CU Population Center

Institute of Behavioral Science

CUPC research on well-being in rural America receives NIH funding

The rural-urban divide is vast, with rural places tending to have poorer public health, lower levels of education, higher unemployment and lower wages and income, as just a few examples. CUPC affiliates Lori Hunter, Myron Gutmann, and Stefan Leyk received funding to examine health, social and demographic trends in small rural communities across the U.S. for the period 1980 to 2010. Better understanding of conditions in rural America is essential for policies and interventions designed to improve rural public health and rural residents’ well-being.

This project is the first to systematically develop an understanding of health, social and demographic conditions and change in small rural communities across the U.S. Patterns of change are identified, in addition to exploration of how they have intertwined in small rural communities over the period 1980 to 2010. The focus is on places with fewer than 2,500 residents but patterns are contrasted with those in slightly larger places (2,500-19,999 pop.) to improve understanding of unique place-based challenges. A place-based dataset is generated by integrating data from the Census Bureau, National Center for Health Statistics, USDA, FCC, National Park Service and other sources. Importantly, methodological innovations are undertaken to generate a place-based health information, an important extension since health data tends to be available only at the county level. In the end, the researchers argue that the small size and isolation of tiny towns pose particular challenges for policies and programs designed to improve public health, economic opportunity and social well-being. Improved understanding of their socioeconomic, demographic and health dynamics is critically essential for the development of informed policy.

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.

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.

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