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PubMed2001

Information and socioeconomic factors associated with early breastfeeding practices in rural and urban Morogoro, Tanzania.

UNLABELLED: A cross-sectional study was undertaken in a rural and an urban area in Tanzania with the aim of identifying factors related to early infant feeding practices. The study included 320 mothers from each area with infants below 7 mo of age. A significant proportion of both rural and urban mothers had erroneous beliefs about infant feeding practices. None of the socioeconomic, demographic or biological variables studied were associated with feeding practices. Urban residence was positively associated with the duration of exclusive but not predominant breastfeeding. Better knowledge about specific breastfeeding issues was positively associated with the duration of both exclusive and predominant breastfeeding. Ownership of a radio was positively associated with both exclusive and predominant breastfeeding in the rural area. Although both rural and urban mothers had a high antenatal clinic attendance rate, 65% of the rural and 14% of the urban mothers delivered at home. Urban mothers informed about breastfeeding at the antenatal clinic had better feeding practices. CONCLUSION: We hypothesize that exclusive breastfeeding is not a traditionally recognized practice and thus its duration is mainly associated with information and knowledge about breastfeeding. This suggests that information programmes to provide knowledge, beginning at antenatal visits, may reduce premature complementation, though additional support may also be required.

Adult↗
PubMed2001

The health status of rural and urban ambulatory elderly in Taipei County.

BACKGROUND: To study the differences in the health status of rural and urban ambulatory elderly in Taipei County. METHOD: Non-compulsory general health check-up for elderly people over 65 years old in rural and urban areas. The content of the health examination included past medical history, health behavior, physical examination, laboratory examination, electrocardiogram and x-ray. Chi square test, t-test and logistic regression were applied for analysis. Risk factors relating to the cardiovascular system were included in the study. Gender differences affecting the prevalence of diseases and health behavior were also considered in the analysis. RESULTS: Significantly higher proportions of the rural elderly men smoked, drank alcohol, and had hypertension and impaired renal function. On the other hand, higher proportions of rural elderly women were obese and had diabetes, hypertension and renal impairment. The mean plasma glucose level of newly-diagnosed diabetic patients in the rural area was significantly higher than that in the urban area (p < 0.05). Diabetes, obesity, hypercholesterolemia and smoking were significantly associated with hypertension. The odds ratio for hypertension between rural and urban areas was 1.45 (p < 0.0001). The cardiovascular risk-rating score of rural elderly was statistically higher than that of urban elderly (p < 0.001). CONCLUSION: There were some minor differences in health status between urban and rural elderly. Health promotion should be varied according to the needs of various communities and various risk groups. Further studies should concentrate on prospective cohort research with well-defined determinants to evaluate whether cost-effective biopsychosocial intervention is necessary.

Aged↗
PubMed2002

Helpful or harmful? The impact of strategic change on the performance of U.S. urban hospitals.

OBJECTIVE: To contribute to the debate as to whether strategic change helps or harms organizations by empirically examining how strategic change influences performance change in urban hospitals. DATA SOURCES: AHA Annual Survey (1994 and 1996), Health Care Financing Administration's Medicare Cost Reports (1994 and 1996) and Medicare HMO Files (1994), U.S. Bureau of the Census' County Business Patterns Files (1994), and Area Resources File (1994). STUDY DESIGN: This work employed a longitudinal approach using a panel design to study the effect of environmental and organizational characteristics on urban hospital strategic behavior and performance. A path analytic model was used to examine the simultaneous effects of environmental and organizational characteristics (1994) on strategic behavior (change in strategies to enhance HMO business and change in strategies to control costs 1994-96), as well as the effects of all of these variables on change in urban hospital performance (change in market share, change in operational efficiency, change in financial performance 1994-96). PRINCIPAL FINDINGS: (1) Environmental context exerts a greater influence on urban hospitals' HMO business enhancement strategies, whereas organizational characteristics have more influence on cost-control strategies. (2) Between the two strategies, HMO business enhancement and cost control, strategic change to enhance business with HMOs is much more complex. (3) Strategic change observed across the 1994 to 1996 time period can be either helpful or harmful to urban hospitals. A strategic change that contributes positively to one type of performance can negatively impact the other. CONCLUSIONS: Although differences of opinion persist in the strategic change debate, results of this study indicate that strategic change can be helpful or harmful to urban hospitals, and its consequences are far more complex than previously thought. Strategic rationality has its own limitations and cannot always be relied on to yield expected results. Hospital strategic changes require coordination to achieve greater performance results.

