Challenges of using nationally representative, population-based surveys to assess rural cancer disparities

Whitney E. Zahnd; Natoshia Askelson; Robin C. Vanderpool; Lindsay Stradtman; Jean Edward; Paige E. Farris; Victoria Petermann; Jan M. Eberth

doi:10.1016/j.ypmed.2019.105812

Challenges of using nationally representative, population-based surveys to assess rural cancer disparities

Whitney E. Zahnd, Natoshia Askelson, Robin C. Vanderpool, Lindsay Stradtman, Jean Edward, Paige E. Farris, Victoria Petermann, Jan M. Eberth

College of Nursing

Research output: Contribution to journal › Article › peer-review

15 Scopus citations

Abstract

Population-based surveys provide important information about cancer-related health behaviors across the cancer care continuum, from prevention to survivorship, to inform cancer control efforts. These surveys can illuminate cancer disparities among specific populations, including rural communities. However, due to small rural sample sizes, varying sampling methods, and/or other study design or analytical concerns, there are challenges in using population-based surveys for rural cancer control research and practice. Our objective is three-fold. First, we examined the characterization of “rural” in four, population-based surveys commonly referenced in the literature: 1) Health Information National Trends Survey (HINTS); 2) National Health Interview Survey (NHIS); 3) Behavioral Risk Factor Surveillance System (BRFSS); and 4) Medical Expenditures Panel Survey (MEPS). Second, we identified and described the challenges of using these surveys in rural cancer studies. Third, we proposed solutions to address these challenges. We found that these surveys varied in use of rural-urban classifications, sampling methodology, and available cancer-related variables. Further, we found that accessibility of these data to non-federal researchers has changed over time. Survey data have become restricted based on small numbers (i.e., BRFSS) and have made rural-urban measures only available for analysis at Research Data Centers (i.e., NHIS and MEPS). Additionally, studies that used these surveys reported varying proportions of rural participants with noted limitations in sufficient representation of rural minorities and/or cancer survivors. In order to mitigate these challenges, we propose two solutions: 1) make rural-urban measures more accessible to non-federal researchers and 2) implement sampling approaches to oversample rural populations.

Original language	English
Article number	105812
Journal	Preventive Medicine
Volume	129
DOIs	https://doi.org/10.1016/j.ypmed.2019.105812
State	Published - Dec 2019

Bibliographical note

Funding Information:
This publication was supported, in part, by the Cancer Prevention and Control Research Network, funded by the Centers for Disease Control and Prevention and the National Cancer Institute (3 U48 DP005000-01S2, University of South Carolina PI: Friedman, Authors: Zahnd, Eberth; 3 U48 DP005006-01S3, Oregon Health & Science University PI: Shannon and Winters-Stone, Author: Perry; 3 U48 DP005014-01S2, University of Kentucky PI: Vanderpool, Authors: Vanderpool, Stradtman, Edward; 3 U48 DP005013-01S1A3, 3 U48 DP005021-01S4, University of Iowa PI: Askelson, Author: Askelson, University of North Carolina PI: Wheeler, Author: Petermann). This study was also supported by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS) under cooperative agreement [5 U1CRH30539-03-00; Eberth, Zahnd]. The information, conclusions, and opinions expressed in this brief are those of the authors and no endorsement by FORHP, HRSA, NCI, CDC, or HHS is intended or should be inferred. Funders were not involved in the design, data collection, analysis, data interpretation, or submission of this manuscript. Publication of this supplement was supported by the Cancer Prevention and Control Network (CPCRN), University of North Carolina at Chapel Hill and the following co-funders: Case Western Reserve University, Oregon Health & Science University, University of South Carolina, University of Iowa, University of Kentucky, University of Pennsylvania and University of Washington.

Funding Information:
This publication was supported, in part, by the Cancer Prevention and Control Research Network, funded by the Centers for Disease Control and Prevention and the National Cancer Institute ( 3 U48 DP005000-01S2 , University of South Carolina PI: Friedman, Authors: Zahnd, Eberth; 3 U48 DP005006-01S3 , Oregon Health & Science University PI: Shannon and Winters-Stone, Author: Perry; 3 U48 DP005014-01S2 , University of Kentucky PI: Vanderpool, Authors: Vanderpool, Stradtman, Edward; 3 U48 DP005013-01S1A3 , 3 U48 DP005021-01S4 , University of Iowa PI: Askelson, Author: Askelson, University of North Carolina PI: Wheeler, Author: Petermann). This study was also supported by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS) under cooperative agreement [5 U1CRH30539-03-00; Eberth, Zahnd]. The information, conclusions, and opinions expressed in this brief are those of the authors and no endorsement by FORHP, HRSA, NCI, CDC, or HHS is intended or should be inferred. Funders were not involved in the design, data collection, analysis, data interpretation, or submission of this manuscript.

Publisher Copyright:
© 2019 Elsevier Inc.

