Journal of Rural Health最新文献_第8页

Three lessons for rural health care systems from COVID-19 COVID-19 给农村医疗保健系统带来的三点启示。

IF 4.9 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2023-12-25 DOI: 10.1111/jrh.12819

John Leland BA, George Pink PhD

引用次数: 0

Rural and urban differences in disparities in substance use and substance use disorders affecting sexual minority populations 影响性少数群体的药物使用和药物使用障碍的城乡差异。

IF 4.9 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2023-12-19 DOI: 10.1111/jrh.12816

Christina Dyar PhD, Ethan Morgan PhD

Background

Sexual minority populations are at elevated risk for substance use (SU) and substance use disorders (SUD) compared to heterosexual populations. These disparities are theorized to be amplified for rural sexual minority populations due to their increased exposure to minority stress and reduced access to sexual minority communities. However, there is a lack of research examining differences in SU disparities affecting sexual minority populations by urbanicity, and little research has examined differences in SUD treatment utilization by sexual minority status or urbanicity.

Methods

We utilized data from 2015 to 2019 National Survey on Drug Use and Health to examine disparities in SU, SUD, SUD treatment utilization, and unmet SUD treatment need between sexual minority and heterosexual populations and test whether such disparities vary by urbanicity.

Results

Results indicate that disparities in SU and SUD affecting sexual minority populations generalize across urbanicities. A subset of disparities differed by urbanicity, and the direction of these differences varied, with some disparities being stronger in urban than rural populations and vice versa. Despite elevated treatment utilization among some sexual minority groups, disparities in unmet SUD treatment need were prevalent across urbanicities and sexual identity groups.

Conclusions

Study findings highlight the ubiquity of disparities in SU, SUD, and unmet SUD treatment need affecting rural and urban sexual minority populations, while also demonstrating nuanced differences in disparities by urbanicity. The persistence of disparities in unmet SUD treatment need emphasizes the need for future research to identify factors contributing to this disparity and for policies that alleviate these disparities.

背景：与异性恋人群相比，性少数群体使用药物（SU）和药物使用失调（SUD）的风险较高。据推测，由于农村性少数群体面临更多的少数群体压力，且进入性少数群体社区的机会较少，因此这些差异在农村性少数群体中会被放大。然而，目前还缺乏研究来探讨影响城市性少数群体的 SU 差异，也很少有研究探讨性少数群体身份或城市性少数群体在 SUD 治疗利用方面的差异：我们利用 2015 年至 2019 年全国药物使用和健康调查的数据，研究了性少数群体和异性恋群体在 SU、SUD、SUD 治疗利用率和未满足的 SUD 治疗需求方面的差异，并检验了这些差异是否因城市而异：结果：结果表明，影响性少数群体的 SU 和 SUD 的差异在城市中普遍存在。一部分差异因城市而异，这些差异的方向也各不相同，有些差异在城市人口中比在农村人口中更明显，反之亦然。尽管一些性少数群体的治疗利用率较高，但未得到满足的 SUD 治疗需求方面的差异在不同城市和不同性身份群体中普遍存在：研究结果凸显了影响农村和城市性少数群体的 SU、SUD 和未满足的 SUD 治疗需求方面的普遍差异，同时也显示了城市性差异的细微差别。在未满足的 SUD 治疗需求方面持续存在的差异强调了未来研究的必要性，以确定造成这种差异的因素，并制定政策来缓解这些差异。

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引用次数: 0

Excess deaths associated with COVID-19 by rurality and demographic factors in the United States 美国按乡村和人口因素分列的与 COVID-19 相关的超额死亡人数

IF 4.9 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2023-12-11 DOI: 10.1111/jrh.12815

Katherine A. Ahrens MPH, PhD, Lauren M. Rossen PhD, Carly Milkowski MPH, Catherine Gelsinger RN, MPH, Erika Ziller PhD

Purpose

To estimate percent excess deaths during the COVID-19 pandemic by rural-urban residence in the United States and to describe rural-urban disparities by age, sex, and race/ethnicity.

Methods

Using US mortality data, we used overdispersed Poisson regression models to estimate monthly expected death counts by rurality of residence, age group, sex, and race/ethnicity, and compared expected death counts with observed deaths. We then summarized excess deaths over 6 6-month time periods.

