Medicine and Health Sciences Commons^™

A Rural/Urban Comparison Of Privacy And Confidentiality Concerns Associated With Providing Sensitive Location Information In Epidemiologic Research Involving Persons Who Use Drugs, Abby E. Rudolph, April M. Young, Jennifer R. Havens

Epidemiology and Environmental Health Faculty Publications

Background—Analyses that link contextual factors with individual-level data can improve our understanding of the "risk environment"; however, the accuracy of information provided by participants about locations where illegal/stigmatized behaviors occur may be influenced by privacy/confidentiality concerns that may vary by setting and/or data collection approach.

Methods—We recruited thirty-five persons who use drugs from a rural Appalachian town and a Mid-Atlantic city to participate in in-depth interviews. Through thematic analyses, we identified and compared privacy/confidentiality concerns associated with two survey methods that (1) collect self-reported addresses/cross-streets and (2) use an interactive web-based map to find/confirm locations in rural and …

Comparing Urban And Rural Vulnerability To Heat-Related Mortality: A Systematic Review And Meta-Analysis, Ying Li, Emmanuel A. Odamne, Ken Silver, Shimin Zheng

ETSU Faculty Works

Studies of the adverse impacts of high temperature on human health have primarily focused on urban areas, due in part to urban centers generally having higher population density and often being warmer than surrounding rural areas (the “urban heat island” effect). As a result, urban areas are often considered to be more vulnerable to summer heat. However, heat vulnerability may not only be determined by heat exposure, but also by other population characteristics such as age, education, income, baseline health status, and social isolation. These factors are likely to increase vulnerability among rural populations compared to urban populations. In this …

Marketing Strategies To Encourage Rural Residents Of High-Obesity Counties To Buy Fruits And Vegetables In Grocery Stores, Emily Liu, Tammy Stephenson, Jessica Houlihan, Alison Gustafson

Dietetics and Human Nutrition Faculty Publications

Introduction

Obesity rates in Appalachia are among the highest in the United States, and knowledge of upstream approaches to decrease prevalence among this vulnerable population is limited. The primary aim of this study was to examine the association between healthy, diet-based, social marketing interventions in grocery stores and frequency of fruit and vegetable intake.

Methods

A social marketing campaign was conducted among 17 grocery stores (N = 240 participant surveys) over 4 months in 5 rural Kentucky counties. Interventions included providing food samples, recipe cards, and promotional discounts on fruits and vegetables and moving high-calorie foods to side aisles.

Results …

Community Paramedicine Pilot Programs: Lessons From Maine, Karen B. Pearson Mlis, Ma, George Shaler Mph

Emergency Medical Services (EMS)

Community paramedicine programs are beginning to flourish across the nation, and the need to provide demonstration or pilot programs is essential to providing a consistent and high-level standard for this model of care. While the overarching goals are to align with the Triple Aim, piloting a community paramedicine program also allows each community to develop and implement a program tailored to the healthcare needs of their specific community. A successful program builds the evidence base that can then be used to create legislative change necessary to financially sustain this model of care across the healthcare delivery system. This article provides …

Healthcare Contact And Treatment Uptake Following Hepatitis C Virus Screening And Counseling Among Rural Appalachian People Who Use Drugs, Dustin B. Stephens, April M. Young, Jennifer R. Havens

Behavioral Science Faculty Publications

Background—Hepatitis C virus (HCV) remains a major contributor to morbidity and mortality worldwide. Since 2009, Kentucky has led the United States in cases of acute HCV, driven largely by injection drug use in rural areas. Improved treatment regimens hold promise of mitigating the impact and transmission of HCV, but numerous barriers obstruct people who inject drugs (PWID) from receiving care, particularly in medically underserved settings.

