Too far from care? A descriptive analysis of young Australian mental health aeromedical retrievals.

OBJECTIVES: Young Australians living in rural and remote locations have poorer mental health outcomes and higher rates of self-harm and suicide than their major city counterparts. Significant service gaps and barriers exist in accessing general and youth-specific mental health services. With a lack of access, comes delays in treatment and associated poorer outcomes. This paper describes the characteristics of young people requiring an aeromedical retrieval (AR) for acute inpatient psychiatric care. STUDY DESIGN AND METHODS: A retrospective secondary analysis was conducted of Royal Flying Doctor Service ARs for a six-year period from 2016 to 2021. Data were summarised by demographic, geographic, and diagnostic factors. RESULTS: The total sample size was 1534 (60% male, 40% female; and 31% aged 12-17 years, 69% aged 18-24 years), with 668 (43.5%) affected by schizophrenia and related disorders. Port Augusta, 300 km north of Adelaide, had the highest proportion of aeromedical retrievals (4.4%). The Women's and Children's Hospital in Adelaide received the highest proportion of retrievals (25.6%). Statistically significant gender and age differences were identified as were specific high-usage geographical locations across several Australian states. CONCLUSIONS: AR is essential for young people in accessing specialist acute health services. Developmentally appropriate, responsive, youth mental health services are mostly located in large, already well-resourced major cities. Our study provides valuable information to assist governments, communities, and services to enhance the resources available for young people who live rurally.

Trends in pancreatic cancer mortality in the United States 1999-2020: a CDC database population-based study.

INTRODUCTION: Pancreatic cancer is a significant public health concern and a leading cause of cancer-related deaths worldwide. This study aimed to investigate pancreatic cancer mortality trends and disparities in the United States (US) from 1999 to 2020. METHODS: Data were obtained from the Centers for Disease Control (CDC) Wide-Ranging Online Data for Epidemiologic Research database. Mortality rates were age-adjusted and standardized to the year 2000 US population. Joinpoint regression was used to analyze temporal trends in age-adjusted mortality rates (AAMRs) by sociodemographic and geographic variables. RESULTS: Between 1999 and 2020, pancreatic cancer led to a total of 810,628 deaths in the US, an average mortality of nearly 39,000 deaths per year. The AAMR slightly increased from 10.6 in 1999 to 11.1 in 2020, with an associated annual percent change (APC) of 0.2. Mortality rates were highest among individuals aged 65 and older. Black individuals experienced the highest overall pancreatic cancer-related AAMR at 13.8. Despite this, Black individuals experienced a decreasing mortality trend over time (APC -0.2) while White individuals experienced an increasing trend in mortality (APC 0.4). Additionally, individuals residing in rural areas experienced steeper rates of mortality increase than those living in urban areas (APC 0.6 for rural vs -0.2 for urban). White individuals in urban and rural populations experienced an increase in mortality, while Black individuals in urban environments experienced a decrease in mortality, and Black individuals in rural environments experienced stable mortality trends. CONCLUSIONS: Mortality from pancreatic cancer continues to increase in the US, with racial and regional disparities identified in minorities and rural-dwelling individuals. These disparate findings highlight the importance of ongoing efforts to understand and address pancreatic cancer treatment and outcomes disparities in the US, and future studies should further investigate the underlying etiologies of these disparities and potential for novel therapies to reduce the mortality.

Pediatric Oral Health Online Education for Rural and Migrant Head Start Programs in the United States.

Children living in rural and migrant areas in the United States disproportionately suffer from poor oral health. Additionally, there continues to be a shortage of pediatric dentists practicing in rural/migrant areas. The purpose of this formative research study was to assess whether staff, teachers and families from rural/migrant Head Start/Early Head Start (HS/EHS) programs in California were receptive to oral health online education workshops conducted by pediatric dental residents who were assisted by bilingual (English and Spanish) community oral health workers (COHWs). Our findings suggest that partnering pediatric dental residents with bilingual COHWs to educate HS/EHS teachers, staff and parents on oral health care in rural/migrant areas could result in a rewarding experience for pediatric dentists that might lead them to practice in these communities upon graduation from their residency program. Furthermore, the positive feedback received from the teachers, staff and parents who participated in the workshops indicates they were receptive to receiving oral health information related to oral health literacy from the dental providers and COHWs. COHWs can help increase access to oral health care by serving as a bridge between families and providers by relaying information in a cultural, linguistic and sensitive manner.

