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Interrante JD, Fritz AH, McCoy MB, Kozhimannil KB. Effects of Breastfeeding Peer Counseling on County-Level Breastfeeding Rates Among WIC Participants in Greater Minnesota. Womens Health Issues 2024; 34:232-240. [PMID: 38195269 DOI: 10.1016/j.whi.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/10/2023] [Accepted: 12/01/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE U.S. breastfeeding outcomes consistently fall short of public health targets, with lower rates among rural and low-income people, as well as participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The U.S. Department of Agriculture funded a subset of local WIC agencies in Minnesota to implement Breastfeeding Peer Counseling Programs (BFPCs) aimed at improving breastfeeding rates. We examined the impact of BFPCs on breastfeeding rates among WIC participants in Greater Minnesota (outside the Minneapolis-St. Paul metropolitan area). METHODS We used data from the Minnesota WIC Information System for the years 2012 through 2019 to estimate the impact of peer counseling on breastfeeding duration using difference-in-differences models. Additionally, we examined results among rural counties and assessed the possibility of spillover effects by stratifying whether a county without BFPCs bordered one with BFPCs. RESULTS Availability of BFPCs resulted in a 3.1 to 3.4 percentage-point increase in breastfeeding rates at 3 months and a 3.2 to 3.7 percentage-point increase in breastfeeding rates at 6 months among WIC participants in Greater Minnesota. Among rural counties, results showed a statistically significant 4.1 to 5.2 percentage-point increase in breastfeeding duration rates. Both border and nonborder counties experienced positive impacts of BFPCs on breastfeeding rates, suggesting wide-ranging program spillover effects. CONCLUSIONS BFPCs had a significant positive impact on breastfeeding duration. Findings indicate an opportunity for improving rural breastfeeding rates through increased funding for WIC BFPCs.
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Affiliation(s)
- Julia D Interrante
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
| | - Alyssa H Fritz
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Marcia B McCoy
- Minnesota Department of Health Special Supplemental Nutrition Program for Women, Infants, and Children, Division of Child and Family Health, St Paul, Minnesota
| | - Katy Backes Kozhimannil
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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Kozhimannil KB, Sheffield EC, Fritz AH, Henning‐Smith C, Interrante JD, Lewis VA. Rural/urban differences in rates and predictors of intimate partner violence and abuse screening among pregnant and postpartum United States residents. Health Serv Res 2024; 59:e14212. [PMID: 37553107 PMCID: PMC10915503 DOI: 10.1111/1475-6773.14212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE To describe rates and predictors of perinatal intimate partner violence (IPV) and rates and predictors of not being screened for abuse among rural and urban IPV victims who gave birth. DATA SOURCES AND STUDY SETTING This analysis utilized 2016-2020 Pregnancy Risk Assessment Monitoring System (PRAMS) data from 45 states and three jurisdictions. STUDY DESIGN This is a retrospective, cross-sectional study using multistate survey data. DATA COLLECTION/EXTRACTION METHODS This analysis included 201,413 survey respondents who gave birth in 2016-2020 (n = 42,193 rural and 159,220 urban respondents). We used survey-weighted multivariable logistic regression models, stratified by rural/urban residence, to estimate adjusted predicted probabilities and 95% confidence intervals (CIs) for two outcomes: (1) self-reported experiences of IPV (physical violence by a current or former intimate partner) and (2) not receiving abuse screening at health care visits before, during, or after pregnancy. PRINCIPAL FINDINGS Rural residents had a higher prevalence of perinatal IPV (4.6%) than urban residents (3.2%). Rural respondents who were Medicaid beneficiaries, 18-35 years old, non-Hispanic white, Hispanic (English-speaking), or American Indian/Alaska Native had significantly higher predicted probabilities of experiencing perinatal IPV compared with their urban counterparts. Among respondents who experienced perinatal IPV, predicted probabilities of not receiving abuse screening were 21.3% for rural and 16.5% for urban residents. Predicted probabilities of not being screened for abuse were elevated for rural IPV victims who were Medicaid beneficiaries, 18-24 years old, or unmarried, compared to urban IPV victims with those same characteristics. CONCLUSIONS IPV is more common among rural birthing people, and rural IPV victims are at higher risk of not being screened for abuse compared with their urban peers. IPV prevention and support interventions are needed in rural communities and should focus on universal abuse screening during health care visits and targeted support for those at greatest risk of perinatal IPV.
