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January/February 2003

Inside This Issue:

 

Center Awards $470,000 For Rural Research
January 2nd marked the start of the Center for Rural Pennsylvania's 2003 Grant Program and the onset of 10 grant and two mini-grant projects from researchers at the Pennsylvania State University and the State System of Higher Education (SSHE) universities.

The Center for Rural Pennsylvania's Board of Directors awarded about $470,000 to fund the projects. The seven Penn State faculty and five SSHE faculty members who were awarded the research grants will study a wide range of issues to provide data and policy information to the Pennsylvania General Assembly.

2003 Grant Projects
The Center for Rural Pennsylvania's traditional grant program offers a maximum funding level of $50,000 per project per year. A listing of grant awards under the Targeted and Open Topic categories are summarized below.

Targeted Topics
Recruitment and Retention of Volunteer Firefighters in Rural Pennsylvania
Pennsylvania's rural volunteer fire companies are experiencing difficulties in recruiting and retaining sufficient active members to respond to emergency calls. Dr. Robert D'Intino of Penn State University-Schuylkill Campus will evaluate proposed financial and motivational incentives to recruit and retain volunteers. His research will include an analysis of previous firefighter studies; telephone surveys of national and all state firefighting agencies; and interviews and focus groups with rural Pennsylvania volunteer firefighters.

The Future of Farming in Pennsylvania: An Investigation into the Needs and Concerns of Pennsylvania's Young Farmers
Dr. Jason Phillips of West Chester University will conduct a two-part study that will provide timely and accurate data regarding young Pennsylvania farmers. From the study, Dr. Phillips will provide information on how policymakers can help young farmers achieve long-term economic viability in farming.

Current and Changing Views of Rural Pennsylvania
As a follow-up to a 1999 survey of rural Pennsylvanians funded by the Center for Rural Pennsylvania, Dr. Fern Willits of Penn State University will conduct a study to determine any changes in attitudes toward various social issues. She will also use data from an attitudinal study conducted by PSU in 2000 to further assess the relationships of personal and contextual factors to current rural attitudes.

Adult Day Care in Rural Pennsylvania
Dr. Janet Melnick of Penn State University's Worthington Scranton Campus and a team of researchers will examine existing adult day services (ADS), quantitatively documenting service needs within Pennsylvania's rural regions. Gaps in service will be identified and the research will include a qualitative exploration of transportation and funding issues. A review of exemplary rural ADS programs will also be completed and policy recommendations made for the legislature's consideration.

The Effects of Bank Consolidation on Rural Pennsylvania
Dr. Martin Shields of Penn State University will quantify and describe the degree of bank consolidation in rural Pennsylvania.

An Examination of Pennsylvania's Oil and Gas Industry: A Memory in Need of Revival
Dr. Robert Vargo of California University of Pennsylvania will draw on a team of experts from academia and the oil and gas industry, with input from the Pennsylvania Geological Survey, to examine the status of the oil and gas industry in Pennsylvania compared to that of neighboring states. Findings will be drawn from comparisons of production data, trends in the numbers of producers and other indicators of industry growth, and the impacts of regulatory practices, environmental activism and economic incentives.

Is Bigger Better? Comparison of Rural School Districts
Dr. Wenfan Yan of Indiana University of Pennsylvania will compare fiscal, administrative and student achievement in rural counties of Pennsylvania that have either a single county-wide school district or multiple districts to those with similar size, population and economic conditions. The study will also describe the characteristics of superintendents' perceptions and practices towards current educational issues.

Building on Our Strengths: Workforce Development for the Pennsylvania Dairy Industry
The dairy industry is important to the economy of rural Pennsylvania, yet little information is available to enhance workforce development. Dr. Lisa Holden of Penn State University will gather data that is needed by employers, career counselors, and policy makers to positively affect workforce development of the dairy industry.