Data Collection↗
PubMed1975

Urbanization and differentials in white and nonwhite infant mortality.

This study analyzes infant deaths in the United States, 1962 to 1967, by place of residence, to determine to what degree variations in age at death are related to degree of urbanization and race. Results of the study indicate that: (1) after one day of life infant mortality increases progressively as degree of urbanization decreases; (2) the differences between urban and rural death rates are greatest in the posthebdomadal (1 week or older) period; (3) in all age groups at all levels of urbanization, the nonwhite infant is at a marked disadvantage relative to the white infant; (4) the older the infant, the greater the disadvantage for nonwhite infants in rural areas; (5) had the white infant mortality rate prevailed among the nonwhite population over the six-year period from 1962 to 1967 an estimated annual total of 11,597 nonwhite infants would have survived their first year of life; (6) 40% of the excess deaths are in infants under 7 days and 60% in the posthebdomadal period; (7) fetal death rates increase progressively as degree of urbanization decreases, complementing a direct relationship between under 1 day mortality and urbanization resulting in a level trend for perinatal mortality.

Ethnicity↗
PubMed2002

[Hypertension in the advanced old aged: prevalence and treatment in comparative urban and rural survey].

UNLABELLED: Hypertension is a serious medical, social and economical problem. It is accepted that high blood pressure is one of the major risk factors of all kinds of cardiovascular diseases. The aim of the study was to estimate the prevalence of hypertension and evaluate the difficulties with antihypertensive treatment in the rural and urban community dwelling elderly in advanced old age. The survey was carried out, as a screening, in systematically sampled 463 people 75 years old and over, coming from area served by primary health units (230 in urban area--Białystok and 233 in rural area--Sokółka). Estimation of blood pressure (single measure) and medical anamnesis concerning earlier diagnoses and pharmacological treatment was made in proband's home by general practitioner or community nurse. The diagnosis of hypertension was established according to the WHO-ISN criteria. RESULTS: In general 49.1% of the elderly in urban and 70.4% in rural area had elevated systolic or/and diastolic blood pressure independently on antihypertensive medication; significantly more frequent in female than in male. 32% of the elderly in urban and 22% in rural area had normal blood pressure without antihypertensive treatment ("healthy"), whereas respectively 19% and 7% had normal blood pressure with antihypertensive treatment. 21% of persons in Białystok city and 38% in Sokółka had elevated high arterial pressure and hadn't any antihypertensive treatment. The results of the study confirm the high prevalence of hypertension in elderly population, higher in rural than urban area. Therapy of hypertension in studied group was ineffective in most of the hypertensive patients, mainly in neglected rural area. The differences between urban and rural samples can be partly explained by socio-demografic characteristic of the two studied population.

Aged↗
PubMed2003

Hepatitis B surface antigen prevalence among pregnant women in urban areas: implications for testing, reporting, and preventing perinatal transmission.