Findings

There were 16.9% (95% confidence interval [CI]: 16.8, 17.0) more deaths than expected between March 2020 and February 2023. The percent excess varied by rurality (large central metro: 18.2% [18.1, 18.4], large fringe metro: 15.6% [15.5, 15.8], medium metro: 18.1% [18.0, 18.3], small metro: 15.5% [15.3, 15.7], micropolitan rural: 16.3% [16.1, 16.5], and noncore rural: 15.8% [15.6, 16.1]). The percent excess deaths were 20.2% (20.1, 20.3) for males and 13.6% (13.5, 13.7) for females, and highest for Hispanic persons (49% [49.0, 49.6]), followed by non-Hispanic Black persons (28% [27.5, 27.9]) and non-Hispanic White persons (12% [11.6, 11.8]). The 6-month time periods with the highest percent excess deaths for large central metro areas were March 2020-August 2020 and September 2020-February 2021; for all other areas, these time periods were September 2020-February 2021 and September 2021-February 2022.

Conclusion

Percent excess deaths varied by rurality, age group, sex, race/ethnicity, and time period. Monitoring excess deaths by rurality may be useful in assessing the impact of the pandemic over time, as rural-urban patterns appear to differ.

按美国城乡居住地估算 COVID-19 大流行期间超额死亡的百分比，并按年龄、性别和种族/族裔描述城乡差异。

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引用次数: 0

Assessing the relationship between census tract rurality and severe maternal morbidity in California (1997-2018) 评估加利福尼亚州人口普查区乡村化与严重孕产妇发病率之间的关系（1997-2018 年）。

IF 4.9 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2023-12-06 DOI: 10.1111/jrh.12814

Rachel L. Berkowitz DrPH, MPH, Peiyi Kan MS, Xing Gao PhD, MPH, Elleni M. Hailu PhD, MPH, Christine Board MPH, Audrey Lyndon PhD, RNC, FAAN, Mahasin Mujahid PhD, MS, FAHA, Suzan L. Carmichael PhD, MS

Purpose

Recent studies have demonstrated an increased risk of severe maternal morbidity (SMM) for people living in rural versus urban counties. Studies have not considered rurality at the more nuanced subcounty census-tract level. This study assessed the relationship between census-tract-level rurality and SMM for birthing people in California.

Methods

We used linked vital statistics and hospital discharge records for births between 1997 and 2018 in California. SMM was defined by at least 1 of 21 potentially fatal conditions and lifesaving procedures. Rural-Urban Commuting Area codes were used to characterize census tract rurality dichotomously (2-category) and at 4 levels (4-category). Covariates included sociocultural-demographic, pregnancy-related, and neighborhood-level factors. We ran a series of mixed-effects logistic regression models with tract-level clustering, reporting risk ratios and 95% confidence intervals (CIs). We used the STROBE reporting guidelines.

Findings

Of 10,091,415 births, 1.1% had SMM. Overall, 94.3% of participants resided in urban/metropolitan and 5.7% in rural tracts (3.9% micropolitan, 0.9% small town, 0.8% rural). In 2-category models, the risk of SMM was 10% higher for birthing people in rural versus urban tracts (95% CI: 6%, 13%). In 4-category models, the risk of SMM was 16% higher in micropolitan versus metropolitan tracts (95% CI: 12%, 21%).

Conclusion

The observed rurality and SMM relationship was driven by living in a micropolitan versus metropolitan tract. Increased risk may result from resource access inequities within suburban areas. Our findings demonstrate the importance of considering rurality at a subcounty level to understand locality-related inequities in the risk of SMM.

