Children's health in the rural environment

School-Based Telemedicine and Reduced Avoidable Emergency Care Among Rural Pediatric Patients

Objective: Children living in rural communities have disparate access to preventive health care, shifting the burden of care delivery to emergency services. This study examined the association of school-based telemedicine (SBT) and avoidable emergency department (ED) utilization in rural historically underserved pediatric patients served through an SBT program. Methods: A retrospective analysis was conducted using electronic medical records and claims data from a large integrated health care system serving as the majority health care provider in the area. Participants included all pediatric patients served through an SBT program between 2017 and 2020 across three rural North Carolina counties. The study was a quasi-experimental before/after design comparing 12-month time periods before and after a patient's index virtual care visit. A subset of patients served 12 months before the start of the coronavirus 2019 (COVID-19) pandemic in 2020 was extracted and analyzed separately for a sensitivity analysis. Results: The complete sample included 1,236 patients. The odds of having an avoidable ED visit were reduced by 33% between time periods, and the estimated count of visits was reduced by 26%. (Models were adjusted for race/ethnicity, gender, age, and insurance payer.) No significant differences in unavoidable ED utilization were observed. The sensitivity analysis showed similar trends. Conclusions: Results demonstrate that telemedicine can improve access to health care and may offset the burden of avoidable care through emergency health services. Policy changes and increased use during the COVID-19 pandemic have created an optimal environment for telemedicine expansion to reduce health care access disparities.

A South African Epidemiological Study of Fatal Drownings: 2016-2021

Drowning is a serious public health concern. Low-and-middle-income countries are the most affected by drowning, as they carry 90% of the global drowning burden. The purpose of this retrospective epidemiological study is to provide an overview of fatal drownings in South Africa between 2016 and 2021. The data used for the study were obtained from the South African Police Service. Descriptive statistics were used to summarize the data. Statistical analyses included a t-test and chi-square test. The results indicate that the average number of fatal drownings per annum is 1477 in South Africa, with an average drowning rate of 2.54 per 100,000 population for the period 2016 to 2021. The KwaZulu-Natal province had the highest incidence of drowning. The 0-4-year-age group has the highest prevalence of drowning among all the age categories. More males drowned in South Africa compared to females.

“Everybody Knows Everybody”: Adolescents’ Perceptions of What Helps Them Succeed in a Rural Title I School

The current study explored adolescents’ perceptions of what contributes to their experiences of success in a rural Title I school through interpretative phenomenological analysis (IPA). Participants included adolescents who were enrolled at a rural Title I Middle/High School in the southern United States. The single campus school district serves approximately 185 students from Prekindergarten to grade 12. Approximately, 73% of the students are identified as At-Risk, 88% of the students are economically disadvantaged, and 100% of the students qualify for free or reduced lunch. Ten students from this school, with assent and parental consent, participated in the current study. Participants’ ages ranged from 13 to 18, and the students represented different genders (seven males, three females) and various racial and ethnic backgrounds (three Black/African American, four Latinx, two White, and one Biracial). Results from the current study suggest low-income adolescents in a rural Title I school perceived (a) school size, (b) family support, and (c) their own internal drive to succeed as contributing to their success at school. These themes, their corresponding subthemes, and representative participant statements are included. Implications for school administrators, teachers, and counselors along with directions for future research are discussed.

Rural-urban differences in health among youth in northern Sweden: an outcome-wide epidemiological approach

The aim of this research was to contribute knowledge about rural–urban differences in health among young northern Swedish women and men. This study was based on the 2014 “Health on Equal Terms” survey, distributed in the four northernmost counties of Sweden, with complementary information on areas of residence classified as rural, semi-urban and urban from total population registers. The analytical sample included 2,691 individuals who were selected using a probabilistic sampling method. Prevalence ratios were calculated in multivariable log-binomial regression analyses to measure the association between place of residence and nine outcomes covering three health dimensions (general, mental and lifestyle behaviours). The results indicated that daily smoking and being overweight were more common, while feelings of stress and psychological distress were less prevalent, among youths in rural as compared to urban areas. After including covariates, this pattern appeared stronger for young women, although the direction of the results also applied to young men, albeit without revealing significant differences. In conclusion, the findings from this study indicate that for youths – particularly young women – the rural setting may imply an increased risk of poor general health and lifestyle behaviours, while simultaneously playing a partially protective role for mental health.

