Rural, Suburban, and Urban Differences in Chronic Pain and Coping Among Adults in North Carolina: 2018 Behavioral Risk Factor Surveillance System.

INTRODUCTION: Our study aimed to examine the prevalence of chronic pain, its severity, its causes, and coping mechanisms that are used by North Carolina adults in rural, suburban, and urban areas. METHODS: We analyzed data from the Behavioral Risk Factor Surveillance System's first chronic pain module in 2018, representing 3,598 respondents. Self-reported chronic pain was defined as the affirmative response to the question, "Do you suffer from any type of chronic pain, that is, pain that occurs constantly or flares up often?" We computed prevalence of chronic pain and use of coping mechanisms by rural, suburban, or urban residential status. We used multiple logistic regression to assess the association between chronic pain and residential location, adjusting for demographic characteristics, employment, and health insurance. RESULTS: In 2018, an estimated 27.5% (95% confidence interval [CI], 25.6%-29.3%) of North Carolina adults experienced chronic pain. Prevalence of chronic pain in rural areas (30.9%) and suburban areas (30.8%) was significantly higher, compared with urban areas (19.6%). Compared with urban residents with chronic pain, those with chronic pain in suburban areas (adjusted odds ratio [AOR], 0.44; 95% CI, 0.26-0.76) and in rural areas (AOR, 0.39; 95% CI, 0.24-0.65) were less likely to use nonmedication therapies (eg, acupuncture, physical therapy, yoga) and were less likely to use 3 or more types of chronic pain treatment (suburban AOR, 0.47; 95% CI, 0.25-0.88; rural AOR, 0.53; 95% CI, 0.29-0.95). CONCLUSION: Our results indicate that persons living in rural and suburban areas may be more likely to have chronic pain and less likely to use nonmedication treatments than those in urban areas.

Educational Attainment and Characteristics of Leaders of Schools of Public Health and State Health Departments.

A perceived diversity exists in the educational training of leaders in state and academic public health that isn't observed in other heath disciplines. To assess this perception, the present study describes the training and experience of state health directors and deans of schools of public health. Data were collected in 2017 for deans of schools of public health (n = 56) and state health directors (n = 49) in the United States. Results indicated that 56 deans had at least one terminal degree, while 14 state health directors did not. Women comprised 23 of the dean and 24 state health director positions. Years in current position were 6.91 for deans and 3.51 for state health directors. Thirty-seven deans and 22 state health directors held graduate degrees in public health. As public health leaders advance towards retirement; it is imperative that the public health professionals obtain relevant training necessary to become tomorrow's public health leadership.

Health Literacy and Health Behaviors Among Adults With Prediabetes, 2016 Behavioral Risk Factor Surveillance System.

OBJECTIVES: Evidence is needed for designing interventions to address health literacy-related issues among adults with prediabetes to reduce their risk of developing type 2 diabetes. This study assessed health literacy and behaviors among US adults with prediabetes and the mediating role of health literacy on health behaviors. METHODS: We used data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) (N = 54 344 adults). The BRFSS health literacy module included 3 questions on levels of difficulty in obtaining information, understanding health care providers, and comprehending written information. We defined low health literacy as a response of "somewhat difficult" or "very difficult" to at least 1 of these 3 questions. Respondents self-reported their prediabetes status. We included 3 health behavior indicators available in the BRFSS survey-current smoking, physical inactivity, and inadequate sleep, all measured as binary outcomes (yes/no). We used a path analysis to examine pathways among prediabetes, health literacy, and health behaviors. RESULTS: About 1 in 5 (19.0%) adults with prediabetes had low health literacy. The rates of physical inactivity (31.0% vs 24.6%, P < .001) and inadequate sleep (38.8% vs 33.5%, P < .001) among adults with prediabetes were significantly higher than among adults without prediabetes. The path analysis showed a significant direct effect of prediabetes and health literacy on health behaviors. The indirect effect of prediabetes through health literacy on health behaviors was also significant. CONCLUSION: BRFSS data from 2016 showed that rates of low health literacy and unhealthy behaviors were higher among adults with prediabetes than among adults without prediabetes. Interventions are needed to assist adults with prediabetes in comprehending, communicating about, and managing health issues to reduce the risk of type 2 diabetes.