Rural Healthy People 2010:
VOLUME 1
Editors:
Larry Gamm, Ph.D.
Linnae Hutchison, MBA
Betty Dabney, Ph.D.
Alicia Dorsey, Ph.D.
The
School of Rural Public Health
Southwest Rural
This publication was supported through cooperative agreement #5 U1C RH 00033 from the Health Resources and Services Administration’s Office of Rural Health Policy, United States Department of Health and Human Services.
PROJECT OFFICER:
Joan Van Nostrand, DPA
The Office of Rural Health Policy
Health Resources and Services Administration
United States Department of Health and Human Services
|
The opinions expressed do not
necessarily represent those of the Health Resources and Services Administration or the United States Department of Health and Human Services. |
2003
In Dedication to Dr. Paul Ambrose
The Office
of Rural Health Policy’s interest in working with the
Throughout his career, Dr. Ambrose was a
strong supporter of rural health care and felt strongly that there needed to be
a rural focus to the Healthy People 2010 initiative. A graduate of the
In 2000, Dr. Ambrose was named the Association of Teachers of Preventive Medicine (ATPM) Luther Terry Fellow. This position was established to provide the Office of Disease Prevention and Health Promotion (ODPHP) with clinical research and technical expertise in order to support the Department’s preventive service goals. This Fellowship provides a critical link between ODPHP and the medical community and offers a valuable experience for clinicians in health policy development. During his tenure at DHHS, Dr. Ambrose continued his strong support of rural health issues as well as public health. He believed that it was important that the Healthy People 2010 initiative become a useful tool for rural communities. This effort is dedicated to the memory of Dr. Ambrose.
Preface
This report is comprised of two volumes. Volume 1 contains brief overviews of the top rural health concerns and objectives associated with Healthy People 2010 focus areas, references to key literature about these concerns, and descriptions of models for practice that rural communities can draw upon to achieve key Healthy People 2010 objectives. Volume 2 is an appendix that presents more detailed literature reviews and associated references for the top rural health concerns.
Healthy People 2010 greeted the new century with a report identifying 467 objectives within 28 focus areas intended to stimulate and support action to improve the nation’s health. These objectives were intended to guide actions by national, state, and local governments and by numerous health provider and community-based organizations across the country. The Healthy People 2010 (HP2010) document represented the contributions of more than 350 national organizations and 250 state public health, mental health, substance abuse, and environmental agencies—and the activities of thousands of national, state, and local participants addressing HP2010 objectives in America’s states and communities. Healthy People 2010 documents can be found at the Healthy People 2010 website (http://www.healthypeople.gov).
The leaders and staff of the
Office of Rural Health Policy (ORHP) recognized that the major goals of Healthy
People 2010 to increase the quality and years of healthy life and to eliminate
health disparities faced significant hurdles in rural
The Center proposed to
identify Healthy People 2010 focus areas that were of particular significance
to rural America, to review the research literature related to the selected
areas, and to identify successful practices and programs that rural communities
are employing to address major health problems and that might serve as “models”
for communities wishing to address one or more of the HP2010 objectives. The
Center did not attempt to mirror the wide-ranging work of thousands of people
that went into investigating all of the 28 focus areas with 467 objectives in
the Healthy People 2010 document. Instead, the Center’s approach included the
following steps. First, we selected criteria to be used in identifying HP2010
focus areas that could be considered major health priorities in rural
The following materials reflect the work of the Rural Healthy People 2010 team that began in January 2001 and continued through 2002. Additional work on Rural Healthy People 2010 will continue over the next year, and its products will be reported on our website (www.srph.tamushsc.edu/rhp2010) and in future reports.
This and other Rural Healthy
People 2010 reports are intended to better inform readers on current rural
health conditions, provide insights into possible points of attack, and offer
examples of models that might be employed in practice to improve rural health
conditions. As noted above, this is the first of two volumes. Volume 1 contains
an introduction to the Rural Healthy People 2010 project, brief discussions of
the literature on each of the selected focus areas and objectives, and
descriptions of models for practice for each of 10 Healthy People 2010 focus
areas selected. Volume 2 contains the more detailed literature reviews on the
same 10 rural health topics along with a more lengthy set of references. The
two-volume printed copy of this Rural Healthy People 2010 report captures these
topics at a point in time and, like the web-based version, is intended as a
useful resource for health professionals, administrators, other community
leaders, and policy makers. The web-based version—Rural Healthy People 2010 on
the Web¾is an
“organic document” located at www.srph.tamushsc.edu/rhp2010.
