SCRHRC Researchers Address Cervical Cancer

Cervical cancer, associated with high-risk human papillomavirus (HPV) infection, is a significant public health problem in South Carolina. The state ranks 14^th in cervical cancer mortality overall, but African American and rural women are more likely to die of cervical cancer. This disparity in cervical cancer mortality persists despite a 75% reduction in mortality since the introduction of the Pap test.

Several SCRHRC researchers were involved in the December issue of the Journal of the South Carolina Medical Association, which highlights cervical cancer prevention and control efforts. Dr. Saundra Glover, Associate Director of the SCRHRC, led the effort to combine the resources in the academic community and partnerships with the community. One of the postdoctoral fellows at the Center, Jessica Bellinger, authored an article describing the results of a population-based survey of HPV and cervical cancer in the state. Jessica Bellinger is also involved in community-based programs as part of the Call to Action: Preventing Cervical Cancer Among African-American Women, highlighted in the Summer 2009 issue of “In Our Hands” from the South Carolina Cancer Disparities Community Network. Study results were presented at the NRHA Multicultural and Minority Conference in Memphis, TN.

More information about the cervical cancer issue of the Journal of the South Carolina Medical Association can be found here (http://www.sc.edu/news/newsarticle.php?nid=652&pg=1) and here (www.sph.sc.edu/health_disparities). Details about the community efforts with the SC Cancer Disparities Community Network can be found here (http://sccdcn.sph.sc.edu/newsletters/index.htm).

Crazy teacher rant

We all encourage our students to attend professional conferences to network with established scientists and learn new research techniques.

****The good:

A terrific presentation on the use of video recording and detailed analysis to study the nature of the interaction between nursing assistants and residents in long term care. Very cool method, very caring researcher. Kudos to Dr. Lene Levy-Storms and her colleagues.

Kudos to all the good presentations made by our students/post-docs (who never commit any of the errors outlined below): Jessica Bellinger, Minnjuan Flournoy, Chinelo Ogbuanu, & Lekhena Sros.

And kudos to all the wonderful researchers whose presentations I could not attend, as there were 900 individual sessions in a very short period.

****The .... you know.

The next time I attend the APHA Annual Conference, I would dearly love a magic wand [or similar] with which to smite the research unrighteous. Actually, since many presenters are students, I would like to smite the presenters' mentors:

-- If you test 18 [or more] different outcomes and 2 of them are significant at p less than 0.05, don't get all excited. Do the math. Bassmasters does not do this much fishing.

-- Results that do not differ statistically DO NOT DIFFER. Don't pretend they do by discussing them anyway. The purpose of science is to generate new knowledge, not to confirm your hypotheses.

-- Do NOT create "slides" that are actually the sentences from your abstract, pasted into PPT, which you then read.

Kudos to Dr. Van Nostrand

Back from APHA Annual Conference, we are delighted to note the honor afforded to Dr. Joan Van Nostrand of the Office of Rural Health Policy: A Lifetime Achievement Award from the Gerontological Health Section of the American Public Health Association. Beginning with her work at the National Center for Health Statistics (we won't say when), Dr. Van Nostrand has consistently expanded the nation's understanding of health status and the provision of health care among older adults. Since we all plan on being older one day, her work examining issues such as home health care and nursing homes will benefit all of us.

On Cancer, Health Reform, and Rural

According to the AP wire for September 19, Congresswoman Sue Wyrick, R-NC, recently spoke out in opposition to health care reform. She cited her own case, which she described as requiring “six doctors, three mammograms and one ultrasound” as taking “only a few weeks.” She asserted that in Canada and the UK, she might have had to wait “more than a month.” [1]

Leaving aside the question of whether there is a substantive difference between “a few weeks” and “more than a month,” and acknowledging the traumatic nature of breast cancer for any woman, the lawmaker could still use some education regarding health care in the US.

- All women do not have equal access to mammograms, and thus to the quick treatment received by Rep. Wyrick. Among age-appropriate women (over age 40), rural women are less likely to receive timely mammograms than their urban sisters (71% versus 78%). Among uninsured rural women, only 51% get screened. [2] That means barely above a coin flip that cancer will be detected among these women.

- For women who are not receiving routine screening and must wait till they detect a suspicious lump to seek out free screening for the uninsured, the clock starts a lot later than “more than a month.” This has real consequences: uninsured women are more than twice as likely to have advanced stage cancer when they first seek treatment (18% for uninsured versus 8% for privately insured women). [3] At that point, they likely would have traded "more than a month" waits to have had their cancer detected at Stage I.

