The objective of this exploratory study was to explore potential associations between changes to caregiver burden (CB) due to the COVID-19 pandemic and rural-urban status using a nationally representative sample of 761 informal caregivers. Tertiles of two measures of rural-urban status were used: Rural-Urban Commuting Areas (RUCAs) and population density. Bivariate and multivariable binary and ordinal logistic regression were used to asses study objectives. Using RUCAs, rural informal caregivers were more than twice as likely as urban informal caregivers to report a substantial increase in CB due to COVID-19 (OR 2.27, 95% CI [1.28–4.02]). Similar results were observed for population density tertiles (OR 2.20, 95% CI [1.22–3.96]). Having a COVID-19 diagnosis was also significantly associated with increased CB. Understanding and addressing the root causes of rural-urban disparities in CB among informal caregivers is critical to improving caregiver health and maintaining this critical component of the healthcare system.
Background
Racial health disparities in obesity and obesity-related conditions and behaviors are well documented, although a small body of research suggests that geographic factors (e.g., socioeconomic status [SES] and rural/urban status) may alter the magnitude of these disparities.
Methods
This study explored how rurality moderates black/white health disparities using a nationally representative sample from the 2012 Behavioral Risk Factor Surveillance System (
n
=359,157). Respondents' county of residence was linked to the U.S. Census information to obtain the county-level Index of Relative Rurality (IRR). Weighted logistic regression was used to model obesity, diabetes, and lack of physical activity (PA) on race (black/white), IRR, and an interaction term of race and IRR, including covariates (age, sex, education, marital status, employment, and income).
Results
Blacks were significantly more likely to have obesity, diabetes, and a lack of PA compared with whites. Irrespective of race, rural respondents were significantly more likely to have obesity (odds ratio [OR] 1.035, confidence interval [95% CI] 1.028–1.043) and a lack of PA (OR 1.045, 95% CI 1.038–1.053) than respondents in more urban areas. For obesity and diabetes, the interaction term for black×IRR quintile was significant and positive, indicating an increase in the magnitude of the black/white disparity with increasing rurality.
Discussion
These findings underscore the need for policies and programs aimed to reduce racial disparities in obesity and related conditions to consider the geographic context in which these outcomes occur.
Criminal defendants can face significant pressures to plead guilty, but wrongful conviction scholarship has largely overlooked the study of guilty pleas. This study content analyzed 139 Australian appellate court judgments in which a guilty plea conviction was overturned, investigating the types of errors involved in these convictions, and the stage of the criminal justice process at which the errors occurred. The findings revealed that errors occurred during the police investigation, pretrial preparations, and formal court procedures, with the most frequent errors involving incorrect or inappropriate charges, inadequate legal representation, and the courts erroneously accepting a guilty plea. The findings raise important implications regarding the adequacy of safeguards to ensure guilty pleas are appropriate or factually and legally accurate.
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