skip to Main Content
Rural communities like this one face many unique health challenges, but often lack representation in medical research. HHRA hopes to change that.

Archived Blog Posts
  • Russell King | Executive Director Reading Science: A Guide for We Who Are Not Scientists

    By Russell K. King, HHRA Executive Director Less than a week ago, the academic publisher Sage Journals retracted studies that questioned the long-established safety record of mifepristone. In December. Nature ran a piece noting that, in 2023, more than 10,000 scientific papers–a record number–were retracted. Not understanding the data, the anti-science voices decry the retractions as proof of corruption in the research community. Misunderstanding scientific publishing is an old and common problem. Early in my career, I was editor of a peer-reviewed medical journal, and part of my job was to translate the scientific language into messages more easily understood by nonscientific readers. I offer here a guide to reading scientific papers when you’re not a scientist. This method is not the only method, and I didn’t create it, but I’ve found it useful. Before I do, however, I hasten to say that the wave of retractions last year does not indicate a wave of fraud in science. The number of journals in publication rose from 1 million in 1997 to 3 million in 2020, yet the average number of retractions per journal has remained largely flat during that time.  Half of the retractions are for reasons other than fabrication, falsification, or plagiarism. The data seem to say the scientific community has stepped up.  Scientists are pressuring journals, and, in turn, journals are improving their policing of papers after publication. Reading scientific papers Step by step: 1. read the abstract to get the general idea of what the paper is about; 2. read the figures and legends to understand the data (then look to see whether they align with the conclusions in the abstract); 3. read the discussion, where the authors summarize and interpret the data (then see whether it aligns with the data in the figures and the overview in the abstract); and 4. if it’s not your field of expertise (true for most of us, even if it’s hard to admit), read the introduction to get a feel for what the relevant literature says; 5. if you’re evaluating how they got from the data to the conclusions, read the discussion (are they using standard methods, missing controls, using a representative sample and a control group, etc.?); and 6. read through a few references to see whether they say what the authors claim they do (padding the references with papers that do not fit is often a way to build false credibility). Red flags As you’re reading, keep your eyes open for signs that should cause you to pause and question the paper’s validity. Red flags don’t necessarily mean the paper is untrustworthy, just that we should not draw conclusions without digging deeper.  Some such red flags are: 1. the author has no expertise in the subject of the paper (is their degree in a relevant field, have they worked in the field, have they previously published in the field in reputable journals?)–crossovers are not uncommon, but these will typically have a coauthor who has credible expertise; 2. the references are old, meaning fewer than six citations from the past five years; 3. the results asserted are not closely tied to the data or are not placed in context with other studies; 4. the conclusions contradict the literature or general scientific consensus–advances happen, but this should prompt us to withhold judgment until we get more information; 5. funders are not disclosed; 6. conflicts of interest are not declared; and 7. the results have not been peer reviewed. Know yourself Because science and anti-science have become such powerful forces in cultural and political differences, it’s vital that we check ourselves as we read and evaluate scientific papers. No matter how well trained we are in critical thinking, no matter how separate we think we are from the cultural and political echo chambers around us, we are still human and we are still given to myriad thinking errors. To deal with the overwhelming amount of information our brains take in, our brains seek shortcuts to lessen the burden. Sometimes these shortcuts are helpful; too often they are not. At minimum, we process information through our personal confirmation bias and a complex, overlapping, ever-changing matrix of internal filters made of everything from our DNA to what we had for lunch. We must ask ourselves–more often than is comfortable–whether our understanding of what we’re reading is being distorted by our own emotions, preferences, prejudices, assumptions, and hopes. This requires us to be honest with ourselves about our emotions, preferences, prejudices, assumptions, and hopes. Read! Science is always emerging, never static. By the moment, it grows ever broader, deeper, more beautiful, more fascinating, and more important to our lives. We depend on science to bring us new information and understanding, to correct the errors of our past and–yes–to retract papers that are erroneous. The 10,000 retractions of 2023 should enhance, not undermine, our appreciation for the men and women of science who share their work with us.  What’s happening in science is exciting, and I promise you that reading about it is more than worth the effort.    

