Chronic Disease in Rural Health

  • Leslie K. Dennis
  • Stacie L. Pallotta


As a large proportion of the American population grows into old age, it is important to understand how long-term illnesses are affecting us. Chronic disease refers to a health-related state, lasting a long time, often defined as three months or longer (Timmreck, 1988). Risk factors for chronic diseases are genetic, environmental, behavioral, and social. For the purposes of this chapter, we will refer to behavioral and social risk factors as lifestyle factors in comparison to genetic or environmental factors. Some environmental factors may be related to lifestyle factors such as occupation; however, we will address these as environmental factors. Over the past decade there has been an increase in stress, sedentary lifestyles, high-density-population living, poor diet, crime, drugs, gangs, poverty, and pollution, many of which lead to chronic diseases (Timmreck, 1988). Rural health has been examined by looking at farmers, nonmetropolitan health centers, populations not adjacent to a metro area, and populations with less than 20,000 residents.


Multiple Sclerosis Rural Area Chronic Disease Amyotrophic Lateral Sclerosis Rural Community 
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  1. Armstrong, W.,& Borman B. (1996). Breast cancer in New Zealand: Trends, patterns, and data quality. New Zealand Medical Journal, 109, 221–224.Google Scholar
  2. Bannenberg, A. F. I., Ratt, H.,& Plomp, H. N. (1992). Demand for alcohol treatment by problem drinkers. Journal of Substance Abuse Treatment. 9 (1), 59–62.PubMedCrossRefGoogle Scholar
  3. Barrett, J. (1999). A focus on farming health in Iowa. Environmental Health Perspectives, 107, A142–143.Google Scholar
  4. Beckman, L. J.,& Kocel, K. M. (1982). The treatment–delivery system and alcohol abuse in women: Social policy implications. Journal of Social Issues, 38 (2), 139–151.Google Scholar
  5. Beebe, G. W., Kurtzke, J. F., Kurland, L. T., Auth. T. L.,& Nagler, B. (1967). Studies on the natural history of multiple sclerosis—3. Epidemiologic analysis of the army experience in World War II. Neurology, 17, 1–17.Google Scholar
  6. Bishop, D. B., Roesler, J. S., Zimmerman, B. R.,& Ballard, D. J. (1993). Diabetes. In R. C. Brownson, P. L. Remington,& J. R. Davis (Eds.), Chronic disease epidemiology and control (pp. 221––240 ). Washington, DC: American Public Health Association.Google Scholar
  7. Biswas, L. N., Manna, B., Maiti, P. K.,& Sengupta, S. (1997). Sexual risk factors for cervical cancer among rural Indian women: A case–control study. International Journal of Epidemiology, 26 (3), 491–495.PubMedCrossRefGoogle Scholar
  8. Bjorksten, B. (1994). Risk factors in early childhood for the development of atopic diseases. Allergy, 49, 400–407.PubMedCrossRefGoogle Scholar
  9. Blazer, D., George, L. K., Landerman, R., Pennybacker, M., Melville, M. L., Woodbury, M., Manton, K. G., Jordan, K.,& Locke, B. (1985). Psychiatric disorders: A rural/urban comparison. Archives of General Psychiatry, 43 (12), 1142.Google Scholar
  10. Bongers, P., Houthuijs, D., Remijn, B., Brouwer, R.,& Biersteker, K. (1987). Lung function and respiratory symptoms in pig farmers. British Journal of Industrial Medicine, 44, 819–823.PubMedGoogle Scholar
  11. Booth, B. M., Ross, R. L.,& Rost, K. (1999). Rural and urban problem drinkers in six southern states. Substance Use & Misuse, 34 (4&5), 471–493.PubMedCrossRefGoogle Scholar
  12. Braback, L.,& Kalvesten, L. (1991). Urban living as a risk factor for atopic sensitization in Swedish schoolchildren. Pediatric Allergy & Immunology, 2, 14–19.CrossRefGoogle Scholar
  13. Braun-Fahrlander, C. H., Gassner, M., Grize, L., Neu, U., Sennhausers, F. H., Varonier, H. S., Vuille, J. C., Wuthrich. B. (1999). Prevalence of hay fever and allergic sensation in farmer’s children and their peers living in the same rural community. Clinical & Experimental Allergy, 29, 28–34.Google Scholar
