bluuebunny/crossref_metadata_2025 huggingface dataset:
Small Rural Hospitals with Long‐Term Care: 1983 to 1987
Authors: Beaulieu Joyce E.
Published: April 2008

Rural hospitals were under tremendous stress in the 1980s, as evidenced by decreasing use and closures. Rural populations increased in the two proportions of people older than 65 years relative to urban areas. Rural communities had more chronically ill residents than urban areas. Population aging and hospital stress have opened an option for small rural hospitals to develop long‐term care units. Analysis of a national cohort of 750 small rural hospitals was undertaken in 1983,1985, and 1987 to identify the characteristics of these hospitals, their communities, and the relative contribution of the small rural hospital to long‐term care bed supply. Hospitals more likely to have long‐term care during this period of time had lower occupancy rates and higher expenses per admission both prior to and after developing long‐term care. While only 14 percent of the 750 hospitals studied had long‐term care, they contributed nearly 30 percent of the total long‐term care bed supply in their counties. Population‐based need and bed supply measures were not significantly different in counties having a small rural hospital with long‐term care. Areas of further analysis of the small rural hospital as a resource for long‐term care are suggested. The implications for the health care system of small rural hospitals with long‐term care are discussed.
Cancer in Rural Versus Urban Populations: A Review
Authors: Monroe Adele C. , Ricketts Thomas C. , Savitz Lucy A.
Published: April 2008

Rural‐urban comparisons have identified higher age‐, race‐, and sex‐adjusted cancer incidence and mortality rates in urban populations for most anatomic sites, suggesting that rural populations are at lower risk from cancer. Conversely, findings that rural cancer patients are diagnosed at later stages of disease, that higher proportions of rural cancer cases are unstaged at diagnosis, and that rural cancer patients are at a more advanced stage of illness when referred to home health care agencies, suggest that rural cancer patients are disadvantaged when compared to their urban counterparts.

This paper summarizes rural‐urban patterns of cancer mortality, incidence, and survivorship since 1950; outlines rural‐urban differences in utilization of health care services; questions the appropriateness of using rural‐urban comparisons of cancer mortality and incidence to evaluate access to cancer care; and suggests potential approaches to the question of whether rural residents have access to cancer care comparable to that available to urban residents.
Job Satisfaction Among Hospital Nurses: Facility Size and Location Comparisons
Authors: Coward Raymond T. , Horne Claydell , Duncan R. Paul , Dwyer Jeffrey W.
Published: April 2008

Despite recent declines in turnover and vacancy rates, maintaining a stable nursing staff continues to be critical to the effective operation of American hospitals, fob satisfaction is a pivotal element in nurse retention, and organizational theory suggests that some of the factors that influence job satisfaction vary by facility size. This is a study of job satisfaction among a sample of 731 nurses providing direct patient care in 22 hospitals. The sample includes approximately equal numbers of nurses employed in very small rural hospitals (1‐49 beds), medium sized facilities located in small towns (50‐99 beds), and larger metropolitan institutions (>100 beds). Differences by hospital size were observed in overall job satisfaction and in five sub‐dimensions of that concept (i.e., professional status, task requirements, pay, organizational policies, and autonomy). With the exception of pay, the results indicated that nurses employed in the very small rural hospitals were more satisfied with their jobs. Differences by hospital size were also observed in the personal characteristics of the nurses, several specific aspects of their job, and in their perceptions of job mobility. A set of four hierarchically nested ordinary least squares regression models indicated that job‐specific characteristics were the most powerful predictors of job satisfaction.
The Role of Nursing Education in Preparing Students for Rural Practice
Authors: Straub LaVonne A. , Frels Lois
Published: April 2008

This paper discusses research on the role of nursing education in preparing students for rural practice. The purpose of the research was to learn how education programs respond to unique features of rural nursing. Results from a two‐phase nationwide survey of 275 baccalaureate nursing programs are presented. The first phase identified programs offering a rural track, the second phase was a follow‐up survey to the deans and faculty of rural‐oriented programs. These findings indicate educators recognize that rural nursing differs from urban nursing because of cultural and demographic features, as well as technical and economic characteristics. Most educators believe their role should include developing student interest in rural practice. Recommendations from the findings are presented.
Rurality and Prescription Drug Utilization among the Elderly: An Archival Study
Authors: Lago Dan , Stuart Bruce , Ahern Frank
Published: April 2008

