Rural/urban differences in mental health and social well-being among older US adults in the early months of the COVID-19 pandemic.

OBJECTIVES: This study seeks to identify differences in mental health and social well-being during the early months of the COVID-19 pandemic among older adults by rural/urban location. METHODS: We use data from the COVID-19 Coping Study, a nation-wide online study of U.S. adults aged 55 and older (n = 6,873) fielded during April-May, 2020. We investigated rural/urban differences in mental health (depressive symptoms and anxiety symptoms) and social well-being (loneliness and social isolation); concern about COVID-19; and types of social participation (e.g. phone/video calls, visits). We also used multivariable logistic regression models to assess the relationship of rurality with mental health, adjusting for socio-demographic correlates, COVID-19 history, and COVID-19 concern. RESULTS: We found similar prevalence of mental health and social well-being outcomes for rural and urban respondents. Rural respondents reported lower concern about COVID-19 and more frequent use of social media than urban respondents. CONCLUSION: Mental health and social well-being did not differ by rural/urban location in the early months of the COVID-19 pandemic. However, rural residents reported less concern about COVID-19 and more use of social media, potentially leading to greater risk of illness from the pandemic in later months.

Rural/urban differences in access to paid sick leave among full-time workers.

PURPOSE: Access to paid sick leave is critically important to promoting good health, caregiving, and stopping the spread of disease. In this study, we estimate whether access to paid sick leave among US full-time workers differs between rural and urban residents. METHODS: We used data from the 2020 National Health Interview Survey and included adult respondents between the ages of 18 and 64 who were employed full-time (n = 12,086). We estimated bivariate differences in access to paid sick leave by rural/urban residence, and then calculated the predicted probability of access to paid sick leave, adjusting for sociodemographic and health characteristics, across different education levels. FINDINGS: We find a nearly 10-percentage point difference in access to paid sick leave between rural and urban adults (68.1% vs 77.1%, P<.001). The difference in access to paid sick leave between rural and urban residents remained significant even after adjusting for sociodemographic and health characteristics. The fully adjusted predicted probability of paid sick leave for rural full-time workers was 69.8%, compared with 76.4% for urban full-time workers (P<.001). We also identified lower levels of paid leave for rural (vs urban) workers within each educational category. CONCLUSIONS: Full-time workers in rural areas have less access to paid sick leave than full-time workers in urban areas. Without access to paid sick leave, rural and urban residents may go to work while contagious or forego necessary health care. Left to individual employers or localities, rural inequities in access to paid sick leave will likely persist.

Loneliness and Social Connectedness Among Rural Older Adults Since the COVID-19 Pandemic Onset

Rural areas have a higher proportion of older adults aging in place. Rural areas also face structural barriers to supporting social connectedness among older adults, including transportation barriers, greater geographic distances, and access to technological connectivity. This research aims to discuss rural-specific risks of loneliness and social isolation among older adults, as well as rural/urban differences in loneliness and social isolation among older adults using the national COVID-19 Coping Study. Cross-sectional bivariate analyses highlight rural/urban differences in social activities during the pandemic. For example, rural older adults were more likely to use social media daily, compared with urban older adults (67% vs. 61%, p<0.05), but were less likely to have phone or video calls with others daily (21% vs. 26%, p<0.001). We will also share results of differences within rural older adults in loneliness, isolation, and social activities by socio-demographic characteristics in order to design targeted interventions to improve connectedness.

Health Care and Health Insurance Access for Farm Families in the United States during COVID-19: Essential Workers without Essential Resources?

In the midst of the COVID-19 pandemic, farmers and farm workers have been deemed essential workers across the world. Yet, despite working in one of the most dangerous occupations, and despite being especially vulnerable to the virus (due to existing health risk factors and risk of infection stemming from difficulties adopting control measures), many farmers and farm workers in the United States have long lacked essential resources to ensure they can meet their health needs: affordable and accessible health insurance and health care. In this commentary, we draw on our own research focused on farm families and collective experiences to discuss three main challenges farm families have faced meeting their health needs: reliance on off-farm work for health insurance coverage, the need to forecast income when purchasing a plan on the health insurance marketplace, and barriers to health care in rural areas. As we discuss these challenges, we highlight the ways in which the COVID-19 pandemic is likely exacerbating these pressures. Recognizing that major crises in the past have led to major shifts in economic, social, and political systems, the disruptions brought on by COVID-19 could be leveraged to work toward increasing access to affordable and adequate health insurance and health care. As such, we conclude our commentary by outlining policy reforms and research efforts that are needed to ensure that those working in the farm sector have access to essential resources to preserve their health and safety.

The Unique Impact of COVID-19 on Older Adults in Rural Areas.

Older adults in rural areas of the U.S. face unique risks related to COVID-19. Rural areas are older, on average, than urban areas, and have more underlying health conditions and fewer economic resources. Rural health care is more limited, as is access to technology and online connectivity. Altogether, this puts rural older adults at risk of not only the virus, but of not being able to meet their health care, social, and basic needs. Rural/urban inequities, combined with within-rural inequities in health, health care, and financial resources cause particular challenges to health and well-being from COVID-19 for some older adults.