Health and Poverty of Rural Children: An Under-Researched and Under-Resourced Vulnerable Population

Bettenhausen, Jessica L.; Winterer, Courtney; Colvin, Jeffrey D.

doi:10.1016/j.acap.2021.08.001

Cited by 33 publications

(15 citation statements)

References 26 publications

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“…This paper describes barriers, facilitators, and opportunities to promote healthy weight behaviors in preschool-aged children in two rural communities, a topic on which little research presently exists [ 12 ]. Similar to previous studies [ 3 , 9 , 10 , 32 ], the authors found that participants were generally ambivalent about their community’s attributes, often appreciating the small, rural, slow-paced and close-knit community feel, with access to open spaces and nature, but bemoaning the high poverty levels and built environment barriers. Notably, participants’ reports about the built environment barriers related to nutrition and PA (Table 4 ) were supported by findings from the audits that showed the need to improve access to healthy foods (Table 2 ) and high-quality PA resources (Table 3 ), and consistent with findings of other studies of older children and adults in rural communities [ 33 – 35 ].…”

Section: Discussionsupporting

confidence: 80%

Barriers, facilitators, and opportunities to promote healthy weight behaviors among preschool-aged children in two rural U.S communities

Pope

Whitcomb

et al. 2023

BMC Public Health

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Background Obesity levels are higher in rural versus urban children. Multi-level community-based interventions can be effective in promoting healthy child weight, but few of such interventions have focused on rural children. This formative study assessed barriers, facilitators, and opportunities to promote healthy child weight in two rural communities. Methods Multiple data collection methods were used concurrently in two rural communities in Indiana and North Carolina. Focus groups and interviews were conducted with participants, including parents of children aged 2–5 years (n = 41), childcare providers (n = 13), and stakeholders from 23 community organizations. Observational audits were conducted at 19 food outlets (grocery stores) and 50 publicly-accessible physical activity resources. Focus groups/interviews were analyzed thematically. Surveys were analyzed using descriptive statistics, Fisher’s exact test, and t-tests. Results Family level barriers included limited financial resources and competing priorities, whereas parental role-modeling was perceived as a facilitator of healthy weight behaviors. At the organizational level, childcare providers and community stakeholders cited limited funding and poor parental engagement in health promotion programs as barriers. Childcare providers explained that they were required to comply with strict nutrition and physical activity guidelines, but expressed concerns that similar messages were not reinforced at home. Facilitators at the organizational level included healthy meals provided at no cost at childcare programs, and health promotion programs offered through community organizations. At the community level, lack of public transportation, and limited access to healthy food outlets and physical activity-promoting resources posed barriers, whereas existing physical activity resources (e.g., parks) and some ongoing investment to improve physical activity resources in the community were assets. In designing/implementing a potential child obesity prevention intervention, participants discussed the need to garner community trust, emphasize wellness instead of obesity prevention, establish community partnerships, and leverage existing community resources. Conclusions Rural areas experience multiple challenges that make it difficult for children/families to engage in healthy weight behaviors. This study highlights several assets (existing programs/resources, expertise within communities) that can be leveraged as facilitators. Findings will guide the study team in developing a child obesity prevention intervention for the two rural communities.

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Section: Discussionsupporting

confidence: 80%

Barriers, facilitators, and opportunities to promote healthy weight behaviors among preschool-aged children in two rural U.S communities

Pope

Whitcomb

et al. 2023

BMC Public Health

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“…A study finds that the experience of being left behind or of parents' migration may reduce the care provided to Chinese children and thus affect the health of children (70). Kristin (71) confirms that cumulative adverse childhood experiences may exacerbate existing social disparities in children's health. Jessica et al (72) confirm that rural children experience health and healthcare disparities compared with their urban peers and represent a unique and vulnerable pediatric patient population.…”

Section: Discussionmentioning

confidence: 98%

“…Kristin ( 71 ) confirms that cumulative adverse childhood experiences may exacerbate existing social disparities in children's health. Jessica et al ( 72 ) confirm that rural children experience health and healthcare disparities compared with their urban peers and represent a unique and vulnerable pediatric patient population. The root causes of health inequalities (obesity, anxiety, infectious diseases, injuries, prematurity, and low birth weight) of children are complex, and interventions to address child health inequalities must consider the structural determinants ( 73 ).…”