Effect of Rurality in Head and Neck Cancer: A Scoping Review.

OBJECTIVES: This scoping review sought to evaluate the current literature regarding the following outcomes in relation to rurality: stage at diagnosis, clinical characteristics, treatment characteristics, and survival outcomes of head and neck cancer (HNC). DATA SOURCES: A literature search was performed using PubMed (MEDLINE), Science Direct, EMBASE, SCOPUS, and Web of Science databases. REVIEW METHODS: A 20-year study cutoff from the initial search was used to increase the comparability of the studies regarding population and standards of clinical care. These searches were designed to capture all primary studies reporting HNC incidence, presenting characteristics, treatments, and treatment outcomes. Two reviewers independently screened abstracts, selected articles for exclusion, extracted data, and appraised studies. Critical appraisal was done according to the Joanna Briggs Institute Quality Assessment Tool for Cohort Studies. FINDINGS: Twenty eligible original articles were included. Stage at diagnosis, clinical characteristics, treatment characteristics, and survival outcomes were measured. Our review indicates that although this relationship is unclear, there may be variations in treatment choice for laryngeal cancer based on geographic location and rural residency status. The studies assessing HNC outcomes related to stage at diagnosis, clinical characteristics, treatment characteristics, and overall survival demonstrated conflicting findings, indicating a need for further research examining HNC outcomes with a focus on rurality as the main exposure. CONCLUSIONS: The relationship between HNC and rural-urban status remains unclear. More studies are needed, along with a consistent metric for measuring rurality and recruitment of comparable populations from both rural and urban areas. Laryngoscope, 2024.

Clinical effectiveness of cardiac rehabilitation and barriers to completion in patients of low socioeconomic status in rural areas: A mixed-methods study.

OBJECTIVE: To investigate cardiac rehabilitation utilisation and effectiveness, factors, needs and barriers associated with non-completion. DESIGN: We used the mixed-methods design with concurrent triangulation of a retrospective cohort and a qualitative study. SETTING: Economically disadvantaged areas in rural Australia. PARTICIPANTS: Patients (≥18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status. MAIN MEASURES: A Cox survival model balanced by inverse probability weighting was used to assess the association between cardiac rehabilitation utilization and 12-month mortality/cardiovascular readmissions. Associations with non-completion were tested by logistic regression. Barriers and needs to cardiac rehabilitation completion were investigated through a thematic analysis of semi-structured interviews and focus groups (n = 28). RESULTS: Among 16,159 eligible separations, 44.3% were referred, and 11.2% completed cardiac rehabilitation. Completing programme (HR 0.65; 95%CI 0.57-0.74; p < 0.001) led to a lower risk of cardiovascular readmission/death. Living alone (OR 1.38; 95%CI 1.00-1.89; p = 0.048), having diabetes (OR 1.48; 95%CI 1.02-2.13; p = 0.037), or having depression (OR 1.54; 95%CI 1.14-2.08; p = 0.005), were associated with a higher risk of non-completion whereas enrolment in a telehealth programme was associated with a lower risk of non-completion (OR 0.26; 95%CI 0.18-0.38; p < 0.001). Themes related to logistic issues, social support, transition of care challenges, lack of care integration, and of person-centeredness emerged as barriers to completion. CONCLUSIONS: Cardiac rehabilitation completion was low but effective in reducing mortality/cardiovascular readmissions. Understanding and addressing barriers and needs through mixed methods can help tailor cardiac rehabilitation programmes to vulnerable populations and improve completion and outcomes.

Genomic Answers for Kids: Toward more equitable access to genomic testing for rare diseases in rural populations.

