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      Self-reported vs RUCA rural-urban classification among North Carolina pharmacists

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          Abstract

          Background:

          The various ways in which rurality is defined can have large-scale implications on the provision of healthcare services.

          Objective:

          The purpose of this study was to identify the relationship between self-perceived urban-rural distinction and the United States (US) Census tract-based Rural-Urban Commuting Area (RUCA) scheme that defines rurality among pharmacists.

          Methods:

          This was a secondary analysis of data collected through a web-based survey of licensed pharmacists in North Carolina. Respondents self-reported their workplace settings, zip codes, and the pharmacy services offered in their place of work. Zip codes were replaced with the corresponding RUCA codes. The relationship between self-reported classification and RUCA codes was analyzed and a chi square test was performed to measure statistical significance.

          Results:

          Of the original survey, 584 participants reported their workplace zip code and 579 reported their workplace setting (urban, rural). A significant difference was found between pharmacists who self-reported working in rural areas and the RUCA classifications – 94 (56.6%) of the 166 participants who reported working in “rural” areas were considered “urban” according to RUCA.

          Conclusions:

          A significant discordance between pharmacists’ self-reported classification and the RUCA codes was found, with more respondents self-reporting their workplace area as “rural” as compared to the RUCA classification. Decision-makers examining the pharmacy workforce and pharmacy services should be aware of this discordance and its implications for resource allocation. We recommend the use of standardized metrics, when possible.

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          Most cited references35

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          Rural-urban disparities in the prevalence of diabetes and coronary heart disease.

          To examine the rural-urban differences in the prevalence of diabetes and coronary heart disease, and the extent to which they are explained by the presence of established risk factors including poverty. Cross-sectional study of more than 214,000 respondents using data from the US Centers for Disease Control and Prevention's (CDC's) 2008 Behavioral Risk Factor Surveillance System. Logistic regression models were utilized; prevalence odds ratios with corresponding confidence intervals and P-values are provided. The crude prevalence rates of diabetes and coronary heart disease were 8.6% (P = 0.001) and 38.8% (P < 0.001) higher among respondents living in rural areas compared with urban areas, respectively. The higher prevalence in rural areas of many of the common risk factors for these conditions, including poverty (P < 0.001), obesity (P < 0.001) and tobacco use (P < 0.001), may contribute to these findings. After controlling for these and other risk factors, the prevalence of diabetes was lower among respondents living in rural areas [prevalence odds ratio (POR) = 0.94, P = 0.032], but the prevalence of coronary heart disease was higher (POR = 1.09, P = 0.011). The higher prevalence of diabetes and coronary heart disease in rural populations in the USA presents a formidable public health challenge. It exacerbates many of the pre-existing rural health disparities, including a lack of access to financial resources and primary care providers. Copyright © 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
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            Rural definitions for health policy and research.

            The term "rural" suggests many things to many people, such as agricultural landscapes, isolation, small towns, and low population density.However, defining "rural" for health policy and research purposes requires researchers and policy analysts to specify which aspects of rurality are most relevant to the topic at hand and then select an appropriate definition. Rural and urban taxonomies often do not discuss important demographic, cultural, and economic differences across rural places-differences that have major implications for policy and research. Factors such as geographic scale and region also must be considered. Several useful rural taxonomies are discussed and compared in this article. Careful attention to the definition of "rural" is required for effectively targeting policy and research aimed at improving the health of rural Americans.
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              Rural–Urban Differences in Objective and Subjective Measures of Physical Activity: Findings From the National Health and Nutrition Examination Survey (NHANES) 2003–2006

              Introduction Lower levels of physical activity among rural relative to urban residents have been suggested as an important contributor to rural–urban health disparity; however, empirical evidence is sparse. Methods We examined rural–urban differences in 4 objective physical activity measures (2 intensity thresholds by 2 bout lengths) and 4 subjective measures (total, leisure, household, and transportation) in a nationally representative sample of participants in the National Health and Nutrition Examination Survey (NHANES) 2003–2006. The sample comprised 5,056 adults aged 20 to 75 years. Rural-Urban Commuting Area (RUCA) codes were matched with NHANES subjects to identify urban status and 2 types of rural status. Rural–urban and within–rural differences in physical activity were estimated without and with controls for demographic and socioeconomic variables. Results Rural residents were less active than urban residents in high-intensity long bout (2,020 counts per minute threshold and 10 miniutes or longer bout length) accelerometer-measured physical activity (42.5 ± 6.2 min/wk vs 55.9 ± 2.8 min/wk) but the difference disappeared with a lower-intensity threshold (760 counts per minute). Rural residents reported more total physical activity than urban residents (438.3 ± 35.3min/wk vs 371.2 ± 12.5 min/wk), with differences primarily attributable to household physical activity. Within rural areas, micropolitan residents were less active than residents in smaller rural areas. Controlling for other variables reduced the size of the differences. Conclusion The direction and significance of rural–urban difference in physical activity varied by the method of physical activity measurement, likely related to rural residents spending more time in low-intensity household physical activity but less time in high-intensity physical activity. Micropolitan residents were substantially less active than residents in smaller rural areas, indicating that physical activity did not vary unidirectionally with degree of urbanization.
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                Author and article information

                Contributors
                Journal
                Pharm Pract (Granada)
                Pharm Pract (Granada)
                Pharmacy Practice
                Centro de Investigaciones y Publicaciones Farmaceuticas
                1885-642X
                1886-3655
                Jul-Sep 2021
                21 August 2021
                : 19
                : 3
                : 2406
                Affiliations
                MPharm. School of Pharmacy, University College London , London (United Kingdom). mcastle33@ 123456gmail.com
                PhD, MPH. Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill , Chapel Hill, NC (United States). casey_tak@ 123456unc.edu
                Author notes

                Conceptualization: CT. Data curation: CT. Formal analysis: MC. Investigation: MC, CT. Methodology: CT. Project administration: MC, CT. Resources: MC, CT. Software: MC. Supervision: CT. Validation: MC. Writing: original draft: MC, CT. Writing: review & editing: MC, CT.

                Author information
                https://orcid.org/0000-0003-0084-6316
                https://orcid.org/0000-0002-1203-1782
                Article
                pharmpract-19-2406
                10.18549/PharmPract.2021.3.2406
                8412893
                34522240
                f8e0b264-a872-4b2f-a7b2-ccc02a4a4594
                Copyright: © The Authros

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY-NC-ND 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 April 2021
                : 15 August 2021
                Categories
                Original Research

                rural population,rural health,delivery of health care,resource allocation,workplace,pharmacists,pharmacies,pharmaceutical services,surveys and questionnaires,north carolina

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