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JournalISSN: 0890-765X

Journal of Rural Health 

Wiley-Blackwell
About: Journal of Rural Health is an academic journal published by Wiley-Blackwell. The journal publishes majorly in the area(s): Rural area & Health care. It has an ISSN identifier of 0890-765X. Over the lifetime, 1909 publications have been published receiving 45457 citations. The journal is also known as: JRH.


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Journal ArticleDOI
TL;DR: Obesity is markedly higher among adults from rural versus urban areas of the United States, with estimates that are much higher than the rates suggested by studies with self-reported data.
Abstract: Purpose: Rural residents have higher rates of chronic diseases compared to their urban counterparts, and obesity may be a major contributor to this disparity. This study is the first analysis of obesity prevalence in rural and urban adults using body mass index classification with measured height and weight. In addition, demographic, diet, and physical activity correlates of obesity across rural and urban residence are examined. Methods: Analysis of body mass index (BMI), diet, and physical activity from 7,325 urban and 1,490 rural adults in the 2005-2008 National Health and Nutrition Examination Survey (NHANES). Findings: The obesity prevalence was 39.6% (SE = 1.5) among rural adults compared to 33.4% (SE = 1.1) among urban adults (P= .006). Prevalence of obesity remained significantly higher among rural compared to urban adults controlling for demographic, diet, and physical activity variables (odds ratio = 1.18, P= .03). Race/ethnicity and percent kcal from fat were significant correlates of obesity among both rural and urban adults. Being married was associated with obesity only among rural residents, whereas older age, less education, and being inactive was associated with obesity only among urban residents. Conclusions: Obesity is markedly higher among adults from rural versus urban areas of the United States, with estimates that are much higher than the rates suggested by studies with self-reported data. Obesity deserves greater attention in rural America.

503 citations

Journal ArticleDOI
TL;DR: The results suggest that most rural residents do not rely on urban areas for much of their care, particularly true for rural residents with specific diagnoses or those undergoing specific procedures.
Abstract: : Context: Patients in rural areas may use less medical care than those living in urban areas. This could be due to differences in travel distance and time and a utilization of a different mix of generalists and specialists for their care. Purpose: To compare the travel times, distances, and physician specialty mix of all Medicare patients living in Alaska, Idaho, North Carolina, South Carolina, and Washington. Methods: Retrospective design, using 1998 Medicare billing data. Travel time was determined by computing the road distance between 2 population centroids: the patient's and the provider's zone improvement plan codes. Findings: There were 2,220,841 patients and 39,780 providers in the cohort, including 6,405 (16.1%) generalists, 24,772 (62.3%) specialists, and 8,603 (21.6%) nonphysician providers. There were 20,693,828 patient visits during the study. The median overall 1-way travel distance and time was 7.7 miles (interquartile range 1.9–18.7 miles) and 11.7 minutes (interquartile range 3.0–25.7 minutes). The patients in rural areas needed to travel 2 to 3 times farther to see medical and surgical specialists than those living in urban areas. Rural residents with heart disease, cancer, depression, or needing complex cardiac procedures or cancer treatment traveled the farthest. Increasing rurality was also related to decreased visits to specialists and an increasing reliance on generalists. Conclusions: Residents of rural areas have increased travel distance and time compared to their urban counterparts. This is particularly true for rural residents with specific diagnoses or those undergoing specific procedures. Our results suggest that most rural residents do not rely on urban areas for much of their care.