  14. Brownson, R. C., Reif, J. S., Alavanja, M. C. R.,& Bal, D. G. (1993). Cancer. In R. C. Brownson, P. L. Remington,& J. R. Davis (Eds.), Chronic disease epidemiology and control (pp. 137–168 ). Washington, DC: American Public Health Association.Google Scholar
  15. Butler, M. A.,& Beale, C. L. (1994). Rural–urban continuum codes for metro and nonmetro counties, 1993. (Staff report no. 9425.) Washington, DC: Agricultural and Rural Economy Division, Economic Research Service, U.S. Washington, D.C.: Department of Agriculture.Google Scholar
  16. Byrne, M. J., Jamrozik, K., Parsons, R. W., Fitzgerald, C. J., Dewar, J. M., Harvey, J. M., Sterrett, G. F., Ingram, D. M., Sheiner, H. J., Cameron, F. G. (1993). Breast cancer in Western Australia in 1989. II. Diagnosis and primary management. Australian & New Zealand Journal of Surgery, 63, 624–629. Chan–Yeung, M., Schulzer, M., MacLean, L., Dorken, E., Grzybowski, S. (1980). Epidemiologic health survey of grain elevator workers in British Colum–bia. American Review of Respiratory Disease, 121, 329–338.Google Scholar
  17. Chimonides, K. M.,& Frank, D. I. (1998). Rural and urban adolescents’ perceptions of mental health. Adolescence, 33 (132), 823–832.PubMedGoogle Scholar
  18. Cockroft, A. E., McDermott, M., Edwards, J. H., McCarthy, P. (1983). Grain exposure–Symptoms and lung function. European Journal of Respiratory Diseases, 64, 189–196.Google Scholar
  19. Commerce Clearing House. (1990). Medicare and Medicaid guide. Chicago: Commerce Clearing House, Inc.Google Scholar
  20. Cooper, J. E., Goodhead, D., Craig, T., Harris, M., Howat, J.,& Korer. J. (1987). The incidence of schizophrenia in Nottingham. British Journal of Psychiatry, 151, 619–626.Google Scholar
  21. Cotton, D. J., Graham, B. L., Li, K. Y. R., Froh, F, Barnett, G. D., Dosman, J. A. (1983). Effects of grain dust exposure and smoking on respiratory symptoms and lung function. Journal of Occupational Medicine, 25, 131–141.PubMedGoogle Scholar
  22. Crowell, B. A., Jr., George, L. K., Blazer, D.,& Landerman, R (1986). Psychosocial risk factors and urban/rural differences in the prevalence of major depression. British Journal of Psychiatry, 149, 307314.Google Scholar
  23. Dassel, H. (1960). A survey of multiple sclerosis in a northern part of Scotland. Acta Neurologica Scandinavica, 35 (suppl. 147), 64–72.CrossRefGoogle Scholar
  24. Davies, M. A., Bromet, E. J., Schulz, C., Dunn, L. O.,& Morgensterm, M. (1989). Community Adjustment of chronic schizophrenic patients in urban and rural settings. Hospital and Community Psychiatry, 40 (8), 824–830.Google Scholar
  25. DeLeon, P. H., Wakefield, M., Schultz, A. J., Williams, J.,& VandenBos, G. R. (1989). Rural America, Unique opportunities for health care delivery and health services research. American Psychologist, 44 (10), 1298––1306.PubMedCrossRefGoogle Scholar
  26. Department of Health and Human Services. (1993). Tak ing rural into account: Report on the National Public Forum. Lincoln, NE: Department of Health and Human Services.Google Scholar
  27. Devereux, G., Ayatollahi, T., Ward, R., Bromly, C., Bourke, S. J., Stenton, S. C.,& Hendrick, D. J. (1996). Asthma, airways responsiveness and air pollution in two contrasting districts of northern England. Thorax, 51, 169–174.PubMedCrossRefGoogle Scholar
  28. Doll, R.,& Peto, R. (1981). The causes of cancer: Quantitative estimates of avoidable risks of cancer in the United States today. New York: Oxford University Press.Google Scholar
  29. Donham, K. J.,& Mutel, C. R (1982). Agricultural medicine: The missing component of the rural health movement. Journal of Family Practice, 14, 511.Google Scholar
  30. Donham, K., Haglind, P., Peterson, Y., Rylander, R.,& Belin L. (1989). Environmental and health studies of farm workers in Swedish swine confinement buildings. British Journal of Industrial Medicine, 46, 31–37.PubMedGoogle Scholar
  31. do Pico, G. A. (1996). Lung (agricultural/rural).Otolaryngol Head and Neck Surgery, 114 (2), 212–216.CrossRefGoogle Scholar