Abstract: Despite documentation that rural elderly have reduced access to both primary care and specialist physician services, there have been very few studies comparing rural and urban patterns of prescription drug use. This is unfortunate, because prescription drugs are the most commonly used type of health care by the elderly. This research merged claims data for a random sample of 18,641 enrolled elderly in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) for the years 1984 through 1988 with Medicare inpatient and outpatient health services records and with county‐level demographic and health services resources data bases to test several models of factors associated with prescription drug use. The Human Resources Profile County Code from 1980 census data (HRPCC80) in the Area Resource File provided a very detailed (10 levels) definition of rurality. Consistent with our hypotheses based on preliminary studies, neither rurality designations nor county‐level health care resource indices, nor interaction trans of health services resources with rurality were powerful predictors of prescription drug use. Use of health services (from Medicare data) and variables of longevity and continuity in the PACE program were consistently robust predictors of prescription drug use. Personal demographic characteristics were also strong predictors: white widowed women under age 85 with relatively higher incomes used more prescription drugs.
Consequences of Differential Residence Designations for Rural Health Policy Research: The Case of Infant Mortality
Authors: Farmer Frank L. , Clarke Leslie L. , Miller Michael K.
Published: April 2008

Abstract: In 1991, members of the rural caucus proposed numerous bills designed to attenuate the rural‐urban differences in health care delivery and health status. Implicit in the legislative process is the assumption that “rural America” differs systematically from “urban America.” However, research has consistently demonstrated that there is not a single rural America but rather, those areas outside of the major metropolitan areas represent a complex mosaic of varying social and environmental settings. Rural communities differ in meaningful ways along a number of socioenvironmental parameters, and accordingly, health status indicators also differ across rural communities. Thus, health outcome statistics averaged across rural communities will often mask important health disparities experienced by certain population groups. Policies based on these aggregate indicators may overlook the needs of the most disadvantaged. While a number of measures of rurality have emerged in the last decade, much of the information presented to policy‐makers is either too aggregated (i.e., metropolitan‐nonmetropolitan) to identify important differences across the range of communities, or it is gathered in agency‐specific categories that are not comparable. The central question under examination in the current context is the possibility of distorting the picture of infant health status by aggregating the diverse rural locales of the United States. Empirical results indicate that when considering infant mortality, any rural disadvantage is contingent upon how ‘rural’ and ‘urban’ have been defined. Further, the results indicate that conclusions must be conditioned on other important sociodemographic parameters such as region of the county and race.
Rural‐Urban Differences in Stigma and the Use of Care for Depressive Disorders
Authors: Rost Kathryn , Smith G. Richard , Taylor J. Lynn
Published: April 2008

Abstract: Stigma may be a particularly important barrier to mental health care in rural communities where lack of anonymity increases the probability that someone who seeks care will be labeled “crazy.” This study examined rural‐urban differences in the stigma associated with depressive symptoms and the stigma associated with seeking treatment for depressive disorders. In addition, the study compared how the stigma associated with seeking treatment predicted use of care in rural and urban residents with a history of depressive symptoms. Two hundred subjects from metropolitan and adjacent non‐metropolitan counties rated one of four randomly selected vignettes using 14‐point semantic differential scales. The findings indicated that rural residents with a history of depressive symptoms labeled people who sought professional kelp for the disorder somewhat more negatively than their urban counterparts. Logistic models controlling for sociodemographic characteristics demonstrated that the more negative the labeling, the less likely depressed rural residents were to have sought professional help. Labeling was not associated with use of care among urban people with depressive symptoms. We concluded that prospective studies are warranted to inform the development of interventions to decrease the stigma associated with seeking treatment for depressive disorders in rural communities.
Health and Well‐Being Among Rural Americans: Variations Across the Life Course
Authors: Eggebeen David J. , Lichter Daniel T.
Published: April 2008

Abstract:This study uses data from the 1988 National Survey of Families and Households conducted by the University of Wisconsin to examine spatial variations in physical, mental, and social well‐being among young, middle aged, and elderly American adults. Rural residents of all ages were found to consistently rate their physical health more poorly than nonrural residents. Both young and old rural adults also rated themselves less happy than nonrural residents. However, middle‐aged and elderly rural residents appear better off on the majority of six other indicators of well‐being, and this group reports the highest proportion of adults with no health impairments. Finally, rural residents of all ages possess distinct advantages in terms of several measures of social ties.
Horizontal and Vertical Integration‐Diversification in Rural Hospitals: A National Study of Strategic Activity, 1983–1988
Authors: Mick Stephen S. , Morlock Laura L. , Sulkever David , de Lissovoy Gregory , Malitz Faye E. , Wise Christopher G. , Jones Alison S.
Published: April 2008