目的：最近的研究表明，居住在农村地区的孕产妇与居住在城市地区的孕产妇相比，严重孕产妇发病率（SMM）的风险更高。这些研究还没有考虑到更细微的县以下人口普查区的乡村性。本研究评估了加利福尼亚州人口普查区一级的乡村性与分娩人群 SMM 之间的关系：我们使用了加利福尼亚州 1997 年至 2018 年出生婴儿的生命统计和出院记录。SMM 的定义是 21 种潜在致命疾病和抢救程序中至少一种。农村-城市通勤区代码用于描述人口普查区的二分法（2 类）和 4 级（4 类）农村特征。协变量包括社会文化-人口、怀孕相关因素和邻里水平因素。我们运行了一系列混合效应逻辑回归模型，并进行了区级聚类，报告了风险比和 95% 置信区间 (CI)。我们采用了 STROBE 报告指南：在 10,091,415 名新生儿中，1.1% 患有 SMM。总体而言，94.3%的参与者居住在城市/大都市，5.7%居住在农村地区（3.9%为大都市，0.9%为小城镇，0.8%为农村）。在 2 类模型中，农村与城市地区的分娩者发生 SMM 的风险高 10%（95% CI：6%，13%）。在 4 类模型中，微型城市与大都市相比，SMM 风险高出 16%（95% CI：12%，21%）：结论：所观察到的乡村与 SMM 之间的关系是由居住在微型都市区与大都市区之间的关系所决定的。郊区资源获取的不平等可能导致风险增加。我们的研究结果表明，必须在县以下层面考虑乡村因素，以了解与当地相关的SMM风险不平等现象。

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引用次数: 0

Differences in use of Veterans Health Administration and non-Veterans Health Administration hospitals by rural and urban Veterans after access expansions 农村和城市退伍军人使用退伍军人健康管理局和非退伍军人健康管理局医院后的差异。

IF 4.9 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2023-11-30 DOI: 10.1111/jrh.12812

Matthew P. Dizon MD, Kenneth W. Kizer MD, MPH, Michael K. Ong MD, PhD, Ciaran S. Phibbs PhD, Megan E. Vanneman PhD, Emily P. Wong MPH, MPA, Yue Zhang PhD, Jean Yoon PhD, MHS

Purpose

To examine changes in rural and urban Veterans’ utilization of acute inpatient care in Veterans Health Administration (VHA) and non-VHA hospitals following access expansion from the Veterans Choice Act, which expanded eligibility for VHA-paid community hospitalization.

Methods

Using repeated cross-sectional data of VHA enrollees’ hospitalizations in 9 states (AZ, CA, CT, FL, LA, MA, NY, PA, and SC) between 2012 and 2017, we compared rural and urban Veterans’ probability of admission in VHA and non-VHA hospitals by payer over time for elective and nonelective hospitalizations using multinomial logistic regression to adjust for patient-level sociodemographic features. We also used generalized linear models to compare rural and urban Veterans’ travel distances to hospitals.

Findings

Over time, the probability of VHA-paid community hospitalization increased more for rural Veterans than urban Veterans. For elective inpatient care, rural Veterans’ probability of VHA-paid admission increased from 2.9% (95% CI 2.6%-3.2%) in 2012 to 6.5% (95% CI 5.8%-7.1%) in 2017. These changes were associated with a temporal trend that preceded and continued after the implementation of the Veterans Choice Act. Overall travel distances to hospitalizations were similar over time; however, the mean distance traveled decreased from 39.2 miles (95% CI 35.1-43.3) in 2012 to 32.3 miles (95% CI 30.2-34.4) in 2017 for rural Veterans receiving elective inpatient care in VHA-paid hospitals.

Conclusions

Despite limited access to rural hospitals, these data demonstrate an increase in rural Veterans’ use of non-VHA hospitals for acute inpatient care and a small reduction in distance traveled to elective inpatient services.

目的:研究《退伍军人选择法案》扩大了退伍军人健康管理局(VHA)和非VHA医院的准入范围后，农村和城市退伍军人对退伍军人健康管理局(VHA)和非VHA医院急性住院护理的利用情况的变化。方法:利用2012年至2017年9个州(AZ、CA、CT、FL、LA、MA、NY、PA和SC) VHA参保人住院的重复横断面数据，我们使用多项logistic回归来调整患者层面的社会人口学特征，比较农村和城市退伍军人在VHA和非VHA医院的住院概率随付款时间的变化。我们还使用广义线性模型来比较农村和城市退伍军人到医院的旅行距离。结果:随着时间的推移，农村退伍军人的vha支付的社区住院的可能性比城市退伍军人增加。对于选择性住院治疗，农村退伍军人的vha支付入院概率从2012年的2.9% (95% CI 2.6%-3.2%)增加到2017年的6.5% (95% CI 5.8%-7.1%)。这些变化与《退伍军人选择法案》实施之前和之后的时间趋势有关。随着时间的推移，到医院的总旅行距离相似;然而，在vha支付的医院接受选择性住院治疗的农村退伍军人的平均旅行距离从2012年的39.2英里(95% CI 35.1-43.3)减少到2017年的32.3英里(95% CI 30.2-34.4)。结论:尽管进入农村医院的机会有限，但这些数据表明，农村退伍军人使用非vha医院进行急性住院治疗的人数有所增加，前往选择性住院服务的路程略有减少。

