County-Level Poverty Is Equally Associated With Unmet Health Care Needs in Rural and Urban Settings

Context: Regional poverty is associated with reduced access to health care. Whether this relationship is equally strong in both rural and urban settings or is affected by the contextual and individual-level characteristics that distinguish these areas, is unclear. Purpose: Compare the association between regional poverty with self-reported unmet need, a marker of health care access, by rural/urban setting. Methods: Multilevel, cross-sectional analysis of a state-representative sample of 39,953 adults stratified by rural/urban status, linked at the county level to data describing contextual characteristics. Weighted random intercept models examined the independent association of regional poverty with unmet needs, controlling for a range of contextual and individual-level characteristics. Findings: The unadjusted association between regional poverty levels and unmet needs was similar in both rural (OR = 1.06 [95% CI, 1.04-1.08]) and urban (OR = 1.03 [1.02-1.05]) settings. Adjusting for other contextual characteristics increased the size of the association in both rural (OR = 1.11 [1.04-1.19]) and urban (OR = 1.11 [1.05-1.18]) settings. Further adjustment for individual characteristics had little additional effect in rural (OR = 1.10 [1.00-1.20]) or urban (OR = 1.11 [1.01-1.22]) settings. Conclusions: To better meet the health care needs of all Americans, health care systems in areas with high regional poverty should acknowledge the relationship between poverty and unmet health care needs. Investments, or other interventions, that reduce regional poverty may be useful strategies for improving health through better access to health care.     

Social capital and health in rural and urban communities in South Australia

Objective : This paper seeks to compare the relationships between social capital and health for rural and urban residents of South Australia.
Methods : Using data from a South Australian telephone survey of 2,013 respondents (1,402 urban and 611 rural), separate path analyses for the rural and urban samples were used to compare the relationships between six social capital measures, six demographic variables, and mental and physical health (measured by the SF-12).
Results : Higher levels of networks, civic participation and cohesion were reported in rural areas. Education and income were consistently linked with social capital variables for both rural and urban participants, with those on higher incomes and with higher educational achievement having higher levels of social capital. However, there were also differences between the rural and urban groups in some of the other predictors of social capital variables. Mental health was better among rural participants, but there was no significant difference for physical health. Social capital was associated with good mental health for both urban and rural participants, but with physical health only for urban participants. Higher levels of social capital were significantly associated with better mental health for both urban and rural participants, but with better physical health only for urban participants.
Conclusions and implications : The study found that social capital and its relationship to health differed for participants in rural and urban areas, and that there were also differences between the areas in associations with socioeconomic variables. Policies aiming to strengthen social capital in order to promote health need to be designed for specific settings and particular communities within these.     

Trauma and Substance Use Disorders in Rural and Urban Veterans

Context: Disparities in the prevalence, morbidity, and mortality of multiple mental health conditions have been described between rural and urban populations. However, there is limited information regarding differences in exposure to trauma and trauma‐related mental health conditions in these populations. Given the number of veterans who are returning to rural communities after serving in Operation Enduring Freedom and Operation Iraqi Freedom, differences in trauma exposure are of particular relevance. Trauma exposure is related to a variety of mental health disorders including substance use disorders (SUD). Purpose: The objectives of this preliminary study were to describe lifetime military and nonmilitary trauma and to compare trauma history between rural and urban veterans in SUD treatment. Methods: Sixty adults in SUD treatment were enrolled at 3 Veterans Health Administration sites in Nebraska over a 3‐month period in 2008. Subjects completed an interview with study staff, which assessed SUD diagnoses and childhood, lifetime, and military trauma. Rural or urban status was determined by self‐report of childhood residence. Childhood trauma, lifetime trauma, and response to military trauma were compared between rural and urban veterans. Findings: Although there were no significant differences in trauma exposure between rural and urban groups, there was an association between specific types of trauma and measures typically associated with increased substance abuse severity and poorer SUD treatment outcome. Conclusion: This is the first study, to our knowledge, which compared trauma exposure between rural and urban veterans and identified an association between childhood trauma exposure and multiple SUD treatment attempts.     

