The Journal Of Rural Health[JOURNAL]
Sun
200 papers
Fixed-to-total cost ratio is predictive of rural hospital financial distress and closures.
Karim SA, Thompson KW, Pink GH … +1 more , Holmes GM
J Rural Health · 2026 Jan · PMID 41603423 · Publisher ↗
PURPOSE: Cost structure, the proportion of fixed-to-total costs, plays a central role in rural hospital financial viability. Rural hospitals face unique challenges due to low volumes and limited flexibility in reducing f...
PURPOSE: Cost structure, the proportion of fixed-to-total costs, plays a central role in rural hospital financial viability. Rural hospitals face unique challenges due to low volumes and limited flexibility in reducing fixed costs. This study evaluated variation in cost structures across rural hospital categories and assessed whether fixed-to-total cost ratios are associated with financial distress and closure. METHODS: We analyzed 2394 rural hospitals using the CMS Healthcare Cost Report Information System data from 2011-2023. Hospitals included 1200 Critical Access Hospitals (CAHs), 870 rural Prospective Payment System (PPS) hospitals, and 224 Rural Referral Center (RRC) hospitals. Fixed-to-total cost ratios were estimated using a mixed-effects regression framework and examined by hospital category, Financial Distress Index (FDI) category, and closure status. FINDINGS: Rural hospital categories exhibited substantial variation in cost structures. CAHs had the highest average fixed-to-total cost ratios (80.6%), followed by rural PPS hospitals (73.6%), and RRC hospitals (58.2%). Higher ratios consistently aligned with a higher risk of financial distress. Hospitals in the highest-risk FDI category and those that closed had higher fixed-to-total cost ratios than other rural hospitals. Differences were most pronounced between rural PPS and RRC hospitals. CONCLUSIONS: Cost structure is a strong indicator of rural hospital vulnerability. Hospitals with heavier fixed cost burdens are less able to adapt to declining volumes, making them more susceptible to financial distress and closure. Regular monitoring of fixed-to-total cost ratios can support policymakers and health system leaders in designing payment models and interventions that strengthen the stability of rural hospitals.
Rural community members' experiences and perceptions regarding lethal means safety in the context of suicide and accidental death rates.
Penzenik ME, Schneider AL, Hoffmire CA … +3 more , Sells JR, Stearns-Yoder KA, Brenner LA
J Rural Health · 2026 Jan · PMID 41588871 · Publisher ↗
BACKGROUND: Together with Veterans (TWV), a community-based suicide prevention intervention, is being implemented in rural locations across the United States, with individuals designing and implementing action plans base...
BACKGROUND: Together with Veterans (TWV), a community-based suicide prevention intervention, is being implemented in rural locations across the United States, with individuals designing and implementing action plans based on community-specific strengths and needs. To increase understanding regarding lethal means safety (LMS) among those living in 3 diverse rural communities where TWV is being implemented (Mississippi [MS], New Mexico [NM], Oregon [OR]), demographic and mortality data were obtained, and a survey was conducted. Responses are presented in the context of demographics and mortality rates. METHODS: Demographic and mortality data were drawn from the American Community Survey and the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research database. In addition, a random survey sample was selected from the United States Postal Service delivery sequence file. Survey recruitment was conducted primarily by mail. RESULTS: Notable differences exist between communities in terms of demographics and mortality rates (eg, average annual suicide mortality rates: MS 11.8/100,000; NM 33.0/100,000, OR 28.0/100,000). Across these communities, 3,846 individuals responded to the survey. Whereas most respondents were at least somewhat willing to discuss access to firearms with health care providers, only 3.8%-10.8% reported that any provider had asked about such access. A low proportion reported discussions with providers regarding safe storage of medications (14.1%-21.66%). Many respondents did not agree that gun locks and safes reduce suicide risk (16.9%-23.5%). CONCLUSIONS: Findings highlight room for growth in terms of education regarding the positive impact of LMS. It is recommended that strategies be guided by community-specific contextual factors.
Text-messaging e-cigarette cessation intervention for young adults in rural areas: A feasibility randomized trial.
Gwon J, Thongpriwan V, Lee HJ … +4 more , Cho YI, Paek S, Machongo RB, Noonan D
J Rural Health · 2026 Jan · PMID 41579093 · Publisher ↗
BACKGROUND: Electronic Nicotine Delivery Systems (ENDS) use is disproportionately high among young adults (YAs) in rural US communities, where cessation support is limited. The REVIVE (Rural Vaping Free Intervention for...