OBJECTIVES: To estimate race/ethnicity-specific prevalence of hepatitis B surface antigen (HBsAg) in pregnant urban women and to evaluate factors associated with maternal HBsAg testing. METHODS: A multicenter, retrospective chart review was conducted of a racially/ethnically stratified random sample of maternal/infant charts of 10 523 women who gave birth to live infants during 1990-1993 in 4 urban areas in the United States. Data were collected on multiple variables, including demographic variables, HBsAg test dates and results, prenatal care type, and amount and source of payment. RESULTS: HBsAg prevalence among white non-Hispanics was 0.60% (95% confidence interval [CI]: 0.22-0.98), black non-Hispanics 0.97% (95% CI: 0.48-1.47), Hispanics 0.14% (95% CI: 0.01-0.26), and Asians 5.79% (95% CI: 4.42-7.16). HBsAg testing rates increased from 56.6% in 1990 to 78.2% in 1993. Factors associated with not being tested varied by urban area, but in the combined area model, they were having no or private prenatal care (odds ratios: 18.75 and 5.07, respectively) and being black (odds ratios: 2.08). Only 20.9% (95% CI: 19.1%-22.8%) of those not tested prenatally were tested at delivery. The expected number of infants born to HBsAg-positive study-area women was 3327 using study prevalence rates, compared with 1761 using national rates. CONCLUSIONS: To help ensure that all urban infants who are born to HBsAg-positive women receive appropriate prophylaxis, health officials in urban areas should use urban-area prevalence rates to ascertain completeness of reporting maternal HBsAg positivity. Needed steps to increase maternal HBsAg testing rates include ensuring that more pregnant women receive prenatal care, promoting testing by private providers, educating providers about testing in all racial and ethnic groups, and reminding providers to test at delivery those women not tested prenatally.

Birth Certificates↗
PubMed1992

Temporal changes and rural-urban differences in cardiovascular disease risk factors and mortality in China.

We summarize several studies, from the last 10 years, of temporal changes and rural-urban differences in the risk factors of cardiovascular disease (CVD) in China to indicate the influences of economic modernization. Two national blood pressure surveys have shown that the prevalence of hypertension increased from 5.1% to 7.7% between 1958-1959 and 1979-1980. Throughout China hypertension is more prevalent in urban areas than in rural areas. Within the Shanghai region body mass index, blood pressure, and total serum cholesterol were higher in urban districts than in rural areas. Rural-urban differences in lipid levels were also found in the Beijing and Guangzhou regions. A related four-year followup study showed that total serum cholesterol and triglycerides increased markedly in both urban and rural areas of Guangzhou. In Shanghai part-time farmers who worked in factories had a higher age-adjusted prevalence of definite hypertension than farmers who worked full-time in the fields (5.0% versus 2.3%). In a prospective study in Wuhan a new productivity-based salary system was associated with increased serum cholesterol and blood pressure. Age-adjusted CVD mortality increased from 1973 to 1982 in a rapidly industrializing county in the Shanghai metropolitan region. The results from several studies indicate that China is undergoing the expected increase in modernization-related CVD risk factors and mortality, especially in urban metropolitan regions.

Adult↗
PubMed2004

Health-related quality of life among urban, rural, and island community elderly in Taiwan.

BACKGROUND AND PURPOSE: There are published norms of the 36-item short form of the Medical Outcomes Study Questionnaire (SF-36) for many countries, but few such studies have been conducted in Taiwan. The purpose of this study was to provide the norms for the SF-36 health status measure in urban, rural, and remote island community elderly populations, and to explore the relation between demographic or characteristic factors and the SF-36. METHODS: A structured questionnaire was used for door-to-door data collection in this survey of an urban, a rural, and a remote population (Shihpai, Yuli, and Kinmen, respectively, in Taiwan). Interviewers also collected information on subjects' demographics, medical history, use of health services, and health-related quality of life using the SF-36. A total of 6503 subjects who were at least 65 years of age were invited, and 4424 (73.1%) participated in the survey. RESULTS: The urban norms were significantly higher than the rural norms in seven scales of the SF-36 and significantly higher than the remote island norms in 4 scales, including physical functioning (84.6 vs 77.1), role limitations due to physical problems (77.8 vs 70.2), general health perceptions (70.5 vs 65.5), and role limitations due to emotional problems (90.6 vs 85.2). Remote island norms were significantly higher than urban and rural norms in vitality and mental health scales. In the multivariate analyses, women had significantly poorer scores in all scales of the SF-36 than men (p < 0.05), except for social functioning. Higher education was significantly associated with increased scores in all scales, except for vitality/energy and mental health scales. Scores of all scales were significantly reduced according to the number of chronic diseases a subject had. The need for domestic services and utilization of inpatient and outpatient health services were associated with lower scales (p < 0.05). CONCLUSIONS: There were significant differences between urban, rural, and remote island elderly populations in most scales of the SF-36. The urban elderly population had the greatest health-related quality of life on most scales, particularly on the physical health scales. The remote island elderly population had the highest scores on the vitality and mental health scales, whereas the rural elderly population had the poorest health-related quality of life, particularly rural women.