  32. do Pico, G. A., Raddan, W., Tsiatis, A., Peters, M. E.,& Rankin, J. (1984). Epidemiologic study of clinical and physiologic parameters in grain handlers of northern United States. American Review of Respiratory Diseases, 130, 759–765.Google Scholar
  33. Dosmon, J. A., Graham, B. L., Hall, D., VanLoon, P., Bhasin, P.,& Froh, F. (1987). Respiratory symptoms and pulmonary function in farmers. Journal of Occupational Medicine, 29, 38–43.Google Scholar
  34. Dottl, S. L.,& Greenley, J. R. (1997). Rural–urban differences in psychiatric status and functioning among clients with severe mental illness. Community Mental Health Journal, 33 (4), 311–332.PubMedCrossRefGoogle Scholar
  35. Farrow, D. C., Hunt, W. C.,& Samet, J. M. (1992). Geographic variation in the treatment of localized breast cancer. New England Journal of Medicine, 326, 1097–1101.PubMedCrossRefGoogle Scholar
  36. Fortney, J. C., Lancaster, A. E., Owen, R. R.,& Zhang, M. (1998). Geographic market areas for psychiatric and medical outpatient treatment. Journal of Behavioral Health Services and Research, 25 (1), 108–116.PubMedCrossRefGoogle Scholar
  37. Franklin, G. M.,& Nelson, L. M. (1993). Chronic neurologic disorders. In R. C. Brownson, P. L. Remington,& J. R. Davis (Eds.), Chronic disease epidemiology and control (pp. 307–336 ). Washington, DC: American Public Health Association.Google Scholar
  38. Furnival, C. M. (1997). Breast cancer in rural Australia. Medical Journal of Australia, 166 (1), 25–26.PubMedGoogle Scholar
  39. Ganguli, M., Mulsant, B., Richards, S., Stoehr, G.,& Mendelsohn, A. (1997). Antidepressant use over time in a rural older adult population: The Mo VIES project. Journal of the American Geriatrics Society, 45 (12), 1501–1503.PubMedGoogle Scholar
  40. Garg, S. K., Mishra, V. N., Bhatnagar, M., Singh, R. B., Srivastava, R. B.,& Garg, A. (1986). Chronic illness among rural population. Indian Journal of Medical Sciences, 42 (3), 60–62.Google Scholar
  41. Garrett, J. E. (1997). Health service accessibility and deaths from asthma. Thorax, 52 (3), 205–206.PubMedCrossRefGoogle Scholar
  42. Goldring, J. M., James, D. S.,& Anderson, H. A. (1993). Chronic lung diseases. In R. C. Brownson, P. L. Remington,& J. R. Davis (Eds.), Chronic disease epidemiology and control (pp. 169–198 ). Washington, DC: American Public Health Association.Google Scholar
  43. Gorell, J. M., Johnson, C. C., Rybicki, B. A., Peterson, E. L.,& Richardson, R. J. (1998). The risk of Parkinson’s disease with exposure to pesticides, farming, well water, and rural living. Neurology, 50 (5), 1346–1350.PubMedCrossRefGoogle Scholar
  44. Hall, K., Gureje, O., Gao, S., Ogunniyi, A., Hui, S. L., Baiyewu, O., Unverzagt, R W., Oluwole, S.,& Hendrie, H. C. (1998). Risk factors and Alzheimer’s disease: A comparative study of two communities. Australian & New Zealand Journal of Psychiatry, 32 (5), 698–706.Google Scholar
  45. Harvei, S., Tretli, S., Langmark, E (1996). Cancer of the prostate in Norway, 1957–1991: A descriptive study. European Journal of Cancer, 32A (1), 111–117.CrossRefGoogle Scholar
  46. He, J., Klag, M. J., Wu, Z., Qian, M. C., Chen, J. Y., Mo, P. S., He, Q. O.,& Whelton, P. K. (1996) Effect of migration and related environmental changes on serum lipid levels in southwestern Chinese men. American Journal of Epidemiology, 144(9), 839848.Google Scholar
  47. Hicks, L. L. (1992). Access and utilization; special populations–special needs. In L. A. Straub & N. Walzer (Eds.), Rural health care: Innovations in a changing environment (pp. 20–25 ). London: Praeger.Google Scholar
  48. Hilton, M. E. (1991). The demographic distribution of drinking patterns in 1984. In W. B. Clark & M. E. Hilton (Eds.), Alcohol in America: Drinking practices and problems (pp. 75–86 ). Albany, NY: State University of New York Press.Google Scholar
  49. Hingson, R., Scotch, N., Day, N.,& Culbert, A. (1980). Recognizing and seeking help for drinking problems: A study in the Boston metropolitan area. Journal of Studies on Alcohol, 41, 1102–1117.Google Scholar
