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Health and Well‐Being Among Rural Americans: Variations Across the Life Course

The Journal of Rural Health 1993年第2期9卷 86-98页

作者： Eggebeen, David J. Lichter, Daniel T. PopulationResearchInstitute PennsylvaniaStateUniversityUniversityPark16802.

Abstract: This study uses data from the 1988 National Survey of Families and Households conducted by the University of Wisconsin to examine spatial variations in physical, mental, and social well‐being among young, middle aged, and elderly American adults. Rural residents of all ages were found to consistently rate their physical health more poorly than nonrural residents. Both young and old rural adults also rated themselves less happy than nonrural residents. However, middle‐aged and elderly rural residents appear better off on the majority of six other indicators of well‐being, and this group reports the highest proportion of adults with no health impairments. Finally, rural residents of all ages possess distinct advantages in terms of several measures of social ties. Copyright © 1993, Wiley Blackwell. All rights reserved

关键词：成年人老年人方差分析健康态度卡方分布数据收集人口统计学健康状况指标人类 Logistic模型中年人多元分析生活质量农村卫生/统计学和数值数据社会经济因素城市卫生/统计学和数值数据

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Hunger and food insecurity in the elderly - Its nature and measurement

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JOURNAL OF AGING AND HEALTH 1998年第3期10卷 327-350页

作者： Wolfe, WS Olson, CM Kendall, A Frongillo, EA Cornell Univ Ithaca NY 14853 USA

To better understand the nature of food insecurity in the elderly and to improve its measurement, in-depth interviews were conducted with 41 urban Black and rural White elderly in 35 households, followed by telephone administration of commonly used measures of food insecurity in 24 of these elderly. Elderly food insecurity appears to follow a progression of severity, beginning with compromised diet quality, followed by food anxiety, socially unacceptable meals, use of emergency food strategies, and finally actual hunger. The five quantitative measures tested were compared to each elderly person's food insecurity status based on the in-depth interview. All measures had reasonable specificity, and good sensitivity for those experiencing severe food insecurity. However, the Cornell-Radimer, Community Childhood Hunger Identification Project (CCHIP) and Nutrition Screening Initiative (NSI) measures appeared more sensitive than the USDA food sufficiency or Urban Institute measures in correctly identifying those in the lesser stages of food insecurity.

关键词：老年人/心理学老年人/统计学和数值数据饥饿纽约/流行病学营养调查农村卫生/统计学和数值数据农村人口绝食/流行病学城市卫生/统计学和数值数据市区人口老年人 80以上女(雌)性人类男(雄)性

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Inequities in Health Care and Survival After Injury Among Pedestrians: Explaining the Urban/Rural Differential

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The Journal of Rural Health 1995年第3期11.0卷 177-184页

作者： Miles‐Doan, Rebecca Center for the Study of Population Florida State University Tallahassee Florida 32306‐4065 United States

Abstract: This study investigated whether rural/urban differences in injury mortality and morbidity are primarily due to medical care maldistribution or to other factors such as sociodemographic or environmental characteristics that are highly correlated with location. To separate incidence from case‐fatality rates, the study analyzed the determinants of survival rather than cause‐specific mortality rates. Using information from Florida traffic crash reports for 1988 through 1990, the study focused on Florida pedestrians hit by motor vehicles. It explores the effect of individual‐level demographic characteristics, crash‐level indicators of impact severity, and county‐level measures of socioeconomic and medical care resources, on the odds a pedestrian survived an injury. Logistic regression analyses reveal the importance of both road environment and percent of the county that is rural. However, these analyses are not able to isolate the influence of medical care from the level of urbanization. Although the percent rural was statistically significant, indicators of the mechanical energy involved in producing the injury, posted speed, and a dark road environment were substantively more important determinants of survival. Copyright © 1995, Wiley Blackwell. All rights reserved

关键词：事故交通/统计学和数值数据佛罗里达/流行病学卫生服务易得程度/统计学和数值数据回归分析农村卫生/统计学和数值数据乡村卫生服务/统计学和数值数据乡村卫生服务/供应和分配社会经济因素存活率分析创伤严重度指数城市卫生/统计学和数值数据市区卫生服务/统计学和数值数据市区卫生服务/供应和分配创伤和损伤/流行病学创伤和损伤/死亡率女(雌)性人类男(雄)性

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Rural populations and rural physicians: Estimates of critical mass ratios, by specialty

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Journal of Rural Health 1991年第4 SUPPL.期7卷 357-372页

作者： Hicks L.L. Glenn J.K. Health Services Management 301 Clark Hall University of Missouri Columbia MO 65211 United States

As physicians and other providers of health care services see their traditional markets erode, an increasingly important element of any provider location decision is the determination of population base or 'critical mass' that can professionally and financially support a given set of health care services. While the size of a local population is not the sole determinant of success, ultimately an adequate population base to support a given spectrum of services must be defined, and providers increasingly need tools for evaluating opportunities in the new economic market. This is especially true in rural areas. An earlier supply and demand model for estimating the critical mass of population needed to support a physician in any one of 25 specialties and subspecialties in urban and suburban areas is adapted to the rural market. The assumptions inherent in the earlier model are examined and the issue of 'critical mass' is examined from a rural health care perspective in this paper.