The Health of Caregiving Grandmothers: A Rural‐Urban Comparison

Purpose: The purpose of this study was to compare the characteristics of rural versus urban caregiving grandmothers along with their physical and mental health status. Methods: A secondary analysis of data produced from the first wave of a longitudinal study of 485 Ohio grandmothers was conducted. Health status was measured using the SF‐36 Health Survey and the 20‐item CES‐D depression scale. Rural‐urban classification was made using Rural Urban Commuting Area (RUCA) codes based on resident ZIP codes, identifying 97 rural and 388 urban grandmothers in the sample. Findings: The rural and urban grandmothers were similar in age, educational level and employment status; however, 90% of the rural grandmothers compared with 60% of the urban grandmothers were white. Rural grandmothers were most likely to have traditional nonresidential relationships with their grandchildren. Approximately 38% of both the rural and urban grandmothers served as primary caregivers for their grandchildren, but a lower percentage of rural grandmothers lived in multigenerational homes. There was no significant difference between the rural and urban grandmothers in relation to physical or mental health. Among rural grandmothers, primary caregivers had significantly lower levels of mental health compared with the other caregiver groups. Conclusions: These findings suggest that rural and urban grandmothers have similar levels of physical and mental health, despite differences in demographics and caregiving arrangements. Health promotion efforts with rural caregiving grandparents are indicated, addressing both mental and physical health.     

Residential Rurality and Oral Health Disparities: Influences of Contextual and Individual Factors

The purposes of the study were (a) to identify disparities between urban and rural adults in oral health and (b) to examine contextual (i.e., external environment and access to dental care) and individual (i.e., predisposing, enabling, and lifestyle behavioral) factors associated with oral health problems in a community population. Study data were derived from a two-stage, telephone-mailed survey conducted in 2006. The subjects were 2,591 adults aged 18 years and older. Cochran-Mantel-Haenszel statistics for categorical variables were applied to explore conditional independence between both health access and individual factors and oral health problems after controlling for the urban or rural residence. Logistic regression was used to investigate the simultaneous associations of contextual and individual factors in both rural and urban areas. Approximately one quarter (24.1%) of the study population reported oral health problems. Participants residing in rural areas reported more oral health disparities. Oral health problems were significantly associated with delaying dental care. These problems also were more common among those who were less educated, were African American, skipped breakfast every day, and currently smoked. The study findings suggest that oral health disparities persist for people in rural areas, and improving oral health status is strongly related to better access to oral health care and improved lifestyles in both rural and urban areas.     

浙江省部分中学生的心理健康状况

目的 探讨浙江省中学生心理健康状况。方法 用症状自评量表（SCL－90）对727名中学生进行评定。结果 心理问题检出率为17．47％,主要问题是强迫症状,人际敏感和偏执,SCL－90总均分年级之间和我显性。但城市学生显高于农村学生,成绩好的学生显高于成绩差的学生,独生与非独生子女,单亲和非单亲学生心理问题检出率差异无显性。结论 中学生的心理健康问题仍不容忽视。     

Impacts of migration on health and well-being in later life in China: Evidence from the China Health and Retirement Longitudinal Study (CHARLS)

Unprecedented internal migration to urban areas has happened in China over the last few decades. While, we know that migration has a bidirectional relationship with health, this relationship has only been studied to a limited extent in China. In particular, the exiting literature has neglected the effects of migration on health and well-being in later life, instead focusing on the relationship between these outcomes over the short term, and also have only focused on temporary rural-to-urban migrants with a rural hukou rather than the broader range of internal migration flows. The hukou system, also known as the Chinese household system, an institutional feature with the power to restrict population mobility and access to local welfare resources.Using an inter-disciplinary approach, drawing on literature from economics, epidemiology and sociology, this paper conceptualises and examines the association between different forms of internal migration and their relationship with later-life health and well-being in China. It then attempts to draw conclusions on likely mechanisms through which migration affects health and well-being, including taking account of the selective nature of migration. To do this, we use the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative and multi-disciplinary dataset that examines the circumstances of the Chinese population aged over 45 years old.The results show that there are strong associations between migration status and later life health and well-being in China, with migrants to or within urban areas report the greatest health. Even after controlling for the selective nature of migration and other post-migration factors, there is still an unexplained, positive and statistically significant association between temporary rural-to-urban migration and depression scores. In addition, there are no differences between rural-to-rural migrants and rural non-migrants across all models. In terms of relevant mechanisms, selection of migrants seems to be particularly important in explaining the health and mental health differences between non-migrants and migrants to or within urban areas. Current socioeconomic circumstances and post-migration adaptation also explain some health differences between migrant groups and non-migrants.     

