Urban/Rural Elderly Health Status Differences

Health policy research analyzes urban/rural differences as a simple dichotomy. Research characterizes the rural elderly as having a higher incidence of sickness, dysfunction, disability, restricted mobility, and acute and chronic conditions than their urban counterparts. However, population density as a dichotomy may obscure urban, rural, or urban/rural differences. Interviews measuring health status were conducted with a representative sample of 2,300 elderly people in six Northeastern Ohio counties constituting an urban/rural continuum. On medical condition, use of medical aids, and symptoms, health status improved significantly when moving from rural to urban, but correlations were small. Using dichotomies, urban elderly reported fewer medical conditions and symptoms than rural elderly, but four other health-status variables revealed no significant association and results differed depending on how dichotomies were defined. When individual communities were compared few urban/ rural patterns emerged. Controlling for demographics did not change interpretations. Findings question blanket assertions about urban/rural health-status differences. Medical resources may be misallocated. Rather than assuming poor health status among the rural elderly, researchers must verify differences through community-based research.     

Community,Family, and Race/Ethnic Differences in Health Status in Rural Areas1

Abstract Many race-specific differences in health outcomes that have been observed in previous research have been attributed to class and racebased group differences which either facilitate or constrain health opportunities and behaviors. These include such variables as different rates of poverty, health insurance coverage, and access to medical care. However, these relationships have been inadequately examined in rural communities where minority status may be even more detrimental to health than in urban areas, due to various constraints on access to health care. We present an analysis that assesses the effects of community, family structure, sociodemographic, and medical care variables on self-reported health status among Hispanics, Mrican Americans, and non-Hispanic whites in six rural communities in Florida. Community structural characteristics had a significant effect on self-reported health, as did some of the measures of how respondents “experience” community. These relationships held even when other sets of variables were added to the models. Family/household characteristics and sociodemographic and medical care variables were less important in explaining self-reported health status. These findings suggest that community continues to be important in explaining differences in health status in rural areas.     

The elderly in rural environments

This paper provides a critical examination of the research available on the rural elderly in America. A detailed review of the many studies and topical areas investigated by rural gerontologists is not attempted. Rather, several ‘salient aspects’ of rurality (occupational, ecological and sociocultural) are identified as a basis for describing and explaining the status and experiences of older people in rural areas. The meaning of these dimensions as they relate to rural environments and the elderly is explored through both a general discussion and an application to two substantive issues — health status and life satisfaction. This examination illustrates the sizeable gaps that exist in what we currently know about the rural elderly and the problems/drawbacks of approaches traditionally used to study this topic. The paper concludes with a call for a more unified and conceptually based approach to future rural elderly research, that focuses on how and why the ‘salient aspects’ of rurality produce different circumstances and experiences for the elderly, and that emphasizes rural variation, not just ‘rural vs urban’ comparisons.     

Understanding Sexual Minority Health Disparities in Rural Areas

This article reviews research from several disciplines including sociology, psychology, and public health to examine recent inconsistencies in findings of rural/urban health disparities among sexual minority populations. Previous work has found that sexual minorities (lesbian, gay, and bisexual individuals) report worse health than their heterosexual counterparts on many physical and mental health measures. To understand this occurrence, scholars have situated these findings most often within either minority stress or fundamental cause frameworks. These theories attribute health differences to unique stressors and stigmatization experienced by sexual minorities within a heteronormative social climate. This review provides an overview of specific health disparities by gender and sexual orientation, critically examines research on rural/urban health differences among sexual minorities, and offers three avenues for future research to help remedy the inconsistent results of previous rural/urban sexual minority health disparities research. Discussions of the ‘rural effect,’ rural social support resources, and the importance of geographic region for health are included as opportunities to further social scientific research on sexual minority health disparities.     

Chapter 7. The Hidden Population

SUMMARY

The purposes of this chapter are to discuss the economic status of the rural elderly females in Korea and to examine factors related to poverty. It suggests that Korean rural female elderly, often windows, are faced with serious financial problems. Poverty is associated with age, educational attainment, marital status and living arrangement, and health. When these factors are considered together, it is apparent that rural female elders are facing more severe financial problems than urban female elderly and rural male elderly.     

