Childhood Thriving in Urban and Rural Areas during COVID-19

The COVID pandemic has exacerbated existing disparities in health and social needs between rural and urban settings across the United States. To discern family needs during COVID, two community-partnered surveys were developed to assess social determinants of health, flourishing, and other health information to collect actionable, real-time data, connect families to existing community resources. The surveys were administered monthly in urban and rural counties of southwestern PA. The surveys included validated and community-informed measures of child and parent wellbeing, unmet health needs, access to care, housing quality/stability, food security and social service use and needs. Data from the September 2021 surveys were analyzed using descriptive statistics, Chi-square, and Fisher's test of differences between rural and urban participant groups. The aim of the study was to explore if the COVID-19 pandemic had similar impacts in urban and rural regions and whether rural households faced similar challenges as urban households during and after the pandemic. A total of 158 caregivers completed the surveys in September 2021. Caregivers in rural areas reported higher levels of unmet health needs for children than caregivers in urban areas (10% vs. 3%), although not statistically significant. Rural caregivers reported greater access challenges such as transportation. A trend of greater food insecurity in rural compared to urban areas (19% vs. 10%) was observed. A significantly greater percentage of caregivers reported using economic assistance in rural (47%) compared to urban areas (16%), despite a similar level of income/employment loss due to COVID across rural and urban settings (36% vs 31%). Caregivers in rural areas had a lower odd of meeting all child thriving measures included in the survey. Rural caregiver responses showed significantly lower odds of meeting five out of ten thriving measures such as getting food to you and children, adequate household utilities, adjusting to changes in work, employment, or income; child safety and supervision; and child protection from inequality, racism, prejudice, and exclusion. The results suggest persistent unmet needs in urban and rural areas during COVID, with a higher trend of health and social needs in rural areas despite higher levels of social service use