Rural Aging Research and Change in Rural Counties: An Emerging Research Agenda Jim Mitchell Professor of Sociology and Family Medicine Director, Center on Aging, Brody School of Medicine Associate Director, UNC Institute on Aging

Presentation Goals To review the use of Rural (residence) as an independent variable in aging research published since 2000 to illustrate the importance of definition and measurement. To assess differential change in selected demographic and economic characteristics of rural counties in 4 eastern states over a 40-year period. Rural counties are more different than represented by federal definitions? To explore the notion of rural according to definitions used by federal agencies and its implication for secondary data analysis. To suggest a strategy to promote research on aging farmers.

First Census Definition: All territory, population, and housing units located outside of Urban Clusters…core census block groups with population densities of at least 1,000 people per square mile and surrounding census blocks with at least 500 people per square mile.

Second Census Definition: Territory, population, and housing units located outside of Urbanized Areas… continuously built- up with populations of 50,000 or more people or places and areas with population densities greater than 1,000 inhabitants per square mile (population size within designated area and density).

Third Census Definition: Territory, population, and housing units located outside of Urban Places… either incorporated places or census- designated places with 2,500 or more inhabitants.

Office of Management and Budget (OMB) Definition (pertinent to economic matters and resource allocation): Outside of a Metropolitan Area …a metropolitan influence region with a city with 50,000 or more inhabitants or a total metropolitan population of 100,000 or more (75,000 or more in New England) people. Adjacent counties are included if either fifty percent of their population falls in the urbanized area surrounding the core city or a substantial proportion of their workers commute for employment to the central urban location.

Limitations of Census and OMB Definitions… Metropolitan counties (OMB) have large rural areas within their bounds, particularly in Western regions of the country. Many Census rural areas include large numbers of residents living close to places with population densities as high as 999 people per square mile.

Administration on Aging contribution… Urban Zip Areas…those with one percent or more (of population) within an urbanized area (Census, we presume) and affiliation with a place of 20,000 to 49,000 residents outside an urbanized area.

USDA Beale Codes…Metropolitan, Urban, and Rural Counties with Adjacency Metropolitan…counties with 250,000+ population. Urban…Counties with 20,000+ population (adjacent or non-adjacent top metro counties). Urban…Counties with 2,500+ population (adjacent or non-adjacent to metro) Rural…Counties with fewer than 2,500 population (adjacent or non-adjacent to metro) Scheme revised recently to include micropolitan counties with urban concentrations of 10,000+(up to 20,000?) people.

USDA Economic Research Service Non-Metro County Classification (2004) Economic Dependence (farming, mining, manufacturing, government, services, and non-specialized). Farming- dependent counties are those in which 15 percent or more of earnings or employment are attributable to farming. Policy (retirement destination, federal lands, commuting, persistent poverty, and transfers dependent) activity. Useful if continuous, non-categorical measure (e.g., continuum of farming dependent)

Rural as an independent variable in research on aging… Reviewed 36 full-text articles published from 2000 to 2006 available electronically via the GSA all- electronic journal data bank (including GSA and other journals). All articles featured the term RURAL in their titles or their abstracts.

Articles According to Rural Definition/Measurement 6 articles provided clear definition and measurement (Census and OMB definitions used 5 of 6 times). 5 articles included descriptions of secondary data used and definition/measurement of rural could be derived. 25 articles featured neither definition nor measurement description of rural. In sum, 30 of 36 articles featured neither definition nor measurement description of rural residence.

Rural County Variability… Premise or “null hypothesis”--- counties that are non-adjacent to metropolitan and either non-adjacent or adjacent to micropolitan (with urban cluster of 10,000+ people) counties are alike.

Research Procedure… Identified 55 counties in NC, VA, WV, & KY that met the rural criteria. Obtained data on selected county demographic and economic characteristics from Geolytics Census data from a university library, from the federal Census and state websites, and from federal Bureau of Health Professions data maintained by the ECU Center for Health Services Research. Computed proportional change measures defining each variable including decennial data from 1970 to Assessed variability among change measures by assessing various principal components rotated factor patterns.