The health care reform debate is not trivial for folks living “outside the Beltway.” We need lawmakers who are both passionate and informed about rural.

References:

[1] “GOP lawmaker warns of dangers in health overhaul” http://www.thestate.com/nationalpolitics/story/949479.html

[2] SCRHRC Health Disparities Chartbook, http://rhr.sph.sc.edu/index.php

[3] Halpern et al, Cancer July 15, 2007, p 395-402.

Reform and Rural

The SCRHRC was fortunate enough to be a participant at the ORHP Grantee Partnership meeting in DC last week. An overwhelming message on the part of participants: let the wonks sort out the details, but let's have a beginning to health care reform now. We can tweak later.

The LA Times published an interesting analysis of the health reform paradox: rural states (South and West) would be the biggest "winners" if health care reform makes care more accessible, but residents in these areas are most likely to oppose change of any kind [http://www.latimes.com/news/nationworld/nation/healthcare/la-na-uninsured-rural2-2009sep02,0,1307203.story]. If it is difficult to bring change in good times, it may be even more challenging to effect change in bad times.

Lest We Forget

Arriving in DC for the ORHP Grantee Partnerships Meeting, I was fortunate enough to encounter the events pictured. USAirways flies WWII vets to DC, free of charge, to visit the WWII memorial. An honor guard of vets from subsequent wars was present to escort their brothers and sisters to the memorial.

Planning the future of rural research

The National Center for Minority Health Disparities (NCMHD) and the Office of Rural Health Policy (ORHP) convened a terriric meeting in DC July 30 and 31, in which the SCRHRC participated. The overall purpose of the meeting, in the words of the pre-meeting materials, was to “provide NCMHD and ORHP with more insight into the best practices, research gaps, and innovation opportunities in addressing and eliminating rural health disparities.” About 30 rural health researchers and representatives of significant rural population groups met to work on defining research opportunities that NCMHD may wish to pursue to reduce disparities experienced by rural (not necessarily minority) populations.

This was a working meeting, not a listening meeting. Participants were divided into three groups, and each group spent the day brainstorming research recommendations for the three areas outlined: best practices, research gaps, and innovation opportunities. The task was harder than it sounds. First, “research gaps” kept sneaking into every discussion. As the rural community has been saying for years, we lack data and quality research on so many aspects of rural: disease burden, health behavior, health care systems operation, and outcomes. Second, it’s hard to keep “best practices” from sneaking into innovation. We know a good thing when we see it. At least, we think it’s a good thing; research is needed to confirm that a cool idea is a best practice. But it’s hard to sit around a table at a hotel in DC and predict the next new thing! Back in the day, I bought a Betamax (kids, ask your parents), so I definitely don’t set myself up as an innovation predictor.

By 5:00 Thursday afternoon, the participants were all drooping slightly from the effort of expending so much creativity. During the Friday summary presentations and discussion, it was clear that most of us agreed on some issues: need for rural data, workforce as a lasting issue, the need for partnerships. The list of topics in all areas was fairly deep and extensive. The proceedings should make a very interesting document.

Rural Faculty Network at AUPHA

   In Chicago last week, the Association of University Programs of Health Administration introduced its new “faculty networks,” scheduled to be implemented in the fall.  These networks will expand the previous loosely configured interest groups into ongoing networks dedicated to sharing resources and expanding teaching in their topic areas. Richard Vallone of Adams State College in Colorado (rvallone@adams.edu) is the current Chair of the Rural Faculty Network; Jan Probst of the SCRHRC is Chair-Elect. 

   Attendance at the first Rural Faculty Network meeting was a tad thin:  There were seven of us in the room.   Along with the Chair & Chair-elect, this included Armando Valdez of Adams State; David Cockley of James Madison University;  Gary Filerman of Georgetown University; Gerald Ledlow of Georgia Southern University; and Warren McDonald of Methodist University.  Discussion at the session was wide-ranging, from the interests of the Veterans Administration in rural workforce, to the need to establish what schools are currently doing to prepare students for the challenges of rural healthcare management.  A key point:  the line between viability and death is a lot thinner for rural hospitals and clinics, with slim margins and limited staff resources, than it is for their urban cousins.

   Got any ideas?  Send ‘em to any of the folks listed above.  We know that there must be lots of rural hospital administrators out there who can tell us “… if only I had known about [insert challenge here], I would have been better prepared.” We hope to develop a charter for our network, so that we can enlist other leaders, teachers and researchers who can help us pool, share, and grow.