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Affiliation(s)
- Katy Backes Kozhimannil
- Division of Health Policy and ManagementUniversity of Minnesota Rural Health Research Center, University of Minnesota School of Public HealthMinneapolisMinnesotaUSA
- Division of Health Policy and ManagementUniversity of Minnesota, University of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - Emily C. Sheffield
- Division of Health Policy and ManagementUniversity of Minnesota Rural Health Research Center, University of Minnesota School of Public HealthMinneapolisMinnesotaUSA
- Division of Health Policy and ManagementUniversity of Minnesota, University of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - Alyssa H. Fritz
- Division of Health Policy and ManagementUniversity of Minnesota Rural Health Research Center, University of Minnesota School of Public HealthMinneapolisMinnesotaUSA
- Division of Health Policy and ManagementUniversity of Minnesota, University of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - Carrie Henning‐Smith
- Division of Health Policy and ManagementUniversity of Minnesota Rural Health Research Center, University of Minnesota School of Public HealthMinneapolisMinnesotaUSA
- Division of Health Policy and ManagementUniversity of Minnesota, University of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - Julia D. Interrante
- Division of Health Policy and ManagementUniversity of Minnesota Rural Health Research Center, University of Minnesota School of Public HealthMinneapolisMinnesotaUSA
- Division of Health Policy and ManagementUniversity of Minnesota, University of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - Valerie A. Lewis
- Department of Health Policy and ManagementGillings School of Global Public Health, University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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MacDougall H, Mork D, Hanson S, Smith CH. Rural-urban differences in health care unaffordability. J Rural Health 2024; 40:376-385. [PMID: 37495555 PMCID: PMC10811280 DOI: 10.1111/jrh.12788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE To compare health care unaffordability in rural versus urban contexts while also examining the impact of sociodemographic/socioeconomic variables on this relationship. METHODS We examined survey responses from the 2019-2021 National Health Interview Survey (n = 90,761). We conducted chi-squared tests comparing urban and rural subsamples and multivariable logistic regression analyses examining the associations between rurality and 3 measures of health care unaffordability while also including interactions between rurality and individual characteristics of respondents. FINDINGS In bivariate analyses, compared to their urban counterparts, rural residents were more likely to report problems paying medical bills (15.0% vs 11.5%, P <.001) and being unable to pay medical bills (9.3% vs 7.1%, P < .001). In fully adjusted multivariable regression analyses, rural residents were significantly less likely than their urban counterparts to report being worried about paying medical bills (AOR: .915, CI: .871-.961, P < .001). We found significant interactions between rural residency and insurance type, age, income to poverty ratio, and race/ethnicity for the outcome of problems paying medical bills; and significant interactions between rural residency and income to poverty ratio and race and ethnicity for the outcome of being unable to pay medical bills. CONCLUSION Rural residents report higher rates of 2 measures of health care unaffordability as compared to their urban counterparts. In multivariable logistic models, rural residency is not associated with higher rates of health care unaffordability; however, significant interactions exist between rural residency and individual variables demonstrating the heterogenous experiences of health care unaffordability based on these intersectional identities.
