Real-World Utilization of an Intrauterine, Vacuum-Induced, Hemorrhage-Control Device.

OBJECTIVE: To assess the real-world effectiveness and safety of a U.S. Food and Drug Administration (FDA)-cleared intrauterine vacuum-induced-hemorrhage control device for postpartum hemorrhage (PPH) management. METHODS: Sixteen centers in the United States participated in this observational, postmarket registry medical record review (October 2020 through March 2022). The primary effectiveness outcome was treatment success , defined as bleeding control after insertion with no treatment escalation or bleeding recurrence. Additional outcomes included blood loss, time to device insertion, indwelling time, bleeding recurrence, and time to bleeding control. Treatment success and severe maternal morbidity measures (transfusion of 4 or more units of red blood cell, intensive care unit admission, and hysterectomy) were evaluated by blood loss before insertion. To assess safety, serious adverse events (SAEs) and adverse device effects were collected. All outcomes were summarized by mode of delivery; treatment success was summarized by bleeding cause (all causes, any atony, isolated atony, nonatony). RESULTS: In total, 800 individuals (530 vaginal births, 270 cesarean births) were treated with the device; 94.3% had uterine atony (alone or in combination with other causes). Median total blood loss at device insertion was 1,050 mL in vaginal births and 1,600 mL in cesarean births. Across all bleeding causes, the treatment success rate was 92.5% for vaginal births and was 83.7% for cesarean births (95.8% [n=307] and 88.2% [n=220], respectively, in isolated atony). Median indwelling time was 3.1 hours and 4.6 hours, respectively. In vaginal births, 14 SAEs were reported among 13 individuals (2.5%). In cesarean births, 22 SAEs were reported among 21 individuals (7.8%). Three (0.4%) SAEs were deemed possibly related to the device or procedure. No uterine perforations or deaths were reported. CONCLUSION: For both vaginal and cesarean births in real-world settings, rapid and effective bleeding control was achieved with an FDA-cleared intrauterine vacuum-induced hemorrhage-control device. The safety profile was consistent with that observed in the registrational trial (NCT02883673), and SAEs or adverse device effects were of the nature and severity expected in the setting of PPH. This device is an important new tool for managing a life-threatening condition, and timely utilization may help to improve obstetric hemorrhage outcomes. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov , NCT04995887.

Intervention Adherence and Self-Efficacy as Predictors of Child Outcomes in School Nurse-Delivered Interventions for Anxiety.

This study examined the association between two implementation factors, nurse-reported intervention adherence and self-efficacy, and children's outcomes in school nurse-delivered anxiety interventions. Data were collected in a pilot randomized controlled effectiveness trial with 54 children and 21 school nurses. Nurses implemented either a cognitive behavioral or relaxation-skills-only intervention. Nurse questionnaires assessed implementation factors. Independent evaluators assessed changes in children's anxiety symptoms at postintervention and at 3-month follow-up using clinical improvement and global functioning scales. Regression analyses indicated that greater intervention adherence was associated with greater anxiety symptom improvement at follow-up. Nurse self-efficacy interacted with intervention group, such that nurses with higher self-efficacy who implemented the cognitive behavioral intervention tended to have children show improvement and higher postintervention functioning. The impact of implementation factors on children's outcomes may differ depending on intervention type. Self-efficacy may be important for nurses using relatively complex interventions. Intervention adherence should be supported through training and consultation.

A pilot RCT of a school nurse delivered intervention to reduce student anxiety.

The goal of this study was to evaluate the feasibility and impact of brief school-nurse-administered interventions for reducing anxiety. Thirty school nurses in Connecticut and Maryland were randomly assigned to deliver the Child Anxiety Learning Modules (CALM; n = 14) or CALM-Relaxation only (CALM-R; n = 16). Students (N = 54) were ages 5-12 (M age = 8; 84.9% White; 68.5% female) with elevated anxiety symptoms and/or anxiety disorders. Feasibility was assessed based on recruitment, retention, attendance, training and intervention satisfaction, and intervention adherence. Multiple informants, including independent evaluators (IEs), completed measures of clinical improvement at postintervention and at a 3-month follow-up. Of nurses in CALM and CALM-R, 62% and 81%, respectively, enrolled a student and completed an average of 6 sessions. Youth retention was 85% and 94% in CALM and CALM-R, respectively. Training and intervention satisfaction were high. At postintervention and follow-up, youth in both groups showed significant reductions in anxiety and related symptoms and improvements in functioning. Within-group effect sizes were medium to large, and between-group effect sizes were small. Task shifting responsibility for delivering brief mental health interventions to school nurses is feasible and shows promise for reducing anxiety and related impairment. This approach may also be integrated within a response to intervention model used in schools.Public Health Significance: Brief school-nurse-administered anxiety reduction interventions were shown to be feasible and had a positive impact on student anxiety and related impairment highlighting that school nurses can be an important school resource.

