People in the most rural areas more likely to die from colon cancer though they're less likely to get it in the first place

Patients who live in remote or very small rural communities are a bit more likely to show up at their doctor's office with late-stage colon cancer than other Americans, which could help explain why patients who live in these areas have such poor colorectal cancer outcomes, a new study says.

Johns Hopkins Medicine image

The study, published in The Journal of Rural Health, looked at the relationship between late-stage colorectal cancer at diagnosis and county-level characteristics, including the level of rurality (how rural a place is), patient characteristics, and factors such as persistent poverty, low education, and low employment.

The study notes that cancer outcomes are often worse for rural patients, with various studies finding they have an 8 to 15 percent greater chance of dying from colon cancer.

"While rural communities overall have lower incidence of cancers compared to urban populations, they have higher cancer-related mortality rates," says the report. In other words, people in the most rural areas are more likely to die from colon cancer even though they are less likely to get it in the first place.

The researchers identified 132,777 patients in 10 states who had colorectal cancer in 2010-14. After placing patients in five rural-to-urban categories, the study found that the adjusted percentages of stage 4 colon-cancer patients by county geography were: metropolitan areas, 19.3%; micropolitan areas (with a city of 10,000 to 50,000) adjacent to a metro area, 20.4%; non-adjacent micropolitan areas, 19.2%; small rural places, 20.2%; and remote rural places, 22.7%.

"Patients living in remote, small counties were significantly more likely to present with stage 4 colorectal cancer than patients living in other counties," the study report says.

The data came from registries in 10 states, including California, Connecticut, Georgia, Hawaii, Iowa, Kentucky, Louisiana, New Mexico, Utah and Washington. Overall, the study found that these registries included 352 rural and 235 urban counties, which represents 18% and 20% of all rural and urban U.S. counties, respectively.

In addition to the rural/urban factor, the study found that younger patients, black patients and single or widowed patients were more likely to present with late-stage colorectal cancer. The researchers note that these findings are consistent with decades of data and suggest that little or no improvement has been made in addressing these disparities.

It also found that a lack of insurance was the most significant predictor of late-stage diagnosis, which was also consistent with other research.

"Patient medical insurance categories had the greatest effects on the rate of stage 4 colorectal cancer at diagnosis. The rate was highest among uninsured patients (28.6%) compared to patients with any type of Medicaid insurance (24.4%) and other insured patients (18.4%)."

There were also differences in the rate of stage 4 colorectal cancer diagnosis across states. "Patients in Kentucky had the lowest adjusted rate (18.2%) of stage 4 diagnosis while New Mexico and Washington State had the highest rates (21.6% and 22.1% respectively)," says the report.

In addition to a known lack of screening services in rural areas, "The high cost of colonoscopy, access to specialty referral networks, lack of transportation, and lower health literacy may all play a role in these findings," says the report.

The researchers point out several limitations to the study, noting that while the data allowed for a patients' urban/rural status to be determined at a county level, some patients may not have been designated appropriately especially in states out West which have very large counties. It also recognized that only 10 states were included in the study, representing about one-third of all cancer patients nationally.

The report also notes that this study is consistent with the findings of several others that look at the rural/urban relationship to late-stage colorectal diagnosis, but not with all of them. It says this could be related to the studies using  different geographic stratifications.

The American Cancer Society recommends colorectal screening for average risk individuals to begin at the age of 45. Those with a family history of colon or rectal cancer should check with their doctor about getting screened earlier. Colon cancer is 90 percent curable when detected early.

GateHouse closing 2 rural Ark. papers; editors in Stuttgart and Helena seek buyer; Democrat-Gazette going digital

GateHouse Media will shutter two rural papers in eastern Arkansas on Sept. 6 and will cease local printing at the nearby Pine Bluff Commercial, Max Brantley reports for the Arkansas Times.

Editors at the Stuttgart Daily Leader and the Helena-West Helena World both say they're trying to find buyers so the papers can keep running, and that they're "actively working" with a prospect.

The news comes on the heels of the latest round of GateHouse layoffs, announced ahead of its merger with Gannett Co. It also lends credence to the fears of Peter Wagner, publisher of the N'West Iowa Review, who warned that the merger would lead to the closure or sale of many smaller, less-profitable weekly papers. Wagner sees that as an opportunity for renewed local ownership, which both Arkansas papers are pursuing, but many weeklies are having a hard time finding buyers.

In related news, Brantley reports that the Arkansas Democrat-Gazette plans to convert to a mostly digital paper by the end of the year, and will cease daily printing except for a Sunday edition. The paper has been giving subscribers iPads to wean them off print.

Census hiring temp workers, including some immigrants; researcher has suggestions to increase rural compliance

The Census Bureau is hiring about 50,000 temporary workers to carry out preliminary work for the 2020 population count; it plans to hire about 500,000 workers next year to do the actual count. That will bump up employment across the nation, Reade Pickert reports for Bloomberg.

Federal law says agencies may only employ citizens, but the bureau is using a loophole to temporarily hire non-citizens in order to reach hard-to-count populations, such as non-English speaking and immigrant communities, Lauren Camera reports for U.S. News & World Report.

Better counts in immigrant-heavy areas could help some rural, agricultural areas. That's important because rural America has a lot riding on the census, but is at a higher risk of being undercounted, John Green writes for The Conversation. Green is a sociology professor at the University of Mississippi and director of the university's Center for Population Studies.

In rural areas, lower census participation stems from various barriers, including lack of awareness and distrust of the government. The bureau's new strategy of offering the census primarily online will probably further lower turnout because of limited internet access in many areas, Green writes.

