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Hirko KA, Xu H, Rogers LQ, Martin MY, Roy S, Kelly KM, Christy SM, Ashing KT, Yi JC, Lewis-Thames MW, Meade CD, Lu Q, Gwede CK, Nemeth J, Ceballos RM, Menon U, Cueva K, Yeary K, Klesges LM, Baskin ML, Alcaraz KI, Ford S. Cancer disparities in the context of rurality: risk factors and screening across various U.S. rural classification codes. Cancer Causes Control 2022; 33:1095-1105. [PMID: 35773504 PMCID: PMC9811397 DOI: 10.1007/s10552-022-01599-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/15/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Prior cancer research is limited by inconsistencies in defining rurality. The purpose of this study was to describe the prevalence of cancer risk factors and cancer screening behaviors across various county-based rural classification codes, including measures reflecting a continuum, to inform our understanding of cancer disparities according to the extent of rurality. METHODS Using an ecological cross-sectional design, we examined differences in cancer risk factors and cancer screening behaviors from the Behavioral Risk Factor Surveillance System and National Health Interview Survey (2008-2013) across rural counties and between rural and urban counties using four rural-urban classification codes for counties and county-equivalents in 2013: U.S. Office of Management and Budget, National Center for Health Statistics, USDA Economic Research Service's rural-urban continuum codes, and Urban Influence Codes. RESULTS Although a rural-to-urban gradient was not consistently evident across all classification codes, the prevalence of smoking, obesity, physical inactivity, and binge alcohol use increased (all ptrend < 0.03), while colorectal, cervical and breast cancer screening decreased (all ptrend < 0.001) with increasing rurality. Differences in the prevalence of risk factors and screening behaviors across rural areas were greater than differences between rural and urban counties for obesity (2.4% vs. 1.5%), physical activity (2.9% vs. 2.5%), binge alcohol use (3.4% vs. 0.4%), cervical cancer screening (6.8% vs. 4.0%), and colorectal cancer screening (4.4% vs. 3.8%). CONCLUSIONS Rural cancer disparities persist across multiple rural-urban classification codes, with marked variation in cancer risk factors and screening evident within rural regions. Focusing only on a rural-urban dichotomy may not sufficiently capture subpopulations of rural residents at greater risk for cancer and cancer-related mortality.
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Affiliation(s)
- Kelly A Hirko
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 Fee Road, East Lansing, MI, 48824, USA.
| | - Huiwen Xu
- Department of Preventive Medicine and Population Health and Sealy Center On Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - Laura Q Rogers
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michelle Y Martin
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Siddhartha Roy
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Kimberly M Kelly
- Department of Pharmaceutical Systems & Policy, West Virginia University, Morgantown, WV, USA
| | - Shannon M Christy
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kimlin Tam Ashing
- Division of Health Equities, City of Hope Comprehensive Cancer Center and Beckman Institute, Duarte, CA, USA
| | - Jean C Yi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Marquita W Lewis-Thames
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cathy D Meade
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Qian Lu
- Department of Health Disparities Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clement K Gwede
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Julianna Nemeth
- Department of Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Rachel M Ceballos
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Usha Menon
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - Katie Cueva
- Institute of Social and Economic Research, University of Alaska, Anchorage, AK, USA
| | - Karen Yeary
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lisa M Klesges
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Monica L Baskin
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kassandra I Alcaraz
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sabrina Ford
- Department of Obstetrics, Gynecology & Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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Solomon CA, Laditka SB, Forthofer M, Racine EF. Alcohol consumption among older women in the United States. J Women Aging 2019; 33:100-117. [PMID: 31657279 DOI: 10.1080/08952841.2019.1684176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Few studies have examined alcohol consumption among older women. Using the nationally representative National Survey on Drug Use and Health, we examined binge, moderate, and no alcohol consumption among women ages 50+ (n = 21,178). We calculated population prevalence by age and used multivariate logistic regression, controlling for seven sociodemographic factors. In adjusted results, women ages 65+ were more likely to have moderate or no alcohol consumption than those 50-64; Hispanic and African American women were more likely to engage in binge consumption than whites (all p < .01). More research is needed to understand binge alcohol consumption among older women in racial/ethnic minorities.
