The Journal Of Rural Health[JOURNAL]
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200 papers
Improving Rural Healthcare by Creating Academic- and Nonacademic-Rural Hospital Partnerships Based on Community Health Needs Assessments and Technological Needs.
Babu S, Weinstein JN, Ferres JML … +1 more , Weeks WB
J Rural Health · 2025 Jan · PMID 39865945 · Publisher ↗
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Not enough: Medicaid expansion, medical debt, and cost avoidance in rural American Indian and Alaska Native households.
Hubbard S
J Rural Health · 2025 Jan · PMID 39865768 · Full text
PURPOSE: Despite expanding health insurance coverage under the Patient Protection and Affordable Care Act (ACA), many Americans struggle with financial barriers to health care. Medicaid expansion was meant to help allevi...
PURPOSE: Despite expanding health insurance coverage under the Patient Protection and Affordable Care Act (ACA), many Americans struggle with financial barriers to health care. Medicaid expansion was meant to help alleviate these barriers, particularly for rural communities, but has shown mixed results. The American Indian and Alaska Native (AI/AN) community, which faces both racial and geographic disparities, is a group that should benefit from Medicaid expansion. This paper examines differences in medical debt and cost avoidance for rural American Indian and Alaskan Native households in Medicaid expansion and nonexpansion states. METHODS: This study uses data from the National Financial Capability Study in binomial logistic regression models to examine whether AI/AN households in rural areas are more likely to have medical and engage in cost avoidance than their urban counterparts. FINDINGS: The results show no differences between Medicaid expansion status but do find a higher likelihood of medical debt for those living in rural areas. The results also show a higher likelihood of medical debt and cost avoidance for those living farther from Indian Health Services (IHS)/Tribal health care facilities. DISCUSSION/CONCLUSIONS: The results indicate that rural AI/AN individuals continue to face financial barriers to health care despite the expansion of Medicaid under the ACA. This suggests that rural AI/AN individuals are seeking care outside of the IHS/Tribal system due to limited access to IHS providers. Addressing these barriers may require policies and programs focusing on rural AI/AN communities.
Cognitive impairment and limited health literacy are associated with poor health outcomes among patients with heart failure residing in rural areas.
Wu JR, Lin CY, Kang J … +1 more , Moser DK
J Rural Health · 2025 Jan · PMID 39854027 · Publisher ↗
BACKGROUND: Cognitive impairment and limited health literacy are prevalent among patients with heart failure, particularly those residing in rural areas, and are linked to poor health outcomes. Little is known about the...
BACKGROUND: Cognitive impairment and limited health literacy are prevalent among patients with heart failure, particularly those residing in rural areas, and are linked to poor health outcomes. Little is known about the intricate relationships among cognitive function, health literacy, and rehospitalization and death in rural patients with heart failure. OBJECTIVES: To determine the relationships among cognitive function, health literacy, and cardiac event-free survival (ie, heart failure hospitalizations and cardiac mortality) in rural patients with heart failure. METHODS: This was a secondary data analysis of a randomized controlled trial of 573 rural patients with heart failure. Cognitive function was measured using the Mini-Cog test. Health literacy was measured by the Short Test of Functional Health Literacy in Adults. Cardiac event-free survival was followed for 2 years. Survival analyses (ie, Kaplan-Meier plots with log-rank test and Cox regression) were used. RESULTS: Cognitive impairment was associated with limited health literacy. Cognitive impairment and limited health literacy predicted worse cardiac event-free survival (P<.05). Patients with both cognitive impairment and limited health literacy had a 2.24 times higher risk of experiencing a cardiac event compared to those without cognitive impairment and with adequate health literacy (P<.001). CONCLUSIONS: Patients with cognitive impairment and limited health literacy were at the highest risk of experiencing a cardiac event. It is important to screen rural patients with heart failure for cognitive impairment and limited health literacy. Interventions to improve outcomes need to be developed to target rural patients who have heart failure with cognitive impairment and limited health literacy.