One way rural communities can increase local census compliance: "people can form or join Complete Count Committees which promote an accurate count of the population in their communities," Green writes. "For example, participants might coordinate census promotion campaigns within churches, or develop community celebrations that feature the civic duty of census participation."

Package explores how immigrant poultry plant workers have transformed a West Virginia town

Amy Fabbri teaches an English as a Second Language class
to plant workers (100 Days photo by Justin Hayhurst)

A recent series by 100 Days in Appalachia paints an intriguing picture of how immigrants working at Pilgrim's Pride poultry plants in Moorefield, West Virginia, have transformed the local community over the past 15 years and left many residents struggling to reconcile social ties with politics. 100 Days is a West Virginia University project launched after the 2016 election, in collaboration with The Daily Yonder and West Virginia Public Broadcasting, that aims to provide in-depth narratives of Appalachia that aren't often reflected in parachute journalism.

The first piece in the package lays out the basics: how Hardy County has become more diverse over the past decade because of the Pilgrim's Pride plants, and why so many of the workers are immigrants.

The second piece is a portrait of a class that teaches English to plant workers, many of whom just got off third-shift work. The class is vital to immigrants, since there are few other foreign language services in the area. The piece also explores the cultural divide between long-time residents and immigrants, and describes the ESL teacher's efforts to bridge that gap.

Moorefield, W.Va. (Wikipedia map)

The third piece puts some faces to the local immigrant population with photos and interviews of some of the adult ESL students.

The fourth piece is an in-depth feature of a local restaurant that makes pupusas, a stuffed corn cake that's the national dish of El Salvador. The owner says she's not just providing a piece of home for Central American plant employees, but that her dishes are also expanding the palettes of many native Moorefield residents.

Lack of unions hurt teacher recruitment in rural Wisconsin

"Finding teachers to make a life in rural America these days isn’t easy. The population is declining. The schools are isolated. The pay is low. And that’s before you get into social considerations, like fewer dating and restaurant options," Samantha Hernandez and Max Cohen report for USA Today. "From Wisconsin to New Hampshire, Illinois to Montana, rural districts are struggling with how to recruit and retain teachers, especially when the economy has been strong and well-prepared graduates have lots of other job options."

In Wisconsin, a 2011 law that essentially eliminated teachers' unions has made the situation worse. "Now teachers enter into individual contracts with districts, subject to annual renewal. Few, if any, have job protection related to their seniority. And teachers now contribute more toward their benefits," Hernandez and Cohen report. "Without union contracts and their financial incentives for those who stayed put until retirement, teachers were free to shop around – and to be poached by other districts."

Since districts could recruit and pay teachers based on performance, many younger and mid-career rural teachers were lured to larger districts that paid more. Many teachers left the state entirely, seeking jobs in nearby states like Michigan and Minnesota that have teachers' unions, Hernandez and Cohen report. Many older teachers simply retired, rather than face teaching without the protection of a union. The high turnover rate hurts student learning, according to one kindergarten teacher, because it leaves kids without consistent routines or longtime connections with teachers.

Rural districts in Wisconsin and elsewhere are dealing with the shortage in various ways, Hernandez and Cohen report. Some districts are increasingly hiring foreign teachers. Some districts are trying to entice high school students to get interested in teaching, in hopes that they'll return and teach after graduating college. Some higher ed institutions offer scholarships to students who teach in rural districts, or offer non-traditional paths for mid-career professionals to switch to teaching in rural areas.

Weeklies and nonprofits produce series on impact of opioid abuse in four counties across Northern Virginia's Piedmont

A 15-minute video by lead reporter Randy Reiland explains the package.

Rural newspapers are beginning to tackle the epidemic of opioid painkillers and other substance abuse in their communities. The latest example is a four-part series by two nonprofit civic news organizations and two weeklies, serving four counties in Northern Virginia. It started this week and is a good example of how to cover the issue and how journalistic and financial partners can help do it.

The four counties, west to east: Rappahannock, Culpeper, Fauquier
and Prince William (Wikipedia map, adapted; click on it to enlarge)

The package was produced by Rappahannock Media (the Rappahannock News and the Culpeper Times) and the Fauquier Times, which also publishes the Prince William Times. In an unusual sharing of material, Potomac Local News in Prince William County and the online-only Fauquier Now are also publishing the project.

The papers gave the project slightly different labels—“Opioid Ripples” and “The Ripple Effect”—that make the same point, that the story of opioid abuse is not just overdoses and deaths, but how it has affected health, public safety, business, education, social services and other community functions, as well as neighborhoods, families and the whole community. A quote makes a main headline: "This has touched everyone."

Randy Reiland's lead story in the News begins, "Mothers sometimes ask Culpeper Police Chief Chris Jenkins to arrest their children. It’s the only way to save them, they tell him, because in jail, their sons or daughters can get the treatment they need. But, as Jenkins points out, the notion that inmates have access to life-changing drug rehab programs is 'nowhere near the truth'." For the Fauquier papers, he also makes that point but leads with the problem of addicted babies at the local hospital.

The work was supported by the Foothills Forum, which has sponsored polling and reporting for several years in Rappahannock County, and the Piedmont Journalism Foundation, which says its serves Fauquier County and "the surrounding Piedmont region," between the Blue Ridge and the Tidewater, and is headed by Boisfeuillet "Bo" Jones, former publisher of The Washington Post and former president and CEO of the company that had originated the PBS NewsHour.

