A rural Ohio pharmacy school embraces pharmacists' expanded 'provider status' by deploying a mobile care unit

Mobile Health Clinics staffed by student pharmacists and 
supervising faculty provided health care in rural Ohio.

Dozens of states across the U.S. allow pharmacists to have expanded care status similar to the role a primary care medical professional would fill. In 2019, the Ohio legislature granted pharmacists "provider status," which means they are "recognized healthcare providers in the state insurance code and allowed to be reimbursed for services like chronic disease management and immunizations."

Using their change to "provider status" as a launching pad, leadership at Ohio Northern University's Raabe College of Pharmacy in rural Hardin County, Ohio, challenged themselves to reenvisioned how they could use their existing "HealthWise" service, which was originally intended for ONU employees, to address health care deficiencies throughout rural Hardin County and its rural county neighbors, reports Kay Miller Temple for Rural Health Information Hub.

During a Hardin County health needs planning meeting, Michael Rush, PharmD, who teaches residents and is the director of operations at ONU HealthWise, was inspired by a food truck he saw outside; he thought a mobile HealthWise might be the answer.

Location of ONU in Ohio

Once shared, Rush's idea gained traction, and numerous funding awards and grants led to Raabe College hiring a pharmacist and purchasing a bus, which "built out ONU HealthWise into the ONU HealthWise Mobile Health Clinic," Temple writes.

Today, ONU student pharmacists and their supervising faculty aboard the HealthWise Mobile unit provide a broad spectrum of health care, including "preventive health education, medication reconciliation, medication therapy management, and chronic disease state management," Temple reports. Health screenings, immunizations and specialty care are also addressed on-site.

The Healthwise Mobile unit services have continued to expand to meet their community's needs. When two rural pharmacies closed in 2024, the traveling care team filled the gaps. 

Michelle Musser, director of ONU's Rural and Underserved Health Scholars Program, told Temple, "The students need those experiences of working in a pharmacy, different from the mobile outreach experiences. This closure allowed them to experience firsthand what a rural pharmacy closure actually does to rural communities."

Building on the first Healthwise Mobile Clinic's success, Raabe College is investing in a second van. Temple adds, "HealthWise will eventually be present in Hardin, Allen, Auglaize, Hancock, and Wyandot Counties."

Federal agencies, farmers focused on preventing harmful algae blooms in Lake Erie

Federal agencies and farmers are working hard to prevent an algae growth disaster like the one that occurred at this time last year in Lake Erie that caused the city of Toledo to lose its drinking water for two days, reports Agri-Pulse. The Environmental Protection Agency "has teamed up with three federal agencies to improve monitoring of algal bloom growth," and the U.S. Department of Agriculture "has granted hundreds of millions of dollars to conservation initiatives across Michigan, Ohio and Indiana. Additionally, farm organizations within the Western Lake Erie Basin have worked tirelessly to prevent nutrients from leaving farms and feeding blooms." (NOAA photo: Algae coats the surface and gathers along the coastline of western Lake Erie each summer)

"City of Toledo officials confirmed last week that microcystin, a toxin produced by cyanobacteria present in some algal blooms, was detected in a Lake Erie intake crib three miles away from the city," reports Agri-Pulse. "This year’s bloom is shaping up to be similar in size to last year’s—National Oceanic Atmospheric Administration expects it to peak in September and measure an '8.7' on its severity scale, a number notably higher than 2014’s 6.5 rating and unnervingly close to 2011’s index high of 10. Fortunately, most stakeholders say that the city is better positioned to manage the bloom this year."

"To start, new sensors at an intake crib are operating 24 hours a day and taking measurements every 10 minutes," Agiri-Pulse reports. "Water samples will be taken at the treatment plant, and up to four times the amount of chemicals used last year will be ready for deployment when needed. The city will also have access to an early warning detection system developed by EPA, NASA, NOAA and the U.S. Geological Survey that will help water quality managers spot cyanobacteria algal blooms with satellite imagery. The partner agencies intend to develop a mobile app that can be utilized by water quality managers on the ground, allowing for more frequent observations over more areas than in the past."

Carrie Vollmer-Sanders, director of the Western Lake Erie Basin Project at The Nature Conservancy, said, “'In the next three years, I want to see us reversing the trend' in algal bloom size," Agri-Pulse reports. She said "if ag conservation initiatives like Lake Erie’s continue to grow in strength and breadth, 'I think we’ve won, we’ve been able to turn the tides, and we’ll be able to—whatever weather patterns we have—we’ll be able to attack any natural resources issue.'” Agri-Pulse is subscription-only but offers a four-week free trial.

Ohio fertilizer law aimed at toxic algae blooms has a loophole exempting big manure users

A loophole in Ohio's pending law to require farmers to get fertilizer licenses "exempts many large dairy, hog, and poultry farmers who spread manure on their fields," Karen Schaefer reports for Great Lakes Echo, a service of the Center for Environmental Journalism at Michigan State University. The law was created in response to algae blooms found in Lake Erie that threatened water drinking water supplies for 11 million people and made Toledo's water toxic.