Stress and Coping Among Missouri Rural and Urban Children

A cross-sectional survey using a convenience sample of 157 Missouri rural and urban children (ages 8-13 years) yielded no significant differences in perceptions of stressors or use of coping strategies for dealing with those stressors between rural and urban children. The Feel Bad Scale and the Schoolagers' Coping Strategies Inventory measured the children's perceptions of stressors and use of coping strategies. Rural children experienced stressor levels equivalent to urban children, yet they were underserved in mental and physical health needs. The children studied reported self-care through coping strategies for management of their stressors. Longitudinal research is needed to identify the impact of stress and interventions on the health and behavior of children in rural settings.     

农民工、城市居民、农村居民心理韧性及对心理健康的影响

目的 了解农民工、城市居民、农村居民的心理韧性与心理健康现状及差异,分析心理韧性对心理健康的影响。方法 采用心理韧性量表和简要症状量表,通过多水平分层空间随机抽样方法抽取武汉市18～45岁1 135名农民工、1 145名农村居民和1 249名城市居民,使用电脑语音辅助问自答卷技术进行问卷调查。结果 农民工、农村居民、城市居民心理韧性总得分分别为（3.48±0.65）、（3.43±0.65）、（3.39±0.63）分,农民工心理韧性水平高于城市居民,差异有统计学意义（F = 5.655,P = 0.004）。农民工、农村居民、城市居民简要症状量表得分分别为（1.96±0.61）、（1.99±0.57）、（2.05±0.58）分,城市居民心理健康水平低于农民工和农村居民,差异有统计学意义（F = 8.036,P＜0.001）。心理韧性各维度和心理健康状况各维度之间均具有相关性(r为-0.132～-0.062,P值均小于0.001)。广义线性模型分析结果显示,控制其他因素后,心理韧性中的情感韧性对心理健康各维度均有正向预测作用（P＜0.001）。结论 心理韧性可以预测心理健康状况,农民工的心理韧性和心理健康水平都相对较高。     

Urban primary health care in Africa: a comparative analysis of city-wide public sector projects in Lusaka and Dar es Salaam

Since the 1980s, a number of health system interventions in Sub-Saharan Africa have targeted urban areas, reflecting increasing attention to the contextual contrasts between urban and rural health settings. This article compares attempts in two projects-in Zambia and Tanzania-to strengthen urban primary health care in the public sector and make it more inclusive in a dual sense: making quality services more accessible to the poor; and fostering community involvement in health care and health-related activity. The paper reveals that the projects have produced many similar outcomes (both positive and negative), despite differences in their managerial arrangements. After identifying issues that may need to be considered in other health initiatives, the discussion revisits the urban/rural dimension of health care in relation to three key aspects: the by-passing of primary services, community participation and inter-sectoral action.     

Unravelling the extent of inequalities in health across urban and rural areas: Evidence from a national sample in England

Studies of inequalities in health between rural and urban settings have produced mixed and sometimes conflicting results, depending on the national setting of the study, the level of geographic detail used to define rural areas and the health indicators studied. By focusing on morbidity data from a national sample of individuals, this study aims to examine the extent of inequalities in health between urban and rural areas, as well as inequalities in health across rural areas of England. Multilevel analyses for poor self-rated health, overweight and obesity, and common mental disorders are reported for a sample of 30,776 individuals aged 18 years and older (obtained from the Health Survey for England years 2000–2003 combined) and distributed across 3645 small areas classed in four categories: two groups of urban areas (Greater London area or ‘other cities’) and two types of rural settings (semi-rural areas or villages). Results show that rural dwellers were significantly less likely than residents of urban areas to report their health as being fair or poor and to report common mental disorders, independent of their socio-demographic characteristics. However, as for urban settlements, there were significant variations in health across semi-rural areas and across villages, indicating the presence of health inequalities within rural settings in England. These inequalities were not fully explained by the individual composition of the areas or by the available measures of area socioeconomic conditions, indicating that in rural contexts more specific factors may have significance for health. Different policies and services for health promotion and care may need to be targeted to different types of rural areas.     

