According to CareQuest Institute research, more than 90% of survey respondents agreed that dental should be covered in Medicare. Survey respondents who had at least one unmet oral health need, such as a cracked tooth or swollen/bleeding gums, were 2.5% more likely to agree that Medicare should cover dental services. And those who rated their oral health as poor were 4.5% more likely to agree than those who rated their oral health as excellent.
How much people moved around town predicted COVID-19 cases in a rural Pennsylvania county in 2020, according to a new study by researchers at Penn State. The researchers approximated movement during the initial stay-at-home orders and subsequent restricted phases by using data from traffic cameras and mobile devices. They confirmed that increases in movement preceded increases in COVID-19 cases in Centre County, Pennsylvania. The results also revealed general compliance with local regulations and suggest that these types of passive surveillance data could be used to monitor and improve behavioral intervention guidelines for outbreak management.
“With the emergence of the COVID-19 outbreak in 2019, local governments initially relied heavily on behavioral interventions like stay-at-home orders in order to limit transmission,” said Christina Faust, postdoctoral researcher at Penn State and first author of the study. “Knowing if people are willing to follow these kinds of interventions, and if these interventions do what they are intended to do, is important to future outbreak planning.”
The researchers approximated movement from March to August 2020 in Centre County, Pa, which is home to Penn State’s University Park campus, during a period when university students were primarily not residing in the area. This period encompassed the strictest restrictions in the county, including a 40-day red phase that involved a stay-at-home order except for life-sustaining businesses and activities; a 20-day yellow phase that stressed remote work and teaching and a preference for curbside retail; and the initial 78 days of a green phase that mandated reduced capacity at local businesses, mask wearing in public, and guidelines for additional businesses to reopen.
“Assessing the impact of intervention strategies is especially important in rural areas, where access to healthcare is often limited and under-resourced,” said Nita Bharti, Lloyd Huck Early Career Professor in Biology at Penn State and senior author of the paper. “Rural areas have limited health care capacity and struggle to manage the large numbers of patients we expect to see during outbreaks like this. Preventive strategies to limit transmission are critical.”
The research team used two data sources as proxies for movement. They collected real time images from 19 traffic cameras from across the county, including “connector” roads that provide links between towns and “internal” roads that measure movement within towns. They also studied anonymized location data from mobile devices from the company SafeGraph, which captured visits to over two thousand points of interest around the county, including grocery stores, coffee shops, gas stations, and locations on the Penn State campus. The team compared numbers of mobile visits recorded in the summer of 2020 to the pre-pandemic summer of 2019 to identify differences due to behavioral interventions. Their results appear in a paper published in the journal Epidemiology & Infection.
The research team found that, when moving from red phase to yellow and especially from yellow phase to green, traffic volume increased on both internal and connector roads. Although the numbers of visits to local points of interest were significantly lower than visit numbers from 2019, they increased as restrictions were lifted.
“During the strictest phases, movement was mostly internal, which is what we would hope to see in order to reduce opportunities for transmission between towns,” said Faust. “As restrictions eased, we saw a lot more traffic, particularly on connector roads, and more mobile visits to points of interest, which collectively suggests overall compliance with these intervention strategies. What is particularly reassuring is that, even though changes in phase regulations were announced 10 days before they were implemented, we did not see a change in movement until the new phase came into effect.”
Reported cases of COVID-19 in the county were related to movement collected from both data sources, with a 9 to 18-day lag depending on data type. The researchers believe this lag includes the incubation time of the virus — when an individual is infected but may not yet show symptoms — as well as in some cases considerable delays in accessing a test and receiving test results.
“Increases in movement reliably preceded increases in COVID-19 cases during the study period,” said Faust. “These results suggest that vehicle traffic and mobile visit data could be used in real time to monitor the outbreak. For example, if there is an uptick in movement, local governments could reinforce messaging and prepare to allocate resources for health care to high-movement areas.”
The researchers note the importance of using multiple types of data; individual data sources may measure different types of behaviors and reflect certain subsets of a population. For example, they believe the vehicle data may represent permanent residents while mobile visits may better reflect students. While urban areas may have more data sources available, this study demonstrates that the combination of existing data sources in rural areas — vehicle traffic and mobile data — provide important information.