Cattle producers, nervous about sales of meat alternatives, get state lawmakers to ban calling the products 'meat'

Lines wrapped around the building when KFC tested a vegan version of its fried chicken in an Atlanta restaurant this week. The restaurant sold out in five hours. (Associated Press photo by John Amis)

Meat analogues are entering a golden age in the US: Burger King and White Castle offer Impossible Burgers, Subway is testing Beyond Meatball subs, Dunkin Donuts is serving up Beyond Sausage breakfast sandwiches in New York, and KFC's Beyond Fried Chicken sold out in less than five hours in a test run in Atlanta this week. But as plant-based meat substitutes gain steam, many of the nation's 800,000 cattle ranchers—and the state lawmakers who listen to the cattlemen's associations—have become increasingly nervous.

"In 2019, officials in nearly 30 states have proposed bills to prohibit companies from using words such as meat, burger, sausage, jerky or hot dog unless the product came from an animal that was born, raised and slaughtered in a traditional way," Laura Reiley reports for The Washington Post. "Arkansas, Louisiana, Mississippi, North Dakota, South Dakota, Oklahoma and Wyoming have already enacted such laws. [There are others.] In Missouri, the first state where the ban took effect, violators incur a $1,000 fine and as much as a year in prison. Mississippi’s new law is sweeping: 'Any food product containing cell-cultured animal tissue or plant-based or insect-based food shall not be labeled meat or as a meat product.'"

Cattle producers say the new laws are important because the meat analogues make unsubstantiated health claims and could confuse customers. Mike Deering, executive vice president of the Missouri Cattlemen's Association, said that Beyond Meat Beefy Crumbles have a picture of a cow on the front and say "plant-based" in small letters at the bottom of the package. "I’m a dad and I’m going through the grocery store before one of my boys has a meltdown, and [if] I pick up that package that says beef with a picture of a cow on it, I’m going to buy it," Deering told Reiley.

But, Deering acknowledges, Beyond Meat and products like it aren't the real worry. He says "some of the hubbub really relates to the anticipated launch next year of cell-based meat: that is meat, poultry and seafood products derived from muscle tissue grown in a lab with cells harvested from a living animal," Reiley reports. "Ranchers fear that insufficient labeling will not distinguish between traditional animal agriculture and these products that do not yet have a track record for safety and human health."

The meat and poultry industries have good reason to be concerned, if the dairy industry's woes are any indication. Sales of cow's milk have dwindled over the last decade, dropping $1.1 billion last year alone, and most of the reason was consumer preference for alternatives like almond milk or oat milk. And, as in the dairy industry, the major processors are staying out of the fight and hedging their bets by investing heavily in the alternatives, Reiley reports.

Meanwhile, the new and proposed labeling laws are getting pushback in court. "On July 22, Tofurky joined forces with the American Civil Liberties Union, the Good Food Institute (a nonprofit that promotes plant-based meat) and the Animal Legal Defense Fund to file a lawsuit claiming Arkansas’ new labeling law, which went into effect July 24, violates the First and Fourteenth amendments," Reiley reports.

EPA calls for rollback of Obama-era methane emission rules

The Trump administration announced today plans to roll back Obama-era rules that limit regulation of methane emissions. Methane is a potent greenhouse gas that, in the short term, traps far more heat in the atmosphere than carbon dioxide and makes up nearly 10 percent of greenhouse gas emissions in the U.S.—most of it from the oil and gas industry.

"The Environmental Protection Agency, in a proposed rule, will aim to eliminate federal requirements that oil and gas companies install technology to inspect for and fix methane leaks from wells, pipelines and storage facilities," Lisa Friedman reports for The New York Times. "Under the proposal, methane, the main component of natural gas, would be only indirectly regulated. A separate but related category of gases, known as volatile organic compounds, would remain regulated under the new rule, and those curbs would have the side benefit of averting some methane emissions."

Many smaller petroleum companies have said it's too expensive to comply with the Obama-era regulations, but larger companies want more restrictions on methane. "Those larger companies have invested millions of dollars to promote the use of electricity from burning natural gas, which produces about half as much carbon dioxide as coal," Friedman reports. "They fear that unrestricted leaks of methane could undermine their pitch that gas is a cleaner energy source, leading to lowered demand for the fuel." The rule would most likely be finalized in early 2020 after going through a public comment period, according to analysts.

'Hemp-wood,' CBD manufacturing plants coming to West Ky.

Graves and Calloway counties (Wikipedia)

Far West Kentucky is shaping up to be a hemp hub, with news that a "hemp-wood" manufacturing plant and a CBD oil plant are coming to the area.

On Monday, a manufacturing plant that turns hemp into a sustainable lumber alternative opened near Murray in Calloway County. The business is the first of its kind in the nation. Greg Wilson, the CEO and founder of HempWood's parent company, Fibonacci LLC, touts the new product as eco-friendly because it causes no deforestation. And, he says, the product is 20 percent stronger than oak and can be used the same way oak wood is used, David Snow reports for The Paducah Sun. The plant is welcome news in Murray, where 600 employees of lawn mower engine manufacturer Briggs & Stratton recently found out their plant is closing in the fall of 2020.

Wilson says he got the idea from working for a bamboo flooring company years ago, according to the company website. "We're taking the plant fiber, or the stalks from a hemp plant after people have already utilized the top of the plant, and then, we are converting that using a bio-based adhesive into a wood composite," Wilson told Snow. "We're taking something that grows in six months and we're able to replicate or outperform a tropical hardwood that grows in 200 years."