A new model-based approach for estimating rural hospital markets.
Malone TL, Pink GH, Holmes GM
J Rural Health · 2025 Jan · PMID 39853652 · Publisher ↗
PURPOSE: To provide a new approach for defining rural hospital markets. METHODS: First, we estimated models of hospital choice. We defined hospitals in the choice set using nationwide hospital data from the Healthcare Co...
PURPOSE: To provide a new approach for defining rural hospital markets. METHODS: First, we estimated models of hospital choice. We defined hospitals in the choice set using nationwide hospital data from the Healthcare Cost Report Information System (HCRIS). We modeled hospital choice using conditional logit regression and 2019 Medicare Fee-for-Service (FFS) claims data from the Centers for Medicare & Medicaid Services (CMS) Virtual Research Data Center. Next, we calculated estimated inpatient and emergency department utilization by patient ZIP code. We then estimated the total Medicare FFS volume for each hospital as well as the percent of each hospital's volume attributable to each ZIP code. We sorted ZIP codes by the patient volume attributable to the given hospital (from most volume to least volume) and then added ZIP codes to the market until at least 50% of the hospital's total patient volume was represented. FINDINGS: The average rural hospital market included three ZIP codes, an estimated population total of 37,221, and an estimated 5385 Medicare FFS beneficiaries. Furthermore, the average rural hospital had an estimated market share of 29%. A lower estimated market population was found for Critical Access Hospitals, hospitals unaffiliated with a system, hospitals with a smaller number of acute beds, and hospitals with fewer staff. CONCLUSIONS: We developed a new approach for defining rural hospital markets. This approach can be used to inform health services researchers, policymakers, and communities about key market predictors of rural hospital financial distress, populations adversely affected by rural hospital closure, and more.
Alzheimer's disease and related dementias among Medicare beneficiaries aged ≥ 65 years in rural America, by Census region and select demographic characteristics: 2020.
Matthews KA, Murray CT, Nguyen BL … +4 more , Spears KS, Jackson EMJ, Hall DM, McGuire LC
J Rural Health · 2025 Jan · PMID 39840892 · Full text
PURPOSE: Alzheimer's disease and related dementias (ADRD) are a significant public health concern characterized by memory decline that, over time, leads to loss of independence. This study reports ADRD diagnosis rates am...
PURPOSE: Alzheimer's disease and related dementias (ADRD) are a significant public health concern characterized by memory decline that, over time, leads to loss of independence. This study reports ADRD diagnosis rates among Medicare beneficiaries aged ≥ 65 years in rural America. METHODS: We conducted a descriptive analysis of Medicare Fee-for-Service (FFS) and Medicare Advantage enrollees using administrative Medicare data from 2020. Combining data from Medicare FFS and Medicare Advantage produces a more complete and representative sample of older adults than previous studies that used FFS data alone. Nonmetropolitan counties were used to define rural. Rural ADRD diagnosis rates, stratified by age, sex, race/ethnicity, and Census region, were adjusted using the 2000 Census population standard. FINDINGS: The study population consisted of 54 million Medicare data Fee-for-Service (FFS) and Medicare Advantage enrollees aged ≥ 65; 5.3 million beneficiaries were diagnosed with ADRD, and 16.2% (n = 861,337) of beneficiaries diagnosed with ADRD resided in rural America. The age-adjusted ADRD diagnosis rate was slightly lower in rural America (9.6 per 100 beneficiaries) than in the United States (10.0 per 100 beneficiaries). The South Census region had the highest rural ADRD diagnosis rates. CONCLUSION: These findings underscore the need for targeted interventions and support mechanisms to address the growing burden of ADRD in rural communities.
The influence of rurality on self-reported physical therapy utilization among patients with severe chronic back pain in the United States.