SCRHRC in Chicago

 Like Miami, Chicago is a far piece from rural.  That didn't stop us from presenting several abstracts at AcademyHealth.  Along the way, we met up with Wendy from North Dakota, and visited "Taste of Chicago" to see what the big city folks eat.  It appears that they eat SC State Fair food.  Not a veggie in sight.




   

SCRHRC Party

At the beginning of summer in South Carolina, there is a brief, wonderful time when the weather's nice and warm and the outdoors hasn't yet become a steam room.  So Center faculty & staff partied at Jan's house. 

Jihong & Jessica

Medha and her lake-loving spouse
Robert & daughter

Jeff & Teddy

  

More baby news

Congrats to SCRHRC staffer Jeff Hatala & wife Annie on the birth of Kevin Baxter ("Bax") Hatala.

Vehicle safety

  While running this morning, I was passed by a pickup with 2 kids, estimated age less than 8 years, riding excitedly in the open back.  Context:  this is a 2-lane country road with a nominal speed limit of 45 mph, on which most folks do 55.  I was appalled and instantly wanted to call child protective services.

   Mind you, the person who wants to call child services distinctly remembers riding with the kids next door on trips to the farm cooperative to deliver eggs.  We rode after the egg cartons, which were stacked right behind the driver, on the open back of a flat-bed truck. On a 4-lane divided highway.

   Farm times change -- thankfully.

Baby shower!

It's hard to be a guy in a mostly-girl Center.  Center

folks threw a baby shower for 

fellow staffer Jeff Hatala, who is 

expecting his second child May 28 

(second c-section, so planned date).  

Note Jeff's expression on

entering the conference room. 

The presence of at least some other guys helped 

(James Hardin, at left in photo). But girl power was 

everywhere (Minnjuan Flournoy, Jeff, Jessica).

And while we're on the subject of babies, 

congrats to Graham Adams of the SC Office of 

Rural Health

on the birth of Lauren!

Rural Health in Miami?

   The SCRHRC was at the annual NRHA meeting in glamourous, non-rural Miami, among narcolords (presumably) and TV stars (confirmed sightings).   Lots of hard work, with presentations by several SC RHRC staffers  In the photos , Jessica presenting on part of her dissertation research, along with Kevin and Graham Adams (RUN chair) discussing some innovative EHR network activity in South Carolina.

   SCRHRC alumni were present, as well, including former Director and current Expert Work Group member Mike Samuels, and former staffer Andy Johnson.

   Not all was hard work, though.  Note Jessica illustrating the absolute hell that constitutes being a postdoc for Jan & Amy, while Dr. Martin experiments with buoyancy devices in one of the Fountainbleu pools.    

   

SCORH at Hilton Head

The SCRHRC sent Jessica & Jan to the annual meeting of the South Carolina Office of Rural Health. Jessica presented part of her dissertation work, looking into perceived racism and distrust of the healthcare system. Amy could not attend, but was represented by posters created by students in her rural health course.  

   As would be anticipated given the times, many of the s

essions (and most of the plena

ries) dealt with financial issues, such as stimulus money flows and the outlook for South Carolina Medicaid.  But there were lighter moments, including a barbeque dinner at Honey Horn plantation.  The photo at right shows a bottle tree, a tradition brought over from Africa.  The light shining through the bottles attracts evil spirits, who are then captured in the bottle.  The picture of gnarled trees draped with Spanish moss has no historical significance; it's just pretty.  Ditto the picture of Carolina coastal marsh at sunset.

Discussing Frontier

   The SCRHRC (Jan) was in Albuquerque on Friday, April 24, for the first in a series of three public discussions of how "frontier" should be defined.  In attendance were several impassioned advocates for frontier interests, with a smattering of academics (us).  Gary Hart, guru of RUCAs and other rural measures, chaired the meeting.

   The most interesting comment was offered by Denise Denton, former NRHA president.  She noted that many on the advocacy side of the discussion were arguing from the assumption that an inclusive definition of frontier was a good thing under all circumstances.  Denise offered a thought experiment:  would you want an inclusive definition if, for example, regulations were passed that required all Federal prisons to be located in frontier counties?

   Potential consensus on a definition structure, first voiced by Denise and more fully expressed by Tom Morris, ORHP administrator, seemed to focus on a "frontier and..." concept.  "Frontier" could be defined geographically.  Eligibility for USDA and ORHP programs, a concern of many present, could be addressed by the "and":  "...and high unemployment" for economic development, or "...and 75 miles from a hospital."  The "frontier and..." or even "rural and..." structure could allow for communities with particular problems to have those problems considered, without conflating geographic and programmatic considerations.

