The Importance of Nurse-Patient Relationships in the Midst of Substance Misuse: Support for Rural Youth Well-Being.

Nurses working in rural acute and community-based settings are often asked for substance use treatment guidance and education in a health care system with minimal treatment services available. Nursing science provides an alternative answer for nurses to lean on in their clinical practice when working with rural-dwelling youth in the midst of substance misuse. Practical strategies are offered, which nurses may integrate into their routine clinical care to strengthen the nurse-patient relationship and enhance positive attributes among youth. Connective caring practice is essential to support rural youth well-being and recovery in the midst of substance misuse. [Journal of Psychosocial Nursing and Mental Health Services, 62(6), 7-11.].

Traditional Chinese medicine health literacy among rural older adults: a cross-sectional study.

Background: The purpose of this study was to understand the current status of traditional Chinese medicine (TCM) health literacy among rural older adults people and its influencing factors. Methods: This study used a random number table method to select one prefecture from Henan Province, China and used a convenience sampling method to select 200 rural older adults who met the inclusion criteria in a township in northern Henan from March to April 2023. A cross-sectional survey was conducted using a general information questionnaire and a traditional Chinese medicine health literacy questionnaire, and the influencing factors of rural older adults were analyzed using univariate analysis of variance (ANOVA) and multiple linear regression. Results: The total TCM health literacy score of 200 rural older adults people was 84.14 ± 6.709. One-way ANOVA revealed that six factors, including education level, marital status, type of occupation, presence of family members engaged in medical-related work, main economic sources, and monthly income, influenced the TCM health literacy score of rural older adults people (p < 0.05). Multiple linear regression analysis revealed that education level, occupation type, and the presence of family members engaged in medical-related work were the factors influencing the TCM health literacy of rural older adults. Conclusion: The TCM health literacy level of rural older adults people is at the lower to middle level, and health educators should strengthen the publicity and education of TCM healthcare knowledge for rural older adults people to improve their TCM health literacy level and thus enhance their quality of life.

Mental health inequality between urban and rural youth under COVID-19 from survey data from China.

Background: While health inequality has been the focus of past scholarly discussions, COVID-19's outbreak and spread have provided a new arena for discussing health inequality, particularly in the context of urban-rural disparities in China. This paper explores the impact of COVID-19 on urban-rural health inequality, and the roles played by socioeconomic status and social capital. Methods: A cross-sectional observational collected data on demographics, mental health, socioeconomic status, and social capital. An online survey was administered from August 27 to August 30, 2020, and, 1936 valid samples were received. Mental health was measured using the Brief Symptom Inventory (BSI-18). This study applied the ordinary least squares regression (OLS) model, and data analysis was performed using STATA. Results: There were 1936 participants, with an equal distribution of genders. Multiple regression analysis showed that the mental health levels of rural youth were superior to those of urban youth (p = 0.049), especially when the epidemic was not severe (p = 0.013). Socioeconomic status had a significant positive promotion effect on mental health (p = 0.008), but the interaction effect between socioeconomic status and the urban-rural divide indicated that the promotion effect of socioeconomic status on the mental health of urban youth was greater than that of rural youth (p = 0.04). Social capital had a significant positive promotion effect on mental health (p = 0.000), and the interaction effect indicated that this promoting effect did not differ between urban and rural areas (p > 0.05).

Relationship between hukou conversion and psychological integration of rural older migrants: the mediating effect of accessibility to health resources.

OBJECTIVE: This study investigates the relationship between hukou conversion and the psychological integration of rural older migrants, exploring the mediating role of accessibility to health resources. METHODS: The 3,963 valid samples of rural older migrants included in the study were sourced from the 2017 China Migrants Dynamic Survey (CMDS). The study established a multiple linear regression model for estimation and utilized inverse probability-weighted regression adjustment (IPWRA) method to correct for the selection bias of hukou conversion. RESULTS: Compared to older migrants with rural hukou, merit-based (ß = 0.384, 95% CI: 0.265 to 0.504), family-based (ß = 0.371, 95% CI: 0.178 to 0.565) and policy-based (ß = 0.306, 95% CI: 0.124 to 0.487) converters have significantly higher psychological integration. These findings remain robust even after addressing the potential issue of endogenous selection bias using the IPWRA method. Bootstrap mediating effect tests indicate that hukou conversion can indirectly affect psychological integration through the mediator role of health resources accessibility. CONCLUSION: Accessibility of health resources mediates the association between hukou conversion and psychological integration. Policymakers should enhance the implementation of hukou conversion, strengthen the health resource guarantee system, and achieve a deeper psychological integration among rural older migrants.