Section: Discussionmentioning

confidence: 98%

Grandchild care, inadequate medical insurance protection, and inequalities in socioeconomic factors exacerbate childhood obesity in China

Yang

Shen

Deng

et al. 2022

Front. Public Health

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This study examines the influences of grandchild care and medical insurance on childhood obesity. Nationally representative longitudinal data—from the China Family Panel Studies 2010–2020—of 26,902 school-age children and adolescents aged 6–16 years and China's new reference standard (“WS/T586-2018”) are used to identify a child's obesity status. Using binary mixed-effects logistic regression models and the Blinder–Oaxaca decomposition method, this study explores the roots of obesity inequalities and finds that at least 15% of Chinese children aged 6–16 were obese in the 2010s. The logistic regression analysis results indicate that grandchild care, public medical insurance, and commercial medical insurance are key risk factors of child obesity. However, the influences are heterogeneous in different groups: Grandchild care and public medical insurance increase urban–rural obesity inequalities because of a distribution effect, and grandchild care may also exacerbate children obesity inequalities between left-behind and non-left-behind children owing to the event shock of parental absence. Inequalities in socioeconomic status (SES) factors such as income, education, and region also cause obesity inequalities. These results indicate that child obesity and its inequalities are rooted in multidimensional environmental inequalities, including medical protection policies and its benefit incidence; intergenerational behavior and family SES factors; and urban–rural and left-behind risk shocks. This study provides new evidence for the development of population-based interventions and equitable medical insurance policies to prevent the deterioration of child obesity among Chinese school-age children and adolescents.

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“…The impact of rurality on financial resources has been evaluated in adult and pediatric CKD populations. There is a higher incidence of poverty among rural children than their non-rural peers (47% of rural children vs. 39% of non-rural children with household income levels < 200% of the federal poverty limit), and most of the counties in the USA with a child poverty rate of 50% or higher are in rural areas [ 19 , 33 ]. Household income level is also associated with CKD severity, emergency department (ED) use, hospitalization, and progression in the USA [ 23 , 34 ].…”

Section: Enabling Factors and Barriers To Care In Rural Areasmentioning

confidence: 99%

The impact of rural status on pediatric chronic kidney disease

Weidemann

Harshman

2023

Pediatr Nephrol

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Children and adolescents in rural areas with chronic kidney disease (CKD) face unique challenges related to accessing pediatric nephrology care. Challenges to obtaining care begin with living increased distances from pediatric health care centers. Recent trends of increasing centralization of pediatric care mean fewer locations have pediatric nephrology, inpatient, and intensive care services. In addition, access to care for rural populations expands beyond distance and encompasses domains of approachability, acceptability, availability and accommodation, affordability, and appropriateness. Furthermore, the current literature identifies additional barriers to care for rural patients that include limited resources, including finances, education, and community/neighborhood social resources. Rural pediatric kidney failure patients have barriers to kidney replacement therapy options that may be even more limited for rural pediatric kidney failure patients when compared to rural adults with kidney failure. This educational review identifies possible strategies to improve health systems for rural CKD patients and their families: (1) increasing rural patient and hospital/clinic representation and focus in research, (2) understanding and mediating gaps in the geographic distribution of the pediatric nephrology workforce, (3) introducing regionalization models for delivering pediatric nephrology care to geographic areas, and (4) employing telehealth to expand the geographic reach of services and reduce family time and travel burden.

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Health and Poverty of Rural Children: An Under-Researched and Under-Resourced Vulnerable Population

Cited by 33 publications

References 26 publications

Barriers, facilitators, and opportunities to promote healthy weight behaviors among preschool-aged children in two rural U.S communities

Barriers, facilitators, and opportunities to promote healthy weight behaviors among preschool-aged children in two rural U.S communities

Grandchild care, inadequate medical insurance protection, and inequalities in socioeconomic factors exacerbate childhood obesity in China

The impact of rural status on pediatric chronic kidney disease

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