Conducting a Community Engagement Studio to Adapt Enhanced Milieu Teaching

Purpose: Barriers to implementing evidence-based practices occur at various levels. Stakeholder input is required to identify challenges specific to clinical practice settings, client populations, and service delivery approaches. The purpose of this project was to solicit feedback from stakeholders on the telepractice service delivery and implementation strategies proposed for a future study of enhanced milieu teaching (EMT) in rural counties. Method: A Community Engagement Studio was conducted with 11 caregivers of children with language delays living in rural counties. Caregivers and the researchers discussed early intervention service delivery for children with language delays in rural Oregon and the proposed telepractice EMT procedures. Researchers gathered feedback on three intervention components: session frequency and schedule, implementation strategies to encourage caregivers' use of EMT, and performance feedback techniques to teach caregivers. Results: Findings from the Community Engagement Studio led to four primary modifications to the telepractice EMT study protocol. The principal investigator increased available days and times for intervention sessions and added text-message reminders for parents. A survey was also added for caregivers to identify their preferences for additional implementation strategies (e.g., tip sheets, checklist, e-mailed session summaries) and graphic representations of performance feedback (e.g., bar graph, radial graph, mountain climber infographic). Conclusion: Community Engagement Studios are a promising method for increasing community engagement in clinical research and soliciting stakeholder feedback on evidence-based intervention adaptations. Supplemental Material: https://doi.org/10.23641/asha.17774819

Comparison of Characteristics of Suicide Attempts Registered in Urban and Rural Areas in China

Objective: The objective of this study is to compare the characteristics of suicide attempts registered in general hospitals in urban and rural areas in China.Methods: From January 2007 to December 2011, suicide attempts registered in hospitals in five rural counties and in the Beijing Municipality were included. Univariate and multivariate analysis were used to compare the characteristics of rural and urban suicide attempts in China.Results: A total of 5,515 episodes of suicide attempts were included, 1,966 (35.6%) of them were from rural counties and 3,549 (64.4%) were from Beijing. Compared with urban counterparts, the rural suicide attempters had lower proportion of females (61.9% vs. 72.3%), more likely reporting previous suicide attempt history (56.9% vs. 16.4%), and staying in hospital for more than 1 day (81.5% vs. 44.6%). The most common methods of suicide attempts were pesticide ingestion in rural areas (52.1%) and taking medications in urban area (39.2%). Results of multivariate analysis indicated that suicide attempt registered in rural areas, pesticide ingestion, and previous suicide attempts history were associated with longer treatment in hospitals.Conclusions: Suicide attempts registered in rural areas were different from those in urban areas in China. It is essential to improve the equipment and ability of medical resuscitation for pesticide ingestion in rural hospitals in China.

County-level Analysis of Perinatal Health Indicators Within a Single Health System Catchment

Background: Adverse perinatal health outcomes are disproportionally impacted in rural communities. Social determinants of health (SDoH) defined by nonclinical social, behavioral, and economic factors may impact up to 90% of health outcomes in rural communities. Objective: To evaluate county-level perinatal patterns in health outcomes, health behaviors, socioeconomic vulnerability, and healthcare providers across rural and non-rural Florida counties within a single health system catchment. Methods: Socioeconomic vulnerability metrics, digital connectivity, licensed provider metrics, and behavioral data and were obtained from Floridahealthcharts.com and the County Health Rankings. County-level birth and perinatal health outcome data were obtained from the Florida Department of Health. The University of Florida Health Perinatal Catchment Area (UFHPCA) was defined as all Florida counties where ≥5% of all infants were delivered at Shands Hospital in Alachua county between June 2011 and April 2017. County-level rurality was determined by Florida Statutes 288.0656 rurality designations. Results: The UFHPCA included three non-rural and ten rural counties that represented more than 64,000 deliveries over a 5-year 9-month period. We found that nearly 1 in 3 infants resided in a rural county (n=20,899), and 7 out of 13 counties did not have a licensed obstetrician gynecologist. Nine counties reported maternal death rates that were between 1 and 4-fold higher than the statewide rate, and rural counties generally reported neonatal mortality and preterm birth rates that were higher than the statewide averages. We found maternal smoking rates (range 6.8% – 24.8%) were above the statewide rate (6.2%) for all counties in the catchment. Except for Alachua county, breastfeeding initiation rates (range 54.9% - 81.4%) and access to household computing devices (range 72.8% - 86.4%) were below the statewide rate (82.9% and 87.9%, respectively). Finally, we found that childhood poverty rates (range 16.3% - 36.9%) in our catchment was above the statewide rate (18.5%), except for Suwanee and Columbia counties.Conclusions: The health burden of the UFHPCA is characterized by both rural and non-rural counties with increased maternal and neonatal death and preterm birth, as well as adverse health behaviors that include smoking during pregnancy and lower levels of breastfeeding.

