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Rural Health
Resources by Topic: Rural-urban differences

Development of a National Childhood Obesogenic Environment Index in the United States: Differences by Region and Rurality
Details the formation of a childhood obesogenic environment index (COEI), which was used to identify rural, urban, and other geographic differences in environmental factors associated with obesity. Variables used to calculate COEI scores include availability of fast-food restaurants, farmers markets, grocery stores, and other related facilities; access to exercise opportunities; violent crime; walkability; and more. Includes county-level data on COEI scores across the U.S.
Author(s): Andrew Kaczynski, Jan Eberth, Ellen Stowe, et al.
Citation: International Journal of Behavioral Nutrition and Physical Activity, 17(83)
Date: 2020
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Health Literacy in Clinical Research: Practice and Impact: Proceedings of a Workshop
Summary of presentations and discussions held April 11, 2019 in Washington, D.C. by the Roundtable on Health Literacy of the National Academies of Sciences, Engineering, and Medicine. Topics include challenges for diverse populations' participation in clinical trials, best practices, and health literacy strategies for effective communication with participants. Chapter 4 includes a description of clinical trials during which researchers conducted health literacy interventions in cancer screenings in mainly rural areas.
Additional links: Read Online
Author(s): Board on Population Health and Public Health Practice
Date: 2020
Sponsoring organization: Health and Medicine Division (HMD), National Academies of Sciences, Engineering, and Medicine
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Birth Settings in America: Outcomes, Quality, Access, and Choice
Examines factors that influence maternal and newborn care in the United States, including social determinants such as geographic variability in access to birth settings. Explores challenges faced by women in rural and underserved areas. Includes statistics on infant mortality rates in 2014 with breakdowns by rural or urban locations, and county-level maps showing access to providers and hospitals offering obstetric services.
Additional links: Read Online
Author(s): Board on Children, Youth, and Families
Date: 2020
Sponsoring organization: Health and Medicine Division (HMD), National Academies of Sciences, Engineering, and Medicine
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Rural-Urban Differences In Severe Maternal Morbidity And Mortality In The US, 2007–15
Analyzes severe maternal morbidity and mortality among rural and urban residents during childbirth. Examines data from the 2007-2015 National Inpatient Sample with breakdowns according to age, insurance type, race/ethnicity, income, Census region, and rurality. Discusses policy implications and strategies to reduce maternal morbidity and mortality.
Author(s): Katy Backes Kozhimannil, Julia D. Interrante, Carrie Henning-Smith, Lindsay K. Admon
Citation: Health Affairs, 38, 12
Date: 12/2019
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Rural-Urban Differences in Financial Burden among Cancer Survivors: An Analysis of a Nationally Representative Survey
Analyzes 2012, 2014, and 2017 data from the National Cancer Institute's Health Information and National Trends Survey to determine differences in reported financial problems due to cancer in rural and urban populations. Table 1 provides a rural and urban comparison on several demographic and cancer characteristics, including sex, age, marital status, race and ethnicity, income, insurance status, and several factors related to cancer treatment.
Author(s): Whitney E. Zahnd, Melinda M. Davis, Jason S. Rotter, et al.
Citation: Supportive Care in Cancer, 27(12), 4779-4786
Date: 12/2019
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Rural–Urban Disparities in Pregnancy Intentions, Births, and Abortions Among US Adolescent and Young Women, 1995–2017
Study examining disparities in intendedness and resolution of first pregnancies among rural and urban adolescent and young women using 2002-2017 data from the National Survey of Family Growth. Breaks down data by race/ethnicity, by urban, rural, and suburban residence, and by state. Discusses public health implications of the findings.
Author(s): April Sutton, Daniel T. Lichter, Sharon Sassler
Citation: American Journal of Public Health, 109(12), 1762-1769
Date: 12/2019
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The Landscape of Obstetric Resources and Risks in Indiana: A Framework for Informing Policy
Provides insight on access to obstetric care resources and infant or maternal health risk factors in Indiana communities. Presents a framework that can be used for targeting state and health system policy and planning by analyzing resources, such as obstetric providers and hospitals with obstetric services, and health risks. Includes a county-level map with breakdowns showing 4 levels of access to obstetric care services, 3 levels of maternal or infant health risks, and shadings to indicate rural counties.
Author(s): Hannah Maxey, Courtney Randolph, Sierra Vaughn
Date: 12/2019
Sponsoring organization: Bowen Center for Health Workforce Research and Policy
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Divergent Trends in Life Expectancy Across the Rural-Urban Gradient and Association with Specific Racial Proportions in the Contiguous United States 2000-2005
Study estimating life expectancy at age 25 by rural and urban residence, race, and sex using county-level data from 2000 - 2005. Discusses geographic determinants of disparities in life expectancy in the contiguous U.S., comparing rurality and the proportion of specific race populations to life expectancy. Features color-coded maps of the contiguous U.S. that represents life expectancy at age 25 for White, Black, American Indian/Alaska Native, and Asian males and females.
Author(s): Yun Jian, Lucas Neas, Lynne C. Messer, et al.
Citation: International Journal of Public Health, 64(9), 1367-1374
Date: 12/2019
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Mortality-to-Incidence Ratios by U.S. Congressional District: Implications for Epidemiologic, Dissemination and Implementation Research, and Public Health Policy
Analyzes congressional district-specific mortality-to-incidence ratios (MIR) between 2011 and 2015 for all cancers and for cancers of breast, cervix, colorectal, esophagus, lung, oral, pancreas, and prostate cancers. Compares MIRs across regions, state Medicaid expansion status, race, and rurality. Discusses implications for policymakers and researchers.
Author(s): Jan M. Eberth, Whitney E. Zahnd, Swann Arp Adams, et al.
Citation: Preventative Medicine, 129(S), 105849
Date: 12/2019
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Access to Specialty Healthcare in Urban Versus Rural US Populations: A Systematic Literature Review
Surveys research between January 2013 – August 2018 on healthcare access, seeking clear definition and understanding of barriers to specialty care. Draws data from 67 peer-reviewed articles, presenting a conceptual framework based on common themes. Discusses issues of availability, perception, policy, stigma, and other access factors.
Author(s): Melissa E. Cyr, Anna G. Etchin, Barbara J. Guthrie, James C. Benneyan
Citation: BMC Health Services Research, 19, 974
Date: 12/2019
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