  50. Hingson, R., Mangione, T., Meyers, A., Scotch, N. (1982). Recognizing and seeking help for drinking problems: A study in the Boston metropolitan area. Journal of Studies on Alcohol, 43 (3), 273–288.PubMedGoogle Scholar
  51. Hochberg, M. C. (1992) Arthritis and connective tissue diseases. In J. Thoene (Ed.), Physician’s guide to rare diseases (pp. 907–959 ). Montvale, NJ: Dowden.Google Scholar
  52. Howland, R. H. (1995). The treatment of persons with dual diagnoses in a rural community. Psychiatry Quarterly, 66 (1), 33–49.CrossRefGoogle Scholar
  53. Hubble, J. P., Cao, T., Hassanein, R. E., Neuberger, J. S.,& Koller, W. C. (1993). Risk factors for Parkinson’s disease. Neurology, 43 (9), 1693–1697.Google Scholar
  54. Ingram, D. O., Gillum, R. F. (1989). Regional and urbanization differentials in coronary heart disease mortality in the United States, 1968–1985. Journal of Clinical Epidemiology, 42, 857–868.PubMedCrossRefGoogle Scholar
  55. International Agency for Research on Cancer (IARC). (1980). An evaluation of chemicals and industrial processes associated with cancer in humans based on human and animal data. Cancer Research, 40, 1–12.Google Scholar
  56. Iverson, M., Dahl, R., Korsgaard, J., Hallas, T.,& Jensen, E. J. (1988). Respiratory symptoms in Danish fanners: An epidemiological study of risk factors. Thorax, 43, 872–877.Google Scholar
  57. Jones, A. P., Bentham, G. (1997). Health service accessibility and deaths from asthma in 401 local authority districts in England and Whales, 1988––1992. Thorax, 52, 218–222.PubMedCrossRefGoogle Scholar
  58. Jordon, C. M., Oei, T. P. S. (1989). Help–seeking behavior in problem drinkers: A review. British Journal of Addiction, 84, 979–988.Google Scholar
  59. Jordan, J. M., Linder, G. F., Renner, J. B., Fryer, J. G. (1995). The impact of arthritis in rural populations. Arthritis Care & Research, 8 (4), 242–250.CrossRefGoogle Scholar
  60. Kann, L., Warren, C. W., Harris, W. A., Collins. J. L., Williams, B. I., Ross, J. G.,& Kolbe, L. J. (1996). Youth risk behavior surveillance–United States, 1995. Journal of School Health, 66 (10), 365–377.CrossRefGoogle Scholar
  61. Kaplan, R. M., Alcaraz, J. E., Anderson, J. P.,& Weisman, M. (1996). Quality-adjusted life years lost to arthritis, effects of gender, race, and social class. Arthritis Care Research, 9 (6), 473–482.CrossRefGoogle Scholar
  62. Kaufman, J. S., Owoaje, E. E., James, S. A., Rotimi, C. N.,& Cooper, R. S. (1996). Determinants of hypertension in West Africa: Contribution of anthropometric and dietary factors to urban–rural and socioeconomic gradients. American Journal of Epidemiology, 143 (12), 1203–1218.PubMedCrossRefGoogle Scholar
  63. Kaur, B., Anderson, H. R., Austin, J., Burr, M., Harkins, L. S., Strachan, D. E,& Warner, J. O. (1998). Prevalence of asthma symptoms, diagnosis, and treatment in 12–14 year old children across Great Britain. British Medical Journal, 316, 118–124.PubMedCrossRefGoogle Scholar
  64. Kay, K. (1974). Occupational cancer risks for pesticide workers. Environmental Research, 7, 243–271.CrossRefGoogle Scholar
  65. Keller–Byrne, J. E., Khuder, S. A.,& Schaub, E. A. (1997). Meta–analyses of prostate cancer and farming. American Journal of Industrial Medicine, 31 (5), 580–586.Google Scholar
  66. Kelsey, J. L,& Hochberg, M. C. (1988). Epidemiology of chronic musculoskeletal disorders. Annual Review of Public Health, 9, 379–401.PubMedCrossRefGoogle Scholar
  67. Kronqvist, M., Johansson, E., Pershagen, G., Johansson, S. G.,& van Hage–Hamsten M. (1999). Increasing prevalence of asthma over 12 years among dairy farmers on Gotland, Sweden: Storage mites remain dominant allergens. Clinical & Experimental Allergy, 29 (1), 35–41.CrossRefGoogle Scholar
  68. Labarthe, D. R., Eissa, M.,& Varas, C. (1991). Childhood precursors of high blood pressure and elevated cholesterol. Annual Review of Public Health, 12, 519–541.PubMedCrossRefGoogle Scholar