Roger Wise uses grass-covered buffer strips to help keep
phosphorous out of local watersheds.(Schaefer photo)

Fourth-generation farmer Roger Wise, former president of the Ohio Farmers Union, told Schaefer, "The original legislation was going to require that all the fields that were going to have the manure applied to, all the fields were going to be labeled, there was going to be a cropping plant and soil tests, and nutrient management – and all of that’s been done away with." 

Jack Shaner, deputy director of the Ohio Environmental Council, said the law, which doesn't go into effect until 2017, "requires only chemical fertilizer applicators to be certified, not those who use manure," Schaefer writes. "Shaner wants to see a watershed-specific nutrient management plan for Lake Erie’s western basin. Agricultural scientist Andrew Ward of Ohio State University agrees. But he says fixing the agricultural practices behind Lake Erie’s algae problem won’t come cheap." Ward told her, "We’re probably talking something like a hundred million dollars a year would be needed in Ohio every year, for many, many years." (Read more)

Excessive algae growth in Lake Erie turns water toxic and causes water ban in Toledo

This weekend Toledo, Ohio, residents could not use the city's water supply because tests revealed dangerous toxins likely resulting from excessive algae growth in Lake Erie. Because they were advised not to drink the water, brush their teeth with it or prepare food with it, they had to rely on bottled water or drive miles away to friends' houses to fill containers, Emma G. Fitzsimmons reports for The New York Times.

On Sunday, tests showed that the water is still contaminated. People in northwestern Ohio and southwestern Michigan are still scrambling to find clean water. "Ohio Gov. John Kasich declared a state of emergency," the Associated Press reports. Hospitals had to cancel some surgeries and send surgical equipment elsewhere to be sterilized, said Bryan Biggie, disaster coordinator for ProMedica hospitals in Toledo.

The Ohio National Guard delivered 33,000 gallons of clean water to the residents, and volunteers distributed bottled water at local high schools. No one was sure when the water ban would end. "I want to make sure that I would be comfortable with my family—my daughters and my wife—drinking the water," Governor John R. Kasich said, Fitzsimmons writes.  "When I'm comfortable with that, then I think we're in a position where we can say to the people here in Toledo that we feel good at it, and we can move forward."

Residents waited in line to receive drinking water in Toledo on Sunday. (NYT photo)

Along Lake Erie, the water is green-tinted like pea soup. After a testing at city water treatment plant discovered unsafe levels of microcystin, "a toxin that can cause diarrhea, vomiting or abnormal liver function," the city issues an urgent water notice on Saturday Morning, Fitzsimmons writes.

Officials said the water probably became toxic as a result of a harmful algae bloom in Lake Erie. The lake provides water for 11 million people, and environmental groups have showed concern about potential algae blooms before. Carroll Township, which is east of Toledo, issued a water ban last year resulting from algae blooms in the water supply. "Over the past decade, the algae blooms have steadily increased," Fitzsimmons writes.

Researchers believe the algae has grown because of manure and chemical fertilizer that has washed into the lake from farms as well as leaky septic tank and stormwater drains that flush large amounts of phosphorus into the lake. "Agriculture industry groups have been asking farmers for more than a year to reduce phosphorus runoff before government regulators step in and impose their own restrictions," the AP reports. (Read more)

Rural schools struggle to bridge the digital divide

Rural schools have long been leaders in distance-learning and online education. "To offer a full slate of courses to their students, they’ve had to be. Some states, fearing a divide between rural and urban communities, have developed statewide initiatives to provide technology to rural schools," Sarah Butrymowicz writes in The Hechinger Report. Maine, she points out, gives every student a laptop, and Alabama requires all school districts "to offer advanced placement courses through distance-learning technology, where students video-conference with teachers. (Edison School in Yoder, Colo.; Butrymowicz photo)

In 2010, only 57 percent of rural households had broadband Internet access, compared to 72 percent in urban areas, according to a November 2011 report by the U.S. Department of Commerce. Teachers in rural settings don't require students to go online to complete assignments and have to be flexible about staying after school so students can work on the computers. “The Internet can give them library resources that they might otherwise not have,” said Aimee Howley, senior associate dean in the College of Education at Ohio University, who studies technology integration in rural schools. Technology can also be used for simulations of things, she said, that “you just can’t do on site."

For schools facing shrinking budgets and consolidation, technology could be rural schools’ saving grace, said Bob Wise, a former governor of West Virginia who now serves as president of the Alliance for Excellent Education, a national advocacy organization in Washington, D.C., that has studied the challenges facing rural schools. “We’re encouraging every district to develop a systematic strategy for employing technology,” he said. “My guess is you will see a number of rural schools actually saved and renewed as learning centers.”
  

Governor goes to Ohio's booming gas fields for his State of the State address, touts new jobs

By Bill Reader, Ohio University
Partner, Institute for Rural Journalism and Community Issues

Ohio Gov. John Kasich broke with tradition Tuesday by giving the annual State of the State address at a small-town high school in Appalachian Ohio rather than in the Columbus statehouse. Kasich spent a portion of his speech talking about the dominant issue in that region and a major plank in his administration's priorities — coal mining and natural gas exploration and drilling — just days after announcing a $500 million investment in the region's booming natural-gas industry.

