Extent of Inclusion of “Rural” in Comprehensive Cancer Control Plans in the United States
ORIGINAL RESEARCH — Volume 18 — September 2, 2021
PEER REVIEWED
Figure 1. Number of elements included in cancer control plans and whether plan included a rural-specific strategy, by state. Plans were assessed as to their inclusion of “rural” across 7 elements: 1) data on cancer burden, 2) reduction of cancer disparities, 3) rural population description, 4) rural definition, 5) goals, 6) objectives, and 7) strategies. Data source: National Comprehensive Cancer Control Program, Centers for Disease Control and Prevention.
| State | No. of elements | Rural-specific strategy |
|---|---|---|
| Alabama | 2 | No |
| Alaska | 2 | Yes |
| Arizona | 0 | No |
| Arkansas | 4 | Yes |
| California | 2 | No |
| Colorado | 1 | Yes |
| Connecticut | 1 | No |
| Delaware | 0 | No |
| Florida | 2 | No |
| Georgia | 2 | No |
| Hawaii | 0 | No |
| Idaho | 3 | Yes |
| Illinois | 2 | No |
| Indiana | 2 | Yes |
| Iowa | 2 | No |
| Kansas | 3 | Yes |
| Kentucky | 1 | Yes |
| Louisiana | 3 | No |
| Maine | 0 | No |
| Maryland | 3 | Yes |
| Massachusetts | 0 | No |
| Michigan | 0 | No |
| Minnesota | 1 | No |
| Mississippi | 3 | Yes |
| Missouri | 2 | Yes |
| Montana | 2 | Yes |
| Nebraska | 1 | No |
| Nevada | 3 | No |
| New Hampshire | 0 | No |
| New Jersey | 2 | Yes |
| New Mexico | 4 | No |
| New York | 3 | Yes |
| North Carolina | 2 | No |
| North Dakota | 1 | Yes |
| Ohio | 0 | No |
| Oklahoma | 2 | Yes |
| Oregon | 5 | Yes |
| Pennsylvania | 2 | Yes |
| Rhode Island | 0 | No |
| South Carolina | 0 | No |
| South Dakota | 1 | No |
| Tennessee | 2 | Yes |
| Texas | 2 | No |
| Utah | 2 | No |
| Vermont | 0 | No |
| Virginia | 2 | No |
| Washington | 1 | No |
| West Virginia | 3 | No |
| Wisconsin | 0 | No |
| Wyoming | 3 | No |
Figure 2. Percentage of state population residing in rural counties, rural cancer mortality rate, and inclusion of rural elements in comprehensive cancer control plan (CCCP), by state. A, Percentage of state population living in rural counties, in tertiles, and number of rural elements in state CCCP. B, Percentage of state population living in rural counties, in tertiles, and whether rural-specific strategy included in state CCCP. C, Age-adjusted cancer mortality rate per 100,000 in rural counties, in tertiles (2013–2017), and number of elements addressed in state CCCP. D, Age-adjusted cancer mortality rate per 100,000 in rural counties, in tertiles (2013–2017), and whether rural-specific strategy included in state CCCP.
| State | No. of Elements | Rural-Specific Strategy | % of Population That Lives in Rural Counties | Tertile of % Rural (Low, Middle, High)a | Age-Adjusted Cancer Mortality Rate per 100,000 in Rural Counties | Tertile of Cancer Mortality Rate (Low, Middle, High)b |
|---|---|---|---|---|---|---|
| Alabama | 2 | No | 23.7 | Middle | 182.9 | High |
| Alaska | 2 | Yes | 32.4 | High | 165.6 | Middle |
| Arizona | 0 | No | 5.1 | Low | 134.0 | Low |
| Arkansas | 4 | Yes | 38.3 | High | 191.2 | High |
| California | 2 | No | 2.2 | Low | 157.0 | Low |
| Colorado | 1 | Yes | 12.7 | Middle | 131.6 | Low |
| Connecticut | 1 | No | 5.1 | Low | 143.3 | Low |
| Delaware | 0 | No | 0 | Low | — | — |
| Florida | 2 | No | 3.5 | Low | 190.3 | High |
| Georgia | 2 | No | 17.4 | Middle | 179.6 | High |
| Hawaii | 0 | No | 18.8 | Middle | 141.2 | Low |
| Idaho | 3 | Yes | 33.4 | High | 154.3 | Low |
| Illinois | 2 | No | 11.5 | Low | 179.1 | Middle |
| Indiana | 2 | Yes | 22.2 | Middle | 180.7 | High |
| Iowa | 2 | No | 41.0 | High | 165.6 | Middle |
| Kansas | 3 | Yes | 32.3 | Middle | 170.6 | Middle |
| Kentucky | 1 | Yes | 41.4 | High | 211.2 | High |
| Louisiana | 3 | No | 16.4 | Middle | 195.6 | High |
| Maine | 0 | No | 41.0 | High | 177.5 | Middle |
| Maryland | 3 | Yes | 2.5 | Low | 155.8 | Low |
| Massachusetts | 0 | No | 1.5 | Low | 153.7 | Low |
| Michigan | 0 | No | 18.1 | Middle | 172.9 | Middle |
| Minnesota | 1 | No | 22.5 | Middle | 157.7 | Low |
| Mississippi | 3 | Yes | 54.1 | High | 193.8 | High |
| Missouri | 2 | Yes | 25.5 | Middle | 185.6 | High |
| Montana | 2 | Yes | 64.7 | High | 153.1 | Low |
| Nebraska | 1 | No | 35.3 | High | 155.3 | Low |
| Nevada | 3 | No | 9.4 | Low | 163.7 | Middle |
| New Hampshire | 0 | No | 37.2 | High | 161.3 | Middle |
| New Jersey | 2 | Yes | 0 | Low | — | — |
| New Mexico | 4 | No | 33.1 | High | 149.1 | Low |
| New York | 3 | Yes | 7.1 | Low | 165.8 | Middle |
| North Carolina | 2 | No | 21.9 | Middle | 172.5 | Middle |
| North Dakota | 1 | Yes | 50.4 | High | 150.4 | Low |
| Ohio | 0 | No | 20.4 | Middle | 181.2 | High |
| Oklahoma | 2 | Yes | 34.5 | High | 189.3 | High |
| Oregon | 5 | Yes | 16.3 | Middle | 175.3 | Middle |
| Pennsylvania | 2 | Yes | 11.6 | Low | 171.7 | Middle |
| Rhode Island | 0 | No | 0.0 | Low | — | — |
| South Carolina | 0 | No | 15.3 | Middle | 184.1 | High |
| South Dakota | 1 | No | 52.2 | High | 158.8 | Low |
| Tennessee | 2 | Yes | 22.7 | Middle | 195.3 | High |
| Texas | 2 | No | 11.1 | Low | 165.9 | Middle |
| Utah | 2 | No | 10.6 | Low | 132.1 | Low |
| Vermont | 0 | No | 65.3 | High | 166.6 | Middle |
| Virginia | 2 | No | 12.6 | Low | 184.4 | High |
| Washington | 1 | No | 10.1 | Low | 161.2 | Middle |
| West Virginia | 3 | No | 38.4 | High | 189.8 | High |
| Wisconsin | 0 | No | 26.0 | Middle | 166.1 | Middle |
| Wyoming | 3 | No | 69.4 | High | 138.3 | Low |
a Low, 0%–12.6%; middle, 12.7%–32.3%; high, 32.4%–69.5%.
b Per 100,000 population: low, 131.6–158.8; middle, 158.9–179.1; high, 179.2–211.2.
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.