关键词：卫生服务范围/统计学和数值数据数据收集卫生人力/统计学和数值数据卫生服务需求/统计学和数值数据模型统计学医师/供应和分配专业场所/统计学和数值数据研究设计农村卫生/统计学和数值数据农村人口/统计学和数值数据社会经济因素专业医学/人力专业医学/统计学和数值数据美国城市卫生/统计学和数值数据

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Human immunodeficiency virus infection in rural areas and small cities of the Southeast: Contributions of migration and behavior

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JOURNAL OF RURAL HEALTH 2000年第1期16卷 20-30页

作者： Lansky, A Nakashima, AK Diaz, T Fann, SA Conti, L Herr, M Smith, D Karon, J Jones, JL Ward, JW Ctr Dis Control & Prevent Surveillance Branch Div HIV AIDS Prevent Special Projects Sect Atlanta GA 30333 USA Ctr Dis Control & Prevent Supplement HIV AIDS Surveillance Project Epidemiol Program Off Atlanta GA 30333 USA Emory Univ Sch Med Dept Med Div Infect Dis Atlanta GA USA Florida Dept Hlth HIV AIDS Suveillance Project Tallahassee FL USA Delaware Dept Hlth & Social Serv Supplement HIV AIDS Surveillance Project Wilmington DE USA S Carolina Dept Hlth & Environm Control Supplement HIV AIDS Surveillance Project Columbia SC 29201 USA Ctr Dis Control & Prevent Stat & Data Management Branch Div HIV AIDS Prevent Atlanta GA 30333 USA Ctr Dis Control & Prevent Surveillance Branch Epidemiol Program Off Atlanta GA 30333 USA

The design of education and prevention strategies to stem the spread of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in rural areas depends on having accurate patterns of risk behavior and transmission in local areas. Interviews were conducted with people in rural areas and small cities in Delaware, Florida, Georgia and South Carolina who were at least 18 years old and infected with HN in order to describe demographic characteristics, migration patterns and risk behaviors. Interviews were conducted with 608 people. Most respondents were male (66 percent), black (63 percent of men, 85 percent of women) and had been infected through sexual contact (67 percent of men, 66 percent of women). Most (65 percent) had lived away from a rural area or small city for at least one month;of those, 71 percent had moved from an urban area. Twenty-seven percent of respondents indicated they had been infected locally. People with a history of injection drug use were less likely to have been infected locally than those rc,ho had no history of injection drug use (6 percent vs. 26 percent among men, 3 percent vs. 40 percent among women, P<0.001). Further understanding of the role of socioeconomic factors in HIV transmission in rural areas and small cities is needed. Programs designed to prevent HIV acquisition among people living in rural areas and small cities in the Southeast should focus on sexual behavior.

关键词：非洲裔美国人/统计学和数值数据年龄分布欧洲大陆世系人群/统计学和数值数据 HIV感染/流行病学 HIV感染/病因学居住流动性/统计学和数值数据危险因素冒险农村卫生/统计学和数值数据性别分布美国东南部/流行病学城市卫生/统计学和数值数据青少年成年人老年人人类中年人

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Urban and Rural Differences in Health Insurance and Access to Care

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The Journal of Rural Health 1994年第2期10卷 98-108页

作者： Hartley, David Quam, Lois Lurie, Nicole Rural Health Research Center University of Washington Department of Geography Seattle Washington United States Institute for Health Services Research Department of Internal Medicine University of Minnesota in Minneapolis Minneapolis Minnesota United States

