Prevalence and correlates of paediatric asthma and wheezing in a largely rural USA population.

OBJECTIVE: The prevalence of asthma among children has been increasing in the United States and it is estimated that there are approximately 5 million children with asthma. This cross-sectional survey sought to estimate the prevalence of asthma and asthma symptoms and potential risk factors among children aged 16 and younger, in a largely rural population in the USA. METHODS: This study was a telephone survey of 1500 households in the South Plains/Panhandle region of Texas. Parents of children were interviewed with a response rate of 64%. Having been diagnosed with asthma by a physician and a report of wheezing in the last 12 months were used as dependent variables in multivariate logistic regressions with several sociodemographic and environmental factors as potential confounders. RESULTS: The age-adjusted prevalence of asthma and wheezing among children were approximately 15 and 18%, respectively. The prevalence of asthma was highest (20%) among children aged 11-16 (P < 0.001). Living in urban areas was associated significantly with asthma and wheezing. Non-Hispanic blacks reported significantly increased odds of asthma in their children (adjusted odds ratio (OR) = 2.04, 95%CI 1.02-4.08), whereas Mexican-Americans reported significantly reduced odds of asthma (adjusted OR = 0.48, 95%CI 0.29-0.78) and wheezing (adjusted OR = 0.58, 95%CI 0.37-0.89) in their children. The odds of asthma (adjusted OR = 1.78, 95%CI 1.09-2.92) and wheezing (adjusted OR = 2.45, 95%CI 1.52-3.95) was highest among children in the highest body mass index quartile. No significant association with pet ownership and exposure to second-hand smoke with asthma and wheezing was observed in this study. CONCLUSION: Urban residence, non-Hispanic black and Mexican-American race/ethnicity, and being overweight were significantly associated with the increased risk of asthma and/or wheezing.

Rural residence and migration for specialty physician care.

This article describes why rural residents migrate or travel outside their local market area for specialty physician care. Data were collected through a random mail survey of persons residing in Iowa's rural counties. The results imply that migration for specialty care is not simply a function of a low perceived availability of local specialty physicians. Managers of rural and urban health care systems may need to rethink the extent to which specialty physician services should be distributed across rural markets.

Limitations of secondary data for strategic marketing in rural areas.

Market research is an important element of the strategic marketing process. By understanding the healthcare needs of a market area, hospital and health system managers can set priorities for new services and allocate resources appropriately. The process of market research often begins with an evaluation of health status and socioeconomic indicators collected from secondary sources. Unfortunately, indicators that have been recommended in the literature may not be feasible for use in rural markets because of their lack of statistical precision or inability to differentiate healthcare service needs. This study evaluated the statistical precision and variability of 79 secondary health status and socioeconomic measures reported at the county level in Iowa, USA, a largely rural state. Our findings suggest that many readily available health status and socioeconomic indicators do not discriminate need among rural health care markets. Only six health status and two socioeconomic indicators met our statistical precision and variability criteria. These findings have important implications for managers planning health services in rural localities. Managers of rural health systems may need to employ alternative market research methods, such as analysis of claims-based utilization rates or community health surveys.

Why rural residents migrate for family physician care.

Several studies have examined why rural residents bypass local hospitals, but few have explored why they migrate for physician care. In this study, data from a random mail survey of households in rural Iowa counties were used to determine how consumers' attitudes about their local health system, health beliefs, health insurance coverage and other personal characteristics influenced their selection of local vs. nonlocal family physicians (family physician refers to the family practice, internal medicine or other medical specialist providing an individual's primary care). Migration for family physician care was positively associated with a perceived shortage of local family physicians and use of nonlocal specialty physician care. Migration was negatively associated with a highly positive rating of the overall local health care system, living in town, Lutheran religious affiliation and private health insurance coverage. By understanding why rural residents prefer to bypass local physicians, rural health system managers, physicians and policy-makers should be better prepared to design innovative health organizations and programs that meet the needs of rural consumers.

Development and validation of the State Hope Scale.

Defining hope as a cognitive set comprising agency (belief in one's capacity to initiate and sustain actions) and pathways (belief in one's capacity to generate routes) to reach goals, the Hope Scale was developed and validated previously as a dispositional self-report measure of hope (Snyder et al., 1991). The present 4 studies were designed to develop and validate a measure of state hope. The 6-item State Hope Scale is internally consistent and reflects the theorized agency and pathways components. The relationships of the State Hope Scale to other measures demonstrate concurrent and discriminant validity; moreover, the scale is responsive to events in the lives of people as evidenced by data gathered through both correlational and causal designs. The State Hope Scale offers a brief, internally consistent, and valid self-report measure of ongoing goal-directed thinking that may be useful to researchers and applied professionals.