Reports (Organized by topic, You can also view this page by date)

Access to Care

Behavioral Health


Health Care Services

Maternal/ Perinatal Health

Child and Adolescent Health

Older Americans

Oral Health


Border Health


Reports Summaries (downloadable executive and full reports)

Report 1:The Changing Rural Landscape, 2000-2010.†July 25, 2016: (pdf) 757 KB.

Our overall findings suggest that rural America experienced the recession that ended the 2000-2010 decade more severely than did urban America. Loss of income, declining population and reduced health care resources marked the period for most rural counties. Rural counties will need continued monitoring in the present decade to ascertain whether these adverse trends continue and to identify any policy approaches that can serve to ameliorate losses in health care services. .

Report 2:Colonoscopy Access and Utilization - Rural Disparities in the Carolinas, 2001- 2010.†July 8, 2016: (pdf) 1757 KB.

In South Carolina (SC), approximately 2,220 people will be diagnosed and 830 will die from colorectal cancer in 2016. In contrast, North Carolina (NC) will experience about 4,280 new cases of colorectal cancer per year and 1,480 deaths.[1] Comparatively, SC and NC have slightly lower incidence rates (40.7 and 39.6 per 100,000) than the national average (41.9 per 100,000). For mortality, findings are mixed; NC has a lower mortality rate (14.7 per 100,000), while SC has a higher mortality rate (16.2 per 100,000) than the national average (15.5 per 100,000).

Report 3:Rural-Urban Differences in Anticipated Need for Aging Related Assistance.†June 30, 2016: (pdf) 437 KB.

This brief uses information collected through the National Health Interview Survey (NHIS) in 2011-2012 to describe the degree to which rural and urban pre-retirement age adults, persons ages 40 - 64, anticipate that they may need assistance later in life, and where they anticipate obtaining such help. Details about the methods for this analysis are provided in the Technical Note. .

Report 4:Role of Free Clinics in the Rural Safety Net .†September 25, 2015: (pdf) 456 KB.

This brief explores two issues. First, we examine where free clinics are located and describe their availability in rural counties across all 50 states. This information was derived from clinic listings on the website of the National Association of Free and Charitable Clinics (NAFC). Second, through telephone interviews with leadership at 14 of the 21 state free clinic associations, we explore issues facing free clinics during the current period of change. Issues examined include perceived changes in demand subsequent to implementation of the Affordable Care Act and different funding models and strategies used by free clinics. .

Report 5:Post-Acute Stroke Care Delivery for Rural Medicare Beneficiaries.† September 23, 2015: (pdf) 268 KB.

Stroke is the fourth leading cause of death and the leading cause of long-term disability in the United States (U.S.).1,2 Post-discharge care has been shown to be vital in preventing long-term morbidity and improving functionality and quality of life for stroke patients.7,8 The most appropriate post-discharge rehabilitation care (PDRC) setting for stroke patients depends on several factors including the patient's clinical profile, patient preferences, provider recommendations, and proximity to available resources. Limited evidence suggests geographic as well as racial and ethnic disparities in receipt of PDRC. We sought to examine the following research questions.

1) Are there differences in the provision and type of PDRC received post-discharge by rurality and race/ethnicity among stroke survivors?
2) Is distance between the patient's home and the discharge hospital related to the type of PDRC recommended?
3) Are factors such as initial hospital admission (transfer from other hospital vs. referral from primary care vs. direct admission from emergency departments) related to PDRC provision and type?

Report 6:Area Deprivation is Higher Among Rural Counties—but Not All Rural Counties are Deprived .†August 8, 2015: (pdf) 1,301 KB.

The study found that rural counties are disproportionality represented among the most deprived-but not all rural counties are deprived. Aggregate county-level rates of ACSC hospitalizations and the subsequent analysis of individual children demonstrated clear increases in hospitalizations from ACSC conditions as the level of area-deprivation worsened. The remainder of this report explains the construction of the index, describes the findings when applied across a nine-state sample of potentially avoidable hospitalizations among children, and discusses the potential implications in using this index for rural health research and policy.