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引用次数: 0

Trends in patient perceptions of care toward rural and urban hospitals in the United States: 2014-2019 美国农村和城市医院患者对护理的看法趋势:2014-2019。

IF 4.9 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2023-11-29 DOI: 10.1111/jrh.12813

Zhong Li PhD, Vivian Ho BA, Melinda A. Merrell PhD, Peiyin Hung PhD

Purpose

Understanding rural-urban disparities in patient satisfaction is critical to identify gaps for improvement in patient-centered care and tailor interventions to specific patient needs, especially those in the Frontier and Remote areas (FAR). This study aimed to examine disparities in patient perceptions of care between urban, rural non-FAR, and FAR hospitals between 2014 and 2019.

Methods

This is a retrospective longitudinal study using 2014-2019 Hospital Consumer Assessment of Healthcare Providers and Systems data linked to American Hospital Annual Survey data (3,524 hospitals in 2014 and 3,440 hospitals in 2019). Multivariable linear regression models were used to identify differential trends in patient perceptions of care by hospital rurality over 2014-2019, adjusting hospital- and county-level characteristics.

Findings

In 2014, patients at rural non-FAR and FAR hospitals had lower percentages of willingness to definitely recommend these hospitals than urban hospitals (average percentage difference, 95% CI: −4.0% [−4.5%, −3.5%]; −2.0% [−2.8%, −1.2%]); yet, over the study period, rural hospitals experienced steeper increases in patient willingness to recommend (0.2% [0.07%, 0.4%]; 0.4% [0.08%, 0.7%]). FAR hospitals also showed improvements in patient experience in a clean environment, communication with nurses, communication about medicines, and responsiveness of staff. Communication with doctors showed slight decreases across hospital locations.

Conclusions

Patient perceptions of care were generally improved in all US hospitals from 2014 to 2019, except communications with doctors. These findings highlight the potential for enhancing patient satisfaction and experience in urban hospitals and suggest the need to improve patient willingness to recommend in rural FAR hospitals.

目的:了解城乡患者满意度的差异对于确定以患者为中心的护理的改进差距和针对特定患者需求量身定制干预措施至关重要，特别是在边境和偏远地区(FAR)。本研究旨在研究2014年至2019年期间城市、农村非FAR和FAR医院之间患者对护理的看法的差异。方法:这是一项回顾性纵向研究，使用2014-2019年医院消费者对医疗保健提供者和系统的评估数据，与美国医院年度调查数据相关(2014年为3524家医院，2019年为3440家医院)。使用多变量线性回归模型确定2014-2019年农村医院患者对护理感知的差异趋势，调整医院和县级特征。结果:2014年，农村非FAR医院和FAR医院的患者明确推荐这些医院的意愿比例低于城市医院(平均百分比差异，95% CI: -4.0% [-4.5%， -3.5%];-2.0% [-2.8%， -1.2%]);然而，在研究期间，农村医院的患者推荐意愿急剧增加(0.2% [0.07%，0.4%];0.4%[0.08%， 0.7%])。FAR医院在清洁环境中的患者体验、与护士的沟通、药物沟通以及工作人员的反应能力方面也有所改善。与医生的沟通在各医院略有减少。结论:2014 - 2019年，除与医生沟通外，美国所有医院的患者对护理的感知总体上有所改善。这些发现强调了在城市医院提高患者满意度和体验的潜力，并建议有必要提高农村FAR医院的患者推荐意愿。

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引用次数: 0

Community engagement through social media: A promising low-cost strategy for rural recruitment? 通过社交媒体进行社区参与:一个有前途的低成本农村招聘策略?