Next-generation sequencing has revolutionized the speed of rare disease (RD) diagnoses. While clinical exome and genome sequencing represent an effective tool for many RD diagnoses, there is room to further improve the diagnostic odyssey of many RD patients. One recognizable intervention lies in increasing equitable access to genomic testing. Rural communities represent a significant portion of underserved and underrepresented individuals facing additional barriers to diagnosis and treatment. Primary care providers (PCPs) at local clinics, though sometimes suspicious of a potential benefit of genetic testing for their patients, have significant constraints in pursuing it themselves and rely on referrals to specialists. Yet, these referrals are typically followed by long waitlists and significant delays in clinical assessment, insurance clearance, testing, and initiation of diagnosis-informed care management. Not only is this process time intensive, but it also often requires multiple visits to urban medical centers for which distance may be a significant barrier to rural families. Therefore, providing early, "direct-to-provider" (DTP) local access to unrestrictive genomic testing is likely to help speed up diagnostic times and access to care for RD patients in rural communities. In a pilot study with a PCP clinic in rural Kansas, we observed a minimum 5.5 months shortening of time to diagnosis through the DTP exome sequencing program as compared to rural patients receiving genetic testing through the "traditional" PCP-referral-to-specialist scheme. We share our experience to encourage future partnerships beyond our center. Our efforts represent just one step in fostering greater diversity and equity in genomic studies.

The United States dermatology inpatient workforce between 2013 and 2019: a Medicare analysis reveals contraction of the workforce and vast access deserts-a cross-sectional analysis.

While time spent practicing inpatient dermatology has decreased since the 1990s, less is known about the current state of inpatient dermatology. We describe the distribution and frequency of inpatient dermatology encounters servicing the United States Medicare population between 2013 and 2019. Cross-sectional analysis of publicly available inpatient Medicare Part B claims data from 2013 to 2019 was conducted. Main outcomes and measures were characteristics and trends of dermatologists performing inpatient encounters. Categorical variables were compared using χ2 analysis. Trends were analyzed for linearity using Pearson correlation coefficient. 782 physicians met inclusion criteria for inclusion. Dermatologists were more often male (56.5%), possessing allopathic Medical Doctorate (MD) (86.3%), and in metropolitan settings (98.2%). However, proportion of female inpatient dermatologists increased significantly (37.9% to 46.2%). Across rural and metropolitan practices, number of inpatient physicians (2013: 356; 2019: 281) and number of medical centers in which dermatology encounters occurred (2013: 239; 2019: 157) decreased, more significantly in non-residency-associated institutions. Spatial analysis revealed wide regions lacking dermatologists meeting defined criteria. Limitations included the need for ten Medicare inpatient encounters for inclusion, counties without reported data. In conclusion, the number of dermatologists performing > 10 inpatient encounters per year is decreasing, and large variations exist in the number of U.S. inpatient dermatology visits.

Association of low-carbohydrate diet scores and type 2 diabetes in Chinese rural adults: The Henan Rural Cohort Study.

PURPOSE: To investigate the association between low-carbohydrate diet scores (LCDs) and the risk of type 2 diabetes in rural China. METHODS: A total of 38,100 adults were included in the Henan Rural Cohort Study. Macronutrient intake was assessed via a validated food-frequency questionnaire to create low-carbohydrate diet (LCD) scores. Multivariate logistic regression models and subgroup analysis were performed to estimate the odds ratio (OR) and 95% confidence interval (95% CI). RESULTS: After multivariable adjustment, participants with a high total low-carbohydrate diet score have a high risk of T2D (extreme-quartile OR = 1.23, 95% CI: 1.04-1.41; P = 0.007), whereas plant-based LCD score is not related to T2D risk. Among individuals with a BMI < 24 (extreme-quartile OR = 1.22, 95% CI: 1.01-1.47; P < 0.001) or high levels of physical activity (extreme-quartile OR = 1.42, 95% CI: 1.17-1.72; P < 0.001), the animal-based LCD score is positively correlated with the risk of T2D. CONCLUSION: Among Chinese rural populations, high-fat-low carbohydrate diet is associated with an increased risk of type 2 diabetes. High intake of animal protein and fat also increases T2D risk in those who are overweight or have high physical activity.

Study supports for rural mature-aged university health students: a Stakian multicase study.

