In 2010, 17% of the U.S. population lived in rural (nonmetropolitan) areas. Many rural areas are medically underserved due to physician (especially specialist) shortages. Rural hospitals often are small, with a low volume of services, and have difficulty remaining financially viable under the regular hospital prospective payment system. Special Medicare hospital payment categories have been est...

The Impact of Local Decentralization on Economic Growth: Evidence from U.S. Counties We analyze the impact of fiscal decentralization on U.S. county population, employment, and real income growth. Our findings suggest that government organization matters for local economic growth, but that the impacts vary by government unit and by economic indicator. We find that single-purpose governments per...

Human capital is one factor that significantly influences local economic growth. Our goal in this research is to analyze trends in local human capital dynamics during the past thirty years. The authors find little evidence of convergence in college attainment across metropolitan and nonmetropolitan areas and evidence of divergence across Census regions. The authors also find within-distribution...

PURPOSE Updated estimates of adolescents' receipt of sex education are needed to monitor changing access to information. METHODS Using nationally representative data from the 2006-2010 and 2011-2013 National Survey of Family Growth, we estimated changes over time in adolescents' receipt of sex education from formal sources and from parents and differentials in these trends by adolescents' gen...

PROBLEM/CONDITION Diabetes self-management education (DSME) is a clinical practice intended to improve preventive practices and behaviors with a focus on decision-making, problem-solving, and self-care. The distribution and correlates of established DSME programs in nonmetropolitan counties across the United States have not been previously described, nor have the characteristics of the nonmetro...