Health maintenance antecedents among older citizens in rural and urban communities

The evidence is clear that rural older people in most nations are less physically healthy than their urban counterparts. Research suggests that such differences may be due more to lifestyle characteristics, biological factors and environmental conditions than to access to, or utilization of, medical services. Utilizing a statewide sample of Idaho residents this study compares the characteristics of those people associated with a disease prevention/health maintenance model and those associated with the medical or disease oriented model. Results show some clear differences in characteristics between people utilizing the two models of health care.     

Urban and Rural Variations in the Characteristics Associated With Elder Mistreatment in a Community-Dwelling Chinese Population

This study compares the urban and rural differences in characteristics associated with elder mistreatment (EM) in a Chinese population. A cross-sectional study of 269 urban and 135 rural participants aged 60 years or greater was performed. Among those with EM, rural participants were more likely to be women, have lower levels of education and income, have lower levels of health status and quality of life, have worse change in recent health, and have lower levels of psychosocial well-being. Both higher levels of depressive symptoms and lower levels of social support were associated with increased risk of EM.     

Rural Parentage and Labor Market Disadvantage in a Sub‐Saharan Setting: Sources and Trends

Abstract High unemployment in many developing countries is intensifying job competition and raising concern for the employment prospects of vulnerable groups, including children of rural parents. This paper examines the trends and sources in employment disadvantage associated with rural parentage in Cameroon. In documenting the sources of inequality, the study moves beyond a “consensus versus conflict” dichotomy, and instead uses regression decomposition to estimate the relative contributions of both perspectives. It also uses fixed‐effects methods to examine the importance of unobserved family influences that have been understudied in previous research. In documenting historical change in rural disadvantage, the study distinguishes between long‐term trends and shorter‐term economic fluctuations. Findings show that although rural parentage does not create a disadvantage in off‐farm employment as a whole, it does so within the formal sector. This disadvantage is predominantly due to rural‐urban differences in returns to schooling rather than levels of schooling. Disadvantage in schooling has been declining over time but, interestingly, these gains may stall during prosperous times, as these tend to inordinately benefit urban children.     

Privatization and Income Change in the Czech Republic: Tensions in the Lives of Rural and Urban Employed Men1

In the Czech Republic, the privatization of property and the emergence of a market economy after the fall of communism created a unique “experiment in nature.” Before 1989, there was virtually no private sector and salary differences between rural and urban workers were relatively small. By the end of 1993, a substantial portion of both the rural and urban labor force had moved into the private sector. Using data from a sample of 443 men who were employed in 1989 and at the beginning of 1994, we found that urban workers who moved to the private sector had obtained larger salary increases and felt less economic pressure than rural workers and those who stayed in the public sector. Economic pressure, in turn, mediated between salary change and subsequent reports of health problems and psychological distress. Respondents also reported that the private sector offered them greater job flexibility. Job flexibility may reduce depressive symptoms by improving the match of workers' skills with the demands of the job, but private sector jobs may also be a source of uncertainty. Tensions associated with increasing rural disadvantage and with moving to the private sector are discussed.     

RURAL POVERTY, URBAN POVERTY, AND PSYCHOLOGICAL WELL-BEING

Data from the National Survey of Families and Households are used to compare the psychological well-being of the rural and urban poor. Overall, the urban poor are higher in perceived health than the rural poor, although no differences are apparent in happiness or depression. Significant interactions are present between rural/urban poverty and sex, race, and family status. The psychological well-being of poor African Americans is higher in rural than urban areas, whereas the well-being of poor whites is higher in urban than rural areas. This trend is especially pronounced for depression among males. In addition, single men without children have especially high depression scores in rural areas, whereas married women without children have especially low depression scores in urban areas. The results are interpreted in terms of the environmental quality of inner-city neighborhoods and attitudes toward poverty in urban and rural communities.     

Borrowing from the Rural to Help the Urban: Organic Farming Exemplars in Postsocialist China

This article examines an alternative food movement in China called exemplary agriculture. A key characteristic of the movement is its recuperation of legacies of state socialism including exemplary morality (leadership by example and the emulation of role models) and the pervasive urban/rural dichotomy (a dichotomy that privileges the urban over the rural economically, politically and culturally). Adopting practices derived from rural culture and putting a positive spin on them, movement protagonists promote alternative urban lifestyles they believe will improve the experience of city living and the malice of modernity. Drawing on ethnographic research across organic farms and farmers’ markets, this article examines some of the tensions revealed when these legacies of socialism interact with processes of globalisation such as consumer culture. It offers insights into the changing nature of activism in postsocialist China and how new economic classes are attempting to reconfigure the cultural and moral landscape of the city.     