Analysis of rural broadband adoption dynamics: A theory-driven agent-based model.

Demand for broadband internet has far outpaced its availability. In addition, the "new normal" imposed by the COVID-19 pandemic has further disadvantaged unserved and underserved areas. To address this challenge, federal and state agencies are funding internet service providers (ISPs) to deploy broadband infrastructure in these areas. To support goals to provide broadband service to as many people as possible as quickly as possible, policymakers and ISPs may benefit from better tools to predict take rates and formulate effective strategies to increase the adoption of high-speed internet. However, there is typically insufficient data available to understand consumer attitudes. We propose using an agent-based model grounded in the Theory of Planned Behavior, a behavioral theory that explains the consumer's decision-making process. The model simulates residential broadband adoption by capturing the effect of market competition, broadband service attributes, and consumer characteristics. We demonstrate the effectiveness of this type of tool via a use case in Missouri to show how simulation results can inform predictions of broadband adoption. In the model, broadband take rates increase as the presence of existing internet users in the area increases and price decreases. With further development, this type of simulation can guide decision-making for infrastructure and digital literacy investment based on demand as well as support the design of market subsidies that aim to reduce the digital divide.

Lifestyle practices and associated factors among adults with hypertension: Conquering Hypertension in Vietnam-solutions at the grassroots level study.

BACKGROUND: Vietnam is experiencing an increasing prevalence of hypertension in its adult population. In addition to medical therapy, modifying adverse lifestyle practices is important for effective blood pressure control. There are limited data on unhealthy lifestyle practices in patients with chronic diseases, however, particularly among hypertensive patients living in rural Vietnam. Our study objectives were to examine the prevalence of unhealthy lifestyle practices and associated factors among rural Vietnamese adults with uncontrolled hypertension. METHODS: Data from the baseline survey of a cluster randomized trial among hypertensive Vietnamese adults (2017-2022) were utilized. Information on unhealthy lifestyle practices including smoking, excessive alcohol consumption, physical inactivity, and inadequate fruit and vegetable intake was collected from study participants. The primary study outcome was having ≥2 unhealthy lifestyle practices. A multivariable logistic regression model was used to examine factors associated with the primary study outcome. RESULTS: The mean age of the 671 patients was 67 years and 45.0% were men. Nearly three out of every four participants had one or fewer unhealthy practices, 24.0% had two, and 3.3% had three or all four unhealthy lifestyle practices. Men, individuals who did unpaid work or were unemployed, and individuals with hypertension level III were more likely to have ≥2 unhealthy lifestyle practices, whereas individuals with higher education were less likely to have ≥2 unhealthy lifestyle practices compared with respective comparison groups. CONCLUSIONS: We observed a high prevalence of unhealthy lifestyle practices among rural Vietnamese patients with uncontrolled hypertension. Several demographic factors were associated with a greater number of unhealthy lifestyle practices. Newer interventions and educational programs encouraging lifestyle modification practices are needed to control hypertension among adults living in rural settings of Vietnam.

Unveiling the nexus between rural population aging, technical efficiency, and carbon emissions in Chinese agriculture.