Effect of pecking stones and age on feather cover, hen mortality, and performance in free-range laying hens.

Severe feather pecking is frequently associated with impaired egg production, poor hen welfare, and increased mortality. The aim of this study was to investigate the potential of pecking stones to ameliorate the incidence of feather pecking. A total of 18 flocks of Hy-Line Brown laying hens were randomly assigned to control (n = 9 no pecking stone access) or treatment (n = 9 pecking stone access) flocks and housed in commercial fixed sheds (farm A, n = 10) or commercial mobile sheds (farm B, n = 8) differing in various housing conditions. Beak length, feather score, egg production, and mortality were evaluated at 16 wk of age and every 10 wk until at least 46 wk of age. On farm A, hens with access to pecking stones had significantly lower mortality than hens without pecking stone access (P = 0.001). A significant interaction between pecking stone and age was observed on feather scores of wings of hens housed in farm A. Hens of the pecking stone group in farm A had higher wing feather score (indicating better feather condition) at the age of 56 and 66 wk than hens with no access to pecking stones (pecking stone × age, P = 0.002). The age of the hens was significantly associated with lower overall feather scores (poorer feather condition), reduced egg production, and higher mortality (P < 0.05). Although pecking stones reduced some feather loss and mortality, this effect was only present on one farm and therefore may be related to farm management. Especially the impact of pecking stones on mortality was inconclusive as the cumulative mortality in farm B was nearly twice as high compared with that in control flocks. Further investigations are warranted including the effects of pecking stone provision at an early age such as during rearing (0-17 wk of age).

School-Based Treatment for Anxiety Research Study (STARS): a Randomized Controlled Effectiveness Trial.

The current study compared the effectiveness of a school-clinician administered cognitive behavioral treatment (CBT) to treatment as usual (TAU) at post-treatment (i.e., after 12 weeks) and at a 1 year follow-up. Sixty-two school-based clinicians (37 in CBT; 25 in TAU) and 216 students (148 students in CBT; 68 in TAU) participated. Students were ages 6-18 (mean age 10.87; 64% Caucasian & 29% African American; 48.6% female) and all met DSM-IV diagnostic criteria for a primary anxiety disorder. Independent evaluators (IEs) assessed clinical improvement, global functioning, and loss of anxiety diagnoses; children and parents completed measures of anxiety symptoms. At post-treatment, no significant treatment main effects emerged on the primary outcome; 42% and 37% of youth were classified as treatment responders in CBT and TAU respectively. However, parent-report of child anxiety showed greater improvements in CBT relative to TAU (d = .29). Moderation analyses at post-treatment indicated that older youth, those with social phobia and more severe anxiety at baseline were more likely to be treatment responders in CBT compared to TAU. At the 1 year follow-up, treatment gains were maintained but no treatment group differences or moderators emerged. CBT and TAU for pediatric anxiety disorders, when delivered by school clinicians were generally similar in effectiveness for lowering anxiety and improving functioning at both post-treatment (on all but the parent measure and for specific subgroups) and 1 year follow-up. Implications for disseminating CBT in the school setting are discussed.

Feed particle selection and nutrient intake altered by pecking stone consumption and beak length in free-range laying hens.

