Findings suggest that a multi-level approach is essential for meeting the mental health service needs of rural residents.
Key facts:
8% of rural adults say that they are in "fair" or "poor" mental health versus 6% of urban adults;
Among those using mental health services, rural residents are more likely than urban residents to use medication but not therapy. Practice guidelines for quality mental health treatment recommend that medications be given in combination with therapy;
Both rural and urban adults have greater cost sharing for their mental health care than for their total health care use. The percentages do not differ by residence; however, rural residents may be at greater risk of forgoing mental health care due to costs.
People living in rural areas have the same incidence of mental illness but far less access to mental health services compared with people living in urban areas. This brief report describes the workforce of advanced-practice psychiatric nurses (APPNs) and explores their potential to ease the rural mental health workforce shortage. METHODS: National certification data were used to describe workforce characteristics and the rural distribution of APPNs. All nationally certified APPNs in 2003 were included (N=8,751). RESULTS: APPNs were more likely than psychiatrists to live in rural areas. The ratio of APPNs to state rural populations ranged from .06 to 14.9. The mean{+/-}SD ratio of APPNs per 100,000 in the rural population was 3.0{+/-}3.0. CONCLUSIONS: APPNs have great potential to be a solution to the rural mental health workforce shortage. Even so, the number of APPNs must increase and barriers to their full scope of practice must be removed. [Journal Abstract]
This study addresses the issue of poor mental health among young to middle-career rural residents and how their employment may be affected. Using the National Longitudinal Survey of Youth (NLSY), a nationally representative survey of adults, the authors investigate how depressive symptoms affect employment patterns, and the extent to which such effects differ by rural and urban residence. Analysis of the data identified the rural sample as more likely to be married, have less education, are less likely to be black or Hispanic, and less likely to have health insurance than the urban sample. For both rural and urban subjects, individuals with depressive symptoms work less than those not depressed. Although the findings indicate no significant difference between depressed rural and urban residents in maintaining employment, questions remain about rural access to mental health services, such as employee assistance, productivity on the job, and the survival or coping strategies of rural workers with depressive symptoms.
Introduction: Childhood obesity rates appear to be more pronounced among youth in rural areas of the USA. The availability of retail food outlets in rural communities that sell quality, affordable, nutritious foods may be an important factor for encouraging rural families to select a healthy diet and potentially reduce obesity rates. Researchers use the term 'food desert' to describe communities where access to healthy and affordable food is limited. Understanding the ways in which the food environment and food deserts impact childhood obesity may be a key component to designing interventions that increase the availability of healthy and affordable foods, thus improving the health of rural communities.
Methods: The food environment was investigated in 6 rural low-income Maine communities to assess how food environments affect eating behaviors and obesity rates of rural children enrolled in Medicaid/State Children
This article by Muskie School researchers assesses the impact of the rural food environment on the eating behaviors and BMI of rural low-income children, using a statewide (Maine, 2009) household survey of parents of children on Medicaid, oversampled in six rural communities, resulting in n=272 for six target communities. The food environment was measured using modified Nutrition Environment Measures Survey in Stores (NEMS-S) for 46 retail food outlets. Multi-variate analysis assessed factors affecting home food environment, child's eating behavior and BMI. Results: Home food behaviors (how often: family eats together, child eats breakfast, vegetables served) and parent food consumption were significantly associated with children's healthy eating behaviors. The only significant predictor of childhood obesity was parent eating behavior. We observed several alternative strategies such as hunting, gathering and buying from local farmers. Parents who drove over 20 miles to shop were found to shop at stores with higher NEMS scores as compared to parents who drove shorter distances. Conclusion: Defining and identifying "food deserts" is not a promising approach to measuring the rural food environment due to long distance trips, careful price shopping, and local, alternative strategies. Strategies to place healthier food in the home should be combined with interventions directed at parents' and families' eating behaviors.
Addressing substance abuse in rural America requires extending our understanding beyond urban-rural comparisons to how substance abuse varies across rural communities of different sizes. The authors address this gap by examining substance abuse prevalence across 4 geographic levels, focusing on youth (age 12-17 years) and young adults (age 18-25 years).
Findings: Rural youth have higher alcohol use and methamphetamine use than urban youth and the more rural the area, the higher the use. Rural young adults living in rural-large areas have higher rates of substance abuse than their urban peers; those living in the most rural areas have nearly twice the rate of methamphetamine use as urban young adults. Rural youth are more likely than urban youth to have engaged in the high-risk behavior of driving under the influence of alcohol or other illicit drugs.
Conclusions: Higher prevalence rates, coupled with high-risk behavior, place rural youth and young adults at risk of continued substance use and problems associated with this use. Rural community infrastructure should be enhanced to support substance abuse prevention and intervention for these populations.
Rural youth are at greater risk than urban youth for obesity and physical inactivity. Active living research incorporates an ecological approach to promoting physical activity (PA) by recognizing that individual behavior, social environments, physical environments, and policies contribute to behavior change. Active living research and interventions have been limited primarily to urban settings. Because rural communities have unique environmental features and sociocultural characteristics, this project combines insights from current active living models with more focused consideration of the physical and social realities of rural areas. In this study, we report on our efforts to develop, test, and refine a conceptual model describing the interaction between the individual and the environment as it enhances or thwarts active living in rural communities. Our findings revealed a host of relevant "predisposing" and "enabling" factors, including sociodemographic, environmental, policy, and programmatic elements, that extend across the four domains of active living--transportation, recreation, occupation, and household. A one-size approach to PA promotion will not fit the needs of rural youth. Given the unique challenges that rural communities face, efforts to combat childhood obesity must consider rural residents a priority population. More research, interventions, and evaluations on ways to promote rural PA are needed.
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