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Affiliation(s)
- Corliss A Solomon
- Department of Public Health Sciences, University of North Carolina at Charlotte , Charlotte, NC, USA
| | - Sarah B Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte , Charlotte, NC, USA
| | - Melinda Forthofer
- Department of Public Health Sciences, University of North Carolina at Charlotte , Charlotte, NC, USA
| | - Elizabeth F Racine
- Department of Public Health Sciences, University of North Carolina at Charlotte , Charlotte, NC, USA
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Blake KD, Moss JL, Gaysynsky A, Srinivasan S, Croyle RT. Making the Case for Investment in Rural Cancer Control: An Analysis of Rural Cancer Incidence, Mortality, and Funding Trends. Cancer Epidemiol Biomarkers Prev 2017; 26:992-997. [PMID: 28600296 DOI: 10.1158/1055-9965.epi-17-0092] [Citation(s) in RCA: 241] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 02/02/2017] [Accepted: 03/09/2017] [Indexed: 12/22/2022] Open
Abstract
Estimates of those living in rural counties vary from 46.2 to 59 million, or 14% to 19% of the U.S. POPULATION Rural communities face disadvantages compared with urban areas, including higher poverty, lower educational attainment, and lack of access to health services. We aimed to demonstrate rural-urban disparities in cancer and to examine NCI-funded cancer control grants focused on rural populations. Estimates of 5-year cancer incidence and mortality from 2009 to 2013 were generated for counties at each level of the rural-urban continuum and for metropolitan versus nonmetropolitan counties, for all cancers combined and several individual cancer types. We also examined the number and foci of rural cancer control grants funded by NCI from 2011 to 2016. Cancer incidence was 447 cases per 100,000 in metropolitan counties and 460 per 100,000 in nonmetropolitan counties (P < 0.001). Cancer mortality rates were 166 per 100,000 in metropolitan counties and 182 per 100,000 in nonmetropolitan counties (P < 0.001). Higher incidence and mortality in rural areas were observed for cervical, colorectal, kidney, lung, melanoma, and oropharyngeal cancers. There were 48 R- and 3 P-mechanism rural-focused grants funded from 2011 to 2016 (3% of 1,655). Further investment is needed to disentangle the effects of individual-level SES and area-level factors to understand observed effects of rurality on cancer. Cancer Epidemiol Biomarkers Prev; 26(7); 992-7. ©2017 AACR.
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Affiliation(s)
- Kelly D Blake
- Division of Cancer Control and Population Sciences, NCI, NIH, Bethesda, Maryland.
| | - Jennifer L Moss
- Division of Cancer Control and Population Sciences, NCI, NIH, Bethesda, Maryland
| | - Anna Gaysynsky
- Division of Cancer Control and Population Sciences, NCI, NIH, Bethesda, Maryland
| | - Shobha Srinivasan
- Division of Cancer Control and Population Sciences, NCI, NIH, Bethesda, Maryland
| | - Robert T Croyle
- Division of Cancer Control and Population Sciences, NCI, NIH, Bethesda, Maryland
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Dean C, Fogleman AJ, Zahnd WE, Lipka AE, Malhi RS, Delfino KR, Jenkins WD. Engaging rural communities in genetic research: challenges and opportunities. J Community Genet 2017; 8:209-219. [PMID: 28477297 DOI: 10.1007/s12687-017-0304-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 04/27/2017] [Indexed: 12/13/2022] Open
Abstract
Statistical analyses of health and disease in rural communities is frequently limited by low sample counts. Still, some studies indicate increased risk for some diseases even after adjustment for known risk factors. It has been hypothesized that the context of community formation in rural areas facilitates the propagation of genetic founder effects-potentially impacting disease susceptibility. However, outright examination of genetic diversity in such communities has not been performed. Our objective was to engage otherwise research-inexperienced rural communities of largely European descent in genomic research in the context of cancer susceptibility. From September 2015 to February 2016, we implemented a systematic process of progressive community engagement. This iterative method sought project buy-in from first the town mayor, then village council. If approved by both, a focus group of community members examined how residents might view the research, informed consent and specimen collection, and issues of privacy. We were successful in engaging three of the four communities approached for the research project. There was universal enthusiasm for the project by all mayors and village councils. The focus groups' main point of discussion involved wording in the informed consent, with little concern regarding the research question or privacy. Perhaps contrary to popular thought, we found each community we approached to be both welcoming and enthusiastic about collaborating in research on genomic diversity. The systematic method of engagement did much to preserve community respect and autonomy and facilitated buy-in.
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Affiliation(s)
- Caress Dean
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62794-9664, USA
| | - Amanda J Fogleman
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62794-9664, USA
| | - Whitney E Zahnd
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62794-9664, USA
| | - Alexander E Lipka
- Department of Crop Sciences, University of Illinois, W-201B Turner Hall, 1102 S Goodwin Ave, Urbana, IL, 61801, USA
| | - Ripan Singh Malhi
- Departments of Anthropology & Animal Biology, Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign, 209F Davenport Hall, 607 Matthews Ave., Urbana, IL, 61801, USA
| | - Kristin R Delfino
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62794-9664, USA
| | - Wiley D Jenkins
- Population Health Science Program, Southern Illinois University School of Medicine, 201 E. Madison St, Springfield, IL, 62794-9664, USA.
