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Study: Rural disease response should differ from urban areas

By Sarah Green | June 18, 2009

Image courtesy of K-State College of Engineering

A graph showing one rural resident, represented in the center, and all of the people that person is connected with, represented by nodes radiating from the center.

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Rural and small-town neighbors help one another through sickness and other problems. That can be a strength and a weakness during an infectious disease outbreak, according to a recent study by Kansas State University researchers.

If those volunteer caregivers aren’t careful, they could carry the disease from one person to another or catch it themselves.

Health officials should keep those neighborly rural traits in mind when crafting epidemic-response plans, said Caterina Scoglio, associate professor of electrical and computer engineering and one of the study’s leaders.

“Residents in rural areas have some priorities that need to be taken into account,” she said.

The findings didn’t surprise two local health department administrators, who said that taking care of sick neighbors and nearby family is a routine part of rural life.

“That’s what we do,” said DeAnn Appelhans, administrator for the Wallace County Health Department in Sharon Springs. “A large part of our county are family members who are related. But it doesn’t matter if they are related, or aren’t. We take care of each other here.”

Educating the public by reminding them to wash their hands and use good hygiene, Applehans said, is the best line of defense in a disease outbreak.

It’s common to think of epidemics striking large cities where many people live in close proximity and come into contact through public transportation or otherwise, the K-State researchers said.

But using mathematical models to map social networks in rural areas, the researchers found that members of rural communities are intricately connected in ways not always found in larger cities – their neighbors, for instance, may also be family members, which means they see each other often and for longer periods. They also watch out for one another and likely would do so regardless of a disease outbreak.

Surveys of residents in two rural Kansas towns showed that even in an epidemic, about 35 percent said they would continue to visit and care for friends, family and neighbors.

The closer relationships and the likelihood that community members spend more time together could increase the chance of infection and transmission to others, the researchers said.

The researcher’s findings were made possible by a $50,000 National Science Foundation “exploratory grant” that brought together engineers and social scientists, Scoglio said.

The recent outbreak of H1N1 influenza throughout the state has tested, to some extent, local public health responses to quick-spreading diseases and sparked new campaigns reminding Kansans to take better care of themselves, wash their hands, and avoid large crowds if they think they have an infectious disease. Public health officials have also warned that the H1N1 virus could have a dramatic impact on the upcoming flu season this fall and winter.

The K-State study could have ramifications for rural health officials as they plan their responses to the upcoming flu season, Scoglio said.

For example, certain populations at greater risk of catching the disease — typically the elderly, the very young, and health care workers — are already targeted to receive influenza vaccines. An additional group to consider might be those who have large social networks or are non-traditional caregivers, she said.

Also, rural residents may be more likely to be affected by zoonotic diseases – those that generate through animals on farms or in the wild and are spread to humans, such as the avian or “bird” flu and some forms of the so-called swine flu.

“Obviously there are main areas where epidemics can spread, such as big cities with a large population,” Scoglio said. “But we believe that people in rural areas are particularly vulnerable to the zoonotic diseases.”

The group will apply for more funding to further explore the role zoonotic diseases could play in rural areas, as well as how human behavior could change the spread of infectious diseases.

The study findings also suggest that a one-size-fits-all approach to controlling pandemics would be less likely to succeed than a plan tailored to a local community’s needs.

Rural health officials said they already stress education about how to avoid catching or spreading infections.

In Sharon Springs, Applehans said, that means posting reminders at the grocery store and post office, as well as longer, more informative pieces in the weekly newspaper – and understanding that word-of-mouth works faster than most any other means of communication.

“Education is the best thing I can do, period,” she said. “If we don’t have the education in place, there’s nothing else in the county that people will be able to use if something happens.”

Clay County Health Department Administrator Dana Rickley said the county has had a public health response plan in place for six years that involves the local hospital, emergency medical services, schools, and other local government leaders. The planners meet quarterly and on an as-needed basis to respond to emergencies, such as the recent H1N1 outbreak.

In addition to reminding people to take precautions and stay home when they’re sick, they also make a point to remind caregivers to take good care of themselves.

“We’re letting the community be responsible for themselves by staying home and using social distancing techniques to stay away from crowds,” she said. “But we’re not telling people who are well to stay away from the sick. We’re instructing them to wash their hands and use good hygiene, especially if they are providing the care.

“This is what small communities do to keep sick people out of stores. Their friends and neighbors bring over food. That’s common practice in this community.”

Also, Rickley said, peer pressure can be effective in rural communities.

“People will give dirty looks to those who aren’t covering their coughs,” she said.

“Smaller communities definitely need to understand that they function differently than large cities,” said Phillip Schumm, a K-State graduate electrical engineering student who worked on the project. “They have to consider adopting different strategies that won’t just work in Kansas City, but strategies that would be more accepted by people who live there.”

-Sarah Green is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. She can be reached at or at 785-233-5443, ext. 118.