Further Clarification of the Use of “Nonmetropolitan” in Describing a Michigan County:

Reply to “Nonmetropolitan Counties Have a Standard Definition”

Katherine L. Hughey, MD | Tammy Chang, MD, MPH, MS

PRiMER. 2018;2:2.

Published: 1/10/2018 | DOI: 10.22454/PRiMER.2018.220676

Thank you for these comments on this issue. The definition of metropolitan areas is nuanced1 and we understand and appreciate our readers’ comments.

Drs Wendling and Phillips correctly indicate that Washtenaw County, Michigan, is considered urban in many governmental definitions of urban-rural geographic areas. They cite the same widely-accepted references we considered in describing Washtenaw County in our manuscript.

Our aim was to describe a heterogeneously populated county that contains neither a uniformly dense urban population like those found in the largest 100 US cities, nor a high concentration of Latino inhabitants—for example, cities like Los Angeles, Chicago, New York City, and Miami, among others. A large number of Latinos in the United States live outside these large metropolitan centers, and the fastest US Latino population growth in recent years has occurred in areas with a relatively small number of Latinos.2

We chose to call Washtenaw County “nonmetropolitan” based on the reference we included from the Brookings Institution Center on Urban and Metropolitan Policy and The Pew Hispanic Center. That article is titled “Latino Growth in Metropolitan America,” and defines “metropolitan America” as the largest 100 metropolitan statistical areas (MSA) in the United States.3 Although Ann Arbor is a city in Washtenaw County and is designated as an MSA, it is not in the top 100 in the United States. Due to the brief nature of the report, we included population data about our county in the manuscript, and listed this reference as clarification of our use of nonmetropolitan, as there is no standardized term to describe a county outside the largest 100 MSAs in the United States, and with heterogeneous urban, suburban, and rural population components.

The main focus of our report is the novel findings of high risk for unintended pregnancy among Latinos in Washtenaw County.4 The risks for both men and women were found to be significantly higher than national figures, and were also significantly different between men and women in this county. Further research is underway to deepen our understanding of the reasons behind this finding, with the ultimate goal of informing policies and interventions that may help to reduce unintended pregnancy among Latinos in Washtenaw County, and other similar communities.


  1. Isserman AM. In the national interest: defining rural and urban correctly in research and public policy. Int Reg Sci Rev. 2005;28(4):465-499.
  2. Pew Research Center, Fact-Tank. Key facts about how the U.S. Hispanic population is changing. http://www.pewresearch.org/fact-tank/2016/09/08/key-facts-about-how-the-u-s-hispanic-population-is-changing/. Accessed December 12, 2017.
  3. Suro R, Singer A. Latino growth in metropolitan America: changing patterns, new locations. The Brookings Institution Center on Urban & Metropolitan Policy and the Pew Hispanic Center. http://www.pewhispanic.org/files/reports/10.pdf. Accessed January 16, 2017.
  4. Hughey KL, Llanes M, Plegue M, et al. Risk for unintended pregnancy among Latino men and women in a nonmetropolitan county in Michigan. PRiMER. 2017;1:21.

Lead Author

Katherine L. Hughey, MD

Affiliations: University of Michigan Department of Family Medicine


Tammy Chang, MD, MPH, MS - University of Michigan Department of Family Medicine and Institute for Healthcare Policy and Innovation, Ann Arbor, MI

Corresponding Author

Katherine L. Hughey, MD

Correspondence: Department of Family Medicine, University of Michigan Medical School, 1150 West Medical Center Drive, M7300 Medical Science I, SPC 5625, Ann Arbor, Michigan 48109-5625. 224-639-3989. Fax: 734-615-2687

Email: klemler@med.umich.edu

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