INTRODUCTION: According to the seventh national population census in China, the proportion of people aged 65 and above in the population reached 13.5%. The aging trend is more pronounced in rural areas, indicating that China has entered an aging society. This article focuses on agricultural carbon emissions in the context of aging, studying the impact of rural population aging on agricultural carbon emissions. STUDY OBJECTIVES: Under the background of deepening population aging, let us discuss how to maintain the green and sustainable development of agriculture in China. METHODOLOGY: Fixed effects and mediating effects models are used. Technical efficiency is used as a mediating variable to discuss the relationship between rural population ageing, technical efficiency and agricultural carbon emissions. RESULTS: This paper adopts the classical carbon emission calculation theory of IPCC to measure agricultural carbon emissions from 2010 to 2019, and China's plantation carbon emissions show an "inverted U-shaped" trend, reaching a high level in 2015 and then starting to decline. In addition, the fixed-effects benchmark regression found that the aging of the rural population promotes agricultural carbon emissions, and the technical efficiency of agriculture suppresses agricultural carbon emissions. Finally, the mediating effect model is applied to explore the relationship between the three. Using technical efficiency as the mediating variable, it is found that under the masking effect, rural population aging will weaken agricultural carbon emissions through technical efficiency, thus achieving the suppression of agricultural carbon emissions. POLICY RECOMMENDATION: The formulation and modification of agricultural carbon-reducing policy row policies should take full account of the broader context of rural population ageing; increase the interconnectedness and interaction between rural population ageing and agricultural production technology, and actively play a positive role in promoting the efficiency of agricultural technology as a result of rural population ageing; and, in accordance with the actual situation of agricultural research, appropriately increase the strength of financial support for agriculture to improve agricultural technology and promote low-carbon development in agriculture.

A study on the factors influencing the vulnerability of women of childbearing age to health poverty in rural western China.

The health of women of childbearing age in rural areas is crucial for the development of individuals, families, and society. Research on the identification and influencing factors of health vulnerability in impoverished and disadvantaged groups is important for adjusting and implementing health poverty alleviation policies. However, there is limited research on the health vulnerability of women of childbearing age in rural Western China. Based on panel data from the Rural Residents' Family Health Status Survey in 2019 and 2022, the vulnerability to health poverty of women of childbearing age in rural areas was constructed using the three-stage feasible generalized least squares method. Variables from four dimensions-physical capital, financial capital, social capital, and human capital-were included in the sustainable livelihood analysis framework for analysis. The Tobit model was used to analyze the influencing factors of vulnerability to health poverty among women of childbearing age in rural Western China, and the contribution rates of various factors were studied using the Shapley value decomposition method. In 2019 and 2022, under the poverty line standards of $1.90 and $2.15, respectively, the vulnerability to health poverty among rural women of childbearing age exceeded 20%. Tobit regression analysis revealed that the type of drinking water being well water significantly increased the vulnerability to health poverty of rural women of childbearing age (P < 0.05), whereas the separation of housing and kitchen, registered poor households, household loans, annual per capita household income, expenditures on social interactions, educational level, self-assessed health status, respondent age, and the utilization of hospital services significantly reduced the vulnerability to health poverty of rural women of childbearing age (P < 0.05). Shapley's decomposition shows that annual per capita household income, expenditures on social interactions, respondent age, and household loans are the factors contributing most to the vulnerability to health poverty of rural women of childbearing age, while other variables have a smaller contribution rate. The health poverty situation of women of childbearing age in rural Western China is not optimistic. Preintervention for health poverty should be strengthened among rural women of childbearing age, early warning mechanisms for the risk of falling back into poverty due to illness should be established, the precise identification of highly vulnerable rural women of childbearing age should be improved, and the medical insurance system for rural women of childbearing age should be enhanced to help improve their current health poverty situation.

Assessment of knowledge, attitudes, and practices regarding cardiovascular diseases (CVDs) among older individuals of rural Bangladesh: findings from a face-to-face interview.

Introduction: Cardiovascular diseases (CVDs) stand as the foremost contributor to global mortality, claiming roughly 17.9 million lives each year, constituting 32.1% of total fatalities. Their impact is notably profound in economies such as Bangladesh, exacting a substantial economic burden. Consequently, grasping the landscape of knowledge, attitudes, and practices is essential for timely identification and prevention strategies. Methods: This cross-sectional study, carried out between January and May 2023 in the rural regions of Zirani, Savar Upazila, Dhaka, Bangladesh, utilized convenient sampling and conducted face-to-face interviews using a semi-structured questionnaire. It encompassed socio-demographic factors, as well as knowledge, attitudes, and practices concerning CVDs. Data analysis employed descriptive statistics, chi-square tests, and regression analyses, utilizing both the R programming language and SPSS (Version 26). Result: A total of 424 participants aged 60 years and above were included. The majority were male (60.8%), and the mean age was 71.21 ± 9.21 years, 57.3% were between 60 and 70 years old. Factors such as education, monthly family income, high blood pressure, diabetes, and non-smoking. Were significantly associated with higher knowledge, attitudes and practices scores. Conclusion: This study illuminates CVD-related KAP among rural Older Individuals in Bangladesh, revealing significant associations between factors such as education, monthly family income, high blood pressure, and non-smoking, with higher scores in knowledge, attitudes, and practices regarding cardiovascular health. These insights underscore the importance of addressing socio-economic factors and health behaviors in developing targeted interventions for the prevention and management of cardiovascular diseases in this demographic.

