Jocelyn Richgels, director of national policy programs for the University of Iowa-based Rural Policy Research Institute (RUPRI), was one of a small number of rural health advocates, researchers, and providers at a recent Centers for Medicare and Medicaid Services listening session on rural health transformation. The meeting took place on Dec. 3, 2018, at the U.S. Department of Health and Human Services headquarters in Washington, D.C.
During the session, Richgels shared information from recent RUPRI rural health policy briefs with CMS Administrator Seema Verma. Ms. Verma highlighted CMS’s goal to more fully implement recommendations from the recently released CMS Rural Health Strategy. The CMS rural health strategy is intended to provide direction on health care issues to ensure the nearly one in five Americans who live in rural areas have access to care that meets their needs.
The Healthy Schools-Healthy Students program works with school districts to encourage students to eat more nutritious lunches more often. The program in Iowa is administered by the Iowa Department of Education and evaluated by the University of Iowa College of Public Health. Its goal is to use strategies proven by research to reduce childhood obesity, provide fresh fruits and vegetables to students who may not have regular access to them, and establish good eating habits for life.
“Research has shown that if you get kids eating spinach and broccoli and other nutritious foods when they’re young, they’re more likely to eat them for life,” says Natoshia Askelson, assistant professor of community and behavioral health in the College of Public Health who oversees the program at UI. She and a group of UI students have been working with 10 high schools, 10 middle schools, and 10 elementary schools in two-year cycles since 2013 to implement strategies and measure results. The program wraps up in May 2019.
The University of Iowa College of Public Health is proud to recognize the innovation, quality of care, and dedication of health professionals and volunteers in our community during National Rural Health Day 2018. National Rural Health Day falls on the third Thursday in November each year and recognizes the efforts of those serving the health needs of over 60 million people across the nation.
Faculty, staff, and students in the college engage in research and service that helps improve the health and well-being of rural residents. Here’s a sample of some recent projects.
Telling the Story Project
The Telling the Story Project shares the stories of farmers, agricultural workers, and family and community members who’ve been impacted by injuries, fatalities, or close calls. The initiative was developed in part by the Great Plains Center for Agricultural Health located in the University of Iowa College of Public Health. “Our goal is to use farmers” words, insight, and advice in a way that makes safety messages more credible with other farmers who understand their own way of life,” says Stephanie Leonard, occupational safety manager in the Great Plains Center. “Farmers talking to farmers is the groundwork for any kind of effort to improve farm safety.” Read the stories
Rural Health Values Project
Dramatic changes are underway in health care delivery and finance. The changing landscape creates new opportunities to design and strengthen local systems of care in rural America. The Rural Health Values Project, funded by the Federal Office of Rural Health Policy, uses the extensive analytic and technical assistance capacity of the RUPRI Center for Rural Health Policy Analysis and Stratis Health to understand how new health care delivery and financing systems affect rural communities and providers. The project will help rural providers transition to new approaches that support success in a rapidly changing environment. Learn more about the project.
The HPV (human papillomavirus) vaccine protects against a number of diseases and HPV-related cancers such as cervical cancer and oral cancer, but vaccination rates across Iowa are below the national average. University of Iowa investigators are beginning a yearlong study to better understand why HPV vaccine coverage in rural areas of the state lags behind other adolescent immunizations. The study, funded by the National Cancer Institute through the Holden Comprehensive Cancer Center, will be led by a team from Holden. Natoshia Askelson, assistant professor of community and behavioral health in the UI College of Public Health, is the project director. Other partners include the Iowa Primary Care Association, Iowa Department of Public Health, American Cancer Society, Iowa Cancer Consortium, and local public health agencies. Read more about the study
A new video from the University of Iowa’s Cancer Prevention and Control Research Network (CPCRN) highlights community-based participatory research approaches that began in 2014 to increase human papillomavirus (HPV) vaccination rates in the east central Iowa community of West Liberty.
Farm Equipment Vibration and Back Pain Research
During harvest season, it’s common for farmers to work 10 to 14 hours a day. Long hours sitting on agricultural equipment can take a physical toll on the body and lead to back pain. A new study conducted by researchers at the University of Iowa College of Public Health examined whole-body vibration exposures during the operation of several types of agricultural machinery. Whole-body vibration is defined as mechanical vibrations that are transmitted to the human body through a contact surface, such as a seat.
