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Improving the Health of Rural, Minority Populations

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Environmental Health".

Deadline for manuscript submissions: closed (31 December 2020) | Viewed by 30679

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Special Issue Editors

Dr. Thomas A. Arcury

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Guest Editor

Department of Family and Community Medicine, Center for Worker Health, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
Interests: rural health; minority health; aging; agricultural health; occupational health; immigrant workers

Dr. Gregory D. Kearney

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Guest Editor

Department of Public Health, Brody School of Medicine, East Carolina University, 115 Heart Drive, Greenville, NC 27834, USA
Interests: environmental and occupational health, rural public health, childhood asthma, climate change and public health

Prof. Dr. Sara A. Quandt

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Guest Editor

Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
Interests: social determinants of health; occupational health of vulnerable workers; nutritional assessment; rural health; food insecurity; minority health; farmworker health; qualitative research

Special Issue Information

Dear Colleagues,

Rural populations continue to experience excessive levels of acute illness, chronic disease, injury, and poorer health outcomes and greater mortality than do urban and suburban populations. This results from limited access to health care—particularly specialty care—in rural regions; the prevalence of individuals with low incomes and limited educational attainment; limited employment opportunities; and the dominance of low-income industries (e.g., tourism) and hazardous extractive industries (agriculture, forestry, fishing, mining, etc.). The circumstance of excessive illness and injury and poor outcomes is compounded for minority group members residing in rural regions, who often must deal with the additional effects of discrimination and structural racism, which further limit their access to health care and economic opportunity. Efforts to improve the health of rural minority populations must address these issues.

This Special Issue focuses on improving the health of rural minority populations. Papers that discuss interventions to improve health in rural minority populations, describe community efforts to improve health, and basic research that discusses the health policy implications of its results are all appropriate for this Special Issue. Analyses can include those that compare rural with urban populations, as well as those that compare minority to majority populations. Authors will define the rurality of the populations that are the subject of their analyses, but they can apply a common-sense approach. Minority populations will be defined in terms of where the study was conducted (e.g., Mexicans are a minority in the US, but not in Mexico; indigenous communities constitute minorities in Mexico and the US).

Dr. Thomas A. Arcury
Dr. Gregory D. Kearney
Dr. Sara A. Quandt
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

rural health
minority health
health disparities
health equity
health services
structural racism
migrant health
environmental justice
environmental racism

Published Papers (7 papers)

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Research

16 pages, 1089 KiB

Open AccessArticle

Relationships between Physical and Mental Health in Adolescents from Low-Income, Rural Communities: Univariate and Multivariate Analyses

by Robyn Feiss and Melissa M. Pangelinan

Int. J. Environ. Res. Public Health 2021, 18(4), 1372; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18041372 - 03 Feb 2021

Cited by 5 | Viewed by 4117

Abstract

Environment (i.e., rural vs. urban) and socioeconomic status (SES) are moderating factors of physical (i.e., obesity and/or physical activity) and internalizing mental health (i.e., stress, anxiety, and depressive symptoms) in adolescents. Relationships between physical and mental health have been shown in adolescents; however, research has not addressed these relationships in those from low-income, rural backgrounds. Thus, the present study characterized physical and mental health in rural, low-SES adolescents and investigated relationships between physical and mental health in this population. Data were collected from 253 10th and 11th-grade students from Title I schools in rural Alabama. Self-report measures of mental health, self-esteem, body image, and physical activity were obtained, in addition to functional fitness and physical health assessments completed at each school. Relationships between mental and physical health were assessed using Pearson correlations and multivariate data-driven cluster analysis. Positive correlations were observed between body composition and mental health symptoms, while negative correlations were observed between body image and mental health and body composition. However, sex differences were present in these relationships. The multivariate cluster analysis identified groups of individuals based on profiles of mental and physical health. This individual-level analysis identified students with greater mental and/or physical health burdens (n = 53 and n = 40) who may benefit from targeted interventions. Overall, these results provide evidence of elevated mental and physical health burdens among rural, low-income adolescents. Moreover, targeted programs are needed to provide education about the relationship between physical and mental health to reduce health burdens in both domains in this population. Full article

(This article belongs to the Special Issue Improving the Health of Rural, Minority Populations)

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13 pages, 2221 KiB

Open AccessArticle

Community-Based Interventions to Reduce Child Stunting in Rural Guatemala: A Quality Improvement Model

by Michel Juarez, Carlos Dionicio, Neftali Sacuj, Waleska Lopez, Ann C. Miller and Peter Rohloff

Int. J. Environ. Res. Public Health 2021, 18(2), 773; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18020773 - 18 Jan 2021