"If we can create a national energy policy, we need an energy policy in Ohio," Kasich said in his speech. "We are the Saudia Arabia of coal. We need to clean it and burn it. We also need to be for renewable energy. We need to embrace renewable energy. We need to have energy conservation, and we need to use our natural gas through fracking. We can't degrade the environment at the same time we're developing this industry."

The first-term governor gave his speech in the auditorium of the Steubenville High School, on the Ohio River across from West Virginia's Northern Panhandle and near the Pennsylvania border. Steubenville has a population of fewer than 19,000, according to the U.S. Census Bureau.

The day before Kasich's speech, the Steubenville Herald Star reported that the governor had announced that Denver-based MarkWest planned to expand its processing plant in nearby Marshall County and to build new plants in the region.

The newspaper contacted the company to verify Kasich's claims: "A spokesman for MarkWest, who declined to give his name, said the company could not divulge the cost of the new plants. He also said the company is still working out the details for the exact locations for the Ohio facilities." The development could create hundreds of short-term construction jobs and more than 40 long-term jobs, a MarkWest official told the newspaper.

That region of Ohio has seen considerable activity related to the Marcellus and Utica shale gas exploration and drilling. Last week, the Herald Star reported that another related facility might be built in nearby Belmont County — an "ethane cracker" that would remove ethane from the "wet" natural gases in the shale deposits. A Kasich spokesman would only confirm to the newspaper that Royal Dutch Shell was considering building such a facility in Eastern Ohio. A local county commissioner told the newspaper that such a facility could create thousands of construction jobs and hundreds of long-term jobs.

Not all the news related to the oil-and-gas boom in Ohio has been about economic growth in the traditionally depressed region. Weeks earlier, D&L Energy held a news conference in Youngstown to discuss the company's oil-and-gas wastewater well near the city, which a Columbia University seismologist has said "almost certainly" caused as many as 11 small earthquakes in the region.

Ohio has about 170 such sites to dispose of the brine and fluids used in hydraulic fracturing, or "fracking," of the shale deposits to release the oil and gas. A special report by The Columbus Dispatch states that "more than half of the brine coming to Ohio injection wells is from the shale-gas fields in Pennsylvania" and "The disposal industry is expected to grow as Ohio’s shale is exploited."

Family farming sees resurgence, Ohio paper finds

Family ties and new technology are two key factors in getting younger generations to join family farming operations, and trends point to a resurgence in family farming. "Between the two, today's farm may be smaller, but it is more efficient, production is higher, and it is attracting more of its young people back to farming, according to local agricultural experts," writes Connie Cartmell in the The Marietta Times. in southeastern Ohio. Those experts say they're seeing a resurgence in young farmers throughout the area, and Cartmell's piece profiles several family farmers in the community.

Working close to home is another perk attracting younger farmers to the business. "Working on the farm, I don't have to make a special time for my family after work. I'm with them all the time," said 36-year-old Christie Haines, who co-owns a farm with her parents. "You get way more than 40 hours a week, but you don't have a commute or worry about day care." (Read more)

What's the state of family farming in your community? There are stories to be told.

Ohio, Ohio, Ohio: Obama, Palin on rural routes

UPDATE, Oct. 11: For a Daily Yonder report on Obama in Portsmouth, click here.

Barack Obama and Sarah Palin are in Ohio today, in search of the 20 electoral votes that could decide who is president and vice president. Palin, after campaigning with John McCain in Wisconsin, will be in Wilmington, population 12,000, northeast of Cincinnati, in Clinton County, pop. 40,000. (Bill Clinton and Al Gore stopped there on their post-convention bus tour in 1992.)

Obama is rallying in Dayton, Cincinnati and Portsmouth, an Ohio River and Appalachian town of 21,000 in bellwether Scioto County, pop. 80,000, where the economy is "particularly bleak," reports Dan Sewell of The Associated Press. Sewell notes how badly Obama lost to Hillary Clinton in the primary but says the economy has created an opening for him. He quotes Eric Rademacher, co-director of the Ohio Poll at the University of Cincinnati: "Southeast Ohio could potentially make the difference in who wins Ohio, so it will be a very important campaign ground. I think right now there is a real question of just how the region is going to vote." (Read more)

Ryan Scott Otney of the Portsmouth Daily Times outlines preparations for Obama's visit and reports, "The city was abuzz with excitement on Wednesday, as the finishing touches were set into place . . . " (Read more) The Wilmington News-Journal's home page advises, "Rally goers: Please carpool." (Read more)

Obama opens a lead in Ohio but not in its hills; he gains in Pa., where McCain banks on character

UPDATES, Oct. 7: A Washington Post-ABC News poll taken in Ohio Oct. 3-5 shows Obama leading McCain 51 percent to 45 percent among likely voters, with an error margin of plus or minus 3.5 percentage points. (Read more) A CNN-Time-Opinion Research Corp. poll, taken in the state Oct. 3-6, gave Obama a lead of 50-47, plus or minus 3.5 for each figure.

Barack Obama has opened up a lead over John McCain in Ohio, a battleground state that has proven decisive in many presidential elections, but still appears to trail McCain in rural Appalachian Ohio, according to a Columbus Dispatch Poll taken Sept. 24 through Oct. 3 and published yesterday.