"The top of the plant" is the flower buds that contain the heaviest concentration of cannabinoids, the main medically active ingredients of the cannabis plant. Just west of Murray, in the Graves County seat of Mayfield, cannabidiol manufacturer GenCanna is working on a $40 million processing facility that it says will provide more than 80 jobs. The company already owns a 120,000-square-foot facility in Paducah, says The Lane Report, a statewide business publication.

The HempWood plant will use more than $1 million a year in raw materials, all from local farms, and will pay out more than $1 million to workers annually, Wilson said. "Each one of these presses will have 12 people working on it, plus three management positions per shift per press," Wilson told Snow. "Our plan is to eventually move into the building that's being built right next door so we can have two pressing operations going, hopefully turning into two shifts per press, which means having a maximum impact approaching the 50 employee mark."

In surprise call, Trump tells farmers trade war could drag on but appeals for votes; some applaud, some leave, a few boo

Perdue takes call (FarmProgress photo)

With his farm base restive due to the trade war with China and other matters, President Trump reached out to farmers directly Wednesday with a call to Agriculture Secretary Sonny Perdue, who was on stage at the annual Farm Progress Show in Decatur, Ill. They "stunned the crowd," Natalina Sents reports for Successful Farming.

"I'm with a group of your friends, Midwest farmers," Perdue told Trump, but the audience reaction to the president's pitch, which suggested that the trade war may not end until after the November 2020 election, was not entirely positive, report Sents and Mindy Ward of FarmProgress.

Trump said, "I can make a quick deal with China, and I can carry that deal into a tremendous amount of agriculture products. Immediately I would be a hero, I would easily win the election. And that would be that, but it would be the wrong deal. Or I can do it the right way like it should have been done over the last 35 years, and do it the way we are doing right now, stay the course." He added, "I can do a quick deal and look like a hero, or I can do it the right way, but it has to take a little time."

Sents writes, "Trump acknowledged China may look to delay a trade agreement until after the 2020 election, saying, 'They'd rather deal with sleepy Joe Biden than with me.'" Perdue, "looking at the crowd of show attendees spilling out of the building," told Trump, "These farmers are long-term players."

Trump noted the tentative trade deal with Japan and said, “China targeted our farmers thinking they can get to me because they knew I loved the farmers.” Addressing them, he said, “I hope you like me even better now than you did in '16.”

"Some farmers applauded, while a few booed," Ward reports. "The presidential phone call was cut short due to connection problems. Perdue quipped, 'That’s why we need broadband across the country Mr. President, we don’t have a good signal here.'"

Water wells go deeper; makers of unique map say that won't solve supply problems; 120 million in U.S. rely on wells

Well depth trends, 2000-15; some states and areas lack data. Click on image to enlarge it. (Map by Perrone and Jasechko)

A first-of-its-kind map illustrates how important groundwater is to American livelihoods, and shows that water wells are going deeper due to shrinking aquifers and other issues. But deeper drilling is an unsustainable practice, say the water-resource scientists who created the map, Debra Perrone and Scott Jasechko. Both are assistant professors at the University of California, Santa Barbara.

Though the U.S. recently had its wettest spring on record, groundwater supplies in many areas are still lower than normal, even in places with wet climates like southern Georgia, Perrone and Jasechko write for The Conversation. That matters because groundwater supplies drinking water to more than 120 million Americans and provides more than half of the water used for irrigation.

"As climate change intensifies, groundwater is likely to become even more important because it is generally more resilient to climate variations than river flows are. But unlike rivers and the dams, levees and spillways people have built to control them, groundwater is hidden. Groundwater wells are small, widely distributed and often out of view," Perrone and Jasechko write.

They created the groundwater map over the past four years using state, regional and county agency data from more than 60 different databases; the process took longer because there is no national requirement to collect information about groundwater wells, Perrone and Jasechko write.

What their map found: between 1975 and 2015, wells have been dug increasingly deep in 70 percent of the areas they studied, especially in the Colorado River Basin. "There are many reasons why people may be drilling increasingly deep wells, and they don’t all imply doom and gloom," Perrone and Jasechko write. "For example, deeper wells may be the result of improved well and pump technologies; discovery of deeper fresh groundwater reserves; different permit requirements for shallower versus deeper groundwaters; inadequate water yields in some layers; or poor water quality at shallower depths."

However, drilling deeper can't go on forever for a variety of reasons: sometimes it's impractical because of the nature of rock strata, and deeper groundwater is sometimes too salty. Deep wells also may be too expensive for many farmers, Perrone and Jasechko write.

21 states have no local newspaper with dedicated reporter to cover their representatives and senators in D.C.

Pew Research Center map; click the image to enlarge it.

As newspapers keep tightening their belts, more and more have stopped paying reporters to cover readers' representatives in Congress.

"Between 2009 and 2014, the number of D.C.-based reporters for local newspapers around the country who are accredited by the Senate to cover Congress declined by 11 percent, according to data from the U.S. Senate Press Gallery, which accredits Capitol Hill journalists," Kristine Lu and Jesse Holcomb report for Pew Research Center. "Papers that do employ these reporters – who are tasked in part with interpreting the decisions and policies of Washington for readers back home – are not clustered in any one part of the country, but rather are spread out around the United States. But 21 of 50 states do not have a single local daily newspaper with its own dedicated D.C. correspondent accredited to cover Congress."