  • Securing the Future of Science: Planned Giving for HHRA

    Planned giving is the process of donating planned gifts, also known as legacy gifts, which are contributions that are arranged in the present and allocated at a future date. Commonly donated through a will or trust, planned gifts are usually granted when a donor passes away.  If you’d like to plan a gift for to support the important work of HHRA, you may use this form.  Thank you. Tax benefits:  Donors can contribute appreciated property, like securities or real estate, receive a charitable deduction for the full market value of the asset, and pay no capital gains tax on the transfer.  Donors who establish a life-income gift receive a tax deduction for the full, fair market value of the assets contributed, minus the present value of the income interest retained; if they fund their gift with appreciated property they pay no upfront capital gains tax on the transfer.  Gifts payable to the HHRA upon the donor’s death, like a bequest or a beneficiary designation in a life insurance policy or retirement account, do not generate a lifetime income tax deduction for the donor, but they are exempt from estate tax. More information: For those who wish to make legacy gifts that are guaranteed to support their own philanthropic interests and intentions, planned or deferred gifts may be most effective. Planned gifts require more planning than most current gifts or income or equity, often including legal and accounting counsel from a donor’s trusted advisors. Because these gifts produce philanthropic benefits to recipient organizations, there may be benefits to the donors or their heirs via reductions in state or federal income, capital gains, estate, or gift taxes. There are many ways to make planned gifts, the most simple of which are life insurance policies, designated distributions from retirement funds, or bequests, where donors designate a percentage or a specific amount of their estate to the recipient charity.  Specific amounts are preferable, as they do not require a full valuation of the estate before distribution can be made. For donors over the age of 70 ½ years who are required to take minimum annual distributions from their Traditional or Roth Individual Retirement Accounts (IRAs), up to $100,000 may be directed to charitable causes, with potentially significant tax savings each year. More complex planned giving arrangements such as charitable gift annuities, charitable remainder unitrusts, charitable remainder annuity trusts, lead trusts and others may provide donors with guaranteed income for the remainder of their lives in exchange for funds transferred to charities now. The gist of most such gift vehicles involves a donor making a current gift to a charity with commensurate tax benefits, the charity paying the donor per agreed-upon terms from those funds in the years that follow, with the remainder of the funds at the donor’s death remaining with the charity in perpetuity.

  • HHRA Earns 2024 Highest Recognition for Transparency

    By Russell K. King, HHRA Executive Director I’m pleased to announce that the HHRA has once again earned the Candid Platinum Seal of Transparency (our first was in 2023)-–an achievement earned by fewer than one percent of US-based nonprofits. The Candid Platinum Seal is the highest level of recognition offered by Candid (formerly known as GuideStar) and is awarded to organizations that meet the highest standards of transparency and accountability. The Candid Platinum Seal demonstrates the HHRA’s commitment to transparency and accountability. Our board, staff, volunteers, and partners believe that by sharing our data, metrics, and strategic priorities with the public, we can build trust and confidence in our organization and our work. To earn the Candid Platinum Seal, non-profit organizations must meet a rigorous set of criteria, including providing complete and accurate information about their mission, programs, finances, and governance on the Candid website, and sharing strategic priorities and information about outcomes.

  • Russell King | Executive Director The Importance of Integrity

    By Russell K. King, HHRA Executive Director Living, as we do, during an era overwhelmed by misinformation, disinformation, mistrust, grifters, posers, and pretenders, integrity is an increasingly rare and valuable quality. For a nonprofit organization like the HHRA, integrity is essential. By funding the Heartland Study, we are seeking the answer to a controversial question:  Are there health problems for mothers and infants that correlate to higher exposure of agricultural chemicals? Why is that controversial? Because there are people who insist they already know the answer and, regardless of whether they insist it’s “yes” or “no,” they prefer we don’t ask. They have vested interests in the answers they promote and fear an unbiased scientific inquiry may produce an answer that does not support those interests. A vested interest—”a strong personal interest in something because you could get an advantage from it,” according to the Cambridge Dictionary—is deadly to integrity. We don’t know whether we’re being told the truth or being told what advances your interest, so we can’t fully believe you. Doubt will endure and undermine your message. Thankfully, the HHRA has no vested interest in the outcome of the Heartland Study. The chair of the HHRA Science Advisory Committee insists we must be “agnostic about the outcome,” and the chair of the HHRA Board of Directors insists we must not “get ahead of the data.”  The principle investigator for the Heartland Study oft reminds us to “always let the science lead.”  As the HHRA executive director, I don’t care what the answer is, but I’m certain the question must be asked. The HHRA and the scientists working on the Heartland Study are not out to prove the answer is yes or no, but to learn whether the answer is yes or no. Likewise, our donors are supporting the effort to find “the” answer not “an” answer. There are no foregone conclusions here. All of which points to the integrity of our mission and our work. Integrity is demonstrated and enhanced by transparency, which is why the HHRA makes public its IRS determination letter, audited financials, bylaws (including our conflict of interest policy), strategic plan, gift acceptance policy, volunteers and staff, and the Heartland Study’s methods paper, published in a peer-reviewed journal.  Such transparency has already earned the highest award from Candid. Integrity yields many positive results.  First, the people and foundations that support the HHRA can know that the money they donate is being used for its stated purpose.  Second, and more importantly, the people who will eventually learn of our outcomes and recommendations, if any, can know that they can trust what they’re being told. That trust will make it more likely that our work will be used in improving public health.  And that is what it’s all about.