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Jenkins W, Lipka A, Fogleman A, Delfino K, Malhi R, Hendricks B. Variance in disease risk: rural populations and genetic diversity. Genome 2016; 59:519-25. [DOI: 10.1139/gen-2016-0077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Over 19% of the US population resides in rural areas, where studies of disease risk and disease outcomes are difficult to assess due to smaller populations and lower incidence. While some studies suggest rural disparities for different chronic diseases, the data are inconsistent across geography and definitions of rurality. We reviewed the literature to examine if local variations in population genomic diversity may plausibly explain inconsistencies in estimating disease risk. Many rural communities were founded over 150 years ago by small groups of ethnically and ancestrally similar families. These have since endured relative geographical isolation, similar to groups in other industrialized nations, perhaps resulting in founder effects impacting local disease susceptibility. Studies in Europe and Asia have found that observably different phenotypes may appear in isolated communities within 100 years, and that genomic variation can significantly vary over small geographical scales. Epidemiological studies utilizing common “rural” definitions may miss significant disease differences due to assumptions of risk homogeneity and misinterpretation of administrative definitions of rurality. Local genomic heterogeneity should be an important aspect of chronic disease epidemiology in rural areas, and it is important to consider for designing studies and interpreting results, enabling a better understanding of the heritable components of complex diseases.
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Affiliation(s)
- W.D. Jenkins
- Population Health Science Program, Southern Illinois University School of Medicine, 801 N. Rutledge St., Springfield, IL 62794-9664, USA
| | - A.E. Lipka
- Department of Crop Sciences, University of Illinois, W-201B Turner Hall, 1102 S Goodwin Ave., Urbana IL 61801, USA
| | - A.J. Fogleman
- Center for Clinical Research, Southern Illinois University School of Medicine, 801 N. Rutledge St., Springfield, IL 62794-9664, USA
| | - K.R. Delfino
- Center for Clinical Research, Southern Illinois University School of Medicine, 801 N. Rutledge St., Springfield, IL 62794-9664, USA
| | - R.S. Malhi
- Depts. of Anthropology & Animal Biology, Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign, 209F Davenport Hall, 607 Matthews Ave., Urbana, IL 61801, USA
| | - B. Hendricks
- Department of History, Southern Illinois University, 1000 Faner Drive, Rm 3374, Carbondale, IL 62901, USA
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Browne T, Priester MA, Clone S, Iachini A, DeHart D, Hock R. Barriers and Facilitators to Substance Use Treatment in the Rural South: A Qualitative Study. J Rural Health 2015; 32:92-101. [PMID: 26184098 DOI: 10.1111/jrh.12129] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Little qualitative research has examined factors associated with care in substance abuse treatment agencies in Southeastern rural communities. This study explored client- and agency stakeholder-perceived barriers and facilitators to substance use treatment delivery in southeastern rural communities. METHODS Group and individual interviews were conducted with 40 key stakeholders and 40 clients at 9 substance abuse agencies serving rural communities in a southeastern state. Qualitative thematic analysis was used to identify perceived barriers and facilitators to substance abuse services in rural communities. FINDINGS Four primary themes emerged from the client and stakeholder interviews as both barriers and facilitators: availability of services for individuals with substance use disorders; access to the current technology for client services and agency functioning; cost of services; and stigma. CONCLUSIONS This study identifies novel barriers and facilitators to substance use care in the rural South and highlights essential areas for consideration when developing and implementing substance use care in this geographic region. These findings can be used as guidelines to provide better care to individuals with substance use disorders living in rural communities.
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7
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Slaunwhite AK, Macdonald S. Alcohol, Isolation, and Access to Treatment: Family Physician Experiences of Alcohol Consumption and Access to Health Care in Rural British Columbia. J Rural Health 2015; 31:335-45. [PMID: 25953523 DOI: 10.1111/jrh.12117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this project was to study the experiences of physicians who treat persons with alcohol-attributed diseases in rural areas of British Columbia, Canada. METHOD A cross-sectional survey was distributed to primary health care physicians that had a family practice in a designated rural community using the Rural Coordination Centre of British Columbia's community isolation rating system. Data were collected through a mail and online survey sent to primary health care physicians. Purposeful sampling was used to select participants that had a primary health care practice in a designated rural community. RESULTS Surveys were returned by 22% of potential participants (N = 67) that had an average of 15.8 years in family practice. The majority of participants (95.4%) reported that alcohol had a negative impact on population health, and physicians expressed particular concern for alcohol consumption in relation to mental health (85.1%) and physical illness (82.1%). Most participants had referred patients out of the community for treatment; however, 76.4% reported difficulty with referrals, including long wait-lists, limited services, and issues related to transportation and leaving the community for substance use treatment. CONCLUSION Rural physicians showed an awareness and concern for alcohol consumption in their community, but they also reported difficulties referring patients for substance use treatment. Additional study is required to understand how to improve the continuity of care provided to persons with alcohol-related issues in rural British Columbia.