Jocelyn Richgels, director of national policy programs for the Rural Policy Research Institute, was an invited panelist at a National Academies of Sciences, Engineering, and Medicine information gathering session held Sept. 19 in Washington, D.C.
The session was convened by the Committee on Summertime Experiences and Child and Adolescent Education, Health, and Safety. Richgels contributed perspectives on the summertime experiences of children and adolescents in rural communities.
The committee, chaired by Martín Sepúlveda, IBM Fellow, CEO of CLARALUZ, LLC., and long-time member of the College of Public Health Board of Advisors, is studying how summertime experiences affect children across four areas of well-being: 1) academic learning and opportunities for enrichment; 2) social and emotional development; 3) physical and mental health and health-promoting behaviors; and 4) safety, risk-taking, and anti-and pro-social behavior.
Researchers found that since 2002, more than 1,200 independently owned rural pharmacies in the United States have closed, with the most drastic decline occurring between 2007 and 2009. The report states that 630 rural communities that had at least one retail (independent, chain, or franchise) pharmacy in March 2003 had no retail pharmacy in March 2018. This decline has continued through 2018, although at a slower rate.
Keith Mueller, professor and head of health management and policy at the University of Iowa College of Public Health and director of the RUPRI Center for Rural Health Policy Analysis, is the lead author on the report.
According to Mueller, the spike in rural pharmacy closures can be attributed to the financial challenges posed to these pharmacies by the implementation of Medicare Part D.
“The biggest challenge for these pharmacies is the delayed maximum allowable cost adjustment and remuneration fees that drive up the cost of providing medications when the payments from Medicare Part D and others do not keep pace,” he says.
The report also states that the closing of so many rural pharmacies can pose significant obstacles to residents living in these communities.
“Local pharmacists are part of the health care system who provide essential services such as counseling residents as prescriptions are filled, attending to residents with mild illnesses that can be treated with over-the-counter medications, providing immunizations, and supporting other local providers,” Mueller says. “Their departure creates a big gap in these communities.”
The report was co-authored by program director Fred Ullrich and doctoral student Abiodun Salako, both in the Department of Health Management and Policy at the University of Iowa.
The full brief is available at bit.ly/2Mth3eO and was recently highlighted in The Washington Post’s “The Health: 202” newsletter.
On May 24, Keith Mueller, interim dean of the University of Iowa College of Public Health and director and chair of RUPRI’s Rural Health Initiatives, testified at a United States Senate Finance Committee Public Hearing on rural health. The hearing focused on challenges and opportunities in rural health care delivery.
The College of Public Health recently hosted the Mental Health First Aid Training Course. Julie Baker and Nancy Adrianse, both with the Iowa Primary Care Association in Urbandale, provided the 8-hour training. Diane Rohlman, associate professor of occupational and environmental health, with support from the CPH Diversity Committee, organized the training as part of her Topics in Agricultural and Rural Health course, which focused on mental health in rural areas this semester.
In addition to raising awareness about different types of mental illness, the Mental Health First Aid course provides participants with the key skills and resources necessary to help someone who is developing a mental health problem or experiencing a mental health crisis. These skills and resources include the identification of risk factors and warning signs for a range of mental health problems, as well as a 5-step action plan to help a person in crisis connect with appropriate professional help.
In attendance were 25 University of Iowa faculty, staff, and students who received certification in Mental Health First Aid upon completion of the training. Participants represented the Departments of Occupational and Environmental Health, Epidemiology, Public Health Administration, and Community and Behavioral Health in the College of Public Health, as well as the College of Liberal Arts and Sciences.
According to a post-training survey, 92 percent of respondents said that they found the training useful and 100 percent would recommend the training to others. Some feedback included: “The Mental Health First Aid course was very informative and I suggest it be added to the curriculum for all first-year students,” and “I think the information is useful to those who have no background in any of the mentioned mental health topics. This is useful as a basic primer. Though this should be mandatory for all faculty and staff.”