Indiana University-Purdue University Indianapolis (IUPUI) / According to the US government, nearly 1 in 5 Americans live in rural areas. In
general, rural Americans have poor health outcomes, including higher rates of chronic
disease, mental illness and certain types of substance use. A variety of different methods
are used to assess rurality in health services research, making it challenging to precisely
quantify the prevalence of mental illness and substance use in this population, as well as
compare study conclusions. As policymakers become increasingly interested in
addressing health disparities between urban and rural populations, it is important to
assess and evaluate the different methods used to define rurality itself and determine how
those methods affect estimates of depression and substance use, so that true disparities
can be accurately captured and addressed.
This dissertation will identify current definitions and methods used to measure
rurality among published studies and then employ various identified methods to quantify
the effect of measurement choice on prevalence of mental illness and substance use in
rural populations. The dissertation will follow a three publishable paper model that will
include a literature review and two empirical studies using secondary data as described
below. For Paper 1, I identify peer-reviewed studies from HSR journals that use any
method to measure rurality in their analysis. I analyze whether geographic units and
methods used to classify rurality differ by focus area including costs, quality, and access
to care. For paper 2, I quantify the impact of different measurements of rurality have on
estimates for hospitalizations for depression and substance use. Using 5 different measurements of rurality, I calculate the levels of agreement as well as examine how
characteristics of patients with depression or substance use disorder differ based on the
definition of rurality used. In paper 3, I examine differences in the relationship between
unmet mental health need and subsequent drug use in individuals with a history of
depression. Using the National Survey on Drug Use and Health and a pooled crosssectional
study design, I examine drug use by alcohol, marijuana, and prescription opioid
use. Additionally, I compare self-medication and substance use in individuals by
geographic location.
| Identifer | oai:union.ndltd.org:IUPUI/oai:scholarworks.iupui.edu:1805/27255 |
| Date | 12 1900 |
| Creators | Danek, Robin Lynn |
| Contributors | Menachemi, Nir, Blackburn, Justin, Greene, Marion, Mazurenko, Olena |
| Source Sets | Indiana University-Purdue University Indianapolis |
| Language | en_US |
| Detected Language | English |
| Type | Dissertation |
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