Open Topics
Public Health Infrastructure for Rural Pennsylvania
Dr. Alberto Cardelle of East Stroudsburg University will identify the financial and structural issues surrounding the development of local health departments (LHDs) in rural Pennsylvania and will then identify policy issues critical for the establishment of LHDs. He will develop viable models of LHDs that are suitable for rural counties as well as analyze state legislation, the structures and budgets of existing LHDs, and the demographic and budgetary characteristics of a sample of rural counties.

An Assessment of Community Watershed Organizations in Rural Pennsylvania
Dr. Francis Higdon of Penn State University will examine the formation, function and influence of community watershed organizations (CWOs) in rural Pennsylvania. In-depth interview data from 30 representative organizations will be gathered and research outcomes will focus on the formation processes affecting CWO growth; CWO needs, issues, activities, structure and effectiveness; the function of CWOs within the local context; and the influence of CWOs on environmental policy-making and watershed protection.

2003 Mini Grants
The Center's mini grant program offers a maximum funding level of $10,000 per project for a nine-month period. The two mini grant projects for 2003 are summarized below.

An In-Depth Analysis of Employment Dynamics for Former TANF Recipients
Dr. C. Nielsen Brasher of Shippensburg University will revisit an earlier Center for Rural Pennsylvania study of Temporary Assistance to Needy Families (TANF) recipients. Dr. Brasher will re-survey 282 former TANF recipients who were part of the earlier study to identify programs and policies Pennsylvania might use to help those who have left TANF. Through the research, Dr. Brasher plans to identify the challenges and barriers for former recipients who are unemployed or underemployed, and the reasons for success for those making above poverty wages.

Health and Nutrition of Migrant Farm Workers and Their Families
Dr. Katherine Cason of Penn State University will examine the nutrition and health status of migrant farm workers and their families through the collection of focus group and key informant data in Chester and Adams counties. The study may help to shape health policy, contribute to education programs, and provide the groundwork to develop a future statewide study of the migrant farm worker population.

Topics for 2004
As this year's grantees begin their projects, the Center for Rural Pennsylvania's Board of Directors is identifying topics for the 2004 Grant Program. The grant topics will address relevant issues impacting Pennsylvania's 2.8 million rural residents and may include the quality of affordable housing, Pennsylvania's meat packing industry and child obesity rates as they relate to nutrition, income and other factors.

After the topics have been identified, the Center will issue its Request for Proposals (RFP) in February.

While the Center's grant program is only available to faculty at SSHE and Penn State universities, the Center encourages cooperation and collaboration between these faculty and other public or private organizations.

For more information about the 2004 RFP or to receive a copy, call the Center at (717) 787-9555 or visit our website at www.ruralpa.org.

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Chairman's Message
Start at the end. That's usually the approach I take as I make the transition from one year to the next. At some point around the start of the New Year, I take a mental walk, or in some cases a quick sprint, back through the past year. The exercise usually helps me to get some perspective on my present condition and, probably more importantly, a better idea of how to approach the year, or even years, ahead.

Examining the past to understand the present is part of the idea behind a new series, called Trends in Rural Pennsylvania, that the Center for Rural Pennsylvania is introducing in this issue of the newsletter. The series will include nine separate articles, each detailing a specific rural issue and analyzing how that issue has evolved over the past decade. A more in-depth fact sheet will also be available on each issue.

The first in the series, which examines rural health care access and affordability, begins on page 4. If you would like to receive the more detailed fact sheet, just call or email the Center at the phone number or email address listed on this page.

As the past year came to a close, the Center's Board of Directors said goodbye to one of its original members, Dr. J. Dennis Murray of Mansfield University, who resigned his Board position. Dr. Murray was a strong guiding force of the Center over the past 15 years and a strong supporter of rural Pennsylvania in general. The Board will miss his insights and his presence, but we wish him well in his new endeavors.

