Rural-Urban Disparities in Telemedicine Use Among U.S. Adults with Cancer.

Introduction: The COVID-19 pandemic has resulted in significant changes in health care delivery worldwide, including the widespread adoption of telemedicine. This study examines the prevalence of telemedicine use among cancer survivors in the United States based on rurality and investigates its association with telemedicine use. Methods: The 2021 National Health Interview Survey was used to analyze telemedicine use among cancer survivors during the pandemic. Telemedicine use was the primary outcome, and rurality was the main exposure. Descriptive statistics and multiple logistic regression models were used to examine the association. Results: Out of 27,500 eligible cancer survivors, 51.6% reported using telemedicine in 2021. Telemedicine usage varied across rural areas, with 41.4% of rural cancer survivors using telemedicine compared with 57.5% of cancer survivors in large metropolitan areas (p < 0.001). Rural cancer survivors had significantly lower odds of using telemedicine during the pandemic compared with large metropolitan cancer survivors. Cancer survivors residing in rural areas were 0.56 times less likely (odds ratio [OR] = 0.56; 95% confidence interval [CI] = 0.41-0.75), and those residing in medium and small metropolitan areas were 0.69 times less likely (OR = 0.69; 95% CI = 0.56-0.86) to report telemedicine use compared with cancer survivors in large metropolitan areas. Conclusions: Substantial disparities in telemedicine use were observed between rural and urban areas among cancer survivors. Rural cancer survivors were less likely to utilize telemedicine during the COVID-19 pandemic. Ensuring equitable access to telemedicine requires continued reimbursement for telemedicine services, along with additional efforts to improve access to and utilization of health care for rural cancer survivors.

Behaviors associated with HIV transmission risk among rural sexual and gender minority and majority residents.

Multiple rural states and communities experience elevated rates of human immunodeficiency virus (HIV), often associated with diminished healthcare access and increased drug use. Though a substantial proportion of rural populations are sexual and gender minorities (SGM), little is known of this group regarding substance use, healthcare utilization, and HIV transmission behaviors. During May-July 2021, we surveyed 398 individuals across 22 rural Illinois counties. Participants included cisgender heterosexual males (CHm) and females (CHf) (n = 110); cisgender non-heterosexual males and females (C-MSM and C-WSW; n = 264); and transgender individuals (TG; n = 24). C-MSM participants were more likely to report daily-to-weekly alcohol and illicit drug use prescription medication misuse (versus CHf; aOR = 5.64 [2.37-13.41], 4.42 [1.56-12.53], and 29.13 [3.80-223.20], respectively), and C-MSM participants more frequently reported traveling to meet with romantic/sex partners. Further, more C-MSM and TG than C-WSW reported healthcare avoidance and denial due to their orientation/identity (p < 0.001 and p = 0.011, respectively); 47.6% of C-MSM and 58.3% of TG had not informed their provider about their orientation/identity; and only 8.6% of C-MSM reported ever receiving a pre-exposure prophylaxis (PrEP) recommendation. More work is needed to explore the substance use and sexual behaviors of rural SGM, as well as their healthcare interactions, to better target health and PrEP engagement campaigns.

Predictors and Spatial Variation of Radon Testing in Illinois, 2005-2012.

CONTEXT: Radon is the second leading cause of lung cancer, but exposure can be reduced through testing one's home and mitigating if levels are high. OBJECTIVE: To determine what factors predict radon testing and to identify, through spatial analysis, areas in Illinois with lower or higher than expected testing rates. DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOMES: An ecological study design was used to evaluate data on radon tests performed in Illinois by a licensed professional or a home radon test kit analyzed by a state-approved laboratory between 2005 and 2012. Zip code-level rates of testing per 1000 occupied residences were calculated for all testing methods combined and for licensed professional testing and home kit testing separately. The following zip code-level factors associated with radon testing were considered: Environmental Protection Agency (EPA) radon zones (ie, categorization of areas by predicted radon risk), socioeconomic characteristics, homeowner occupancy, and rurality. Univariate and multivariable incidence rate ratios were calculated to examine what factors were associated with each testing type. Hotspot analysis was performed to identify zip codes with lower than expected and higher than expected testing rates (ie, "coldspots" and "hotspots," respectively). RESULTS: Radon testing rates varied across EPA zone, socioeconomic characteristics, and level of rurality. In multivariable analysis, EPA zone, education, and median household income positively predicted all testing types combined. Median home value was associated with licensed testing, whereas rurality was negatively associated with licensed testing. Owner occupancy positively predicted home kit testing. Between 19.6% and 31.1% of zip codes were coldspots for radon testing rates, dependent upon testing type. Coldspots of all testing method rates were concentrated in the southern part of the state. CONCLUSION: Public health professionals can benefit from understanding what area-level factors predict radon testing and what geographic areas may under-utilize testing. Such information can aid the development of geographically targeted, cost-effective interventions that increase radon testing and subsequently reduce lung cancer risk.

The Mini Report: a Practical Tool to Address Lung Cancer Disparities in Rural Communities.

