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Consequences of Differential Residence Designations for Rural Health Policy Research: The Case of Infant Mortality

The Journal of Rural Health 1993年第1期9卷 17-26页

作者： Farmer, Frank L. Miller, Michael K. Department of Agricultural Economics and Rural Sociology Agriculture Building University of Arkansas Fayetteville Arizona 72701 Room 222 United States

Abstract: In 1991, members of the rural caucus proposed numerous bills designed to attenuate the rural‐urban differences in health care delivery and health status. Implicit in the legislative process is the assumption that “rural America” differs systematically from “urban America.” However, research has consistently demonstrated that there is not a single rural America but rather, those areas outside of the major metropolitan areas represent a complex mosaic of varying social and environmental settings. Rural communities differ in meaningful ways along a number of socioenvironmental parameters, and accordingly, health status indicators also differ across rural communities. Thus, health outcome statistics averaged across rural communities will often mask important health disparities experienced by certain population groups. Policies based on these aggregate indicators may overlook the needs of the most disadvantaged. While a number of measures of rurality have emerged in the last decade, much of the information presented to policy‐makers is either too aggregated (i.e., metropolitan‐nonmetropolitan) to identify important differences across the range of communities, or it is gathered in agency‐specific categories that are not comparable. The central question under examination in the current context is the possibility of distorting the picture of infant health status by aggregating the diverse rural locales of the United States. Empirical results indicate that when considering infant mortality, any rural disadvantage is contingent upon how ‘rural’ and ‘urban’ have been defined. Further, the results indicate that conclusions must be conditioned on other important sociodemographic parameters such as region of the county and race. Copyright © 1993, Wiley Blackwell. All rights reserved

关键词：非洲裔美国人/统计学和数值数据阿肯色数据收集欧洲大陆世系人群/统计学和数值数据佛罗里达地理学卫生政策卫生服务研究/标准人类婴儿死亡率婴儿新生居住特征农村卫生/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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DEMOGRAPHY 1999年第4期36卷 535-551页

作者： Brien, MJ Lillard, LA Waite, LJ Univ Virginia Dept Econ Charlottesville VA 22903 USA Univ Michigan Dept Econ Ann Arbor MI 48109 USA Univ Michigan ISR Ann Arbor MI 48109 USA Univ Chicago Dept Sociol Chicago IL 60637 USA Univ Chicago NORC Chicago IL 60637 USA

Data from the National Longitudinal Study of the High School Class of 1972 are used to estimate a series of models of entry into marriage, entry into cohabitation, and nonmarital pregnancy. Our models account explicitly for the endogeneity of one outcome as a predictor of another by taking into account both heterogeneity across individuals due to unmeasured factors that may affect all these outcomes and the correlation in the unmeasured factors across processes. We find that these heterogeneity components ave strongly and positively related across the outcomes. Women who are move likely to cohabit, marry, or become pregnant while unmarried are also more likely to do each of the others. Although black and white women differ in the likelihood of these behaviors, the interrelations of the behaviors are quite similar across groups.

关键词：非洲裔美国人/心理学非洲裔美国人/统计学和数值数据欧洲大陆世系人群/心理学欧洲大陆世系人群/统计学和数值数据家庭特征受精似然函数纵向研究婚姻/心理学婚姻/统计学和数值数据模型心理学模型统计学妊娠/心理学妊娠/统计学和数值数据比例危险度模型性伴侣/心理学单亲/心理学单亲/统计学和数值数据青少年成年人女(雌)性人类男(雄)性

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Age-by-Race Differences in the Health and Functioning of Elderly Persons

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Journal of Aging and Health 1991年第3期3卷 335-351页

作者： Gibson, Rose C. University of Michigan United States

A review of health data identified four major trends in the elderly population: (a) a younger Black group that was more morbid than an older Black group, (b) an alternating pattern of Black morbid and robust age groups, (c) a Black disadvantage in health and functioning that was greater in race comparisons involving the Black morbid and less in comparisons involving the Black robust age groups, and (d) a Black health detriment that seemed to narrow at age 85. The trends suggest that age and health are more strongly related in the White elderly than in the Black elderly population. The trends also are compatible with the more rapid growth of Blacks aged 85 and over than any other group of the elderly, adverse mortality selection processes, and the racial mortality crossover. Issues for new research that will explain these four trends are discussed.

关键词：非洲裔美国人/统计学和数值数据年龄因素欧洲大陆世系人群/统计学和数值数据健康状况指标年患病率美国/流行病学老年人女(雌)性人类男(雄)性

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The geographic distribution of AIDS in the United States: Is there a rural epidemic?