Obama led McCain statewide, 49 percent to 42 percent, plus or minus 2 percentage points. McCain lead Obama in Southeast Ohio 47 percent to 39 percent, probably within the error margin for that smaller sample, but the Dispatch didn't give subsample margins. McCain led in Southwest Ohio 50 to 45 percent and in west-central 50 to 39. Central Ohio was virtually even, with McCain leading 47-45, while Obama led in the northeast 57-35 and the northwest 45-41.

McCain "is scheduled to appear in Cleveland on Wednesday, while Obama plans a two-day bus trip across Ohio this week," the Dispatch's Darrel Rowland writes. (Read more) To help sign up more young voters on today's registration deadline, Obama's campaign had Bruce Springsteen play at a free concert at Ohio State yesterday.

Though McCain gave up on another Great Lakes state, Michigan, last week, and fell far behind in the most recent public poll in Pennsylvania, the latter state will stay in his sights, Chuck Todd and Mark Murray write on NBC News' First Read: "If there is one blue state the McCain campaign may never give up on, it's the Keystone State. Of all the Kerry blue states, it's the most competitive -- even right now at a time that appears to be Obama's high-water mark. Of the remaining blue states in play, Pennsylvania may be the most culturally sensitive and may explain why the McCain folks want to shift the debate a bit to character. Shifting the campaign to character isn't about changing the national narrative; it's about keeping the undecided column larger in Pennsylvania. Now, the character strategy could backfire in a Florida or even a Nevada or Colorado. But Pennsylvania, by the numbers, is worth it to McCain."

Obama led McCain 54 percent to 39 percent in Pennsylvania Sept. 27-29, according to a Qunnipiac University poll. Other battleground-state polls by QU's Polling Institute found Obama leading in Ohio 50 to 42 percent and in Florida 51 to 43. All the surveys had error margins of just under 3 percentage points. For details, click here.

In Appalachian Ohio, McCain says he will return; Obama gets to know the country he wants to lead

Presumptive Republican presidential nominee John McCain brought his town-hall campaign to Appalachian Ohio yesterday, "the first in what he said would be repeated visits to southern and rural Ohio between now and the November election," writes Mike James of The Independent in nearby Ashland, Ky. "Ohio’s rural counties are shaping up to be a deciding factor in who wins the state’s electoral votes." (Photo is from The Ironton Tribune, which had no credit online. For a nicely done slide show of McCain's visit, by Independent photographer John Flavell, click here.)

Aboard McCain's "Straight Talk Express" bus, Frank Lewis of the Portsmouth Daily Times interviewed the candidate and Ohio Sen. Mike DeWine, who said, "What we find is, when a Democrat wins as president in Ohio, they do well in southeast Ohio." DeWine noted that in the primary election, Obama lost some counties in the region to Hillary Clinton by 6 to 1. "McCain said he still was attempting to get Obama to join him in a series of town hall meetings, but told the audience, so far, Obama had declined. But McCain said he is holding out hope Obama will change his mind," Lewis reports. (Read more)

James, reporting on the Portsmouth town-hall meeting, writes, "One questioner asked McCain why he didn’t distance himself from the increasingly unpopular President George W. Bush." McCain replied, “I respect President Bush, but I believe it is time for a change in America … We’ve got to stop the out-of-control pork-barrel spending … It corrupted us … We forgot that it’s your money, not our money.” (Read more)

Benita Heath of the Tribune found an emblematic observer in the crowd: "Was he a sign of things to come? That young teen with a crew cut and deep blue Hillary T-shirt sitting in the bleachers at Portsmouth High School. Not only did this anonymous supporter of the Democrat who lost show up at John McCain’s town hall meeting Wednesday, he applauded over and over as McCain took pot shots at his Democratic opponent, Sen. Barack Obama." Ohio Gov. Ted Strickland said last month that he would not be Obama's running mate, but he showed up to marshal Obama forces "across the street from the McCain event at the Plumbers and Steamfitters Local 577 Hall in his own rally where he denounced the Republican nominee’s platform," Heath reports. (Read more)

Meanwhile, The New York Times reports that the presumptive Democratic nominee's campaign "has not only given the country a chance to meet Mr. Obama. It has also given Mr. Obama a chance to meet the country, taking him to large swaths of the United States that he has never seen before. Since his political rise began less than four years ago, he has visited New Orleans, toured parts of the Great Plains and traveled across the South — all for the first time."

The story is written by Jeff Zeleny, an Iowa native who covered Obama in small-town Iowa. He writes, “One of his most pressing challenges is to assure voters that he is one of them, that his background and upbringing are not so different from theirs. . . . Many of the regional distinctions in the United States, he said, 'in terms of culture, politics, attitudes, people,' have been muted. After 18 months of traveling extensively across the country, he said, 'the biggest differences have more to do with rural, suburban, urban, as opposed to north, south, east or west.'”