McLaughlin KH
J Rural Health · 2025 Jan · PMID 39835344 · Publisher ↗
PURPOSE: To examine the association of rurality and physical therapy utilization among a nationally representative sample of individuals with severe chronic back pain. METHODS: This study utilized a publicly available da...
PURPOSE: To examine the association of rurality and physical therapy utilization among a nationally representative sample of individuals with severe chronic back pain. METHODS: This study utilized a publicly available dataset from the 2019 National Health Information Survey (Adult Sample). Individuals with severe chronic back pain were identified based on survey items examining respondents' pain frequency and location. Physical therapy utilization was identified based on survey questions asking about pain management strategies utilized over the previous 3 months. Rurality was classified as large central metro, large fringe metro, medium and small metro, and nonmetropolitan/rural, based on the county of residence. Regression was used to examine the association between rurality and physical therapy utilization, while controlling for relevant covariates. National estimates were calculated using provided weighting variables. RESULTS: We identified 2925 individuals (weighted = 20,468,134) meeting the criteria for severe chronic back pain. We observed that individuals with severe chronic back pain living in nonmetropolitan/rural areas had 34% lower odds of (weighted OR: 0.66, 95% CI: 0.47, 0.92) utilizing physical therapy compared to individuals living in large central metropolitan areas. We did not observe significant differences in the odds of utilizing physical therapy among individuals living in large fringe metropolitan areas or medium-small metropolitan areas. CONCLUSIONS: Individuals living in rural parts of the United States have lower odds of using physical therapy for management of their severe chronic back pain. Additional research is needed to examine the factors that contribute to these differences and improve access to care.
Correction to "Rural-urban disparities in cardiovascular disease mortality vary by poverty level and region".
J Rural Health · 2025 Jan · PMID 39833112 · Publisher ↗
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Rural nonprofit hospital community benefit and financial assistance spending: A call for greater reporting transparency.
MacDougall H, Latcham M, Eliason E
J Rural Health · 2025 Jan · PMID 39797532 · Full text
PURPOSE: US nonprofit hospitals must provide community benefits including financial assistance to be tax-exempt. Rural residents particularly benefit from financial assistance because they have higher medical debt on ave...
PURPOSE: US nonprofit hospitals must provide community benefits including financial assistance to be tax-exempt. Rural residents particularly benefit from financial assistance because they have higher medical debt on average. The Internal Revenue Service allows nonprofit hospitals that are members of health systems to report expenditures for their entire system (group returns) rather than for individual hospitals. Our study examined how (if at all) rural nonprofit hospitals filing group returns are different than those filing individual returns. METHODS: We used 2021 data extracted from Community Benefit Insight and the American Hospital Association for 100 rural nonprofit hospitals in Wisconsin and Minnesota. We conducted bivariate analyses examining differences in mean total community benefit spending and mean financial assistance spending as a percentage of total operating expenses for hospitals filing individual versus group returns. We conducted multivariable regression models examining the association of filing group returns and individual returns with community benefit spending and financial assistance spending. FINDINGS: Bivariate analysis revealed significant differences between group return hospitals and individual return hospitals in spending on community benefits (5.81% vs. 9.49%, respectively) and on financial assistance (0.36% vs. 0.71% respectively). Multivariable regression demonstrated filing group returns is significantly negatively associated with community benefit expenditures (β = -2.90, p < 0.05) and financial assistance expenditures (β = -0.31, p < 0.01). CONCLUSION: In our sample, filing group returns was associated with less spending on community benefits and financial assistance. To understand this finding, researchers need data on individual hospital spending to increase transparency and accountability.
Determinants of HIV pre-exposure prophylaxis (PrEP) use among men who have sex with men (MSM) living in rural areas of the United States: A scoping review framed by the PrEP care continuum.
O'Neil AM, Hubach RD, Owens C … +3 more , Walsh JL, Quinn KG, John SA
J Rural Health · 2025 Jan · PMID 39780357 · Publisher ↗
BACKGROUND: HIV pre-exposure prophylaxis (PrEP) is a highly effective intervention to prevent HIV transmission among men who have sex with men (MSM). Despite its effectiveness, PrEP uptake and adherence among MSM in the...
