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In this commentary, we discuss our experiences as women of different races growing up in the same rural area and how these experiences relate to health and health policy. Despite nearly five million Black people living in nonmetro areas, rural Black Americans face erasure in the rural narrative and the policies enacted to support them. This is detrimental to the overall uplifting of rural communities and to the elimination of the compounded disparities of being rural and Black. We aim to bring to life rural America for Black and White residents and the impact of the policies that shape it.

Lesser health care access and utilization in rural areas are associated with ruralurban health outcome disparities. While some work has examined similar disparities by sexual orientation, little has explicitly explored the combined influences of rural residence and lesbian, gay, and bisexual (LGB) status. This study aims to explore literature specific to rural LGB health care access and utilization, identify gaps, and suggest future research. Several databases were searched to identify studies specific to LGB health care access and utilization, and 18 articles were identified and divided into two categories: barriers and facilitators to health care access. Barriers included provider training, discrimination, distance and physical access, and fewer social supports. The data also indicated that sexual orientation disclosure is associated with better health care. Rural sexual minority individuals undergo health care access and utilization inequities, even in excess of their heterosexual rural peers that may be addressed with training and social interventions. Further research is warranted.

To examined human papillomavirus (HPV) vaccination rates and identified factors that are associated with HPV vaccination among Native Hawaiian and Pacific Islander (NHPI) young adults aged 18-34.Data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey were analyzed. The outcome variables were HPV vaccination initiation (receipt of ≥1 dose) and completion (receipt of ≥3 doses). Multivariable logistic regressions were used to identify socio-demographic, healthcare access and utilization factors that were associated with HPV vaccination.A total of 663 adults were included in the study. The overall HPV vaccination initiation and completion rates were 17.6% and 7.9%, respectively. Most of the respondents who had initiated and completed the vaccine were women, of multiple race, un-married, had some college or associate degree, insured, and had a usual place of getting care. In the weighted multivariable models, men were less likely to initiate (AOR = 0.21, 95% CI = 0.12, 0.34) and complete (AOR = 0.16, 95% CI = 0.07, 0.34) the HPV vaccination compared with women.The low HPV vaccination coverage found in this study signals the need for more evidence-based, culturally relevant immunization and cancer prevention interventions for NHPIs. Failure to improve HPV vaccination rates may increase the burden of HPV associated preventable cancers among NHPIs and broaden disparities.

Purpose: County-level health departments (HD) have lead roles in COVID-19 response, with actions guided by 15 federal capabilities We sought to assess Illinois HD perception of preparation and ability to accomplish these, and how perceptions might vary by population size and rurality Methods: We attempted contact with all 96 certified HD (4/6-24/2020) and administered a survey asking 4 identical questions regarding each capability: 1) adequacy of past preparation (pastPreparation);2) current ability to accomplish (currAbility);3) sufficiency of current resources (Resources);and 4) sufficiency of local cooperation and support (Cooperation;all Likert 1-5) Rurality was assessed with Rural-Urban Continuum Codes (levels 1-9;stratified as metropolitan [1-3] and nonmetropolitan [4-9]);and population data obtained from the Census Bureau T-test, chi-square and regression analyses were conducted with SAS Results: We received 34 surveys representing 40/100 counties with HDs (11 metropolitan and 23 nonmetropolitan) Respondents/non-respondents did not differ by population or rurality Ave-currAbility (currAbility averaged across all 15 capabilities) was positively associated with population (+3 57E-6;p=0 027), and nonmetropolitan counties reported significantly lower ave-Cooperation (3 37 [95% CI 3 16-3 57] vs 3 93 [3 47-4 38]) For individual capabilities, nonmetropolitan HDs reported significantly lesser Resources for capabilities #2-Community Recovery, #3-Emergency Operation Coordination, and #5-Fatality Management;and lesser Cooperation for #2, #8 and #9-Medical Countermeasure and Material Dispensing, #10-Medical Surge, and #15-Volunteer Management Conclusions: Though metropolitan areas experience greater numbers of COVID-19 cases, many rural communities experience comparably high infection rates Though statewide HD response is critical, many nonmetropolitan HDs report comparatively lesser ability to meet this challenge