College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
Transl Behav Med. 2020 Dec 31;10(6):1554-1558. doi: 10.1093/tbm/ibz098.
Residents of rural communities generally have limited access to preventive health services such as lifestyle programs for weight management. In 2009, the U.S. Congress authorized the Centers for Disease Control and Prevention (CDC) to partner with local community organizations to disseminate the Diabetes Prevention Program (DPP), an evidence-based lifestyle intervention for weight management. Given that the National DPP (NDPP) was designed to broaden nationwide access to weight-loss treatment for adults at high risk for developing diabetes, the present study examined the implementation of the NDPP in rural and urban counties across the USA. The names and locations of NDPP community partnership sites were collected from the CDC website and cross-referenced with the U.S. Census Bureau's classification of counties as rural versus urban. Results showed that overall 27.9% of the 3,142 counties in the USA contained one or more NDPP partnership sites. However, significantly fewer rural counties had access to a NDPP site compared with urban counties (14.6% vs. 48.4%, respectively, p < .001). This disparity was evident across all types of partnership sites (ps < .001). These findings indicate that implementation of the NDPP has expanded the overall availability of evidence-based weight-management programs across the USA. However, this increase has been disproportionately greater for urban counties versus rural counties, thereby widening the rural/urban disparity in access to preventive health services. Alternative dissemination strategies that address the special barriers to implementation faced by rural communities are needed to increase access to the NDPP.
农村社区的居民通常难以获得预防性卫生服务，如体重管理的生活方式项目。2009 年，美国国会授权疾病控制与预防中心（CDC）与当地社区组织合作，推广基于证据的生活方式干预体重管理的糖尿病预防计划（DPP）。鉴于国家 DPP（NDPP）旨在扩大全国范围内为有患糖尿病风险的成年人提供减肥治疗的机会，本研究在美国农村和城市县检查了 NDPP 的实施情况。NDPP 社区伙伴关系网站的名称和位置从 CDC 网站收集，并与美国人口普查局对县的农村与城市分类进行交叉引用。结果表明，美国 3142 个县中，总体上有 27.9%的县有一个或多个 NDPP 伙伴关系网站。然而，与城市县相比，农村县获得 NDPP 网站的机会明显较少（分别为 14.6%和 48.4%，p<.001）。所有类型的伙伴关系网站都存在这种差异（p<.001）。这些发现表明，NDPP 的实施已经扩大了全美基于证据的体重管理项目的整体可用性。然而，与农村县相比，城市县的增长幅度不成比例地更大，从而扩大了农村/城市在获得预防性卫生服务方面的差距。需要采取解决农村社区实施特殊障碍的替代传播策略，以增加对 NDPP 的获取。