BACKGROUND: HIV pre-exposure prophylaxis (PrEP) is a highly effective intervention to prevent HIV transmission among men who have sex with men (MSM). Despite its effectiveness, PrEP uptake and adherence among MSM in the United States remain suboptimal, particularly in rural areas. OBJECTIVE: The present study presents a scoping review of the self-reported barriers and facilitators of PrEP use among MSM living in rural areas of the United States. DESIGN: Preferred Items for Systematic Reviews-Extension for Scoping Reviews (PRISMA-ScR) guidelines informed this review. Seven online databases were searched to identify papers published from 2012 to 2023 in English with keywords related the concepts of MSM, rural, and HIV PrEP. RESULTS: From an initial 340 articles, nine were selected. Awareness significantly impacts PrEP uptake in rural areas, with challenges including limited dissemination of information through mainstream channels and low perceived HIV risk among rural MSM. However, nonmainstream information sources can enhance PrEP awareness and use. Several barriers hinder rural residents from accessing PrEP, such as a lack of competent providers, geographic isolation, cost, and stigma. High PrEP care costs, lack of financial assistance for lab work, and limited telePrEP options are key challenges in retaining individuals in PrEP care. CONCLUSIONS: Suboptimal PrEP uptake in rural areas with high HIV burden remains a concern, hindered by limited information dissemination, low perceived HIV risk, geographic isolation, nonaffirming medical providers, and expensive PrEP care. Leveraging telePrEP, co-pay assistance, 340B drug pricing, and geospatial networking apps can enhance PrEP use. Multilevel interventions are crucial to combat the HIV epidemic in rural regions.
Sexualized drug use factors among rural sexual minority men.
Owens C, Montemayor BN
J Rural Health · 2025 Jan · PMID 39780355 · Full text
PURPOSE: Although rural sexual minority men (SMM) use substances immediately before/during sex (i.e., sexualized drug use), the factors contributing to this behavior are unknown. We examined the factors associated with p...
PURPOSE: Although rural sexual minority men (SMM) use substances immediately before/during sex (i.e., sexualized drug use), the factors contributing to this behavior are unknown. We examined the factors associated with past year sexualized drug use among rural SMM. METHODS: Rural SMM in the Southern region of the United States (N = 345) completed an online cross-sectional survey from February to March 23, 2024. Participants answered questions about their sexualized drug use behaviors, sexual behaviors, minority stressors, and demographics. We conducted a hierarchical logistic regression to estimate the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with past year sexualized drug use. FINDINGS: Over three-quarters of participants (79.7%) used substances immediately before/during sex in the past year. Sexualized drug use was associated with exposure to sexual minority stressors, polysubstance use, sexually transmitted infection testing, having oral sex, receiving drugs from a man in exchange for sex, and older age. CONCLUSION: Sexualized drug use is prevalent among rural SMM, and sexual minority stressors and past year sexual risk and substance misuse behaviors were contributing factors. Rural primary care clinics, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) service organizations, and outpatient and inpatient substance use organizations should implement integrative sexual and substance use screening, counseling, and referral services for their rural clients.
What cancers explain the growing rural-urban gap in human papillomavirus-associated cancer incidence?
Semprini J, Zahnd W, Brandt HM
J Rural Health · 2025 Jan · PMID 39757446 · Full text
PURPOSE: Human papillomavirus (HPV) can cause cancers of the genital system, anus/rectum, and oropharynx. Prior research showed that HPV-associated cancer incidence was rising faster in nonmetro than in metro populations...