Report 7:The Intersection of Residence and Area Deprivation: The Case of Hospitalizations from Ambulatory Care Sensitive Conditions among Children.†August 8, 2015; (pdf) 306 KB.

The passing and implementation of the 2010 Affordable Care Act (ACA) ushered in a new era for the delivery of health services in the United States. The broad goals of expanding insurance coverage, controlling health care costs, and improving health care delivery system are ambitious and have implications for providers and the population. Observers have suggested that expanding insurance and decreasing financial barriers for receipt of health services will increase the demand for healthcare; simultaneously, the existing supply of providers remains constrained, as they struggle to accommodate new patients... Click here to read the report.

Report 8:Characteristics, Utilization Patterns, and Expenditures of Rural Dual Eligible Medicare Beneficiaries.†November 11, 2014: (pdf) 0.4 MB.

The Center for Medicare and Medicaid Innovation is charged with examining alternative models of care delivery, such as integration of services and joint financing models. Given the pressing need to improve care while simultaneously reducing costs for dual eligible beneficiaries, it is important to ascertain how rural dual eligible beneficiaries may differ from their urban peers, and to examine potential differences associated with race/ethnicity and region of residence. We used a 5 percent sample of Medicare fee for service beneficiaries for 2009 to examine three related questions about the dual eligible population:
-- What was the 2009 distribution of dual eligible beneficiaries by rurality, race/ethnicity, and region?
-- What was the aggregate and median per capita Medicare spending for dual eligible beneficiaries, and did either differ by rurality, race/ethnicity, or region?
-- What were the characteristics of high cost(upper tenth percentile in Medicare expenditures) dual eligible beneficiaries, by rurality, race/ethnicity, or region?

Report 9: Intensity of Service Provision for Medicare Beneficiaries Utilizing Home Health Services.†November 10, 2014: (pdf) 0.3 MB.

Medicare pays for home health (HH) services for beneficiaries who are homebound or for whom travel for care would be difficult or detrimental to health. These HH services are paid on a per-episode basis with an episode consisting of all services provided over a 60-day period. Each episode or claim can entail a varying number of visits; payment is adjusted to account for large differences in the number of visits. Patients with ongoing problems can receive more than one episode of care

To ensure comparability between rural and urban patients, we restricted the analysis to patients receiving care for three conditions each analyzed separately: cerebrovascular disease (stroke and related diagnoses), diabetes and joint replacement.

Report 10: Rural Border Health Chartbook II.†October 20, 2014: (pdf) 3.4MB.

The chartbook presents a cross-sectional analysis of border counties, urban and rural, comparing these counties to other counties within the four border states and to rural and urban counties in the rest of the U.S. We examined county-level rates and statistics for:
-Physical environment
-Access to care
-Health outcomes

Report 11: Differences in Case-Mix between Rural and Urban Recipients of Home Health Care.†October 6, 2014: (pdf) 364KB.

The Centers for Medicare and Medicaid Services (CMS) requires that each home health care recipient be assessed at the start of care using a set of questions developed to reflect the specific needs of home health patients. Our report is based on a review of 1,468,465 unique beneficiary assessments from the 2010 Outcome Assessment Information Set (OASIS).

Report 12: Home Health Care Agency Availability In Rural Counties†June 30, 2014: (pdf) KB.

We used Medicare Compare Home Health Agency files for 2008 to examine two aspects of home health care (HHC) across the U.S.: HHC agency availability and quality of services provided. Home health agencies are required to report the geographic areas they serve by ZIP Code; they are also required to report quality results across a range of 12 outcomes. This report is based on agency reports; we did not independently verify that services were actually provided within all listed areas.

Report 13:  Racial and Rural Differences in Cervical Cancer Prevention and Control Practices.†May 2, 2013 : (pdf) KB.

We examined differences in receipt of cervical cancer screening and HPV vaccination associated with residence and race/ethnicity. Data for the study were drawn from two nationally representative samples of medical practices, the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS).

Report 14:  Dental Sealant Utilization Among Rural and Urban Children. March 20, 2013: (pdf) 185KB.