IF 4.9 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2023-11-20 DOI: 10.1111/jrh.12809

Sarah C. Vos PhD, Reuben Adatorwovor PhD, Michelle K. Roberts MS, Deanna Lee Sherman MA, Delaney Bonds MPH, Madeline N. Dunfee MEd, MPH, PhD, Bonnie Spring PhD, Nancy E. Schoenberg PhD

Purpose

For the same reasons that rural telehealth has shown promise for enhancing the provision of care in underserved environments, social media recruitment may facilitate more inclusive research engagement in rural areas. However, little research has examined social media recruitment in the rural context, and few studies have evaluated the feasibility of using a free social media page to build a network of rural community members who may be interested in a research study. Here, we describe the rationale, process, and protocols of developing and implementing a social media approach to recruit rural residents to participate in an mHealth intervention.

Methods

Informed by extensive formative research, we created a study Facebook page emphasizing community engagement in an mHealth behavioral intervention. We distributed the page to local networks and regularly posted recruitment and community messages. We collected data on the reach of the Facebook page, interaction with our messages, and initiations of our study intake survey.

Findings

Over 21 weeks, our Facebook page gained 429 followers, and Facebook users interacted with our social media messages 3,080 times. Compared to messages that described desirable study features, messages that described community involvement resulted in higher levels of online interaction. Social media and other recruitment approaches resulted in 225 people initiating our in-take survey, 9 enrolling in our pilot study, and 26 placing their names on a waiting list.

Conclusions

A standalone social media page highlighting community involvement shows promise for recruiting in rural areas.

目的:由于农村远程保健有望在服务不足的环境中加强提供护理，因此，社交媒体招聘可能促进农村地区更具包容性的研究参与。然而，很少有研究考察了农村背景下的社交媒体招聘，也很少有研究评估了使用免费社交媒体页面建立农村社区成员网络的可行性，这些成员可能对研究感兴趣。在这里，我们描述了开发和实施社交媒体方法招募农村居民参与移动医疗干预的基本原理、过程和协议。方法:通过广泛的形成性研究，我们创建了一个研究Facebook页面，强调社区参与移动健康行为干预。我们将这个页面分发给当地的网络，并定期发布招聘和社区信息。我们收集了Facebook页面的访问量，与我们的信息的互动，以及我们的研究摄入量调查的启动数据。研究发现:在21周的时间里，我们的Facebook页面获得了429名关注者，Facebook用户与我们的社交媒体信息互动了3080次。与描述理想学习特征的信息相比，描述社区参与的信息导致了更高水平的在线互动。社交媒体和其他招聘方式导致225人发起了我们的调查，9人报名参加了我们的试点研究，26人将他们的名字放在了等待名单上。结论:强调社区参与的独立社交媒体页面显示了在农村地区招聘的希望。

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引用次数: 0

The impact of rural general hospital closures on communities—A systematic review of the literature 农村综合医院关闭对社区的影响——文献系统综述。

IF 4.9 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2023-11-20 DOI: 10.1111/jrh.12810

Carol A. Mills PhD, MS, RN, Valerie A. Yeager DrPH, Kathleen T. Unroe MD, MHA, Ann Holmes PhD, Justin Blackburn PhD

Purpose

To compile the literature on the effects of rural hospital closures on the community and summarize the evidence, specifically the health and economic impacts, and identify gaps for future research.

Methods

A systematic review of the relevant peer-reviewed literature, published from January 2005 through December 2021, included in the EMBASE, CINAHL, PubMed, EconLit, and Business Source Complete databases, as well as “gray” literature published during the same time period. A total of 21 articles were identified for inclusion.

Findings

Over 90% of the included studies were published in the last 8 years, with nearly three-fourths published in the last 4 years. The most common outcomes studied were economic outcomes and employment (76%), emergent, and non-emergent transportation, which includes transport miles and travel time (42.8%), access to and supply of health care providers (38%), and quality of patient outcomes (19%). Eighty-nine percent of the studies that examined economic impacts found unfavorable results, including decreased income, population, and community economic growth, and increased poverty. Between 11 and 15.7 additional minutes were required to transport patients to the nearest emergency facility after closures. A lack of consistency in measures and definition of rurality challenges comparability across studies.

Conclusions

The comprehensive impact of rural hospital closures on communities has not been well studied. Research shows predominantly negative economic outcomes as well as increased time and distance required to access health care services. Additional research and consistency in the outcome measures and definition of rurality is needed to characterize the downstream impact of rural hospital closures.