PURPOSE: Human papillomavirus (HPV) can cause cancers of the genital system, anus/rectum, and oropharynx. Prior research showed that HPV-associated cancer incidence was rising faster in nonmetro than in metro populations. Our study identified which cancers contributed to the widening disparity. METHODS: Representing ∼93% of all cancers in the United States, we analyzed data from the North American Association of Central Cancer Registries (2000-2019). Restricting the analysis to HPV-associated cancers, we compared 5-year average age-adjusted incidence rates (per 100,000 population) for nonmetropolitan (Rural-Urban Continuum Codes 4-9) and metropolitan populations, by sex and cancer site. To quantify the rural-urban gap, we calculated rate ratios and absolute differences of incidence trends. RESULTS: Although incidence was similar in 2000-2004 (nonmetropolitan = 9.9; metropolitan = 9.9), incidence in 2015-2019 was significantly higher in nonmetropolitan (12.3) than metropolitan (11.1) populations. The gap was widest for cervical cancers (females) in 2015-2019 (1.0 case per 100,000) but grew the most since 2000-2004 in oropharyngeal cancers among males (+1.1 cases per 100,000). The nonmetropolitan rate ratios for females (RR = 1.15, 95% C.I. = 1.13, 1.17) and males (RR = 1.07, 95% C.I. = 1.05, 1.09) in 2015-2019 were higher than the respective RRs for all other years. Since 2000, the nonmetropolitan disparity has significantly grown for anal and cervical cancers in females, and oropharyngeal cancers in both sexes. DISCUSSION: Although preventable, nonmetropolitan Americans have shouldered a growing burden of HPV-associated cancers. To address these cervical, anal, and oropharyngeal cancer disparities, it is imperative that HPV vaccination programs are effectively implemented at scale.
Well-being interventions for rural health professionals: A scoping review.
McKennon S, Fricke S, DeWitt D
J Rural Health · 2025 Jan · PMID 39757437 · Full text
INTRODUCTION: The objective of this scoping review is to identify interventions to promote well-being that have been tried or proven effective to prevent or address burnout in rural health care professionals and trainees...
INTRODUCTION: The objective of this scoping review is to identify interventions to promote well-being that have been tried or proven effective to prevent or address burnout in rural health care professionals and trainees (HCPTs). Secondarily, we aimed to identify potentially applicable and feasible well-being interventions that could help rural HCPTs. METHODS AND ANALYSIS: We used PRISMA guidelines to conduct a scoping review of peer-reviewed English language studies, from all countries, published in core health sciences databases. We focused on intervention studies for burnout and well-being in rural HCPTs published from July 2013 to January 2024. Searches identified 571 studies; 18 additional studies were identified from hand searches of websites, reviews, and bibliographies identified in the original search strategy. Two authors screened and extracted all data using Covidence. FINDINGS: After deduplication, 507 studies were screened for inclusion, and 50 full-text studies were assessed for eligibility. After discussion and consensus, 30 studies were selected for inclusion. We included selected "applicable" studies, for example, online interventions. We excluded potentially applicable studies that would not be feasible in rural settings, that is, health system interventions requiring substantial personnel and infrastructure. Interventions included individual interventions (eg, mindfulness), increased support for professionals (eg, remote pharmacist assistance), and interventions to improve quality or teamwork. CONCLUSIONS: Few interventional studies have been done to support well-being and prevent burnout in vulnerable rural HCPTs. While individual interventions, such as mindfulness, are most effective to date, studies replicating or extending these interventions, and to identify supports that address workload and systems issues are needed.
Medicare Advantage and rural hospital profitability.
Kim YH, Reiter KL, Thompson KW … +1 more , Pink GH
J Rural Health · 2025 Jan · PMID 39731350 · Publisher ↗
PURPOSE: This study compares 2018-2023 Medicare Advantage (MA) days as a percentage of total Medicare days in rural and urban hospitals, describes 2022-2023 operating profitability of rural and urban hospitals by quartil...