Cited by 7 | Viewed by 4892

Abstract

Rural Guatemala has one of the highest rates of chronic child malnutrition (stunting) in the world, with little progress despite considerable efforts to scale up evidence-based nutrition interventions. Recent literature suggests that one factor limiting impact is inadequate supervisory support for frontline workers. Here we describe a community-based quality improvement intervention in a region with a high rate of stunting. The intervention provided audit and feedback support to frontline nutrition workers through electronic worklists, performance dashboards, and one-on-one feedback sessions. We visualized performance indicators and child nutrition outcomes during the improvement intervention using run charts and control charts. In this small community-based sample (125 households at program initiation), over the two-year improvement period, there were marked improvements in the delivery of program components, such as growth monitoring services and micronutrient supplements. The prevalence of child stunting fell from 42.4 to 30.6%, meeting criteria for special cause variation. The mean length/height-for-age Z-score rose from −1.77 to −1.47, also meeting criteria for special cause variation. In conclusion, the addition of structured performance visualization and audit and feedback components to an existing community-based nutrition program improved child health indicators significantly through improving the fidelity of an existing evidence-based nutrition package. Full article

(This article belongs to the Special Issue Improving the Health of Rural, Minority Populations)

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13 pages, 322 KiB

Open AccessArticle

Understanding Challenges to Well-Being among Latina FarmWorkers in Rural Idaho Using in an Interdisciplinary, Mixed-Methods Approach

by Cynthia L. Curl, Lisa Meierotto and Rebecca L. Som Castellano

Int. J. Environ. Res. Public Health 2021, 18(1), 169; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18010169 - 29 Dec 2020

Cited by 5 | Viewed by 2814

Abstract

The aim of this study was to identify social, cultural and workplace-related risk factors affecting well-being among Latina farmworkers in rural Idaho. We recruited 70 Latina farmworkers from southwestern Idaho in 2019. We employed an inter-disciplinary, mixed-methods approach—including surveys, focus groups, interviews, and pesticide biomonitoring—to characterize multiple domains that influence well-being, including food security and access, housing conditions, social supports, access to medical care, and workplace safety. Six major themes emerged as primary challenges to Latina farmworkers’ well-being. In the public sphere, study participants identified these challenges as long working hours, concerns regarding pesticide exposure, and lack of enforcement of regulatory protections. Participants’ concerns regarding pesticide exposure were underscored by biological sampling results; multiple biomarkers of pesticide exposure were detected in all samples, with the highest concentrations measured in samples collected from women who reported mixing, loading or applying pesticides. Within the private sphere, food security and provisioning, childcare responsibilities, and social isolation were identified as significant challenges to well-being. Gender, ethnicity, and geography emerged as important, intersecting statuses that shaped the life experiences of these agricultural workers. Our findings suggest that gender may play a particularly critical role in the unique challenges facing Latina farmworkers. As a result, the services and regulations needed to support well-being in this population may be highly specific, and almost certainly include attention to work–family dynamics, pesticide exposure, and social connections. Full article

(This article belongs to the Special Issue Improving the Health of Rural, Minority Populations)

16 pages, 344 KiB

Open AccessArticle

Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud

by Ryan I. Logan and Heide Castañeda

Int. J. Environ. Res. Public Health 2020, 17(24), 9223; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17249223 - 10 Dec 2020

Cited by 35 | Viewed by 6851

Abstract

Rural populations in the United States are faced with a variety of health disparities that complicate access to care. Community health workers (CHWs) and their Spanish-speaking counterparts, promotores de salud, are well-equipped to address rural health access issues, provide education, and ultimately assuage these disparities. In this article, we compare community health workers in the states of Indiana and Texas, based on the results of two separate research studies, in order to (1) investigate the unique role of CHWs in rural communities and (2) understand how their advocacy efforts represent a central form of caregiving. Drawing on ethnographic, qualitative data—including interviews, photovoice, and participant observation—we analyze how CHWs connect structurally vulnerable clients in rural areas to resources, health education, and health and social services. Our primary contribution to existing scholarship on CHWs is the elaboration of advocacy as a form of caregiving to improve individual health outcomes as well as provoke structural change in the form of policy development. Finally, we describe how CHWs became especially critical in addressing disparities among rural populations in the wake of COVID-19, using their advocacy-as-caregiving role that was developed and well-established before the pandemic. These frontline workers are more vital than ever to address disparities and are a critical force in overcoming structural vulnerability and inequities in health in the United States. Full article

(This article belongs to the Special Issue Improving the Health of Rural, Minority Populations)