Place-based strengths and vulnerabilities for mental wellness among rural minority older adults: an intervention development study protocol.

INTRODUCTION: Severe inequities in depression and its diagnosis and treatment among rural-dwelling, racial-minority and ethnic-minority older adults compared with their urban white counterparts result in cognitive impairment, comorbidities and increased mortality, presenting a growing public health concern as the United States (US) population ages. These inequities are often attributable to social and environmental factors, including economic insecurity, histories of trauma, gaps in transportation and safety-net services, and disparities in access to policy-making processes rooted in colonialism. This constellation of factors renders racial-minority and ethnic-minority older adults 'structurally vulnerable' to mental ill health. Fewer data exist on protective factors associated with social and environmental contexts, such as social support, community attachment and a meaningful sense of place. Scholarship on the social determinants of health widely recognises the importance of such place-based factors. However, little research has examined how they shape disparities in depression and treatment specifically, limiting the development of practical approaches addressing these factors and their effects on mental well-being for rural minority populations. METHODS AND ANALYSIS: This community-driven mixed-method study uses quantitative surveys, qualitative interviews and ecological network research with 125 rural American Indian and Latinx older adults in New Mexico and 28 professional and non-professional social supporters to elucidate how place-based vulnerabilities and protective factors shape experiences of depression among older adults. Data will serve as the foundation of a community-driven plan for a multisystem intervention focused on the place-based causes of disparities in depression. Intervention Mapping will guide the intervention development process. ETHICS AND DISSEMINATION: This study has been reviewed and approved by the University of New Mexico Health Sciences Center Institutional Review Board. All participants will provide informed consent. Study results will be disseminated within the community of study through community meetings and presentations, as well as broadly via peer-reviewed journals, conference presentations and social media.

Racial and Ethnic Disparities in Cancer Occurrence and Outcomes in Rural United States: A Scoping Review.

BACKGROUND: Cancer is the second-leading cause of death in the United States. Most studies have reported rural versus urban and Black versus White cancer disparities. However, few studies have investigated racial disparities in rural areas. OBJECTIVE: We conducted a literature review to explore the current state of knowledge on racial and ethnic disparities in cancer attitudes, knowledge, occurrence, and outcomes in rural United States. METHODS: A systematic search of PubMed and Embase was performed. Peer-reviewed articles published in English from 2004-2023 were included. Three authors independently reviewed the articles and reached a consensus. RESULTS: After reviewing 993 articles, a total of 30 articles met the inclusion criteria and were included in the present review. Studies revealed that underrepresented racial and ethnic groups in rural areas were more likely to have low cancer-related knowledge, low screening, high incidence, less access to treatment, and high mortality compared to their White counterparts. CONCLUSION: Underrepresented racial and ethnic groups in rural areas experienced a high burden of cancer. Improving social determinants of health may help reduce cancer disparities and promote health.

Cognition, physical function, and life purpose in the rural elderly population: A systematic review protocol.

