Legend and description for supplementary figure.

Supplementary Figure 1. Rural and Urban Counties in the United States by U.S. Census Region The Supplementary Figure indicates the rural and urban counties in the United States and indicates the states (Vermont, Maryland, Minnesota, and Kansas) that chose not to include their data in the North American Association of Central Cancer Registries public use dataset.

More than 46 million Americans live in rural areas, but rural populations remain relatively understudied in cancer disparities research. However, several analyses of multistate cancer registry data that describe the rural cancer incidence burden have been recently published. In light of this, our article aims to characterize the utility and generalizability of multistate, population-based cancer registry datasets for rural cancer surveillance research. First, we describe the accessibility, geographic coverage, available variables, and strengths and weaknesses of five data sources. Second, we evaluate two of these data sources—the North American Association of Central Cancer Registries (NAACCR) public use dataset (93% population coverage) and the Surveillance Epidemiology and End Results (SEER) 18 dataset (28% population coverage)—on their characterization of rural–urban cancer incidence rates and sociodemographic representation. The five data sources varied in geographic coverage and extent of available variables. SEER 18′s cancer rates sociodemographic representation differed from the more geographically representative NAACCR data. We suggest that SEER increase its geographic coverage to improve their generalizability and to take advantage of their utility to assess disparities along the cancer control continuum. We also suggest that non-SEER data sources be utilized more frequently to capitalize on their extensive geographic coverage. Cancer Epidemiol Biomarkers Prev; 27(11); 1252–60. ©2018 AACR.

Abstract Background: Cancer incidence and mortality rates in the United States are declining, but this decrease may not be observed in rural areas where residents are more likely to live in poverty, smoke, and forego cancer screening. However, there is limited research exploring national rural–urban differences in cancer incidence and trends. Methods: We analyzed data from the North American Association of Central Cancer Registries' public use dataset, which includes population-based cancer incidence data from 46 states. We calculated age-adjusted incidence rates, rate ratios, and annual percentage change (APC) for: all cancers combined, selected individual cancers, and cancers associated with tobacco use and human papillomavirus (HPV). Rural–urban comparisons were made by demographic, geographic, and socioeconomic characteristics for 2009 to 2013. Trends were analyzed for 1995 to 2013. Results: Combined cancers incidence rates were generally higher in urban populations, except for the South, although the urban decline in incidence rate was greater than in rural populations (10.2% vs. 4.8%, respectively). Rural cancer disparities included higher rates of tobacco-associated, HPV-associated, lung and bronchus, cervical, and colorectal cancers across most population groups. Furthermore, HPV-associated cancer incidence rates increased in rural areas (APC = 0.724, P < 0.05), while temporal trends remained stable in urban areas. Conclusions: Cancer rates associated with modifiable risks—tobacco, HPV, and some preventive screening modalities (e.g., colorectal and cervical cancers)—were higher in rural compared with urban populations. Impact: Population-based, clinical, and/or policy strategies and interventions that address these modifiable risk factors could help reduce cancer disparities experienced in rural populations. Cancer Epidemiol Biomarkers Prev; 27(11); 1265–74. ©2017 AACR.

The Patient Protection and Affordable Care Act (ACA), passed in 2010, is considered by many to be the most significant healthcare overhaul since the 1960s, but part of its promise - improvement of population health through requirements for non-profit hospitals to provide "community benefit" - has not been met. This paper examines the history of community benefit legislation, how community benefit dollars are allocated, and innovative practices by a few hospitals and communities that are addressing primarily non-medical factors that influence health such as social disadvantage, attitudes, beliefs, risk exposure, and social inequalities.

ABSTRACTBACKGROUNDSchools may be an effective avenue for interventions that prevent childhood obesity. I am Moving I am Learning/Choosy Kids© (IMIL/CK) is a curriculum recommended by Head Start (HS) for education in nutrition, physical activity, and healthy lifestyle habits.METHODSWe formed an academic‐community partnership (ACP), the Springfield Collaborative for Active Child Health, to promote prevention of childhood obesity, in part, to implement the IMIL/CK curriculum in local HS sites. The ACP included a medical school, HS program, public school district, and state health department.RESULTSCommunity‐based participatory research principles helped identify and organize important implementation activities: community engagement, curriculum support, professional teacher training, and evaluation. IMIL/CK was piloted in 1 school then implemented in all local HS sites. All sites were engaged in IMIL/CK professional teacher training, classroom curriculum delivery, and child physical activity assessments. Local HS policy changed to include IMIL/CK in lesson plans and additional avenues of collaboration were initiated. Furthermore, improvements in physical activity and/or maintenance or improvement of healthy weight prevalence was seen in 4 of the 5 years evaluated.CONCLUSIONSAn ACP is an effective vehicle to implement and evaluate childhood obesity prevention programming in HS sites.

Community-based participatory research (CBPR) is an effective way to address cancer disparities in medically underserved populations. Our research demonstrates how CBPR principles were used to develop lung cancer and risk factor mini reports for a network of community coalitions in the Illinois Delta Region, a predominately rural region with high lung cancer disparities in southern Illinois. An academic-community partnership, including a community-based medical school, state public health department, and a healthcare system, used CBPR principles to translate epidemiological, behavioral, and demographic data into understandable, comprehensive, yet concise mini reports for each coalition. A cyclical and iterative process was used to draft, revise, and optimize these mini reports to raise awareness about lung cancer disparities in the community and to provide information to help guide the development of interventions that address these disparities. The use of CBPR principles was a successful way to create mini reports about local lung cancer disparities and risk factors that were usable in individual communities. Local coalitions used the mini reports to educate community members at local meetings, to guide strategic planning, and to disseminate information through their respective websites. Additionally, the process of creating these reports built trust among academic-community partners and provided additional avenues of engagement, such as the involvement of an academic partner in the strategic planning process of a local coalition. Using CBPR processes is an effective way to translate epidemiological data into a community-friendly format to address cancer disparities.