目的:整理关于农村医院关闭对社区影响的文献，总结证据，特别是对健康和经济的影响，并确定未来研究的差距。方法:系统回顾2005年1月至2021年12月发表的相关同行评议文献，包括EMBASE、CINAHL、PubMed、EconLit和Business Source Complete数据库，以及同期发表的“灰色”文献。共有21篇文章被确定纳入。研究结果:超过90%的纳入研究发表于最近8年，近四分之三的研究发表于最近4年。研究中最常见的结果是经济结果和就业(76%)，紧急和非紧急运输，包括运输里程和旅行时间(42.8%)，获得和提供卫生保健提供者(38%)，以及患者结果质量(19%)。调查经济影响的研究中有89%发现了不利的结果，包括收入、人口和社区经济增长的减少，以及贫困的增加。关闭后，将病人运送到最近的急救设施需要额外的11至15.7分钟。农村性的测量和定义缺乏一致性，挑战了研究之间的可比性。结论:农村医院关闭对社区的综合影响尚未得到很好的研究。研究表明，主要是负面的经济后果，以及获得卫生保健服务所需的时间和距离增加。为了确定农村医院关闭的下游影响，需要进一步的研究和结果衡量标准和农村定义的一致性。

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引用次数: 0

Cross-sectional population-based estimates of a rural-urban disparity in prevalence of long COVID among Michigan adults with polymerase chain reaction-confirmed COVID-19, 2020-2022 2020-2022年密歇根聚合酶链反应确诊COVID-19成人长冠状病毒流行率城乡差异的横断面人口估计

IF 4.9 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2023-11-16 DOI: 10.1111/jrh.12807

Colleen L. MacCallum-Bridges PhD, MS, Jana L. Hirschtick PhD, MPH, Kristi L. Allgood PhD, MPH, Soomin Ryu PhD, MA, Robert C. Orellana PhD, MPH, Nancy L. Fleischer PhD, MPH

Purpose

To (1) assess whether residential rurality/urbanicity was associated with the prevalence of 30- or 90-day long COVID, and (2) evaluate whether differences in long COVID risk factors might explain this potential disparity.

Methods

We used data from the Michigan COVID-19 Recovery Surveillance Study, a population-based probability sample of adults with COVID-19 (n = 4,937). We measured residential rurality/urbanicity using dichotomized Rural-Urban Commuting Area codes (metropolitan, nonmetropolitan). We considered outcomes of 30-day long COVID (illness duration ≥30 days) and 90-day long COVID (illness duration ≥90 days). Using Poisson regression, we estimated unadjusted prevalence ratios (PRs) to compare 30- and 90-day long COVID between metropolitan and nonmetropolitan respondents. Then, we adjusted our model to account for differences between groups in long COVID risk factors (age, sex, acute COVID-19 severity, vaccination status, race and ethnicity, socioeconomic status, health care access, SARS-CoV-2 variant, and pre-existing conditions). We estimated associations for the full study period (Jan 1, 2020-May 31, 2022), the pre-vaccine era (before April 5, 2021), and the vaccine era (after April 5, 2021).

Findings

Compared to metropolitan adults, the prevalence of 30-day long COVID was 15% higher (PR = 1.15 [95% CI: 1.03, 1.29]), and the prevalence of 90-day long COVID was 27% higher (PR = 1.27 [95% CI: 1.09, 1.49]) among nonmetropolitan adults. Adjusting for long COVID risk factors did not reduce disparity estimates in the pre-vaccine era but halved estimates in the vaccine era.

Conclusions

Our findings provide evidence of a rural-urban disparity in long COVID and suggest that the factors contributing to this disparity changed over time as the sociopolitical context of the pandemic evolved and COVID-19 vaccines were introduced.