Zeleny writes, "Having grown up in Hawaii and Indonesia and spending much of his adult life in large cities, Mr. Obama, 46, is now acquainting himself more deeply with his country and finds himself unusually surprised by some of his findings. he told Zeleny, “A place that I’ve come to love, which I did not expect until this campaign, is Texas. I ended up loving Texas!” As we have noted before, Zeleny has a sharp eye for local coverage of Obama, and reports that "Local newspapers have picked up on a handful of his on-location gaffes," such as calling Sioux Falls, S.D., Sioux City, which is in Iowa. (Read more)

Journal Register Co., owner of more than 300 newspapers, sees stock and debt ratings slide

The stock of the Journal Register Co., a Yardley, Pa.-based newspaper chain, has been falling for weeks. On Monday, the stock closed at 22 cents per share, slightly up from the day's low of 19 cents, reports The Associated Press.

As of yesterday afternoon, the stock was trading at 28 cents per share, and Moody Investors Service downgraded the company's debt rating "two notches deeper into junk territory late Thursday on concerns the publisher of the New Haven (Conn.) Register is losing too much top-line revenue to cover its repayment obligations," reports Mark Fitzgerald of Editor & Publisher.

Journal Register stock (NYSE: JRC) has been trading below $1 for the past month and is in danger of being de-listed. The company announced earlier this week that it might put itself for sale and that it had hired Lazard Freres & Co. LLC for financial advice. Fitzgerald writes that there are reports the company is considering filing for bankruptcy. (Read more)

Besides its flagship Register, the company owns 21 other daily newspapers and 310 non-daily publications in Connecticut, Massachusetts, Michigan, New Jersey, New York, Ohio and Pennsylvania. The Hartford Courant's Capitol Watch sees other signs of trouble. "When New Haven Register's longtime Capitol bureau chief, Gregory Hladky, was abruptly laid off exactly one month ago, some Capitol insiders said the already weak finances of the Journal Register Company must be worse than anyone realized," Christopher Keating writes, adding, "Hladky's position had once been considered safe by many because his articles from the Capitol appeared in a wide variety of the JRC's publications, including the weeklies." (Read more)

UPDATE, April 14: Alan Mutter explains in his Reflections of a Newsosaur blog that the company is "highly profitable" but is suffering from too much debt, largely from buying a chain of papers in the Detroit area.

Kentucky's rural demographics and history give Clinton an advantage in state's May 20 primary

As the Democratic presidential primaries roll on, white men could be the key to the contest. Dan Balz of The Washington Post examines this crucial bloc of voters in light of Ohio's results, which he says raise the "question of whether racial prejudice would be a barrier to (Obama's) candidacy in some of the major industrial battlegrounds in the general election if he becomes the Democratic nominee."

Given the demographics and history of Kentucky, that question will be a key one in the state's May 20 primary, a fact that likely gives Clinton an advantage, writes Al Cross in his Sunday column for The Courier-Journal of Louisville. Cross focuses on Kentucky's voters — about 40 percent of whom are rural — but it's a similar look at the intersection of race and politics in this campaign.

The campaign's recent storylines and results highlight "the harder fact about race and Obama," that "there are still some white voters for whom his race is a disincentive or even a disqualifier," Cross writes. Exit polling from Ohio's March 4 primary shows Clinton held an advantage among voters who said race was a key factor for their vote, such as in the state's Appalachian 6th Congressional District — known as "Pennsyltucky" since it borders Kentucky and Pennsylvania — where Clinton won 72 percent of the vote. Add that to polls and results from other states that shows Obama's struggle to win over lower-income, lesser-educated whites, and it looks like Clinton should have an advantage in a Southern state like Kentucky.

Six weeks ago, Cross wrote that Obama could win Kentucky thanks to "swing voters over 55 who still feel angst about how they acted during the civil rights struggle of the 1960s and would like to cast a cathartic vote" for an African American. This week, he has a different outlook and writes:

That was wishful thinking -- not in hope of an Obama victory, but in hope of a victory over our racist past, which still lingers. William Faulkner was not just describing the old Confederacy when he said, "The past is not dead. In fact, it's not even past." Obama says he is the candidate of the future. If he is to succeed, he must confront the past -- and in some places, the present.

Cross is director of the Institute for Rural Journalism and Community Issues and former political writer for The Courier-Journal. Forgive the "cross-promotion" here, but the column is worth checking out since Kentucky — with all its baggage — is entering in the political spotlight. (Read more)

50 state polls show rural battlegrounds, tight race in fall; Pennsylvania will continue to get attention

What states will be the big battlegrounds for rural voters in the election for president this fall? It depends on whether Democrats choose Hillary Clinton or Barack Obama, but the outlines of the battle with Republican John McCain became clearer today, with the release of the first poll to take statistically solid samples from every state.

Survey USA is able to do that because it uses automated calling with recorded voices, usually of anchors at the television stations that sponsor the polling. Traditional pollsters and many political observers discount such polling, which may over-estimate turnout and under-estimate undecided voters, but Survey USA has established a decent track record and deserves consideration.

The polls indicate that the biggest rural battleground, in terms of population, is likely to be the current Democratic primary battleground: Pennsylvania. The Keystone State has 2.8 million rural residents, third behind No. 1 Texas (3.6 million) and No. 2 North Carolina (3.2 million), both of which could be big rural battlegrounds if Obama is nominated, the polls there indicate. Each state poll sampled 600 registered voters, for an error margin of plus or minus 4 percentage points for each candidate's figure.