Trends in Premature Mortality From Acute Myocardial Infarction in the United States, 1999 to 2019

Background Evaluating premature (<65 years of age) mortality because of acute myocardial infarction (AMI) by demographic and regional characteristics may inform public health interventions. Methods and Results We used the Centers for Disease Control and Prevention’s WONDER (Wide‐Ranging Online Data for Epidemiologic Research) death certificate database to examine premature (<65 years of age) age‐adjusted AMI mortality rates per 100 000 and average annual percentage change from 1999 to 2019. Overall, the age‐adjusted AMI mortality rate was 13.4 (95% CI, 13.3–13.5). Middle‐aged adults, men, non‐Hispanic Black adults, and rural counties had higher mortality than young adults, women, NH White adults, and urban counties, respectively. Between 1999 and 2019, the age‐adjusted AMI mortality rate decreased at an average annual percentage change of −3.4 per year (95% CI, −3.6 to −3.3), with the average annual percentage change showing higher decline in age‐adjusted AMI mortality rates among large (−4.2 per year [95% CI, −4.4 to −4.0]), and medium/small metros (−3.3 per year [95% CI, −3.5 to −3.1]) than rural counties (−2.4 per year [95% CI, −2.8 to −1.9]). Age‐adjusted AMI mortality rates >90th percentile were distributed in the Southern states, and those with mortality <10th percentile were clustered in the Western and Northeastern states. After an initial decline between 1999 and 2011 (−4.3 per year [95% CI, −4.6 to −4.1]), the average annual percentage change showed deceleration in mortality since 2011 (−2.1 per year [95% CI, −2.4 to −1.8]). These trends were consistent across both sexes, all ethnicities and races, and urban/rural counties. Conclusions During the past 20 years, decline in premature AMI mortality has slowed down in the United States since 2011, with considerable heterogeneity across demographic groups, states, and urbanicity. Systemic efforts are mandated to address cardiovascular health disparities and outcomes among nonelderly adults.

Impact of a Regional Campus on the Placements of Students at Rural Pharmacy Experiential Sites

Pharmacist shortages in rural communities underscore the need to focus on increasing the pipeline of pharmacists practicing rurally. Experiential placement in rural communities is one method to approach this challenge. Regional pharmacy campuses may facilitate rural experiential placements. The objective of this study was to assess the effect of a regional campus on the number of rural experiential placements. This retrospective analysis compared experiential student placements in the five-year periods before and after the addition of a regional school of pharmacy campus. Experiential placements in the designated time periods were compared with respect to numbers of overall pharmacy practice experiences, experiences in rural locations, and rural counties with rotation sites. The average distance to rural sites was also compared. Differences in rural experiential placements were not statistically different. The number of rural counties with pharmacy experiential placements grew from eight to twelve, and driving distance increased. While institution of a regional campus contributed to an increase in the number of rural counties with experiential placements, overall rural experiential placements did not statistically differ versus suburban placements. Additional inquiry into factors that affect rural placement is needed to influence strategies to develop and maintain rural experiential sites and consistently place students at those sites.

Targeting COVID Vaccine Hesitancy in Rural Communities in Tennessee: Implications for Extending the COVID-19 Pandemic in the South

Approximately 40% of Tennesseans are vaccinated fully, due mainly to higher vaccination levels within urban counties. Significantly lower rates are observed in rural counties. Surveys suggest COVID-19 vaccine hesitancy is entrenched mostly among individuals identifying as white, rural, Republican, and evangelical Christian. Rural counties represent 70 of the total 95 counties in Tennessee, and vaccine hesitancy signifies an immediate public health crisis likely to extend the COVID-19 pandemic. Tennessee is a microcosm of the pandemic’s condition in the Southern U.S. Unvaccinated communities are the greatest contributors of new COVID-19 infections, hospitalizations, and deaths. Rural Tennesseans have a long history of cultural conservatism, poor health literacy, and distrust of government and medical establishments and are more susceptible to misinformation and conspiracy theories. Development of novel strategies to increase vaccine acceptance is essential. Here, I examine the basis of COVID-19 following SARS-CoV-2 infection and summarize the pandemic’s extent in the South, current vaccination rates and efforts across Tennessee, and underlying factors contributing to vaccine hesitancy. Finally, I discuss specific strategies to combat COVID-19 vaccine hesitancy. We must develop novel strategies that go beyond financial incentives, proven ineffective toward vaccinations. Successful strategies for vaccine acceptance of rural Tennesseans could increase acceptance among unvaccinated rural U.S. populations.