  • Russell K. King | Executive Director Holding the “Splendid Torch”

    By Russell K. King, MBA, HHRA Executive Director This time of year is especially rich with holidays that inspire deeper thoughts about our lives.  While peering through the steam rising from my coffee and contemplating my own mix of Thanksgiving gratitude, Christmas joy, and New Year’s hope and resolution, I heard the words of G. B. Shaw coming back to me: “This is the true joy in life, being used for a purpose recognized by yourself as a mighty one. Being a force of nature instead of a feverish, selfish little clod of ailments and grievances, complaining that the world will not devote itself to making you happy. I am of the opinion that my life belongs to the whole community and as long as I live, it is my privilege to do for it what I can. I want to be thoroughly used up when I die, for the harder I work, the more I live. I rejoice in life for its own sake. Life is no brief candle to me. It is a sort of splendid torch which I have got hold of for the moment and I want to make it burn as brightly as possible before handing it on to future generations.” Shaw’s words drew the HHRA into my musing.  Yes, the mission of the HHRA is a purpose I find “mighty” for which I hope to be “used up,” but I realized it’s much more than just one mighty purpose or worthy cause.  Within the HHRA mission, there are a number of splendid torches we may proudly carry. In the HHRA’s flagship program, the Heartland Study, we can find the worthy causes of maternal health, children’s health and development, environmental health, and public health, among others.  The HHRA’s Dietary Risk Index encompasses at least the worthy causes of consumer choice, food safety, and public health. Our Pesticide Use Data System and policy recommendations activities are also fertile with worthy efforts and promise. In our era, science is too often twisted to suit political, religious, and pecuniary ends, but the HHRA holds high the splendid torch of science as a search for truth.  The chair of our board oft reminds us “not to get ahead of the data,” and the chair of our science advisory committee reminds us of our obligation to be “agnostic about the outcomes” of our study.  I’m proud to say my own life has been spent promoting science and combating both pseudoscience and anti-science.  While much of the world tries to create data to fit their agenda, we are trying to learn what the data tell us.  Of all the splendid torches the HHRA offers us, my own favorite me be this:  Science unfettered by ulterior motives. In this season of reflection and contemplation of the deeper things of life, I urge you to recognize and cherish the worthy causes you are serving with your life.  If you’re still searching for a worthy cause that will bring you a taste of Shaw’s “true joy in life,” I invite you to join and support our work at the HHRA.  Find your splendid torch and carry it high!

Side Effects of Rural Living: Health Disparities in the Heartland

by Grace Koch | Nov 17th, 2021
by Grace Koch | Nov 17th, 2021
Rural communities like this one face many unique health challenges, but often lack representation in medical research. HHRA hopes to change that.

Thursday November 18th, 2021 is National Rural Health Day. This year the National Organization of State Offices of Rural Health (NOSORH) is specifically highlighting health equity in rural communities. One of the goals of HHRA’s flagship project, The Heartland Study, is to analyze the impact of pesticide exposures on human health, especially on reproductive impacts, healthy pregnancies and children’s development. Our research is already documenting rising levels of herbicide use and exposures across all citizens in the Midwest and rural communities in particular.

Factors impacting the health of rural populations are often underexplored in large scale clinical research projects carried out in large urban centers. According to the U.S. Census Bureau, 97% of land in America is considered rural. Recognition of rural health disparities, and the factors driving them, is an important part of HHRA’s current and future research.

