Translation and Validation of Thai Versions of the Chronic Oral Mucosal Disease Questionnaire-15 and Oral Lichen Planus Symptom Severity Measure.

While rural residents comprise approximately 20% of the U.S. population, less than 10% of physicians serve rural communities nationwide. This may partially explain a disproportionate prevalence of complex chronic health conditions paired with inadequate accessible, affordable healthcare among rural populations. One of these conditions is obesity. Obesity, particularly among children, is an ongoing public health concern that has reached epidemic levels nationwide and disproportionately affects those in rural areas. Children who are overweight at an early age are at increased risk of developing obesity in adulthood, which is associated with chronic diseases, including type 2 diabetes, hypertension, and cardiovascular disease. Further, children in rural areas are more likely to live in economically disadvantaged areas, are at a higher risk of being undiagnosed as overweight or obese, and demonstrate lower preventative medical healthcare utilization, compared to their non-rural peers. The root of growing childhood obesity in rural areas is multi-faceted, including higher rates of food insecurity, limited access to healthy food, limited opportunities for physical activity and recreation, and limited access to preventative healthcare services for proper identification, treatment, and management of obesity. Historically, over one-third (33.67%) percent of SC residents have lived in rural areas, and a more significant proportion of rural residents in SC travel more than 30 minutes for employment compared to rural residents nationwide (11.4% vs. 10.4%, respectively). Previous research found rural SC residents have few public transportation options providing healthcare access. In addition to rurality challenges, those who are insured by Medicaid and who identify as minority racial and/or ethnic groups demonstrate higher rates of obesity and lower rates of preventative healthcare utilization. Reduced preventative healthcare utilization among pediatric populations may be attributed to barriers related to access and transportation, and may contribute to the utilization of emergency department services for primary care—an indicator of inadequate healthcare access. Still, existing research suggests that Medicaid-insured children who seek preventative care services have improved long-term health outcomes, compared to those who are uninsured. Lifestyle interventions implemented in primary care settings have effectively treated obesity and improved health outcomes, often employing a family-oriented approach. Further, the American Academy of Pediatrics (AAP) published clinical guidelines recommending weekly follow-up visits for obesity treatment and management, which may be difficult to adhere to for children and families struggling with social drivers of health (SDOH) that create barriers to, or who must travel long distances for, primary care services. Medicaid-insured children often live in households with low socioeconomic status, compounding challenges related to traveling for care and adoption of healthy lifestyle behaviors among rural populations. Medicaid-insured children may also experience disruptions in Medicaid enrollment and, subsequently, inconsistent healthcare access as a result of fluctuating household stability.