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HUNG PEIYIN, GRANGER MARION, BOGHOSSIAN NANSI, YU JIANI, HARRISON SAYWARD, LIU JIHONG, CAMPBELL BERRYA, CAI BO, LIANG CHEN, LI XIAOMING. Dual Barriers: Examining Digital Access and Travel Burdens to Hospital Maternity Care Access in the United States, 2020. Milbank Q 2023; 101:1327-1347. [PMID: 37614006 PMCID: PMC10726888 DOI: 10.1111/1468-0009.12668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/30/2023] [Accepted: 07/31/2023] [Indexed: 08/25/2023] Open
Abstract
Policy Points The White House Blueprint for Addressing the Maternal Health Crisis report released in June 2022 highlighted the need to enhance equitable access to maternity care. Nationwide hospital maternity unit closures have worsened the maternal health crisis in underserved communities, leaving many birthing people with few options and with long travel times to reach essential care. Ensuring equitable access to maternity care requires addressing travel burdens to care and inadequate digital access. Our findings reveal socioeconomically disadvantaged communities in the United States face dual barriers to maternity care access, as communities located farthest away from care facilities had the least digital access. CONTEXT With the increases in nationwide hospital maternity unit closures, there is a greater need for telehealth services for the supervision, evaluation, and management of prenatal and postpartum care. However, challenges in digital access persist. We examined associations between driving time to hospital maternity units and digital access to understand whether augmenting digital access and telehealth services might help mitigate travel burdens to maternity care. METHODS This cross-sectional study used 2020 American Hospital Association Annual Survey data for hospital maternity unit locations and 2020 American Community Survey five-year ZIP Code Tabulation Area (ZCTA)-level estimates of household digital access to telecommunication technology and broadband. We calculated driving times of the fastest route from population-weighted ZCTA centroids to the nearest hospital maternity unit. Rural-urban stratified generalized median regression models were conducted to examine differences in ZCTA-level proportions of household lacking digital access equipment (any digital device, smartphones, tablet), and lacking broadband subscriptions by spatial accessibility to maternity units. FINDINGS In 2020, 2,905 (16.6%) urban and 3,394 (39.5%) rural ZCTAs in the United States were located >30 minutes from the nearest hospital maternity units. Regardless of rurality, these communities farther away from a maternity unit had disproportionally lower broadband and device accessibility. Although urban communities have greater digital access to technology and broadband subscriptions compared to rural communities, disparities in the percentage of households with access to digital devices were more pronounced within urban areas, particularly between those with and without close proximity to a hospital maternity unit. Communities where nearest hospital maternity units were >30 minutes away had higher poverty and uninsurance rates than those with <15-minute access. CONCLUSIONS Socioeconomically disadvantaged communities face significant barriers to maternity care access, both with substantial travel burdens and inadequate digital access. To optimize maternity care access, ongoing efforts (e.g., Affordable Connectivity Program introduced in the 2021 Infrastructure Act), should bridge the gaps in digital access and target communities with substantial travel burdens to care and limited digital access.
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Affiliation(s)
- PEIYIN HUNG
- University of South Carolina Arnold School of Public Health
- University of South Carolina Rural and Minority Health Research Center
- South Carolina SmartState Center for Health Care QualityUniversity of South Carolina Arnold School of Public Health
| | - MARION GRANGER
- University of South Carolina Arnold School of Public Health
| | | | - JIANI YU
- Division of Health Policy and Economics of the Department of Population Health SciencesWeill Cornell Medical College
| | - SAYWARD HARRISON
- South Carolina SmartState Center for Health Care QualityUniversity of South Carolina Arnold School of Public Health
- Department of PsychologyUniversity of South Carolina College of Arts and Sciences
| | - JIHONG LIU
- University of South Carolina Arnold School of Public Health
- South Carolina SmartState Center for Health Care QualityUniversity of South Carolina Arnold School of Public Health
| | - BERRY A. CAMPBELL
- Department of Obstetrics and GynecologyUniversity of South Carolina School of Medicine
| | - BO CAI
- University of South Carolina Arnold School of Public Health
| | - CHEN LIANG