Keywords

Cancer
Health care survey
Health status disparities
Rural health

ASJC Scopus subject areas

Epidemiology
Public Health, Environmental and Occupational Health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.ypmed.2019.105812

Cite this

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title = "Challenges of using nationally representative, population-based surveys to assess rural cancer disparities",

abstract = "Population-based surveys provide important information about cancer-related health behaviors across the cancer care continuum, from prevention to survivorship, to inform cancer control efforts. These surveys can illuminate cancer disparities among specific populations, including rural communities. However, due to small rural sample sizes, varying sampling methods, and/or other study design or analytical concerns, there are challenges in using population-based surveys for rural cancer control research and practice. Our objective is three-fold. First, we examined the characterization of “rural” in four, population-based surveys commonly referenced in the literature: 1) Health Information National Trends Survey (HINTS); 2) National Health Interview Survey (NHIS); 3) Behavioral Risk Factor Surveillance System (BRFSS); and 4) Medical Expenditures Panel Survey (MEPS). Second, we identified and described the challenges of using these surveys in rural cancer studies. Third, we proposed solutions to address these challenges. We found that these surveys varied in use of rural-urban classifications, sampling methodology, and available cancer-related variables. Further, we found that accessibility of these data to non-federal researchers has changed over time. Survey data have become restricted based on small numbers (i.e., BRFSS) and have made rural-urban measures only available for analysis at Research Data Centers (i.e., NHIS and MEPS). Additionally, studies that used these surveys reported varying proportions of rural participants with noted limitations in sufficient representation of rural minorities and/or cancer survivors. In order to mitigate these challenges, we propose two solutions: 1) make rural-urban measures more accessible to non-federal researchers and 2) implement sampling approaches to oversample rural populations.",

keywords = "Cancer, Health care survey, Health status disparities, Rural health",

author = "Zahnd, {Whitney E.} and Natoshia Askelson and Vanderpool, {Robin C.} and Lindsay Stradtman and Jean Edward and Farris, {Paige E.} and Victoria Petermann and Eberth, {Jan M.}",

note = "Funding Information: This publication was supported, in part, by the Cancer Prevention and Control Research Network, funded by the Centers for Disease Control and Prevention and the National Cancer Institute (3 U48 DP005000-01S2, University of South Carolina PI: Friedman, Authors: Zahnd, Eberth; 3 U48 DP005006-01S3, Oregon Health & Science University PI: Shannon and Winters-Stone, Author: Perry; 3 U48 DP005014-01S2, University of Kentucky PI: Vanderpool, Authors: Vanderpool, Stradtman, Edward; 3 U48 DP005013-01S1A3, 3 U48 DP005021-01S4, University of Iowa PI: Askelson, Author: Askelson, University of North Carolina PI: Wheeler, Author: Petermann). This study was also supported by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS) under cooperative agreement [5 U1CRH30539-03-00; Eberth, Zahnd]. The information, conclusions, and opinions expressed in this brief are those of the authors and no endorsement by FORHP, HRSA, NCI, CDC, or HHS is intended or should be inferred. Funders were not involved in the design, data collection, analysis, data interpretation, or submission of this manuscript. Publication of this supplement was supported by the Cancer Prevention and Control Network (CPCRN), University of North Carolina at Chapel Hill and the following co-funders: Case Western Reserve University, Oregon Health & Science University, University of South Carolina, University of Iowa, University of Kentucky, University of Pennsylvania and University of Washington. Funding Information: This publication was supported, in part, by the Cancer Prevention and Control Research Network, funded by the Centers for Disease Control and Prevention and the National Cancer Institute ( 3 U48 DP005000-01S2 , University of South Carolina PI: Friedman, Authors: Zahnd, Eberth; 3 U48 DP005006-01S3 , Oregon Health & Science University PI: Shannon and Winters-Stone, Author: Perry; 3 U48 DP005014-01S2 , University of Kentucky PI: Vanderpool, Authors: Vanderpool, Stradtman, Edward; 3 U48 DP005013-01S1A3 , 3 U48 DP005021-01S4 , University of Iowa PI: Askelson, Author: Askelson, University of North Carolina PI: Wheeler, Author: Petermann). This study was also supported by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS) under cooperative agreement [5 U1CRH30539-03-00; Eberth, Zahnd]. The information, conclusions, and opinions expressed in this brief are those of the authors and no endorsement by FORHP, HRSA, NCI, CDC, or HHS is intended or should be inferred. Funders were not involved in the design, data collection, analysis, data interpretation, or submission of this manuscript. Publisher Copyright: {\textcopyright} 2019 Elsevier Inc.",

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doi = "10.1016/j.ypmed.2019.105812",

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AU - Zahnd, Whitney E.

AU - Askelson, Natoshia

AU - Vanderpool, Robin C.

AU - Stradtman, Lindsay

AU - Edward, Jean

AU - Farris, Paige E.

AU - Petermann, Victoria

AU - Eberth, Jan M.

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PY - 2019/12

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N2 - Population-based surveys provide important information about cancer-related health behaviors across the cancer care continuum, from prevention to survivorship, to inform cancer control efforts. These surveys can illuminate cancer disparities among specific populations, including rural communities. However, due to small rural sample sizes, varying sampling methods, and/or other study design or analytical concerns, there are challenges in using population-based surveys for rural cancer control research and practice. Our objective is three-fold. First, we examined the characterization of “rural” in four, population-based surveys commonly referenced in the literature: 1) Health Information National Trends Survey (HINTS); 2) National Health Interview Survey (NHIS); 3) Behavioral Risk Factor Surveillance System (BRFSS); and 4) Medical Expenditures Panel Survey (MEPS). Second, we identified and described the challenges of using these surveys in rural cancer studies. Third, we proposed solutions to address these challenges. We found that these surveys varied in use of rural-urban classifications, sampling methodology, and available cancer-related variables. Further, we found that accessibility of these data to non-federal researchers has changed over time. Survey data have become restricted based on small numbers (i.e., BRFSS) and have made rural-urban measures only available for analysis at Research Data Centers (i.e., NHIS and MEPS). Additionally, studies that used these surveys reported varying proportions of rural participants with noted limitations in sufficient representation of rural minorities and/or cancer survivors. In order to mitigate these challenges, we propose two solutions: 1) make rural-urban measures more accessible to non-federal researchers and 2) implement sampling approaches to oversample rural populations.

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Challenges of using nationally representative, population-based surveys to assess rural cancer disparities

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

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