Rural Health 

“…the health of neither individuals nor populations occurs in a vacuum.  Instead, it is shaped by a wide range of factors…”

                        Institute of Medicine: the Future of Public’s Health in the 21st Century

The Geisinger Center for Health Research (GCHR) examines the role of social and community characteristics as determinants of health. Socioeconomic factors, social support systems, work conditions, social capital, and cultural traditions within communities are known to influence health and wellness.  GCHR researchers are engaged in policy, health services, and health intervention research that integrates the characteristics of community into research models.  Electronic health records and GIS databases are combined in a multilevel approach to understanding the connection between where people live and work and their health, health attitudes and behaviors.

Approximately 40% of Geisinger’s patient population resides in rural areas.  Rural residents tend to be older and have a lower SES.  Understanding mediators of health and disease among rural residence is a particular focus of interest.  The GCHR Rural Health Policy Institute specifically conducts rural health policy research, offering periodic advice to Pennsylvania state officials and legislatures. The Institute has led the way in developing a School Health Network to partner with local school systems to coordinate the health and wellness of school-aged children.

Individual Parent and School Factors Associated with Childhood Overweight

PI: Sharon Larson, PhD

Obesity among school-aged children in the region is high in comparison to national estimates.  Among children, ages 6 through 17 years old, with measured height and weight in the Geisinger electronic health records, approximately 24% were overweight or obese.  The highest prevalence was reported among children between 10 and 12 years old.  A study is currently underway to study the built and social environment of children with a healthy weight status as compared with children who meet the criteria for obesity.  This study is conducted using in-home visits with children and their caretakers and includes measures of physical activity, body composition of parents and children, dietary intake, inventory of electronic and video entertainment in the home, parent stress measures, and a child behavior checklist.   Additionally, hemoglobin A1C values have been assessed in children to evaluate current risk for Type 1 diabetes.  Children also wear accelerometers to capture physical activity for a one week period.  This is a pilot study.  Findings will be available at the conclusion of data collection.

School Health Index

PI: Sharon Larson, PhD

Most school districts have a wellness council or committee that works to establish health and safety policy within school districts.  Many of these emerged in response to regulatory requirements or through participation in federal programs to provide meals.  These wellness councils are a first step in developing coordinated health care for children.   The School Health Index (SHI) was developed by the Center for Disease Control to aid schools in assessing health policy and programming at the local school and school district level.  In partnership with the GCHR and the Rural Health Policy Institute 12 to 15 school districts have either completed the school health index or will complete the SHI by the end of 2008.  School districts surveyed serve populations from 12,800 to 67,000 and had student populations from 1700 to nearly 11,000.  All schools currently have a school wellness committee.  Poverty among families in these districts ranged from 2.6% to nearly 13% among families in the community.  Poverty status appears to be associated with full implementation of some school health policy. In preliminary evaluation of School Health Index data there appears to be a positive relationship between poverty in the community and implementation of some school health policy. As the proportion of families living in poverty increases, fewer school health policies related to nutrition, physical activity, and safety are fully implemented in school districts. Nutrition policy in most school districts prohibits the use of food as a reward.  However, no school district had a fully implemented policy to require fundraising supportive of healthy eating.  In this small sample of school districts the economic and demographic characteristics of the community do not appear to be associated with school breakfast/lunch nutrition policy in the school district.  Further analysis will be developed upon completion of currently scheduled school health assessments.

The Science of Play

PI: Sharon Larson, PhD

Childhood obesity has risen significantly in the past 30 years.  Current estimates suggest that as many as 1 out of every 4 children in this region meet height and weight criteria for obesity.  Researchers and child health experts suggest that this may be the result of increased ‘screen time’ and decreased physical activity and outdoor recreation.  This study measures estimated energy expenditure among school aged children while playing on a public playground.  Children wore Actigraph accelerometers for 30 minutes of play on three different types of playground equipment.  Accelerometry measures revealed that children expended twice as many calories and took more steps per minute when playing on the traditional post and platform equipment and on a new computerized playground apparatus than they expended on a ‘rope course’ type apparatus that did not require vertical movement.   Children spent about 70% of their playtime on post and platform and computerized apparatus at a moderate level of intensity activity, while children on the ‘rope course’ only spent about 22% of their time at the moderate intensity level.  There were no gender differences in steps or caloric expenditure after adjusting for weight and age.  Further studies will assess the relationship between reported frequency of outdoor park play and participation in extra-curricular sports activity with caloric expenditure and activity levels.

Health Locus of Control Impacts Exercise Response to Telemedicine in Urban and Rural Underserved Populations 

PI: Sharon Larson, PhD

Telemedicine (electronic communication between patient and provider) is an efficient means for information exchange regarding health care.  Differences between rural and urban populations’ response to telemedicine may be the function of differences regarding multidimensional health locus of control (MHLC).  This study evaluated the differential influence of MHLC exercise response to telemedicine between rural and urban CVD patients.  Participants were recruited from rural Pennsylvania and urban Philadelphia and randomized to a telemedicine or in-person contact group.  The Telemedicine group transmitted steps/day and received feedback.  Controls had no electronic communication.  Both groups had clinic visits during the 1-year follow-up.   Rural residents reported more steps walked and walked greater distances than urban residents after controlling for gender, age, race, and income level.  Among participants with higher scores in the "internal locus of control" subscale number of steps taken and distance walked was higher, while among those participants with higher scores in the "powerful others locus of control" subscale, there were fewer steps recorded and shorter distances walked. Increased health knowledge was associated with an increase in steps reported and distance walked but did not change the contribution made by locus of control.  MHLC was independent of residence and residence remained a significant predictor of physical activity.  Assignment to treatment or control group was not significantly related to distance walked.