How Green is My Valley? Tracking Rural and Urban Environmentalism in the Southern Appalachian Ecoregion1

Abstract Research on the social bases of environmentalism in the United States has generally found that urban residents are more concerned about the environment than rural residents. Recent research suggests this may no longer be the case, particularly in specific settings or under certain conditions. This paper examines the issue by reviewing recent survey research on rural and urban environmentalism. Tests for significant differences between urban and rural inhabitants of the Southern Appalachian Ecoregion on cognitive and behavioral dimensions of environmentalism are also conducted using data obtained from 1,239 telephone interviews. Findings are consistent with previous research showing that younger people, those with higher levels of education, and political liberals generally express higher levels of environmentalism. However, no significant rural-urban differences were found on several indicators of environmentalism. A range of conditions that are rapidly changing the character and composition of the region may help to explain why the findings do not conform to the general pattern of rural-urban differences. Overall, it appears that environmentalism has broadened its appeal in rural areas, especially in communities located near national and state parks, wildlife refuges, and other outdoor recreation sites.     

Religiousness/Spirituality and Subjective Well-Being Among Rural Elderly Whites,African Americans,and Native Americans

SUMMARY

Little attention has been paid to subjective well-being among non-White elderly in rural areas where medical resources and financial support are deficient. The present study assessed a rural community sample of 215 elderly comprising 85 Caucasians, 75 African Americans, and 55 Native Americans, to examine roles of spirituality/religiousness on their subjective well-being. This study found ethnic differences in the reliance on religiosity/spirituality and a significant association between dimensions of religiousness/spirituality and subjective well-being among all ethnic rural elderly groups. The results of the study suggest that health providers, social workers, and faith communities need to provide rural elderly with religious and spiritual support in order to enhance their life satisfaction and lessen their emotional distress.     

HOW HEALTH STATUS IMPACTS THE TYPES OF INFORMATION CONSUMERS SEEK ONLINE

A few studies examine what types of health information people seek online, yet we know little about how this varies by health status. To examine this question we used data collected from a random sample of 2,038 adults for the Pew Internet and American Life Project, which asked respondents in the United States whether they searched for 16 different types of information. These 16 topics were grouped into three broad areas, including medical conditions and treatments, health issues (e.g. diet and smoking cessation), and providers and payment (e.g. a particular hospital). To build on prior literature, two measures of health status were used: a self-report and the presence of a medical condition. The data suggest that health status impacts the types of health or medical information people seek on the Internet. Self-reported health status was not significantly related to any of the topics; however, respondents diagnosed with a disability or chronic disease were more likely to seek medical information on 13 of the 16 topics addressed. These include specific diseases or medical conditions, medical treatments or procedures, experimental treatments or medicines, alternative treatments or medicines, pharmaceutical or over-the-counter drugs, diet, immunizations, smoking cessation, depression, sexual health, environmental health hazards, a particular physician or hospital, and Medicaid/Medicare (governmental health programs in the United States for the poor and elderly). These results suggest that individuals in the United States who have a medical condition are more likely than healthy individuals to research most health topics online. The Internet can provide consumers with a wealth of information on issues of health and illness, yet healthcare providers need to educate consumers to be cautious given the range in quality.     