This study considers differences in access to health care and insurance characteristics between residents of urban and rural areas. Data were collected from a telephone survey of 10,310 randomly selected households in Minnesota. Sub‐samples of 400 group‐insured, individually insured, intermittently insured, and uninsured people, were asked about access to health care. Those with group or individual insurance were also asked about the costs and characteristics of their insurance policies. Rural areas had a higher proportion of uninsured and individually insured respondents than urban areas. Among those who purchased insurance through an employer, rural residents had fewer covered benefits than urban residents (5.1 vs 5.7, P < 0.01) and were more likely to have a deductible (80% versus 40%, P < 0.01). In spite of this, rural uninsured residents were more likely to have a regular source of care than urban residents (69% versus 51%, P < 0.01), and were less likely to have delayed care when they thought it was necessary (21% versus 32%, P<0.01). These differences were confirmed by multivariate analysis. Rural residents with group insurance have higher out‐of‐pocket costs and fewer benefits. Uninsured rural residents may have better access to health care than their urban counterparts. Attempts to expand access to health care need to consider how the current structure of employment‐based insurance creates inequities for individuals in rural areas as well as the burdens this structure may place on rural providers. Copyright © 1994, Wiley Blackwell. All rights reserved

关键词：卡方分布绝对免赔额与共同保险/统计学和数值数据地理学卫生服务易得程度/经济学卫生服务易得程度/统计学和数值数据保险赔偿费/统计学和数值数据保险健康/统计学和数值数据采访最小二乘法分析 Logistic模型未参加医疗保险者/统计学和数值数据明尼苏达多元分析农村卫生/统计学和数值数据城市卫生/统计学和数值数据成年人人类

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Dementing illnesses in rural populations: The need for research and challenges confronting investigators

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JOURNAL OF RURAL HEALTH 1996年第3期12卷 178-187页

作者： Keefover, RW Rankin, ED Keyl, PM Wells, JC Martin, J Shaw, J W VIRGINIA UNIV DEPT NEUROL MORGANTOWN WV 26506 USA W VIRGINIA UNIV DEPT BEHAV MED MORGANTOWN WV 26506 USA JOHNS HOPKINS UNIV SCH HYG & PUBL HLTH DEPT EPIDEMIOL BALTIMORE MD USA JOHNS HOPKINS UNIV DEPT PSYCHIAT & BEHAV SCI BALTIMORE MD USA MARSHALL UNIV DEPT FAMILY MED HUNTINGTON WV USA W VIRGINIA UNIV DEPT BEHAV MED & PSYCHIAT MORGANTOWN WV 26506 USA

Expansion of the world's elderly populations has increased concerns about aging-related medical disorders like Alzheimer's disease and other dementias. In the United States, one fourth of those older than age 65 and at greatest risk for developing dementia live in rural environments that may influence its manifestation. The objectives of this study were to determine the need for and potential benefits of further epidemiological research concerning dementia and similar disorders in rural U.S. populations and to identify pertinent methodological issues related to rural dementia research. This study employed a National Library of Medicine (MEDLINE) document search based on the key words ''cognitive disorders,'' ''dementia,'' ''Alzheimer's disease,'' and ''rural,'' followed by recovery of literature resources referenced in the bibliographies of selected articles. Nineteen studies focusing on dementia or related disorders in rural settings have been reported form around the world. While four of these were conducted in the United States, only one rural dementia prevalence study has been undertaken in this country. Because of methodological variability, comparisons of prevalence estimates between these rural studies, as well as with those from urban investigations, is difficult. Nonetheless, there is reason to believe that certain potentially dementing illnesses are more common in rural populations. There is also evidence to suggest that the screening instruments commonly used in such studies tend to misclassify rural elders as ''false positive'' dementia cases. Information regarding dementing disorders, particularly Alzheimer's disease, in rural populations is scarce. Preliminary observations that dementia may be more common in rural settings and that rural families are more likely to maintain their dementing elders in the community imply that further rural dementia research could yield important insights into the risk factors for these illnesses, the variables influencin

关键词：适应心理学阿尔茨海默病/流行病学阿尔茨海默病/病因学医疗护理提供者/心理学患病代价痴呆/流行病学痴呆/病因学老年人身心健康评价卫生服务研究家庭护理(非专业)/统计学和数值数据患病率危险因素农村卫生/统计学和数值数据农村人口/统计学和数值数据社会经济因素美国/流行病学老年人女(雌)性人类男(雄)性

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To Stay or Not to Stay: Issues in Rural Primary Care Physician Retention in Eastern Kentucky

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The Journal of Rural Health 1994年第4期10卷 273-278页

作者： Cutchin, Malcolm P. Norton, James C. Quan, Mae Marie Bolt, David Hughes, Sarah Lindeman, Barry University of Kentucky in Lexington Kentucky United States Southeast Kentucky Area Health Education Center in Hazard Kentucky United States Southern Kentucky Area Health Center in Corbin Kentucky United States