As one of his last duties, Dr. Murray joined the Board in awarding seven researchers from Penn State University and five researchers from the State System of Higher Education universities more than $470,000 in research funds as part of the Center's 2003 Grant Program. The research projects touch on a wide range of issues and as the research results are presented to and accepted by the Board next year, we will be sure to share the information with you. Details about each project are provided in the cover story.

As you prepare your calendars for the months ahead, be sure to check out the Conferences section on page 7. Make special note of the conferences being offered by Pennsylvania Farm Link in March and Preservation Pennsylvania in April. Both promise to provide insightful information for rural Pennsylvanians who are interested in farming and heritage education, respectively.

As the New Year begins, let me take this opportunity to thank you for your support of the Center for Rural Pennsylvania over the past year and for the year ahead.

Representative Sheila Miller

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Trends in Rural Pennsylvania: Health Care Access and Affordability
Introduction
This issue of Rural Perspectives features the first in a new series of articles that focuses on trends in Rural Pennsylvania.

The "Trends" series will look at nine major areas of interest, which are based on the mandates outlined in the Center for Rural Pennsylvania's enabling legislation (Act 16 of 1987).

The areas of interest are: agriculture, economic development, local government capacity and fiscal stress indicators, transportation, sociodemographics, health care and human services, environment and natural resources, education, and the condition of existing local infrastructure.

We will examine the trends in each interest area from 1990 to 2000, or the best time period according to data availability, and will make comparisons between the rural and urban areas of our state.

A more detailed fact sheet on each featured topic will also be available upon request by calling or emailing the Center for Rural Pennsylvania.

Background
The health care delivery system is important to the overall economic and community viability of rural Pennsylvania. Integral to this system is the availability of health care professionals and the affordability of services. Over the past few years, personnel shortages and insurance costs have been important topics for discussion. Even today, the impact of nursing shortages and malpractice insurance on health care availability and accessibility has yet to be determined.

To better understand the issues, the Center for Rural Pennsylvania analyzed data on health care providers and health insurance participation rates. The analysis shows a slight increase in the number of medical personnel over the last decade and a slight increase in health insurance participation rates.

Since 1994, for example, there has been a 15 percent increase in the per capita number of rural doctors, and health insurance participation rates throughout Pennsylvania increased about 3 percentage points.

Total Docs
Of the commonwealth's 41,500 doctors, 10 percent practice in rural counties, serving 21 percent of the state's total population. The remaining 90 percent of physicians serve the 79 percent of the population living in urban counties.

Pennsylvania's 42 predominantly rural counties share 4,194 doctors for an average of about 100 doctors per county. The number of rural doctors increased by 31 percent between 1989 and 1999. Per capita, in 1999, there were 162 rural doctors for every 100,000 residents: that was an increase of 24 percent since 1989. In 1999, the per capita urban rate was 385 doctors for every 100,000 residents. Across the United States, there were 227 physicians for every 100,000 residents in 1998.

Doc Types
Nearly half, or 1,974, of all rural doctors are primary care physicians, including family and general practice physicians, obstetricians/gynecologists (OB/GYNs), pediatricians, and general internal medicine physicians. About half of all primary care physicians, or 996, are family and general practice physicians. The 213 OB/GYNs and 198 pediatricians each make up about 10 percent of rural primary care doctors. An average of five of each of these last two types of doctors practice in a rural county compared to the 80 that practice in an urban county.

From 1989 to 1999, there was a 58 percent growth in the number of primary care physicians in Pennsylvania, which translates to a growth of 49 percent per capita. While there were only 51 primary care physicians per 100,000 rural residents in 1989, there were 76 in 1999. This new higher rate still remains much lower than the urban rate of 153, however.

Only 12 percent of the state's primary care physicians practice in rural counties, just slightly better than the 10 percent of total doctors. In 1999, 47 percent of all rural doctors were primary care physicians, while only 39 percent were primary care physicians in 1989.

Ten percent of the commonwealth's OB/GYNs practice in rural counties. That's 21 OB/GYNs for every 100,000 adult females, compared to 47 for every 100,000 adult females in urban counties.