  69. Lantz, P. M., Weigers, M. E.,& House, J. S. (1997). Education and income differentials in breast and cervical cancer screening. Policy implications for rural women. Medical Care, 35 (3), 219–236.PubMedCrossRefGoogle Scholar
  70. Larson, O. F. (1978). Values and beliefs of rural people. In T. R. Ford (Ed.), Rural USA: Persistence and change (pp. 33–35 ). Ames: Iowa State University Press.Google Scholar
  71. Lauer, K.,& Fimhaber, W. (1985). Epidemiological investigations into multiple sclerosis in Southern Hesse: The influence of urban and rural environment on disease risk. Acta Neurologica Scandinavica, 72, 403–406.Google Scholar
  72. Lensky, P. (1979). Geographical disproportions of multiple sclerosis in Czechoslovakia. Geographia Medica, 9, 1–7.PubMedGoogle Scholar
  73. Link, B.,& Dohrenwend, B. P. (1980). Formulation of hypotheses about the ratio of untreated to treated cases in the true prevalence studies of functional psychiatric disorders in adults in the United States. In B. D. Dohrenwend & B. S. Dohrenwend (Eds.), Mental illness in the United States: Epidemiological estimates (pp. 1–161 ). New York: Praeger Special Studies.Google Scholar
  74. Mental illness in the United States: Epidemiological estimates (pp. 1–161). New York: Praeger Special Studies.Google Scholar
  75. Logan, T. K., Schenck, J. E., Leukefeld, C. G., Meyers, J.,& Allen, S. (1999). Rural attitudes, opinions, and drug use. Substance Use Misuse, 34 (4&5), 545–565.CrossRefGoogle Scholar
  76. Masala, G., Di Lollo, S., Picoco, C., Crosignani, P., Demicheli, V., Fontana, A., Funto, I., Miligi, L., Nanni, O., Papucci, A., Ramazzotti, V., Rodella, S., Stagnaro, E., Tumino, R., Vigano, C., Seniori Costantini, A.,& Vineis, P. (1996). Incidence rates of leukemias, lymphomas, and myelomas in Italy: Geographic distribution and NHL histotypes. International Journal of Cancer, 68 (2), 156–159.CrossRefGoogle Scholar
  77. McBride, D. C., Mutch, P. B., Kilcher, C., Inciardi, J. A., McCoy, H. V.,& Pottieger, A. E. (1996). Barriers to treatment among crack–dependent and other drug–abusing inner city women. In D. D. Chitwood, J. E. Rivers & J. A. Inciardi (Eds.), The American Pipe Dream, Crack, Cocaine, and the Inner City (pp. 7–10 ). Ft. Worth, TX: Harcourt Brace.Google Scholar
  78. Metsch, L. R.,& McCoy, C. B. (1999). Drug treatment experiences: Rural and urban comparisons. Substance Use & Misuse, 34 (4&5), 763–784.PubMedCrossRefGoogle Scholar
  79. Miller, F. T. (1982). Emergency crisis services in rural mental health centers. In P. A. Keller & J. D. Murray (Eds), Handbook of rural community mental health (pp. 1–230 ). New York: Human Science Press.Google Scholar
  80. Miller, A. B. (1992). Planning cancer control strategies. In Health and Welfare (Eds.), Chronic diseases in Canada. Vol. 13, No. 1. Toronto, Ontario: Health and Welfare.Google Scholar
  81. Mintzer, C. L., Culp, J.,& Puskin, D. S. (1992). Health care reform: What it means for rural America.Rockville, MD: National Advisory Committee on Rural Health, Office of Rural Health Policy.Google Scholar
  82. Morgan, D. C., Smyth, J. T., Lister, R. W., Pethybridge, R. J., Gilson, J. C. Callaghan, P.,& Thomas, G. O. (1975). Chest symptoms in farming communities with special reference to farmer’s lung. British Journal of Industrial Medicine, 32, 228–234.PubMedGoogle Scholar
  83. Murray, J. D.,& Keller, P. A. (1991). Psychology and rural America. American Psychologist, 46(3), 220231.Google Scholar
  84. Mushak, E. W.,& Piver, W. T. (1992). Agricultural chemical utilization and human health. Environmental Health Prospectives, 97, 269–274.Google Scholar
  85. National Center for Health Statistics. (1994). Current estimates from the National Health Interview Survey, 1992. Vital & Health Statistics Series 10: Data from the National Health Survey, 10, 189.Google Scholar
  86. National Longitudinal Study of Adolescent Health. (1989). MMWR, 38 (9), 147–149.Google Scholar
