Meeting Summary – HHS and HRSA Rural Summit. Earlier this year, HHS and HRSA convened a forum of rural health care stakeholders to discuss challenges rural communities face in providing and accessing health care and how HRSA and HHS can address these challenges in the course of program and policy development. The summary from this discussion is now available online at the Federal Office of Rural Health Policy’s Rural Health Resource Guide.

AHA Rural Report Podcast Series.  The American Hospital Association (AHA) has a podcast built around their recently published “Rural Report: Challenges Facing Rural Communities and the Roadmap to Ensure Local Access and High-quality, Affordable Care.” The first episode, 14 minutes in duration, features experts discussing current approaches to mental and behavioral health.

The Pennsylvania House of Representatives Insurance Committee unanimously adopted House Bill 3, a bi-partisan bill sponsored by House Majority Leader Bryan Cutler (R-Lancaster) and Minority Leader Frank Dermody (D-Allegheny) to create a state-based insurance exchange. This exchange would supersede Pennsylvania’s current participation in the Federally Facilitated Marketplace via healthcare.gov by creating state-level infrastructure to replace the current enrollment process and its oversight. The transition is intended to create a health insurance marketplace comparable to the federal marketplace originally created by the Affordable Care Act rather than the continually volatile marketplace that exists today. It will also establish a reinsurance program that aims to lower premium costs of plans offered and helps sustain the program. HB 3 has been fast-tracked by the administration and legislature with the current expectation that it will be enacted along with the state budget later in June.

By Tom Marema, The Daily Yonder, June 3, 2019

Rural counties added one job for every $10,000 in extra SNAP reimbursements during the Great Recession, says a first-of-its-kind study. Metro counties also gained jobs from SNAP, but at a lesser rate.

Increased food-assistance spending that was part of the 2009 economic stimulus package helped increase employment at the peak of the Great Recession, especially in rural areas, a first-of-its-kind study says.

During the peak and immediate aftermath of the Great Recession, nonmetropolitan counties gained one job for every $10,000 in increased snapped redemptions, said the study, which was conducted by USDA Economic Research Service.

The economic impact in metropolitan areas was measurable but not as great. Metropolitan counties saw an increase of 0.4 jobs for every $10,000 in additional SNAP redemptions during the height of the recession, according to the study.

The American Recovery and Reinvestment Act of 2009 allotted an additional $40 billion in total SNAP benefits for low-income Americans from 2009 to 2013. The increase was enough to give each recipient an extra 13% in benefits. Part of the rationale for including increased SNAP benefits in the stimulus package was that the program would help both SNAP families and the greater economy, which would benefit from an infusion of cash-like benefits.

Previous studies have predicted that’s what happens with increased SNAP benefits. The ERS study is the first to confirm that prediction using historical economic data after the fact.

The study is also the first to look at the county-level impact of SNAP expenditures, giving economists a way to compare the economic impact in metropolitan vs. nonmetropolitan areas.

As expected, the economic impact was greater in rural areas, because the poverty rate is higher and a greater percentage of families participate in SNAP in nonmetropolitan counties.

The study controlled for other federal transfer payments, meaning the increase in employment is related to SNAP payments exclusively, not to other forms of government funding that went to individuals during the study period.

As expected, the economic impact of SNAP redemptions was less before and after the Great Recession of 2018.

The study examined three time periods – before the recession (2001-07), the recession and its immediate aftermath (2008-10), and post-recession (2011-14). Both metropolitan and nonmetropolitan counties saw statistically significant numbers of jobs created during the recession and its aftermath.

Surprisingly, while pre-recession SNAP reimbursement correlated with job-creation in nonmetro counties, in metro counties before the recession, SNAP had the opposite impact. Metro counties had a 0.2 job reduction for every $10,000 in SNAP redemptions. Researchers said that finding “is not robust” and needs further investigation.

“The main findings … — that SNAP redemptions have a positive and statistically significant impact on county-level employment, that these impacts were larger during the Great Recession than before or after it, and that the impacts were larger in nonmetro than metro counties – are robust across the models estimated,” the study stated.

The study also found that SNAP spending has a “spill over” effect. Increased SNAP reimbursements in one county were linked to job creation in adjoining counties, as well.

To view the article, including graphs and maps, visit https://www.dailyyonder.com/study-links-snap-spending-job-creation/2019/06/03/32155/

By Liz Carey, The Daily Yonder, June 5, 2019

Sexually transmitted diseases like gonorrhea, chlamydia, and syphilis can spread quickly in rural areas, where access to medical screening is harder to find and fewer people are aware of the problem.

An increase in sexually transmitted diseases across the country isn’t as surprising to health professionals as is the insight that rates of STDs are rising more in rural areas than in urban areas.

Health officials are working to educate rural residents about the dangers of unprotected sex and to make residents aware that STDs are present in their area.

According to the US Centers for Disease Control and Prevention, Sexually Transmitted Disease Surveillance Report, rates for chlamydia, gonorrhea and syphilis all increased from 2016 to 2017. Chlamydia rates rose by 6.9 percent to more than 1.7 million cases, while gonorrhea rates increased 18.6 percent to more than 555,000 case and syphilis increased by 10.5 percent to over 30,000 cases.