Abstract: This study examines both the magnitude of and factors influencing the adoption of 13 horizontal and vertical integration and diversification strategies in a national sample of 797 U.S. rural hospitals during the period 1983–1988. Using organization theory, hypotheses were posed relating environmental and market factors, geographic location, and hospital characteristics to the adoption of horizontal and vertical integration and diversification. Results indicate that only one of 13 strategies was adopted by more than 50 percent of all rural hospitals during the study period, and that most of the directional hypotheses were not confirmed using Cox's proportional hazards models. In particular, environmental and market factors were unrelated to the strategies studied. Issues of methodology and theory are discussed; however, during an historically turbulent period, both relatively low levels of rural hospital strategic activities and lack of predictive power of the theory suggest caution in relying heavily on a policy for rural hospital survival that is dependent on individual market‐oriented strategic behavior.
Effects of Payment Changes on Urgent/Emergent Admissions in Rural and Urban Communities
Authors: Ahern Melissa , McCoy Virginia
Published: April 2008

Abstract: Reimbursement changes during the 1980s, particularly Medicare diagnosis‐related group (DRG) reform and the growth of managed care, have squeezed hospital revenues available for cross‐subsidizing care for uninsured patients and patients for whom marginal costs exceed marginal revenues. This study uses logistic regression with time and residence interactions to explore the impact of payment changes on rural versus urban patients' admission status (urgent versus nonurgent). Findings show that uninsured rural patients had a significantly higher probability in 1987 than they did in 1983 of being admitted to hospitals in an urgent/emergent condition. Findings also show incrementally higher probabilities for Medicare and Medicaid rural patients in 1987. Results are consistent with the view that cross‐subsidization is no longer effective for covering uninsured rural care and that more direct subsidies may be necessary.
Stress and Coping Among Missouri Rural and Urban Children
Authors: Atkins Frances D. , Krantz Steven
Published: April 2008

Abstract: A cross‐sectional survey using a convenience sample of 157 Missouri rural and urban children (ages 8–13 years) yielded no significant differences in perceptions of stressors or use of coping strategies for dealing with those stressors between rural and urban children. The Feel Bad Scale and the Schoolagers' Coping Strategies Inventory measured the children's perceptions of stressors and use of coping strategies.

Rural children experienced stressor levels equivalent to urban children, yet they were underserved in mental and physical health needs. The children studied reported self‐care through coping strategies for management of their stressors. Longitudinal research is needed to identify the impact of stress and interventions on the health and behavior of children in rural settings.
Research Reviews
Authors: Farmer Frank L
Published: April 2008

This section of The Journal of Rural Health is intended to assist readers in their efforts to keep current in the research literature that is relevant to rural health. In monitoring the journals from neighboring disciplines, the journal attempts to alert readers to new research and scholarly debate. The scope of this section is, for the most part, limited to publications from the United States. Inclusion of a publication does not represent an endorsement of the research or the validity of the conclusions reported. As research reviews editor, I invite comments on this section. I am particularly interested in innovative ways the section might be used to ensure that the journal's readers are the most erudite professionals involved in rural health.
Enhancing the Representation of Rural Areas in the National Medical Expenditure Survey
Authors: Cohen Steven B. , Braden Jill J. , Ward Edward P.
Published: April 2008

Abstract: This study examines the issues associated with enhancing the representation of rural areas in the National Medical Expenditure Survey (NMES). It reviews alternative definitions of rural areas and describes the classification schemes considered for future cycles of the NMES. A review of the NMES sample representation in rural areas and an examination of the analytical capabilities and limitations of the current design for deriving health care estimates of the rural population is provided. The options presented in this article would extend the analytical capacity of the NMES to permit estimates of rural areas of the national classified by census region, by gradations of rural classification, and for individuals residing in rural frontier counties.
Survey of Prevention‐Relevant Beliefs and Efforts to Enhance Parenting Skills Among Rural Parents
Authors: Spoth Richard L. , Conroy Sue M.
Published: April 2008

Abstract: The first objective of this article is to summarize literature on selected variables that can influence parents' efforts to enhance their parenting skills, including participation in prevention‐oriented education and skills‐training programs. The second objective is to report the results of a survey of rural parents with preadolescents (N=203) on prevention‐relevant parenting beliefs and past parenting enhancement efforts, such as parent education program attendance. Descriptive analyses of these variables and their relationships to socioeconomic status and family composition are reported. Results regarding prevention‐relevant parenting beliefs indicate relatively low levels of perceived susceptibility to adolescent problem behaviors and high levels of perceived parent efficacy in preventing adolescent problems. High levels of past parenting enhancement efforts also were reported. Little evidence of gender differences on the parenting belief and enhancement variables was found, but education, income, and family structure and composition variables were significantly associated with several key parenting belief and enhancement variables.
The Benefits of Telephone‐Access Medical Consultation
Authors: Smego Raymond A. , Khakoo Rashida A. , Burnside Christine Ann , Lewis Michael J.
Published: April 2008