We examined the proportion of rural children who have received dental sealants, thin plastic materials applied to the surface of the teeth to prevent or delay the development of dental decay. Our principal source of information was the Survey of Income and Program Participation (SIPP) of the Census Bureau (2001-2004 panel, the most recent SIPP version available when the project was initiated), which asked parents about children'¬ôs teeth. To confirm findings based on parental report, we also examined dental results from the 2003-2004 National Health and Nutrition Examination Survey (NHANES), which are based on professional examination of children's teeth.

Report 15:  Dialysis Availability in Rural America, Feburary 14, 2013: (pdf) 572KB.

End stage renal disease (ESRD), a potential consequence of diabetes, hypertension and other chronic conditions, leaves the individual in need of a kidney transplant or kidney dialysis to survive.† Depending on their clinical condition and service availability, patients may receive hemodialysis, generally performed in a clinic, or peritoneal dialysis, which can be performed at home. We used the Medicare Dialysis Compare files, which contain information about dialysis facilities in 2008, and the Standard Analysis File of the US Renal Data System, which contains information about ESRD patients in 2008, to explore the availability of services in rural America.† Our research questions were:

  • What is the current distribution of dialysis facilities, by characteristics and capacity, across levels of rurality?
  • How does the distribution of facilities compare to estimated need, defined as patients with ESRD?
  • How do dialysis facility performance measures compare across levels of rurality?
Report 16:  HIV/AIDS in Rural America: Prevalence and Service Availability, Janury 28, 2013: (pdf) 1.1 MB.
This report examines two main subjects: the prevalence of HIV/AIDS in rural counties across 28 states in 2008, and the rural-versus-urban distribution of Ryan White providers. The latter provide care for uninsured and financially vulnerable individuals and serve nearly half of all persons living with HIV/AIDS in the rural United States. While many individuals receive care from other sources, the Ryan White Programs national scope and large service population make it good proxy for the availability of services for persons living with HIV/AIDS in rural counties.

Although this HIV/AIDS prevalence data is not fully representative of all rural America (only 28 states published county-level data and could be included in the analysis), information was available for states in each major Census region. All 50 states are included in the analysis of Ryan White service availability. Overall, the report represents an initial attempt to portray the distribution of patients and services across the rural-urban continuum.

Report 17:  Rural Border Health Chartbook, Janury 10, 2013: (pdf) 1.1 MB.
    Our chartbook adds to existing knowledge regarding conditions in the border region by examining potential geographic and ethnic disparities among U.S. border residents. Our chartbook describes select indicators related to access to care, women's preventive services, oral health, infectious and communicable diseases and mental health that have been previously identified as serious disparities warranting programmatic and policy interventions. We examine these issues among residents of the four border states, Arizona, California, New Mexico, and Texas, comparing indicators by ethnicity (Hispanic vs. non-Hispanic), rurality (rural vs. urban), and proximity to border (border vs. non-border). Our findings should be useful in educating public health officials, policymakers and intervening organizations such as the United States Border Health Commission, the Office of Rural Health Policy, and the National Rural Health Association.
Report 18:  State Policy Levers for Addressing Preventive Dental Care Disparities for Rural Children:  Medicaid Reimbursement to Non-Dental Clinicians for Fluoride Varnish and Dental Hygiene Supervision in Primary Care Safety Net Settings. March 13, 2012: (pdf) 232KB.
    Previous work has found that rural children are less likely to receive preventive dental services or any dental services at all, during the year than are urban children. The children’s oral health care safety net can be characterized in terms of the settings in which care is offered, the clinicians who offer it, and the sources of payment. In this report we examine two questions:
  • To what degree have states expanded access to and reimbursement of fluoride varnish applications by allowing non-dental clinicians to provide this service?
  • To what extent can dental hygienists provide select preventive dental services in primary care safety net settings without supervision or under general, indirect, or public health supervision?

