Research aids rural health

Jennie Kushner

Innovation meets integration at the College of Community Health Sciences Institute for Rural Health Research.

The Institute, now almost 10 years old, was founded to bring the highest attainable standard of health to rural citizens of Alabama.

John Higginbotham, associate dean for research and health policy and director of the Rural Health Institute, said the Institute was born from another program designed to unite communities and discuss the needs of rural Alabama.

It quickly became apparently that although people knew anecdotally that there were problems, there wasn’t a lot of hard numbers and statistics that people brought together to show those problems, Higginbotham said.

“The institute was designed to do research and investigate the disparities and differences that rural individuals experience compared to their urban counterparts,” he said.

Higginbotham said there are many disparities in individuals living in rural and urban areas, both in negative and positive ways.

“Access to health care can be a little more difficult for those in rural areas, simply by distance, there are also fewer doctors in rural areas,” he said.

“National statistics show that Alabama is short about 200 doctors than where it should be, if they were meeting the optimal number of primary care physicians,” Higginbotham said. “The vast majority of those are lacking in rural areas.”

According to the Centers for Disease Control and Prevention, obesity has been increasing in the United States since the 1990s. In 2002, Alabama joined the ranks of states in which 25 percent of their populations were considered obese.

By 2007, 31 percent of Alabama’s population was considered obese.

Higginbotham said the Institute works intensely to define the term ‘rural.’ The Federal Government has at least eight official definitions of rural, he said.

“That makes looking at that data really difficult sometimes because not all definitions are the same,” Higginbotham said. “A lot of places that are rural are closer than you think, Hale County [or] Greene County.”

Higginbotham said what the Institute considers ‘rural’ to be based on the location of the population and whether or not they commute to an urban area for work and other encounters.

Currently one undergraduate and three undergraduate students work with the institute, but there have been collaborations campus wide.

Collaborations on campus include projects with the Honors College, the Blackburn Institute, and both the nursing and social work schools on campus, said Leslie Zganjar, associate director for editorial services.

Students who do work with the Institute can be expected to have a variety of jobs.

“We have had them participate in the full gamete of the activities that we do, being out in rural communities, working with rural communities based organizations all the way to looking at death certificates and morbidity and mortality data here,” Higginbotham said.

Zganjar said the Institute also participates on the local and state level.

“We also collaborate with the Alabama Department of Health and other state agencies and the Alabama Department of Mental Health,” she said.

“We also collaborate with local community organizations. Sowing Seeds for Hope in Perry County and the West Alabama Aids Outreach,” Zganjar said.

Professor Browen Lichtenstein, who once worked with the Institute, has written extensively on the topic of HIV in rural areas. Lichtenstein said people underestimate the impact of HIV on rural residents because there is much association with HIV in cities.

“On a per capita basis, rural people (e.g. in Alabama’s Black Belt counties) are as much as, if not more than, at HIV risk than other people,” Lichtenstein said.

“A lot of it has to do with poverty and the social fault lines of the south where whites are land-owning and African-Americans are living on the economic margins. Poverty drives HIV risk,” she said.

Zganjar said in addition to research, the Institute has seen growth in the area of clinical investigations division, telemedicine and EMS.

“Telemedicine, we see patients over the TV. If we have doctors here, they can see patients in Dekalb County over the television,” he said.

“Clinical investigations does clinical trials to see how effective vaccines are for example, and we have EMS which looks to help promote quality in emergency medical services,” he said.

Graduate student Randi Henderson has worked with the Institute since January 2009. Henderson said her work at the institute has taught her important lessons.

“It has been a great learning experience,” she said. “Learning about the research process is invaluable for a graduate student.”

Henderson said her daily tasks vary.

“I do anything from contracts to data analysis to helping faculty with research.”

Although Henderson does not work directly with patients, she has much experience in assistant doctors and facility members with research on rural health.