Wonderment Wednesday - 04/13/2016

A happy Wednesday to you! Since the last time we spoke, we are officially in Spring!

The birds and bees are in the air, the flowers are blooming, and there is new life in the air. Just because it's Spring, it doesn't mean rural health disparities have changed any much more. Which is why today's post is on..

3 Facts of Rural Health Disparities

1. Health disparities is not just based on rurality, but by race as well
For the most part, research has shown that there are disparities between rural America and urban America. However, when we dig deeper, it finds there are disparities among rural populations by race. In a study written by Kevin J. Bennett, PhD it looked at different rates of disease of rural black Americans compared to other racial groups. Rural black adults were found to be more at risk for obesity and diabetes.

2. Less access to care
Based on the same study, it found that rural blacks were less likely to have preventative visits for their diabetes. In addition, rural black residents were less likely to meet any CDC recommendations for physical activity.

3. Less access to care Part 2
Based on a recent finding by Amy Martin, DrPH, only backs up the results by Dr. Bennett. In her research, it looked at the location of free clinics, which serves to treat populations with lower income levels. The results showed that 22% of clinics were located in rural areas. The most astounding result from the study? 17 states had no free clinics in rural areas.

Final Thoughts
Today, we've highlighted the health disparities between rural and urban. Unfortunately, for rural populations these disparities are magnified because the lack of care. What you can do is to help give to organizations running free clinics and help write to your local congressmen or congresswomen about the need for funding in rural areas.

References


Bennett KJ, Olatosi B, Probst JC, Health Disparities: A Rural-Urban Chartbook, June 2008

Martin A, Bhavsar G, Workman L, Probst, JC, Free Clinics in the Rural Safety Net, September 2015

Wonderment Wednesday: Pregnancy Research

In one of the more interesting election cycles in recent memory, the results from the Iowa caucuses have come in. Based on multiple reports, these are the closest results that Iowa has ever head. 6 precincts decided by a coin toss! This only means that this election cycle is pregnant with possibilities. With just 9 months left, after a long and tenuous process, our nation will decide a new president.

But why all these analogies to pregnancy you ask? Obviously, it is a thinly veiled attempt to transition to our topic today:

4 Findings of Pregnancy Research

Rural pregnant women are more likely to gain weight than urban women
It is known that unhealthy prepregnancy weight and gaining weight during pregnancy has been shown to increase the risk of a poor pregnancy and birth outcomes. Therefore, Alexa Gallagher, PhD, looked into whether or not mothers in rural areas were more likely to be at an unhealthy weight at pregnancy. It found that rural women were more likely to be at an unhealthy weight than their urban counterparts. In addition, it found for rural women of normal weight, they had more trouble gaining appropriate amounts of weight during the pregnancy. However, obese and overweight rural women were less likely to have excessive weight gain during the pregnancy themselves.


Pregnant women receiving poor prenatal care are more likely to have excessive fetal growth
Nathan Hale, PhD had a study that looked into the variation for pregnancies that had excessive fetal growth. For the most part, the it found that women with gestational diabetes were more likely to have excessive fetal growth. However, when looking at closer among women with gestational diabetes, women who had inadequate prenatal care were more likely to have excessive fetal growth than women who had intermediate/adequate prenatal care.

Women delivering in rural hospitals are less likely to have delivery complications
In a study by Sarah Laditka, PhD it looked at whether the area of a hospital location had any effect on delivery complications. When looking at the data, it found that women on Medicaid who had a pregnancy in a rural hospital were actually less likely to have a delivery complication. Surprise!

However, the authors pointed out that this difference is most likely to due to women in rural areas driving to urban areas for their births.


African American women delivering in rural hospitals are more likely to have delivery complications
Unfortunately, when we look into the data deeper, we find that African American women are still at a disadvantage. African Americans women delivering in rural hospitals were more likely to have a delivery complication than their African American counterparts in urban hospitals. One of the factors that made this difference is because African American women were less likely to have access to care than their other women.