INTRODUCTION: Aging in rural settings worldwide, from the perspective of cognition, physical function, and life purpose essential constructs for a prosperous old age, still needs comprehensive discussion. This systematic review protocol aims to highlight the prevalence of cognitive decline, physical functioning, and life purpose in older adults aging in rural community settings. METHODS AND ANALYSIS: We will include cross-sectional studies published until April 2023 found in 8 databases: Embase, MEDLINE, LILACS, PsycINFO, Scopus, SciELO, and Web of Science. Ryyan software will be used for the first selection, and the Observational Study Quality Evaluation (OSQE) will assess methodological quality and risk of bias. Primary analysis will involve titles and abstracts using MeSH descriptors such as "Physical functioning," "Cognition," "Cognitive function," "Life purpose," "Elderly," "Older," "Rural aging," "Rural population," "Communities, rural," "Distribution, rural spatial," "Medium communities," "Rural settlement," "Small community." If necessary, secondary analysis will include a complete reading of selected articles by two blinded reviewers, confirmed by a third person. Publication bias will be assessed using cross-sectional analytical study quality. Sensitivity analyses will identify manuscripts significantly influencing combined prevalence of endpoints.

Prevailing Food Intake, Physical Activity and Health Beliefs in a Rural Agricultural Community in the Philippines: Factors to Consider Prior to a Diabetes Prevention Program.

Objective: A diabetes prevention program is being proposed in the rural agricultural town of San Juan, Batangas, Philippines. This study aims to determine the prevailing level of food intake, physical activity, and health beliefs prior to any intervention. Methodology: Adults were recruited via random sampling with proportional allocation. Interviews were done to determine food intake and physical activity. Small group discussions were held to determine prevailing health beliefs. Results: The average energy intake (1,547 kcal/d) is only 72% of the recommended values for Filipinos. Only 12% of the respondents achieved the recommended energy intake. Carbohydrates comprise a large part (71%) of calorie intake. A majority (91%) already have moderate to high levels of physical activity. There are prevailing health beliefs that need to be considered when dietary modifications and physical activity interventions are to be done. Conclusion: Internationally recommended diabetes prevention interventions such as reducing calorie intake and increasing physical activity may not be directly applicable here. We recommend that the features of a diabetes prevention program for this locale must include the following: 1) introduction of affordable plant sources of proteins; 2) decreasing the proportion of rice as a source of carbohydrates in the diet; 3) maintaining the level of physical activity; and 4) being sensitive to the prevailing health beliefs.

Implications of COVID-19 prevention on the occurrence of childhood diarrhea in the Semen Bench district, Bench Sheko zone, southwestern Ethiopia.

Background: Coronavirus (COVID-19) is a virus that occurred in Wuhan, China, in December 2019 and has spread to several countries. Although interventions in water, sanitation, and hygiene (WASH) for COVID-19 are likely a pre-existing response to childhood diarrhea, evidence of the effects of COVID-19 preventative strategies on childhood diarrhea has been lacking. This study aimed to assess the implications of COVID-19 prevention for the occurrence of childhood diarrhea in rural communities of Ethiopia. Methods: A community-based cross-sectional study was conducted from 10 May 2020 to 30 July 2020 involving selected households in the Semen Bench district, Bench Sheko zone, southwestern Ethiopia. A single population proportion formula was used to obtain a total of 768 sample sizes. Data were collected from selected households using a simple random sampling technique. Epidata 3.1 was used to enter the data and then exported to Stata 14 for analysis. Descriptive statistics along with binary and multivariable logistic regression analyses were used to identify factors of COVID-19 knowledge and practices related to childhood diarrhea. The chi-squared test was used to check the association between COVID-19 prevention and childhood diarrhea reduction. Results: A total of 720 (93.75%) households participated in the study to achieve the study objectives. Approximately 55% of the participants had a good understanding of COVID-19 prevention, while only 48.5% had good COVID-19 prevention practices. The prevalence of childhood diarrhea was 19.3% which was more common among households with poor practices of COVID-19 prevention. The respondents with poor COVID-19 prevention knowledge were 42% (AOR = 0.58, 95% CI: 0.398, 0.847, P = 0.005) less likely to develop childhood diarrhea than those who had good COVID-19 prevention knowledge. Households with poor practices for COVID-19 prevention were 75.1% more likely to develop childhood diarrhea than those who had good preventive practices for COVID-19 prevention (AOR = 1.751, 95% CI: 1.193, 2.571, P = 0.004). The lower risk of childhood diarrhea is significantly related to good COVID-19 prevention practices. However, households with no formal education and a lack of WASH facilities have a higher likelihood of having childhood diarrhea in the household. Conclusion: COVID-19 preventative strategies help reduce the prevalence of diarrhea in children. More research using prospective study designs and advanced statistical models is needed to better understand the implication of COVID-19 preventative efforts in reducing childhood diarrhea.