Report 19Handling the Handoff:Rural and Race-Based Disparities in Post-Hospitalization Follow-up Care Among Medicare Beneficiaries with Diabetes. September 20, 2011 : (pdf) 561kKB
  • Diabetes is one of the most common chronic diseases, affecting an estimated 23.6 million people in the United States (7.8% of the total population)
  • Rural African American and Hispanic residents with diabetes are less likely to exhibit good control of their condition, putting them at greater risk for the consequences of this disease, such as kidney failure, blindness and amputation.
  • Effective outpatient care is key to diabetes management. Absence of such care, conversely, may play a role in poorer diabetes control in rural areas.
  • The present report uses information regarding Medicare beneficiaries with diabetes to examine the provision of care in rural America. It provides estimates of hospital admission rates for rural Medicare beneficiaries with diabetes, tracks the proportion of patients who receive adequate outpatient care post discharge, and assesses subsequent readmissions to the hospital. It also explores the potential for race-based disparities in care for diabetes.
  • The data were obtained from the 2005 Medicare claims data from the Chronic Condition Warehouse (CCW), merged with the 2007 Area Resource File (ARF).


Report 20Rural Acute Care Hospital Boards Of Directors: Education and Development Needed. January 23, 2011 : (pdf) 1.4MB
  • Is Your Hospital'ôs Board Prepared to Govern?
  • Our study examined the structural, leadership, and educational needs of rural hospital boards, as viewed by rural hospital board chairs and chief executive officers (CEOs).
  • Overall, we found that many rural chairs and CEOs lacked full confidence in their board'ôs ability to conduct its oversight and governance functions effectively.


Report 21Diet, Physical Activity, and Sedentary Behaviors as Risk Factors for Childhood Obesity: An Urban and Rural Comparison. November 23, 2010 : (pdf) 1.2MB
  • Knowledge about the prevalence of obesity in rural America is very limited.
  • The current report expands on prior work by using information from the 1999-2006 National Health and Nutrition Examination Surveys (NHANES).
  • The prevalence of overweight and obesity is higher among rural children than urban children.


Report 22Community Health Center and Rural Health Clinic Presence Associated with Lower County-Level Hospitalization Rates for Ambulatory Care Sensitive Conditions. August 12, 2009 : (pdf) 379KB
  • Two principal types of federally designated safety net providers are present in rural areas: federally qualified community health centers (CHCs) and rural health clinics (RHCs).
  • The present study sought to clarify the current understanding of the contribution that CHCs and RHCs make to access to care, as measured by rates of ACS hospitalization.
  • Our research adds to present knowledge by examining the impact of RHC presence across multiple states and all county types.


Report 23Health Disparities: A Rural – Urban Chartbook. January 13, 2009 : (pdf) 187KB
  • Rural minorities experience disparities in health and health care delivery.
  • The Chartbook seeks to expand the work of the National Healthcare Disparities Reports, issued annually by the Agency for Healthcare Research and Quality.
  • The present Chartbook expands upon prior work by examining potential disparities among rural populations in health, health behaviors, preventive services and diabetes care.


Report 24Dental Health and Access to Care among Rural Children: A National and State Portrait. September 20, 2008 : (pdf) 212KB
  • Although children’s dental health in the U.S. has improved over recent decades, a subset of children continues to suffer dental disease severe enough to constitute a public health problem.
  • The Chartbook that follows examines dental health status, use of preventive services, and dental insurance among rural and urban children.
  • Overall, rural children were less likely than urban children to have excellent teeth, as described by their parents (41.0% versus 42.9%).


Report 25Use of Preventive Services Among Hispanic Sub-Groups: Does One Size Fit All? July 2007 : (pdf) 65KB
  • We explored the use of preventive health services among Mexicans, Puerto-Ricans, Cubans, and “other” Latinos and examined how the use of preventive services was influenced by nation of origin and by rural versus urban residence.
  • Rural residents, whether Hispanic or non-Hispanic White, were generally less likely to receive preventive services.
  • Hispanics were significantly less likely than whites to report having received any of the preventive services studied.


Report 26Overweight and Physical Inactivity among Rural Children Aged 10-17: A National and State Portrait. May 2007 (Revised October 2007) : (pdf) 424KB
  • Recent studies have found that the tide of child obesity is rising faster in rural communities in several states, including Pennsylvania, New Mexico, Michigan, West Virginia, and North Carolina.
  • Our report examines the presence of overweight and obesity among children in both rural and urban settings using the data from a recent national survey, the 2003 National Survey of Children’s Health (NSCH).
  • In 2003, 30.6% of children aged 10-17 years old were overweight, 14.8% of which were obese. Rural children (16.5%) were more likely to be obese than urban children (14.4%).