In the meantime, remember to give a nice tap on that subscribe button to the very bottom or top left hand side of this page to read more about the South Carolina Rural Health Research Center.
-Matt



References
Catalano PM. Increasing maternal obesity and weight gain during pregnancy: the obstetric problems of plenitude. Obstetrics and Gynecology 2007; 110(4):743-744

Gallagher A, Liu J, Probst JC, Martin AB, Hall JW. Maternal obesity and gestational weight gain in rural versus urban dwelling women in South Carolina. J Rural Health. 2013 Winter;29(1):1-11

Hale N, Probst JC, Martin AB, Bennett K, Liu J, Glover S. Variation in Excessive Fetal Growth Across Levels of Prenatal Care among Women with Gestational Diabetes. Journal of Primary Care and Community Health. Accepted for publication April 19, 2011.\


Laditka SB, Laditka JN, Bennett KJ, Probst JC. Delivery complications associated with prenatal care access for Medicaid-insured mothers in rural and urban hospitals. J Rural Health. 2005 Spring; 21(2):158-66.

Wonderment Wednesday: Get Covered by January 31st, Or Else....

Happy Wonderment Wednesday!
We don't know if you heard, but the last day to sign up for health insurance is Sunday on January 31st. This means that if you are uninsured by that day, be prepared to pay a penalty to the IRS.


Now some of you may be asking, why do I need insurance? I'm glad you asked because here are

4 Facts of Being Uninsured
1. Having continuous insurance is better for you physically
In a paper written by Janice C. Probst, PhD it looked at the effect of continuous insurance coverage on physical health at age 40. What the study itself did, was look at the insurance coverage of an adult for the 10 years prior to age 40. The paper looked at whether on not the person had been continuously insured  for a decade had any effect on both physical health. The results showed that people with continuous coverage had higher physical scores than those who didn't.

2. Having continuous insurance is better for you physically
In the same paper written by Janice C. Probst, PhD it also looked at the effect of continuous insurance coverage at age 40. Similar to the results of physical health, people who had continuous insurance coverage 10 years prior had better mental health scores than those who didn't.

2. Dental insurance is important for adolescents 
In a study written by Jihong Liu, PhD, it looked at the rate of dental insurance among U.S. children. According to the study, a total of 22.1% of U.S. children's parents reported not having dental coverage in 2006. Another 26.9% reported not having routine preventive dental visits. Looking deeper into the information, the children who lacked dental insurance were less likely to have preventative care and more likely to have an unmet dental need.


4. Rural residents have similar rates of uninsured as urban areas
Because we are the South Carolina Rural Health Research Center, and no post cannot go without mentioning people living in rural areas, let us talk about insurance in rural areas. In this post by the Kaiser Family Foundation, it shows that rural residents have similar rates of insurance as their urban counterparts. However, this comes with a caveat: rural residents are more likely to have public insurance than urban residents. 



In the meantime, remember to give a nice tap on that subscribe button to the very bottom or top left hand side of this page to read more about the South Carolina Rural Health Research Center.We will be taking the next few weeks off, so until next time, take care!

-Matt


References
Probst JC, Moore CG, Powell MP, Martin AB. Continuity of Health Insurance Coverage and Perceived Health at Age 40. Med Care Res Review. Med Care Res Rev. 2008 Aug;65(4):450-77. Epub 2008 May 19.

Probst JC, Moore CG, Baxley EG. Update: Health insurance and utilization of care among rural adolescents. Journal of Rural Health, Fall 2005, pp. 279-287.

Newkirk V, Damico A. The Affordable Care Act and Insurance Coverage in Rural Areas. The Henry J. Kaiser Family Foundation, n.d., retrieved from": http://kff.org/uninsured/issue-brief/the-affordable-care-act-and-insurance-coverage-in-rural-areas/

Liu J, Probst JC, Martin AB, Wang JY, Salinas CF. (2007). Disparities in dental insurance coverage and dental care among US children: the National Survey of Children's Health. Pediatrics. 2007 Feb;119 Suppl 1:S12-21.

Wonderment Wednesday: Cold Fronts

Good Wonderment Wednesday Everyone!
Do you feel that shaking? That's us at the South Carolina Rural Health Research Center shivering over our computers in what is reported the worst cold front  of the year. Fortunately if it get's cold enough, as KARE 11 has reported, this gives us all the opportunity to play the standing jean prank.
Too bad it isn't actually cold enough in South Carolina to partake in this Minneapolis tradition. However, today's Wonderment Wednesday topic has our jeans standing up in anger over....