Some of those have to divide their attention between the needs of more than one paper in a chain. McClatchy and Gannett, for example, have D.C. reporters who keep tabs on several states. "One Gannett correspondent describes her beat as encompassing Tennessee, South Carolina, Alabama, Virginia and North Carolina," Lu and Holcomb report.

States with no dedicated reporters tend to be those with smaller populations and smaller delegations, with the exceptions of Arizona and Indiana, which have nine-member delegations, Pew notes.

The downward trend in coverage troubles some D.C. correspondents. Todd Gillman, Washington bureau chief for the Dallas Morning News, told Pew: "It is only the regional media outlets that keep close ongoing tabs on lawmakers, politicians, lobbyists, issues, interest groups from discrete geographic areas, and as the number of regional reporters has dwindled, that watchdog function has absolutely been watered down."

A few papers have re-established D.C. coverage, and some digital news startups and public-radio outlets are trying, but that isn't enough to fully replace the lost coverage, Lu and Holcomb report.

Program that pays remote employees to move to Vermont succeeding; new program aims to lure workers for local jobs

A state program to pay remote workers to move to Vermont is succeeding beyond officials' initial expectations. "Originally, state officials said they’d select 100 people to receive as much as $10,000 in the first year of the Remote Worker Grant Program, and then 20 people in the following years," Emma Coleman reports for Route Fifty. "Each new resident would submit moving expenses, membership fees for coworking spaces, broadband costs, or security deposits for reimbursement up to $5,000 per year for two years."

News media across the country covered the story, which apparently led to far more interest than officials had anticipated. After receiving thousands of inquiries, the state Department of Economic Development decided to expand the program, Commissioner Joan Goldstein said. The department had planned to distribute $125,000 in incentives from January to June of this year, but spent it all by April. The state allocated more funds in July and eliminated the annual cycle, meaning people can apply until the remaining $375,000 is gone, Coleman reports.

How effective has the program been? Since January, 170 people (including family members of workers) have relocated to Vermont. "It’s a great outcome," Goldstein told Coleman. "People are moving from metropolitan areas all over the country, and moving into rural areas and small towns, just spreading out throughout the state."

Goldstein's office is working on a new, similar program meant to recruit workers for local jobs (no freelancers). "Her department has over $1 million to start allocating in January of 2020 to people who accept new positions in Vermont. The new program provides $5,000 for one year (or $7,500 if moving to a rural area of the state) to qualifying applicants on an approved occupational list, whose new jobs pay them at or above 160 percent of the minimum wage," Coleman reports.

Trump administration proposes opening public lands, once part of national monument in Utah, to mining and drilling

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Gatehouse lays off more than two dozen newsroom staffers

About a week after announcing its merger with Gannett Co., GateHouse Media began another round of newsroom cuts.

"More than two dozen newsroom staffers were reportedly laid off from at least 10 papers, including the Providence Journal and The Oklahoman," Keith Kelly reports for the New York Post, citing a story from The Associated Press. "The two dozen new cuts are only a sliver of the 10,000-plus employees at Gatehouse, which publishes more 150 dailies and 500 weeklies mostly in small-market America."

Gatehouse already had two major rounds of layoffs this year; some journalists say they worry that more cuts are coming. "GateHouse doesn’t have a vision for growing revenue, only cutting costs, Andrew Pantazi, a reporter at the Florida Times-Union, a Gatehouse paper in Jacksonville, told AP. "Eventually, they’ll run out of costs to cut."

In public comments, Michael Reed, the CEO of GateHouse's parent company New Media Investment Group, said the merger would save millions, mostly from consolidating newspapers' finance, sales, digital services, and tech, but he hasn't mention newsroom cuts, Kelly reports.

Small towns increasingly vulnerable to cyberattacks

Small towns are increasingly getting hit with cyberattacks, in which hackers infiltrate government computer and/or utility systems and encrypt the data, then demand a ransom to unlock them. Many of the hackers are from Eastern Europe, Iran, Russia, and some are even from the U.S.

More than 40 municipalities of all sizes have been victims this year, from the City of Atlanta to dozens of small towns. "The majority have targeted small-town America, figuring that sleepy, cash-strapped local governments are the least likely to have updated their cyberdefenses or backed up their data," Manny Fernandez, David Sanger, and Marina Martinez report for The New York Times.

Attacked city governments have essentially three choices: Reconstruct their systems from scratch, pay an expert to recover the data, or pay the hackers steep ransoms to get their systems unlocked. Communities have proven so willing to pay up that hackers are spending considerable time and effort figuring out ways to make their attacks even sneakier and more precise. Some local governments have purchased cyber insurance; cybersecurity expert Kimberly Goody told the Times she expects hackers will start targeting organizations with insurance, because of the more likely payout.

Beyond the financial fallout and the massive disruption of government, the attacks have serious consequences: "Even when the information is again accessible and the networks restored, there is a loss of confidence in the integrity of systems that handle basic services like water, power, emergency communications and vote counting," the Times reports.

The attacks are unlikely to stop any time soon. "The business model for the ransomware operators for the past several years has proved to be successful," Chris Krebs told the Times. "Years of fine-tuning these attacks have emboldened the actors, and you have seen people pay out — and they are going to continue to pay out." Krebs is the director of the Department of Homeland Security's Cybersecurity and Infrastructure Security Agency, which aids American victims of cyberattacks. Homeland Security urges local governments to back up data and system configurations and keep the copies offline, as well as update their software.

Democrats see a trade-war opportunity among farmers, but some remain skeptical that many votes are there to get

Mainstream journalists are catching up to cracks in President Trump's support among farmers. Two major news organizations have stories today, and a third has an analysis doubting that the trade war will hurt Trump much among agricultural interests.