“Rural areas typically experienced delayed introductions to the virus and delayed outbreaks, but statewide regulations were largely based on outbreaks in urban areas, where the bulk of cases occurred,” said Bharti. “Local oversight, when paired with federal and statewide response and relief, can more effectively serve outbreak response, management, and planning efforts. Here we show that measuring local population movements through passive approaches can help assess the effectiveness of intervention strategies and inform policies that target transmission prevention.”
In addition to Faust and Bharti, the research team at Penn State includes Brian Lambert, computational scientist; Cale Kochenour, spatial analyst; and Anthony Robinson, associate professor of geography.
The latest feature article in The Rural Monitor spotlights a New Mexico doula program that reaches American Indian, Hispanic, and other populations who lack nearby labor/delivery units, a Minnesota program helping moms experiencing incarceration, and a North Dakota program training postpartum doulas to care for families impacted by opioid use disorder and other substance use.
Read the article here: Rural Doulas Supporting Maternal and Infant Health.
A report from HHS shows that insurance coverage and access to care improved significantly for Latinos between 2013 and 2016, but they still have among the highest uninsured rate of any racial or ethnic group within the U.S. To build on progress, HHS launched a Spanish version of its QuestionBuilder app, which can help Latino patients prepare for their in-person or telehealth appointments. The Agency for Healthcare Research and Quality built the app to help users improve their interaction with clinicians, providing questions they might want to ask with links to helpful resources. The 2020 Census reports that Hispanics are the second most prevalent racial or ethnic group in rural America, comprising 10.4 percent of the rural population.
See more at New Spanish Language App Helps Latinos With Health Care.
HHS revealed its roadmap for assuring that all parts of the Department address the effects that climate change can have on health and well-being. The plan is in response to an Executive Order for a whole-of-government approach to confronting the crisis that includes extreme weather, rising temperatures and sea levels, and increases in levels of carbon dioxide.
See the plan here: New Plan and Policy Statement for Climate Impacts on Health.
In an open-access article from the Journal of the American Medical Association (JAMA), researchers report that, among more than 34 million hospital births in the U.S., 37.4 percent of the hospitals were low volume. Among low-volume hospitals, 18.9 percent were isolated and 58.4 percent of these were rural.
See JAMA: Birth Volume and Geographic Distribution of U.S. Obstetric Hospitals, 2010 – 2018 for the article.
Age-friendly policies and programs have typically occurred at the local level but are becoming increasingly common at the state level. This is of particular importance for rural communities as the share of older adults is increasing in rural areas faster than in urban areas, yet funding of and access to aging supports in rural areas may be more limited or disjointed. This policy brief from the University of Minnesota Rural Health Research Center identifies these state-level initiatives and the extent to which such programs have an explicit rural focus.
For more information, see Statewide Age-Friendly Initiatives: An Environmental Scan.
In June of this year, the Health Resources and Services Administration (HRSA) launched an effort to improve access to substance use disorder treatment by paying for providers who are waivered to prescribe buprenorphine, a medication used to treat opioid use disorder. Rural Health Clinics still have the opportunity to apply for a $3,000 payment on behalf of each provider who trained to obtain the waiver necessary to prescribe buprenorphine after January 1, 2019. Approximately $1.5 million in program funding remains available for RHCs and will be paid on a first-come, first-served basis until funds are exhausted. Send questions to DATA2000WaiverPayments@hrsa.gov. There is ongoing availability of a free online course for waiver eligibility training from the American Osteopathic Academy of Addiction Medicine and the Providers Clinical Support System.
See HRSA Payment Program for RHC Buprenorphine-Trained Providers for more information.
The AgriSafe Network is a nonprofit organization that provides information and training on injury and disease related to agriculture. Their health professionals and educators created a social media toolkit that aims to provide clear messages about COVID-19 vaccination for agriculture, forestry, and fishing workers.
See Reaching Farm Communities for Vaccine Confidence for more information.
An analysis of public-use data from the Centers for Disease Control and Prevention revealed rural-specific trends in suicide for Americans aged 10 to 24 over the last 20 years. The study from the American Communities Project and the Center on Rural Innovation found that rural communities have seen some of the highest rates in the age group. Two of the geography types studied, Hispanic Centers and the African American South, had lower rates than the national average. However, rates for Native American communities were far above all others, in some cases more than double other types.
See Place-Based Patterns in Youth Suicide Rates for more information.