5 Facts About Rural Disparities 

1. There Are Disparities in Education
In a study written by Janice C. Probst, PhD looked at different health disparities in terms of education, health insurance, and access to care. One of the interesting results from the study written by Janice C. Probst, PhD was the fact that minorities in rural areas had lower education levels. Interestingly, it goes into the educational disadvantages among rural African Americans. Essentially, it found that African Americans that moved from rural to urban areas are more highly educated. This meant that the population that is left over in the rural areas are less educated than their counterparts. This is important because education has direct effects on health and income level as well. Both of which in turn effects health access.

2. Rural Minorities Are Less Likely To Have Health Insurance
In the same study by Janice C. Probst, PhD it looked at the rates of insurance among rural residents. It found that African Americans (31.9%) and Hispanics (44.9%) had higher uninsurance rates than Whites (17.8%). In a study written by Saundra Glover, PhD it went deeper into the data that looked at rural minority adults and their ability to access care. When the analysis included other resource related factors such as education, income and employment, it found that these differences were insignificant. This means that minorities in rural areas suffer from a lack of resources.However, uninsurance is just one barometer of access. 

3. Rural Minorities Also Were Less Likely To Use Health Care Services
Going back to the study by Janice C. Probst, PhD it also looked at whether there were any differences in going to see a health care professional as well. It found that Hispanics (37%) and African Americans (27%) vs 20% of Whites had not seen a health care professional in the past year. Once again, in Sandra Glover, PhD looked at the results when resources were taken into account. Dr. Glover found that the difference between African Americans and Whites was gone. However, Hispanics were still less likely to receive healthcare services.


4. Minorities Need To Drive More For Their Healthcare
In another study by Janice C. Probst, PhD it looked at the amount of distance needed to drive for care by minorities compared to whites. White and African Americans did not differ much in terms of travel distance. However, African Americans, on average, spent more time traveling than whites (29.1 vs. 20.6 minutes).

5. Rural Minorities Are More At Risk For Death
With so many factors working against rural minorities it comes with little surprise that rural minorities are more at risk for death. In another study written by Janice C. Probst, it looked at whether or not health outcomes were effected among rural minority populations. In the study, it found that rural African Americans and rural Hispanics were more at risk of early death compared to Whites. Like before, when resources are accounted for in the analysis, the disparities between the groups were eliminated.


In the meantime, remember to give a nice tap on that subscribe button to the very bottom or top left hand side of this page to read more about the South Carolina Rural Health Research Center.We will be taking the next few weeks off, so until next time, take care!

-Matt

References:

Probst JC, Moore CG, Glover SH, Samuels ME (2004). Person and place: the compounding effects of race/ethnicity and rurality on health. American Journal of Public Health 94(10): 1695-703.

Glover S, Moore CG, Probst JC, Samuels ME (2004). Disparities in access to care among rural minority adults. J Rural Health, 20(3):193-205.

Probst JC, Bellinger JD, Walsemann KM, Hardin J, Glover SH. Higher risk of death in rural blacks and whites than urbanites is related to lower incomes, education, and health coverage. Health Aff (Millwood).2011 Oct;30(10):1872-9

Probst JC, Laditka SB, Wang J-Y, Johnson AO. Effects of Residence and Race on Burden of Travel for Care: Cross Sectional Analysis of the 2001 US National Household Travel Survey. BMC Health Serv Res. 2007 Mar 9;7:40.

Wonderment Wednesday: Hitting it BIG

Happy Wednesday everyone! Unless you have not been reading the news, you might have heard that the lottery has now grown to $1.3 Billion. I don't know about you, but I have sold all belongings, including my entire collectible marble set. I'm going to use all that money, including my life savings, just for just an infinitesimal chance at winning the Powerball.