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Affiliation(s)
- Amanda K Slaunwhite
- Department of Sociology, University of New Brunswick, Fredericton, New Brunswick, Canada.,Centre for Addictions Research of British Columbia, Victoria, British Columbia, Canada
| | - Scott Macdonald
- Centre for Addictions Research of British Columbia, Victoria, British Columbia, Canada.,School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
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8
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Dwyer-Lindgren L, Flaxman AD, Ng M, Hansen GM, Murray CJL, Mokdad AH. Drinking Patterns in US Counties From 2002 to 2012. Am J Public Health 2015; 105:1120-7. [PMID: 25905846 DOI: 10.2105/ajph.2014.302313] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We estimated the prevalence of any drinking and binge drinking from 2002 to 2012 and heavy drinking from 2005 to 2012 in every US county. METHODS We applied small area models to Behavioral Risk Factor Surveillance System data. These models incorporated spatial and temporal smoothing and explicitly accounted for methodological changes to the Behavioral Risk Factor Surveillance System during this period. RESULTS We found large differences between counties in all measures of alcohol use: in 2012, any drinking prevalence ranged from 11.0% to 78.7%, heavy drinking prevalence ranged from 2.4% to 22.4%, and binge drinking prevalence ranged from 5.9% to 36.0%. Moreover, there was wide variation in the proportion of all drinkers who engaged in heavy or binge drinking. Heavy and binge drinking prevalence increased in most counties between 2005 and 2012, but the magnitude of change varied considerably. CONCLUSIONS There are large differences within the United States in levels and recent trends in alcohol use. These estimates should be used as an aid in designing and implementing targeted interventions and to monitor progress toward reducing the burden of excessive alcohol use.
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Affiliation(s)
- Laura Dwyer-Lindgren
- All authors are with the Institute for Health Metrics and Evaluation, University of Washington, Seattle
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9
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Lake SL, Hill-Kapturczak N, Liang Y, Roache JD, Mullen J, Karns TE, Dougherty DM. Assessing the Validity of Participant-Derived Compared to Staff-Derived Values to Compute a Binge Score. Alcohol Alcohol 2015; 50:413-9. [PMID: 25770137 DOI: 10.1093/alcalc/agv018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/19/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS This study examined the validity of two methods of classifying binge drinkers. METHODS Adult drinkers (n = 166) completed the Alcohol Use Questionnaire (AUQ) and a Timeline Followback (TLFB) interview to characterize drinking during the past 28 days. Using Townshend and Duka's (2005) recommendations, answers on three AUQ items (average drinks per hour, number of times drunk within the prior 6 months and percentage of times drunk when drinking) were used to derive a binge score that was then used to classify drinkers as Binge, Non-Binge and Unclassifiable. Two methods for calculating binge scores were compared: (a) Participant-derived, using participants' answers on the 3 AUQ items; and (b) Staff-derived, staff used TLFB interview information to answer the 3 AUQ items. Additionally, Participant- and Staff-derived classifications were used to predict future drinking behaviors assessed by a second TLFB interview. RESULTS Participant- and Staff-derived binge scores had a low concordance rate. Staff-derived classifications were better than Participant-derived classifications at predicting future binge drinking behavior and identifying group differences in drinking behavior reported during the second TLFB interview (average drinks per hour, number of times drunk within the prior 6 months, and percentage of times drunk when drinking). CONCLUSIONS Classifying drinkers using staff-guided TLFB interview methods instead of self-reported participant generalizations of typical drinking habits better relates to real-world drinking. Classification schemes that rely on dichotomous categorization of drinkers (Binge vs. Non-Binge) may be missing individuals who engage in harmful patterns of drinking. A continuous scale or index characterizing problematic drinking may be more useful.