Principal Components Analysis of County Indicators Rotated Factor Loadings Variable Factor 1 a Factor 2 b Population Increase Change in Long Commute Change in Female- Headed Households Change in Vacant Housing Increase in Poverty Change in Per Capita Social Security Income Change in Extractive Employment Change in Retail Employment Change in Service Employment Change in Government Employment Explained Variation 27% 19% a Job Loss. b Depopulation/Economic Decline.

Toward a Rural County Typology… Summing only the 4 indicators of employment change, virtually all counties were negative, indicating job loss. Negative values underlined in factor 2 were reversed and the underlined values were summed to indicate demographic/economic decline. The distributions of continuous values of job loss and demographic/economic decline were divided at the 33 rd and 66 th percentiles and the categorical variables were cross-tabulated to create a 9X9-cell table. Counties were classified according to the 2 change measures and mapped.

Metro- and Micropolitan Core Based Counties Non-core Counties adjacent to Metropolitan Counties Job Loss Population Decline ))) ))) ))) Job loss is declining decennial employment from 1970 to 2000 across government, retail, service, and extractive (farming, timber, mining, and aquaculture). Population/Economic Decline is a measure of decennial change from 1970 to 2000 in county population, job commutes of 40+ minutes, ratio of female-headed households, vacant housing, proportion in poverty, and proportionate change in Social Security income. Rural Transitions: Job Loss and Population Decline 1970 to 2000 In 55 Isolated * Non-Core Counties Located in Kentucky, North Carolina, Virginia, and West Virginia Data Sources and Definitions: US Census Bureau and Geolytics, Inc. Center for Health Services Research and Development East Carolina University Greenville, NC * A non-core county is considered isolated if it is not geographically adjacent to a Metropolitan Statistical Area county. Defining Metropolitan and Micropolitan Statistical Areas (CBSA Method) 1. Each CBSA must contain an urban area (UA) of 10,000 or more population. 2. A Metropolitan Statistical Area has at least one UA of 50,000 or more population. 3. A Micropolitan Statistical Area has at least one urban cluster of at least 10,000 but less than 50,000 population. 4. Outlying counties are included in a CBSA if certain commuting requirements are met.

Implications… Rural counties vary considerably according to Job Loss and Demographic/Economic Decline. Such variability has consequences for the definition and measurement of rural places (reject null hypothesis).

Implications (continued)… Taking variability across rural counties into account as an important socioeconomic and demographic ecological place characteristic can enhance knowledge of the effect of rural residence and a myriad of quality of life (QOL) outcomes among older adults.

Implications (continued)… Taking variability across rural counties into account facilitates targeted resource allocation and intervention to enhance the QOL of older residents.

Conclusions (shame on us)… We know little about the effect of rural residence because of inconsistent definitions across federal agencies. This inconsistency affects the utility of data maintained by those agencies for secondary analysis by gerontological researchers. We need to advocate for a common comprehensive definition of rural areas that takes ecologically-important variability into account.

Conclusions (shame on us again)… Authors, reviewers, and journal editors need to insist upon rigorous definition of rural residence and measurement description to enhance replication and development of a body of knowledge.

Research on Aging Farmers Build institutional alliances (CDC & NIOSH with Southern Gerontological Society [SGS], American Society on Aging [ASA], and the Gerontological Society of America [GSA—call for papers for 11/07 out soon]).

Research on Aging Farmers (continued) Encourage federal agencies (e.g., NIOSH) to include variables pertinent to… farming and ranching (e.g., machinery condition and operation, farm/ranch income, seasonal hiring practices), aging (self-reported physical and cognitive ability/disability, medication regimen/warnings), and injury/disease prevalence and incidence in data gathered and maintained.

Research on Aging Farmers (continued) A progression of research…. Descriptive (a-theoretical--such as incidence of injury among older farmers). Multivariate Cross-Sectional Explanatory (theoretical or a-theoretical assessing the effects of variables intervening in the relationship between age and injury/disability among farmers) Multivariate Longitudinal Panel Studies Theoretically- driven assessments of change in variables over time affecting the probability of farm injury/disability/mortality. Enables determination whether initial injury or illness in company with continued work, safety precautions, and limited cash resources lead to subsequent injury/ disability/mortality).