It will be updated periodically, adding reviews of additional rural health
priority areas and adding new “models for practice,” as we identify them, for
each of the top health priority areas. Two new focus areas and associated
models for practice will be added during 2003¾Immunization
and Infectious Diseases, and Injury and Violence Prevention. The dynamic nature
of the web version will reflect change as new models for practice emerge, new
and important research is published, or other relevant and timely sources of
information appear on key health issues for rural
The Rural Healthy People 2010 contributors explore many of the disadvantages and disparities facing many rural communities with an eye toward creating wider understanding of rural health needs. At the same time, we do not wish to diminish advantages and attractions that many rural areas already offer to their residents and visitors. More important, we want to recognize and highlight the many rural communities, like those featured in Rural Healthy People 2010 "models for practice." They reflect the hard work and commitment of rural people unwilling to accept existing conditions and who, instead, explore new pathways to improve the health of rural people.
This report and the
subsequent success of Rural Healthy People 2010 depends on generous sharing of
information from a multitude of people. The following pages only begin to
reflect the widespread input from rural constituencies in the initial
development of our work and its reports. This is the case for the selection of
the rural health priorities, some of the materials incorporated in the reviews,
and the compilation and analysis of the dozens of models for practice presented
here. All of these elements benefited from the cooperation of hundreds of
national, state, and local rural health participants. We encourage these people
and others who read Rural Healthy People 2010 materials to forward to the
Acknowledgments
From the beginning of the Rural Healthy People 2010 project, starting with the original request from the Office of Rural Health Policy, that office and many other national and state organizations played an active and significant role in the project. The State Offices of Rural Health along with other state and national experts were very responsive from the beginning in nominating rural health priorities and in assessing the most important criteria for identifying rural priorities. Leaders of the other federally funded rural health research centers, along with the ORHP staff, were very helpful in reviewing the study design and initial products from the project and offering recommendations. Based, in part, upon such recommendations, the project was expanded to garner input from a wide range of state and local rural health leaders on nominations of rural health priorities and accompanying models for practices across the county.
More than a dozen research
colleagues at The Texas A&M University System’s School of Rural Public
Health (SRPH) participated in the early discussions leading up to the design of
the project. A number of these faculty played a role in authoring chapters
and/or providing guidance on models for practice. They include, in alphabetical
order, Craig Blakely, Jane Bolin, James Burdine,
Susan Carozza, Brian Colwell, Betty Dabney, Linnae Hutchison, Ken McLeroy, Jennifer Peck, Stacey Stephens, Tom Tai-Seale, and
Miguel Zuniga. Peter Fos of the
We appreciate, too, the contributions of our former colleague, Gail Bellamy, now of the Institute for Health Policy Research and the Robert C. Byrd Health Sciences Center of West Virginia, who played an important role in the development of criteria and guidelines for selecting models for practice and identification of models. Alicia Dorsey of SRPH provided valuable support in editing the literature reviews and models for practice. The final editing work of Susan Lee is visible, too, in the final product.
Catherine Hawes, Director of
the
We are especially indebted to
the Office of Rural Health Policy, particularly Marcia Brand, its director, for
providing the impetus and funding for the Rural Healthy People 2010 project.
Joan Van Nostrand, Director of Research for ORHP, and
Kathy Hayes, the ORHP liaison to the Rural Healthy People 2010 project, were
particularly generous in offering feedback, advice, and encouragement. Many
other staff members of ORHP, the Healthy People 2010 Consortium, the Bureau of
Primary Health Care, the National Organization of State Offices of Rural
Health, and the National Rural Health Association provided assistance and/or
provided opportunities to share our work with others and to gain additional
valuable information from informed audiences. A number of other national
associations provided assistance, as well, including: American Hospital
Association’s Section on Small or
Finally, all of the
Larry Gamm
Principal Investigator, Rural Healthy People 2010
The Southwest Rural
School of Rural Public Health
The
TAMU 1266
www.srph.tamushsc.edu/srhrc
Contents (Volume 1)
AUTHORS AND CONTRIBUTORS............................................................................................
INTRODUCTION..........................................................................................................................
Larry Gamm, Linnae Hutchison, Gail Bellamy, and Betty Dabney
Introduction to Rural Healthy People 2010.................................................................................
Methodology............................................................................................................................
Models for Practice in Rural Healthy People 2010......................................................................
Other Sources of Innovative Models..........................................................................................
Data and Data Sources for RHP2010........................................................................................
OVERVIEWS
1. Access to Quality Health Services in Rural Areas...........................................................
a. Access to Quality Health Services in Rural Areas¾Insurance............................................
Jane Bolin and Larry Gamm
Associated Models for Practice:
1.) CHOICE Regional Health Network Regional Access,
2.) Inland Northwest in Charge,
3.) Lake Plains Community Care Initiative,
4.)
5.)
b. Access to Quality Health Services in Rural Areas¾Primary Health Care ...........................
Larry Gamm, Graciela Castillo, and Stephanie Pittman..................................................
Associated Models for Practice:
1.)
2.)