12 pages, 596 KiB

Open AccessArticle

Respiratory Health and Suspected Asthma among Hired Latinx Child Farmworkers in Rural North Carolina

by Gregory D. Kearney, Thomas A. Arcury, Sara A. Quandt, Jennifer W. Talton, Taylor J. Arnold, Joanne C. Sandberg, Melinda F. Wiggins and Stephanie S. Daniel

Int. J. Environ. Res. Public Health 2020, 17(21), 7939; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17217939 - 29 Oct 2020

Cited by 8 | Viewed by 1810

Abstract

The aim of this study was to evaluate respiratory health problems, including suspected asthma, and healthcare provider utilization among a sample of Latinx hired child farmworkers in rural North Carolina (n = 140). In 2018, a respiratory health questionnaire and breathing tests were collected from Latinx child (11–19 years) farmworkers (35.0% girls and 65.0% boys). Overall, 21.4% of children reported having been told by a medical provider that they had asthma, yet based on a combination of responses to respiratory survey questions, 36.4% or 15% more were identified as having suspected asthma. While 56.4% reported having a regular medical doctor, 38% had not had a medical exam in the past year. Respiratory dysfunction, including suspected, or uncontrolled asthma was prevalent among this group. Latinx children working in agriculture are vulnerable to occupational hazards and exposures and require assurances that they will receive access to high quality healthcare services that include routine respiratory health screenings. Full article

(This article belongs to the Special Issue Improving the Health of Rural, Minority Populations)

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17 pages, 356 KiB

Open AccessArticle

COVID-19 Pandemic among Latinx Farmworker and Nonfarmworker Families in North Carolina: Knowledge, Risk Perceptions, and Preventive Behaviors

by Sara A. Quandt, Natalie J. LaMonto, Dana C. Mora, Jennifer W. Talton, Paul J. Laurienti and Thomas A. Arcury

Int. J. Environ. Res. Public Health 2020, 17(16), 5786; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17165786 - 10 Aug 2020

Cited by 48 | Viewed by 6068

Abstract

(1) Background: The COVID-19 pandemic poses substantial threats to Latinx farmworkers and other immigrants in food production and processing. Classified as essential, such workers cannot shelter at home. Therefore, knowledge and preventive behaviors are important to reduce COVID-19 spread in the community. (2) Methods: Respondents for 67 families with at least one farmworker (FWF) and 38 comparable families with no farmworkers (nonFWF) in North Carolina completed a telephone survey in May 2020. The survey queried knowledge of COVID-19, perceptions of its severity, self-efficacy, and preventive behaviors. Detailed data were collected to document household members’ social interaction and use of face coverings. (3) Results: Knowledge of COVID-19 and prevention methods was high in both groups, as was its perceived severity. NonFWF had higher self-efficacy for preventing infection. Both groups claimed to practice preventive behaviors, though FWF emphasized social avoidance and nonFWF emphasized personal hygiene. Detailed social interactions showed high rates of inter-personal contact at home, at work, and in the community with more mask use in nonFWF than FWF. (4) Conclusions: Despite high levels of knowledge and perceived severity for COVID-19, these immigrant families were engaged in frequent interpersonal contact that could expose community members and themselves to COVID-19. Full article

(This article belongs to the Special Issue Improving the Health of Rural, Minority Populations)

13 pages, 884 KiB

Open AccessArticle

Preconception Care in a Remote Aboriginal Community Context: What, When and by Whom?

by Emma Griffiths, Julia V Marley and David Atkinson

Int. J. Environ. Res. Public Health 2020, 17(10), 3702; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17103702 - 24 May 2020

Cited by 5 | Viewed by 3554

Abstract

Preconception care (PCC) is acknowledged as a vital preventive health measure aiming to promote health today and for subsequent generations. We aimed to describe the content and context of PCC delivery in a very remote Australian Aboriginal Community Controlled Health Service setting. A retrospective audit was undertaken to identify what PCC was delivered between 2011 and 2018 to 127 Aboriginal women who had at least one pregnancy during this period. Of 177 confirmed pregnancies, 121 had received PCC prior to the pregnancy. Sexually transmissible infection screening (71%) was the most common care delivered, followed by folic acid prescription (57%) and smoking cessation support (43%). Younger women received PCC less often, particularly screening for modifiable pregnancy risk factors. Rates of prediabetes/diabetes, albuminuria, overweight/obesity and smoking were high amongst those screened (48–60%). PCC was usually patient-initiated and increased significantly over the audit period. Presentation for antenatal care in the first trimester of pregnancy was high at 73%. Opportunities to increase PCC delivery include integration with routine health checks, pregnancy tests and chronic disease programs. PCC programs codesigned with young people are also recommended. All primary care providers should be supported and assisted to provide opportunistic PCC and health promotion. Full article

(This article belongs to the Special Issue Improving the Health of Rural, Minority Populations)

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