Defining rural spaces within pharmacy practice research: Current practice and implications.

The literature suggests that community pharmacies are a critical buffer to poor health for rural spaces, which are disproportionately impacted by a lack of facilities, providers, and resources. Yet, the actual impact is hard to measure because location is not often considered in assessments of community pharmacy practice. We explored the definitions applied to rural spaces in community pharmacy practice-based research studies that explicitly discuss rural pharmacy practice in 2 U.S. based pharmacy practice research publications. Across both journals, we identified 10 articles that used 8 different definitions of "rural" including both a variety of federal designations and idiosyncratic definitions developed just for that research. A consensus definition in rural community pharmacy practice research could make comparison across studies possible, help to build the evidence base for rurally focused interventions, and ultimately improve patient outcomes in this setting.

An exploration of key barriers to healthcare providers' use of food prescription (FRx) interventions in the rural South.

OBJECTIVE: The purpose of this exploratory study was to examine the attitude towards food prescriptions (FRx) interventions among clinicians and identify potential barriers to their use in clinical practice. DESIGN: The current study employed an exploratory research design using in-depth semi-structured interviews. Research participants were selected from primary care facilities, family practice offices and obesity clinics located in Mississippi and Louisiana. SETTING: Providers selected for participation in the current study serve predominantly rural, low-income communities in the US South. PARTICIPANTS: From an original population of fifty healthcare providers that included physicians, registered dieticians and nurse practitioners, from Oxford, Tupelo, Batesville, Jackson, and Charleston, MS and New Orleans, LA. Fifteen healthcare providers agreed to participate, including three physicians, four registered dieticians, three nurses and three nurse practitioners. RESULTS: The current study found that while healthcare providers expressed a desire to use FRx interventions, there was a universal lack of understanding by healthcare providers of what FRx interventions were, how they were implemented and what outcomes they were likely to influence. CONCLUSIONS: The current study identified key bottlenecks in the use of FRx interventions at the clinic level and data provided evidence for two key recommendations: (1) development and validation of a screening tool to be used by clinicians for enrolling patients in such interventions and (2) implementation of nutrition education in primary professional training, as well as in continuing education.

National Food Affordability: A County-Level Analysis.

The purpose of this study was to explore the sociodemographic factors that contribute to food affordability across space, with specific emphasis on rural and urban differences in the United States. A regression analysis was used to predict food affordability from several predictors in rural and urban areas, with a subanalysis of Appalachian and Delta counties. Rural households had significantly higher food expenditures to income ratios compared with urban counties; Appalachian and Delta counties had the highest on average food expenditure to income ratio. Affordable food buffers vulnerable families against food insecurity and subsequent chronic health issues, which are especially relevant in the Appalachian and Delta counties.

Naloxone Accessibility Under the State Standing Order Across Mississippi.

Importance: Naloxone is a life-saving medication for individuals experiencing an opioid overdose. Naloxone standing orders aim to make naloxone more available by allowing patients improved access to this medication at community pharmacies; however, lawful availability does not mean that this life-saving intervention is accessible to patients. Objective: To characterize naloxone availability and out-of-pocket cost under the state standing order in Mississippi. Design, Setting, and Participants: This telephone-based, mystery-shopper census survey study included Mississippi community pharmacies open to the general public in Mississippi at the time of data collection. Community pharmacies were identified using the Hayes Directories April 2022 complete Mississippi pharmacy database. Data were collected from February to August 2022. Exposures: Mississippi House bill 996, the Naloxone Standing Order Act, signed into law in 2017, allowing pharmacists to dispense naloxone under a physician state standing order at a patient's request. Main Outcomes and Measures: The main outcomes were naloxone availability under Mississippi's state standing order and the out-of-pocket cost of available formulations. Results: There were 591 open-door community pharmacies surveyed for this study, with a 100% response rate. The most common pharmacy type was independent (328 [55.50%]), followed by chain (147 [24.87%]) and grocery store (116 [19.63%]). When asked, "Do you have naloxone that I can pick up today?" 216 Mississippi pharmacies (36.55%) had naloxone available for purchase under the state standing order. Of the 591 pharmacies, 242 (40.95%) were unwilling to dispense naloxone under the state standing order. Among the 216 pharmacies with naloxone available, the median out-of-pocket cost for naloxone nasal spray (n = 202) across Mississippi was $100.00 (range, $38.11-$229.39; mean [SD], $105.58 [$35.42]) and the median out-of-pocket cost of naloxone injection (n = 14) was $37.70 (range, $17.00-$208.96; mean [SD], $66.62 [$69.27]). Conclusions and Relevance: In this survey study of open-door Mississippi community pharmacies, availability of naloxone was limited despite standing order implementation. This finding has important implications for the effectiveness of the legislation in preventing opioid overdose deaths in this region. Further studies are needed to understand pharmacists' unwillingness to dispense naloxone and the implications of lack of availability and unwillingness for further naloxone access interventions.