What do I plan to do with the winnings? Buy an alpaca farm of course. The internet on the other hand is convinced that with the winnings alone could solve U.S. poverty (hint: do the math and it doesn't). While it may not be true, it does allow us to segue into today's Wonderment Wednesday topic on

5 Facts About Rural Poverty

1. The More Rural A County Is, The More Likely The Residence Live in Poverty
In a report written by Charity Moore, PhD, it ventured into the concept of whether or not rurality had an effect on poverty. What the study found was as rurality increase, the likelihood of poverty increased as well.

2. A Disproportionate Amount Of Minorities Live In Poverty
In the same report as before, it also looked at how rurality effected minority children. Unfortunately, rural minority children were much more likely to be in poverty than White rural children.

3. Rural Poverty Has High Rates Of Obesity
A study written by Kevin J. Bennett, PhD looked at the relationship of obesity among resident in rural counties. What made this study significant was that it broke up rurality by Urban, Rural, and Rural Persistent Poverty counties. By breaking the analysis like so, we find that residents in Rural Persistent Poverty counties had higher rates of obesity than Rural and Urban counties.

4. People In Poverty Are Much More Likely To Have Tooth Loss 
In a study Jordan Mitchell, PhD, it looked at whether poverty in rural area had an effect on tooth loss. During the course of the study, it found that people that lived in poverty were much more likely to have tooth loss. Most importantly, the study highlighted that socioeconomic-level factors played a significant role in the likeliness of tooth loss.

5. Parental Stress Are Effected By Poverty
The report that looked into poverty by Charity Moore, PhD also looked into how poverty effected parental stress levels of parents. In general, populations were much more likely to have parental stress the lower the income. However, looking deeper into the information, minority populations were found to have higher stress levels than Whites when it came to parental stress.

In the meantime, remember to give a nice tap on that subscribe button to the very bottom or top left hand side of this page to read more about the South Carolina Rural Health Research Center.We will be taking the next few weeks off, so until next time, take care!

-Matt

Note: SCRHRC does not condone the Powerball or gambling of any sort.

References
Moore C, Probst JC, Tompkin M, Cuffe S, Brock- Martin A. Depression in Rural Populations: Prevalence, Effects on Life Quality, and Treatment-Seeking Behavior. May 2005
Mitchell J, Bennett K, Brock-Martin A. Edentulism in high poverty rural counties. J Rural Health. 2013 Winter:29(1):30-8.   
Bennett KJ, Probst JC, Pumkam C. (2011). Obesity among working age adults: The role of county-level persistent poverty in rural disparities. Health Place. Jun 10.              

Wonderment Wednesday - New Year's Resolutions

HAPPY NEW YEAR'S EVERYONE! Here is to spending the next month remembering to write 20156 correctly and following through on your new's years resolution. Our New Year's resolution? To stop bringing down anyone who read these Wonderment Wednesday posts, especially when it comes to highlighting research. Like this piece by Forbes which reports only 8% of people follow through on their New Year's goal.

Oh. Well, there is always next year. Even though we didn't quite follow through our New Year's resolution, here are some tips to keep yours. It also shouldn't take away from the fact how good New Year's resolutions are. They help encourage healthy activities by people, like our topic today on

4 Facts About Rural Preventive Health Services

1. Rural Residents Are Less Likely To Receive Preventive Health Services
Kevin Bennett looked at rural urban differences for people with the flu vaccine. The results found that people who lived in rural areas were less likely to receive flu vaccines than people in urban areas.However, this isn't just limited to flu vaccines.

In another study also written by Kevin Bennett, PhD  looked into whether rural or urban populations were more likely receive cancer screening services. Rural residents were less likely to receive cancer screenings than urban residents .

2. Healthcare Provider Location Matters
In the same in the same flu vaccine study, it gave us a better understanding of why rural residents have less access to healthcare. Looking closer, rural residents were much more dependent on their clinical providers for their flu vaccines.

In a study written by Jessica Bellinger, PhD, it looked at the role family history when it came to cervical cancer screening. However, what they came to determine was younger populations were more likely to receive cervical cancer screenings. The author suggested that younger populations were more likely to receive cervical cancer screenings because younger women see provider more often. They study suggested that more targeted programs for older women should be implemented, but do these programs work?