目的:(1)评估居住乡村性/城市化是否与30天或90天的COVID流行率相关，(2)评估长期COVID风险因素的差异是否可以解释这种潜在的差异。方法:我们使用了密歇根COVID-19康复监测研究的数据，这是一项基于人群的COVID-19成人概率样本(n = 4937)。我们使用二元城乡通勤区域代码(大都市和非大都市)来测量居住的乡村/城市性。我们考虑了30天(病程≥30天)和90天(病程≥90天)的结果。使用泊松回归，我们估计了未调整的患病率(pr)，以比较大都市和非大都市受访者之间30天和90天的COVID。然后，我们调整了模型，以考虑各组之间在长COVID风险因素(年龄、性别、COVID-19急性严重程度、疫苗接种状况、种族和民族、社会经济地位、医疗保健可及性、SARS-CoV-2变体和先前存在的疾病)方面的差异。我们估计了整个研究期间(2020年1月1日至2022年5月31日)、疫苗前时期(2021年4月5日之前)和疫苗时期(2021年4月5日之后)的相关性。结果:与大都市成年人相比，非大都市成年人中30天的COVID患病率高15% (PR = 1.15 [95% CI: 1.03, 1.29])， 90天的COVID患病率高27% (PR = 1.27 [95% CI: 1.09, 1.49])。调整长期COVID风险因素并没有减少疫苗前时代的差距估计值，但在疫苗时代将估计值减半。结论:我们的研究结果提供了城乡长期COVID差异的证据，并表明导致这种差异的因素随着大流行的社会政治背景的演变和COVID-19疫苗的引入而随着时间的推移而变化。

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引用次数: 0

Substance use among rural adolescents with incarcerated parents: Evidence from a state-wide sample 父母被监禁的农村青少年的物质使用:来自全州样本的证据。

IF 4.9 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2023-11-15 DOI: 10.1111/jrh.12806

Luke Muentner PhD, MSW, Katie K. McLaughlin JD, Rebecca Shlafer PhD, MPH

Purpose

Incarceration rates are highest in rural communities, disproportionately exposing rural children to parental incarceration (PI). Substance use is a pressing public health issue—and a key driver of incarceration—in rural areas, yet limited research has examined PI as a social determinant of health for adolescent alcohol and drug use. This study links exposure to PI with rural adolescent substance use and examines the role of coresidence with parents in these associations.

Methods

Data come from the 2019 Minnesota Student Survey, including 18,820 rural adolescents. Respondents self-reported experiences of PI (current, former, never), whether they lived with the parent at the time of incarceration, and past-year alcohol, marijuana, cocaine, heroin, and methamphetamine use.

Findings

Over 22% of rural adolescents experienced PI. In adjusted logistic regression models, current PI was associated with greater past-year alcohol (aOR = 2.20), marijuana (aOR = 4.08), cocaine (aOR = 3.61), heroin (aOR = 4.96), and methamphetamine (aOR = 5.43) use compared to peers who never experienced PI. Current PI was also associated with greater counts of use. Associations between coresidence and substance use were largely nonsignificant.

Conclusions

The elevated risk for substance use in the context of rural PI and its adverse sequelae call for expanded prevention and intervention strategies that support adolescent health alongside targeted decarceration efforts in rural communities that reduce the number of families put in the potentially compromising situation of PI.

目的:农村社区的监禁率最高，使农村儿童不成比例地暴露于父母监禁(PI)。在农村地区，物质使用是一个紧迫的公共卫生问题，也是监禁的关键驱动因素，然而，有限的研究已经将PI作为青少年酒精和药物使用健康的社会决定因素。本研究将暴露于PI与农村青少年物质使用联系起来，并考察了与父母共同居住在这些关联中的作用。方法:数据来自2019年明尼苏达州学生调查，包括18820名农村青少年。受访者自我报告了PI的经历(现在，以前，从未)，他们是否在监禁期间与父母住在一起，以及过去一年的酒精，大麻，可卡因，海洛因和甲基苯丙胺的使用情况。结果:超过22%的农村青少年经历过PI。在调整后的logistic回归模型中，与从未经历过PI的同龄人相比，当前PI与过去一年更多的酒精(aOR = 2.20)、大麻(aOR = 4.08)、可卡因(aOR = 3.61)、海洛因(aOR = 4.96)和甲基苯丙胺(aOR = 5.43)使用相关。当前的PI也与更多的使用次数有关。同居与药物使用之间的关联基本上不显著。结论:农村PI背景下物质使用风险的增加及其不良后遗症要求扩大预防和干预策略，支持青少年健康，同时在农村社区开展有针对性的脱毒工作，减少处于PI潜在危害状况的家庭数量。

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