Examining the context, logistics, and outcomes of food prescription programs: A scoping review.

BACKGROUND: Obesity and associated metabolic conditions are endemic. Finding new strategies to mitigate the impact on wellbeing and healthcare systems is critical. Food prescription programs (FPPs) have been promoted as one route to address this problem in a way that simultaneously addresses the socio-cultural context of obesity. Yet, little is known about the standard practices and logistics of using food prescription programs as an effective intervention. OBJECTIVES: To 1) identify the context in which food prescription programs are used; 2) identify implementation logistics of food prescription program; and 3) understand the scope of food prescription program outcomes. METHODS: A scoping review was conducted from October 2019 to May 2020 using Google Scholar, EBSCOhost, and AcademicOne Search to identify research articles focused on the implementation of prescription food programs in the US. Updates to articles were made in May of 2021 and May of 2022 to ensure the most up-to-date sample for analysis. There was no publication date restriction for article inclusion. RESULTS: A total of 213 articles were identified for abstract review via the search strategy, and 30 articles were included for analysis following article exclusion. Overall, there was little consistency among included articles regarding the target population, participant recruitment, delivery, and evaluation of the food prescription programs implemented. Most food prescription programs studied were associated with farmers markets, lasted less than 6 months, and utilized produce consumption and biometric data as primary outcomes measures. CONCLUSION: Significant gaps in the literature concerning the long-term effectiveness, impact on health behaviors, screening of eligible participants, and logistics for implementation were identified. Future research should focus on addressing these shortcomings in the current literature to improve the implementation, sustainability, and scaling of food prescription programs.

Food pantry offerings and awareness at a southeastern public university.

OBJECTIVE: This study documents campus awareness of an on-campus food pantry and the value of its nutritional offerings in order to provide tailored recommendations for improving this particular emergency resource for food insecure students. PARTICIPANTS: This study surveyed 253 students, and 185 faculty and staff at the Southeastern Flagship Institution. METHODS: This mixed methods study combined a quantitative survey administered to 438 participants with an in-depth nutritional analysis of the food pantry's offerings. RESULTS: Results showed low levels of awareness by faculty and staff and limited offerings of fresh fruits and vegetables, dark leafy greens, and whole grains in the on-campus food pantry. CONCLUSIONS: This research helps to fill critical gaps regarding faculty and staff awareness of on-campus food pantries. Importantly, this article provides recommendations for campus food pantries to improve their campus awareness and nutritional offerings through engaging University stakeholders with long-term appointments and increasing donor education.

Barriers, Enablers, and Possible Solutions for Student Wellness: A Qualitative Analysis of Student, Administrators, and Staff Perspectives.

BACKGROUND: Child well-being, which includes physical, mental, and social health, has a critical effect on academic performance. Schools face many challenges in meeting needs for child well-being. Schools in low-resource areas, including the Mississippi Delta, face greater challenges when meeting student needs. METHODS: Eleven focus groups with middle school students and 12 interviews with teachers, staff, and administration in one Mississippi Delta middle school were completed in 2019. The Social Ecological Model and Theory of Organizational Readiness for Change were used as a framework for the study. RESULTS: Focus group data with middle school students and interviews with teachers, staff, and administrators show that academic stressors play a major role in student well-being; yet, teachers, staff, and administrators face immense pressure to achieve high test scores. However, students seem to be encouraged by a positive school environment, which could help minimize some stressors. CONCLUSIONS: It seems that small improvements to the school environment could have a significant effect on student well-being, especially when school infrastructure and limited resources do not support comprehensive changes.

Understanding High Incidence of Severe Obesity and Very Low Food Security in Food Pantry Clients: Implications For Social Work.

The United States is facing two interconnected social and public health crises of severe obesity and food insecurity within the social-ecological environment. Marginalized groups experience the highest rates and the greatest impacts in terms of morbidity, mortality, and financial burdens. Consequences include experiencing multimorbidities, mental health issues, and decreased quality of life. Food pantries have served as spaces to obtain food to meet household needs, but for some, food pantries have become long-term solutions. We surveyed 2,634 people who accessed pantries in 2005, 2010, and 2013 across 32 counties in a Midwest state. The authors sought to understand to what extent does length of time using a food pantry, food security status, income sources, use of federal food benefits, visiting a doctor, and demographic variables increase odds of severe obesity. More than 14% were severely obese; those who were long-term food pantry users and very low food secure were 1.732 times more likely to be severely obese. Receiving Disability/Supplemental Security Income, seeing a doctor in the last year, being female, and older age reduced the odds of severe obesity. Discussion includes implications for social workers who interact with groups likely to experience very low food security and severe obesity at different systems levels.