The Pennsylvania poll showed McCain beating Obama, 47 percent to 42 percent, but losing to Clinton, 47 to 46. That reflects polling for the critical April 22 primary in the state, which has Clinton leading Obama. In North Carolina, which has a primary May 6, McCain beat Obama 47-45 and Clinton 49-41. In Texas, McCain beat Obama 47-46 and Clinton 49-42. Both states have voted Republican in presidential elections for three decades; the Texas result may reflect more interest in Obama as a result of Tuesday's primary there. The same may be true in Ohio, which voted Tuesday. It is widely forecast to be a tossup state in the fall, but the poll there had McCain losing to either Democrat, 50-40. Ohio has the fourth largest rural population, 2.6 million.

One of the more interesting states in the poll was Virginia, a long-reliable Republican state that has been trending Democratic. The poll there showed McCain beating Clinton 50-40 but losing to Obama by less than 1 percent of the vote, rounded to 47-47. Virgina had 1.9 million rural residents, 27 percent of its population, in the 2000 census. In Missouri (31 percent, 1.7 million rural), McCain beat Clinton 48-44 and Obama 48-42.

In Iowa (39 percent, 1.1 million rural), which started Obama's rise, the poll showed McCain losing to him 50-41 but beating Clinton 46-41. Other states going Democratic only with Obama as the nominee were North Dakota, Nevada, Oregon, Colorado and New Hampshire. States going Democratic with only Clinton as the nominee were Florida, New Jersey, Arkansas (where she was first lady) and West Virginia. In the polls' electoral-vote projection, McCain lost to Obama 280-258 and to Clinton 276-262.

The difference between the potential Democratic nominees in West Virginia, the third most rural state at 54 percent, was marked: McCain beat Obama 53-35 but lost to Clinton 47-42. The Mountain State was the heart of an anti-Obama pattern in Eastern states with mountains, running from Pennsylvania to Arkansas. In Kentucky, McCain beat Obama 54-33 and Clinton 50-41; in Tennessee, he beat Obama 54-38 but was less than 1 percent ahead of Clinton, rounded to 46-46. Clinton won Tennessee's primary by a big margin. Kentucky votes May 20.

For the poll results, click here.

In final push, Clinton seeks rural white men's votes

Having lost her advantage, or most of it, among women voters, Hillary Clinton has focused on Ohio's rural and blue-collar men -- "a crucial swing vote who could make the difference in tomorrow's primary here -- and a group that's proven implacably hostile to her over the years," reports Glenn Thrush of Newsday. (Associated Press photo by Mark Duncan)

Writing from Youngstown, Ohio, for the Long Island newspaper, Thrush sets the scene this way: "The Rebel anthem 'Sweet Home Alabama' -- which proclaims 'Watergate does not bother me' -- found its way onto Hillary Clinton's loudspeakers here yesterday. The music at Clinton's events is typically you-go-girl rock, but it's been given a testosterone boost in Ohio, with the addition of Lynyrd Skynyrd, John Mellencamp, Bruce Springsteen and Stevie Ray Vaughan.

"The switch reflects the Clinton campaign's focus . . . Clinton's aides believe that a substantial number of undecided voters, who now make up 8 to 10 percent of those eligible to vote in the Democratic primary, are working-class white men. . . . Her campaign sees a real opportunity to pick up undecided white male voters in the Appalachian eastern part of the state, rural western counties and rust belt towns in the north."

A big part of Clinton's pitch to this target group is the argument that she is more qualified than Barack Obama to be commander in chief. Her campaign "touted her endorsement by 25 high-ranking military officials," Thrush notes, adding, "Obama made his own pitch to rural voters in the Appalachian region yesterday during a small town hall in Nelsonville focusing on his plan to develop 'green jobs' to replace the region's vanishing smokestack industries." (Read more)

Obama riding Democrats' partisan base; Clinton does best in counties (mainly rural) with more Rs

"Sen. Barack Obama campaigns against the blue-and-red ideological division in the country, but he is leading in the Democratic primary contest against Sen. Hillary Clinton because he has done a better job of turning out the Democratic base in the most partisan of Democratic communities," reports the Daily Yonder. "Clinton, meanwhile, is judged to be the more polarizing of the candidates. Yet she has found her strength among those who live in the counties with the most Republican voters" -- counties that are largely rural.

The Yonder's Bill Bishop and Tim Murphy analyzed primary and caucus results in "landslide counties," those where President Bush or Sen. John Kerry won by more than 20 percentage points in 2004. "Obama won 72 percent of the landslide Democratic counties from 2004," they write. "Clinton, meanwhile, has won 62 percent of the largely rural counties where Bush defeated Kerry in 2004 with landslide margins" -- counties where voters are "whiter, older and poorer" than in Democratic landslide counties. Obama lost such counties until the Virginia and Maryland primaries.