Methods—503 rural people who use drugs were recruited using respondent-driven sampling and received HCV screening and post-test counseling. Presence of HCV antibodies was assessed using enzyme immunoassay of dried blood samples. Sociodemographic and …

Self-Collected Vaginal Swabs For Hpv Screening: An Exploratory Study Of Rural Black Mississippi Women, Richard A. Crosby, Michael E. Hagensee, Rebecca Fisher, Lindsay R. Stradtman, Tom Collins

Health, Behavior & Society Faculty Publications

Objectives. To determine the post-procedure acceptability of self-collecting a vaginal swab for HPV testing among a highly impoverished and geographically isolated population of medically underserved Black women residing in the Mississippi Delta. Further, to test correlates of reporting that self-collection is preferred over Pap testing. Finally, to determine the prevalence of any of 13 high-risk HPV types among this population and the correlates of testing positive.

Methods. Eighty-eight women were recruited from two churches located in different towns of the Mississippi Delta. After completing a survey, women were provided instructions for self-collecting a cervico-vaginal swab and completing a post-collection survey. …

Providing Patient-Centered Enhanced Discharge Planning And Rural Transition Support: Verifying Discharge Orders During Rural Transitions, Tom Seekins

Health and Wellness

Patients typically leave a hospital with numerous tasks that need to be performed in order to complete their treatment successfully. The discharge process is designed, in part, to describe the services a patient needs to secure or the tasks they need to perform in order to complete treatment and promote recovery once he or she gets home. Many of the orders or services planned should be implemented immediately or soon after discharge to be useful. Some involve additional medical treatment. Others may involve starting long-term services that address chronic conditions.

In this delicate transition, hospital staff may not convey the …

Providing Patient-Centered Enhanced Discharge Planning And Rural Transition Support: Developing A Local Health And Human Services Resource Bank For Rural Communities, Tom Seekins

Health and Wellness

Patients may have a wide range of needs when they are discharged from a regional hospital back home to a small town or rural community. Discharge planners and other staff at the regional referral hospital are seldom aware of the range of services and resources that a patient could use to facilitate their recovery close to home. Indeed, in our research, regional providers acknowledged that they lacked information about the many small towns they served in their catchment area. Patients, regional referral hospital staff, and small town providers all reported that this frequently led regional providers to refer patients to …

Providing Patient-Centered Enhanced Discharge Planning And Rural Transition Support: Conducting A Rural Transition Needs Assessment, Tom Seekins

Health and Wellness

Researchers have suggested that readmissions following hospital discharge might be reduced by providing additional resources to patients most likely to be re-hospitalized. They have suggested three broad approaches to assessing the likelihood of readmission and prioritizing patients for extra support. These approaches include: (1) medical risk, (2) personal capacity, and (3) environmental. While work on assessing medical risk and personal capacity has been reported, few researchers have explored the role of environmental factors.

We used the third approach, an environmental perspective, to develop and test a Rural Transition Needs Assessment. This process involved patients in assessing their practical needs for …

Anthropometric Indices For Non-Pregnant Women Of Childbearing Age Differ Widely Among Four Low-Middle Income Populations., K. Michael Hambidge, Nancy F. Krebs, Ana Garcés, Jamie E. Westcott, Lester Figueroa, Shivaprasad S. Goudar, Sangappa Dhaded, Omrana Pasha, Sumera Aziz Ali, Antoinette Tshefu, Adrien Lokangaka, Vanessa R. Thorsten, Abhik Das, Kristen Stolka, Elizabeth M. Mcclure, Rebecca L. Lander, Carl L. Bose, Richard J. Derman, Robert L. Goldenberg, Melissa Bauserman

Global Health Articles

BACKGROUND: Maternal stature and body mass indices (BMI) of non-pregnant women (NPW) of child bearing age are relevant to maternal and offspring health. The objective was to compare anthropometric indices of NPW in four rural communities in low- to low-middle income countries (LMIC).

METHODS: Anthropometry and maternal characteristics/household wealth questionnaires were obtained for NPW enrolled in the Women First Preconception Maternal Nutrition Trial. Body mass index (BMI, kg/m(2)) was calculated. Z-scores were determined using WHO reference data.