Abstract: A major disadvantage of rural medical practice is the limited reserve of consultative options. To determine the perceived clinical utility and educational impact of the West Virginia University Medical Access and Referral System (MARS), a 24‐hour prompt telephone‐consultation service, a mailed questionnaire was administered to 303 West Virginia clinicians who had used MARS for infectious disease problems. The overall questionnaire response rate was 62 percent. Callers included family practitioners (35%), medical specialists (32%), surgical specialists (13%), pediatricians (11%), obstetricians (5%), and nonphysicians (4%). Major referral questions posed were therapeutic (60%), diagnostic (48%), and epidemiologic (10%) in nature. On a scale of 1 (not useful) to 5 (very useful), survey responders rated the overall clinical usefulness of MARS as either a 4 (22%) or 5 (76%). Callers felt that MARS consultation assisted in accurate case diagnosis in 80 percent of cases, and aided in successful therapeutic management of 96 percent of cases. An educational benefit was reported by 96 percent of responders. Physicians located in more rural, underserved areas tended to use MARS to a greater degree than colleagues in more populated, medically accessible areas (P<0.005). These findings suggest that an academic telephone‐access consultation program can be a clinically relevant and educational consultative tool for practicing clinicians, especially those located in rural areas.
Adequate Access to Posthospital Home Health Services: Differences Between Urban and Rural Areas
Authors: Chen Valerie , Phillips Bardara
Published: April 2008

Abstract: The health care environment in rural areas changed dramatically in the 1980s. Policy‐makers are concerned that these changes have reduced access to care among residents of rural areas. This study measures adequate access to Medicare home health services and determines whether it differs for urban and rural beneficiaries.

Adequate access to care is measured by whether a patient with a specific health condition received a level of skilled services predetermined as appropriate for that condition. The predetermined levels of care were developed in an earlier study and were found to correlate with adverse outcomes. This study focused on patients with diabetes mellitus and surgical hip procedures to concentrate on access to skilled nursing services and physical therapy services.

To conduct the analysis, a data base was constructed that included both patient utilization and health status data, drawing on three different data sources: Medicare hospital claims data, Medicare home health bill record data, and home health plan of treatment data from patients' utilization review forms (forms 485 and 486). The analysis samples consisted of 404 patients with diabetes and 876 patients who had surgical hip procedures.

Significant differences were found between urban and rural areas in access to home health services. The largest differences were found in access to physical therapy services, but differences in access to skilled nursing services also exist. The data suggest that the availability of skilled care services may cause these differences.
Urban/Rural Differences in Health Service Utilization by Elderly Persons in the United States
Authors: McConnel Charles E. , Zetzman Marion R.
Published: April 2008

Abstract: This paper presents the results of a longitudinal analysis of differences between urban and rural elderly persons in the use of hospital, nursing home, and physician services. Multivariate logistic and Tobit utilization models were estimated with data from the National Center for Health Statistics' Longitudinal Study of Aging (a national survey of more than 5,000 elderly, 70 years of age and older) and health resource data from the Bureau of Health Professions' Area Resources File. The research investigated the independent effect of residential location on both the frequency of service use and the likelihood of using a service over the period 1984–1986. Under a trichotomous definition of urban/rural residency and controlling for differences in predisposing, enabling, and need characteristics, the analysis revealed that the utilization pattern of hospital, nursing home, and physician services was unrelated to either rural or urban residential location or the availability of health resources in those areas.
The Emerging Epidemiology of Rural AIDS
Authors: Berry David E.
Published: April 2008

Abstract: The incidence of AIDS in rural areas is increasing rapidly. However, historically it has been overshadowed by AIDS in the epicenters. From 1991–1992 the increased percentage of cases was higher in nonmetropolitan areas than in any other areas of residence. The rate per 100,000 also increased at almost the same rate in rural areas as in the largest metropolitan areas, defined by the Centers for Disease Control (CDC) as having a population of more than 500,000, and in other metropolitan areas of 50,000 to 500,000 population, as designated by CDC.