The present study investigated the effects of pecking stones on feeding behaviour of hens from 16 to 46 weeks of age. Eighteen flocks of Hy-Line Brown hens were housed in 2 commercial free-range housing systems. Farm A housed 10 flocks of beak trimmed (infrared beak treatment) hens in fixed sheds. Farm B housed 8 flocks of hens with intact beaks in mobile sheds. On each farm, flocks were equally assigned to control groups (no access to pecking stones) and treatment groups (access to pecking stones). Data were evaluated every 10 weeks. At each time point, 10 hens per flock were housed in individual pens, and each hen was provided with 250 g of mash diet and ad libitum water for 24 h. After 24 h, feed samples were collected and used to determine 24-h feed intake. Nutrient and particle selection was measured by subtracting nutrients and particles present in the leftover feed from the vaules obtained in the offered feed and expressed the change (Δ). In addition, pecking stone consumption was recorded for each flock. Data were analysed separately for each farm using fixed effects of pecking stone availability and hen age. Spearman's rho correlation coefficients and linear regression models were constructed to evaluate the relationship of beak length and pecking stone usage, discrete mean particle size (dMEAN) consumption (Δ dMEAN), and Δ nutrient intake. Hens with access to pecking stones consumed significantly lower quantities of large feed particles (>2.8 mm) on farm A (P = 0.029) and selected significantly more fine particles, on farm B (P = 0.013). Overall, positive relationships (P = 0.001) between beak length and pecking stone consumption, Δ dMEAN, and Δ phosphorus consumption were observed. In conclusion, pecking stone consumption resulted in reduced selection and consumption of feed particles in hens housed on both farms. Further research is warranted to investigate the effect of pecking stones on sensory innervation of the beak.

Saltbush (Atriplex nummularia and A. amnicola) as potential plants for free-range layer farms: consequences for layer performance, egg sensory qualities, and excreta moisture.

Highly adapted plant species suited to low rainfall conditions need to be considered for free-range poultry farms, particularly in marginal rainfall areas. A group of suitable plants are the saltbushes, in particular old man saltbush (Atriplex nummularia) can provide shelter, shade, and possibly forage. The first experiment examined whether hens eat old man saltbush while ranging. Free-range Hy-Line Brown layer hens were provided saltbush or "no" saltbush on the outdoor range throughout 11 wk of early production (16 to 27 wk). The quantity of saltbush eaten by the hens was determined by the n-alkane method. Hen interactions with saltbush were video recorded, and hen live weight, feed intake, egg production, and egg quality were measured. Hens ate the saltbush at 5% of their dietary dry matter intake. This level of saltbush intake had no influence on egg production. The video footage revealed hens actively pecked at the saltbush. The second experiment investigated the consequences of hens diluting their diet by eating increased levels of River saltbush (Atriplex amnicola). Air-dried, hammer-milled river saltbush was mixed and pelleted into a standard commercial layer diet at the following levels; 0 (control), 5, 10, 15, and 20%. Hy-Line Brown layer hens were fed the diets for 28 D (32 to 35 wk of age). Seventy-five hens were housed in individual cages, with 15 hen replicates per diet. The saltbush had no significant impact on egg production, hen live weight, or feed intake. Excreta moisture increased significantly (P < 0.001) with increased saltbush (5, 10, 15, and 20%) in the diet. Furthermore, high saltbush eggs (20%) had significantly stronger egg yolk color (P = 0.006) and thicker egg shells (P < 0.001) compared to the control eggs. Consumers were presented with the eggs from the second experiment and they preferred the high saltbush eggs (20%). In conclusion, saltbush would be a valuable plant on free-range poultry farms to provide shade and shelter, especially in those areas with marginal rainfall.

Family and Parent Predictors of Anxiety Disorder Onset in Offspring of Anxious Parents.

BACKGROUND: Offspring of anxious parents are at increased risk for developing anxiety disorders. There is a need to identify which youth are at greatest risk for disorder onset in this population. OBJECTIVE: This study prospectively examined several theory-based family and parent characteristics (e. g., family conflict, parental over-control, parental psychopathology) as predictors of anxiety disorder onset in children whose parents were clinically anxious. METHODS: Families were enrolled in a randomized controlled trial evaluating a familybased preventative intervention, relative to an information monitoring control condition, for offspring of anxious parents (N= 136; child mean age 8.69 years; 55% female; 85% Caucasian). Family and parent measures were collected using multiple informants and an observational task at baseline, post-intervention, and at a six and 12 month followup. Child anxiety disorder diagnosis was determined by independent evaluators using the Anxiety Disorders Interview Schedule for Children. RESULTS: Results indicated that none of the baseline family or parent variables examined predicted the onset of an anxiety disorder in children over the one year follow-up period. CONCLUSIONS: Findings raise questions about the short-term risk associated with family and parent factors in anxiety disorder development in this high risk population.

Perceived Peer Victimization Predicts Anxiety Outcomes in a Prevention Program for Offspring of Anxious Parents.