RESULTS: A total of 7268 NPW participated in Equateur, DRC (n = 1741); Chimaltenango, Guatemala (n = 1695); North Karnataka, India (n = …

A Preliminary Examination Of Elevated Blood Lead Levels In A Rural Georgia County, R. Christopher Rustin, Yu Sun, Chris Calhoun, Christy Kuriatnyk

Journal of the Georgia Public Health Association

Background: Children in Flint, Michigan were exposed to lead at unsafe levels in drinking water bringing renewed interest and national attention to an old public health problem. In Georgia, thousands of children are exposed annually to lead at unsafe levels primarily from paint in homes built before 1978. With lead poisoning typically viewed as an urban problem, rural areas are often considered lower-risk in light of similar lead poisoning risk factors, albeit on a smaller scale. The purpose of this preliminary study was to examine the prevalence of elevated blood lead levels in childrenCounty, Georgia, a county designated as lower …

Reducing Sexual Risk Behaviors And Intentions Among Rural African American Youth, Natasha De Veauuse Brown

Journal of the Georgia Public Health Association

Background: In spite of dramatic declines in teen pregnancy and childbearing in every state and amongst all racial groups, progress to-date remains unbalanced and disparities persist. Blacks, Hispanics, and youth residing in southern states or rural areas continue to experience the highest teen pregnancy rates in the nation. In an effort to enhance protective factors that help youth avoid behaviors placing them at risk for pregnancy, between September 2011 and May 2013, a public school district in rural southeast U.S. implemented an evidence-based youth development program designed to address these issues.

Methods: A single-group, repeated measures design was employed to …

Community Health News, Georgia Southern University

Community Health Department News (2011-2018)

• Georgia Southern Examines Increasing Breastfeeding Duration and Exclusivity in Rural Women

After Closure: Options For Pursuing A High Performance Rural Health System, Andrew F. Coburn Phd

Rural Hospitals (Flex Program)

Presented at the 2017 National Rural Health Association Annual Meeting. Coburn, a member of the Rural Policy Research Institute Panel, discussed the following key questions: What kind of rural health system is possible in places that cannot support a full-service hospital? How does a rural community navigate the transition from hospital-centric care toward new models that deliver high performance? What implementation support will be needed? Coburn noted that there is no single model for re-configuring the rural health system after hospital closure; local assets, affiliations and partnerships, financial and delivery flexibility and capacities must be critically assessed to determine the …

The Role Of Public Versus Private Health Insurance In Ensuring Health Care Access & Affordability For Low-Income Rural Children, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Amanda Burgess Mppm

Access / Insurance

Medicaid and the Children’s Health Insurance Program (CHIP) have played a critical role in ensuring access to health insurance coverage among children and have been particularly important sources of coverage for rural children. More than 35.5 million children were enrolled in Medicaid or CHIP in September 2016—accounting for just over half of total Medicaid and CHIP enrollment. Given the large proportion of rural children covered by public insurance, it is critically important to understand the role of that coverage in ensuring access to affordable healthcare for rural children. Using data from the 2011-2012 National Survey of Children’s Health, this study …

Social Support For Physical Activity For High Schoolers In Rural Appalachia, Pooja M. Shah

Undergraduate Honors Theses

The purpose of the present study is to conduct a secondary qualitative analysis to examine parent, teacher, and high school adolescents’ perceptions of social support for physical activity (PA) for high schoolers in Southern Appalachia. Social support for PA is linked to higher rates of PA participation in adolescents. Parents, siblings, and peers provide key sources of support. Social support for PA may be even more important in under-resourced communities such as Appalachia, where geographic, economic, and environmental barriers negatively impact PA engagement. During 2013-2014, focus groups and semi-structured interviews were conducted with parents of adolescents (n=39), high school teachers …

Rural Opioid Prevention And Treatment Strategies: The Experience In Four States [Working Paper], John A. Gale Ms, Anush Hansen Ms,Ma, Martha Elbaum Williamson Mpa

Mental Health / Substance Use Disorders

Although opioid use rates are comparable in rural and urban counties, rural opioid users tend to be younger, unmarried, have lower incomes, and are more likely to lack health insurance, all vulnerabilities that may negatively impact their ability to seek treatment and recover. Additionally, the rural health care system is characterized by numerous resource, workforce, access, and geographic challenges that complicate the delivery of specialized care for OUDs in rural communities. The nature and scope of the opioid crisis vary across rural communities and require multifaceted, community-based strategies to address the problem. Based on interviews with key stakeholders in Indiana, …

