Rural Children Experience Different Rates of Mental Health Diagnosis and Treatment

Research indicates that privately insured, rural adults have lower use of office-based mental health services, but higher use of prescription medicines than their urban counterparts. Patterns for rural children may be different from urban children because of the limited supply of pediatric mental health providers in rural areas, which may lead to reduced access and lower use of mental health services in rural areas versus urban. Using data on children ages 5-17 from the 2002-2008 of the Medical Expenditure Panel Survey, researchers from the Maine Rural Health Research Center find that rural children are significantly less likely to be diagnosed and treated for non-ADHD mental health problems than urban children and are less likely to receive mental health counseling. The rural-urban difference is greatest among those children scoring in the “possible impairment” range on the Columbia Impairment Scale

Patterns of Care for Rural and Urban Children with Mental Health Problems

Introduction Research indicates that privately insured, rural adults have lower use of office-based mental health services, but higher use of prescription medicines than their urban counterparts. Similar studies for rural children have been limited to specific populations, diagnoses, or to single states. Patterns for rural children may be different than those of urban children and adults generally because of their high enrollment in Medicaid and the State Children\u27s Health Insurance Program, which tend to have more generous behavioral health benefits than private coverage and may equalize rural-urban treatment patterns. On the other hand, the more limited supply of specialty mental health providers in rural areas, particularly for children, could lead to lack of access and lower utilization of some types of mental health services in rural areas versus urban. Methods Using data on children ages 5-17 from the 2002-2008 Medical Expenditure Panel Survey, this study examines two research questions: 1) do patterns of children\u27s mental health diagnosis and service use (e.g., office visits and psychotropic medications) differ by rural-urban residence? and 2) what is the effect of income and insurance type on use of mental health services? Findings Controlling for demographic and risk factors, rural children are as likely as urban children to have an attention deficit or hyperactivity disorder (ADHD) diagnosis and less likely to have any other type of psychiatric diagnosis. Initially observed higher prevalence of mental health diagnoses among rural children is explained by underlying differences in demographic characteristics and risk factors, such as higher rates of poverty, public coverage, mental health impairment, and lower prevalence of minorities. Rural children with the highest mental health need are no more or less likely to be diagnosed or treated for mental health conditions. However, among those with a possible impairment, rural children are less likely to be diagnosed with a psychiatric illness other than ADHD and are less likely to receive counseling

How Does the Rural Food Environment Affect Rural Childhood Obesity?

Objective: Assess the impact of the rural food environment on the eating behaviors and BMI of rural low-income children. Method: Statewide (Maine, 2009) household survey of parents of children on Medicaid (n=1722), oversampled in six rural communities, resulting in n=272 for six target communities. Food environment measured using modified Nutrition Environment Measures Survey in Stores (NEMS-S) for 46 retail food outlets. Multi-variate analysis assessed factors affecting home food environment, child\u27s eating behavior and BMI. Results: Home food behaviors (how often: family eats together, child eats breakfast, vegetables served) and parent food consumption were significantly associated with children\u27s healthy eating behaviors. The only significant predictor of childhood obesity was parent eating behavior. We observed several alternative strategies such as hunting, gathering and buying from local farmers. Parents who drove over 20 miles to shop were found to shop at stores with higher NEMS scores as compared to parents who drove shorter distances.Conclusion: Defining and identifying food deserts is not a promising approach to measuring the rural food environment due to long distance trips, careful price shopping, and local, alternative strategies. Strategies to place healthier food in the home should be combined with interventions directed at parents\u27 and families\u27 eating behaviors

Health Insurance Profile Indicates Need to Expand Coverage in Rural Areas

Key Findings: A greater percentage of rural residents than urban residents are uninsured, especially those living in remote areas Among adults over age 50, uninsured rates are highest in the most remote rural places Compared to urban adults, rural adults are less likely to be in employment situations where private coverage is offered

Catastrophic Consequences: The Link Between Rural Opioid Use and HIV/AIDS

This chapter from HIV/AIDS in Rural Communities compares the rural–urban prevalence of HIV and opioid use, treatment, and harm reduction, and highlights efforts to control HIV and opioid use in rural states and communities. Rural persons who use opioids appear to have lower perceived risks of contracting HIV and lower perceived consequences associated with heroin use. Close social networks in rural communities and high-risk sex and injection drug use practices may facilitate exposure and transmission of HIV. Rural persons who use opioids may experience numerous potential barriers to HIV and substance abuse treatment and harm reduction activities. Given the challenges of studying a small population of opioid users and dealing with confidential information like HIV status and drug use, studies comparing rural and urban persons within the same state or nationwide will be important going forward.https://digitalcommons.usm.maine.edu/facbooks/1166/thumbnail.jp