Recent research suggests the spread of these infections might be particularly affecting rural areas where the diseases are not as common. While STDs are generally associated with more urban areas, research across the country found that rural areas are seeing more incidents of sexually transmitted diseases.

“Compared with urban hubs, rural populations tend to have less access to public health resources, less experience with syphilis and less willingness to address it because of socially conservative views toward homosexuality and non-marital sex,” Lauren Weber said in Kaiser Health News.

In one study, “Does Core Area Theory Apply to Sexually Transmitted Diseases in Rural Environments” by Dionne Gesink published in Sexually Transmitted Diseases January edition in 2013, researchers found that some rural areas were seeing high rates of gonorrhea and syphilis infections. Gonorrhea rates were the “highest in the rural parts of the eastern coastal region of the state” while the syphilis rates were “particularly high” in the southern part of the state.

But rural communities were more likely to recover more quickly from high STD rates than some urban areas. The study authors theorized that “the communities of rural North Carolina are too small and isolated for STI epidemics to persist at endemic levels…”

Other studies showed that residents in rural areas were less likely to be screened for STDs, and that residents in higher poverty areas had higher case rates for both gonorrhea and chlamydia.

In Farmerville, Louisiana, located in Union Parrish, a community health assessment by Union General Hospital there found that sexually transmitted diseases were alarmingly high. Not only were the rates higher than the rest of the state, but the rates in some cases were higher than the rest of the country.

Union Parish has a population of about 23,000, 80 percent of whom live in rural areas, according to the U.S. Census. Union is part of the Monroe, Louisiana, metropolitan statistical area, a small MSA on the border with Arkansas. Union General’s Community Health Assessment in 2012 found that rates of syphilis and gonorrhea were increasing, particularly in black women. “For 2008, the female chlamydia rate in Union Parish (887.4 per 100,000) was higher than the State rate (790.79 per 100,000). For 2008, the female chlamydia rate in Union Parish among Black females (2421.21 per 100,000) was significantly higher than the State rate (1574.07 per 100,000),” the assessment found. The rates within Louisiana at the time put it among the top three states for sexually transmitted diseases across the board for the nation.

The hospital developed a program targeting young women to reduce STDs, teen pregnancy, low birth rates and drug and alcohol abuse. Called “It’s a Girl Thing,” the program was open to girls in middle and high school in the county. Mentors within the program met with girls in their schools once a week as well as provided them with larger programs once a month at the hospital. The programs focused on self-esteem issues, education and hygiene and helped girls develop the tools to deal with the complex issues surrounding sexual health.

Mykalia Alexander, one of the first girls to go through the program, said the program helped her to delay sexual activity until she was ready, while preparing her for life after high school.

“In a sense, it helped me become a woman. We talked about our daily struggles, our body, our self-esteem… The program really helps girls shape their values and what they want to do with their lives,” Alexander said. “Sex wise, I wasn’t active at all. There were people around me who were, but the program helped prevent me from doing that. It helped me make the right decisions.”

Alexander said it helped those girls who were in the program with her make better choices too.

“I think becoming sexually active is 50 percent your environment and 50 percent your education,” she said. “I think ‘It’s a Girl Thing’ helps to educate girls about their bodies. But it’s not just a program, it’s a support system. So it’s not just a sex and pregnancy prevention program, it goes much farther than that. It’s so much more about self-worth and self-esteem.”

Claudia Wade, program director for It’s A Girl Thing and community development manager for Union General, said the decision was made to address the issue through education.

“Lack of education is the main reason for the increase,” Wade said. “Lack of self-esteem – a lot of girls, many who come from broken families and unstable situations – it’s a pattern that they come from that’s hard to break.”

Targeting girls, she said, was decided on based on resources, and responsibility.

“It depends probably more on our reactions (as women) when a boy approaches a lady for them to take that next step forward,” Wade said. “Also it’s our responsibility to say no. It’s hard for the little girls to learn how to say no. Their self-esteem, if they know who they are and what they want in life, makes it easy.”

Since implementing the program, the rate of STDs has decreased, according to the hospital’s latest community assessment report. Teen birth rates and infant mortality rates have also declined.

To view the article, including charts and graphs, access https://www.dailyyonder.com/health-officials-battle-increase-rural-std-rates/2019/06/05/32200/

Governor Tom Wolf announced a first-of-its-kind, statewide Suicide Prevention Task Force to develop the state’s suicide prevention plan, a long-term strategy to reduce suicide in Pennsylvania, and let Pennsylvanians in crisis know their lives are valuable and help is available. The announcement was made by various state agencies that will be represented on the task force, Rep. Mike Schlossberg, Rep. Malcolm Kenyatta, and Prevent Suicide PA.

It is vital that people with lived experience with mental health recovery and/or who have survived suicide attempts participate in this task force. To apply, get more information or to be added to the task force email distribution list, please email Caitlin Palmer, caipalmer@pa.gov, special adviser.