries, the degree of urbanization and rural economic development appeared to be the most important determinants of the level of geographic imbalance. Among developed countries, those with very high overall physician/ population ratios tended to have the least degree of imbalance, but this effect was not consistent. At the national level in most countries, the effect of policies or programs specifically designed to redistribute physician manpower appeared to be limited.
Studying the Retention of Rural Physicians
Authors: Pathman Donald E. , Konrad Thomas R. , Agnew Christopher R.
Published: April 2008

Rural communities and policy‐makers struggle with efforts to enhance the retention of rural physicians. Research available to guide these efforts is often weak methodologically and thus may be pointing retention efforts in nonproductive directions. This article discusses a range of methodologic issues encountered in rural physician retention studies for the purpose of strengthening future studies.

Ideal study approaches to answer causal questions, including questions about the “causes” of rural physician retention, must demonstrate good internal validity, for which chance, bias, and confounding are accounted. Retention studies that rely simply on asking physicians why they stay or leave rural areas can be useful at times, but are too prone to bias and their findings difficult to verify. Simply identifying what physicians find satisfying or dissatisfying about rural work also will not reliably reveal why they stay or leave, a related but still distinct question. Stronger approaches to studying retention include the traditional quantitative study – in which retention factors are identified when they are statistically related to physicians’retention, and the increasingly popular qualitative study – in which retention issues are revealed through prolonged, in‐depth interactions with physicians.

This article also discusses various definitions of retention, the use of survival curves to present retention findings, and the importance of studying retention in inception cohorts. The benefits and downside of studying retention with prospective and retrospective study designs are described.
Geographic Benefit from Decentralized Medical Education: Student and Preceptor Practice Patterns
Authors: Fryer George E. , Stine Curtis , Krugman Richard D. , Miyoshi Thomas J.
Published: April 2008

The performance of area health education center (AHEC)‐stimulated programs and decentralized education for medicine is not well understood. The Statewide Education Activities for Rural Colorado's Health (SEARCW/AHEC project at the University of Colorado School of Medicine was examined to determine if the program had an effect on the practice location of its graduates. Practice location and specialty of graduates of the University of Colorado School of Medicine (UCSOM) classes 1980‐1985 were compared for students who had participated in decentralized SEARCH/AHEC experiences versus students who had not. The majority of the graduates were practicing out of state in 1990. Non‐Colorado doctors were more often practicing in rural (non‐metropolitan statistical area [MSA]) counties and in towns of fewer than 2,500, 5,000 and 10,000 residents, respectively. In addition, of the 251 active patient care physicians practicing in Colorado communities of fewer than 10,000 in non‐MSA counties in 1986, those who precepted UCSOM students on SEARCH rotations were more likely to have remained in their same practice location in 1992 (77.8% versus 62.1% for those who had not precepted students). This analysis of both student and preceptor practice patterns documents the value of decentralized medical education in addressing the geographic and specialty maldistribution of physicians. These results have important policy implications for funding medical education programs.
Wash Day Blues: Secondhand Exposure to Agricultural Chemicals
Authors: Grieshop James I. , E.Villanueva Ninfa , Stiles Martha C.
Published: April 2008

The issue of personal cleanliness for farm workers exposed to pesticides is a significant health problem. One area that requires more attention centers on the issues of handling and laundering of clothing suspected of being contaminated by pesticides. This exploratory research focused on the handling and laundering behaviors of California farm workers with pesticide contaminated clothing. Of particular interest was the phenomenon of “secondhand” exposure that may result from improper handling and unsafe laundering practices.

Members of farm worker families (N=109) were interviewed at two California health clinics that serve a large portion of low income farm worker families. The sample was divided into three groups based on exposure to pesticides: direct exposure, indirect exposure, nonexposed. The findings revealed the least safe handling and laundering behaviors were reported by the group most at risk from first hand exposure (i.e., handlers, loaders, applicators). Also, secondhand exposure to pesticides appears to be related to storage and laundering practices reported by those who are directly or indirectly exposed to pesticides.