To date, the epidemiology of AIDS in rural areas has not been defined. This information is necessary to developing effective policies and programs. The research presented here reviews the literature on AIDS in specific areas and populations at risk as a basis for generating hypotheses for further study. The first wave of the epidemic, primarily affecting homosexual or bisexual men, is strongly evident in many rural locations. The second wave of the epidemic is strongly evident in the South and can be seen among high‐risk groups such as black women, adolescents, migrant and seasonal farm workers, people who abuse alcohol, intravenous drug users, and users of crack cocaine, including those who trade sex for drugs. Poverty is a common characteristic of the second‐wave population. Proximity to interstate highways as well as metropolitan areas may also be associated. A national study of the epidemiology of AIDS in rural America is imperative.
Smoking Cessation Experiences of Chronic Lung Disease Patients Living in Rural and Urban Areas of Virginia
Authors: Labuhn Karen , Lewis Carolyn , Koon Kathleen , Mullooly John P.
Published: April 2008

AbstractRural residents differ from individuals living in urban areas in their views about health and health behavior, their socioeconomic status, and their access to health care services. Such differences may have implications for health policy and the focus and design of health care services, including educational interventions. This paper reports findings from a comparative analysis of rural and urban chronic obstructive pulmonary disease (COPD) patients' smoking cessation experiences. The study's aims were to determine whether rural COPD patients differed from their urban counterparts in smoking patterns, smoking cessation attempts (i.e., number of quitting attempts, methods used, withdrawal symptoms, professional and personal supports for quitting smoking), and smoking cessation outcomes. Forty‐eight rural and 86 urban COPD patients were interviewed by telephone using a pretested questionnaire.

The rural and urban samples did not significantly differ in demographic characteristics, disease severity, functional status, smoking patterns, reasons for smoking, perceived benefits of smoking cessation, or withdrawal symptoms. However, the rural COPD patients used fewer smoking cessation methods and had fewer persons supporting their smoking cessation attempts. Rural patients' support networks for smoking cessation primarily consisted of family members, whereas those of urban patients were more varied. Similar percentages of rural and urban patients had been abstinent from smoking for at least six months at the time of the interview, controlling for age and disease severity. Logistic regressions were used to identify predictors of current smoking for the rural and urban samples. For the rural sample, less educated individuals were more likely to be current smokers. Spouse smoking predicted current smoking in the rural sample but was only marginally significant (P=0.054). In the urban sample, use of daily medication for breathing (a proxy measure of disease severity) had a significant negative effect on current smoking. Smoking due to stress was a significant positive predictor of current smoking. Findings from this exploratory study suggest the existence of rural/urban differences in COPD patients' smoking cessation patterns that warrant further investigation.
Determinants of Physician Vacancy Rates in Rural Hospitals
Authors: Hyde John C. , Fottler Myron D.
Published: April 2008

This study examines the determinants of physician vacancy rates in rural hospitals from the perspective of the rural hospital administrator. Data on community characteristics, hospital characteristics, and hospital recruitment strategies are examined for 50 rural hospitals in Kentucky using questionnaire and archival data. Physician vacancy rates in this sample were quite high (mean of 37 percent). Results indicate lower physician vacancy rates in hospitals with a chain affiliation. In addition, the “job shopping” model for physicians decisions on where to practice (Johnson, 1978) is supported. Hospitals that target physician candidates with more work experience display lower physician vacancy rates. Generally, hospital characteristics ivere more significant predictors of physician vacancy rates than were community characteristics. Implications for rural hospital physician recruitment/retention strategies are discussed.
Urban and Rural Differences in Health Insurance and Access to Care
Authors: Hartley David , Quam Lois , Lurie Nicole
Published: April 2008

This study considers differences in access to health care and insurance characteristics between residents of urban and rural areas. Data were collected from a telephone survey of 10,310 randomly selected households in Minnesota. Sub‐samples of 400 group‐insured, individually insured, intermittently insured, and uninsured people, were asked about access to health care. Those with group or individual insurance were also asked about the costs and characteristics of their insurance policies.

Rural areas had a higher proportion of uninsured and individually insured respondents than urban areas. Among those who purchased insurance through an employer, rural residents had fewer covered benefits than urban residents (5.1 vs 5.7, P < 0.01) and were more likely to have a deductible (80% versus 40%, P < 0.01). In spite of this, rural uninsured residents were more likely to have a regular source of care than urban residents (69% versus 51%, P < 0.01), and were less likely to have delayed care when they thought it was necessary (21% versus 32%, P<0.01). These differences were confirmed by multivariate analysis.

Rural residents with group insurance have higher out‐of‐pocket costs and fewer benefits. Uninsured rural residents may have better access to health care than their urban counterparts. Attempts to expand access to health care need to consider how the current structure of employment‐based insurance creates inequities for individuals in rural areas as well as the burdens this structure may place on rural providers.
Physician Recruitment in Rural Canada: Programs in New Brunswick, Newfoundland, and Nova Scotia
Authors: Reamy Jack
Published: April 2008