Rural Opioid Prevention And Treatment Strategies: The Experience In Four States [Policy Brief], John A. Gale Ms, Anush Yousefian Hansen Ms,Ma, Martha Elbaum Williamson Mpa

Mental Health / Substance Use Disorders

Little is known about what states with large rural populations are doing to combat opioid use disorders (OUD) in rural communities. This qualitative study identified rural challenges to the provision of OUD prevention, treatment, and recovery services and explored promising strategies to tackle the opioid crisis in rural communities.

Community To Clinic Navigation To Improve Diabetes Outcomes, Nancy E. Schoenberg, Gabriele Ciciurkaite, Mary Kate Greenwood

Behavioral Science Faculty Publications

Rural residents experience rates of Type 2 Diabetes Mellitus (T2DM) that are considerably higher than their urban or suburban counterparts. Two primary modifiable factors, self-management and formal clinical management, have potential to greatly improve diabetes outcomes. “Community to Clinic Navigation to Improve Diabetes Outcomes,” is the first known randomized clinical trial pilot study to test a hybrid model of diabetes self-management education plus clinical navigation among rural residents with T2DM. Forty-one adults with T2DM were recruited from two federally qualified health centers in rural Appalachia from November 2014–January 2015. Community health workers provided navigation, including helping participants understand and implement …

Acceptability Of Hiv Testing Sites Among Rural And Urban African Americans Who Use Cocaine, D. Keith Branham, Tyrone F. Borders, Katharine E. Stewart, Geoffrey M. Curran, Brenda M. Booth

Health Management and Policy Faculty Publications

African Americans (AAs) who use cocaine in the Southern region of the U.S. have a relatively high risk of HIV and need for HIV testing. Among this group, those residing in rural areas may have less favorable opinions about common HIV testing sites, which could inhibit HIV testing. We examined rural/urban variations in their acceptability of multiple HIV testing sites (private physician clinic, local health department, community health center, community HIV fair, hospital emergency department, blood plasma donation center, drug abuse treatment facility, and mobile van or community outreach worker). Results from partial proportional odds and logistic regression analyses indicate …

A Chart Review Of Acute Care Inter-Hospital Transfers From Rural Wv Hospitals, Dilip Nair, Freddie Vaughan, Katherine Bennett

Marshall Journal of Medicine

Abstract

Objective: To document the characteristics of acute care patient transfers from rural West Virginia hospitals.

Data Sources/Study Setting: Hospital patient charts in rural West Virginia hospitals

Design: We examined 40 acute care patient transfers from rural West Virginia hospitals for patients’ age, gender, race and primary health insurance, the diagnosis and desired specialty service. We compared patients who were not transferred. For each transfer we collected data on the reason for transfer, the availability of beds of the appropriate acuity level as well as the availability of the relevant specialty at the time of transfer.

Principal Findings: Transferred patients …

Environmental Health News, Georgia Southern University

Environmental Health News (2012-2018)

• Georgia Southern Partners to Assess Risk Factors for Public Swimming Pools
• Georgia Southern Conducts a Preliminary Examination of Blood Lead Levels in Rural Georgia

Using A Social Ecological Model To Explore Upstream And Downstream Solutions To Rural Food Access For The Elderly, Lauri Andress

Faculty & Staff Scholarship

A social ecological model is applied to the secondary analysis of qualitative data to study the impact of place on rural food access for older adults in West Virginia. The use of a social-ecological model to review the senior’s coded narratives provided a clearer picture of higher impact, upstream levers to address food security for older adults in a rural region. The elderly have restricted access to food in rural West Virginia because of an indirect relationship with place that acts through the social ecological domains of the built environment, macrosocial factors, stressors, the natural environment, and social support. The …

Food Insecurity And Fruit And Vegetable Consumption Among Regional And Remote Western Australian Children: Determinants, Prevalence And Predictors, Stephanie Louise Godrich