Rural pediatricians are almost as rare at 32 for every 100,000 children. In urban counties there are 94 pediatricians for every 100,000 children. Just 8 percent of the statewide total operate in rural Pennsylvania; the lowest percent of any of the medical professionals in this study. This means that 8 percent of pediatricians serve 21 percent of the state's children.

Dentists are also concentrated in urban areas. Rural Pennsylvania has 1,154 dentists or 14 percent of the state's total number of dentists, who are asked to serve more than 20 percent of the state's population.

Health Care Infrastructure
The Census Bureau's 1999 County Business Patterns shows that employment in the Health Care and Social Services sector was at 110,541 in rural Pennsylvania. Nearly 15 percent of rural employment was in this sector, which includes ambulatory health care services, hospitals, nursing and residential care facilities, and social assistance.

Pennsylvania Department of Health data show that rural Pennsylvania had just two fewer hospitals from 1990 to 2000, a very small drop from 58 to 56. The number of beds set up and staffed, however, fell by more than 30 percent from 8,776 to 6,038. Over the same period, hospital admissions also fell by 8 percent to 247,336.

The number of rural county nursing homes has increased slightly between 1996 and 1999 from 199 to 204. The number of nursing home beds decreased by less than 1 percent to 22,087.

On a per capita basis, rural counties fared better than their urban counterparts in terms of the number of hospitals, nursing homes, and nursing home beds but not the number of hospital beds.

Health Insurance
According to the Census, since 1993 about 10 percent of Pennsylvanians had no health insurance coverage. In 2000, the rate fell to 7.6 percent. Meanwhile, the national rate has consistently been about 6 percentage points higher than Pennsylvania's or 14 percent in 2000. About 72 percent of Pennsylvanians had employment-based health coverage compared to 64 percent for the nation.

According to the Census's Current Population Survey (1999 to 2001, based on a three-year annual average), about 33 percent of Pennsylvania's children live at or below 200 percent of poverty and of those, 4.3 percent have no health insurance. The number of children with health insurance has been steadily improving since 1993, however, and progress may be attributed in part to the Children's Health Insurance Program (CHIP), which increased enrollment of eligible children by nearly 75 percent in the three years between September 1998 and 2001 from 65,500 to nearly 114,000. In rural counties, the increase was even greater at almost 85 percent.

Summary
Although access to medical professionals in Pennsylvania's rural counties continues to lag behind urban areas, it has improved. Rural health care is a target for both state and federal government funds. Not only is the number of providers increasing but also the diversity in the types of providers.

There remain, however, a number of challenges. The rural population is aging faster than the urban population. With this phenomenon, it becomes increasingly critical to address the gap in the number of hospital beds and to continue focusing on the delivery of hospital and nursing home care.

Want more info?
For the fact sheet, Trends in Rural Pennsylvania: Health Care, call the Center for Rural Pennsylvania at (717) 787-9555 or email info@ruralpa.org.

Sources
Rural counties are defined as those whose population is more than 50 percent rural according to the 1990 Census, the most current rural designation being used by the Center for Rural Pennsylvania.

The 1999 physician data is from the Pennsylvania State-Wide AHEC Provider Atlas, 2000, a product of the Pennsylvania Office of Rural Health, which includes a compilation of files of the American Medical and American Osteopathic Associations and the Pennsylvania Department of State's Bureau of Professional and Occupational Affairs. Counts include only active physicians and those engaged in non-clinical activities.

National data comes from the U.S. Department of Health and Human Services for 1998. Both Pennsylvania and United States data include Federal and non-Federal physicians.