水利院校大学生的社会支持与其心理健康水平的相关研究

目的 了解水利院大学生的社会支持与心理健康水平的相互关系。方法 采用社会支持评定量表和症状自评量表（SCL－90）对某水利院校大学生326名进行测查。结果 水利院校大学生SCL－90的9个因子均分与社会支持各因子呈一定程度的相关，差异有显性（P＜0．05），男，女大学生在社会支持方面差异无显意义。城，乡大学生在社会支持总分和客观支持分上差异存在显性（P＜0．05）；不同年级在支持的利用度方面差异存在显性（P＜0．05）。结论 水利院校大学生的社会支持与其心理健康水平有一定的联系。     

The Relationship Between Rural Status,Individual Characteristics,and Self‐Rated Health in the Behavioral Risk Factor Surveillance System

Purpose: To examine rural status and social factors as predictors of self‐rated health in community‐dwelling adults in the United States. Methods: This study uses multinomial logistic and cumulative logistic models to evaluate the associations of interest in the 2006 US Behavioral Risk Factor Surveillance System, a cross‐sectional survey of 347,709 noninstitutionalized adults. Findings: Self‐rated health was poorer among rural residents, compared to urban residents (OR = 1.77, 95% CI: 1.54, 1.90). However, underlying risk factors such as obesity, low income, and low educational attainment were found to vary by rural status and account for the observed increased risk (OR = 1.03, 95% CI: 0.94, 1.12). There was little evidence of effect modification by rural status, though the association between obesity and self‐rated health was stronger among urban residents (OR = 2.50, 95% CI: 2.38, 2.64) than among rural residents (OR = 2.18, 95% CI: 2.03, 2.34). Conclusions: Our findings suggest that differences in self‐rated health by rural status were attributable to differential distributions of participant characteristics and not due to differential effects of those characteristics.     

Differences in health-related quality of life in rural and urban veterans

OBJECTIVES: We sought to determine whether disparities in health-related quality of life exist between veterans who live in rural settings and their suburban or urban counterparts. METHODS: We determined health-related quality-of-life scores (physical and mental health component summaries) for 767109 veterans who had used Veterans Health Administration services within the past 3 years. We used rural/urban commuting area codes to categorize veterans into rural, suburban, or urban residence. RESULTS: Health-related quality-of-life scores were significantly lower for veterans who lived in rural settings than for those who lived in suburban or urban settings. Rural veterans had significantly more physical health comorbidities, but fewer mental health comorbidities, than their suburban and urban counterparts. Rural-urban disparities persisted in all survey subscales, across regional delivery networks, and after we controlled for sociodemographic factors. CONCLUSIONS: When compared with their urban and suburban counterparts, veterans who live in a rural setting have worse health-related quality-of-life scores. Policymakers, within and outside the Veterans Health Administration, should anticipate greater health care demands from rural populations.     

浙江省城市与农村居民心理卫生知识水平调查

目的了解浙江省城市和农村居民心理卫生知识水平,为健康教育提供依据.方法采用分层随机抽样方法,抽取15岁以上样本2636人采用自编的<心理卫生知识问卷>进行居民心理卫生知识水平的调查.结果城乡居民在精神疾病的发病因素、治疗,常见精神疾病的认识等方面存在一定的差异,在症状识别、预后等方面城乡居民比较接近.结论加强城市和农村居民的心理卫生知识及心理卫生健康教育,以提高居民的心理卫生知识的知晓率,促进居民的心理健康.     

Comparative academic performance of medical students in rural and urban clinical settings

OBJECTIVE: To determine whether the academic performance of medical students learning in rural settings differs from those learning in urban settings. DESIGN: Comparison of results of assessment for 2 full cohorts and 1 part cohort of medical students learning in rural and urban settings in 2002 (209 students), 2003 (226 students) and 2004 (220 students), including results for each specialist rotation in the 3rd year and end-of-year examinations in the 2nd and 4th years. SETTING: University of Queensland School of Medicine, Brisbane. Students spent the whole 3rd year (of a 4-year graduate entry programme) conducting 5 specialist 8-week rotations in either the rural clinical division (rural students) or in Brisbane (urban students), all following the same curriculum and taking the same examinations. RESULTS: For the 2002 cohort there were no statistically significant differences in academic performance between rural and urban students. For the 2003 cohort the only significant difference was a higher score for rural students in the end of the 4th-year clinical skills examination (65.7 versus 62.3%, P = 0.025). For the 2004 cohort, rural students scored higher in the 3rd-year mental health rotation (79.3 versus 76.2%, P = 0.038) and lower in the medicine rotation (65.5 versus 68.6%, P = 0.037). CONCLUSION: Academic performance among students studying in rural and urban settings is comparable.     