Aged↗
PubMed2004

Dietary fiber intake and dental health status in urban-marginal, and rural communities in central Mexico.

INTRODUCTION: Oral health status in older people is frequently poor which can contribute to inadequate dietary patterns and nutrition status. OBJECTIVE: To investigate whether an association between the number of teeth present and dietary fiber intake exists in elderly people living independently, across different geographic and socioeconomic locations. METHODS: A cross-sectional household survey was undertaken in three Mexican communities (urban, marginal urban, and rural), incorporating geographic and socio-demographic information and a 24-hour diet recall. Dental status (teeth present, coronal and root caries, and periodontal status) was determined by clinical examination. Data were analyzed using ANOVA, Pearson's chi2 and Tukey's range tests. RESULTS: 407 persons 60 years old and over participated in the study. Subjects in the rural community had better dental/periodontal status and more teeth present than urban and marginal-urban participants. Intake of fiber was 8.4 g/day for the urban, 7.6 g/day for the marginal-urban, and 13.5 g/day for the rural community. While gender had no detectable effect, the location of residence and the number of teeth present were associated with mean fiber intake; having more than 21 teeth and/or living in a rural location were associated with increased mean fiber intake.

Age Distribution↗
PubMedDate not supplied

Physical activity, smoking, and obesity among Canadian school youth. Comparison between urban and rural schools.

BACKGROUND: More information is needed to document the prevalence of health risk factors in youth. The purpose of this study is to compare the prevalence of physical inactivity, smoking and overweight/obesity among youth in urban and rural schools. METHODS: Data were obtained from a Student Physical Activity and Smoking Survey of 2,697 high school students in four urban schools in Ontario and four rural schools in Alberta. Prevalence of physical inactivity was assessed by examining compliance with Canada's Physical Activity Guide to Healthy Active Living, and with daily energy expenditure classification values. Prevalence of smoking was assessed by examining current smoking status. Overweight and obesity prevalences were examined by comparing BMI values to the BMI index for age and sex percentiles set by the Centers for Disease Control and Prevention. RESULTS: Physical activity prevalence was found to be low in our study, with only 57.0% of youth achieving Canada's Physical Activity Guidelines, and with 26.0% classified as sedentary based on the daily energy expenditure classification values. A higher proportion of rural students reported "trying smoking" than urban school students (73.0% versus 64.4%, p<0.001). A significantly higher proportion of rural males were 'overweight' than urban males, and a significantly higher proportion of rural females were 'obese' in comparison to urban females. CONCLUSION: Our findings add further support for an urgent need to promote physical activity among Canadian youth. Additionally, our results suggest that it is especially important to target rural students, particularly girls, for smoking prevention programs. Future studies are required to examine such rural and urban differences within provinces.

Adolescent↗
PubMed2004

Reasons for extraction of permanent teeth in urban and rural populations of Croatia.