PURPOSE: This study compares 2018-2023 Medicare Advantage (MA) days as a percentage of total Medicare days in rural and urban hospitals, describes 2022-2023 operating profitability of rural and urban hospitals by quartiles of MA days as a percentage of total Medicare days, and explores hospital characteristics that may be important for understanding the relationship between MA and profitability of rural hospitals. METHODS: Financial and hospital data were obtained from the Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System (HCRIS) for the years 2018 to 2023. Hospitals were assigned to quartiles based on MA days as a percentage of total Medicare days. Descriptive analyses were conducted to compare hospital characteristics and financial performance across quartiles. FINDINGS: Between 2018-2019 and 2022-2023, the median percentage of total Medicare days from MA grew from 11.3% to 28.0% for rural hospitals. The 2022-2023 median operating margin varied from 0.0% for rural hospitals in Q1 (lowest MA days as a percentage of total Medicare days) to 3.4% for hospitals in Q4 (highest MA days as a percentage of total Medicare days). CONCLUSION: Among rural hospitals, higher MA days as a percentage of total Medicare days was found to be associated with higher operating margin. However, results suggest that MA is not randomly distributed: rural hospitals with higher MA days as a percentage of total Medicare days exhibit distinct characteristics. This non-random distribution suggests that descriptive analysis may not fully capture the actual financial impact of MA on rural hospitals. Future research should recognize these complexities.
POSITION STATEMENT: Support policies to address opioid use disorder among rural communities.
LaRowe LR, Hardin HK, Goetzinger AM … +4 more , Fox KR, Kilpatrick R, Seng EK, Figueroa R
J Rural Health · 2025 Jan · PMID 39731348 · Publisher ↗
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Addressing substance use disorder-related stigma in rural communities using Community Conversations.
Ashrafioun L, Cobb T, Sayres K … +1 more , Cretelle C
J Rural Health · 2025 Jan · PMID 39731347 · Publisher ↗
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Social determinants of contraception use among rural adolescents: Implications for addressing disparities.
Bishop AS, Nurius PS, Rousson AN … +2 more , Bhattacharya A, Baumgarten EB
J Rural Health · 2025 Jan · PMID 39731344 · Publisher ↗
PURPOSE: Few studies have examined disparities in-and social determinants of-contraception use among rural adolescents despite evidence of higher teen birth rates and greater STI risk in rural communities. Guided by a so...
PURPOSE: Few studies have examined disparities in-and social determinants of-contraception use among rural adolescents despite evidence of higher teen birth rates and greater STI risk in rural communities. Guided by a social determinants of health (SDoH) framework, this cross-sectional study aimed to address these gaps. METHODS: Data come from the 2018 Healthy Youth Survey, including N = 3757 sexually active, rural-based adolescents. Chi-square and independent samples t-tests examined group differences in rates of self-reported contraception use (condoms and any form of contraception) at last sex. Logistic regression models examined associations between SDoH factors (social/community, economic, and health care access) and contraception use outcomes. FINDINGS: Contraception use disparities were observed for rural-based youth identifying as Black, Asian, Indigenous, and Latino/a/x/e; lesbian, gay, bisexual, and questioning their sexual identity (LGBQ); and those experiencing poverty. Regression models accounting for youth characteristics found that SDoH factors across the social/community domain-but not economic or health care access-were the strongest predictors of contraception use outcomes. In these models, LGBQ status remained negatively associated with contraception use. CONCLUSIONS: Rural disparities in contraception use, particularly for marginalized youth, call for service approaches that are relevant and responsive to diverse needs. Findings also suggest that rural disparities are influenced by a complex interplay of social factors, where existing health care resources may not sufficiently mitigate youths' adverse living conditions. Addressing contraception use disparities in rural communities will require greater uptake of comprehensive sexuality education and multilevel service approaches that attend to youths' social contexts.
A descriptive examination of rurality in the Environmental influences on Child Health Outcomes Cohort: Implications, illustrations, and future directions.