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Affiliation(s)
- Sarah L Lake
- Psychiatry Department, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Nathalie Hill-Kapturczak
- Psychiatry Department, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Yuanyuan Liang
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - John D Roache
- Psychiatry Department, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Jillian Mullen
- Psychiatry Department, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Tara E Karns
- Psychiatry Department, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Donald M Dougherty
- Psychiatry Department, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
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Alanee S, Dynda D, LeVault K, Mueller G, Sadowski D, Wilber A, Jenkins WD, Dynda M. Delivering kidney cancer care in rural Central and Southern Illinois: a telemedicine approach. Eur J Cancer Care (Engl) 2014; 23:739-44. [PMID: 25286964 DOI: 10.1111/ecc.12248] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2014] [Indexed: 11/29/2022]
Abstract
There is a growing body of experience and research suggesting that telemedicine (video conferencing, smart phones and online patient portals) could be the solution to addressing gaps in the provision of specialised healthcare in rural areas. The proposed role of telemedicine in providing needed services in hard to reach areas is not new. The United States Telecommunication Act of 1996 provided the initial traction for telemedicine by removing important economic and legal obstacles regarding the use of technology in healthcare delivery. This initial ruling has been supplemented by the availability of federal funding to support efforts aimed at developing telemedicine in underserved areas. In this paper, we explore one aspect of disease disparity pertinent to rural Illinois (kidney cancer incidence and mortality) and describe how we are planning to use an existing telemedicine program at Southern Illinois University School of Medicine (SIUSOM) to improve kidney cancer (Kca) care in rural Illinois. This represents an example of the possible role of telemedicine in addressing healthcare disparities in rural areas/communities and provides a description of general challenges and barriers to the implementation and maintenance of such systems.
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Affiliation(s)
- S Alanee
- Department of Surgery, Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA; Simmons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL, USA
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11
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McGarvey EL, Leon-Verdin M, Bloomfield K, Wood S, Winters E, Smith J. Effectiveness of A-CRA/ACC in treating adolescents with cannabis-use disorders. Community Ment Health J 2014; 50:150-7. [PMID: 23229053 DOI: 10.1007/s10597-012-9566-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 10/29/2012] [Indexed: 11/24/2022]
Abstract
An evidence-based treatment for adolescent cannabis users, Adolescent Community Reinforcement Approach with Assertive Continuing Care, was implemented in a rural county and small city in the USA. A total of 147 adolescents, ages 12-18, were enrolled and assessed at baseline and three time points: 3, 6, and 12 months using the Global Appraisal of Individual Needs and related measures. Program effectiveness was confirmed. The treatment was equally effective for youth from the city versus the county. More than two-thirds (68.7%) of the adolescents reported quitting use of cannabis by 12 months. The days of cannabis use in the last 90 days decreased significantly from the first follow-up, controlling for age (p value < .01), and shows consistent decline until the end of the treatment. In addition to reduction in substance use, the average number of days missing school and expelled from school decreased significantly from baseline to the end of the treatment.
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Affiliation(s)
- Elizabeth L McGarvey
- Department of Public Health Sciences, School of Medicine, University of Virginia, P.O. Box 800717, Charlottesville, VA, 22908, USA,
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12
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Bailey BA, Manning T, Peiris AN. The impact of living in rural and urban areas: vitamin D and medical costs in veterans. J Rural Health 2013; 28:356-63. [PMID: 23017006 DOI: 10.1111/j.1748-0361.2012.00407.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Living in a rural region is associated with significant health disparities and increased medical costs. Vitamin D deficiency, which is increasingly common, is also associated with many adverse health outcomes. The purpose of this study was to determine whether rural-urban residence status of veterans was related to vitamin D levels, and to determine if this factor also influenced medical costs/service utilization. Additionally explored was whether vitamin D differences accounted for part of the association between area of residence and medical costs/service utilization. METHODS Medical records of 9,396 veterans from 6 Veterans Administration Medical Centers were reviewed for variables of interest including county of residence, vitamin D level, medical costs and service utilization, and background variables. Rurality status was classified as large metropolitan, urban, and rural. FINDINGS The 3 rurality status groups differed significantly in vitamin D levels, with the highest levels observed for urban residents, followed by rural residents, and the lowest for large metro residents. Compared with urban residents, large metro residents were 49% more likely, while rural residents were 20% more likely, to be vitamin D deficient. Both rural and large metro residents had higher medical costs, and they were significantly more likely to be hospitalized. Vitamin D levels explained a statistically significant amount of the relationship between rurality status and medical costs/service utilization. CONCLUSIONS Vitamin D deficiency may be an additional health disparity experienced by both rural and inner-city veterans, and patients residing in these locations should be considered at increased risk for deficiency and routinely tested.
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Affiliation(s)
- Beth A Bailey
- Department of Family Medicine, East Tennessee State University, Johnson City, Tennessee 37684, USA.
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13
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Barbosa-Leiker C, McPherson S, Cameron JM, Jathar R, Roll J, Dyck DG. Depression as a mediator in the longitudinal relationship between psychological stress and alcohol use. JOURNAL OF SUBSTANCE USE 2013. [DOI: 10.3109/14659891.2013.808711] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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14
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Staton-Tindall M, Wahler E, Webster JM, Godlaski T, Freeman R, Leukefeld C. Telemedicine-based alcohol services for rural offenders. Psychol Serv 2013; 9:298-309. [PMID: 22867122 DOI: 10.1037/a0026772] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Research has consistently shown that alcohol use is a problem in rural communities and access to substance abuse treatment, particularly evidence-based treatment is limited. Because telemedicine has been shown to be effective in delivering services, this article presents a novel and innovative way of using telemedicine technology in the form of videoconferencing to deliver an evidence-based alcohol intervention (motivational enhancement therapy) with at-risk alcohol users in real-world settings (rural probation and parole offices). This article focuses on: (a) creating a profile of an at-risk group of rural alcohol users; (b) describing the evidence-based intervention; and (c) describing the innovative telemedicine-based service delivery approach.