Offspring of anxious parents are at heightened risk for developing anxiety disorders. Preventive interventions for these youths are promising but not universally effective, creating a need to identify outcome predictors. Peer experiences (e.g., peer victimization, social support) are associated with youth anxiety trajectories but have been relatively unexplored in this context. Thus, this study tested whether peer experiences predicted anxiety-related outcomes in families participating in a randomized controlled trial of a child anxiety prevention program for families with a clinically anxious parent. Parental anxiety severity was also examined as a moderator of relations between peer experiences and subsequent child anxiety. Participants were 121 families (child M age = 8.69, 55.90% girls). Hierarchical logistic and linear regressions were used to test whether baseline peer-related factors predicted increased anxiety symptom severity and anxiety disorder onset over 12 months. Youths reporting greater perceived peer victimization at baseline were more likely to develop an anxiety disorder and had more severe anxiety symptoms 12 months later. Lower social support from classmates also predicted increased anxiety severity, but this effect became nonsignificant after accounting for peer victimization. Further, parental anxiety severity moderated the peer victimization-child anxiety severity link: Higher child-reported peer victimization predicted increased anxiety in offspring of highly and moderately anxious but not low anxious parents. Children's reports of peer victimization appear important for understanding which youth may not respond to preventive interventions in high-risk families-especially for children with more severely anxious parents. Implications for the focus of selective anxiety prevention programs are discussed.

Demographics and practices of semi-intensive free-range farming systems in Australia with an outdoor stocking density of ≤1500 hens/hectare.

Baseline information on demographics and practices on semi-intensive free-range egg farms with an outdoor stocking density of ≤1500 hens/hectare in Australia is presented. Free-range egg production is changing the structure of the egg industry in Australia and a broad variety and tiers of free-range systems have emerged due to lack of concrete legislative standards on outdoor stocking densities in the past. Information was extracted from a pre-existing online free-range poultry survey dataset, consisting of a total of 79 questions related to nutrition, pasture management, welfare and health, animal housing, environmental impact and economics. Forty-one free-range egg farms, with an outdoor stocking density of ≤1500 hens/hectare, were identified in the dataset from all major Australian states. Two types of semi-intensive free-range housing systems were documented: mobile (modified caravan/trailer) housing (56%), and fixed sheds (44%). Seventy-two percent of respondents reported >75% of the hens in the flock used the outdoor range. All respondents reported ingestion of range components by hens in the form of vegetation, insects, stones and grit. Up to 10% mortality was reported by 40% respondents with predation (34%), cannibalism (29%), heat stress (24%) and grass impaction (19.5%) as major causes. Biosecurity on farms was sub-optimal with 8 of the 10 actions implemented by <50% respondents. Customer demand, consumer sentiment and welfare were the major factors for farmers moving into free-range egg production. This study resulted in identification of current practices and key challenges on semi-intensive free-range egg farms. Applied research and communication of results to farmers is highly recommended to ensure optimum health and welfare of free-range laying hens and sustained egg production.

Child Anxiety Prevention Study: Impact on Functional Outcomes.

This study examined the impact of a selective anxiety prevention program for offspring of clinically anxious parents on three domains of child functioning: (1) social, (2) familial, and (3) emotional/behavioral. Dyads were randomized into either the Coping and Promoting Strength program (CAPS; n = 70) or Information Monitoring (IM; n = 66) comparison group. Multi-informant assessments were conducted at baseline, post intervention, and 6 and 12 months follow-ups. Random effects mixed models under the linear growth modeling (LGM) framework was used to assess the impact of CAPS on growth trajectories. Over time, children in the CAPS group had significantly lower anxiety, anxious/depressed symptoms, and lower total behavior problems (parent report), compared to children in IM group. The intervention did not impact other domains assessed (e.g., social functioning), which may be due to "floor effects" on these measures. Longitudinal follow-up data is needed to provide valuable information about this high risk population.

Bacterial contamination of eggs and behaviour of poultry flocks in the free range environment.