  87. Neutel, C. I. (1980). Multiple sclerosis and the Canadian climate. Journal of Chronic Diseases, 33, 47–56.PubMedCrossRefGoogle Scholar
  88. Office of Technology Assessment. (1990). Health care in rural America (OTA–H–434). Washington, DC: U. S. Government Printing Office.Google Scholar
  89. Paradiso, G., Tripoli, J., Galicchio, S.,& Fejerman, N. (1999). Epidemiological, clinical, and electrodiagnostic findings in childhood Guillain–Barre syndrome: A reappraisal. Annals of Neurology, 46 (5), 701–707.PubMedCrossRefGoogle Scholar
  90. Pearson, T. A.,& Lewis, C. (1998). Rural epidemiology: Insights from a rural population laboratory. American Journal of Epidemiology, 148 (10), 949–957.PubMedCrossRefGoogle Scholar
  91. Popp, W., Zwick, H., Steyrer, K., Rauscher, H.,& Wanke, T. (1989). Sensitization to aeroallergens depends on environmental factors. Allergy, 44, 572–575.PubMedCrossRefGoogle Scholar
  92. Poskanzer, D. C., Sheridan, J. L., Prenney, L. B.,& Walker, A. M. (1980). Multiple sclerosis in the Orkney and Shetland Islands. II. The search for an exogenous aetiology. Journal of Epidemiology Community Health, 34, 240–252.Google Scholar
  93. Pothier, P. (1991). Demythologizing rural mental health. Archives of Psychiatric Nursing, 5 (3), 119–120.PubMedCrossRefGoogle Scholar
  94. Powe, B. D.,& Weinrich, S. (1999). An intervention to decrease cancer fatalism among rural elders. Oncology Nursing Forum, 26 (3), 583–588.Google Scholar
  95. Proctor, M. H., Moore, L. L., Singer, M. R., Hood, M. Y., Nguyen, U. S.,& Ellison, R. C. (1996). Risk profiles for noncommunicable diseases in rural and urban schoolchildren in the Republic of Cameroon. Ethnicity & Disease, 6 (3–4), 235–243.PubMedGoogle Scholar
  96. Pruitt, B. E., Kingery, P. M., Mirzaee, E., Heuberger, G.,& Hurley, R. S. (1991). Peer influence and drug use among adolescents in rural areas. Journal of Drug Education, 21 (1), 1–11.PubMedCrossRefGoogle Scholar
  97. Puskar, K. R., Tusaie–Mumford, K., Sereika, S.,& Lamb, J. (1999). Health concerns and risk behaviors of rural adolescents. Journal of Community Health Nursing, 16 (2), 109–119.Google Scholar
  98. Rinne, U. K., Panelius, M., Kivalo, E., Hokkanen,& E., Palo, J. (1966). Distribution of multiple sclerosis in Finland with special reference to some geological factors. Acta Neurologica Scandinavica, 42, 385–399.Google Scholar
  99. Risser, D. R. (1996). Cancer incidence and mortality in urban versus rural areas of Texas: 1980–1985. Texas Medicine, 92 (1), 58–61.PubMedGoogle Scholar
  100. Robertson, E. B.,& Donnermeyer, J. F. (1997). Illegal drug use among rural adults, mental health consequences and treatment utilization. American Journal of Drug & Alcohol Abuse, 23 (3), 467–484.CrossRefGoogle Scholar
  101. Room, R. (1989). The U.S. general population’s experiences of responding to alcohol problems. British Journal of Addiction, 84 (11), 1291–1304.PubMedCrossRefGoogle Scholar
  102. Rost, K., Zhang, M., Fortney, J.,& Smith, J., Smith, G. R. (1998). Rural–urban differences in depression treatment and suicidality. Medical Care, 36 (7), 1098–1107.PubMedCrossRefGoogle Scholar
  103. Saag, K. G, Doebbeling, B. N., Rohrer, J. E., Kolluri, S., Mitchell, T. A.,& Wallace, R. B. (1998). Arthritis health service utilization among the elderly: The role of urban–rural residence and other utilization factors. Arthritis Care & Research, 11 (3), 177–185.CrossRefGoogle Scholar
  104. Schmidt, L. (1992). A profile of problem drinkers in public mental health services. Hospital and Community Psychiatry, 43, 245–250.PubMedGoogle Scholar
  105. Schneider, D.,& Greenberg, M. R. (1992). Death rates in rural America, 1939–1981. Convergence and poverty. In W. M. Gesler & T. C. Ricketts (Eds.), Health in rural North America. The geography of health care services and delivery (pp. 55–85 ). New Brunswick, NJ: Rutgers University Press.Google Scholar