McCormack LA, MacKenzie DA, Deutsch A … +37 more , Beene D, Hockett CW, Ziegler K, Knapp EA, Kress AM, Li ZR, Bakre S, Habre R, Jacobson L, Karagas MR, LeWinn K, Nozadi SS, Alshawabkeh A, Aris IM, Bekelman TA, Bendixsen CG, Camargo C, Cassidy-Bushrow AE, Croen L, Assiamira F, Fry R, Gebretsadik T, Hartert T, Hirko KA, Karr CJ, Kloog I, Loftus C, Magee KE, McEvoy C, Neiderhiser JM, O'Connor TG, O'Shea M, Straughen JK, Urquhart A, Wright R, Elliott AJ, ECHO Cohort Consortium
J Rural Health · 2025 Jan · PMID 39731317 · Full text
PURPOSE: The Environmental influences on Child Health Outcomes (ECHO) Cohort has enrolled over 60,000 children to examine how early environmental factors (broadly defined) are associated with key child health outcomes. T...
PURPOSE: The Environmental influences on Child Health Outcomes (ECHO) Cohort has enrolled over 60,000 children to examine how early environmental factors (broadly defined) are associated with key child health outcomes. The ECHO Cohort may be well-positioned to contribute to our understanding of rural environments and contexts, which has implications for rural health disparities research. The present study examined the outcome of child obesity to not only illustrate the suitability of ECHO Cohort data for these purposes but also determine how various definitions of rural and urban populations impact the presentation of findings and their interpretation. METHODS: This analysis uses data from children in the ECHO Cohort study who had residential address information between January 2010 and October 2023, including a subset who also had height and weight data. Several rural-urban classification schemes were examined with and without collapsing into binary rural/urban groupings (ie, the Rural-Urban Continuum Codes, 2010 Rural-Urban Commuting Area [RUCA] Codes, and Urban Influence Codes). FINDINGS: Various rural/urban definitions and classification schemes produce similar obesity prevalence (17%) when collapsed into binary categories (rural vs urban) and for urban participants in general. When all categories within a classification scheme are examined, however, the rural child obesity prevalence ranges from 5.8% to 24%. CONCLUSIONS: Collapsing rural-urban classification schemes into binary groupings erases nuance and context needed for interpreting findings, ultimately impacting health disparities research. Future work should leverage both individual- and community-level datasets to provide context, and all categories of classification schemes should be used when examining rural populations.
Rural-urban divide in risk perception of LSD: Implications for psychedelic-assisted therapy.
Bradley M, Grossman D, Simonsson O … +2 more , Copes H, Hendricks PS
J Rural Health · 2025 Jan · PMID 39731315 · Publisher ↗
BACKGROUND: Recent legislative initiatives in the United States have focused on the medical and legal status of psychedelics, prompting interest in understanding public perceptions of their risks. This study investigates...
BACKGROUND: Recent legislative initiatives in the United States have focused on the medical and legal status of psychedelics, prompting interest in understanding public perceptions of their risks. This study investigates rural-urban differences in the perception of LSD and cannabis risks using national survey data. METHODS: Data from the National Survey of Drug Use and Health (NSDUH) between 2015 and 2021 were analyzed. Logistic regression models were used to compare risk perceptions of LSD and cannabis between rural and urban respondents, adjusting for relevant factors. RESULTS: Rural residents were 1.2 to 1.4 times more likely to perceive using LSD once or twice as of great risk compared to urban residents during the survey period. However, the perception of monthly cannabis use as having great risk was slightly higher among rural residents only until 2019, with no significant differences observed in 2020 and 2021. CONCLUSION: The study highlights a significant rural-urban divide in the perception of LSD risk, which could impact policymaking on psychedelic therapies. Understanding these differences is crucial for developing effective and equitable policies regarding psychedelic substances and treatments.
Ambulatory care utilization in the first 24 months' postpartum by rurality and pregnancy-related conditions: A prospective cohort study from Maine.