The findings revealed the actual laundering practices of farm workers and their knowledge of what constitutes unsafe laundering behavior, including “secondhand” contamination. This information can help to identify realistic safe laundering practices for farm worker families who come in contact with pesticides in the field or at home.
The Effects of On‐ and Off‐reservation Residence on In‐home Service Use Among Great Lakes American Indians
Authors: Chapleski Elizabeth E. , Dwyer Jeffrey W.
Published: April 2008

Abstract: Community‐based, in‐home services are a crucial component in the long‐term care continuum. Research has shown rural populations to be less likely to use these services. American Indian elders are more likely than their non‐American Indian counterparts to reside in non‐metropolitan areas, yet little rural research has focused on this subpopulation. The purpose of this article is to explore differences in in‐home service use among urban, rural off‐reservation, and rural on‐reservation older American Indians using data from a statewide needs assessment. The sample includes 206 206 Great Lakes American Indians aged 55 and older. Predictor variables include the residential classification variable (rural off‐reservation, rural on‐reservation, and urban) along with sociodemographic, social support, health and functional status, and general knowledge of services. Results of logistic regression analysis indicate that the odds are significantly greater for on‐reservation rural American Indian elders use of home services, home health aides, and home visits, than for urban American Indian elders. The off‐reservation rural American Indian elder is significantly less likely than the urban American Indian elder to use a home health aid. Health rating, activities of daily living/instrumental activities of daily living (ADL/IADL) impairments, and general knowledge of in‐home service availability increase the odds for all groups use of home services and home health aides.
The Influence of Insurance Status and Income on Health Care Use Among the Nonmetropolitan Elderly
Authors: Kassab Cathy , Luloff A.E. , Kelsey Timothy W. , Smith Stephen M.
Published: April 2008

Abstract:The objective of this research is to examine the influence of income and type of insurance coverage on the use of health services among the nonmetropolitan elderly. A model of health service utilization is used as the foundation for examining this issue with data from a telephone survey of a randomly selected sample of residents from four nonmetropolitan counties in Pennsylvania. Results indicated that those elders with Medicaid coverage were less likely to visit a doctor than respondents with private insurance or Medicare only, even after controlling for income and other relevant factors. Further, lower income respondents with Medicare were less likely to visit the dentist than those with private insurance (Medicare does not cover dental care). In contrast, neither income nor insurance predicted hospital use. As such, the health and dental care needs of many lower income nonmetropolitan elders may potentially be going unmet. In general, findings highlight the continued relevance of economic barriers to the use of such services among the nonmetropolitan elderly.
The Effects of Mental Health Factors on Ambulatory Care Visits by Rural Teens
Authors: Rickert Vaughn I. , Pope Sandra K. , Tilford John M. , Wayne John , Scholle Sarah H. , Kelleher Kelly J.
Published: April 2008

Abstract: This study sought to determine the effects of mental health variables on rural adolescents' use of ambulatory health care services and whether these effects varied across common outpatient settings. Using a cross‐sectional survey design, 2,297 adolescents who attended public schools in grades 7 through 12 in one isolated rural Mississippi River Delta county were assessed via a standardized health behavior survey. This self‐report measure inquired about relevant health behaviors such as alcohol use, depressive symptoms, and health service use. The students' mean age was 15 years and 58 percent of the sample were black. Approximately 11 percent of the sample reported symptoms of depression, 16.5 percent reported problem drinking, and slightly fewer than 6 percent reported both. After controlling for predisposing, enabling, and need factors, the reporting of depressive symptoms, problem drinking, or both was related to an increased number of outpatient visits in three of four sites examined. However, differences among sites were observed. These data suggest that mental health problems are associated with increased visits to ambulatory settings, and these problems affect service use differentially. Thus, effective interventions and better linkages between ambulatory settings and mental health providers may reduce unnecessary use.
The Relationships Among Gender, Perceived Financial Barriers to Care, and Health Status in a Rural Population
Authors: Beck Rubye W. , Jijon Caroline R. , Edwards Joellen B.
Published: April 2008

Abstract: This study examined the relationships among gender, perceived financial barriers to health care, and selected health status indicators in a randomly selected rural Appalachian sample. The data were gathered through the Johnson County Health Survey. The survey was conducted through personal interviews with 207 females and 178 males representing 197 households. The Duke Health Profile was used to measure the perceived health of the respondents. Analysis of variance, t tests, and descriptive statistics were used to analyze the data. Analysis of the data revealed that women perceive financial barriers to health care significantly more than men (P<0.01), even when living in the same household; women had significantly poorer health than men (P<0.01); and both women and men with perceived financial barriers experienced poorer health (P<0.01) than those who did not perceive such barriers. Conclusions from the study suggest that in this rural sample women were the most compromised by both gender and health status, and that they perceived that their health care needs were not being adequately met.
Hills, Ridges, Mountains, and Roads: Geographical Factors and Access to Care in Rural Kentucky
Authors: Ramsbottom‐Lucier Mary , Emmett Kim , Rich Eugene C. , Wilson John F.
Published: April 2008