Tim Reid and Joseph Ax report for the Reuters wire service, "Seizing on mounting Farm Belt frustration with President Donald Trump’s economic agenda, Democratic rivals are stepping up their push to take back part of rural America, whose overwhelming support for Trump helped propel his upset 2016 election victory."

Alan Rappeport writes for The New York Times, "The predicament of farmers is becoming a political problem for Mr. Trump as he heads into an election year. For months, farmers have remained resolute, continuing to pledge support to a president who says his trade policies will help the agricultural industry win in the end. While there are few signs of an imminent blue wave in farm country, a growing number of farmers say they are losing patience with the president’s approach and are suggesting it will not take much to lose their vote as well. . . . As the trade fight gets uglier, farmers are beginning to panic."

Reuters notes, "Farmers and ethanol producers are also upset with the administration’s latest decision to allow more oil refiners to skirt biofuel laws and use less corn-based ethanol," and says several Democratic presidential candidates have made the two issues "the central plank of their pitches to rural America."

The Times report begins with the Aug. 7 episode in which Minnesota soybean farmers vented to Agriculture Secretary Sonny Perdue and he responded with a joke that drew boos. Citing a report from the American Farm Bureau Federation, Rappeport notes, "Farm bankruptcy filings in the year through June were up 13 percent from 2018 and loan delinquency rates are on the rise," and adds, "Losing the world’s most populous country as an export market has been a major blow to the agriculture industry. . . . Deere & Co., the maker of agricultural equipment, said this month that it was cutting its profit forecast for the second time this year. The administration has tried to mollify farmers by rolling out two financial aid packages totaling $28 billion." The help has depleted the funds of the federal Commodity Credit Corp., which would require action by Congress to replenish.

Farm Journal surveys in July and August showed Trump's support among 1,100 farmers polled dropped from 79% to 71%, the Times notes. But Greg Sargent writes in his "Plum Line" column for The Washington Post,  "There is likely zero chance that farmers — or rural voters — break with Trump in 2020. Still, this illustrates the limits on Trump’s lying powers: If they stick with Trump, it isn’t because he mesmerized them into ignoring reality; it’s that they still see other reasons for sticking with him. Those are likely rooted in partisanship more than anything else; farmers are overwhelmingly Republican voters."

Nevertheless, Reuters notes, "Even a small erosion in Trump’s support among rural voters could make a difference in battleground states like Pennsylvania, Wisconsin and Michigan, where Trump won by razor-thin margins in 2016, Democratic strategists say."

Sargent adds, "Trump also seems to have zero fear that gaslighting his own constituencies might cost him politically. Why? One possible answer: Fox News. According to indefatigable Fox tracker Matthew Gertz, as of Tuesday morning Fox hadn’t said anything about the report of farmers getting angry at Trump’s agriculture secretary for accusing them of 'whining,' but it did feature a farmer who pledged his undying 'trust' in Trump’s handling of the trade war. . . . It probably won’t be a big story that Trump’s agriculture secretary got booed by farmers for being dismissive of their travails — or that some farmers’ reps don’t like it when Trump lies about their difficulties. . . . Trump frequently makes such claims as 'farmers are starting to do great again'."

Firearm suicide prevention efforts are tricky in rural Utah

Robin Hatch hands out gun socks with a suicide prevention
hotline printed on them. (KUER photo by Erik Neumann)

Firearms account for just over half of all suicide deaths, but trying to prevent use of guns for suicide can be difficult in rural areas, where firearms are part of the local culture.

Suicides by gun are much more common in rural areas, mostly because of easier access to firearms. It's a particular problem in Utah, which has one of the highest suicide rates in the nation, and especially in rural northeastern Utah, which has a suicide rate 58 percent higher than the rest of the state. Guns are a popular means of suicide in Utah: 85% of the state's firearm deaths are suicides, and suicide attempts with guns are far more likely to be successful, Erik Neumann reports for NPR.

Because guns are so popular in Utah, efforts to prevent suicide have mostly focused on increasing gun safety with devices such as free gun locks, expanding mental-health and crisis-response programs in rural areas, and promoting awareness among locals about when and how to intervene if they see someone at risk of suicide, Neumann reports. 

Dee Cairoli is a pastor who teaches concealed-carry classes on the side. "When hosting classes, Cairoli explains how gun owners can intervene if another gun owner shows signs of a mental-health crisis," Neumann reports. When Cairoli was 15, his father killed himself with a gun, but Cairoli says he never hated or blamed the gun; he focuses on the fact that his father could get a gun in a "desperate moment," and wants other gun owners to understand the importance of keeping an eye on friends.

Republican state Rep. Steve Eliason, who represents suburbs near Salt Lake City, has sponsored several bills focused on firearm safety, suicide prevention, and mental health. Eliason also has been touched by gun tragedy; three young male relatives have been firearm suicides. He told Neumann he has been careful to focus on safety and not restricting gun rights, since guns are so popular.

Counselors from Northeastern Counseling Center, in the northeast Utah community of Roosevelt, are more pointed. They have a table at a local gun-and-knife show to give out safety goodies meant to slow someone considering suicide in a moment of crisis: cable locks and gun socks with the National Suicide Prevention Lifeline phone number printed on them, Neumann reports. As they hand out the swag, they strike up conversations. One counselor, Robin Hatch, told an attendee: "Lethal access to lethal means makes a difference. Suicide attempts by any other means are less lethal."