3.) Rural Health Network of
4.) A Rural Minority Geriatric Care
Management Model,
5.) St. Mary’s County Health Department Medical Assistance Transportation
Program,
6.)
c. Access to Quality Health Services in Rural Areas¾Emergency Medical Services...............
Cortney Rawlinson and Paul Crews
Associated Models for Practice:
1.) Rural Health Community Systems,
2.) TENKIDS EMS Computer Network,
2. Cancer in Rural Areas...........................................................................................................
Annie Gosschalk and Susan Carozza
Associated Models for Practice:
1.) Kokua Program (Hui No Ke Ola Pono),
2.) Real
Men Checkin’ It Out,
3.) Women’s
Way,
3. Diabetes in Rural
Betty Dabney and Annie Gosschalk
Associated Models for Practice:
1.) Diabetes
Collaborative,
2.) Delta
Community Partners in Care,
3.) Holy Cross
Diabetes Self- Management Program,
4.)
4. Heart Disease and Stroke in
Rural
Miguel Zuniga, D’Arcie Anderson, and Kristie Alexander
Associated Models for Practice:
1.)
2.)
3.) Healthy
Hearts
4.)
5. Maternal, Infant, and Child Health in Rural Areas
Jennifer Peck and Kristie Alexander
Associated Models for Practice:
1.) Rural Healthcare Cooperative Network and Panhandle Partnership for Health and
Human Services,
2.)
Nurse-Family Partnership,
3.)
Maternal Infant Care Program,
6. Mental Health and Mental Disorders¾A Rural Challenge............................................
Larry Gamm, Sarah Stone, and Stephanie Pittman
Associated Models for Practice:
1.) Pro
Bono Counseling Program, Mental Health Association of the
Valley, Inc,
2.) Sowing
the Seeds of Hope;
3.) Thomas
E. Langley Medical Center¾Behavioral
Health Department,
4.) Turning
Point Counseling Services, Inc,
7. Nutrition and Overweight Concerns in Rural Areas........................................................
Tom Tai-Seale and Coleman Chandler
Associated Models for Practice:
1.)
Physical Dimensions/Focus,
2.) Daya Tibi “House of Good Living”/
Center,
8. The State of Rural Oral Health.........................................................................................
Pete Fos and Linnae Hutchison
Associated Models for Practice:
1.) Choptank Community Health System’s Oral Health Prevention
Program,
2.) FirstHealth of the
3.) Miles
for Smiles
4.)
5.) Rural
Health Dental Clinic,
9. Substance Abuse¾Trends in Rural Areas.......................................................................
Linnae Hutchison and Craig Blakely
Associated Models for Practice
1.)
Community Family Services Program,
2.) Project
Forward, a Program of the Center for Community Outreach,
Clinic,
3.) Project
Northland,
10. Tobacco Use in Rural Areas.............................................................................................
Stacey Stevens, Brian Colwell, and Linnae Hutchison
Associated Models for Practice
1.)
Stickers-Suckers-Smokers Pregnancy Tobacco Cessation Program,
2.) Tobacco
Intervention and Prevention Strategy,
3.) Too
Smart to Smoke Tobacco Prevention Campaign,
(NOTE: See Volume 2: Appendix for Rural Healthy People 2010 literature reviews.)
Contents of Volume 2: Appendix
Rural Healthy People 2010 Literature Reviews
1. Access to Quality Health Services in Rural Areas
a. Access to Quality Health Services in Rural Areas¾Insurance
Jane Bolin and Larry Gamm
b. Access to Quality Health Services in Rural Areas¾Primary Care
Larry Gamm, Graciela Castillo, and Stephanie Pittman
c. Access to Quality Health Services in Rural Areas¾Emergency Medical Services
Cortney Rawlinson and Paul Crews
2. Cancer in Rural Areas
Annie Gosschalk and Susan Carozza
3. Diabetes in Rural
Betty Dabney and Annie Gosschalk
4. Heart Disease and Stroke in Rural
Miguel Zuniga, D’Arcie Anderson, and Kristie Alexander
5. Maternal, Infant, and Child Health in Rural Areas
Jennifer Peck and Kristie Alexander
6. Mental Health and Mental Disorders¾A Rural Challenge
Larry Gamm, Sarah Stone, and Stephanie Pittman
7. Nutrition and Overweight Concerns in Rural Areas
Tom Tai-Seale and Coleman Chandler
8. The State of Rural Oral Health
Pete Fos and Linnae Hutchison
9. Substance Abuse¾Trends in Rural Areas
Linnae Hutchison and Craig Blakely
10. Tobacco Use in Rural Areas
Stacey Stevens, Brian Colwell, and Linnae Hutchison
Authors and Contributors
Larry Gamm, Ph.D.
Professor, Department of Health Policy and Management, Associate Director of the Southwest Rural Health Research Center, School of Rural Public Health, The Texas A&M University System Health Science Center
Linnae Hutchison,
Research Associate, Southwest Rural
Betty Dabney, Ph.D.