Geographic Disparities in Access to Assisted Reproductive Technology Centers in China: Spatial-Statistical Study.

A study on infertility in China found that while 543 health care institutions are approved for assisted reproductive technology (ART), only 10.1% offer all ART services, with a significant skew toward the eastern regions, highlighting the accessibility challenges faced by rural and remote populations; this study recommends government measures including travel subsidies and education initiatives to improve ART access for economically disadvantaged individuals.

Acceptance and hesitancy towards COVID-19 vaccines in rural and tribal areas of Maharashtra (India).

INTRODUCTION: Hesitancy towards COVID-19 vaccines may be a major hindrance to a successful vaccination program. We assessed the vaccine uptake, facilitators, and barriers for the COVID-19 vaccine in tribal and rural populations in Maharashtra, India. METHODOLOGY: The present study is a cross-sectional analysis of data collected from 373 individuals from six villages (three tribal and three rural) from August 2022 to September 2022. Demographic information, COVID-19 history, details about vaccination, and reasons for taking/not taking the vaccine were collected. RESULTS: In these individuals, 236 (63.3%) had taken two doses, 85 (22.8%) had taken one dose, and 52 (13.9%) had not taken the vaccine. Tribal villagers were less likely to have completed vaccination (50.7% vs 79.3%; p < 0.001). Males were more likely to state 'compulsory at my workplace' (27.7% vs 7.7%; p < 0.001), whereas females were more likely to report 'could not get ration food without it' (52.7% vs 31.5%; p < 0.001) as the reason for vaccination. Common reasons for not taking the vaccine were: fear of side effects (56%); no need for vaccination (41.2%); do not trust the vaccines (40%); and 'there is no such thing as COVID-19'(16%). A majority (94.7%) had completed COVID-19 vaccination at government vaccination centers. CONCLUSIONS: Tribal villagers, women, and those from lower socioeconomic status were less likely to have taken the vaccine. Fear about side effects and mistrust about vaccines were the main reasons for not having taken the vaccine. Addressing these issues in mass information campaigns may help improve vaccination coverage.

Asthma Care from Home: Study protocol for an effectiveness-implementation evaluation of a virtually enabled asthma care initiative in children in rural NSW.

BACKGROUND: Asthma is the leading source of unscheduled hospitalisation in Australian children, with a high burden placed upon children, their parents/families, and the healthcare system. In Australia, there are widening disparities in paediatric asthma care including inequitable access to comprehensive ongoing and planned asthma care for children. METHODS: The Asthma Care from Home Project is a comprehensive virtually enabled asthma model of care that aims to a. supports families, communities and healthcare providers, b. flexible and locally acceptable, and c. allow for adoption of innovations such as digital technologies so that asthma care can be provided "from home", reduce potentially preventable asthma hospitalisation, and ensure satisfaction at a patient, family, and healthcare provider level. The model of care includes standardisation of discharge care through provision of an asthma discharge resource pack containing individual asthma action plan, follow-up letters for the child's general practitioner (GP) and school/child care, and access to online asthma educational sessions and resource; post-discharge care coordination through text message reminders for families for regular GP review, email correspondence with their child's GP and school/childcare; and virtual home visits to discuss home environmental triggers, provide personalised asthma education and respond to parental concerns relating to their child's asthma. This study is comprised of three components: 1) a quasi-experimental pre/post impact evaluation assessing the impact of the model on healthcare utilisation and asthma control measures; 2) a mixed-methods implementation evaluation to understand how and why our intervention was effective or ineffective in producing systems change; 3) an economic evaluation to assess the cost-effectiveness of the proposed model of care from a family and health services perspective. DISCUSSION: This study aims to improve access to asthma care for children in rural and remote areas. Implementation evaluation and economic evaluation will provide insights into the sustainability and scalability of the asthma model of care.

Cervical Cancer Screening Rates Among Rural and Urban Females, From 2019 to 2022.