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JOURNAL OF RURAL HEALTH 2000年第1期16卷 11-19页

作者： Steinberg, S Fleming, P Ctr Dis Control & Prevent Div HIV AIDS Prevent Surveillance & Epidemiol Natl Ctr HIV STD & TB Prevent Atlanta GA 30333 USA Ctr Dis Control & Prevent HIV AIDS Surveillance Branch Natl Ctr HIV STD & TB Prevent Atlanta GA 30333 USA

The goal of this study was to examine where people with acquired immune deficiency syndrome (AIDS) in the United States live and the degree to which AIDS is present in rural areas. AIDS cases reported to the Centers for Disease Control and Prevention (CDC) in 1996 were categorized by metropolitan statistical area (MSA) size and compared to the general population. Data were analyzed by region, race/ethnicity and risk exposure;AIDS incidence rates were compared over time by MSA size. Relative to the U.S. population, AIDS cases were disproportionately black (43 percent vs. 11 percent), male (80 percent vs. 48 percent), and from the Northeast (32 percent vs. 20 percent). In all regions, a greater proportion of AIDS cases reside in large MSAs compared with the general population. Risk exposures differ little by MSA size, except in the Northeast. The proportion of people with AIDS who reside in large MSAs exceeds the proportion of the population in those areas, especially when race/ethnicity is considered. AIDS rates have increased in non-MSAs relative to large MSAs, yet do not indicate that the epidemic is increasing rapidly in rural areas. Fewer AIDS cases are reported from smaller communities, yet require medical and social services that may burden the rural health care system.

关键词：获得性免疫缺陷综合征/流行病学获得性免疫缺陷综合征/人种学非洲裔美国人/统计学和数值数据美国疾病控治中心哥伦比亚特区/流行病学欧洲大陆世系人群/统计学和数值数据西班牙裔美国人/统计学和数值数据发病率患病率农村人口/统计学和数值数据性别分布美国/流行病学市区人口/统计学和数值数据青少年成年人人类

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Methodological advances in the use of recidivism rates to assess mental health treatment programs

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JOURNAL OF MENTAL HEALTH ADMINISTRATION 1996年第2期23卷 190-206页

作者： Hafemeister, TL Banks, SM INST MENTAL DISABIL & LAW NATL CTR STATE COURTS300 NEWPORT AVEWILLIAMSBURGVA 23187 USA

This study of recidivism rates within a state psychiatric system identifies and controls for a number of flaws in other recidivism studies and provides one of the few direct comparisons between different mental health programs using recidivism rates as a dependent variable. It is not an attempt to predict the likelihood of an individual patient's recidivism or to improve the treatment provided the individual patient. Instead, it is an endeavor to address the issue of using recidivism rates to assess a treatment program's effectiveness and to examine such treatment at the macro- or systemwide level.

关键词：缺勤欧洲大陆世系人群/统计学和数值数据医院精神病/标准医院精神病/利用住院病人精神障碍/病理生理学精神障碍/治疗纽约结果评价(卫生保健) 病人再入院/统计学和数值数据方案评价/方法卫生保健质量复发人类男(雄)性

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Mental health care for Asian, black and white patients with non-affective psychoses: pathways to the psychiatric hospital, in-patient and after-care

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SOCIAL PSYCHIATRY AND PSYCHIATRIC EPIDEMIOLOGY 1999年第9期34卷 484-491页

作者： Commander, MJ Cochrane, R Sashidharan, SP Akilu, F Wildsmith, E No Bimingham Mental Hlth Trust Res & Dev Unit Erdington B23 6AL England Univ Birmingham Sch Psychol Edgbaston England

Background: This UK-based study compares the pathways to the psychiatric hospital and the provision of in-patient and after-care for Asian, black and white patients with non-affective psychoses. Method's: Two overlapping samples of 120 patients, 40 from each ethnic group, were drawn;one on admission and the other at discharge. In addition to socio-demographic data, details were obtained on the pathways to care and the in-patient episode. An assessment of needs and service provision was undertaken 3 months post-discharge. Patient satisfaction was ascertained at each stage. Results: Asian and especially black patients experienced more complex pathways and had higher levels of both involvement with the police and compulsory detention than their white counterparts. They were less likely to perceive themselves as having a psychiatric problem or as needing to go into hospital and expressed less satisfaction with the admission process. Black patients, as compared to Asian but especially white patients, were more often detained in hospital against their will, confined to the ward and treated within a secure environment. However. there were few differences in satisfaction with hospital care. Likewise, perceptions of unmet need? provision of after-care and satisfaction with services were similar across the ethnic groups. Conclusions: The implications of these findings are discussed. The potential of early intervention programmes and home treatment services to address the ethnic differentials identified in this study merit consideration.