Rural Health Disparity

A whole host of compounding factors have created significant health disparities for rural communities. Rurality is generally classified as any area outside of an urban area. The Census Bureau defines rural as any population, housing, or territory NOT in an urban area. In 2020, there were approximately 57.23 million people living in rural areas in the United States, about 17% of the overall population (Source).

Rural communities are often geographically isolated from the many resources urban and suburban people take for granted. Something as simple as a yearly doctor’s appointment, or finding a healthcare specialist, can be difficult for rural families, due to long distances they may have to travel and limited transportation options. Census data of medical doctors in the US shows that rural areas only have 11 MDs per 10,000 people, compared to 31 per 10,000 in urban/metro areas. In addition, the extent and quality of healthcare services varies greatly across rural regions of the country.

Source: March of Dimes

Data from March of Dimes shows how access to hospitals in the Heartland state of Iowa are limited to only a few counties (see map). Many families in rural counties have little or no access to a nearby hospital or birth center. This distance can complicate a person’s ability to get appropriate treatment for serious health problems, especially for rural individuals who don’t have a car, money, or access to transportation.

Lack of access to healthcare resources has a direct impact on the health and quality of life of rural communities. These populations have statistically higher rates of disease and disability, pain, increased mortality, and shorter life expectancies. The top five leading causes of death (heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke) are all higher in rural populations compared to urban populations.

In the Heartland State of Indiana, for example, cancer related deaths are far higher in rural/nonmetro counties than in urban/metro counties (see chart below).

Source: RHIhub

Food insecurity is also higher among rural populations. According to the USDA Economic Research Service report in 2020, 11.6% of rural households are food insecure, compared to 10.5% for the nation as a whole. Child poverty and food insecurity is also higher in rural areas, with 16.1% of rural households with children being food insecure, compared to 14.8% overall.

Inequality and Social Determinants of Health in Rural Populations

One rural population that is particularly vulnerable to pesticide exposure is farmworkers. HHRA hopes to translate Heartland Study materials into Spanish and other languages to promote participation by farmworker communities.

Health inequalities are often exacerbated by social determinants of health. Rural Americans are more likely to be low in socioeconomic status or be unemployed, have less post-secondary education, and are less likely to have healthcare coverage by employers or through Medicaid.  In addition, rural households have less access to community social programs, foodbanks, and SNAP program benefits.

Social inequities and health disparities go hand in hand. Social determinants of health like income, education, health literacy, environmental health, gender identity, and race/ethnicity all impact an individual’s physical and mental health.

The data backs this up – adults of racial and ethnic populations, living in rural areas, face more health disparities than white adults. A 2017 CDC report showed that Indigenous, Hispanic, and Black individuals in rural areas were more likely to have higher rates of poor health, report multiple chronic conditions, and are at most risk for obesity.

Rural communities may also face more environmental challenges that can impact health. Overall access to safe drinking water, healthy food options, and stable housing is a problem for many rural communities. Hazardous materials often end up in rural areas, contaminating local environments. In farming areas, heavy use of agricultural chemicals can expose both farmers and non-farmers to toxic pesticides in air, water and dust and soil particles. These additional routes of exposure to possibly toxic chemicals are at the crux of HHRA’s scientific research on the impacts of pesticide exposure on reproductive health, pregnancy outcomes and children’s development in the Midwest. By including rurality in our research, we hope to better understand the connections between farming practices, pesticides and other toxins unique to rural areas and public health outcomes.

HHRA is committed to taking account of the impacts of the unique risk factors and unequal access to healthcare services in specific rural areas, as well as gleaning insights from rural-based clinical research. Progress in understanding these factors will help HHRA address how access to food and farming systems impact public health outcomes in the Heartland and beyond. 

We are committed to enrolling at least 30% of participants in our flagship project, The Heartland Study, from rural areas. Most clinical research on pregnancy and reproduction takes place in urban research hospitals, and the unique health challenges faced by rural women are often not explored. We want to change that.

This is why HHRA is working to build research capacity in rural hospitals and why we will be recruiting more rural hospitals into The Heartland Study. 

We are also hoping to raise adequate funding for 2022 to translate our clinical research documents into other languages. Inclusivity starts with ensuring everyone has a seat at the table, where their voice can be heard.

This #GivingNovember please help us expand our reach to rural families and healthcare providers in the Heartland.  You can do so my making a contribution, signing up for the HHRA newsletter and following us on social media.

Back To Top