"Clinton's ability to pull votes from 'red' counties will be tested this coming Tuesday in the Texas and Ohio primaries, two states Bush won in both 2000 and 2004," the writers conclude. "The results of the Yonder study raise questions both about Clinton's strategy and Obama's ability to find a non-partisan compromise with Republican ('red') America. Clinton largely ignored caucuses in 'red' states, such as Idaho, North Dakota and Colorado. Obama won easy victories in these places where Clinton might have had an advantage.

"It's impossible to predict a vote in a general election based on the vote in the primary, but Obama has not yet shown an ability to pull voters from more conservative communities. He has been able to excite the most partisan of Democratic voters — the Democratic base that may be the least willing to compromise with Republicans should Obama be elected. It's interesting that the likely Republican nominee, John McCain, has done best in the cities — the same communities where Obama has excelled." (Read more)

Rockefeller backs Obama; could affect rural Ohio

U.S. Sen. Jay Rockefeller of West Virginia, chairman of the Senate Intelligence Committee, endorsed Sen. Barack Obama for president yesterday, a move that could undercut Sen. Hillary Clinton's efforts to win Ohio partly on the strength of votes from that state's adjoining slice of Appalachia.

"Barack Obama was right about Iraq when many of us were wrong," Rockefeller said. "It was a tough call and the single greatest national security question, and mistake, of our time." Clinton and Obama are running ads on national security, and much of Appalachian Ohio gets its television from stations in West Virginia -- where Rockefeller's statement got strong coverage from stations such as WSAZ in Huntington, where reporter Scott Saxton pointed out that no other member of the Mountain State's congressional delegation had taken sides in the race. He appended the senator's full statement to the online version of his story.

Rockefeller's endorsement "has got to hurt on multiple levels," Al Giordano writes on The Field blog of RuralVotes. "His state of West Virginia was likely to be one of the next illusory 'firewalls' claimed by Clinton if she survived March 4. . . . This will help Obama dampen Clinton’s lead in Ohio’s 6th and 18th congressional districts -- each with five delegates at stake -- and The Field wouldn’t be surprised to see Rockefeller make an appearance there this weekend."

Tom Searls of The Charleston Gazette noted, "Rockefeller was one of the Clintons' main allies in the early 1990s, when they tried to push through legislation to create universal health care. He has been considered a friend of the New York senator, but indicated in his statement Friday that he believes Obama will be more successful in domestic policies, also." (Read more)

Obama advertising heavily on local news sites

Presidential campaigns have spent relatively little money with newspapers in recent years, but the new technology of videostreaming is bringing political advertising to some widely viewed newspaper Web sites in the critical March 4 primary states.

Erik Sass of MediaPost reports that Barack Obama has "sliding billboard" ads "with an embedded 30-second video across 26 high-traffic local sites in Ohio and Texas," where he could put Hillary Clinton's campaign into a tailspin with victories in primaries Tuesday. "Clinton has also utilized online efforts, but not on this scale."

Sass writes, "The campaign will run 39 different creative versions of the ads, including three different videos touting the candidate's various positions. The embedded video ads are re-purposed spots that are also running on TV in the same local markets. When users click on the ads, they are taken to a landing page with a personalized video message from Obama. This includes, for example, Spanish-language messaging on some sites in Texas." (Read more)

Job loss inspires rural entrepreneurs, but they may not be ready to run a business, Ohio study says

Over the past few decades, Ohio has seen the number of self-employed double, climbing to almost half a million. An Ohio State study finds an increasing number of them are motivated to become entrepreneurs by a recent job loss, and "the ramifications are startling" for rural areas, reports Paula Schleis of the Akron Beacon Journal.

"That increases the number of entrepreneurs who are said to be ill-equipped to handle the risks and challenges of starting a small business, and lowers the average income of the sector as a whole," Schleis writes. She also points out that in 1969 rural self-employed workers made 4 percent more than their traditionally employed counterparts, but now the self-employed make 50 percent less.

Ohio State professor Mark Partridge wrote the report, called ''Does Enhancing Ohio's Small Businesses and Entrepreneurs Provide the Key to Growth?'' He said technology has allowed more people to do "casual work" from home. He said that in rural areas where manufacturing jobs have disappeared, the decision to become self-employed is more a matter of desperation. Partridge explained, ''If people are kind of forced into starting their own business, they may not come at it at a systemic or dynamic way, and they probably won't be as successful as if they formed a business for creative reasons.'' (Read more)

Clinton and Obama campaigns target southeastern Ohio's rural voters; former president a draw

In the final days before Ohio's March 4 Democratic primary, the campaigns of Sens. Hillary Clinton and Barack Obama are devoting plenty of time to the rural voters of southeastern Ohio. The campaigns' schedules and press releases make it clear that both see the Appalachian region as key. Hillary and Bill Clinton both traveled the region for campaign events today, while former Sen. Tom Daschle and Joe Logan, president of the Ohio Farmer's Union, held a conference call with Ohio reporters to discuss Obama's agenda for rural America. (A growing crowd waited for Hillary Clinton today in Zanesville; photo from The Times-Recorder.)