Report 27Rural Hospitals and Spanish Speaking Patients with Limited English Proficiency. October 2006 : (pdf) 66KB
  • 40 million Latinos in the United States, 14.2% of the population, have limited English proficiency (LEP), which can lead to poor health outcomes in the absence of effective medical interpretation or translation services.
  • Our study explored how rural hospitals are meeting the needs of LEP patients, reflecting the Federal standards for culturally and linguistically appropriate services (CLAS standards).
  • Seventy-eight percent of hospitals reported having a written policy related to language assistance and 91.7% reported having tools for patients to communicate their language needs, yet only 40% reported language assistance advertisements in Spanish.


Report 28Early Alcohol Use, Rural Residence, and Adulthood Employment. June 2006 : (pdf) 66KB
  • Drinking during youth and early adulthood was common in the early 1980’s. Nearly half (47.6%) of respondents reported drinking before age 18, and 55.3% reported binge drinking.
  • Generally speaking, drinking behaviors did not differ significantly between rural and urban residents.
  • Rural youth surveyed in 1979-1983 were as likely as their urban counterparts to start drinking before the age of 18, binge drink before 18, and report that work or school was impacted by drinking.


Report 29Trends in Uninsurance among Rural Minority Children. June 2006 : (pdf) 95KB
  • Rural children have been consistently less likely to have insurance than urban children, and minority status adds to the disparity
  • Several factors consistently influenced the odds that a child would lack health insurance, measured in 1980, 1986, 1994 and 2001. Compared to urban white children, rural white children and Hispanic children, both urban and rural, were more likely to lack insurance.
  • Factors consistently associated with lack of health insurance, such as poverty, low education, and non-parental households, have been more prevalent among minority children since 1979, and remained so in 2001. Rural disadvantages for minority children are marked.


Report 30Mode of Travel and Actual Distance Traveled For Medical or Dental Care By Rural and Urban Residents. May 2006 : (pdf) 91KB
  • Across the whole US, the average distance traveled for medical/dental care was 10.2 miles.
  • Rural trips averaged 17.5 miles, versus 8.3 miles for urban residents.
  • Nationwide, the average trip for medical/dental care took 22.0 minutes.
  • Rural trips averaged 27.2 minutes, versus 20.7 minutes for urban residents.


Report 31Disability Burdens among Older Americans Associated with Gender and Race/Ethnicity in Rural and Urban Areas. September 2005 : (pdf) 162KB
  • Among a cohort of Americans aged 65 to 69 in 1982, in seven of the eight subgroups, individuals in rural areas lived longer lives than those in urban areas.
  • There were striking differences among the high and low education groups, with individuals with more education living substantially longer, less disabled lives.
  • Women lived longer, more disabled lives than men.
  • For most subgroups, African Americans lived shorter, more disabled lives than Whites.


Report 32Mental Health Risk Factors, Unmet Needs, and Provider Availability for Rural Children. September 2005 : (pdf) 150KB
  • Rural children are not protected from biologic and environmental factors that can cause mental health problems. However, few studies report specifically on mental health needs and the receipt of services by rural children.
  • The study reported here uses the 2001 National Health Interview Survey, a nationally representative survey of the US population, to assess the prevalence of sub-clinical mental health problems among children, the degree to which children with potential problems use mental health and general providers for these problems, and the degree of unmet need.
  • Possible mental health problems are identified based on the Strengths and Difficulties Questionnaire (SDQ), rather than reports of diagnosed problems, to control for potential differences in use of services and thus receipt of a clinical diagnosis.


Report 33  Effects of Uninsurance during the Preceding 10 Years on Health Status among Rural Working Age Adults. September 2005 : (pdf) 538KB
  • Our study sought to determine if individuals with longer periods of uninsurance, in multivariable analyses controlling for income, poverty and health status/behavior at the beginning of the time period, will be more likely to be overweight, to report experiencing hypertension or diabetes, or to describe their health as “fair” or “poor.”
  • We also looked to see if the effects of uninsurance would be greater in rural than in urban respondents, and greater for minority rural populations than for white rural populations.