An important aspect of primary care physician availability is the retention of physicians once they have located. While retention has been under‐researched compared to recruitment, it is especially important in rural areas where physician shortages already exist. This study reports the results of a retention survey completed by 132 primary care physicians in rural eastern Kentucky. The survey sets up an objective, hypothetical retention scenario and asks physicians to respond to structured questions and to an open‐ended question about factors not appearing in the survey. In response to the structured portion of the survey, physicians indicate that relief coverage is the most important factor in rural physician retention. A content analysis of 75 open‐ended responses reveals that besides the other factors in the survey, “socio‐cultural integration” is the pre‐eminent retention issue for rural practitioners. This article concludes that the role of the local rural community may be more important in retention than in recruitment. Finally, it is suggested that additional in‐depth qualitative research be conducted within the local contexts to enhance the understanding of rural physician retention processes. Copyright © 1994, Wiley Blackwell. All rights reserved

关键词：医务工作者的态度数据收集评价研究卫生服务研究肯塔基人员的忠诚医师家庭/统计学和数值数据医师家庭/供应和分配初级卫生保健/人力初级卫生保健/统计学和数值数据专业场所/统计学和数值数据农村卫生/统计学和数值数据女(雌)性人类男(雄)性

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THE EFFECT OF HIGHER RURAL INTERSTATE SPEED LIMITS IN ALCOHOL-RELATED ACCIDENTS

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JOURNAL OF HEALTH ECONOMICS 1993年第3期12卷 281-299页

作者： MCCARTHY, PS PURDUE UNIV KRANNERT GRAD SCH MANAGEMENT1310 KRANNERT BLDGW LAFAYETTEIN 47907 USA

This research analyzes the effect which recent speed limit increases on rural interstate highways have had upon accidents that are alcohol-related. Although there has been considerable work on the separate highway safety effects of higher speed limits and alcohol-related accidents, surprisingly little work has explicitly examined the relationship between them. Based upon extensive county wide data on alcohol-related accidents and several theoretically important determinants of these accidents for the state of Indiana and over the period 1981 through 1989, fixed effects models were estimated. For the state as a whole, the analysis finds that the increase in rural interstate speed limits increased alcohol-related accidents and the magnitude of the effect was statistically significant. In addition, the relaxed speed limit led to a significant redistribution of alcohol-related accidents away from higher speed environments and towards lower speed environments. With few exceptions, this was true for every type of alcohol-related highway accident examined.

关键词：事故交通/预防和控制事故交通/统计学和数值数据急性酒精中毒/流行病学汽车驾驶/立法和法学数据收集印第安纳/流行病学模型统计学政府政策回归分析农村卫生/统计学和数值数据时间因素人类

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Prevalence of abnormal Pap smears in rural family practice

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JOURNAL OF RURAL HEALTH 1996年第1期12卷 33-38页

作者： Miller, KS Yunger, J Single, N Kunz, J OHIO STATE UNIV HOSP CLIN DEPT FAMILY MED ROOM B0902B 456 W 10TH AVE COLUMBUS OH 43210 USA

The purpose of this study was to examine the prevalence of abnormal Pap smears in rural family practice, to compare this to the published literature, and to determine if the prevalence of abnormalities is higher in the younger age group (less than or equal to 35 years of age). A retrospective chart audit was performed on all Pap smears from four rural family practice sites during a 12-month period. Data collected were Pap smear result, patient's age, and interval since previous Pap smear. Statistical analysis was used to determine if the prevalence of abnormal Pap smears was consistent among the practices as well as similar to the three larger published studies. Also, chi-square analysis was used to compare the prevalence of abnormal Pap smears in the younger (less than or equal to 35 years of age) versus the older (>35 years ofage) age groups. There were 2,891 Pap smears reviewed, with 782 (27%) recorded as abnormal. The prevalence of cervical intraepithelial neoplasia (CIN) (76 or 2.6%) was compared to the published literature and was found to be statistically significantly higher (chi square=772.194, P=0.000). The prevalence of abnormal Pap smears was higher in the younger than age 35 group when compared to the older than age 35 group (chi square=20.953, P=0.000). Pap smear interval and age varied between the four practice sites, but the prevalence of CIN was not statistically different (chi square=3.154, P=0.368). The results of this study suggest that rural family physicians may encounter abnormal Pap smears at rates similar to those reported in the literature. This study also suggests that the prevalence of abnormal Pap smears may be higher in the younger groups in this population.

关键词：年龄分布宫颈上皮内瘤样病变/流行病学家庭医学普查北卡罗来纳/流行病学患病率回顾性研究农村卫生/统计学和数值数据城市卫生宫颈疾病/流行病学宫颈肿瘤/流行病学阴道涂片成年人女(雌)性人类中年人

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