The survey aimed to determine the reasons for extraction of permanent teeth by general dental practitioners in urban and rural population of the Senj region, Adriatic coast, Croatia. During a two-year period (1998-9), a total of 2006 teeth were extracted in both regions, in patients aged 15+. The causes were defined as follows: (1) decay or root without a crown (radix relicta), (2) periodontal disease, (3) endodontic or periapical diseases and (4) other reasons--orthodontics/prosthodontics and dental trauma. The statistical Chi-square-test was used to determine the significant difference between the populations and the sexes. Dental caries was the most frequent cause for extraction (over 50%), followed by endodontic and periapical diseases (23%) as the result of untreated caries and at the end periodontal disease (21%). Urban population more often lose teeth due to periodontal disease (22.75%) than rural (18.93%, p < 0.05). Similarly, this is more frequent in the urban male population (25.61%) than the female urban population (20%, p < 0.05). In rural areas, people more often lost teeth as a result of endodontic and periapical disease (25.85%) than in the urban locations (19.07%, p < 0.01) and this is more frequent in women from rural areas (28.37%) than the rural men (22.44%, p < 0.05). Periodontal disease was not the main cause of tooth loss in either the rural or the urban population. Dental caries and its sequel remain the most important challenge for the dental service. It also reveals the inadequacy of dental services. Education of both the population and the general dental practitioners must be conducted in order to improve oral hygiene and to insist on conservative rather than extraction therapy.

Adolescent↗
PubMed2005

[The prevalence and its effective factors of primary angle-closure glaucoma in defined populations of rural and urban in Beijing].

OBJECTIVE: To investigate the prevalence of primary angle-closure glaucoma (PACG) of urban and rural residents in Beijing, China. A quantitative comparison was made based on the data collected from this epidemiological survey. We also identify some of the most typical risk factors associated with PACG. METHODS: Glaucomatous screening examination was applied to specific age group populations (aged 40 and older) in the defined district of Beijing and its remote rural county, from June to October, 2001. There are 4451 subjects in all, 1980 rural subjects and 2471 urban subjects, 1939 males and 2512 females. The screen and diagnostic methods used in this survey included van Herick methods and gonioscopy examination to estimate the peripheral depth of the anterior chamber, visual acuity, intraocular pressure, refraction status, stereoscopic fundus photography, and threshold-related visual field tests. Subjects regarded as suspected glaucoma and glaucoma patients are reexamined with standard glaucomatous examination. RESULTS: The response rate of rural and urban population is 79.6% (1980/2488), 87.1% (2471/2836), respectively. The prevalence of PACG (in aged 40 years or older population) resulted from this survey was 1.2% (95% CI 0.9% - 1.5%). However, the prevalence was different between urban and rural residents, 1.1% (95% CI 0.8% - 1.4%) vs. 1.6% (95% CI 1.2% - 2.0%). The prevalence of PACG in female was more than that in male, 1.7% (95% CI 1.3% - 2.1%) vs.0.8% (95% CI 0.5% - 1.1%). A drastic increase in prevalence of PACG with age increase was identified in both survey sites, however, this increase in rural subjects (aged 60-69 years group) occurred ten years earlier than those from urban subjects (aged more than 70 years group). Compared to urban residents, rural residents showed higher prevalence of unilateral low vision (39.3% vs. 20.6%) and blindness (28.6% vs. 14.7%). This survey also confirmed that, as people aging, refraction status became hyperopia, the depth of peripheral anterior chamber became narrow. In the different age groups, female and male groups, the changes of refraction status and the depth of peripheral anterior chamber paralleled the prevalence of PACG. CONCLUSIONS: The prevalence of PACG was obviously different in different groups. This could due to several factors including gender, age, change of refraction status and chamber angle as well.

Adult↗
PubMed1992

Firearm and nonfirearm homicide among persons 15 through 19 years of age. Differences by level of urbanization, United States, 1979 through 1989.