Report 34Poverty, Stress, and Violent Disagreements in the Home among Rural Families. August 2005 : (pdf) 12KB
  • Studies have shown that witnessing domestic violence increases a child’s chance of having emotional/ behavioral problems and being in abusive relationships in adulthood, even without co-occurring child maltreatment.
  • The study reported here used information from a large, nationally representative telephone survey of households with children, carried out by the National Center for Health Statistics, to explore the prevalence of violent disagreements in the home.
  • “Violent” disagreements are those that involve hitting or throwing, as opposed to heated argument or calm discussion.
  • We also examined two factors, poverty and parenting stress, hypothesized to be associated with violent disagreement.


Report 35Depression in Rural Populations: Prevalence, Effects on Life Quality, and Treatment-Seeking Behavior. May 2005 : (pdf) 68KB
  • In light of the greater prevalence of depression among rural populations, rural shortages of mental health personnel should be addressed.
  • The ability of the medical care system to address mental health care through tele-education should be expanded.
  • The ability of rural first responders to recognize mental health problems should be enhanced through training.
  • Rural safety net programs should cooperate with each other and with the community to provide access to mental health services.
  • Medicaid fosters access to mental health care among beneficiaries at a level paralleling private insurance


Report 36Violence and Rural Teens: Teen Violence, Drug Use, and School-Based Prevention Services in Rural America. March 2005 : (pdf) 239KB
  • This study had three main purposes: (1) to explore the prevalence of violence-related exposures and drug use among rural teens, (2) to investigate the effects of race and gender on the risk of exposure to violence and drug use, and (3) to compare the policies and mental health care services of rural and urban schools.
  • This study found no evidence to support the common assumption that rural youth are protected from exposure to violence. Rural teens are equally or more likely than suburban and urban teens to be exposed to violent activities, including weapons carrying, fighting, fear of violence, and suicide behaviors.
  • Rural teens are at significantly greater risk of using cigarettes, chewing tobacco, crack/cocaine, and steroids than both suburban and urban teens. Of important note is the high prevalence of “crystal-meth” use among rural teens.


Report 37Impact of Medicaid Managed Care, Race/Ethnicity, and Rural/Urban Residence on Potentially Avoidable Maternity Complications: A Five-State Multi-level Analysis. December 2004 : (pdf) 124KB
  • Complications of pregnancy affect the lives of many women and infants. This study examines pregnancy-related complications using Potentially Avoidable Maternity Complications (PAMCs) as an indicator of access.
  • Mothers delivering in rural hospitals had lower PAMC risks than those with urban deliveries.
  • In rural hospitals, African American women had greater PAMC risks than white women.
  • In urban hospitals, adjusted PAMC risks were substantially lower for Hispanics and Asians than for whites.


Report 38Assessment of Barriers to the Delivery of Medicare Reimbursed Diabetes Self-Management Education in Rural Areas. September 2004: (pdf) 319KB
  • Diabetes is one of the most prevalent chronic conditions among older adults in the United States, disproportionately affecting women and minorities. If untreated, diabetes can lead to severe complications or death. However, this disease can be successfully managed through exercise, proper nutrition, and as appropriate, prescription medication.
  • Diabetes Self-Management Education (DSME) programs provide services to newly diagnosed and chronic sufferers with diabetes. The objective of this project was to explore the barriers that rural practitioners face in providing diabetes education services to Medicare beneficiaries.


Report 39Diabetes & Hypertension among Rural Hispanics: Disparities in Diagnostics and Disease Management. August 2004 : (pdf) 306KB
  • Rural and minority populations are particularly vulnerable to the consequences of lower access to care. This project investigated the association of Hispanic ethnicity and rural residence on rates of diagnosis of diabetes and hypertension, indicators of poor medical control (i.e. glycemic control, blood pressure control, lipid control) among people with these diagnoses, and likelihood of having the undiagnosed conditions.
  • The study found modest disparities in health, with rural Hispanics having a higher prevalence of diabetes. Among persons with diagnosed diabetes or hypertension, rural Hispanics did not experience poorer glycemic or blood pressure control. Rural Hispanics with diabetes did exhibit poorer control of co-morbid hypertension than did whites.