Hatch told Neumann, "Anything that we can do to get people off track a little bit, thinking something different. We believe that will help make a difference in our suicide rates."

Brooklyn lawyer doesn't let politics come between her and her cousins at annual reunion in southeastern Kentucky

Rural and urban areas look unequivocally divided on any political map, and many Americans wonder how to bridge the gap. That's one reason Brooklyn-based lawyer Caroline Aiken Koster decided to go to her extended family's annual reunion in Pineville, Ky., this summer. "I wanted to remind my husband and two college-age sons of the things we had in common with the rest of America, Koster writes for The Wall Street Journal.

Pineville, in Bell County (Wikipedia map)

But the Louisville native (whose parents are from Pineville) also wanted "a dose of unconditional Kentucky love. I was hungry for the potluck fried chicken, fried corn, fried apples and green beans sauteed in bacon grease. But I also sought escape from the 24-hour news cycle, the East Coast echo chambers and my like-minded friends on Facebook," Koster writes.

Several of Koster's friends in New York were skeptical about her trip, and wondered whether she would fit in anymore. But, Koster writes that the act of being together, of listening to each other's concerns with love, is what makes understanding possible: "Like many Americans, I’ve been alarmed by studies and polls suggesting we’ve lost empathy for one another. Up in the mountains, love and civility forced us to talk it out. There was no room for identity politics when we sat elbow to elbow at the picnic table. We all knew we had to get along if we want to come back next year. There was no avoiding tough conversations, no unfriending, no ghosting or canceling."

Rural hospital closures in Calif. raised mortality rate 5.9%

"When a hospital closes in an urban area, mortality rates don’t change. But when a rural hospital shuts its doors, according to a new study, mortality rates increase nearly 6 percent," at least in California, where the study was done, Bill Bishop reports for The Daily Yonder. "The new study helps clear up a question about the impact of hospital closures on health. Earlier studies at times have shown that a closed hospital didn’t seem to have much impact on health."

University of Washington researchers analyzed 92 hospital closures between 1995 and 2011 in California. Urban hospital closures didn't affect local mortality rates much, but in rural areas with hospital closures, mortality rates increased 5.9%. "This matched earlier studies, which found mortality rates increasing from 3 to 10 percent after a rural hospital closes," Bishop reports.

That has sobering implications for rural areas, which have seen increasing hospital closures in the past decade; 97 rural hospitals have closed since 2010, and more than a fifth of the nation's rural hospitals—about 430 in 43 states—are at high risk of closure, report researchers at the University of North Carolina.

Mortality rates increase after a rural hospital closure because local patients have a harder time accessing care: they must often drive much longer distances to see a doctor, and many patients lack reliable transportation, time for the trip, or gas money. Nearby facilities become overcrowded because of the influx of new patients, which can lead to a decrease in the quality of care and longer wait times. All those factors add up to higher mortality rates, Bishop reports.

Beyond the mortality rate, rural hospital closures have a cataclysmic effect on the surrounding economy, since hospitals are often the largest employer in the area.

Trump administration seeks to drop rule that aims to ensure there are enough doctors to treat Medicaid patients

The Trump administration wants to kill a 2016 rule meant to ensure there are enough doctors to treat beneficiaries of the federal-state Medicaid program, which covers about one in five American citizens and nearly one in four rural citizens under 65 (when Medicare kicks in).

"State health officials say the rule, which requires states to monitor whether Medicaid reimbursement rates are high enough to keep doctors in the program, forces them to spend a lot of time collecting and analyzing data with little benefit," Michael Ollove reports for Stateline. "Health-care advocates, though, fear that dropping the regulation would enable states to set those payments at a level that would cause some of the 72 million Americans who rely on Medicaid to scramble for health care. Research shows that when reimbursement rates drop, fewer providers agree to accept low-income Medicaid patients."

For that reason, many doctors don't accept Medicaid patients, and critics of Medicaid expansion under Obamacare say getting a Medicaid card doesn't guarantee that you'll get a health-care provider.

Advocates of the proposal say the Obama-era regulation, called the Medicaid Access Rule, hasn't improved patient access and is a bureaucratic bother. Opponents say the rule hasn't been in place long enough and needs more time for effects to be visible, Ollove reports.

"CMS last year called for a significant watering down of the Obama rule. Last month, the agency proposed to scrap it altogether," Ollove reports. "The comment period on elimination of the rule runs through next month, after which CMS will announce its decision."

Friday PBS documentary traces history of bluegrass music

Bill Monroe at the first multi-day bluegrass
music festival, in 1965 (Ron Petronko photo)

PBS viewers have been bombarded with reminders that Ken Burns's "Country Music" documentary will begin on the network Sept. 15, but have gotten relatively little notice of a similar film on bluegrass music, which will air Friday at 9 ET.

Big Family: The Story of Bluegrass Music "joyfully reaffirms" the genre's wide appeal, taking viewers from its Kentucky roots to the surprising global locales that have made it their own, Walter Tunis writes for the Lexington Herald-Leader. It's narrated by actor Ed Helms, a bluegrass enthusiast who played the banjo-playing character Andy Bernard in "The Office."

"Along with the international fascination, you’re left with the sense of how deeply a part of the American cultural fabric the music has become. Banjoist Graham Sharp of the Grammy-winning Steep Canyon Rangers states as much at the film’s onset," Tunis writes.

Sharp says, "I think of bluegrass as one of those very sort-of-ingrained American things. Like baseball."