OBJECTIVE: To examine trends (1979 through 1989) and current status in firearm and nonfirearm homicide rates by level of urbanization among persons 15 through 19 years of age. DESIGN: The Compressed Mortality File, a county-level mortality and population database maintained by the National Center for Health Statistics, Centers for Disease Control, Hyattsville, Md, and the 1980 Human Resource Profile County Codes are used to analyze age-, sex-, and race-specific firearm and nonfirearm homicide rates by urbanization level. SETTING: United States, 1979 through 1989. SUBJECTS: Black and white males and females 15 through 19 years of age whose underlying cause of death was either firearm homicide (E965.0 through E965.4 or E970) or nonfirearm homicide (E960 through E964, E965.5 through E969, or E971 through E978) in the ICD-9 (International Statistical Classification of Diseases, Injuries, and Causes of Death, Ninth Revision). MAIN OUTCOME MEASURES: Urbanization level-specific firearm and nonfirearm homicide rates. RESULTS: The 1989 firearm homicide rate in metropolitan counties was nearly five times the rate in nonmetropolitan counties (13.7 vs 2.9 deaths per 100,000 population). Firearm homicide rates were highest in core metropolitan counties, 27.7 per 100,000 population; rates were higher for black males than for any other race-sex group in each of five county urbanization strata for 1979 through 1989. Nonfirearm homicide rates are considerably lower, with smaller urban differentials; the rate in metropolitan counties was 1.4 times the rate in nonmetropolitan counties (2.6 vs 1.8 per 100,000 population). From 1979 through 1984, firearm homicide rates declined in each of the county strata. From 1984 through 1987, firearm homicide rates increased, and from 1987 through 1989 they increased rapidly, from 23% to 35% per year in the four metropolitan strata. From 1979 through 1989, nonfirearm homicide rates declined or remained stable. CONCLUSIONS: Large urbanization differentials in firearm homicide and smaller differentials in nonfirearm homicide are identified. Firearm homicide rates are highest and increasing the fastest among black teenage males in the core, fringe, and medium metropolitan strata.

Adolescent↗
PubMed2005

Urban versus rural environment--any differences in aeroallergens sensitization in an allergic population of Cova da Beira, Portugal?

Cova da Beira is an interior central region of Portugal, with a population of 93000 inhabitants divided in urban and rural living areas. The aim of this study was to access the prevalence of aeroallergens sensitisation in an allergic population, according to the urban and the rural environmental exposure and according to age. 1096 patients observed for suspected allergic symptoms, for a five-year period (1995-2000) were submitted to skin prick tests and were included in this study. They were divided in two environmental exposure groups (A: urban; B: rural) and in to four age subgroups (subgroup I: < or = 10yr; subgroup II: 11-20yr; subgroup III: 21-40yr; subgroup IV: >40yr). The total population included 444 male (40.5%) and 652 female (59.4%) with an average age of 26.5 +/- 17.2 yr. 83% of the 1096 performed SPT were positive. The frequency of aeroallergens sensitisation, comparing the urban versus the rural environment, was respectively: D. pteronyssinus 32% and 34.7%, D. farinae 28.5% and 30.7%, moulds mixture 15.3% and 12%, cat dander 17.1% and 15.2%, dog dander 11% and 10%, grasses mixture 51.3% and 36.4%, Parietaria judaica 29.4% and 14%, Olea europea 30.2% and 23.3%. The sensitisation to indoor aeroallergens, was similar in all the age subgroups and it was lower than that to pollens. There were important differences concerning the pollen sensitisation, when comparing the urban and the rural environmental exposure. We admit that pollution could enhance the sensitisation to pollens in the urban environment.

Adolescent↗
PubMed2005

Rural-urban migration and changing physical activity among Papua New Guinea highlanders from the perspective of energy expenditure and time use.

We examined the effects of rural-urban migration on nutritional status, daily activity patterns and physical activity levels for a Papua New Guinea Highland population. A large sample (n = 353) of adult males and females was selected for anthropometry and a smaller sample (n = 56) for behavioral observation in conjunction with heart rate monitoring. Urban migrants had higher body mass index and more body fat than their rural counterparts, particularly the females. The physical exertion index calculated for observed activities using heart rate values was much higher in farming activities in the rural area than in sedentary work activities in the urban area. In addition, walking time was notably shorter in the urban group than in the rural group (118 vs 52 min/day in males and 116 vs 29 min/day in females). Consequently, despite the urban group spending a shorter time resting and a longer time working, their daily physical activity level did not achieve the desirable level (1.75-1.80). It is thus necessary for urban residents to increase walking time to about 2 h per day, the level observed in their rural counterparts.