BACKGROUND: The participation and success of university health students in rural areas is critical in addressing the maldistribution of the rural health workforces internationally. Particular attention to the experiences of mature-aged health students is needed to build a sustainable rural health workforce, given the higher proportions of mature-aged university students in rural, regional and remote areas compared with metropolitan areas and rural mature-aged students wanting to stay in their communities. However, little is known about the kinds of supports rural mature-aged students require to succeed with their studies. METHODS: Drawing on rural standpoint theory and using structural inequality as a retention lens, we explored the current and potential supports that rural mature-aged nursing and allied health students require to successfully participate and complete their pre-professional university course. A Stakian multicase study was undertaken with cases at three rural university campuses in Australia. The data collection was primarily qualitative, with semi-structured interviews, campus surveys and focus groups involving 36 participants (including students, academic and professional staff, and placement supervisors). RESULTS: This study found supports were provided formally and informally by the university, by the community and manifested by students. Several support gaps as well as potential supports to alleviate them were identified. These include formally acknowledging the mature-aged cohort and their diverse experiences and non-university commitments; fostering connections between mature-aged students; making university affordable; preparing mature-aged students for university; adapting course content and delivery; and restructuring placements for mature-aged students. CONCLUSIONS: We argue that rural mature-aged nursing and allied health students require supports that are age-specific, appropriate to the community context, and harness existing relational processes of rural university campus activity. Rural university campuses need to involve rural mature-aged students and other stakeholders relevant to each context in the process of identifying and implementing student supports for this cohort.

A study of rural populations' knowledge, attitude, and practice about brucellosis: a descriptive, cross-sectional, multicenter study.

OBJECTIVE: Brucellosis is a highly contagious disease which is transmitted from animals to humans. One of the populations at high risk of infection is those living in rural areas. The present study was conducted to investigate rural populations' knowledge, attitude, and practice about brucellosis in Iran. The study used a descriptive, cross-sectional design to assess 300 individuals who were living in rural areas. The subjects were selected using convenience sampling from six villages located in the south of Iran. The data gathered were analyzed using Analysis of variance (ANOVA), and Pearson correlation coefficient in SPSS version 23. RESULTS: From the 300 individuals who were enrolled in this study, 189 were male and 111 were female. The mean age of the participants was 48.27 ± 4.28 years. The mean scores of the study population's knowledge, attitude, and practice about brucellosis were found to be low. A significant direct correlation was found between the subjects' knowledge, attitude, and practice regarding brucellosis.

Desafios avaliativos em cenário ribeirinho: pistas metodológicas para o acesso à rede de urgência e emergência / Evaluation challenges in a ribeirinho context: methodological clues in accessing the urgency and emergency network / Desafíos evaluativos en el escenario ribereño: pistas metodológicas para el acceso a la red de urgencia y emergencia

O acesso à saúde e às políticas públicas em áreas remotas é um desafio relevante aos sistemas públicos no Brasil, dada sua dimensão e diversidade territorial. Este artigo tem como proposta apresentar o modelo teórico-lógico elaborado para avaliar o acesso da população ribeirinha à rede de urgência e emergência (RUE) em cenário amazônico, com vistas a fortalecer o planejamento, o monitoramento e a avaliação em saúde voltados para populações específicas. O ponto de partida metodológico foi a revisão temática sobre o acesso à saúde e o contexto amazônico na sua inter-relação com a proposta da pesquisa, que foi problematizada em encontros com colaboradores. Em seguida, buscou-se compreender e analisar os componentes teórico e lógico do modelo e adaptá-los à tríade donabediana ­ estrutura, processo e resultado. O resultado configurou a construção do modelo propriamente dito, com centralidade nas características que representam a oferta dos serviços (sócio-organizacional) e que retratam principalmente o espaço (geográfico). Esses pontos de construção do modelo demonstram sua contribuição para subsidiar outros processos avaliativos e o impacto final na tomada de decisão para qualificar o acesso da população ribeirinha à saúde em momento de sofrimento agudo, auxiliando na superação das condições que segregam essas populações.