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Update Census 2000: Wrapping It Up
Since most Census 2000 data has been released, it's time to wrap up our Census 2000 Update series in Rural Perspectives. All the Census data is now available - and what's left to come is more useful versions and cross tabulations. This spring we should see the release of the Summary File 4 (SF4), which includes socio-economic data crossed by race and ethnicity. Also scheduled for release in 2003 are: a migration file useful for tracking the "brain drain/brain gain" and other such trends; a commuting patterns file showing where residents of each municipality work; and a file with all demographic and socio-economic data by school district.

An additional feature will be added to the Census Bureau's web-based American FactFinder program. This feature will use the entire Census 2000 data set and will allow users to combine any variables for any geography down to the Census tract (with provisions to protect confidentiality).

For more Census 2000 information, visit the U.S. Census Bureau's website at www.census.gov or call the Center for Rural Pennsylvania at (717) 787-9555.

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Board Bids Farewell to Longstanding Member
At its November meeting, the Center for Rural Pennsylvania's Board of Directors bid farewell to Dr. J. Dennis Murray of Mansfield University. Dr. Murray, who submitted his resignation from the Board effective January 2003, has been a member of the Board since the Center for Rural Pennsylvania's inception in 1987. He most recently served as Vice Chairman.

The Board presented Dr. Murray with a plaque to commemorate his longstanding service.


Pictured from left to right: Dr. Robert Pack, Rep. Sheila Miller, Dr. Murray, Sen. Mary Jo White, Jody Bruckner, Rep. Mike Hanna, Dr. Stephan Goetz and Dr. C. Shannon Stokes.

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Businesses Encouraged to Complete Economic Census
"Indispensable to understanding America's economy." That's how Federal Reserve Board Chairman Alan Greenspan describes the Economic Census, which is now underway. The Economic Census provides the foundation for reports on hundreds of industries and data for states, counties and places. Businesses, communities, and governments use the data for planning and market development.

In December, the U.S. Census Bureau sent questionnaires to about 210,000 Pennsylvania businesses, launching the 2002 Economic Census, which is taken every five years. According to Greenspan, the Economic Census "assures the accuracy of the statistics we rely on for sound economic policy and for successful business planning."

Completed census forms are due February 12, 2003. Businesses that receive a form are required by law (Title 13, U.S. Code) to respond.

For help with or questions about the forms, visit the Census Bureau's help site at www.census.gov/econhelp or call the toll-free help line at (800) 233-6136. The help line is open Monday through Friday, 8 a.m. to 8 p.m.

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Did you Know . . .

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Just the Facts: Extracurricular Activities
What students do after school is as important as what they do during school. Extracurricular activities are important components of a well-rounded educational experience since students can apply what they learn in the classroom to their experiences outside of the classroom.

Data from the Pennsylvania Department of Education shows that during the 2000/2001 school year, rural school districts spent about $57.2 million on extracurricular activities, which include athletics, such as football, soccer, baseball, and basketball, and other activities such as theatre, band, student council and clubs. While each school district is different, schools often use revenue from a variety of sources, such as ticket sales, fundraisers and the school's general fund, to support these activities.

On a per-student basis, rural districts spent more on extracurricular activities than urban districts. During the 2000/2001 school year, rural schools spent an average of $142 per student; urban schools spent an average of $131 per student. Most of the extracurricular money spent in rural districts (76 percent) went for athletics. Among urban schools, 67 percent of extracurricular expenditures went to athletics.

Among rural school districts, however, there are differences in how much schools spend for extracurricular activities. About 12 percent of the rural districts spent less than $100 per student, while nearly 16 percent spent more than $200 per student. The districts that spent less than $100 per student for extra curricular activities also spent less on education. For example, the average expenditures per student in these districts were $840 less than districts that spent more than $200 on extracurricular activities. A possible reason why these districts spend less is fewer resources: total taxes collected per student in these districts were nearly $570 below the higher spending rural districts.

Does spending on extracurricular activities have an impact on rural students? Statistically speaking, there are only weak correlations between spending on these activities and test results and dropout rates. There is, however, a significant correlation between district expenditures and postsecondary participation rates.

 

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