"Big Family" was a mammoth undertaking for Kentucky PBS affiliate KET. It has footage shot over three years, including interviews with more than 50 luminaries such as Jeff Hanna of the Nitty Gritty Dirt Band, Del McCoury, J.D. Crowe, Ricky Skaggs and Bela Fleck.

Condensing more than nine hours of material down to two hours was agonizing, according to KET producers Matt Grimm and Nick Helton, Tunis writes. Grimm told him, "We wanted to be true to the story but include all that we could. At the same time, we wanted it to have broad appeal. We wanted those who are not bluegrassers to be able to relate to it."

Helton added that they also wanted to debunk stereotypes about bluegrass musicians and show the genre's connection to American culture. "They’re serious musicians doing things most musicians can’t do. There’s the speed with which they play, the rhythm," Helton said. "One of our biggest points was to show this rich history that really does weave itself through American history, as well. I think a lot of people don’t realize how much bluegrass music played a part in pop culture."

World culture, too. Grimm told Tunis that he and Helton got an unexpected ovation in a small music club in Tokyo where a Japanese bluegrass band was about to play. When the audience members heard the two were from KET, they applauded because they recognized the station's name from its old bluegrass programming. "We couldn’t have felt more welcome," Grimm said.

New FCC order limits local and state authority over cable companies, possibly endangering public-access channels

A recent Federal Communications Commission order that limits state and local authority over cable companies could endanger the existence of public-access channels, which help keep many small-town residents informed about meetings of town councils and school boards.

"The order, which has been under consideration for months, spurred thousands of comments. State and local leaders told the agency that it could jeopardize the public-access stations that communities count on to get out local news, religious services and emergency broadcasts, as well as 'institutional networks' (I-NETs) that many municipalities use to provide cable, phone and internet services to government buildings," Laura Maggi reports for Route Fifty.

Local or state governments can charge cable providers a franchise fee of up to 5 percent of television gross revenues from TV service. The new order allows companies to deduct from those fees the fair-market value of in-kind services that many provide as part of their agreements, including public-access channels, discounts for seniors and the I-NETs, Maggi reports. The measure passed 3-2, with both Democratic commissioners voting against.

"In another part of the order, the FCC says local and state governments can’t regulate the broadband networks being rolled out by cable companies, which are an increasingly large component of their businesses," Maggi reports.

FCC Chair Ajit Pai argued that reducing the regulatory burden on cable companies will help them expand broadband service, and that the savings will be passed on to customers. But Angelina Panettieri, a technology specialist for the National League of Cities, noted that the order doesn't require providers to spend the savings on network buildout or price reduction, Maggi reports.

Another Republican FCC commissioner, Brendan Carr, said he supported the new measure because some local governments have "taken advantage" of cable companies by making them provide free service to "municipal liquor stores and government-owned golf courses," Maggi reports.

Trade war is increasingly hurting small businesses

The intensifying trade war with China is increasingly hurting small and mid-sized businesses across the U.S., and the tariffs announced Friday raised the stakes. Tariffs imposed over the past year mainly affected agricultural products and manufacturing components, but the latest round has prompted small business owners to delay store openings, freeze hiring, and consider price increases.

For example, Cindy Michael, who owns a yarn store in Cuyahoga Falls, Ohio, says her latest yarn bill was $447, instead of the usual $120 or so. It turns out that the yarn, which comes from a Dutch company but is manufactured in China, is now subject to 25% tariffs from China and 5% tariffs from the European Union, Ray Strickland reports for WKYC-TV in Cleveland.

"Michael says if she does business with another company, she could end up in the same predicament where she’s blindsided by the company’s products being manufactured in China," Strickland reports. "Using a distributor in the U.S means they pay the tariff cost, and in turn the distributor could make her pay more. According to her, doing business with a company in the US is more expensive too."

Brewers will get hit too, since brewing machinery is on the list for the new tariffs. Adrian and Dara Sawczuk, who have been planning to open a brewery in Myrtle Beach, S.C., have been forced to downsize their operation and possibly delay the opening. They had planned to order $300,000 of brewing equipment from China, but can't afford a 15% tax on that, CNBC's Spencer Kimball reports.

"He would order the equipment from a domestic manufacturer — the problem is there just aren’t that many in the U.S. that offer the equipment he needs at a price that makes sense for the business," Kimball reports. "And it would create a supply problem if breweries suddenly started sourcing all their equipment domestically, Sawczuk said."

Sawczuk told Kimball, "There’s a day either my shareholders are going to make less money, I’m going to pay my employees less, or I’m going to charge my customers more."

In national opioid case, lawyers for babies born addicted seek earmarked settlement or verdict money for treatment

Consolidated federal court cases in Cleveland and Akron, set to begin in October, will provide a legal test for how much responsibility drug companies bear for the opioid epidemic. Attorneys representing children across the country who were born addicted to opioids are asking that a portion of settlement or verdict money from the lawsuits be earmarked for long-term treatment of their clients. The funds could be particularly welcome in rural areas, which have a disproportionate share of addicted babies.

"The attorneys, from 20 firms that represent children across the country, insist that a settlement or verdict must yield billions of dollars specifically earmarked for years-long monitoring of the physical and mental health of children born with 'neonatal abstinence syndrome,'" Lenny Bernstein reports for The Washington Post. "Without that guarantee, the attorneys contend, cities and towns are likely to spend any money they receive from drug companies on more pressing and popular needs, as some states did with windfalls from the $206 billion settlement with tobacco companies two decades ago."

The court case combines the lawsuits of about 2,000 cities, counties, tribes and other plaintiffs against about two dozen drug companies.