Neighborhood Influences and Intimate Partner Violence: Does Geographic Setting Matter?

Intimate partner violence is one health-related outcome that has received growing attention from those interested in the role of neighborhood context. A limitation of existing contextual health research is its' failure to look beyond urban settings. Because suburban and rural areas have received so little attention, it is not clear whether data generated from urban samples can be generalized to non-urban geographic settings. We began to explore this issue using concept mapping, a participatory, mixed method approach. Data from 37 urban and 24 suburban women are used to explore and compare perceptions of neighborhood characteristics related to intimate partner violence. While several similarities exist between the perceptions of participants residing in urban and suburban areas, some differences were uncovered. These results provide valuable information regarding the perceived relationship between neighborhood context and intimate partner violence and suggest future avenues for research interested in examining the role of geographic setting.     

Role of neighbourhoods in child growth and development: Does ‘place’ matter?

It is estimated that at least 200 million children – mostly from developing countries – suffer from developmental delays. The study aims to contribute to an understanding of the contextual environment in which a child grows and develops in such setup; and in particular to evaluate the relative contributions of socio-economic status and rural-urban neighbourhoods on growth and psychomotor development. A cross-sectional study was conducted from May to November 2002 in 15 rural and 11 urban communities of Sindh, Pakistan. 1,244 children aged less than 3 years were assessed via home visits using Bayley’s Infant Developmental Scale for psychomotor development, anthropometry and a socio-economic and demographic questionnaire. A socio-economic index was created using principal component analysis, and the study hypotheses explored through hierarchical linear modelling. We found that sub-optimal growth and development were prevalent among the study’s children. Overall the mean psychomotor development (PD) index was 96.0 (SD 16.7), with 23% assessed as having delayed development, and undernourished with 39.8% stunted, 30.9% underweight and 18.1% wasted. Lower socio-economic status and living in a rural rather than urban neighbourhood were all found to have strong associations with lower psychomotor scores and with undernutrition. Rural-urban differences in undernutrition were explained by the lower socio-economic status of families in rural areas. By contrast, rural-urban differences in psychomotor scores remained strong even after controlling for differences in socio-economic status. It was estimated that rural residence accounted for 28% of cases of delayed psychomotor development among study children. Improvements in socio-economic status are vital to achieve optimal growth and development during early childhood. The study draws attention to the importance of taking heed of contextual needs, especially relating to differences between rural and urban neighbourhoods, in the formulation and implementation of early child care and development interventions.     

A geographic comparison of the prevalence and risk factors for postnatal depression in an Australian population

Objective: This study sought to compare the contribution of demographic and psychosocial variables on the prevalence of, and risk for, PND in urban and rural women. Methods: Demographic, psychosocial risk factor and mental health data was collected from urban (n=908) and rural (n=1,058) women attending perinatal health services in Victoria, Australia. Initial analyses determined similarities and significant differences between demographic and psychosocial variables. The association between these variables and PND case/non‐case was evaluated using logistic regression analysis. Results: There were a number of significant differences between the two cohorts in terms of socio‐economic status (SES), age, marital status and past history of psychopathology Antenatal depression was more common in the urban group compared to the rural group (8.5% vs 3.4%, p=0.006); there was no significant difference in the prevalence of PND (6.6% vs 8.5%, p=0.165). For urban mothers, antenatal EPDS score was the best predictor of PND. For rural mothers antenatal EPDS score, SES and psychiatric history had a significant influence on postnatal mood. Conclusions: Findings confirm the contribution of established risk factors such as past psychopathology, antenatal EPDS score and SES on the development of PND and reiterate the need for procedures to identify and assess psychosocial risk factors for depression in the perinatal period. Other predictors such as efficacy of social support and perceived financial burden may strengthen statistical models used to predict PND for women living in a rural setting.