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Affiliation(s)
| | | | | | | | | | - Carl Leukefeld
- University of Kentucky, Center on Drug and Alcohol Research
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Coomber K, Miller PG, Livingston M, Xantidis L. Larger Regional and Rural Areas in Victoria, Australia, Experience More Alcohol-Related Injury Presentations at Emergency Departments. J Rural Health 2013; 29:320-6. [DOI: 10.1111/jrh.12014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kerri Coomber
- School of Psychology; Deakin University; Geelong Australia
| | | | - Michael Livingston
- Drug Policy Modelling Program; National Drug and Alcohol Research Center; University of New South Wales; Sydney Australia
- Centre for Alcohol Policy Research; Turning Point Alcohol and Drug Centre; Melbourne Australia
| | - Luke Xantidis
- School of Psychology; Deakin University; Geelong Australia
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Kennedy AJ, Mellor D, McCabe MP, Ricciardelli LA, Brumby SA, Head A, Mercer-Grant C. Training and experience of nurses in responding to alcohol misuse in rural communities. Public Health Nurs 2013; 30:332-42. [PMID: 23808858 DOI: 10.1111/phn.12029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Alcohol misuse by farmers continues to challenge rural nurses. This article reports on the experiences of Australian nurses participating in the Alcohol Intervention Training Program (AITP). DESIGN AND SAMPLE Qualitative interviews of 15 rural and remote nurses. MEASURES Semi-structured phone interviews were utilized to assess the response to and implementation of the AITP-an intervention designed to build nurses' knowledge, confidence and skills when responding to alcohol misuse. It comprises practical and theoretical components and was designed for rural and remote settings where nurses encounter alcohol misuse. RESULTS Nurses found the training provided new-or built on existing-knowledge of alcohol misuse and offered practical hands-on "real life" skills. A range of workplace and personal situations where the content of the training was now being utilized were identified, and future use anticipated. Barriers to using the new knowledge and skills included both rural and generic issues. Constructive feedback to increasingly target the training to rural settings was recommended. CONCLUSIONS The AITP is an effective training program. It can be further tailored to meet common needs of rural and remote nurses working with farmers who misuse alcohol, while recognizing diversity in rural practice.
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Affiliation(s)
- Alison J Kennedy
- School of Psychology, Deakin University, Burwood, Victoria, Australia.
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Brumby S, Kennedy A, Chandrasekara A. Alcohol consumption, obesity, and psychological distress in farming communities-an Australian study. J Rural Health 2013; 29:311-9. [PMID: 23802933 DOI: 10.1111/jrh.12001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Alcohol consumption patterns nationally and internationally have been identified as elevated in rural and remote populations. In the general Australian population, 20.5% of adult males and 16.9% of adult females drink at short-term, high-risk levels. Farmers are more likely to drink excessively than those living in major cities. This study seeks to explore the relationships between farmers' physical and mental health and their alcohol consumption patterns. Our hypothesis is that farmers consume alcohol at high-risk levels more often than the Australian average and that this consumption is associated with obesity and psychological distress. METHODS Cross-sectional descriptive data were collected within Australian farming communities from 1,792 consenting adults in 97 locations across Australia. Data on anthropometric measurements, general physical attributes and biochemical assessments were used to explore the interrelationships of self-reported alcohol consumption patterns with obesity, psychological distress, and other physical health parameters. FINDINGS There was a higher prevalence of short-term, high-risk alcohol consumption (56.9% in men and 27.5% in women) reported in the study compared with national data. There was also a significant positive association between the prevalence of high-risk alcohol consumption and the prevalence of obesity and abdominal adiposity in psychologically distressed participants. CONCLUSIONS The prevalence of short-term, high-risk alcohol consumption practices in this cohort of farming men and women is significantly higher than the Australian average. These consumption practices are coupled with a range of other measurable health issues within the farming population, such as obesity, hypertension, psychological distress, and age.
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Affiliation(s)
- Susan Brumby
- National Centre for Farmer Health, Western District Health Service, Hamilton, Victoria, Australia.