   All in all, a challenging task!  Gary & John Cromartie (USDA) will really be working hard over the next year.

 

Worrying about South Carolina wildfires

   There's something unnerving about arriving in a city halfway across the country (Albuquerque, in this case) and learning that something awful is happening back home.  Reportedly, a wildfire has by now destroyed 70 homes, damaged more, and affected a considerable swath of coastal Horry County.  The distress experienced by those families is significant, and there are other reasons for concern about fires.

   While Horry County may not technically be rural, it is an important employer for rural persons in South Carolina, who often commute long distances to work in the huge coastal tourist industry.   South Carolina's unemployment rate at its highest levels since the early 1980s and the economy leads experts to predict shortfalls in pleasure travel for the coming tourist season. Overall human costs could spread beyond those families unfortunate enough to have been in the direct path of the fire.

    There is also a "critter cost."  Not many people outside of South Carolina know about the "Carolina Bays," mentioned in the news feeds as a source of peat and other vegetation that kept the fire burning and make it difficult to extinguish.  The Bays are not offshoots of the ocean, but shallow depressions scattered across the landscape that form mini-wetlands; a rich and unique feature of the Carolina landscape.  [For more information, see http://www.dnr.sc.gov/managed/heritage/lewisbay/description.htmlor http://www.srel.edu/outreach/edpubs/carolinabays.html]  While the Bays evolved experiencing periodic fires, bulldozers creating firebreaks are not something the trees & critters are prepared for.  

Bringing Rural to Social Work

Jan and Saundra were guest speakers at the College of Social Work seminar on Friday, April 17.  Saundra's presentation focused on the many activities of the USC Institute for Partnerships to Eliminate Health Disparities, with particular attention to the community based participatory research projects surrounding HPB and HIV in the rural Orangeburg, SC community.  CBPR was catnip to an audience of social work faculty!  Jan focused on the recent work of the SCRHRC from Health Disparities: A Rural-Urban Chartbook.  Numbers are a harder sell for that particular discipline, unless their focus is very macro social work.  But there is a need for all of our gifts.  

Congrats to Saundra Glover

We're delighted to report that the SCRHRC's Associate Director, Dr. Saundra Glover, has been recognized by the Black Faculty and Student Association at the University of South Carolina.  At the April 15 awards luncheon, Dr. Glover received the Affirmative Action Award of the BFSA, for her role in promoting meaningful job opportunities for minority faculty, staff, and students.  In the photo:  Dr. Rodrick Moore, President of the BFSA; Dr. Glover; Dr. Harris Pastides, President of the University.  Go Saundra!

Thanks to our Researcher-User Network!

We had our first phone meeting of our Researcher-User Network group yesterday.  Many thanks to all participants! We are enormously grateful to this talented group of individuals who are willing to work with the SCRHRC to ensure that our research is a] helpful to rural practitioners, and b] reaches the persons who can benefit from our findings most effectively.  These folks are both generous and terrific:

     Graham Adams, PhD CEO of the South Carolina Office of Rural Health and past president of the National Organization of State Offices of Rural Health

     Patrick (Pat) Libbey, immediate past executive director of the National Association of County and City Health Officials  

     Roberta (Bobbi) Ryder, CEO of the National Center for Farmworker Health, Inc. 

     Robert Graham, MD, Professor at the Department of Family Medicine, University of Cincinnati 

     Maya Rockeymoore, PhD, Director of Program Leadership, Robert Wood Johnson Foundation.

     [Catherine Hess, Senior Program Director at the National Academy for State Health Policy, couldn't make the phone call, but we hope to meet her soon!]

Jan

Worrying about North Dakota

Here in South Carolina, most of the state remains in drought despite modest rain during the past two days.  But what worries us is our friends in North Dakota, who are living with the opposite problem.  Hoping that the sandbags hold.

Promoting rural health everywhere

Moving into new media:  Note T-shirts worn by SCRHRC faculty at the Downtown Columbia Triathlon, March 21.  We always promote rural.  The back of the shirt was even better, but a photo of two backs would look odd.

Reflections

     This story eventually gets to a research-related point and it does have a moral.  Will not be taking up a collection.