Community-Level Exposure to the Rural Mining Industry: The Potential Influence on Early Adolescent Alcohol and Tobacco Use

PURPOSE

Rural youth have higher rates of alcohol and tobacco use compared to their urban counterparts. However, the economic dependence of rural communities may differentially influence risk behaviors. While research has shown that adults working in mining have elevated rates of alcohol and tobacco use, the influence of living in a mining community on early adolescent substance use is unknown.

METHODS

Using data from a representative sample of 4,535 middle school students in a state with heavy reliance on mining, we conducted weighted logistic regression to investigate whether community-level mining economic dependence influences rural-urban differences in adolescent alcohol and tobacco use. All models adjusted for sociodemographics, military family involvement, parental monitoring, and length of residence.

FINDINGS

Over one quarter of the sampled students lived in rural counties and approximately half of these counties met the USDA mining economic typology. After stratifying rural counties by mining and nonmining economic dependence, students in rural mining counties had significantly higher odds of all measures of alcohol use (AORs ranged from 1.83 to 3.99) and tobacco use (AORs ranged from 1.61 to 5.05) compared to students in urban counties. Only use of smokeless tobacco was higher among students in rural nonmining counties.

CONCLUSIONS

Our findings demonstrate rural-urban disparities in adolescent substance use that are particularly pronounced among youth living in counties with economic dependence on mining. Future research on this subject should include a wider range of community-level factors that may have specific relevance in rural settings to inform the development of population-level interventions.

Prevalence and risk factors of abdominal obesity in Polish rural children

Secular trends of body mass index (BMI) and waist circumference indicate greater increase in abdominal obesity compared to general obesity. Determinants of obesity described by BMI are relatively well documented in various populations, unlike abdominal obesity described by waist-to-height ratio (WHtR). The aim of the study was to determine prevalence and abdominal obesity (WHtR) risk factors in a cohort of 3048 rural children aged 7-12 years from southern Poland. Biological, socio-demographic and lifestyle factors were analysed, and odds ratio and 95% confidence interval were calculated using a logistic regression analysis. The prevalence of abdominal obesity in rural boys and girls in the sample was 11% and 9% respectively. Obesity in both parents, irregular breakfasts, irregular meals during the day and regularly consumed tea were significant factors of abdominal obesity risks in rural girls. Being the only child, low number of people in a household, obesity in both parents, high energy-dense food index and no exercise significantly increased the risk of abdominal obesity in rural boys. The study demonstrated tendencies similar to other European countries in the prevalence of abdominal obesity among sexes. Lifestyle behaviours should be changed and adapted to each sex since risk factors differ between the sexes and indicate higher eco-sensitivity in boys.

Preliminary assessment of a school-based healthy lifestyle intervention among rural elementary school children

BACKGROUND

Childhood obesity has become a national public health crisis in America. Physical inactivity and unhealthy eating behaviors may contribute to the childhood obesity epidemic. School-based healthy lifestyle interventions play a promising role in preventing and controlling childhood obesity. A comprehensive school-based healthy lifestyle intervention was implemented in 4 rural elementary schools in Kentucky.

METHODS

The intervention included 4 goals: improving physical education, health education, family/community involvement, and school wellness policies. Children's physical activity was assessed by pedometer, and nutrition was assessed by a previous day recall survey in January (baseline), February (t1), March (t2), April (t3), and May (t4) of 2011.

RESULTS

The intervention had significant effects on increasing the percentages of children meeting physical activity (1% vs 5%, p < .01) and nutrition (15% vs 26%, p < .01) recommendations. The effects of the intervention on physical activity and nutrition depended on school, grade, and age of the children. There was an increasing linear trend of physical activity and an increasing quadratic trend of nutrition over time among children.

CONCLUSIONS

The intervention had beneficial effects in improving healthy behaviors among children. Further studies are needed to assess its long-term effects and cost-effectiveness.

Residency and racial/ethnic differences in weight status and lifestyle behaviors among US youth

PURPOSE

Elevated risk for obesity is found in rural environments and in some minority populations. It is unclear whether living in rural or nonmetropolitan areas and being a minority compound the risk of obesity beyond that of either factor acting alone. Our purpose was to examine adolescent obesity in light of the potential concomitant influences of race/ethnicity, residency, and obesity-related lifestyle behaviors.

METHODS

We assessed obesity prevalence, physical activity, consumption of fatty snack foods, and screen time in 8,363 US adolescents based on variation in race/ethnicity and residency. Descriptive, bivariate, and multivariate statistics were used to: (1) calculate race- and residency-based rates of obesity and obesity-related lifestyle behaviors and (2) generate race- and residency-based obesity odds ratios as a function of those same behaviors.