Community-based participatory research (CBPR) is an effective way to address cancer disparities in medically underserved populations. Our research demonstrates how CBPR principles were used to develop lung cancer and risk factor mini reports for a network of community coalitions in the Illinois Delta Region, a predominately rural region with high lung cancer disparities in southern Illinois. An academic-community partnership, including a community-based medical school, state public health department, and a healthcare system, used CBPR principles to translate epidemiological, behavioral, and demographic data into understandable, comprehensive, yet concise mini reports for each coalition. A cyclical and iterative process was used to draft, revise, and optimize these mini reports to raise awareness about lung cancer disparities in the community and to provide information to help guide the development of interventions that address these disparities. The use of CBPR principles was a successful way to create mini reports about local lung cancer disparities and risk factors that were usable in individual communities. Local coalitions used the mini reports to educate community members at local meetings, to guide strategic planning, and to disseminate information through their respective websites. Additionally, the process of creating these reports built trust among academic-community partners and provided additional avenues of engagement, such as the involvement of an academic partner in the strategic planning process of a local coalition. Using CBPR processes is an effective way to translate epidemiological data into a community-friendly format to address cancer disparities.

Point-of-Care Ultrasound and Procedural Instruction in the Family Medicine Clerkship: A CERA Study.

BACKGROUND AND OBJECTIVES: Point-of-care ultrasound (POCUS) education has become a mainstay in resident education in multiple specialties, including family medicine (FM), but literature regarding the use of POCUS during clinical medical student education is lacking. The purpose of this study was to investigate whether and how POCUS education is conducted in FM clerkships in the United States and Canada and how it compares to more traditional FM clinical procedural instruction. METHODS: As part of the 2020 Council of Academic Family Medicine's Educational Research Alliance survey of FM clerkship directors, we surveyed clerkship directors in the United States and Canada about whether and how POCUS education, as well as other procedural instruction in their institutions and FM clerkships, was conducted. We included questions regarding POCUS and other procedural use by preceptors and faculty. RESULTS: We found that 13.9% of clerkship directors reported structured POCUS education during clerkship, while 50.5% included other procedural training. The survey revealed that 65% of clerkship directors felt that POCUS was an important component of FM, but this was not a predictor of POCUS use in personal or preceptor practice nor of its inclusion in FM clerkship education. CONCLUSIONS: Structured POCUS education is a rare component of FM clerkship education; while more than half of clerkship directors felt that POCUS was important for FM, few used it personally or included it in clerkship education. As POCUS continues to be integrated into medical education in FM, the clerkship may represent an opportunity to expand POCUS exposure for students.

Simulation-Based Medical Education in Family Medicine Residencies: A CERA Study.

BACKGROUND AND OBJECTIVES: To better understand the current use of simulation and barriers to its use in family medicine resident education, we surveyed US family medicine residency (FMR) program directors (PDs) about opinions and use of simulation-based medical education (SBME) in their programs. A number of specialties have incorporated or required simulation-based educational techniques in residency education over the past 10 years, but little is known about the current use of SBME in family medicine graduate medical education. We also evaluated associations between program characteristics and the use of SBME in FMR education. METHODS: Questions were included on the 2019 Council of Academic Family Medicine Education Research Alliance (CERA) survey of US FMR PDs. The survey included questions regarding current use of SBME along with questions to identify barriers to its use in family medicine programs. RESULTS: Thirty-nine percent (n=250) of PDs completed the survey; 84.5% reported using simulation. PDs reporting they did not use simulation were less likely to view simulation as valuable for education or assessment. Unexpectedly, residency program size was not associated with simulation use or access to a dedicated location for SBME. DISCUSSION: Use of SBME in family medicine resident education has increased since 2011. PDs value simulation for education and remediation, and most programs have introduced some degree of simulation despite barriers. The results of this study can inform resources to support the continued integration of SBME into family medicine resident education.

Rurality and Health in the United States: Do Our Measures and Methods Capture Our Intent?

Rural status in the United States can be objectively measured using multiple designations within different geographic extents, often considering both population density and proximity to urban areas. However, these measurements are often incomplete for assessing the relationship between rural status and health and are often inadequately considered in analysis. To address these limitations, we posit four recommendations: two recommendations to improve current measures by including additional factors and making measures continuous and two recommendations to improve regression analysis by considering rural status as a contextual factor in multilevel modeling and as a variable in conjunction with socioeconomic factors derived through principal component analysis.

Cancer Mortality in the Mississippi Delta Region: Descriptive Epidemiology and Needed Future Research and Interventions.

The Delta Region is a federally designated, socioeconomically disadvantaged region of the United States covering 252 counties in eight states along the Mississippi River. The objective of this study is to describe the Region's cancer mortality burden. National Center for Health Statistics data were used to calculate age-adjusted mortality rates and rate ratios for the Delta Region for all cancers, lung, colorectal, breast (female), cervical, and prostate cancers. Rates were also calculated for comparison groups, and were stratified by gender, race, rurality, and socioeconomic status. The all-cancer mortality rate in the Delta Region was higher than all comparison groups across all stratifications. Higher rates were seen for cervical and colorectal cancer across comparison groups and stratifications. Delta Blacks had higher rates than Whites, and rural Delta residents had higher rates than their urban peers for most cancers. Further research and interventions should be conducted to elucidate and reduce these disparities.