     Met one of the many charming & talented Arnold School of Public Health grad student women when exiting the Blatt PE Center last Thursday.  In the usual hi good to see you what are you doing here exchange, I noted that I was training for the upcoming Columbia triathlon.  Since disclaimers were clearly needed [I don't look the part], added that I took up the sport a few years ago, at age 57.  Further down the conversational line, as we were parting, the young woman said "I think it's so wonderful that you're still doing new things at your age."   At your age.  My internal response was not a pleasant one.  But I recognized the misguided sweetness and answered pleasantly, and we each wandered off home.

     As an early Baby Boomer, I'm just reaching the stage at which appearance trumps potential.  When I shopped for my current bike, salesmen automatically led me to the fat seat cruisers, not the racers.  I'm just an old woman.  But I've been able to spend most of my life being something else.  For persons of color, the experience of being categorized based on appearance begins a lot earlier.  That knot in the stomach translates into stress and stress related disorders.  My hope:  that as Baby Boomers age, more and more of them come to understand how it stings to be judged based on appearance and develop a broader empathy for others who encounter the same sting.  Promoting health disparities research will be a lot easier when a broad base of scientists have a visceral feel for the nature of discrimination.   --  JP

SCRHRC at the UNC Minority Health Conference

Kudos to USC grad (and former SCRHRC post-doc, current SCRHRC related faculty) Banky Olatosi, who represented the Center at the 30th Annual University of North Carolina Minority Health Conference, February 27, 2009.  Dr. Olatosi is currently faculty at Mount Olive College in Mount Olive, NC.  He participated in a panel discussion of Urban and Rural Health Programs.  

Cool Stuff at the SC Telemedicine Summit

   The SCRHRC, South Carolina AHEC, and the Medical University of South Carolina, with funding from the Duke Endowment, collaborated on "Telemedicine for South Carolina:  Addressing Healthcare Needs in Rural and Underserved Communities."  Full proceedings, including video, will be posted on the web.

   Coolest presentations, other than our own Amy Martin outlining the results of our statewide surveys of primary care and specialist docs:

   Ronald Weinstein, MD of Arizona on how that state created a telemedicine utility

   Herrmann Spetzler from the Open Door Community Health Network in Eureka, CA.  As a teacher of healthcare management, I particularly liked his focus on telemedicine as a business model, not a technology.  With telemedicine giving him the ability to draw patients from geographically diverse sites, Mr. Spetzler can afford to pay a flat fee for a specialist's time spent at one of the Network's clinics, knowing that all of that time will be filled.  

    The next hurdle: if we can just convince our educational accrediting bodies that if medicine can be handled in a virtual world, face-to-face video education can count as "contact time."

   

SCRHRC at the Office of Minority Health Leadership Summit

    We were represented at the Office of Minority Health Leadership Summit, held February 25-27, by Jan (Director) and two post-docs (Jessica and Crystal).  Jessica presented a poster reporting some of her dissertation work, dealing with the relationships between perceptions of racial discrimination and mistrust of the medical system and receipt of preventive health services.  Jessica & Crystal are shown at the luncheon on Thursday -- sorry that I didn't take more pictures, as that isn't Crystal's best look!  

     

Just out: Health Disparities: A Rural-Urban Chartbook

The South Carolina Rural Health Research Center at the Arnold School of Public Health, University of South Carolina, is pleased to announce the release of a new final report.  The Chartbook, "Health Disparities:  A Rural-Urban Chartbook," is authored by Drs. Kevin J. Bennett, Bankole Olatosi, and Janice Probst.  

The SC Rural Health Research Center is in the process of updating our website to allow for immediate downloading of major reports.  However, at this time the final report is still available through our website online report request system, at http://rhr.sph.sc.edu.  Questions pertaining to this report should be directed to Dr. Kevin Bennett at kevin.bennett@sc.edu.

New HRSA Director

President Obama today announced the new Director of the Human Services and Resources Administration (HRSA), Mary Wakefield. This is important (to us, at least) for a couple reasons:
1--She understands rural health, having worked as an advocate and researcher for rural health issues for many years (and prior to this appointment, served as the Director of the Center for Rural Health at the University of North Dakota)
2--HRSA is our major funder, so we will be working more closely with Mary and her staff in the coming years.

Congrats, Mary!

Welcome!

Welcome to the official blog of the South Carolina Rural Health Research Center. We will be posting here as a supplement to our website (http://rhr.sph.sc.edu/index.php), and try to keep you all abreast of what we are up to in a more accessible way. Feel free to drop us a line by email or by saying hello in the comments!