Assistant Professor, Department of Environmental and Occupational
Health, School of Rural Public Health, The
Alicia Dorsey, Ph.D.
Associate Professor, Department of Social and Behavioral Health,
Administrator of Academic Programs, School of Rural Public Health, The
Gail Bellamy, Ph.D.
Director of Community Studies, Associate Director in the West Virginia University Health Science Center Eastern Division, West Virginia University Institute for Health Policy Research, Charleston, West Virginia; formerly Adjunct Associate Professor, School of Rural Public Health, The Texas A&M University System Health Science Center
Craig Blakely, Ph.D., MPH
Professor and Department Head, Department of Health Policy and
Management, Director of the Office of Research, School of Rural Public Health,
The
Jane Bolin, Ph.D., JD, RN
Assistant Professor, Department of Health Policy and Management,
School of Rural Public Health, The
James Burdine, Dr.PH, MPH
Associate Professor, Director of the Department of Social and Behavioral
Health, School of Rural Public Health, The
Susan Carozza, Ph.D.
Assistant Professor, Department of Epidemiology and Biostatistics,
School of Rural Public Health, The
Brian Colwell, Ph.D.
Associate Professor, Department of Social and Behavioral Health,
School of Rural Public Health, The
Pete Fos, Ph.D., MPH, DDS
Professor, Chair of Clinical Sciences,
Catherine Hawes, Ph.D.
Professor, Department of Health Policy and Management, Director of the Southwest Rural Health Research Center, School of Rural Public Health, The Texas A&M University System Health Science Center
Ken McLeroy, Ph.D.
Professor, Department of Social and Behavioral Health, Associate Dean for Academic Affairs, School of Rural Public Health, The Texas A&M University System Health Science Center
School
of Rural Public Health, The
Jennifer Peck, Ph.D.
Assistant Professor, Department of Epidemiology and Biostatistics,
School of Rural Public Health, The
Stacey Stevens, Ph.D.
Texas Commission on Alcohol and Drug Abuse,
Tom Tai-Seale, Ph.D.
Assistant Professor, Department of Social and Behavioral Health,
School of Rural Public Health, The
Miguel Zuniga, Dr.PH, MD
Assistant Professor, Department of Health Policy and Management,
School of Rural Public Health, The
Graduate Research Assistants – 2001-2003, School of Rural Public
Health, The
Kristie Alexander, MPH ’02
Memorial Hermann Children’s Hospital, Houston, Texas; formerly Graduate Research Assistant, School of Rural Public Health, The Texas A&M University System Health Science Center
D’Arcie
Medical School, Missouri School of Osteopathy, Missouri; formerly
Graduate Research Assistant,
Scott Bell, Ph.D., MPH ’02
Medical Student, University of Texas Health Science Center at San Antonio, College of Medicine, San Antonio, Texas; formerly Graduate Research Assistant, School of Rural Public Health, The Texas A&M University System Health Science Center
Denise Blevins, MPH ’02
Office of the Inspector General, Department of Health and Human Services, Dallas, Texas; formerly Graduate Research Assistant, School of Rural Public Health, The Texas A&M University System Health Science Center
Graciela Castillo, MPH Candidate ’03
Graduate Research Assistant, School of Rural Public Health, The
Coleman Chandler, MPH Candidate ’03
Graduate Research Assistant, School of Rural Public Health, The
Paul Crews, MPH ’02
Guthrie Ambulatory Health Care Clinic, Fort Drum, New York; formerly Graduate Research Assistant, School of Rural Public Health, The Texas A&M University System Health Science Center
Magda de la Torre, MPH ’02
University of Texas Health Science Center, Department of Dental Hygiene, School of Allied Health Sciences, San Antonio, Texas; formerly Graduate Research Assistant, School of Rural Public Health, The Texas A&M University System Health Science Center
Annie Gosschalk, MPH ’02
Graduate Research Assistant, School of Rural Public Health, The
Stephanie Pittman, MHA ’02
Wise Regional Health System and Foundation,
Cortney Rawlinson, MPH candidate ’03
Graduate Research Assistant, School of Rural Public Health, The
Leticia Shanley, MPH student and Medical student
University of Texas Health Center at San Antonio, College of Medicine, San Antonio, Texas; formerly Graduate Research Assistant, School of Rural Public Health, The Texas A&M University System Health Science Center
Sarah Stone, MSPH candidate ’03
Graduate Research Assistant, School of Rural Public Health, The
Susan Lee, BA
Technical
Editor, The
Southwest
Rural
School of Rural Public Health
The
1266 TAMU
(979) 458-0653
www.srph.tamhsc.edu/centers/srhrc
www.srph.tamhsc.edu/centers/rhp2010
Office of Rural Health Policy
Health Resources and Services Administration