FINDINGS

The results indicated that nonmetropolitan black youth had the highest risk of obesity (26%), rate of consuming fatty snack foods on more than 2 days/week (86%), and rate of spending more than 2 hours/day in screen time (91%) compared to white metropolitan youth. Compared to their metropolitan counterparts, black nonmetropolitan youth had greater odds of being obese if they exercised less than daily (1.71 times), ate fatty snack foods on more than 2 days/week (1.65 times), or spent more than 2 hours/day in screen time (1.64 times).

CONCLUSIONS

Race/ethnicity and residency may have a compounding effect on the risk of obesity. Prevention and intervention must be viewed in a socioecological framework that recognizes the importance of culture and community on obesity-related behaviors.

Childhood agricultural injuries: an update for clinicians

Every three days a child dies in an agriculture-related incident, and every day 45 children are injured in the United States. These tragedies should not be regarded as "accidents," as they often follow predictable and preventable patterns. Prevention is not only possible, but vital, since many of these injuries are almost immediately fatal. Major sources of fatal injuries are machinery, motor vehicles, and drowning. Tractor injuries alone account for one-third of all deaths. The leading sources of nonfatal injuries are structures and surfaces, animals (primarily horses), and vehicles (primarily all-terrain vehicles [ATVs]). Children living on farms are at a higher risk than hired workers, and are unprotected by child labor laws. Preschool children and older male youth are at the highest risk for fatal injury, while nonfatal injury was most common among boys aged 10-15 years. Multiple prevention strategies have been developed, yet economic and cultural barriers often impede their implementation. Educational campaigns alone are often ineffective, and must be coupled with re-engineering of machines and safety devices to reduce fatalities. Legislation has the potential to improve child safety, yet political and economic pressures often prohibit changes in child labor laws and mandated safety requirements. Clinicians play a pivotal role in injury prevention, and should actively address common rural risk-taking behaviors as part of the routine office visit in order to help prevent these tragedies.

OVERWEIGHT AND OBESITY IN RURAL GIRLS FROM POLAND: CHANGES BETWEEN 1987 AND 2001

Several studies have documented increased prevalence of overweight and obesity in inhabitants of rural regions, but determinants of their prevalence are complex and not always in one direction. The aim of this study was to estimate both the prevalence and extent of overweight and obesity among rural girls in Poland between 1987 and 2001, as well as to assess differentiation of the phenomenon between regions of different social structures. The data come from two series of cross-sectional studies; the first in 1987 included 7764 girls, and the second in 2001 included 9431 girls aged 9–18. Body mass index (according to the International Obesity Task Force, IOTF) and the EOW index (extent of overweight), which shows by what mean BMI value the overweight boundaries are exceeded, were calculated. Overweight and obesity prevalences in the whole sample, were, respectively, 14.9% and 2.7% in 1987 and 15.5% and 2.5% in 2001, but significant differentiation in the direction of the changes was observed between the examined regions. In one of them, characterized by sudden, mass and long-term unemployment, there was a considerable decrease in overweight and obesity prevalence, whereas in a relatively wealthier region no changes were observed during the 14-year period. Two other regions with a relatively low standard of living and low incomes and education status presented a significant increase in overweight and obesity prevalence. The EOW index increased from 1.9 to 2.1 in the whole examined sample, and it also confirmed significant differences in expansion of overweight and obesity between the examined regions. The complex character of political and socioeconomic changes in Poland during the 1990s has resulted in two-directional changes in biological measures of living conditions. The analysis of the whole sample led to different results in comparison to separate analyses of each of the examined regions.

Children's safety on American Indian farms: information and recommendations

It is estimated that 1.2 million youth younger than age 20 live on farms; American Indian children constitute an important but understudied subset of this at-risk group. Despite documented risks of injuries and death among children who live and work on farms and a descending trend in the overall reported fatalities among youth who live and/or work on farms, very little is known about the agriculture-related injury and fatality experience of American Indian youth. Limited data indicate that drowning, motor vehicles, and poisonings are leading causes of unintentional mortality and morbidity for this group, although the attribution to agricultural exposure is not evident. The scant available data indicate a need to look more closely at agricultural work, bystander exposures, and other farm events that put American Indian youth at risk of illness, injury, or death compared to factors more fully reported for majority youth in the agriculture population, in order to guide intervention and prevention programs that are appropriate and acceptable to this vulnerable population.

Demographic differences in self-report pubertal status among rural adolescents in the US

BACKGROUND

While sex and racial/ethnic differences in pubertal development have been noted, most of this research has been in urban areas.