- University of South Carolina Arnold School of Public Health
- South Carolina SmartState Center for Health Care QualityUniversity of South Carolina Arnold School of Public Health
| | - XIAOMING LI
- University of South Carolina Arnold School of Public Health
- South Carolina SmartState Center for Health Care QualityUniversity of South Carolina Arnold School of Public Health
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Baldomero AK, Kunisaki KM, Wendt CH, Bangerter A, Diem SJ, Ensrud KE, Nelson DB, Henning-Smith C, Bart BA, Hammett P, Hagedorn HJ, Dudley RA. Drive Time and Receipt of Guideline-Recommended Screening, Diagnosis, and Treatment. JAMA Netw Open 2022; 5:e2240290. [PMID: 36331503 PMCID: PMC9636523 DOI: 10.1001/jamanetworkopen.2022.40290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
IMPORTANCE Many patients do not receive recommended services. Drive time to health care services may affect receipt of guideline-recommended care, but this has not been comprehensively studied. OBJECTIVE To assess associations between drive time to care and receipt of guideline-recommended screening, diagnosis, and treatment interventions. DESIGN, SETTING, AND PARTICIPANTS This cohort study used administrative data from the National Veterans Health Administration (VA) data merged with Medicare data. Eligible participants were patients using VA services between January 2016 and December 2019. Women ages 65 years or older without underlying bone disease were assessed for osteoporosis screening. Patients with new diagnosis of chronic obstructive pulmonary disease (COPD) indicated by at least 2 encounter codes for COPD or at least 1 COPD-related hospitalization were assessed for receipt of diagnostic spirometry. Patients hospitalized for ischemic heart disease were assessed for cardiac rehabilitation treatment. EXPOSURES Drive time from each patient's residential address to the closest VA facility where the service was available, measured using geocoded addresses. MAIN OUTCOMES AND MEASURES Binary outcome at the patient level for receipt of osteoporosis screening, spirometry, and cardiac rehabilitation. Multivariable logistic regression models were used to assess associations between drive time and receipt of services. RESULTS Of 110 780 eligible women analyzed, 36 431 (32.9%) had osteoporosis screening (mean [SD] age, 66.7 [5.4] years; 19 422 [17.5%] Black, 63 403 [57.2%] White). Of 281 130 patients with new COPD diagnosis, 145 249 (51.7%) had spirometry (mean [SD] age, 68.2 [11.5] years; 268 999 [95.7%] men; 37 834 [13.5%] Black, 217 608 [77.4%] White). Of 73 146 patients hospitalized for ischemic heart disease, 11 171 (15.3%) had cardiac rehabilitation (mean [SD] age, 70.0 [10.8] years; 71 217 [97.4%] men; 15 213 [20.8%] Black, 52 144 [71.3%] White). The odds of receiving recommended services declined as drive times increased. Compared with patients with a drive time of 30 minutes or less, patients with a drive time of 61 to 90 minutes had lower odds of receiving osteoporosis screening (adjusted odds ratio [aOR], 0.90; 95% CI, 0.86-0.95) and spirometry (aOR, 0.90; 95% CI, 0.88-0.92) while patients with a drive time of 91 to 120 minutes had lower odds of receiving cardiac rehabilitation (aOR, 0.80; 95% CI, 0.74-0.87). Results were similar in analyses restricted to urban patients or patients whose primary care clinic was in a tertiary care center. CONCLUSIONS AND RELEVANCE In this retrospective cohort study, longer drive time was associated with less frequent receipt of guideline-recommended services across multiple components of care. To improve quality of care and health outcomes, health systems and clinicians should adopt strategies to mitigate travel burden, even for urban patients.
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Affiliation(s)
- Arianne K. Baldomero
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Ken M. Kunisaki
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis
| | - Chris H. Wendt
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis
| | - Ann Bangerter
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Susan J. Diem
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Kristine E. Ensrud
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - David B. Nelson
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Division of Biostatistics, University of Minnesota, Minneapolis
| | | | - Bradley A. Bart
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Cardiology, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Patrick Hammett
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Division of Biostatistics, University of Minnesota, Minneapolis
| | - Hildi J. Hagedorn
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - R. Adams Dudley
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
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