Rural Healthy People 2020

Rural Healthy People 2020 (RHP2020) is a result of the work of several researchers, graduate assistants, dedicated project staff, and the guidance of our national RHP2020 Expert Advisory Board. Over a decade ago, the Health Resources and Services Administration’s Office of Rural Health funded the two-volume Rural Healthy People 2010 – the result of a rural-focused survey of Healthy People 2010 priorities and objectives. TeThis served as a foundational starting point for identifying rural health priorities and objectives for the decade.Texas A&M Health Science Center School of Public Health and the Florida State University College of Medicin

Uncertainty, Scarcity and Transparency: Public Health Ethics and Risk Communication in a Pandemic

Communicating public health guidance is key to mitigating risk during disasters and outbreaks, and ethical guidance on communication emphasizes being fully transparent. Yet, communication during the pandemic has sometimes been fraught, due in part to practical and conceptual challenges around being transparent. A particular challenge has arisen when there was both evolving scientific knowledge on COVID-19 and reticence to acknowledge that resource scarcity concerns were influencing public health recommendations. This essay uses the example of communicating public health guidance on masking in the United States to illustrate ethical challenges of developing and conveying public health guidance under twin conditions of uncertainty and resource scarcity. Such situations require balancing two key principles in public health ethics: the precautionary principle and harm reduction. Transparency remains a bedrock value to guide risk communication, but optimizing transparency requires consideration of additional ethical values in developing and implementing risk communication strategies

Travel for medical or dental care by race/ethnicity and rurality in the U.S.: Findings from the 2001, 2009 and 2017 National Household Travel Surveys

The travel burden for medical or dental care is a well-documented barrier to healthcare access, particularly in rural areas. There is limited research providing national estimates of the travel trends for medical/dental care, particularly among racial/ethnic groups, and among rural and urban populations. We analyzed data from the 2001, 2009, and 2017 National Household Travel Surveys. Main outcomes were the average travel distance (in miles), average travel time (in minutes), and travel burden, characterized as the percentage of trips lasting ≥ 30 miles or minutes for medical/dental care. We used ordinary least squares and multivariable logistic regressions to examine trends in the travel time/distance and travel burden, controlling for socio-demographic and travel dynamics. Among rural residents, the average travel distance for medical/dental care increased by 17.8% between 2001 and 2017, while no increase was observed among urban residents. Thirty-six percent of trips among rural residents lasted ≥ 30 minutes in 2001 but increased to 47.4% in 2017. Logistic regression estimates show that though Blacks experienced higher odds of a travel time burden compared to Whites, the burden lessened over time. In 2017, urban Blacks (OR = 0.41, 95% C.I. = 0.26,0.66), and rural Blacks (OR = 0.16, 95% C.I. = 0.05,0.55) were less likely to spend ≥ 30 minutes traveling for medical/dental care compared to Whites, using the year 2001 as the baseline. The travel distance and time for medical/dental care have increased in rural areas. However, the travel burden among rural and urban Black residents has decreased. Continuing to alleviate excess burdens of transportation may be beneficial

Data Sharing in a Decentralized Public Health System: Lessons From COVID-19 Syndromic Surveillance

The COVID-19 pandemic revealed that data sharing challenges persist across public health information systems. We examine the specific challenges in sharing syndromic surveillance data between state, local, and federal partners. These challenges are complicated by US federalism, which decentralizes public health response and creates friction between different government units. The current policies restrict federal access to state and local syndromic surveillance data without each jurisdiction’s consent. These policies frustrate legitimate federal governmental interests and are contrary to ethical guidelines for public health data sharing. Nevertheless, state and local public health agencies must continue to play a central role as there are important risks in interpreting syndromic surveillance data without understanding local contexts. Policies establishing a collaborative framework will be needed to support data sharing between federal, state, and local partners. A collaborative framework would be enhanced by a governance group with robust state and local involvement and policy guardrails to ensure the use of data is appropriate. These policy and relational challenges must be addressed to actualize a truly national public health information system

Rural Healthy People 2020 Volume 2

Rural health challenges are complex, reflecting both significant disparities across rural populations residing in the United States and unique regional, political, and social differences that influence how we craft solutions to problems. Rural populations face even greater challenges today than they did in 2001 when Rural Healthy People 2010 was conceptualized. To better understand challenges that rural residents face in accessing health care, researchers, practitioners, and policy makers must rethink the lens through which they view rural populations. Beyond location, rural challenges also include race, ethnicity, customs, the economy, and geography.Texas A&M Health Science Center School of Public Health and The Florida State University College of Medicin

Rural Healthy People 2020

Rural Healthy People 2020 (RHP2020) is a result of the work of several researchers, graduate assistants, dedicated project staff, and the guidance of our national RHP2020 Expert Advisory Board. Over a decade ago, the Health Resources and Services Administration’s Office of Rural Health funded the two-volume Rural Healthy People 2010 – the result of a rural-focused survey of Healthy People 2010 priorities and objectives. TeThis served as a foundational starting point for identifying rural health priorities and objectives for the decade.Texas A&M Health Science Center School of Public Health and the Florida State University College of Medicin

Rural Healthy People 2020 Volume 2

Rural health challenges are complex, reflecting both significant disparities across rural populations residing in the United States and unique regional, political, and social differences that influence how we craft solutions to problems. Rural populations face even greater challenges today than they did in 2001 when Rural Healthy People 2010 was conceptualized. To better understand challenges that rural residents face in accessing health care, researchers, practitioners, and policy makers must rethink the lens through which they view rural populations. Beyond location, rural challenges also include race, ethnicity, customs, the economy, and geography.Texas A&M Health Science Center School of Public Health and The Florida State University College of Medicin

Factors associated with hospitalizations for co-occurring HIV and opioid-related diagnoses: Evidence from the national inpatient sample, 2009–2017

There has been evidence of rising HIV incidence attributable to opioid misuse within some areas of the U.S. The purpose of our study was to explore national trends in co-occurring HIV and opioid-related hospitalizations and to identify their risk factors. We used the 2009–2017 National Inpatient Sample to indicate hospitalizations with co-occurring HIV and opioid misuse diagnoses. We estimated the frequency of such hospitalizations per year. We fitted a linear regression to the annual HIV-opioid co-occurrences with year as a predictor. The resulting regression did not reveal any significant temporal changes. We used multivariable logistic regression to determine the adjusted odds (AOR) of hospitalization for co-occurring HIV and opioid-related diagnoses. The odds of hospitalization were lower for rural residents (AOR = 0.28; CI = 0.24–0.32) than urban. Females (AOR = 0.95, CI = 0.89–0.99) had lower odds of hospitalization than males. Patients identifying as White (AOR = 1.23, CI = 1.00–1.50) and Black (AOR = 1.27, CI = 1.02–1.57) had higher odds of hospitalization than other races. When compared to co-occuring hospitalizations in the Midwest, the odds were higher in the Northeast. (AOR = 2.56, CI = 2.07–3.17) Future research should explore the extent to which similar findings occur in the context of mortality and targeted interventions should intesify for subpopulations at highest risk of co-occuring HIV and opioid misuse diagnoses