AIM

The purpose of this study is to examine demographic differences in pubertal status among a school-based sample of US rural adolescents aged 11-17 (n = 6425).

METHODS

Pubertal status was measured using the Pubertal Development Scale (PDS), a self-report scale of secondary sexual characteristics. This study compared pubertal status means by age, sex and race/ethnicity.

RESULTS

At all ages, females had a higher mean pubertal status than males. Most racial/ethnic differences were between White and Black youth. Between the ages of 11 and 13, Black youth reported more advanced development than White youth. However, contrary to research with urban samples, this pattern of development reversed in later adolescence and the reversal was more prominent among males than females. Although there were no differences in pubertal status between White and Latino males, White females had higher mean levels of development than Latino females.

CONCLUSION

Demographic patterns were both consistent with and different from previous research with urban adolescents, suggesting the need for comparison of demographic patterns of pubertal development in samples that include youth from urban and rural areas.

Urban and rural differences in sedentary behavior among American and Canadian youth

We examined relationships between urban-rural status and three screen time behaviors (television, computer, video games), and the potential mediating effect of parent and peer support on these relationships. Findings are based on American (n = 8563) and Canadian (n = 8990) youth in grades 6-10 from the 2005/06 Health Behavior in School-Aged Children Survey. Weekly hours of individual screen time behaviors were calculated. Urban-rural status was defined using the Beale coding system. Parent and peer support variables were derived from principal component analysis. In comparison to the referent group (non-metro adjacent), American youth in the most rural areas were more likely to be high television users and less likely to be high computer users. Conversely, Canadian youth in medium and large metropolitan areas were less likely to be high television users and more likely to be high computer users. Parent and peer support did not strongly mediate the relationships between urban-rural status and screen time. These findings suggest that interventions aiming to reduce screen time may be most effective if they consider residential location and the specific screen time behavior.

Treating rural pediatric obesity through telemedicine: baseline data from a randomized controlled trial

OBJECTIVE

To describe baseline characteristics of participants in a pediatric obesity intervention tailored specifically to rural families delivered via telemedicine.

METHODS

Randomized-control trial comparing a family-based behavioral intervention to a usual care condition. Participants Fifty-eight first through fifth graders and their parents from the rural Midwest. Measures Demographic, body mass index (BMI), Actigraph activity monitor information, 24-h dietary recalls, Child Behavior Checklist, Behavioral Pediatrics Feeding Assessment Scale.

RESULTS

Child mean BMI was in the 94th percentile for weight. Average daily dietary intake exceeded 2,000 kcal and children consumed over eight servings of high-calorie, low-nutrient-dense foods. Children are engaged in approximately 65 min of moderate, 12 min of vigorous and over 300 min of sedentary physical activity daily.

CONCLUSIONS

Baseline data suggest children in rural areas may engage in adequate physical activity but eat many daily servings of energy-dense foods. Rural families may benefit from a comprehensive, rurally tailored obesity-related health behavior intervention.

Elevated blood pressure in relation to overweight and obesity among children in a rural Canadian community

OBJECTIVE

Childhood overweight and obesity may result in premature onset of cardiovascular risk factors such as hypertension. Rural populations in North America may be at increased risk for overweight. We evaluated whether overweight and obesity were associated with prehypertension and hypertension in a well-characterized population of children in rural Canada.

METHODS

The study population for this cross-sectional study was composed of children (aged 4-17 years) who were participants of the Walkerton Health Study (Canada) in 2004. Prehypertension and hypertension were defined on the basis of percentiles from the average of 3 blood pressure measures taken on a single occasion. Percentiles for BMI and blood pressure were calculated by using the 2000 Centers for Disease Control and Prevention growth charts. Multinomial logistic regression was used to evaluate the odds for prehypertension and hypertension resulting from overweight and obesity.

RESULTS

Of 675 children (98.7% white), 122 (18.1%) were overweight and 77 (11.4%) were obese. Prehypertension and hypertension were detected in 51 (7.6%) and 50 (7.4%), respectively. After adjustment for family history of hypertension and kidney disease, obesity was associated with both prehypertension and hypertension. Overweight was associated with hypertension but not prehypertension. These associations were observed across the genders and children aged <13 and >or=13 years, except that overweight was not associated with hypertension among girls.

CONCLUSIONS

In this population of children who lived in a rural community in Canada, overweight and obesity were strongly associated with elevated blood pressure. Whether blood pressure normalizes with improvements in diet, physical activity, and environment is an area for additional study.