This paper examines programs used in the Atlantic provinces of New Brunswick, Newfoundland, and Nova Scotia to recruit and retain physicians in rural areas. The provinces have many similarities but have unique characteristics that have shaped recruitment methods. The total number of physicians in each province has grown at a faster rate than the population. Each has problems attracting physicians to underserved areas, although the magnitude of the problems vary. The data for this paper were gathered from documents available from various agencies in each province and a series of personal interviews conducted in the spring of 1993. The provinces have chosen different avenues in attempting to solve the maldistribution of physician resources, ranging from regulatory methods in New Brunswick to moves in Newfoundland to encourage graduates of the province's medical school to locate in the rural areas and lessen the dependence on foreign medical graduates. Nova Scotia, with fewer areas needing physicians, has been able to focus its efforts on selected locations. Reviewing the methods used in the three provinces provides an insight into the attempts to solve the shortage of physicians in rural areas.
Strategic Activity and Financial Performance of U.S. Rural Hospitals: A National Study, 1983 to 1988
Authors: Mick Stephen S. , Morlock Laura L. , Salkever David , de Lissovoy Gregory , Malitz Faye , Wise Christopher G. , Jones Alison
Published: April 2008

This study examines the effect of 13 strategic management activities on the financial performance of a national sample of 797 U.S. rural hospitals during the period of 1983‐1988. Controlled for environment‐market, geographic‐region, and hospital‐related variables, the results show almost no measurable effect of strategic adoption on rural hospital profitability and liquidity. Where statistically significant relationships existed, they were more often negative than positive. These findings were not expected; it was hypothesized that positive effects across a broad range of strategies would emerge, other things being equal. Discussed are possible explanations for these findings as well as their implication for a rural health policy relying on individual rural hospital strategic adaptation to environmental change.
Rurality and Tuberculosis Incidence Trends in North and South Carolina, 1980 to 1992
Authors: Millard Peter S. , Cegielski J. Peter , Wing Steve , Silver Andrew
Published: April 2008

U.S. tuberculosis incidence rates increased steadily from 1985 through the end of 1992. Many factors have been implicated as contributors to the reversal in the historic decline of tuberculosis: the HIV epidemic, poverty and homelessness, immigration from less developed countries, and a deteriorating public health infrastructure. The purposes of this study were to demonstrate the extent of geographic variation in tuberculosis incidence rate trends in North and South Carolina and to quantify the association between aggregate‐level characteristics of state economic areas and incidence rate trends. Data were obtained from the U.S. 1980 and 1990 decennial census and from the North and South Carolina health departments. In North Carolina, tuberculosis trends declined rapidly in the early 1980s, but declined much less rapidly from 1986 to 1992. In South Carolina, tuberculosis trends were nearly static during the early 1980s, but declined rapidly from 1986 to 1992. Rural and high‐*poverty state economic areas in South Carolina experienced especially favorable changes in tuberculosis incidence trends. South Carolina has a unique tuberculosis control program that makes widespread use of enablers, incentives, and directly observed therapy. This study demonstrates the distinct tuberculosis incidence trends that existed in two contiguous states and suggests that approaches to tuberculosis control that improve access to care may be effective in improving tuberculosis incidence trends, particularly in poor and rural areas. Strengthening tuberculosis programs may be an important strategy for controlling the current resurgence of tuberculosis in the United States.
The Impact of Informal Care Giving on Labor Force Participation by Rural Farming and Nonfarming Families
Authors: Horwitz Mary E. , Rosenthal Thomas C.
Published: April 2008

Using data from the National Survey of Families and Households, 1987, this study contrasts urban versus rural, and farm versus rural nonfarm informal care givers of the elderly and disabled to illustrate the conflicts that each group experiences when combining work and care giving. Women are the primary care givers in both rural and urban areas. Rural care givers spent more time providing care than urban caregivers, whether the dependent resided in the care giver's home or elsewhere in the community. A moderate difference existed in the number of hours care givers spent at work, although the rural care giver's spouses worked significantly more hours than urban spouses. Rural nonfarm care givers spent more hours caring for individuals residing in their communities, while farm caregivers spent the most time in household‐related activities when caring for someone in their homes. In‐home activity decreased the number of hours spent at work, while community care giving did not.
Health Insurance Coverage and Use of Services Among Low‐Income Elders:Does Residence Influence the Relationship?
Authors: Seccombe Karen
Published: April 2008