Bebus SM, Palmsten K, Lipkind HS … +2 more , Ackerman-Banks CM, Ahrens KA
J Rural Health · 2025 Jan · PMID 39722432 · Full text
PURPOSE: To estimate the rate of ambulatory care use among postpartum persons by rurality of residence and pregnancy-related conditions. METHODS: We used Maine Health Data Organization's All Payer Claims Data for persons...
PURPOSE: To estimate the rate of ambulatory care use among postpartum persons by rurality of residence and pregnancy-related conditions. METHODS: We used Maine Health Data Organization's All Payer Claims Data for persons who delivered between 2007 and 2019 (N = 121,905). We estimated rates of ambulatory care (nonemergency department outpatient health care) utilization during the first 24 months' postpartum by level of rurality (urban, large rural, small rural, and isolated rural) and by pregnancy-related conditions (prenatal depression, hypertensive disorders of pregnancy, and gestational diabetes). To estimate rate ratios (RR), we used Poisson regression with an offset for population at risk, adjusting for potential confounders and restricting the analysis to those with continuous insurance (n = 70,431). FINDINGS: The mean monthly rate per 100 deliveries of ambulatory care visits was 86.1; the median number of visits was 12 (interquartile range = 6, 25). Persons living in rural areas had lower monthly rates of visits than persons living in urban areas (adjusted RR ranged from 0.87 [95% CI: 0.85, 0.89] in isolated rural areas to 0.91 [95% CI: 0.90, 0.93] in large rural areas). Persons with prenatal depression (aRR = 2.07; 95% CI: 2.04, 2.11), hypertensive disorders of pregnancy (aRR = 1.07; 95% CI: 1.05, 1.10), and gestational diabetes (aRR = 1.11; 95% CI: 1.08, 1.14) had higher rates of visits than those without these conditions. CONCLUSIONS: New practices and policies may be needed to improve postpartum ambulatory care access and utilization in rural areas. Postpartum persons with pregnancy-related conditions are accessing ambulatory care at higher rates after delivery, which may reduce their need for acute health care use.
Disparities in telehealth utilization between US rural and urban areas during the COVID-19 pandemic.
Bin Abdul Baten R, Zohora FT, Siddiqui MUH
J Rural Health · 2025 Jan · PMID 39722428 · Publisher ↗
PURPOSE: During the COVID-19 pandemic, telehealth services were expanded across the United States to meet the increased demand and safety requirements of care. This observational study aims to understand rural-urban diff...
PURPOSE: During the COVID-19 pandemic, telehealth services were expanded across the United States to meet the increased demand and safety requirements of care. This observational study aims to understand rural-urban differences in telehealth utilization during the early part of the COVID-19 pandemic. METHODS: Individual-level data from the National Health Interview Survey 2020-2021 (age ≥18) were analyzed for this study. The Propensity Score Matching method with multivariable Ordinary Least Square was used to analyze 2 outcome variables-(1) having a medical appointment by video or phone in the past 12 months and (2) having a virtual one for reasons related to the pandemic. Event study models were analyzed to understand the trend of telehealth utilization throughout 6 quarters of the pandemic. Subgroup analysis by health insurance, age, sex, race, citizenship, and disability status was performed to identify underlying disparities between rural and urban residents. FINDINGS: Analysis reveals that rural respondents (N = 6,984) were 8.7 percentage points (P<.001) less likely than urban respondents (N = 40,207) to have a medical appointment by video or phone. Rural residents were 8.1 percentage points (P<.001) less likely to have had a virtual medical appointment because of reasons related to the COVID-19 pandemic than urban users. The event study showed that rural-urban telehealth utilization disparities persisted throughout the pandemic. Subgroup analysis revealed significant rural-urban disparities in telehealth utilization by demographic characteristics. CONCLUSIONS: Results demonstrate that rural residents were less likely than urban residents to utilize telehealth services during the COVID-19 pandemic, highlighting concerns about access to care for rural residents.
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