Abstract: Access to health care remains an important issue facing many individuals. Barriers to health care include financial factors, characteristics of the individuals and of the health care delivery system, as well as geographical factors. Using a telephone survey of Kentucky residents, this study investigated the relationship between the road quality and county elevation and access to health care for individuals in rural and urban areas of the state. Controlling the comparison for known individual characteristics, community characteristics, and medical infrastructure characteristics, this study uncovered that worse road conditions, mea‐sured by a road “rideability” index, were associated with longer times to reach medical care. It also found an association between higher county elevations and shorter times to reach medical care.
Obstacles and Opportunities in Designing Cancer Control Communication Research for Farmworkers on the Delmarva Peninsula
Authors: Hooks Carol , Ugarte Carlos , Silsby Joscelyn , Brown Ruth , Weinman Joanne , Fernandez Gloria , Foxwell Julia , Newton Nancy , Connally L. Barbara
Published: April 2008

Abstract: Little is known about the incidence of cancer among farmworker populations or about effective strategies for communicating with farmworkers about cancer prevention. Some studies suggest that farmworkers may have unusually high incidences of skin and cervical cancers. With these two cancers as the focus, a group of interviewers, researchers, and health communication specialists set out to create, implement, and evaluate a cancer control demonstration project geared toward farmworkers. In 1994, a situation analysis was conducted to identify constraints and opportunities for providing farmworkers with cancer control information and services. The situation analysis provided valuable information to aid in developing intervention and evaluation strategies. This paper outlines how and why the situation analysis was conducted and what was learned with regard to the farmworker population on the Delmarva Peninsula. Living conditions and the local availability of cancer control services are described. Obstacles to conducting research and interventions with farmworkers are high‐lighted. Based on what was learned, recommendations are made for designing cancer control research and intervention for farmworkers.
Cancer Prevention Strategies Among California Farmworkers: Preliminary Findings
Authors: Goldsmith David F. , Sisneros Gil C.
Published: April 2008

Abstract: This study was conducted to identify barriers to cancer prevention and evaluate the effectiveness of a cancer prevention project to increase screening for cervical and breast cancer among Spanish‐speaking farmworkers in California's Central Valley. Bilingual health educators met with farmworker communities near Merced and Modesto, CA, to determine barriers that prevented women from seeking screening for breast and cervical cancer. Using information from focus groups and health fairs, a targeted outreach protocol was developed that will eventually enroll 2,500 farmworkers in a cancer education and screening program. Participants received a presentation in Spanish on breast and cervical cancer that included a pretest and post‐test to assess increases in knowledge. Clients were encouraged to attend Golden Valley Health Centers Inc. (GVHC) to receive free breast and cervical cancer screenings. Vouchers, redeemable for modest personal hygiene gifts by clients, were tracked to assess prevention behavior when appointments were kept at GVHC.

Sixty farmworkers attended focus groups and 363 attended health fairs to provide input to the cancer prevention program. As of December 1,1995,1,732 female farmworkers were enrolled in an outreach program designed to increase knowledge and promote cancer screening. Data from pretests and post‐tests indicated a statistically significant increase in knowledge about cancer and its prevention among participants. Furthermore, 317 participants redeemed vouchers for cancer screenings at GVHC.

Active community collaboration and culturally appropriate intervention strategies, employed in conjunction with clinical services, can be successful in increasing cancer prevention awareness and screenings among female farmworkers.
Metropolitan Versus Nonmetropolitan Differences in Functional Status and Self‐care Practice: Findings from a National Sample of Community‐dwelling Older Adults
Authors: Rabiner Donna J. , Konrad Thomas R. , DeFriese Gordon H. , Kincade Jean , Bernard Shulamit L. , Woomert Alison , Arcury Thomas , Ory Marcia G.
Published: April 2008

Abstract:The objective of this study was to use a recent national probability survey of the noninstitutionalized older adult population to compare the functional status and self‐care practices of older adults residing in metropolitan and nonmetropolitan communities and to identify differences associated with residential location. The survey used in this study was the National Survey of Self‐care and Aging (NSSCA). A cross‐sectional design was employed using weighted bivariate and multivariate logistic regression analyses to examine the relationship between metropolitan and nonmetropolitan residential location and self‐reported ability to perform basic, mobility, and instrumental activities of daily living (ADLs), as well as to assess the degree to which the levels and types of functional limitations affect metropolitan versus nonmetropolitan older adults' performance of self‐care activities