449 citations

Journal ArticleDOI
TL;DR: The high prevalence of obesity and inactive lifestyles among rural populations call for research into effective rural interventions.
Abstract: Context and Purpose: Obesity and physical inactivity are common in the United States, but few studies examine this issue within rural populations. The present study uses nationally representative data to study obesity and physical inactivity in rural populations. Methods: Data came from the 1998 National Health Interview Survey Sample Adult and Adult Prevention Module. Self-reported height and weight were used to calculate body mass index. Physical inactivity was defined using self-reported leisure-time physical activity. Analyses included descriptive statistics, x2 tests, and logistic regression. Findings: Obesity was more common among rural (20.4%, 95% CI 19.2%–21.6%) than urban adults (17.8%, 95% CI 17.2%–18.4%). Rural residents of every racial/ethnic group were at higher risk of obesity than urban whites, other factors held equal. Other predictors of obesity included being male, age 25–74, lacking a high school diploma, having physical limitations, fair to poor health, and a history of smoking. Proportionately more rural adults were physically inactive than their urban peers (62.8% versus 59.3%). Among rural residents, minorities were not significantly more likely to be inactive than whites. Males and younger adults were less likely to be inactive. Rural adults who were from the Midwest and South, had less than a high school education, had fair to poor health, and currently smoked were more likely to be inactive compared to their respective referent group. Conclusions: The high prevalence of obesity and inactive lifestyles among rural populations call for research into effective rural interventions.

400 citations

Journal ArticleDOI
TL;DR: The transportation variables that were significantly associated with health care visits suggest that the underlying conceptual frameworks, the Health Behavior Model and Hagerstrand's time geography, are useful for understanding transportation behavior.
Abstract: Context: Access to transportation to transverse the large distances between residences and health services in rural settings is a necessity. However, little research has examined directly access to transportation in analyses of rural health care utilization. Purpose: This analysis addresses the association of transportation and health care utilization in a rural region. Methods: Using survey data from a sample of 1,059 households located in 12 western North Carolina counties, this analysis tests the relationship of different transportation measures to health care utilization while adjusting for the effects of personal characteristics, health characteristics, and distance. Findings: Those who had a driver's license had 2.29 times more health care visits for chronic care and 1.92 times more visits for regular checkup care than those who did not. Respondents who had family or friends who could provide transportation had 1.58 times more visits for chronic care than those who did not. While not significant in the multivariate analysis, the small number who used public transportation had 4 more chronic care visits per year than those who did not. Age and lower health status were also associated with increased health care visits. The transportation variables that were significantly associated with health care visits suggest that the underlying conceptual frameworks, the Health Behavior Model and Hagerstrand's time geography, are useful for understanding transportation behavior. Conclusions: Further research must address the transportation behavior related to health care and the factors that influence this behavior. This information will inform policy alternatives to address geographic barriers to health care in rural communities.

388 citations

Journal ArticleDOI
TL;DR: To examine what barriers rural elders report when accessing needed health care, including how they cope with the high cost of prescription medication, focus groups were conducted in rural West Virginia.
Abstract: Context: Many rural elders experience limited access to health care. The majority of what we know about this issue has been based upon quantitative studies, yet qualitative studies might offer additional insight into individual perceptions of health care access. Purpose: To examine what barriers rural elders report when accessing needed health care, including how they cope with the high cost of prescription medication. Methods: During Spring 2001, thirteen 90-minute focus groups were conducted in 6 rural West Virginia communities. A total of 101 participants, aged 60 years and older, were asked several culminating questions about their perceptions of health care access. Findings: Five categories of barriers to health care emerged from the discussions: transportation difficulties, limited health care supply, lack of quality health care, social isolation, and financial constraints. In addition, 6 diverse coping strategies for dealing with the cost of prescription medication were discussed. They included: reducing dosage or doing without, limiting other expenses, relying on family assistance, supplementing with alternative medicine, shopping around for cheapest prices, and using the Veteran's Administration. Conclusions: Overall, rural older adults encounter various barriers to accessing needed health care. Qualitative methodology allows rural elders to have a voice to expound on their experiences. Research can contribute valuable information to shape policy by providing a forum where older adults can express their concerns about the current health care delivery system.

339 citations

Performance
Metrics
No. of papers from the Journal in previous years
YearPapers
202348
202290
2021173
202082
201960
201861