The free range production system is becoming more common in Australia and is expected to increase. Free range hens are exposed to more stressors in comparison to hens from barn and cage systems and it is suggested that stress can increase bacterial shedding on eggs. The aims of this study were to examine the level of total bacteria and Enterobacteriaceae populations, as well as the presence of Salmonella and Campylobacter, in eggs collected from two free range flocks on two different farms and to conduct longitudinal observations of the behaviour and welfare of hens in the free range production system. Hen age (weeks) was shown to have a significant effect (increase) on the level of total bacteria on the egg shell surface and in shell pores, as well as having an effect on feather condition score. As the hens aged, the frequency of external visual egg characteristics increased, as did feather condition score (where feather condition was poorer). These observations indicate areas which should be investigated further to improve the food safety of eggs and optimise the welfare of free range hens.

An Open Trial of the Anxiety Action Plan (AxAP): A Brief Pediatrician-Delivered Intervention for Anxious Youth.

BACKGROUND: Anxiety disorders in youth are among the most common psychiatric disorders, yet the majority of affected youth do not receive treatment. One approach to improving access to care is identification and intervention within the primary care setting. OBJECTIVE: This manuscript presents data from a single group pre-post open trial of the Anxiety Action Plan (AxAP), a brief pediatrician-delivered intervention to reduce anxiety in youth who present in the primary care setting. METHODS: Eleven pediatricians conducted the intervention with 25 youth (mean age 11.16 years; range 6-18 years) with elevated levels of anxiety in their primary care practice setting. RESULTS: Pediatricians' ratings of the AxAP training were positive (mean overall satisfaction was 4.82 on 5 point scale). Pediatricians and parents also reported high levels of intervention satisfaction and acceptability. Parents (but not children) who completed the intervention reported significant reductions from pre- to post-intervention on measures of child anxiety severity, impairment, and caregiver burden (Cohen's d 1.06, .75, .60, respectively). CONCLUSIONS: Findings suggest that a brief, pediatrician-delivered intervention in primary care settings appears feasible and beneficial to patients. Additional controlled evaluation of the intervention's efficacy is needed.

Preventing Onset of Anxiety Disorders in Offspring of Anxious Parents: A Randomized Controlled Trial of a Family-Based Intervention.

OBJECTIVE: The authors examined the efficacy of a family-based intervention to prevent the onset of anxiety disorders in offspring of anxious parents. METHOD: Participants were 136 families with a parent meeting DSM-IV criteria for an anxiety disorder and one child 6-13 years of age without an anxiety disorder. Families were randomly assigned to the family-based intervention (N=70) or to an information-monitoring control condition (N=66). All families were expected to complete assessments, administered by blind interviewers, at baseline, at the end of the intervention (or 8 weeks after randomization) and at 6- and 12-month follow-ups. Onset of any anxiety disorder and anxiety symptom severity (assessed using the Anxiety Disorders Interview Schedule for Children) at 12 months were the primary and secondary outcome measures, respectively. RESULTS: The incidence of child anxiety disorders was 31% in the control group and 5% in the intervention group (odds ratio=8.54, 95% CI=2.27, 32.06). At the 1-year follow-up, youths in the control group also had higher anxiety symptoms ratings than those in the intervention group. Effect sizes were medium to large (0.81 at 6 months and 0.57 at 12 months for anxiety symptoms), and the number needed to treat was 3.9 at 12 months. Significant moderators included baseline levels of child anxiety; significant mediators were parental distress and modeling of anxiety. Child maladaptive cognitions and parental anxiety did not mediate outcomes. CONCLUSIONS: A brief psychosocial prevention program holds promise for reducing the 1-year incidence of anxiety disorders among offspring of anxious parents.

Enhancing the Capacity of School Nurses to Reduce Excessive Anxiety in Children: Development of the CALM Intervention.

PROBLEM: Excessive anxiety is among the most common psychiatric problems facing youth. Because anxious youth tend to have somatic complaints, many seek help from the school nurse. Thus, school nurses are in an ideal position to provide early intervention. This study addresses this problem and describes the plans to develop and test a new intervention (Child Anxiety Learning Modules; CALM), delivered by school nurses, to reduce child anxiety and improve academic functioning. METHODS: An iterative development process including consultation with an expert panel, two open trials, and a pilot randomized controlled study comparing CALM to usual care is proposed. Feedback will be solicited from all participants during each phase and data on outcome measures will be provided by children, parents, teachers, and independent evaluators. FINDINGS: Data will be collected on intervention satisfaction and feasibility. Primary outcomes that include child anxiety symptoms, classroom behavior, and school performance (e.g., attendance, grades, standardized test scores) will be collected at pre- and post-interventions and at a 3-month follow-up evaluation. CONCLUSIONS: Pediatric anxiety is a common problem that school nurses frequently encounter. Consequently, they are well positioned to play a key role in enhancing access to behavioral health interventions to reduce anxiety and may therefore make a significant positive public health impact.