Access to health and public policies in remote areas is a major challenge for public systems in Brazil, given its dimension and territorial diversity. This article presents a theoretical-logical model designed to assess the ribeirinho population's access to the urgency and emergency network in the Amazon as to strengthen health planning, monitoring, and evaluation aimed at specific populations. Starting from a thematic review on access to health and the Amazon in its interrelation with the research proposal, which were problematized in meetings with collaborators, the research sought to understand and analyze the model's theoretical and logical components and adapt them to the Donabedian triad (structure, process and result). This resulted in the model itself, centered on service provision (socio-organizational) and the space (geographic). These points demonstrate its contribution to support other evaluation processes and the final impact on decision-making to qualify this population's access to health under acute suffering, helping to overcome current restrictive conditions.

El acceso a la salud y a las políticas públicas en áreas remotas es un desafío relevante para el sistema público en Brasil dada su dimensión y diversidad territorial. El objetivo de este artículo es presentar un modelo teórico-lógico desarrollado para validar el acceso de la población ribereña a la red de urgencia y emergencia en el escenario amazónico, para fortalecer la planificación, la vigilancia y la evaluación de los resultados de salud de poblaciones específicas. El punto de partida metodológico fue la revisión temática sobre el acceso a la salud en el contexto amazónico, en especial su interrelación con la propuesta de investigación, que fue problematizada en reuniones con colaboradores. Después, se buscó comprender y analizar los componentes teórico y lógico del modelo y adaptarlos a la tríada donabediana ­estructura, proceso y resultado. El resultado configuró la construcción del modelo propiamente dicho, con foco en las características que representan la prestación de los servicios (social-organizacional) y que retratan principalmente el espacio (geográfico). Estos puntos de construcción del modelo destacan su contribución para subsidiar otros procesos evaluativos y el impacto final en la toma de decisiones para calificar el acceso de la población ribereña a la salud en un momento de sufrimiento agudo, ayudando a superar las condiciones que segregan a estas poblaciones.

Estrategias usadas en la atención de la salud sexual de poblaciones rurales de bajos ingresos / Strategies Used in Sexual Health Care for Low-Income Rural Populations / Estratégias utilizadas na atenção à saúde sexual de populações rurais de baixa renda

Introducción: en la ejecución de políticas públicas de salud sexual, resultan cruciales las estrategias utiliza-das en la construcción de la relación agente de salud-usuario. En la literatura son pocos los artículos que exploran las estrategias que utilizan los agentes de salud para interactuar con pobladores rurales al abor-dar estas problemáticas. Este artículo se propone describir y comprender las estrategias que utilizan los agentes de salud en la atención de la salud sexual y reproductiva de pobladores rurales de bajos ingresos. Para ello, se conceptualiza la relación médico-paciente como una interfaz social, es decir, como un espacio de articulación entre los mundos de sentido de los actores involucrados. Materiales y métodos: se desarrolló un estudio de carácter exploratorio-descriptivo de tipo transversal. Se realizaron 21 entrevistas semiestruc-turadas a agentes del sistema de salud, y su análisis se hizo desde un enfoque cualitativo. Resultados: los agentes de salud utilizan un amplio repertorio de estrategias para abordar la salud sexual de los pobladores rurales. Se identificaron y caracterizaron dos tipos de estrategias (dialógicas y monológicas), con sus respectivos subtipos. Conclusión: el estudio visibiliza las estrategias dialógicas como modo alternativo de relación médico-paciente, en contraste con estrategias tradicionales, de tipo monológico. Además, contribuye a la formación de los agentes de salud, y en la conformación de los equipos que abordan la salud sexual y reproductiva en contextos rurales