Abstract: This research uses a nationally representative sample of 1,425 low‐income elders from the 1987 National Medical Expenditure Survey (NMES) to assess the independent and interaction effects of health insurance coverage and residence on the use of seven health care services: doctor visits, visits to other personnel, telephone contact, emergency room visits, overnight hospital stays, outpatient visits, and prescription medicines. It is hypothesized that (a) elders without insurance to supplement Medicare; (b) those who lived in nonmetropoli‐tan areas use fewer health services; and (c) insurance status and residence interact to influence use of health services, with nonmetropolitan elders using fewer services than those living in metropolitan areas, regardless of insurance type. Using multivariate statistical analyses with both main effects and interaction term models, the data indicate that the type of insurance that low‐income elders have is associated with their use of health services, and that residence has only modest effect. Individuals who have Medicaid, and to a lesser extent private supplements, use services more frequently than do those without supplements. Finally, despite the hypothesis, residence does not interact with insurance status in influencing use of services; the relationship between insurance and use of services does not vary across area of residence. The data suggest that the ability to pay, rather than supply constraints associated with nonmetropolitan areas, are of primary importance in determining health care use among low‐income elders.
Providing Rehabilitative Services in Rural Communities: Report of a Conference
Authors: Jones Harold P. , Brand Marcia K.
Published: April 2008

Abstract: Rural communities have a disproportionate need for rehabilitative services, partly attributable to an aging population and higher incidence of occupational injuries. Despite increased need, many rural communities find rehabilitative services unavailable due to personnel shortages, maldistribution of health care personnel, and related recruitment and retention issues. The National Rural Health Association and the Division of Associated, Dental, and Public Health Professions of the Health Resources and Services Administration co‐sponsored a conference to explore issues related to ensuring that rural communities have access to vital rehabilitation services provided by allied health professionals. The status of rehabilitative care in rural settings and the barriers to improvement in services delivery were described by consumers, providers, educators, and public and private agency representatives. Recommendations directed to state and federal authorities, educational institutions, and professional organizations centered around increasing the supply of appropriately trained allied health providers. Improving retention of rehabilitative personnel in rural areas could be achieved by specific changes to the practice climate.
Access to Health Care: Urban‐Rural Comparisons from a Midwestern Agricultural State
Authors: Comer John , Mueller Keith
Published: April 2008

Abstract: Lack of access to quality health care for a large number of Americans, particularly those living in rural areas, is a major health care problem. Differences in access between rural and urban areas are caused by obstacles to providing adequate care, such as hospital closures and physician shortages, and low income and/or employment that does not provide health insurance as an employee benefit. This study, based on a random sample of 6,000 households in Nebraska, finds that access to health care is better for residents of rural than urban areas. The relationship holds with controls for health status and health insurance. The pattern in Nebraska reflects an absence of differences in income, health insurance, and health status that produce differences in access between rural and urban areas nationwide. The findings suggest that any serious proposal to reform health care delivery should involve the states and use established patterns of seeking care among state residents.
Universal Precautions Compliance and Exposure Frequency to Patient Body Fluids in Nurses Employed By Urban and Rural Health Care Agencies
Authors: Glenn L. Lee , Ramsey Priscilla W.
Published: April 2008

Abstract: Previous studies have suggested that health care workers may differ with respect to universal precautions knowledge, compliance, practice setting barriers, or exposure to patient body fluids in rural and urban areas. The purpose of this study was to determine whether or not there are rural/urban differences in the degree of precaution taken by health care workers to prevent the spread of blood borne pathogens, specifically human immunodefiency virus (HIV) and hepatitis B virus (HBV). A random sample of rural and urban registered and licensed practical nurses in Tennessee was surveyed. The respondents completed two instruments that assessed self‐reported universal precautions knowledge, precautions, and practice barriers.

No measurable differences in universal precautions knowledge, compliance, or barrier scores between the two groups were found; yet rural nurses were 2.7 times as likely to be exposed to patient body fluids than urban nurses (P<0.005). The conclusion was that rural nurses were as experienced and as knowledgeable about universal precaution techniques as their urban peers, but their knowledge was not translated into practice to the same degree. Two possible explanations offered are (1) rural nurses are more likely to be acquainted with, and thus trusting of, their patients, and (2) the lower seroprevalence of human immunodefiency virus and hepatitis B virus in rural areas may lead to complacency.
Families and Family Life in Rural Areas
Authors: Whitener Lynn
Published: April 2008

“Research Reviews” are a regular feature of The Journal of Rural Health, presenting current research on a particular theme or topic of interest.
Risk Perceptions of Occupational Hazards Among Black Farmers in the Southeastern United States
Authors: Arcury Thomas A.
Published: April 2008

Abstract: Farming is one of the most hazardous occupations in the United States, and it is no less dangerous for black farmers than it is for farmers of other ethnic backgrounds. Yet very little research has addressed the epidemiology of occupational risks for black farmers, nor has research investigated the risk perceptions of black farmers. Occupational risk perception data are needed if culturally appropriate interventions are to be implemented. This article presents the results of a study designed as a first step in the process of designing an intervention program for black farmers. This study used data collected through in‐depth interviews and focus group interviews to analyze the occupational risk perceptions of black farmers in four southeastern states: Kentucky, Mississippi, North Carolina, and Tennessee. These farmers are realistic about the hazardous nature of farming. They perceive carelessness rather than fate to be an important cause of farm injury. They realize that changing technology has brought new risks as well as benefits. Like those from other ethnic backgrounds, these farmers grouped most of their occupational risks around the major production activities of using machinery, using chemicals, and working with livestock.
Agriculture‐related Residual Injuries: Prevalence, Type, and Associated Factors Among Alabama Farm Operators—1990
Authors: Zhou Chun , Roseman Jeffrey M.
Published: April 2008