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Chen W, Shiao WB, Lin BYJ, Lin CC. Rural and Urban Married Asian Immigrants in Taiwan: Determinants of their Physical and Mental Health. J Immigr Minor Health 2012. [DOI: 10.1007/s10903-012-9750-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bouchard JC, Kim J, Beal DR, Vaickus LJ, Craciun FL, Remick DG. Acute oral ethanol exposure triggers asthma in cockroach allergen-sensitized mice. THE AMERICAN JOURNAL OF PATHOLOGY 2012; 181:845-57. [PMID: 22796441 DOI: 10.1016/j.ajpath.2012.05.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 04/24/2012] [Accepted: 05/22/2012] [Indexed: 11/28/2022]
Abstract
Asthma may be triggered by multiple mediators, including allergen-IgE cross-linking and non-IgE mechanisms. Several clinical studies have shown acute ethanol consumption exacerbates asthma, yet no animal model exists to study this process. We developed a model of ethanol-triggered asthma in allergen-sensitized mice to evaluate the mechanisms of ethanol inducing asthma-like responses. Outbred mice were exposed to cockroach allergens on Days 0 and 14; and on Day 21, mice received ethanol by oral gavage. Tracer studies confirmed alcohol aspiration did not occur. Within 30 minutes, alcohol induced degranulation of over 74% of mast cells, and multiple parameters of asthma-like pulmonary inflammation were triggered. Ethanol-gavaged mice had a fivefold increased production of eotaxin-2 (534 pg/mL) and a sevenfold increase in bronchoalveolar eosinophils (70,080 cells). Ethanol induced a 10-fold increase in IL-13, from 84 pg/mL in sensitized mice to 845 pg/mL in ethanol-gavaged sensitized mice. In cockroach allergen-sensitized mice, ethanol triggered asthma-like changes in respiratory physiology and a significant fivefold increase in airway mucin production. Importantly, none of these asthmatic exacerbations were observed in normal mice gavaged with ethanol. Cromolyn sodium effectively stabilized mast cells, yet increased mucin production and bronchoalveolar eosinophil recruitment. Together, these data show a single oral alcohol exposure will trigger asthma-like pulmonary inflammation in allergen-sensitized mice, providing a novel asthma model.
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Affiliation(s)
- Jacqueline C Bouchard
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Massachusetts, USA
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Kranzler HR, Scott D, Tennen H, Feinn R, Williams C, Armeli S, Taylor RE, Briggs-Gowan MJ, Covault J. The 5-HTTLPR polymorphism moderates the effect of stressful life events on drinking behavior in college students of African descent. Am J Med Genet B Neuropsychiatr Genet 2012; 159B:484-90. [PMID: 22488930 PMCID: PMC3682418 DOI: 10.1002/ajmg.b.32051] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 03/21/2012] [Indexed: 11/12/2022]
Abstract
Covault et al. [Covault et al. (2007); Biol Psychiatry 61(5): 609-616] reported that the common functional polymorphism, 5-HTTLPR, in the serotonin transporter gene moderated the association between past-year stressful events and daily reports of drinking in a sample of European-American (EA) college students. We examined this effect in college students of African descent. Students recruited at a Historically Black University (n = 564) completed web-based measures of past-year stressful life experiences and daily reports of drinking and heavy drinking over a 30-day period. Participants were genotyped for the tri-allelic 5-HTTLPR polymorphism and dichotomized as low-activity S' allele carriers or high-activity L' homozygotes. Generalized linear models were used to examine the effects of life stress, genotype, and their interaction on the two drinking measures. In students who completed 15 or more daily surveys (n = 393), there was a significant interaction of past-year stressful events, 5-HTTLPR genotype, and gender on the number of drinking days (P = 0.002). Similar findings were obtained in relation to heavy drinking days (P = 0.007). Men showed a main effect of past-year stressful events on both drinking outcomes (P's < 0.001), but no main or moderator effects of genotype. In women, the S' allele moderated the impact of past-year life stressors on the frequency of drinking and heavy drinking days (P's < 0.001). In college students of African descent, past-year stressful events were associated with more frequent drinking and heavy drinking, an effect that was moderated by the 5-HTTLPR polymorphism. However, in contrast to the findings in EA students, in the current sample, 5-HTTLPR moderated the association only among women.