Activities of Daily Living↗
PubMed2005

Spatio-temporal patterns and driving forces of urban land expansion in China during the economic reform era.

Along with its economic reform, China has experienced a rapid urbanization. This study mapped urban land expansion in China using high-resolution Landsat Thematic Mapper and Enhanced Thematic Mapper data of 1989/1990, 1995/1996 and 1999/2000 and analyzed its expansion modes and the driving forces underlying this process during 1990-2000. Our results show that China's urban land increased by 817 thousand hectares, of which 80.8% occurred during 1990-1995 and 19.2% during 1995-2000. It was also found that China's urban expansion had high spatial and temporal differences, such as four expansion modes, concentric, leapfrog, linear and multi-nuclei, and their combinations coexisted and expanded urban land area in the second 5 y was much less than that of the first 5 y. Case studies of the 13 mega cities showed that urban expansion had been largely driven by demographic change, economic growth, and changes in land use policies and regulations.

China↗
PubMedDate not supplied

Need for dedicated focus on urban health within National Rural Health Mission.

National Rural Health Mission represents an important public health initiative to address essential health needs of the country's underserved population. For the Mission to achieve its goals, urban population needs to be included in its scope. Urban poor population constitutes nearly a third of India's urban population and is growing at three times the national population growth rate. Health status and access of reproductive and child health services of slum dwellers are poor and comparable to the rural population. Efforts to improve the conditions of urban poor necessitate strengthening national policy and fiscal mandate, augmenting and strengthening the urban health delivery system, coordinating among multiple stakeholders, involving private sector, strengthening municipal functioning and building community capacities. National Rural Health Mission should be broadened to National Public Health Mission. This paper discusses issues pertaining to health conditions of the urban poor, present status of services, challenges and suggests options for NRHM to bridge the large gap.

Health Services Accessibility↗
PubMed2006

An exploration of when urban background medical students become interested in rural practice.

INTRODUCTION: While it is well recognized that rural background medical students are more likely to enter rural practice than urban background, students' research shows that 34% to 67% of rural doctors have urban backgrounds. This article explores the factors influencing urban background medical students' interest in rural practice. METHOD: The study used a qualitative design employing focus groups and semi-structured interviews. Data were collected at three Australian universities and a national student rural health conference, and the participants were 82 first and final year medical students who participated in focus groups, and 49 who were interviewed individually. Data were analysed using the N6 computer package to manage the data. Forty-three urban background students indicated an interest in rural practice and the data presented in this article relate to this group of students. RESULTS: This article presents an analysis of data from one part of a larger project conducted from 2002 to 2004 investigating medical student career choice. The students' level of interest in rural practice depends on an interaction between student and location factors and other external influences with students seeking to match their needs and interests with locations. Some are 'predisposed' to develop interest in rural practice via their familiarity with rural areas, level of altruism, interest in generalist work, and interest in certain leisure activities. Exposure to rural locations provides knowledge about different places. Students recognize differences between rural locations in relation to the size of town and the remoteness of the town, and they seek specific rural locations which will match their values and interests. Existing social relationships can be enabling or limiting factors in the student's ability to follow through their interest in rural practice and to enter rural practice, and are important in the students finding a match between themselves and an appropriate location. CONCLUSIONS: Exposure of urban background students to rural practice and a range of rural locations generates an interest in rural practice among many urban background students. This exposure may increase the number of students who become interested in rural practice and decide to enter rural practice. Further quantitative research is required to test the findings from this exploratory qualitative study.

Adolescent↗