Search

Objectives. To provide adjusted rates of self-reported receipt of the influenza vaccine in the 2018–2019 flu season among adults in large metropolitan, medium and small metropolitan, and nonmetropolitan areas of the United States by age group, gender, and race. Methods. We queried the 2019 National Health Interview Survey for respondents aged 18 years and older. To provide national estimates of influenza vaccination coverage, we performed sample-weighted multivariable logistic regressions and predicted marginal modeling while adjusting for age, gender, race/ethnicity, and urban–rural household designation. Results. After weighting, 48.1%, 46.2%, and 43.6% of adults from large metropolitan, small and medium metropolitan, and nonmetropolitan areas, respectively, received the influenza vaccine. Additionally, there was a trend toward declining influenza vaccination status from large metropolitan to rural areas in all age groups, both genders, and multiple racial/ethnic groups. Conclusions. Self-reported influenza vaccination rates were lower in rural than in urban areas among adults of all age groups and both genders. Using community leaders for health promotion, augmentation of the community health care workforce, and provision of incentives for providers to integrate influenza vaccination in regular visits may expand influenza vaccine coverage. (Am J Public Health. 2022;112(2):304–307. https://doi.org/10.2105/AJPH.2021.306575) [ABSTRACT FROM AUTHOR]

Objectives. To examine changes in the scope of activity and organizational composition of public health delivery systems serving rural and urban US communities between 2014 and 2018. Methods. We used data from the National Longitudinal Survey of Public Health Systems to measure the implementation of recommended public health activities and the network of organizations contributing to these activities in a nationally representative cohort of US communities. We used multivariable regression models to test for rural–urban differences between 2014 and 2018. Results. The scope of recommended activities implemented in rural areas declined by 3.4 percentage points between 2014 and 2018, whereas it increased by 1.4 percentage points in urban areas. The rural–urban disparity in scope of activities grew by a total of 4.8 percentage points (P <.05) over this time. The disparity in network density grew by 2.3 percentage points (P <.05). Conclusions. Urban public health systems have enhanced their scope of activities and organizational networks since 2014, whereas rural systems have lost capacity. These trends suggest that system improvement initiatives have had uneven success, and they may contribute to growing rural–urban disparities in population health status. [ABSTRACT FROM AUTHOR]

Objectives. To examine rural–suburban–urban disparities in intendedness and resolution of first pregnancies among adolescent and young women (aged 15–19 and 20–24 years) across racial/ethnic backgrounds in the United States. Methods. We used the National Survey of Family Growth and pooled pregnancy files from 2002 through the 2015–2017 surveys. We report baseline rural–suburban–urban disparities in first pregnancy intention and outcomes. We used multinomial logistic regression to estimate these disparities, accounting for sociodemographic background, religious upbringing, and other factors. Results. The first adolescent pregnancies of rural women were more likely to be unintended and end in live birth relative to their urban counterparts. Disparities were most striking among Black adolescents, with about 60% of first adolescent pregnancies among rural Black women being unintended and ending in live birth (urban: 51%). Newly collected state health department data on rural and urban adolescent births and abortions corroborate the findings from the National Survey of Family Growth. Conclusions. Rural–urban differences in the share of first adolescent pregnancies ending in live births are not accounted for by pregnancy intention or confounding individual-level characteristics. Future research should explore the role of structural barriers, including access to family planning and abortion services. [ABSTRACT FROM AUTHOR]

Objectives. To demonstrate how inferences about rural–urban disparities in age-adjusted mortality are affected by the reclassification of rural and urban counties in the United States from 1970 to 2018. Methods. We compared estimates of rural–urban mortality disparities over time, produced through a time-varying classification of rural and urban counties, with counterfactual estimates of rural–urban disparities, assuming no changes in rural–urban classification since 1970. We evaluated mortality rates by decade of reclassification to assess selectivity in reclassification. Results. We found that reclassification amplified rural–urban mortality disparities and accounted for more than 25% of the rural disadvantage observed from 1970 to 2018. Mortality rates were lower in counties that reclassified from rural to urban than in counties that remained rural. Conclusions. Estimates of changing rural–urban mortality differentials are significantly influenced by rural–urban reclassification. On average, counties that have remained classified as rural over time have elevated mortality. Longitudinal research on rural–urban health disparities must consider the methodological and substantive implications of reclassification. Public Health Implications. Attention to rural–urban reclassification is necessary when evaluating or justifying policy interventions focusing on geographic health disparities. [ABSTRACT FROM AUTHOR]