关键词：非洲裔美国人/统计学和数值数据非洲大陆世系人群文化交叉比较人种群/统计学和数值数据欧洲大陆世系人群/统计学和数值数据大不列颠卫生服务需求住院/统计学和数值数据医院精神病/统计学和数值数据病人满意度精神病/人种学精神病/心理学抽样研究青少年成年人女(雌)性人类男(雄)性中年人

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Rural health care issues in the Lower Mississippi Delta: an agenda for the year 2000

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Journal of Health & Social Policy 1990年第1期2卷 79-94页

作者： Hawkins, W.F. Hyland, S.E. LowerMississippiDeltaDevelopmentCommission MemphisTN38119.

The 214 counties bordering both sides of the Lower Mississippi Delta from Cape Girardeau, Missouri, to New Orleans, Louisiana, currently represent one of the four major poverty regions in the US. Despite the location of five major medical centers, the Lower Mississippi Delta continues to lag behind the rest of the country in important health indices. This paper presents comparative data on infant mortality rates and health care availability between the Lower Mississippi Delta and the rest of the nation. It also contains comparative data on the rural Lower Mississippi Delta and the rest of the rural US. Further comparisons of European and African-American infant mortality rates reveal necessary directions and important realities for future health efforts. Commission research, gathered in public hearings from the Delta, reveals a pattern of interrelated development factors that also seriously affect health care in rural Delta counties. -Authors

关键词：非洲裔美国人/统计学和数值数据欧洲大陆世系人群/统计学和数值数据婴儿死亡率/发展趋势路易斯安那缺医地区美国中西部密西西比医师/供应和分配贫困区地区卫生计划/组织和管理农村卫生/统计学和数值数据美国人类婴儿婴儿新生

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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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Birth Outcomes to Rural Illinois Residents: Is There a Crisis?

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The Journal of Rural Health 1994年第2期10卷 122-130页

作者： Rock, Steven M. Straub, LaVonne A. Department of Economics Western Illinois University Macomb Illinois United States

In recent years, the supply of obstetric services in rural areas has been a concern. At the same time, the demand for such services has been affected by the reduction in population and economic base. This article explores the extent of these trends in Illinois and whether they have led to a deterioration in amount of prenatal care and birth outcomes. Using birth certificate and infant death data for residents of rural Illinois counties in 1983 and 1988, prenatal care and birth outcomes for each year are compared within rural areas and to the rest of the state, as well as between the two time periods. Although rural residents began prenatal care later, they obtained similar qualities of care as their urban counterparts. The data revealed no adverse impact on birth outcomes of residing in increasingly rural areas, nor was there a deterioration during the time period. An attempt was made to identify rural counties that lost providers and/ or facilities and those that gained them. Although such a classification scheme is subjective, similar results ensued. While indirect costs such as time and effort to obtain care may have increased, at 1988 levels of care availability there was no crisis in Illinois. Copyright © 1994, Wiley Blackwell. All rights reserved

关键词：数据收集欧洲大陆世系人群/统计学和数值数据卫生服务易得程度/统计学和数值数据伊利诺伊/流行病学产妇卫生保健服务/供应和分配产科学/人力妇产科医院妊娠结局/流行病学产前保健/标准产前保健/统计学和数值数据产前保健/利用农村卫生/统计学和数值数据女(雌)性人类婴儿新生妊娠

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Severity of abuse before and during pregnancy for African American, Hispanic, and Anglo women

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JOURNAL OF NURSE-MIDWIFERY 1999年第2期44卷 139-144页

作者： McFarlane, J Parker, B Soeken, K Silva, C Reed, S Texas Womans Univ Coll Nursing Houston TX 77030 USA Univ Virginia Sch Nursing Charlottesville VA 22903 USA Univ Maryland Sch Nursing College Pk MD 20742 USA Univ Texas Sch Nursing Galveston TX USA

Objective: To describe timing and severity of abuse before and during pregnancy for African American, Hispanic, and white Angle American women. Findings: Among 199 abused women, 18.1% of the women were abused during pregnancy but not the year before, 30.2% were abused the year before but not during pregnancy, and 51.8% were abused both the year before and during pregnancy. The timing of abuse did not vary by ethnicity. The three (ethnicity) by three (timing) factorial analysis of variance showed severity of abuse to vary by timing of abuse. Women reporting abuse both before and during pregnancy reported greater severity of abuse on each of the five measures than did women abused only before pregnancy or only during pregnancy. Conclusions: Over half (51.8%) of the women reported abuse before and during pregnancy with these women reporting greater severity of abuse on all five severity scores. Timing and severity of abuse did not vary by ethnic group. The majority of women abused during pregnancy were also abused prior to pregnancy, indicating the need for universal screening of all women during each health encounter. (C) 1999 by the American College of Nurse-Midwives.

关键词：非洲裔美国人/统计学和数值数据方差分析卡方分布欧洲大陆世系人群/统计学和数值数据西班牙裔美国人/统计学和数值数据妊娠/人种学妊娠/统计学和数值数据问卷调查虐待配偶/人种学虐待配偶/统计学和数值数据美国/流行病学青少年成年人女(雌)性人类

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