3. Targeted Programs For Preventative Health Services Work
Remember the cancer screening study written by Kevin Bennett, PhD?  It found that African American women were more likely to receive preventative health services regardless of rurality. This suggest that this is proof that targeted programs encouraging African American women to receive preventative services work!

4. There Is Still Racial Differences In Preventative Health Services Access.
Unfortunately, there still is racial differences in preventative health access. In another study by Kevin Bennett, PhD, it looked at another area of preventative healthcare which is flu vaccines. It found that white rural residents were more likely to be vaccinated than urban areas than their urban counterparts, On the other hand, rural African Americans were less likely to be vaccinated than their urban counterparts.



In the meantime, remember to give a nice tap on that subscribe button to the very bottom or top left hand side of this page to read more about the South Carolina Rural Health Research Center.We will be taking the next few weeks off, so until next time, take care!

-Matt




References
Bellinger JD, Brandt HM, Hardin J, Bynum S, Sharpe P, Jackson D. (2013). The role of family history of cancer on cervical cancer screening behavior in a population-based survey of women in the southeastern United States. Women Health Iss, 23(4):e197-204.

Bennett KJ, Bellinger JD, Probst JC. (2011). Receipt of cancer screening services: Surprising results from some rural minorities. J Rural Health. Epub 11 Mar 2011.

Bennett KJ, Pumkam C, Probst JC. (2011). Rural-urban differences in the location of influenza vaccine administration. Vaccine. 29(35):5970-7. Epub 2011 Jun 25.

Bennett KJ, Bellinger JD, Probst JC. (2010) Receipt of influenza and pneumonia vaccinations: the dual disparity of rural minorities. J Am Geriatr Soc. 58(10):1896-902.

Wonderment Wednesday: The South Carolina Rural Health Research Center Is Going STAR WARS

We don't know about you, but we here at the South Carolina Rural Health Research Center IS PUMPED for this Thursday. After sitting on the edge of our seats for the past year, Star Wars: The Force Awakens finally opens in theaters. We're not pumped because of all the lightsaber fights we have been recreating at the South Carolina Rural Health Research Center.

Rather, it means we can finally stop hearing everyone and their parents talk about Star Wars and how much nostalgia the trailers bring them. Before we change our profile pictures to have lightsabers, listen to the Notorious B.I.G. Star Wars mix, and fully engross ourselves in the Star Wars hype, let me pose this important question:

Will a galaxy far far away that has all this futuristic equipment include health information technology (IT)? Would it even have something called Wonderment Wednesday that talks about.......

4 Facts On Health IT
1. Health IT makes a difference
In a study that was published by Chaudry and friends, it looked at different studies that looked at the impact of health IT. In short, the study found that health IT did indeed help improve quality and efficiency of care.

2. Health IT isn't some fancy operation
Many times when people think of health IT, they think of large expensive operations requiring futuristic new machines and special suits to operate.

No,

However, that isn't always the case. In this paper written by Dr. Kevin J. Bennett, it looked at the effects of just improving the paperwork associated with health IT work. Essentially, the paperwork was customized to the needs of the academic center. The result? A 5% increase in completed charts.

3. Rural residents are less likely to have internet
Since we are the South Carolina Rural Health Research Center, we couldn't get too far without talking about rural at least once. One problem facing rural residents is the distance they need to drive, which is why the internet is important. In this study, written by Dr. Jong-Yi Wang, it found that people living in rural areas were less likely to have internet than people in urban areas. Most importantly, minorities and people with medical conditions were less likely to use the internet.

4. Rural health providers need a lot of help
This is not just a patient level problem when it comes to health information technology, it is also an organization problem. In a study published Dr. Amy Martin, it looked at the differences between rural hospitals and rural primary care providers in South Carolina on: a. telemedicine adoption, b. telemedicine training needs c. current use of technology for patient care, In all three metrics, rural hospitals were more likely to fare better than their rural primary care providers. Unfortunately, this highlights the overwhelming need in rural areas for a stronger primary care workforce.


In the meantime, remember to give a nice tap on that subscribe button to the very bottom or top left hand side of this page to read more about the South Carolina Rural Health Research Center.We will be taking the next few weeks off, so until next time, take care!

-Matt