Using Community-Based Participatory Research to Disseminate a Mass Media Campaign Into Rural Communities.

The authors present the results of a media documentary, Weight of the Nation, disseminated in rural communities in the Brazos Valley region of east central Texas. Researchers relied on a community-based participatory research strategy to assure community participation in the implementation and evaluation of the media documentary in rural communities. To measure the short-term effects of the documentary, the research team used a mixed-methods approach of quantitative panel data from a pre/post survey, qualitative meeting notes, and observations from facilitated discussion groups. Results showed short-term increases in behavioral intention, as well as an increase in self and collective efficacy of participants to make healthy changes at individual and community levels to reduce obesity. The findings suggest that Weight of the Nation is a catalyst for increasing awareness about obesity and initiating changes in intention and efficacy perceptions.

Utilization of an interorganizational network analysis to evaluate the development of community capacity among a community-academic partnership.

BACKGROUND: Following a community health assessment the Brazos Valley Health Partnership (BVHP) organized to address fragmentation of services and local health needs. This regional partnership employs the fundamental principles of community-based participatory research, fostering an equitable partnership with the aim of building community capacity to address local health issues. OBJECTIVES: This article describes changes in relationships as a result of capacity building efforts in a community-academic partnership. Growth in network structure among organizations is hypothesized to be indicative of less fragmentation of services for residents and increased capacity of the BVHP to collectively address local health issues. METHODS: Each of the participant organizations responded to a series of questions regarding its relationships with other organizations. Each organization was asked about information sharing, joint planning, resource sharing, and formal agreements with other organizations. The network survey has been administered 3 times between 2004 and 2009. RESULTS: Network density increased for sharing information and jointly planning events. Growth in the complexity of relationships was reported for sharing tangible resources and formal agreements. The average number of ties between organizations as well as the strength of relationships increased. CONCLUSION: This study provides evidence that the community capacity building efforts within these communities have contributed to beneficial changes in interorganizational relationships. Results from this analysis are useful for understanding how a community partnership's efforts to address access to care can strengthen a community's capacity for future action. Increased collaboration also leads to new assets, resources, and the transfer of knowledge and skills.

Anxiety-promoting parenting behaviors: a comparison of anxious mothers and fathers.

The majority of research identifying anxiety-promoting parenting behaviors has been conducted with mothers, leaving a gap in current knowledge about the role of fathers' parenting behaviors. In an attempt to fill this gap, this study compared anxiety-promoting parenting behaviors of anxious mothers and fathers. Parents completed self-report measures of parenting behavior and independent coders rated parenting behaviors (i.e., overcontrol, granting of autonomy, warmth, hostility, anxious behavior) of mothers (n = 34) and fathers (n = 21) during a challenging parent-child interaction task (children were ages 6-12). Results indicated that anxious fathers were observed to be more controlling than anxious mothers; while anxious mothers reported using more punishment and reinforcement of children's dependence in anxiety provoking situations compared to fathers. Findings extend our knowledge about anxious fathers, and highlight the need for additional research on the impact of fathers' parenting with respect to the development of child anxiety.

The utility of rural and underserved designations in geospatial assessments of distance traveled to healthcare services: implications for public health research and practice.

Health disparities research in rural populations is based on several common taxonomies identified by geography and population density. However, little is known about the implications of different rurality definitions on public health outcomes. To help illuminate the meaning of different rural designations often used in research, service delivery, or policy reports, this study will (1) review the different definitions of rurality and their purposes; (2) identify the overlap of various rural designations in an eight-county Brazos Valley region in Central Texas; (3) describe participant characteristic profiles based on distances traveled to obtain healthcare services; and (4) examine common profile characteristics associated with each designation. Data were analyzed from a random sample from 1,958 Texas adults participating in a community assessment. K-means cluster analysis was used to identify natural groupings of individuals based on distance traveled to obtain three healthcare services: medical care, dental care, and prescription medication pick-up. Significant variation in cluster representation and resident characteristics was observed by rural designation. Given widely used taxonomies for designating areas as rural (or provider shortage) in health-related research, this study highlights differences that could influence research results and subsequent program and policy development based on rural designation.