Introduction: The strategies used for constructing health agent-user relationship are crucial for exe-cuting public policies on sexual health. In the literature, few articles explore the strategies used by health agents to interact with rural residents when addressing these problems. We aimed to describe and understand these strategies used by health agents for sexual health care in low-income rural resi-dents. To achieve this, the doctor­patient relationship is assumed to be a social interface and a space of articulation between the worlds of meaning of the actors involved. Materials and methods: An explor-atory, descriptive, and cross-sectional study was developed. Overall, 21 semistructured interviews were conducted with health agents, and the results were qualitatively analyzed. Results: Health agents use a wide repertoire of strategies to address the sexual health of rural residents. Two types of strategies (dia-logical and monological) and their respective subtypes were identified and characterized. Conclusion:Dialogic strategies are an alternative to the doctor­patient relationship and are contradictory to the traditional monological strategies. They impact the training of health agents and the formation of teams that address sexual and reproductive health in rural settings

Introdução: na execução das políticas públicas de saúde sexual, as estratégias utilizadas na construção da relação agente de saúde-usuário são cruciais. Na literatura são escassos os artigos que exploram as estratégias utilizadas pelos agentes de saúde para interagir com os moradores rurais na abordagem desses problemas. Este estudo se propõe a descrever e compreender as estratégias utilizadas pelos agen-tes de saúde na atenção à saúde sexual e reprodutiva de moradores rurais de baixa renda. Para isso, a relação médico-paciente é conceituada como interface social, ou seja, como espaço de articulação entre os mundos de sentido dos atores envolvidos. Materiais e métodos: foi desenvolvido um estudo transver-sal exploratório-descritivo. Foram realizadas 21 entrevistas semiestruturadas com agentes do sistema de saúde e sua análise foi feita a partir de uma abordagem qualitativa. Resultados: os agentes de saúde utilizam um amplo repertório de estratégias para abordar a saúde sexual dos residentes rurais. Dois tipos de estratégias (dialógicas e monológicas) foram identificadas e caracterizadas, com seus respecti-vos subtipos. Conclusão: este estudo torna visíveis as estratégias dialógicas como modo alternativo de relação médico-paciente, em contraste com as estratégias tradicionais de tipo monológico. Além disso, contribui para a formação de agentes de saúde e na formação de equipes que abordem saúde sexual e reprodutiva em contextos rurais.

Evaluating variations in the barriers to colorectal cancer screening associated with telehealth use in rural U.S. Pacific Northwest.

PURPOSE: The incidence and mortality rates of colorectal cancer (CRC) remain consistently high in rural populations. Telehealth can improve screening uptake by overcoming individual and environmental disadvantages in rural communities. The present study aimed to characterize varying barriers to CRC screening between rural individuals with and without experience in using telehealth. METHOD: The cross-sectional study surveyed 250 adults aged 45-75 residing in rural U.S. states of Alaska, Idaho, Oregon, and Washington from June to September 2022. The associations between CRC screening and four sets of individual and environmental factors specific to rural populations (i.e., demographic characteristics, accessibility, patient-provider factors, and psychological factors) were assessed among respondents with and without past telehealth adoption. RESULT: Respondents with past telehealth use were more likely to screen if they were married, had a better health status, had experienced discrimination in health care, and had perceived susceptibility, screening efficacy, and cancer fear, but less likely to screen when they worried about privacy or had feelings of embarrassment, pain, and discomfort. Among respondents without past telehealth use, the odds of CRC screening decreased with busy schedules, travel burden, discrimination in health care, and lower perceived needs. CONCLUSION: Rural individuals with and without previous telehealth experience face different barriers to CRC screening. The finding suggests the potential efficacy of telehealth in mitigating critical barriers to CRC screening associated with social, health care, and built environments of rural communities.

The impact of rural status on pediatric chronic kidney disease.

Children and adolescents in rural areas with chronic kidney disease (CKD) face unique challenges related to accessing pediatric nephrology care. Challenges to obtaining care begin with living increased distances from pediatric health care centers. Recent trends of increasing centralization of pediatric care mean fewer locations have pediatric nephrology, inpatient, and intensive care services. In addition, access to care for rural populations expands beyond distance and encompasses domains of approachability, acceptability, availability and accommodation, affordability, and appropriateness. Furthermore, the current literature identifies additional barriers to care for rural patients that include limited resources, including finances, education, and community/neighborhood social resources. Rural pediatric kidney failure patients have barriers to kidney replacement therapy options that may be even more limited for rural pediatric kidney failure patients when compared to rural adults with kidney failure. This educational review identifies possible strategies to improve health systems for rural CKD patients and their families: (1) increasing rural patient and hospital/clinic representation and focus in research, (2) understanding and mediating gaps in the geographic distribution of the pediatric nephrology workforce, (3) introducing regionalization models for delivering pediatric nephrology care to geographic areas, and (4) employing telehealth to expand the geographic reach of services and reduce family time and travel burden.