Theses: Doctorates and Masters

Living in a community with adequate availability of nutritious food, and the capacity to access and utilise it, are key food security determinants (FSD). However, inequities relating to these determinants exist between regional and remote Western Australian (WA) communities, particularly regarding fruit and vegetables (F&V). This negatively impacts vulnerable populations, especially children. In order to understand determinants, prevalence and predictors of F&V and food security (FS), three concepts were explored in this PhD; (1) F&V consumption among regional and remote WA children (including determinants of F&V consumption, quantities, types, varieties of F&V consumed); (2) FS among regional and remote WA …

Health Literacy, Availability, And The Need For Educational Resources On Infertility, Amber Louise Dessellier

Walden Dissertations and Doctoral Studies

There is a gap in infertility research regarding resource availability within rural communities, yet existing research declares infertility a public health concern. This qualitative study was grounded in the Heggerian phenomenological framework by way of assessing participants' perceptions of and experiences with infertility resources in a rural community. The purpose was to analyze the meaning of those experiences within their world. To accomplish this, Antonovsky's salutogenic theory was applied to investigate the strengths and weaknesses of infertility resources including the availability of resources, participant understanding of, and participants' experiences. Purposive sampling was used and in-depth interviews were conducted with 12 …

Examining Preference Of Home-Based Telemental Health Among Rural Veterans, Paige Dixon

Electronic Theses and Dissertations

Rural veterans face significant disparities to health care that have resulted in lower physical and mental health related quality of life when compared to their urban counterparts (Weeks et al., 2006). Such disparities are further complicated by the six-fold increase in prevalence of mental health diagnoses among Operation Enduring Freedom and Operation Iraqi Freedom veterans (Seal et al., 2009). These rising rates are particularly relevant to rural veterans as they represent 41% of the overall Veteran Health Administration enrollees, but only 19% of the general population (U.S., Department of Veterans Affairs, 2012; U.S. Census Bureau, 2014). Rural veterans face three …

Rural Haitian Women's Experiences With Poor Health Through Poverty, Geralda Felix

Walden Dissertations and Doctoral Studies

People living in rural Haiti lack access to basic health care services due to poverty. Rural poverty in Haiti particularly affects women's health because Haiti has had the highest maternal mortality and infant mortality rates in the Americas, in addition to some of the worst health statistics in the Western Hemisphere. The purpose of this phenomenological study was to cultivate a greater understanding of the poverty factors that affect access to health care services specifically among poor women living in rural Haiti. This study was based on the social ecological model for population health development, theorizing that a person's health …

Nutrition And Exercise Resources For Clinton County, Paige M. Wood

Family Medicine Clerkship Student Projects

The obesity epidemic is a nation wide problem that has increased prevalence in Clinton County, NY when compared to the surrounding areas. Obesity leads to many co-morbid health conditions and is associated with a large increase in health care spending costs. This brochure tackles the limited resources, such as limited number of fitness centers, lack of nutrition education and an overall lower socioeconomic status, that is present in the Clinton County area. This brochure offers help in these areas through free phone applications which cover nutrition education, healthy shopping guidance, at home exercise routines, motivation, habit trackers and mindfulness exercises.

Barriers To Affordable Prescriptions In Rural Vermont, Niketu P. Patel

Family Medicine Clerkship Student Projects

This project aimed at understanding why people in Rutland County, Vermont struggle with buying medications for their health. The project implemented and proposed several methods to help the population of Rutland area better adapt to the growing cost of prescriptions via $4 medication lists, rebates, samples, etc.

Co-Constructing Food Access Issues: Older Adults In A Rural Food Environment In West Virginia Develop A Photonarrative, Lauri Andress, Sunah Hallie

Faculty & Staff Scholarship

This photovoice study examined the hypothesis that photos and narratives produced by older adults would facilitate the co-construction of a shared narrative about the food access issues in a rural county in West Virginia. For older adults, living in rural areas, several factors decrease access to healthy, nutritious food relative to the general population of older adults. Methods: Qualitative data from interviews, written narratives, dialogues, and photos from older adults living in a rural county of West Virginia. Was collected. Using directed content analysis, transcripts of written data were broken down into meaningful quote segments. All written data and …