  106. Schreinemachers, D. M., Creason, J. P.,& Garry, V. F. (1999). Cancer mortality in agricultural regions of Minnesota. Environmental Health Perspectives, 107 (3), 205–211.Google Scholar
  107. Schwartz, D. A. (1999). Etiology and pathogenesis of airway disease in children and adults from rural communities. Environmental Health Perspectives, 107 (3), 393–401.PubMedCrossRefGoogle Scholar
  108. Scott, J. C.,& Hochberg, M. C. (1993). Arthritis and other musculoskeletal diseases. In R. C. Brownson, P. L. Remington,& J. R. Davis (Eds.), Chronic disease epidemiology and control (pp. 285–306 ). Washington, DC: American Public Health Association.Google Scholar
  109. Shepherd, D. I.,& Downie, A. W. (1980). A further prevalence study of multiple sclerosis in northeast Scotland. Journal of Neurology Neurosurgery & Psychiatry, 43, 310–315.CrossRefGoogle Scholar
  110. Smith, C. A.,& Pratt, M. (1993). Cardiovascular disease. In R. C. Brownson, P. L. Remington,& J. R.Google Scholar
  111. Davis (Eds.), Chronic disease epidemiology and control (pp. 83–108). Washington, DC: American Public Health Association.Google Scholar
  112. Sommers, I. (1989). Geographic location and mental health services utilization among the chronically mentally ill. Community Mental Health Journal, 25 (2), 132–144.PubMedCrossRefGoogle Scholar
  113. Soweel, R. L.,& Christensen, P. (1996). HIV infection in rural communities. Nursing Clinics of North America, 31 (1), 107–123.Google Scholar
  114. Sridharan, R.,& Murthy, B. N. (1999). Prevalence and pattern of epilepsy in India. Epilepsia, 40(5), 631636.Google Scholar
  115. Stoodt, G.,& Lengerich, E. J. (1993). Reducing the burden of chronic disease in rural North Carolina. North Carolina Medical Journal, 54 (10), 532–535.Google Scholar
  116. Substance Abuse and Mental Health Services Administration. (1996). National Household Survey on Drug Abuse, 1995. Washington, DC: U.S. Department of Health and Human Services.Google Scholar
  117. Summer, L. (1991). Limited access: Health care for the rural poor. Washington, DC: Center on Budget and Policy Priorities.Google Scholar
  118. Swank, R., Lerstad, O., Strom, A.,& Backer, J. (1952). Multiple sclerosis in rural Norway–Its geographic and occupational incidence in relation to nutrition. New England Journal of Medicine, 246, 721–728.CrossRefGoogle Scholar
  119. Thistle, P. J.,& Chirenje, Z. M. (1997). Cervical cancer screening in rural populations of Zimbabwe. Central African Journal of Medicine, 43 (9), 246–251.Google Scholar
  120. Timmreck, T. C. (1988). An introduction to epidemiol– ogy ( 2nd ed. ). Sudbury, MA: Jones and Bartlett.Google Scholar
  121. Travis, S. S.,& McAuley, W. J. (1999). Preexisting medical conditions in adult day services: An examination of nonmetropolitan and metropolitan admissions. Journal of Gerontology, 54A(5), M262266.Google Scholar
  122. U.S. General Accounting Office. (1990). Rural drug abuse–Prevalence, relation to crime, and programs.Google Scholar
  123. Washington, DC: U.S. General Accounting Office.Google Scholar
  124. Verdes, F., Petrescu, A.,& Cernescu, C. (1978). Epidemiologic survey of multiple sclerosis in the Bucharest city and suburban area Acta Neurologica Scandinavica, 58(2), 109–120.Google Scholar
  125. Vingilis, E., Wade, T.,& Adlaf, E. (1991). What factors predict student self–rated physical health? Journal of Adolescent Psychiatry, 21 (1), 83–97.Google Scholar
  126. Vohlonen, I., Tupi, K., Terho, E. O.,& Husman, K. (1987). Prevalence and incidence of chronic bronchitis and farmer’s lung with respect to the geographical location of the farm and to the work of farmers. European Journal of Respiratory Diseases, 152 ( suppl.), 37–46.Google Scholar
  127. von Mutius, E., Illi, S., Nicolai, T.,& Martinez. E D. (1996). Relation of indoor heating with asthma, allergic sensitization, and bronchial responsiveness, survey of children in south Bavaria. British Medical Journal, 312, 1448–1450.CrossRefGoogle Scholar
