CU Population Center

Institute of Behavioral Science

CUPC research on well-being in small town America receives NIH funding

There is a shortage of research focused on small rural places and CUPC affiliates Lori Hunter, Myron Gutmann, Stefan Leyk and Arizona State’s Dylan Connor are embarking on a nationwide analysis of health, social and demographic trends in America’s smallest places. The research has been supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and CUPC trainee Catherine Talbot will be central to the research team.

Contemporary rural America has been called a “landscape of despair”1 and recently available data (2015) document today’s stunning rural-urban divide. Rural America (broadly defined) exhibits substantially poorer public health: teen pregnancy is far more common (2007-2015 rates: 30.9 rural, 18.9 urban)2 and age-adjusted death rates are higher for many causes (1999 2014).3 Rural America also has substantially higher prescription rates for narcotics4, creating availability from which illegal markets can arise.5 In fact, from 1999 to 2004, the rate of drug poisoning deaths in rural counties increased more than three times that in urban counties.6 Demographics of rural America also differ with a larger proportion of white residents than urban places (79.6% rural; 60.7% urban in 2010), and an older age composition (median age 43 rural; 36 urban). Rural America also has far lower levels of educational attainment (BA or higher, 19.5% rural; 33% urban).7

The CUPC project will bring a wide variety of data sources together to develop, integrate and validate a nationwide harmonized place-based dataset, 1980-2010. Next, the team will determine whether, over the 1980 2010 period, small rural places have been characterized by distinct pathways of change along key sociodemographic and economic characteristics; And finally, the investigators will compute place-level mortality patterns and preliminarily examine whether patterns of place based change are associated with detectable trends in population health.

Such an analysis is overdue; The last nationwide examination that focused particularly on small towns took place over 30 years ago. Also, since tiny towns have been little studied there is a lack of theory to explain their pathways of change, challenges, and successes. These limitations will be overcome by bringing a variety of data sources to bear (e.g. Census, NCHS, USDA, FCC, Zillow) and evaluating theoretical perspectives rarely considered at the scale of small places.


1.       Monnat SM, Brown DL. More than a rural revolt: Landscapes of despair and the 2016 Presidential election. Journal of Rural Studies. 2017;55:227-236. doi:10.1016/j.jrurstud.2017.08.010

2.       Hamilton BE, Rossen LM, Branum AM. Teen Birth Rates for Urban and Rural Areas in the United States, 2007–2015. Hyattsville, MD: National Center for Health Statistics; 2016.

3.       Moy E, Garcia MC, Bastian B, et al. Leading Causes of Death in Nonmetropolitan and Metropolitan Areas-United States, 1999-2014. Morbidity and mortality weekly report Surveillance summaries. 2017;66(1):1 8.

4.       Guy JG, Zhang K, Bohm MK, et al. Vital Signs: Changes in Opioid Prescribing in the United States, 2006-2015. MMWR Morbidity and mortality weekly report. 2017;66(26):697–704.

5.       Inciardi JA, Surratt HL, Kurtz SP, Cicero TJ. Mechanisms of Prescription Drug Diversion Among Drug-Involved Club- and Street-Based Populations. Pain Medicine. 2007;8(2):171-183. doi:10.1111/j.1526 4637.2006.00255.x

6.       Keyes KM, Cerdá M, Brady JE, Havens JR, Galea S. Understanding the Rural–Urban Differences in Nonmedical Prescription Opioid Use and Abuse in the United States. American Journal of Public Health. 2014;104(2):e52-59.

7.       U.S. Census Bureau. New Census Data Show Differences Between Urban and Rural Populations. Release Number: CB16-210. The United States Census Bureau. releases/2016/cb16-210.html. Published 2016.