Report 40Investigating Rural Emergency Medical Service (EMS) Infrastructure. August 2004 : (pdf) 473KB
  • We explore a potential indicator of EMS availability, Expected Annual Emergency Miles per Ambulance (EXAMB).
  • In three of five states, EXAMB values varied in parallel with other measures of resource availability.
  • In Oregon and Wyoming, no relationship was found between the EXAMB indicator and measures of rurality or health services availability.
  • In all states, the EXAMB was positively related to the proportion of the county population in poverty


Report 41Development of a Methodology for Assessing the Effect of a Lay Home Visitation Program for Rural High-Risk Women and Infants. February 2004: (pdf) 326KB
  • The positive impact of paraprofessional support programs on use of services was consistently documented in the literature. However, their effects on pregnancy and birth outcomes among low-income, rural women were less clear.
  • This small pilot study tested a linked data set approach for evaluating the effectiveness of a community health worker program for women at risk for poor pregnancy and birth outcomes. We applied the method to a home visitation program that uses lay health workers to provide health education, referral, and social support to rural, low-income pregnant African American women and their infants receiving Medicaid.


Report 42Rural Minority Children's Access to and Timeliness of Immunizations: 1993-2001. November 2003 : (pdf) 306KB
  • Children living in rural areas are less likely to receive newly recommended vaccines within the first two years after introduction of the recommendation. After 2 years, there are few significant differences in the percentage of children who are up to date with their childhood immunizations based on whether they live in urban or in rural areas.
  • There are no significant differences in the percentages of children up to date with their immunizations between Whites, Blacks, and Hispanics living in urban and rural areas.
  • By 2001 lack of health insurance was the strongest predictor for children not receiving their immunizations in a timely manner.
  • When using national surveys, there is significant year-to-year variation in the percentage of children who are up to date with their immunizations.


Report 43Prevalence of Health Related Behavioral Risk Factors Among Non-Metro Minority Adults. August 2003 : (pdf) 516KB
The Report shows the most common factors that pose a health related risk factor among non metro minority adults. The report lists these as the primary cause:
  • For all groups except African Americans, non-metro rates of current smoking exceed urban rates.  Educational interventions may be failing to reach non-metro populations, particularly Hispanics and adult “others,” principally American Indian .
  • Smokeless tobacco use is a rural behavior, most common among adult “others,” particularly American Indians.  Educational campaigns need to target rural audiences.  
  • Seat belt use is consistently lower among non-metro populations, and non-metro residents of “other” races in particular.  Interventions are needed to increase seat belt use in rural areas.
  • Non-metro white and African American adults reported higher rates of lifetime and current abstention than their urban peers and had the lowest rates of potentially abusive drinking.  Reported heavy drinking was highest among non-metro Hispanics, followed by adult “others.”  Education, screening and intervention efforts among Hispanics and adult “others” need to be improved.




Report 44Emergency Department Use by Medically Indigent Rural Residents. July 2003 : (pdf) 463KB
  • The study reported here examined ED use, combining national data and South Carolina state data to estimate: 1. Uncompensated charges in rural ED’s nationally  2. The ameliorating effects of rural community health centers (FQCHC’s) on ED use by rural residents
  • Two infrastructure programs appear particularly relevant for ameliorating the effects of uninsured patients on rural hospitals: 1. Conversion of appropriate rural hospitals to Critical Access Hospitals, with increased reimbursement, offers one method for ensuring that rural hospitals remain viable in the face of continued high levels of uninsured patients in their ED’s. 2. Expanding community health centers into more rural counties. The research reported here supports the value of community health centers, with their expanded access for all populations, as a means of reducing ED use.