Income Inequality and Opioid Prescribing Rates: Exploring Rural/Urban Differences in Pathways via Residential Stability and Social Isolation

While opioid prescribing rates have drawn researchers' attention, little is known about the mechanisms through which income inequality affects opioid prescribing rates and even less focuses on whether there is a rural/urban difference in mediating pathways. Applying mediation analysis techniques to a unique ZIP code level dataset from several sources maintained by the Centers for Medicare and Medicaid Services, we explicitly examine two mechanisms through residential stability and social isolation by rural/urban status and find that (1) income inequality is not directly related to opioid prescribing rates, but it exerts its influence on opioid prescribing via poor residential stability and elevated social isolation; (2) social isolation accounts for two‐thirds of the mediating effect of income inequality on opioid prescribing rates among urban ZIP codes, but the proportion halves among rural ZIP codes; (3) residential stability plays a larger role in understanding how income inequality matters in rural than in urban ZIP codes; and (4) beneficiary characteristics only matter in urban ZIP codes. These findings offer nuanced insight into how income inequality affects opioid prescribing rates and suggests that the determinants of opioid prescribing rates vary by rural/urban status. Future research may benefit from identifying place‐specific factors for opioid prescribing rates.     

Gender disparities in adult health: an examination of three measures of morbidity

Recent examinations of gender differences in physical health suggest that women's disadvantage may be smaller than previously assumed, varying by health status measure and age. Using data from the 1997-2001 National Health Interview Surveys, we examine gender-by-age differences in life-threatening medical conditions, functional limitations, and self-rated health and consider whether potential mediating mechanisms (e.g., socioeconomic status, behavioral factors) operate uniformly across health measures. The results show that the gender gap is smallest for life-threatening medical conditions and that men do increasingly worse with age. For self-rated health, men are more likely to report excellent health at younger ages, but with increasing age this gap closes. Only for functional limitations do we find a consistent pattern of female disadvantage: Women report more functional limitations than men, and the gap increases with age. The ability of explanatory mechanisms to account for these patterns varies by the health measure examined.     

A Study of Residential Condition and Satisfaction of the Elderly in China

This article investigates the current housing reality and subjective appraisal of the elderly in China by presenting the latest empirical evidence. Based on a literature review, survey data of September 2009 were analyzed, which included 692 Chinese households with a focus on their elderly members. Major findings were the following: (1) affordability was an outstanding issue, with 56.6% of the elderly respondents feeling overburdened by housing costs; (2) facilities in the homes were less of an issue than their community facilities, which were inadequate especially for the handicapped; (3) the elderly respondents as a whole seemed to enjoy their housing property, though significant differences in homeownership and residential satisfaction were found among them; (4) differences were also found among the elderly in terms of access to healthcare (including emergency help), transportation, and housing environment; and (5) residential satisfaction of the elderly were related to their occupational status before retirement, income, health, distance to healthcare facilities, living arrangements, homeownership, housing conditions, social contacts/visits, and gender. Implications of the findings are discussed for research and policy considerations.     

Rural and urban women's perceptions of barriers to health, mental health, and criminal justice services: implications for victim services

The purpose of this study was to examine rural and urban women's perceptions of barriers to health and mental health services as well as barriers to criminal justice system services. Eight focus groups were conducted, two in a selected urban county (n = 30 women) and two in each of three selected rural counties (n = 98 women). Results were classified into a barrier framework developed in the health service utilization literature which suggests there are four main dimensions of barriers: affordability, availability, accessibility, and acceptability. Results indicate that: (1) women face many barriers to service use including affordability, availability, accessibility, and acceptability barriers; (2) it takes an inordinate level of effort to obtain all kinds of services; however, women with victimization histories may face additional barriers over and above women without victimization histories; (3) barriers to health and mental health service utilization overlap with barriers to utilizing the criminal justice system; and (4) there are many similarities in barriers to service use among rural and urban women; however, there are some important differences suggesting barriers are contextual. Future research is needed to further clarify barriers to service use for women with victimization histories in general, and specifically for rural and urban women. In addition, future research is needed to better understand how women cope with victimization in the context of the specific barriers they face in their communities.     

A suggestion for future research on interface design of an Internet-based telemedicine system for the elderly

Telemedicine has emerged as an effective tool for providing high quality healthcare service and health-related information, especially in rural areas. Rural areas often have a larger elderly population with greater rates of preventable disease. These areas also have fewer medical resources and specialists, and have limited access to health services, all of which can influence overall health. An Internet-based telemedicine system can be one solution to provide the rural elderly with the proper health information when needed. The elderly obviously have limited capabilities compared with younger adults in the use of internet technology. However, the interfaces of the currently existing Internet-based telemedicine systems are not specifically developed for elderly users. This paper suggests future interface design research for an Internet-based telemedicine system specifically for the elderly.