Objective. To assess the gender-specific effect of socioeconomic disadvantage on obesity in elementary school students.Methods. We evaluated body mass index (BMI) data from 2,648 first-and fourth-grade students (1,377 male and 1,271 female students) in eight elementary schools in Springfield, Illinois, between 2012 and 2014. Other factors considered in analysis were grade level, year of data collection, school, race/ethnicity, gender, and socioeconomic disadvantage (SD). Students were considered SD if they were eligible for free/reduced price lunch, a school-based poverty measure. We performed Fisher's exact test or chi-square analysis to assess differences in gender and obesity prevalence by the other factors and gender-stratified logistic regression analysis to determine if SD contributed to increased odds of obesity.Results. A higher proportion of SD female students (20.8%) were obese compared to their non-SD peers (15.2%) (p = 0.01). Unadjusted and adjusted logistic regression analysis indicated no difference in obesity in SD and non-SD male students. However, in both unadjusted and adjusted analyses, SD female students had higher odds of obesity than their peers. Even after controlling for grade level, school, year of data collection, and race/ethnicity, SD female students had 49% higher odds of obesity than their non-SD classmates (odds ratio: 1.49; 95% confidence interval: 1.09-2.04).Conclusions. Obesity was elevated in SD female students, even after controlling for factors such as race/ethnicity, but such an association was not seen in male students. Further study is warranted to determine the cause of this disparity, and interventions should be developed to target SD female students. (C) 2015 Elsevier Inc. All rights reserved.

BACKGROUND:Commercial support for continuing medical education (CME) raises questions about potential conflict of interest. Current disclosure methods provide limited, general information about the nature and degree of support, such that potential conflict of interest cannot be studied by researchers or understood by physicians.SUMMARY:This article proposes a semiquantitative method for disclosure of commercial support for CME. The method includes a statement of the degree of support a program receives from all sources and an estimate of how revenue for the program compares to expenses. The new method would standardize the semiquantitative reporting of commercial support for CME programs.CONCLUSION:The proposed method for disclosing conflict of interest for CME events should facilitate the study and understanding of how commercial support affects these programs.

The internal medicine workforce in the United States consists of physicians, residents, and fellows, of which a substantial number are international medical graduates who come to the United States to do their residencies and fellowships and then remain for careers in practice, academia, or other areas. How internal medicine departments at medical schools are affected by the diversity of our trainees and faculty has not been reviewed extensively in the published literature, although it is a regular discussion subject among department and residency program leaders and faculty. This is a sensitive topic because discussions of issues pertaining to international graduates may seem to suggest underlying bias and intolerance. Furthermore, the topic may be overlooked because it gets little attention at the more prestigious medical schools that enroll mostly U.S. residents and fellows and have few international graduates on their faculty. In this commentary, I will summarize the demographic characteristics of the internal medicine workforce in the United States, consider how having substantial numbers of international graduates affects our departments, and conclude with a suggestion that the Alliance for Academic Internal Medicine (AAIM) formally address these and other related training and workforce issues.

Performance‐based examinations that use standardized‐patient (SP) cases have been used to assess the clinical competence of senior medical students in eight classes (1986 to 1993) at Southern Illinois University School of Medicine. Two or more (multiple) SPs have been used to simulate about half the cases in each examination. This study was conducted to assess the effect of multiple SPs on the intercase reliability of SP ratings of interpersonal and communication skills. In general, results showed little effect of multiple SPs on reliability of ratings of interpersonal and communication skills. For example, for ratings on overall patient satisfaction, the generalizability coefficient computed without including measurement error due to multiple SPs was .78, whereas the coefficient computed with measurement error due to multiple SPs included was. 73—suggesting that use of multiple SP raters on the same case reduced reliability by about .05. Similar results were obtained for ratings on the other dimensions. The magnitude of the effect on the reliability of ratings would not seem to present a serious psychometric concern.

A performance‐based examination consisting of standardized‐patient (SP) cases was given to all senior medical students in five classes at Southern Illinois University School of Medicine. Each class taking the examination consisted of about 70 students, so that each SP case had to be simulated a total of 70 times during the examination. Having 70 simulations of the same case by a given SP naturally raises questions about the ability of the SP to portray the case and to complete checklists consistently throughout the entire examination period. One concern is that, with repeated simulations, SPs might grow tired and become careless in portraying their respective cases and completing checklists, so that measurement error would increase throughout the examination. On the other hand, the practice gained with repeated simulations could increase the consistency of the simulations and checklist completions, so that measurement error would decrease throughout the examination. The present analysis, then, was undertaken to determine if intercase reliability was increasing or decreasing systematically throughout the examination period. In general, the results suggest that repeated simulations by SPs had little or no effect on the intercase reliabilities of the checklist or written examination scores.

Standardized‐patient (SP) cases have been used in a postclerkship examination to assess clinical competence of five classes of senior medical students at Southern Illinois University School of Medicine. Two or more (multiple) SPs have been used to simulate at least half the cases in each examination administered to date. The present studies were conducted to determine the effect of multiple SPs on intercase reliability. In Study 1, for each class, generalizability analyses were performed to determine the intercase reliabilities for cases using a single SP and for cases using multiple SPs. Study 2 was conducted to compare the intercase reliabilities of those few cases that were used in two different classes, simulated by single SPs in one class and by multiple SPs in the other. Study 3 was undertaken to determine directly by statistical analysis of the multiple‐SP cases only, the contributions of multiple SPs to measurement error and, hence, reliability. The results of all three studies showed little or no effect of multiple SPs on reliabilities of total, checklist, or written scores.

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