Abstract: A population‐based, cross‐sectional study was conducted to investigate the lifetime agricultural injuries causing traumatic disabilities (referred to as residual injuries) in a simple random sample of 1,000 farm operators in Alabama in 1990. Data were collected by mail questionnaire followed by telephone interviews. The goal of this study was to assess the prevalence, characteristics, and potential related factors of the defined injuries. The overall response rate was 86.2 percent. The prevalence of the residual injuries was 9.3 percent (95%, CI=7.2–11.4) in 1990. Agricultural injuries frequently resulted in traumatic disabilities, including amputation (23.9%), fracture (19.4%), and sprain/strain (11.9%). Fingers were the body part most frequently disabled due to injuries (28.4%) followed by the back (9.0%), and legs (7.5%). The leading external causes were machinery (44.8%), animals (19.4%), and falls (10.5%). Twenty‐eight percent of the injured attributed “carelessness” as the main cause of their injuries. Other main causes included hurry (9.0%), long work hours (9.0%), disturbed animals (6.0%), and equipment design problems (6.0%), according to the injured. The most frequent consequences were amputation (19.4%) followed by functional impairment of limbs and persistent pain. Residual injuries happened most often in animal facilities. Farm operators engaged in forestry, poultry, and dairy had higher prevalence rates. Other factors associated with higher prevalence of residual injuries included larger farm size, higher farm annual production, and more time spent on farming. Those with residual injuries were at much higher risk of being injured again (POR=3.4, P<0.01). The results provide some indications for developing injury control and health planning programs in rural areas and for future research.
Patterns and Predictors of Noninstitutional Health Care Utilization by Older Adults in Rural and Urban America
Authors: Rabiner Donna J.
Published: April 2008

Abstract:Noninstitutional long‐term care is not often included in policy studies or recommendations in the United States even though there have been recent efforts to include this type of care in health reform proposals. This study was designed to provide insight into the patterns and predictors of noninstitutional medical, home‐, and community‐based services utilization by older adults in rural and urban America. The National Long Term Care Survey (NLTCS) was used to explore the relationship between residential setting and subsequent noninstitutional services utilization. Weighted logistic regression procedures for complex survey designs were used to guide the analysis. Living in the Northeast and residence in moderately densely populated areas (towns, small cities, and suburbs) were significant positive predictors of subsequent medical, home‐, and community‐based services utilization. Because some differentials were found in access to and use of services by regional and geographic setting, policy‐makers need to develop alternative strategies to eliminate inequities in the distribution of noninstitutional long‐term care services in more remote areas.
Rural and Urban Differences in Mortality Among Americans 55 Years and Older: Analysis of the National Longitudinal Mortality Study
Authors: Smith Mark H. , Anderson Roger T. , Bradham Douglas D. , Jr. Charles F. Longino
Published: April 2008

Abstract: Previous research on rural and urban differences in risk of mortality has been inconclusive. This article used data from the National Longitudinal Mortality Study to establish whether all‐cause mortality risk among persons 55 years and older varies by degree of urbanization, controlling for the potential sociodemographic confounders of age, gender, race/ethnicity, education, income, and marital status. Using the Cox Proportional Hazards Regression Procedure, the authors found that persons living in the most rural locales and those living in rural communities in standard metropolitan statistical areas (SMSAs) have the lowest risk of mortality, while those living in SMS A central cities had the highest risk of dying during the study period. The protective effect of rural residence declines in older age cohorts.
Rural Emergency Medical Services: Patients, Destinations, Times, and Services
Authors: Morrisey Michael A. , Ohsfeldt Robert L. , Johnson Victoria , Treat Richard
Published: April 2008

Abstract: This study sought to describe the volume of use, mix of patients, origin and destination of runs, times and distances to care, and the volume of clinical services provided in a rural emergency medical services region. This study summarizes all 6,080 rural emergency ambulance trip reports filed from April through September 1991 from the 12 rural counties surrounding Augusta, GA. Rural ambulances are regularly used and are used extensively by elderly populations. The pattern of services provided suggests that while advanced care may or may not have been indicated, it was rarely provided and that rural emergency medical service programs should consider a greater reliance on basic life support teams.