Rural Family Satisfaction With Telehealth Delivery of an Intervention for Pediatric Obesity and Associated Family Characteristics.

Objective: To describe satisfaction with the telehealth aspect of a pediatric obesity intervention among families from multiple rural communities and assess differences in satisfaction based on sociodemographic factors. Methods: This is a secondary analysis of data from a pilot randomized controlled trial of a 6-month intensive lifestyle intervention (iAmHealthy) delivered through telehealth to children 6-11 years old with BMI ≥85th%ile and their parents from rural communities. Parents completed a sociodemographic survey and a validated survey to assess satisfaction with the telehealth intervention across four domains (technical functioning, comfort of patient and provider with technology and perceived privacy, timely and geographic access to care, and global satisfaction) on a 5-point Likert scale. Kruskal-Wallis nonparametric rank test were used to compare mean satisfaction scores based on parent sociodemographics. Results: Forty-two out of 52 parents (67% White, 29% Black, 5% multiracial, and 50% with household income <$40,000) completed the survey. Mean satisfaction scores ranged from 4.16 to 4.54 (standard deviation 0.44-0.61). Parents without a college degree reported higher satisfaction across all domains compared with parents with a college degree, including global satisfaction (mean 4.64 vs. 4.31, p = 0.03). Parents reporting a household income <$40,000 (mean 4.70) reported higher scores in the comfort with technology and perceived privacy domain compared with parents with higher incomes (mean 4.30-4.45, p = 0.04). Discussion: Parents from rural communities, especially those from lower socioeconomic backgrounds, were highly satisfied with the iAmHealthy telehealth intervention. These findings can be used to inform future telehealth interventions among larger more diverse populations. ClinicalTrials.gov Identifier: NCT04142034.

Exploring Individual and Contextual Factors Associated With Sexual Risk and Substance Use Among Underserved GBQMSM and Transgender and Nonbinary Persons in South Central Appalachia.

Gay, bisexual, queer, and other men who have sex with men (GBQMSM) and transgender and nonbinary persons are at elevated risk for HIV, sexually transmitted infections (STIs), and hepatitis C (HCV); in Appalachia, these communities experience more disease burden. However, little is known about the factors influencing risk. Sixteen semistructured in-depth interviews were conducted examining factors influencing prevention and care. Data were analyzed using constant comparison methodology. Fifteen themes emerged within four domains: social environment (e.g., microaggressions across gender, sexual orientation, and racial identities), substance use (e.g., high prevalence, use as coping mechanism), sexual health (e.g., misinformation and denial of risk for HIV and STIs), and access to health care (e.g., cost and transportation barriers, lack of local respectful care). Findings highlighted salient barriers and assets influencing prevention and care and suggest that multilevel interventions are needed to improve access to and use of HIV, STI, and HCV prevention and care services.

Community engagement through social media: A promising low-cost strategy for rural recruitment?

PURPOSE: For the same reasons that rural telehealth has shown promise for enhancing the provision of care in underserved environments, social media recruitment may facilitate more inclusive research engagement in rural areas. However, little research has examined social media recruitment in the rural context, and few studies have evaluated the feasibility of using a free social media page to build a network of rural community members who may be interested in a research study. Here, we describe the rationale, process, and protocols of developing and implementing a social media approach to recruit rural residents to participate in an mHealth intervention. METHODS: Informed by extensive formative research, we created a study Facebook page emphasizing community engagement in an mHealth behavioral intervention. We distributed the page to local networks and regularly posted recruitment and community messages. We collected data on the reach of the Facebook page, interaction with our messages, and initiations of our study intake survey. FINDINGS: Over 21 weeks, our Facebook page gained 429 followers, and Facebook users interacted with our social media messages 3,080 times. Compared to messages that described desirable study features, messages that described community involvement resulted in higher levels of online interaction. Social media and other recruitment approaches resulted in 225 people initiating our in-take survey, 9 enrolling in our pilot study, and 26 placing their names on a waiting list. CONCLUSIONS: A standalone social media page highlighting community involvement shows promise for recruiting in rural areas.