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Affiliation(s)
- Henry R. Kranzler
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania and VISN4 MIRECC, Philadelphia VAMC, Philadelphia, PA 19104
| | - Denise Scott
- Alcohol Research Center, Department of Pharmacology, Howard University, Washington, DC 20060
| | - Howard Tennen
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06030,Department of Community Medicine and Healthcare, University of Connecticut School of Medicine, Farmington, CT 06030
| | - Richard Feinn
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06030
| | - Carla Williams
- Alcohol Research Center, Department of Pharmacology, Howard University, Washington, DC 20060
| | - Stephen Armeli
- Department of Psychology, Fairleigh-Dickinson University, Teaneck, NJ 07666
| | - Robert E. Taylor
- Alcohol Research Center, Department of Pharmacology, Howard University, Washington, DC 20060
| | | | - Jonathan Covault
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06030,To whom correspondence should be addressed at: Department of Psychiatry, 263 Farmington Avenue, Farmington, CT 06030-1410, Phone: 860-679-7560, Fax: 860-679-1296,
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Abstract
Rates of risky alcohol use appear to be elevated among active duty and veteran military personnel. Little is known, however, about characteristics associated with alcohol misuse in these groups. Furthermore, although there is evidence to suggest that patterns of alcohol use differ according to place of residence, no prior studies have investigated variability in alcohol use according to level of rurality and geographic region in US military veterans. The present study evaluated variations in alcohol use (ie, past 30-day use, heavy use, and binge drinking) and drinking and driving according to place of residence among 55,452 US military veterans participating in the Behavioral Risk Factor Surveillance System. Veterans residing in rural areas were significantly less likely than those from suburban and urban areas to have consumed alcohol in the past 30 days (p < .001). Conversely, rural-dwelling veterans who did drink alcohol had higher odds of binge drinking (p < .005) and (relative to urban residents) drinking and driving (p = .013). Veterans residing in the South were significantly less likely than those from other geographic regions to report past 30-day alcohol use (p < .001). In addition, veterans living in the Midwest were significantly more likely than those from the South to report drinking and driving (p = .017). No differences in heavy alcohol use were observed based on location of residence.
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Affiliation(s)
- Mark W Vander Weg
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Medical Center, 601 Highway 6 West, Iowa City, IA 52246, USA.
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Perron BE, Gillespie DF, Alexander-Eitzman B, Delva J. Availability of outpatient substance use disorder treatment programs in the United States. Subst Use Misuse 2010; 45:1097-111. [PMID: 20441453 DOI: 10.3109/10826080903443602] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this study was to examine the availability of outpatient substance use disorder (SUD) treatment programs in the United States. A geographic information system (GIS) was used to spatially locate outpatient SUD treatment programs, calculate areas, and determine population density within specific areas. Urban areas were mapped using data from the US Census (2000). Addresses of outpatient SUD treatment programs were obtained from the Facility Locator Web site of the Substance Abuse and Mental Health Services Administration. A 15-mile service catchment around each outpatient SUD treatment program was drawn. The amount of urban area not covered by the service catchment represents the underserved. Total underserved urban area and population without access was computed for each state. Significant variability of underserved urban area and population was observed across the states. Moderate correlations among area and population suggest that some states are more effective in locating SUD treatment programs than other states.
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Affiliation(s)
- Brian E Perron
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA.
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Beatty K, Harris JK, Barnes PA. The Role of Interorganizational Partnerships in Health Services Provision Among Rural, Suburban, and Urban Local Health Departments. J Rural Health 2010; 26:248-58. [DOI: 10.1111/j.1748-0361.2010.00285.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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26
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Zhou X, Su Z, Deng H, Xiang X, Chen H, Hao W. A comparative survey on alcohol and tobacco use in urban and rural populations in the Huaihua District of Hunan Province, China. Alcohol 2006; 39:87-96. [PMID: 17134661 DOI: 10.1016/j.alcohol.2006.07.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Revised: 06/22/2006] [Accepted: 07/06/2006] [Indexed: 11/23/2022]
Abstract
Modern Chinese society is comprised primarily of two subgroups-urban and rural subpopulations. However, comparative data regarding alcohol and tobacco use between urban and rural subgroups in China is sparse. An epidemiological survey was conducted in the Huaihua District of Hunan Province of China, and 3,543 urban and 4,294 rural dwellers aged 15-65 years were interviewed. The drinking rates were higher in the urban area (45.9%) than in the rural area (39.6%), whereas the smoking rates were higher in the rural area (35.9%) than in the urban area (28.7%). Rural respondents were more likely to report heavy drinking (Adjusted odds ratio [OR]=1.77) and heavy smoking (Adjusted OR=2.46) than urban populations. Specifically, rural males had higher odds of heavy alcohol and tobacco use than urban males, whereas more urban females were more likely to drink and smoke than rural counterparts. The findings suggest that the status of alcohol and tobacco use varies in the urban and rural area. The heavy alcohol and tobacco consumption among rural populations underscores the need to develop and implement culturally appropriate public health intervention and awareness arising programs especially in rural China.
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Affiliation(s)
- Xuhui Zhou
- Mental Health Institute and WHO Collaborating Center for Drug Abuse and Health, the 2nd Xiangya Hospital of Central South University, Changsha 410011, Hunan, PR China
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