In September, the National Institutes of Health (NIH) announced plans for research in rural and remote populations for effective non-opioid interventions for chronic pain management. The NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis, is intending to commit $5.7M in FY2023 to this effort, which will result in five to six awards. The funding opportunity requires partnerships with health care systems or organizations and community partners and encourages links to key rural partners such as State Offices of Rural Health, State Rural Health Associations, and Area Health Education Centers.  On Monday, October 24 at 12.00 pm ET, NIH will hold a one-hour technical assistance webinar for applicants.

A new report from the March of Dimes finds that more than a third of U.S. counties (36 percent) have no obstetric providers, hospitals, or birth centers.  These areas are largely rural areas in the Midwest and South, with a greater impact on women of color: one in 4 Native American babies, and 1 in 6 Black babies, were born in areas with limited or no access to maternity care services.  The report says that roughly 900 women died of pregnancy-related causes in 2020, adding that nearly two-thirds of such deaths are preventable.

On Friday, the White House announced the inaugural report from the group of 25 leaders appointed to represent and provide recommendations for the well-being of approximately 30 million Americans that self-identify with these groups.  Health equity is one of six priorities of the Commission, each with a subcommittee formed for focused efforts.  Asian Americans, Native Hawaiians, and Pacific Islanders are not monolithic, but research has shown that they do share a number of health-related disparities with other rural residents.

The FORHP-supported National Rural Health Resource Center held a virtual summit in June 2022.  The report will assist rural hospitals, clinics, and network leaders on their path to value-based care and alternative payment models.

This policy brief from the Rural Health Equity Research Center documents the burden of the public stigma associated with any mental illness in rural versus non-rural communities in the United States. Differences in stigmatizing attitudes and beliefs by rurality, gender, race and ethnicity, and age are examined.

This study from the Rural and Minority Health Research Center fills a critical gap by comparing rural-urban differences in access to and receipt of mental health services to evaluate the impact of the COVID-19 pandemic on service accessibility and utilization in different geographic settings.

From State Impact PA

Correction: Nicole Deziel of the Yale School of Public Health says Pennsylvania’s wellhead setback from schools and homes should be 1,000 meters. That distance was incorrect in the original version of this story.  

Children who live close to fracking sites in Pennsylvania have a higher risk for the most common form of childhood cancer, a new study found.

Researchers at the Yale School of Public Health used the Pennsylvania Cancer Registry, along with state data on unconventional oil and gas drill sites, to determine that children born within two kilometers, or 1.24 miles, of an active well site were two to three times more likely to be diagnosed with acute lymphoblastic leukemia between the ages of 2 and 7.

The study was published in the journal Environmental Health Perspectives. It looked at 405 children diagnosed with that type of leukemia between 2009 and 2017, and included 2,080 controls matched by birth year.

“The magnitude of the elevated risk that we observed was fairly striking,” said Dr. Cassandra Clark, a post-doctoral fellow at the Yale School of Public Health and co-author of the report. “After accounting for a variety of socioeconomic, demographic and biological factors that could potentially be underlying this association, it was consistent.”

Acute lymphoblastic leukemia is one of the most common childhood cancers, which is why the researchers chose to look at it. Additionally, a known cause is benzene, a chemical released by oil and gas drilling activities into both air and water. The five-year survival rate in children with acute lymphoblastic leukemia is high, at 90 percent.

Unconventional gas development is also referred to as fracking, which is a part of the overall process that injects water with chemicals at high pressure into shale rock formations deep underground to release oil and gas. Water that returns to the surface often includes those chemical additives, along with long-buried naturally occurring toxins and radiological material.

More than 10,000 unconventional natural gas wells were drilled and fracked in Pennsylvania between 2002 and 2017. The Department of Environmental Protection has reported more than 1,000 spills in that period, along with fielding about 4,000 residential well water complaints between 2005 and 2014. Many who live in rural areas rely on water from private wells, about one-third of which are within two kilometers of a wellhead.

The natural gas industry maintains it operates under regulations meant to protect public health. The Marcellus Shale Coalition has said the industry’s “top priority” is protecting health and safety of workers, the environment, and people who live near fracking operations.

One unique aspect of the Yale research includes tracing potential drinking water exposure.

“It really is a superb study,” said Dr. Bernard Goldstein, former dean of the University of Pittsburgh School of Public Health and an expert in environmental causes of childhood leukemia.

Goldstein is not associated with this study. He has conducted prior research into exposures due to oil and gas wastewater in Pennsylvania.

“It looks at a potential problem in ways that include new exposure metrics, which are really needed,” he said.

Goldstein says that though the factors that contribute to childhood leukemia are complex and still unclear, benzene is the one known link.

The interdisciplinary team of researchers included experts on leukemia and environmental science, as well as hydrogeologists. In addition to the location of well sites, researchers mapped individual watersheds and determined the flow of water from well heads to the children’s homes. They did not survey the families to determine individual sources of drinking water.

Still, they say the research shows that a child living within 1.2 miles of a well site, which is within their watershed, could be at a higher risk of exposure through drinking water.

Previous research has shown an association between fracking activities and health impacts, but determining the path to exposure is more difficult.

“I think we have about 50 epidemiological health studies demonstrating increased adverse health outcomes in communities that live near unconventional oil and gas sites,” said Dr. Nicole Deziel, a co-author of the study and associate professor at the Yale School of Public Health in the Department of Environmental Health Sciences. “I think it would be very important to understand which exposures or hazards might be driving these associations.”

Deziel says she wants the study to impact public policy, including regulations on residential setbacks from wellheads and density of drilling sites. Pennsylvania requires a 500-foot setback from schools and homes. Deziel says it should be 1,000 meters, especially since her findings show greater impacts for children exposed in utero.

Those results, she said, suggested “that that may be a sensitive time window, which is also consistent with some other studies of other environmental exposures.”

ARC has released its 12th annual update of The Appalachian Region: A Data Overview from the 2016-2020 American Community Survey. Written in partnership with Population Reference Bureau, “The Chartbook” features over 300,000 data points on Appalachia’s economy, income, employment, education, and more prior to–and during–the first 10 months of the COVID-19 pandemic.

The 2022 report indicates that Appalachia was improving in educational attainment, labor force participation, income levels, and reduced poverty prior to the onset of COVID-19 in March 2020. However, unique vulnerabilities among the region’s oldest, youngest, and most rural residents were likely exacerbated by the pandemic.

“Each year, The Chartbook provides critical data about the Appalachian Region, enabling policymakers and ARC partners to make data-driven economic development decisions. This particular report, however, may be one of the most critical to date,” said ARC Federal Co-Chair Gayle Manchin.

The Small Area Health Insurance Estimates (SAHIE) is the only source of single-year health insurance coverage estimates for all counties in the U.S. The estimates are provided by select demographic and economic characteristics (by age and sex groups and at income levels that reflect thresholds for federal and state assistance programs). The state estimates are also provided by race and Hispanic origin. The data are now available on the Census Bureau’s website athttps://www.census.gov/programs-surveys/sahie.html.

See 2020 COUNTY and STATE estimates of people with and without health insurance coverage by:

• Age groups: Under 65 years, 18-64 years, 21-64 years, 40-64 years, 50-64 years, under 19 years
• Sex groups: Both sexes, male only, female only
• Income groups: All incomes, <=200%, <=250%, <=138%, <=400%, 138-400% of poverty
• Estimates for the under 19 years group are available for just the six income categories listed above
• For states only: White alone, not Hispanic; Black alone, not Hispanic; and Hispanic (any race)