Pediatric Obesity Care via Telemedicine: Expanding the Path Forward-A Review.

PURPOSE OF REVIEW: Review latest data regarding the intersection of pediatric obesity epidemic with telemedicine expansion to meet the need of equitable obesity care in children. RECENT FINDINGS: Prevalence of pediatric obesity in the USA continues to worsen particularly in rural, underserved areas. Although there is an increasing number of obesity medicine specialists over the last decade, availability varies by geographic location. Pre-pandemic centers were limited, rarely located in rural areas, and required in-person visits for reimbursement. Telemedicine changes, responding to pandemic needs, provided increase in telemedicine utilization and acceptance with similar or improved obesity care outcomes. Given pediatric obesity prevalence and need for chronic, effective obesity care, leveraging telemedicine to expand reach and decrease access barriers provides a critical and creative remedy. Data cites similar outcomes between telemedicine and in-person care. The time to reimagine a full spectrum of care delivery for pediatric obesity is now.

Cooking with the Seasons for Health (CwS4H): An Innovative Intervention That Links Nutrition Education, Cooking Skills, and Locally Grown Produce to Increase Vegetable Intake among Limited-Resource Parent-Child Dyads in Rural Washington.

Although children from limited-resource families in rural areas are at great risk for nutrition-related chronic diseases, few hands-on programs have been implemented that simultaneously engage both parents and children and include local produce in a single program. This study reports on the development, implementation, and evaluation of Cooking with the Seasons for Health (CwS4H). Parent-child pairs participated in six sessions (two weekly sessions during each of three growing seasons), which included food tasting, a spotlight vegetable, interactive mini nutrition lesson, a child-focused cooking lesson, hands-on meal preparation, distribution of materials as family guides, and a take-home bag of fresh produce. Pre- and postprogram survey data were collected from 23 parents and 22 children. Children reported improvements in nutrition knowledge, vegetable preference, and self-efficacy in food preparation and cooking. Parents reported gains in nutrition knowledge, nutritional behaviors, vegetable preference, attitude toward food preparation/cooking, involvement of the child in food preparation/cooking, confidence in preparing vegetables, and the child's vegetable intake. Parents commented on the value children placed on food preparation and produce selection and how the program enhanced the parent-child relationship. By focusing CwS4H on a variety of fresh vegetables, this intervention helped to impact children's vegetable intake behaviors by engaging children in preparing and choosing the food they eat.

Cancer survivorship challenges of rural older adults: a qualitative study.

BACKGROUND: Although research has advanced the field of oncologic geriatrics with survivors to assess their cancer-related needs and devise patient-centered interventions, most of that research has excluded rural populations. This study aimed to understand the survivorship challenges and recommendations in the perspective of rural older adults. METHODS: This was a qualitative study that explored the survivorship challenges and recommendations of rural older adults who have completed curative intent chemotherapy for a solid tumor malignancy in the 12 months prior to enrollment in the present study. RESULTS: Twenty-seven older adult survivors from rural areas completed open-ended semi-structured interviews. The mean age was 73.4 (SD = 5.0). Most participants were non-Hispanic White (96.3%), female (59.3%), married (63.0%), and had up to a high school education (51.9%). Rural older survivors reported a general lack of awareness of survivorship care plans, communication challenges with healthcare team, transportation challenges, financial toxicity, psychological challenges, and diet and physical challenges. Rural older survivors recommend the provision of nutritional advice referral to exercise programs, and social support groups and for their healthcare providers to discuss their survivorship plan with them. CONCLUSIONS: Although study participants reported similar survivorship challenges as urban older adult survivors, additional challenges reported regarding transportation and consideration of farm animals have not been previously reported. Heightened awareness of the survivorship needs of rural older adults may result in better survivorship care for this population.