The bivariate logistic analyses pointed to modest, often insignificant metropolitan versus nonmetropolitan differences in the ability to perform functional tasks. However, larger positive effects of nonmetropolitan residence were generally observed once other factors likely to account for some of these differences were taken into account. Older adults from nonmetropolitan areas were more likely to report being able to perform functional activities but also were more likely to report performing self‐care activities both in the presence and absence of disability. This study, therefore, concluded that nonmetropolitan older adults may discount the significance of declining functional status, thus normalizing the trajectory of aging in a different way than do their metropolitan counterparts. If this process occurs, it may affect how nonmetropolitan persons use primary health care and/or long‐term care services, challenging the economists' concept of demand, the clinicians' concept of need, and the policy analysts' concept of equity. Additional work is required to assess whether such a normalization process actually occurs and, if so, to explore its distribution, causes, correlates, and consequences
The Meaning of Ambulatory Care Sensitive Admissions: Urban and Rural Perspectives
Authors: Schreiber Steven , Zielinski Teresa
Published: April 2008

ABSTRACT: Ambulatory care sensitive admission rates have been proposed as measures of access to health care. To test this, admissions for ambulatory care sensitive conditions (ACSC) were analyzed by multiple linear regression. The percentage of population below 200 percent of the federally defined poverty level, the percentage of black people, and the number of primary care providers per 1,000 population were found to be positively associated with ACSC admissions. Population density was negatively associated with ACSC admissions. There was no association between the location of the ZIP code in a health professional shortage area and ACSC admissions. Proximity to the hospital was found to be positively associated with ACSC admissions but was examined only in the most rural ZIP code group. The significant independent variables and the direction of their effects were the same across all ZIP code groups. The analysis suggests that high ACSC admissions may be a reflection of deficits in one or more of the following areas: primary care availability, accessibility, or appropriateness. In‐depth study is needed to determine the relative importance of these factors in a given geographical area. There also may be environmental and social factors external to the health care system that contribute to ACSC admissions. The findings suggest that ACSC should be used cautiously as a measure of primary care system needs, and in conjunction with other health, demographic, or service utilization data.
Physician Visits in a Farming‐dependent County
Authors: Rohrer James E. , Urdaneta Marta , Vaughn Thomas , Merchant James A.
Published: April 2008

Abstract: Physician visits in a farming‐dependent county in the upper‐Midwest were studied using a mail questionnaire. A 16 percent random sample of households yielded 426 surveys (60 percent response rate). The dependent variable was the natural log (plus one) of the number of times the respondent had seen a physician in the prior 12 months. Predisposing, enabling, and medical need variables were tested as potential predictors of medical care usage. Self‐rated health status proved to be an important predictor, as was a history of hospitalization and being married. However, health insurance coverage and family income were not associated with increased physician visits. Implications for modifying the conceptual model employed to analyze medical care utilization in similar populations are discussed.
Health‐related Quality of Life: Does Rurality Matter?
Authors: Goins R. Turner , Mitchell Jim
Published: April 2008

Abstract:This study addresses the question of whether six health‐related quality‐of life domains are related to population density within a rural area while adjusting for the effects of demographic characteristics and social support resources. The sample consisted of 2,178 adults aged 60 years or older who resided in eastern North Carolina between 1989 and 1991. Ordinary least squares regression estimation was used to analyze this survey data. For the analyses, rural residence was broken down into five levels reflecting population density, which was compared with analyses utilizing a collapsed dichotomous residential measure. Results indicate that a more detuiled residence measure within a predominantly rural area provides valuable information that would otherwise be concealed by a dichotomous measure.
Rural Health Research: Rural Hospitals and the Local Economy: A Needed Extension and Refinement of Existing Empirical Research
Authors: Cordes Sam , Van der Sluis Evert , Lamphear Charles , Hoffman Jerry
Published: April 2008

Abstract: The relationship between the health care sector and the rural economy is of increasing importance. Much additional research is needed to fully understand this relationship and to address some of the limitations of the modest amount of research that already exists. In this study, data from Nebraska were used to create a four‐part typology of rural hospitals. Input‐output analysis was used to assess the economic effects of each type of hospital on the local economy and to simulate the effects of three different changes or scenarios: an increase or decrease in hospital utilization; the elimination of local purchases of non labor inputs; and a change in the mix or configuration of services provided. While the hospital is an important contributor to local economies, this contribution is not constant across hospital types. The total job‐related effects ranged from 77 jobs for the smallest type of rural hospital to 1,332 for the largest type. Service and trade (retail plus wholesale) are the two sectors of the local economy most heavily influenced by the presence of a hospital. In today's changing and challenging environment, there is a great need for researchers to create and evaluate the economic effects of a variety of relevant and realistic scenarios (other than hospital closure).