  128. Voukiklaris, G. E., Kafatos, A.,& Dontas, A. S. (1996). Changing prevalence of coronary heart disease risk factors and cardiovascular diseases in men of a rural area of Crete: 1960 to 1991. Angiology, 47 (1), 43–49.PubMedCrossRefGoogle Scholar
  129. Wallace, R. E.,& Wallace, R. B. (1998). Rural–urban contrasts in elder health status: Methodologic issues and findings. In R. T. Coward & J. A. Krout (Eds.), Aging in rural settings: Life circumstances and distinctive features (pp. 67–840 ). New York: Springer.Google Scholar
  130. Warren, C. P. W., Holford–Strevens, V.,& Manfreda, J. (1987). Respiratory disorders among Canadian farmers. European Journal of Respiratory Diseases, 154 (suppl.), 10–14.Google Scholar
  131. Weinert, C,& Long, K. A. (1990). Rural families and health care: Refining the knowledge base. Marriage & Family Review, 15, 57.Google Scholar
  132. Weisner, C.& (1993). Toward an alcohol treatment entry model: A comparison of problem drinkers in the general population and in treatment. Alcoholism Clinical & Experimental Research, 17 (4), 746–752.CrossRefGoogle Scholar
  133. Weisner, C.,& Schmidt, L. (1992). Gender disparities in treatment for alcohol problems. Journal of the American Medical Association, 268(14), 18721876.Google Scholar
  134. Werneck, A. L.,& Alvarenga, H. (1999). Genetics, drugs and environmental factors in Parkinson’s disease. A case–control study. Arquivos de NeuroPsiquiatria, 57 (2B), 347–355.Google Scholar
  135. Wesseling, C, Antich, D., Hogstedt, C.,& Rodriguez, A. C., Ahlbom, A. (1999). Geographical differences of cancer incidence in Costa Rica in relation to environmental and occupational pesticide exposure. International Journal of Epidemiology, 28(3), 365374.Google Scholar
  136. Weston, W. W., Bell Brown, J.,& Stewart, M. A. (1989). Patient–centered interviewing. Part I. Understand–ing patients’ experiences. Canadian Family Physician, 35, 147–151.Google Scholar
  137. Whitehead, R., Chillag, S.,& Elliott, D. (1992). Anabolic steroid use among adolescents in a rural state. Journal of Family Practice, 34 (4), 401–405.Google Scholar
  138. Wilkstrom, J. (1975). Studies on the clustering of multiple sclerosis in Finland. II. Microepidemiology in one high–risk county with special reference to familial cases. Acta Neurologica Scandinavica, 51, 173–183.Google Scholar
  139. Willems, J. P., Saunders, J. T., Hunt, D. E.,& Schorling, J. B. (1997). Prevalence of coronary heart disease risk factors among rural blacks: A community–based study. Southern Medical Journal, 90(8), 814820.Google Scholar
  140. Wing, J. K. (1978). Schizophrenia: Towards a new synthesis. London: Academic Press.Google Scholar
  141. World Health Organization (WHO). (1977). ICD–9: International Classification of Disease, Ninth Revision. Geneva, Switzerland: World Health Organization.Google Scholar
  142. Yach, D., Myers, J., Bradshaw, D.,& Benatar, S. R. (1985). A respiratory epidemiologic survey of grain mill workers in Cape Town, South Africa. American Review of Respiratory Disease, 131, 505–510.Google Scholar
  143. Yawn, B. P., Yawn, R. A.,& Uden, D. L. (1992). Substance use in rural midwestern pregnant women. Archives of Family Medicine, 1 (1), 83–88.Google Scholar
  144. Yesalis, C. E. III, Lemke, J. H., Wallace, R. B., Kohout, F. J.,& Morris, M. C. (1985). Health status of the rural elderly according to farm work history: The Iowa 65+ rural health study. Archives of Environmental Health, 40, 245–253.Google Scholar
  145. Zejda, J. E., McDuffie, H. H.,& Dosman, J. A. (1993). Epidemiology of health and safety risks in agriculture and related industries: Practical applications for rural physicians. Western Journal of Medicine, 158 (1), 56–63.Google Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Leslie K. Dennis
    • 1
  • Stacie L. Pallotta
    • 2
  1. 1.Department of Epidemiology, College of Public HealthUniversity of IowaIowa CityUSA
  2. 2.Department of Epidemiology and Biostatistics, School of MedicineCase Western Reserve UniversityClevelandUSA

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