Objectives: To examine urban-rural differences in US prevalences of traditional and emerging tobacco product use as well as dual or polytobacco use of these products. Methods: Our data were derived from wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study. We estimated weighted prevalences of adult tobacco use across urban-rural geographies and examined prevalences classified by gender, poverty level, and region of the country. Results: Nationally, cigarette use and smokeless tobacco use, as well as dual or polytobacco use of traditional products, were more prevalent in rural than in urban areas. Conversely, cigarillo and hookah use and dual or polytobacco use of emerging products were higher in urban areas. There was no significant urban-rural difference in use of e-cigarettes. Gender, poverty, and region of the country did not seem to be driving most urban-rural differences, although differences related to cigarillo use and dual or polytobacco use of emerging products became nonsignificant after control for covariates. Conclusions: Our findings highlight important urban-rural differences in tobacco use. Whether the changing tobacco product landscape will contribute to a continuation of rural health disparities remains to be seen. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether the use of firearms explains rural-urban differences in suicide rates. Methods: We performed a retrospective analysis on all 6196 well-characterized adult suicides in Maryland from 2003 through 2015. We computed rate ratios by using census data and then stratified by sex, with adjustment for age and race. Results: Suicide rates were higher in rural compared with urban counties. However, the higher rural suicide rates were limited to firearm suicides (incident rate ratio [IRR] = 1.66; 95% confidence interval [CI] = 1.20, 2.31). Nonfirearm suicide rates were not significantly higher in rural settings. Furthermore, 89% of firearm suicides occurred in men and the higher rural firearm suicide rate was limited to men (IRR = 1.36; 95% CI = 1.09, 1.69). Women were significantly less likely to complete suicide in rural areas (IRR = 0.63; 95% CI = 0.43, 0.94), regardless of method. Conclusions: Male firearm use drives the increased rate of suicide in rural areas. The opposite associations between urbanicity and suicide in men and women may be driven by the male preference for firearms as a method for committing suicide. [ABSTRACT FROM AUTHOR]

Objectives. To examine whether living in a rural versus urban area differentially exposes populations to social conditions associated with disparities in access to health care. Methods. We linked Medical Expenditure Panel Survey (2005-2010) data to geographic data from the American Community Survey (2005-2009) and Area Health Resource File (2010). We categorized census tracts as rural and urban by using the Rural-Urban Commuting Area Codes. Respondent sample sizes ranged from 49 839 to 105 306. Outcomes were access to a usual source of health care, cholesterol screening, cervical screening, dental visit within recommended intervals, and health care needs met. Results. African Americans in rural areas had lower odds of cholesterol screening (odds ratio[OR] = 0.37;95%confidence interval[CI] = 0.25,0.57) andcervical screening(OR= 0.48; 95% CI = 0.29, 0.80) than African Americans in urban areas. Whites had fewer screenings and dental visits in rural versus urban areas. There were mixed results for which racial/ethnic group had better access. Conclusions. Rural status confers additional disadvantage for most of the health care use measures, independently of poverty and health care supply. [ABSTRACT FROM AUTHOR]

A model describing physician supply and distribution is described. Two surveys obtained information to examine elements of the model. The first survey identified a group of primary care physicians that had considered rural locations but ultimately selected an urban location. This sub-group, 29 per cent of the primary care supply pool, received a follow-up survey to provide more information about how they made their choice. About one-half of them finally chose on the basis of factors other than metropolitan/non-metropolitan considerations. For this half, some of the factors that entered into the decision were the availability of physician specialists, nearby hospital facilities, and access to medical school programs. Such factors could be affected by future policy decisions, but the cost is unknown. Even if such policy decisions were made, and appropriate programs instituted, the results would probably not solve the problem of disproportionate physician distribution. The most likely-to-succeed approach to increasing the number of rural physicians remains that of increasing the number of entrants to medical school with a rural background. [ABSTRACT FROM AUTHOR]

The article discusses issues in rural health disparities and public health in the U.S. in relation to rising mortality in rural areas. Topics include the lack of public health investment in rural areas of the U.S., the impact of social and economic problems in rural areas, and research contained in the chartbook "The 2014 Update of the Rural-Urban Chartbook."

The article discusses the notion of despair as a cause of death in relation to an issue article on increasing mortality among some white subpopulations in the U.S. Topics include health inequities facing African Americans in relation to white Americans, rural-urban differences in health outcomes, and gender differences in changes to mortality.