Importance: Little nationally representative research has examined Papanicolaou testing rates from before the pandemic in 2019 through the COVID-19 pandemic in 2022. Papanicolaou testing rates among rural females are a concern as they have historically had lower screening rates than their urban counterparts. Objective: To examine the receipt of a Papanicolaou test in the past year among US females overall and females residing in rural and urban areas in 2019, 2020, and 2022. Design, Setting, and Participants: This repeated cross-sectional study used data from 3 years of the Health Information National Trends Survey (HINTS), a nationally representative survey that asks respondents about cancer screenings, sources of health information, and health and health care technologies. Study participants were females aged 21 to 65 years. Individuals who received a Papanicolaou test more than 1 to 3 years prior to a HINTS interview were excluded as they were likely not due for a Papanicolaou test. Exposures: Survey year (2019, 2020, and 2022) and rural or urban residence were the main exposure variables. Main Outcomes and Measures: Self-reported receipt of a Papanicolaou test within the past year. Results: Among the 188 243 531 (weighted; 3706 unweighted) females included in the analysis, 12.5% lived in rural areas and 87.5% in urban areas. Participants had a mean (SE) age of 43.7 (0.27) years and were of Hispanic (18.8%), non-Hispanic Asian (5.2%), non-Hispanic Black (12.2%), non-Hispanic White (59.6%), or non-Hispanic other (4.1%) race and ethnicity. In 2022, unadjusted past-year Papanicolaou testing rates were significantly lower among rural vs urban residents (48.6% [95% CI, 39.2%-58.1%] vs 64.0% [95% CI, 60.0%-68.0%]; P < .001). Adjusted odds of past-year Papanicolaou testing were lower in 2022 than 2019 (odds ratio, 0.70; 95% CI, 0.52-0.95; P = .02). Conclusions and Relevance: This repeated cross-sectional study found that past-year Papanicolaou testing rates were lower in 2022 than 2019, pointing to a need to increase access to screenings to prevent an uptick in cervical cancer incidence. Rural-vs-urban differences in 2022 indicate a need to specifically target rural females.

Maternal exposure to polycyclic aromatic hydrocarbons during pregnancy and timing of pubertal onset in a longitudinal mother-child cohort in rural Bangladesh.

BACKGROUND: In experimental studies, several polycyclic aromatic hydrocarbons (PAHs) have shown endocrine disrupting properties, but very few epidemiological studies have examined their impact on pubertal development and results have been heterogenous. OBJECTIVE: To explore if maternal PAH exposure during pregnancy was associated with the offspring's timing of pubertal onset. METHODS: We studied 582 mother-daughter dyads originating from a population-based cohort in a rural setting in Bangladesh. Maternal urinary samples, collected in early pregnancy (on average, gestational week 8), were analyzed for monohydroxylated metabolites of phenanthrene (1-OH-Phe, Σ2-,3-OH-Phe, and 4-OH-Phe), fluorene (Σ2-,3-OH-Flu), and pyrene (1-OH-Pyr) using liquid chromatography with tandem mass spectrometry (LC-MS/MS). The girls were interviewed on two separate occasions concerning date of menarche, as well as breast and pubic hair development according to Tanner. Associations were assessed using Kaplan-Meier analysis and multivariable-adjusted Cox proportional hazards regression or ordered logistic regression. RESULTS: In early pregnancy, the mothers' median urinary concentrations of Σ1-,2-,3-,4-OH-Phe, Σ2-,3-OH-Flu, and 1-OH-Pyr were 3.25 ng/mL, 2.0 ng/mL, and 2.3 ng/mL respectively. At the second follow-up, 78 % of the girls had reached menarche, and the median age of menarche was 12.7 ± 0.81 years. Girls whose mothers belonged to the second and third quintiles of ΣOH-Phe metabolites had a higher rate of menarche, indicating a younger menarcheal age (HR 1.39; 95 % CI 1.04, 1.86, and HR 1.41; 95 % CI 1.05, 1.88, respectively), than girls of mothers in the lowest quintile. This trend was not observed in relation to either breast or pubic hair development. None of the other maternal urinary PAH metabolites or the sum of all thereof in early pregnancy were associated with age at menarche or pubertal stage. CONCLUSIONS: Indications of non-monotonic associations of prenatal phenanthrene exposure with the daughters' age of menarche were found, warranting further investigation.