Report 45Hospitalization for Ambulatory Care Sensitive Conditions: Asthma, Diabetes, and Congestive Heart Failure in South Carolina. May 2003: (pdf) 308KB
  • Hospitalization rates for ambulatory care sensitive conditions, diseases for which primary care in the preceding six months could have reduced or eliminated the need for hospitalization, are a commonly used indicator of disparities in access to care.
  • the present study examined hospitalization for diabetes, congestive heart failure and asthma among residents of South Carolina who were insured by Medicaid or by a large private insurance plan.
  • Hospitalization rates were not consistently higher for rural or minority populations than for urban white populations.


Report 46Access to Care among Rural Minorities: Older Adults. Feb. 15, 2003 : (pdf) 1.2(MB)
  • Some Key Findings

  • Development of a Research Agenda on the Issues of Access to Care and Reduction of Health Status Disparities of Rural African Americans in South Carolina
  • A greater proportion of non-metro than metropolitan elders report limitations in their ability to carry out activities of daily living (44% versus 37%).
  • Government programs (Medicare and Medicaid) are the principal source of insurance for non-metro minority elders.


Report 47: Access to Care Among Rural Minorities: Children. Feb. 15, 2003 : (pdf) 465KB
This report covers the status of non-metro childern as followings:
Mon's Education
Health insurance
Health care services


Report 48Access to Care Among Rural Minorities: Working Age Adults. January 2003 : (pdf) 275KB
  • The South Carolina  Rural Health Research Center studies the access to health care among working age adults of rural minorities. Data from the 1997 – 1998 National Health Interview Survey were used to examine health insurance coverage and recent physician visits among rural working age adults (persons aged 18 – 64). 
  • Low income and low levels in the non-metro areas translated into jobs that did not offer health insurance. Non-metro minorities were particularly disadvantaged, with rates of uninsurance ranging from 47% among the Hispanic population to 30% among non-metro African Americans.




Report 49Hypertension, Diabetes, Cholesterol, Weight, and Weight Control Behaviors Among Non-Metro Minority Adults.  December 2002 : (pdf) 563KB
The South Carolina Rural Health Research Center addresses the issue of Hypertension , Diabetes , cholesterol , weight , and weight control behaviors among non metro minority adults. This report uses data from the 1998 NHIS to examine the prevalence of the selected problems.
  • The highest rates of reported hypertension were found among rural African Americans, one third of whom (34%) reported having high blood pressure.
  • Across non-metro residents, about seven percent of African Americans and seven percent of “other” race adults reported that they had diabetes.


Report 50Demand For Medical Services Among Previously Uninsured Children: The Roles Of Race And Rurality. October 2002: (pdf) 95KB
  • This project examined the use of medical services over nearly two years among newly insured and continuously insured children, ages six through twelve, in the CHIP and Medicaid programs in South Carolina and West Virginia.
  • There was no evidence of pent-up demand for medical care among newly insured children, when they were compared to children who had been continuously insured.
  • In neither state did newly insured children’s pattern of demand vary by whether a child lived in an urban or rural area or by the race of a child.
  • Rurality and race affected all children’s medical care utilization, regardless of their prior health insurance status.




Report 51Diabetes & Cardiovascular Disease in Rural African Americans. August, 2002 : (pdf) 295KB
  • This project investigated the association of race and rural residence on rates of diagnosis of diabetes and cardiovascular disease and indicators of good medical control among people with diabetes, hypertension and cardiovascular (CV) disease.
  • Among rural African Americans with diagnosed diabetes, 60.6% have inadequate diabetic control, versus 42.5% of urban whites.
  • A quarter of rural African Americans with diagnosed diabetes (24.5%) have diabetic retinopathy, compared to only 11.6% of urban whites.
  • Rural African Americans (7.5%) and urban African Americans (8.6%) were more likely than rural (2.8%) and urban (3.8%) whites to have undiagnosed diabetes.


Report 52Minorities in Rural America: An Overview of Population Characteristics. June 19, 2002 : (pdf) 0.5MB
The South Carolina Rural Health Research Center addresses these questions:
  • Where do rural minorities live?
  • How is the rural minority population distributed across ages and sexes?
  • What is the economic structure of rural minority communities?
  • What health resources are available in rural minority communities?