• A comparison of hospital utilization in urban and rural areas of South Carolina

      Dicks, Vivian; Augusta University (Georgia Public Health Association, 2016)
      Background: Previous studies have described health care utilization based on insurance status and ethnicity. Few investigations, however, have looked at rural populations in relation to distance in securing health care. Methods: The 2008 to 2009 Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) for South Carolina was used to assess the relationship of living in rural versus urban communities and the demographic variables related to insurance coverage. By use of bivariate and multivariate analyses, patient socio-demographic characteristics were explored for working-aged groups in relation to their income and for payer status (Medicaid or uninsured) relative to those privately insured. Results: Of hospitalizations, 68.89% were for those living in urban areas, 20.52% in large rural areas, 6.57% small rural areas, and 4.02% in isolated rural areas. Blacks lived predominantly in small rural (53.65%) and isolated rural communities (51.55%). As income decreased, the percentage of hospital admissions increased, from 5.83% for those earning $66,000 to 43.29% for those earning between $1 and $39,999. Conclusions: Hospital admissions may not be entirely dependent on race, income or insurance, but could also be influenced by geographic access. Further, having private insurance, higher incomes, and living in urban areas are positive predictors for better health outcomes.
    • Quality Rated childcare programs and social determinants of health in rural and nonrural Georgia

      Webb, Nancy C.; Gates, Madison L.; Augusta University (Georgia Public Health Association, 2016)
      Background: Early childhood is linked to school readiness and early school achievement. Through its Quality Rated (QR) program, which was designed to improve the quality of care in early childhood programs, the state of Georgia has been a trailblazer in funding universal preschool and in improving the quality of childcare programs. We have assessed differences in the availability of QR childcare programs in Georgia to learn if, in rural versus non-rural counties, there is a relationship between QR childcare programs and health-related outcomes. Methods: This cross-sectional study evaluated county-level data to evaluate the relationship between QR childcare programs and social determinants of health. County-level data for Georgia were extracted from the Georgia Department of Early Care and Learning, County Health Rankings and Roadmaps, and the Georgia Juvenile Justice Data Clearinghouse. Results: Counties without QR childcare programs had child mortality rates 3.5 times higher than those for the state overall. Other differences in health-related outcomes included, but were not limited to, teen birth rates, low birth-weight babies, children in poverty, housing problems, and food insecurity. Conclusions: It is now appropriate to address the prevalence of health disparities in rural areas of Georgia and focus on some of the disparities through the QR early childhood programs and other state agencies. Empowering rural communities to address health disparities may be the most favorable path toward diminishing these inequalities.
    • A systematic review of lifestyle interventions for chronic diseases in rural communities

      Smith, A Selina; Ansa, Benjamin; Augusta University (Georgia Public Health Association, 2016)
      Background: Rural Americans suffer disproportionately from lifestyle-related chronic diseases (e.g., obesity, diabetes, hypertension, cardiovascular disease, and breast cancer). Interventions that consider the distinctive characteristics of rural communities (e.g., access to healthcare, income, and education) are needed. As an initial step in planning future research, we completed a systematic review of dietary intake and physical activity interventions targeting rural populations. Methods: Manuscripts focused on dietary intake and physical activity and published through March 15, 2016, were identified by use of PubMed and CINAHL databases and MeSH terms and keyword searches. Results: A total of 18 studies met the inclusion criteria. Six involved randomized controlled trials; 7 used quasi-experimental designs; 4 had a pre-/post-design; and 1 was an observational study. Eight studies were multi-site (or multi-county), and 3 focused on churches. Primary emphasis by racial/ethnic group included: African Americans (6); Whites (2); Hispanics (3); and two or more groups (7). Most studies (17) sampled adults; one included children. Two studies targeted families. Conclusions: Additional lifestyle intervention research is needed to identify effective approaches promoting healthy diet and exercise and chronic disease prevention in rural communities. Studies that include rigorous designs, adequate sample sizes, and generalizable results are needed to overcome the limitations of published studies.