Daschle and Logan praised Obama's support for country-of-origin labeling on food and a ban on meatpacker ownership of livestock, as well as his proposals for increased renewable energy such as ethanol. Much of the call was spent on such broad issues, but the first question — from The Ironton Tribune — brought the focus back to southeastern Ohio and its laid-off factory workers. Daschle said Obama's plan to increase renewable energy could create jobs in Ohio, and that Obama understands investing in education is really the best thing to help transition workers and their children to the new economy. Logan called the region "the forgotten stepchild" of Ohio's economy and said Obama's plan could help by reconnecting rural farmers and local consumers through more investments to local entrepreneurs.

The campaign gave reporters time for two more questions. One returned the discussion to biofuels. Asked to respond to recent studies about ethanol increasing greenhouse gases, both Daschle and Logan said there have been plenty of other scientists responding to those claims. Logan said corn ethanol is a "bridge technology" to switchgrass or waste products. Asked to explain his claim that Obama and Clinton differed when it came to renewable energy, Daschle said renewable energy is "a central part of his reason to run," while Clinton "has talked about it in a more passive way." Just another reminder from the Obama campaign that words matter, perhaps -- or a sign that the plans aren't all that different.

Meanwhile, both Clintons continued touring Appalachian Ohio. Today, the senator had events planned for Zanesville, Saint Claresville and Belpre. She was scheduled to attend an "Economic Solutions" summit in Zanesville at 1:30 p.m. (The Times-Recorder is blogging live from the event.) She will head to rallies in the high school gymnasiums of Saint Claresville and Belpre. On Thursday, she will attend another summit in Hanging Rock, near Ironton. Earlier this week, Bill Clinton made a swing through the area, and he was going to return for more events in Findlay, Marion, Mansfield, Wooster and New Philadelphia on Friday.

David Lightman of McClatchy Newspapers writes that Bill Clinton's stops in small-town Ohio keep him away from the national spotlight while still helping the campaign locally. "The appearance of a former president in places such as Marion and Mansfield could get voters excited and give them fresh incentive to vote for his wife," Lightman writes. "The local media are excited already. The Marion Star reported Tuesday that Clinton's visit will be the first by a president, incumbent or otherwise, since Richard Nixon stopped there 40 years ago. The Bucyrus Telegraph Forum ran a story that began with a local woman explaining that she was eager to secure a front-row seat." (Read more)

Ohio governor: Rural Appalachian voters could determine winner of state's Democratic primary

Rural residents in the hills of Appalachian Ohio have the same concerns as the rest of their mountain neighbors to the southeast — high unemployment, poverty, and the feeling that they often are forgotten by the urban parts of their state. Because of next week's Democratic presidential primary in Ohio, however, the region is getting attention, reports The Associated Press. (AP photo shows residents of Peebles, Ohio, discussing the election.) Former president Bill Clinton planned to spend today campaigning in the area for his wife, Sen. Hillary Clinton, while Sen. Barack Obama was sending his surrogates to campaign for him -- including David Wilhelm, an Appalachian Ohio native who managed Clinton's 1992 primary campaign.

"Although the region traditionally leans Republican, Democrats have made inroads in recent elections, giving the party hope that it can continue to pick up votes outside of Cleveland, Columbus, Cincinnati and other urban areas," AP reports. "Gov. Ted Strickland, a Democrat who grew up grew in the Appalachian region, said voters there may determine the outcome of the state's Democratic primary."

Strickland, who supports Clinton, told AP her stances on health care and other working-class issues will help her win votes, as will her past work with the region. In recent weeks, Obama has shown he can draw support from the demographics of regions such as this one. "In the Wisconsin primary last week, exit polls showed Obama running evenly with Clinton among lower-income, lower-education whites and drawing heavy support from white men without college degrees," AP notes. (Read more)

Bill Clinton "started today's swing through the southern part of state in Chillicothe, where he told a rally at a branch campus of Ohio University that his wife is the only candidate who has policies to help working class families," reports AP's Matt Leingag. Clinton also spoke at Shawnee State University in Portsmouth, on the Ohio-Kentucky border), and had stops planned for Athens and Lancaster.

"A Quinnipiac University poll showed Clinton with an 11 percentage point lead, down from 21 points in a poll released a week and a half ago," Leingag writes. "An Ohio Poll had Clinton leading 47-39, with an 18-percentage-point lead among women accounting for most of the difference." (Read more)

Wilhelm gave his first speech supporting Obama during an organizational campaign meeting in his hometown of Athens, reports reports Caitlin Zachry of The Post, the student newspaper of Ohio University. “I’m impressed by Barack Obama because of his rural development strategy,” he said at last week's meeting. “He has presented a philosophy that fits Southeast Ohio.” (Read more)

Bill Clinton was scheduled to appear at 2:45 p.m. at the Athens Community Centers, reports The Athens Messenger. "It's exciting," Susan Gwinn, chairwoman of the Athens County Democratic Party, told The Messenger. "I am glad we are getting so much attention. It shows the importance of Athens County to the Democratic Party." (Read more)

Last week, the paper's managing editor, Monica Nieporte wrote: "For all their 'I feel your pain' speeches, neither Hillary Clinton nor Barack Obama really has any idea what the pain of the middle class or lower-income class feels like. Perhaps one day in the distant past they did, but certainly not now. Most of the people who rise to this level of success in our country leave behind the working class that they love to champion in their rhetoric." (Read more)