BACKGROUND: Electronic Nicotine Delivery Systems (ENDS) use is disproportionately high among young adults (YAs) in rural US communities, where cessation support is limited. The REVIVE (Rural Vaping Free Intervention for Young Adults via Text Messaging) program was developed to address the unique cessation barriers experienced in these settings. The objectives of this study were to examine the feasibility, acceptability, and preliminary efficacy of the REVIVE. METHODS: In a pilot randomized controlled trial, 39 YAs (ages 18-24) who used ENDS in rural areas were assigned to either the REVIVE intervention (n = 19) or standard care control (SCC; n = 20) over 9 months (June-August in 2023 and June-November in 2024). REVIVE participants received an 8-week targeted, interactive text-messaging cessation program. SCC participants received weekly links to general ENDS quitting resources. Feasibility (eg, retention rates), acceptability (eg, thought about quitting), and preliminary efficacy (self-reported 7-day point prevalence abstinence as the primary outcome and self-reported nicotine dependence as the secondary outcome) were assessed. Descriptive statistics, bivariate analyses, and logistic and multiple regression analyses were undertaken. RESULTS: REVIVE participants showed statistically significantly higher self-reported abstinence at 1-month follow-up compared to SCC (71.4% vs 35.7% [52.6% vs 25.0% by intent-treat analysis]). Nicotine dependence statistically significantly decreased in the REVIVE group (mean reduction = 5.09) versus SCC (mean reduction = 2.92). Retention rates were 73.7% in REVIVE and 70.0% in SCC, and 71.4% of REVIVE participants reported reading all text messages. Acceptability was high, with 92.9% indicating the program made them think about quitting and 85.7% saying they would recommend it to others. Participants confirmed the program's relevance, message timing, tone, and engagement features, while also highlighting areas for improvement, such as technical glitches and limited personalization. CONCLUSIONS: REVIVE was feasible, acceptable, and effective in reducing nicotine dependence among rural YAs. These findings support further development of targeted, culturally responsive digital interventions for ENDS cessation in underserved populations in rural areas.
Advancing rural cancer control: A portfolio analysis of research funded by the National Cancer Institute, 2016-2024.
Gaysynsky A, Weaver SJ, Vanderpool RC … +4 more , Iles IA, Kennedy A, Srinivasan S, Blake KD
J Rural Health · 2026 Jan · PMID 41579044 · Full text
PURPOSE: Given well-documented rural-urban disparities in cancer outcomes, we conducted a portfolio analysis to characterize rural cancer control-focused grants funded by the National Cancer Institute (NCI) between fisca...
PURPOSE: Given well-documented rural-urban disparities in cancer outcomes, we conducted a portfolio analysis to characterize rural cancer control-focused grants funded by the National Cancer Institute (NCI) between fiscal years 2016 and 2024 and to identify opportunities for future research. METHODS: ISearch, an NIH portfolio analysis tool, was used to identify rural-focused cancer control research grants funded by NCI. 128 grants were analyzed for key attributes, including grant characteristics (e.g., funding mechanism), cancer site, cancer control continuum phase, research topic, methods, setting, and intervention delivery channel. SAS version 9.4 was used to calculate code frequencies. FINDINGS: On average, 14 new grants focused on rural cancer control were awarded per year. Colorectal (n = 36) and breast cancer (n = 27) were the most frequently studied cancer sites. Prevention (n = 43) and treatment (n = 41) were the most frequently addressed phases of the cancer control continuum. Common research topics included quality of care (n = 30), quality of life/mental health (n = 26), and screening (n = 25). Most grants utilized randomized control trials (n = 78) and qualitative research methods (n = 77). Projects were most frequently set in the home (n = 68) or in health care settings (n = 47). Interventions were most frequently delivered through interpersonal interaction, either in-person (n = 40), over the phone (n = 36), or through videoconferencing (n = 27). CONCLUSIONS: NCI has supported an array of rural cancer control studies since 2016. However, opportunities were identified to further address rural cancer disparities, including efforts focused on understudied topics (e.g., financial toxicity), cancer sites (e.g., cervical cancer), phases of the cancer control continuum (e.g., end-of-life), and settings (e.g., community-based organizations).
How physicians' anticipated retention within urban and rural HPSA practices varies with their assessments of their work and jobs.
Pathman DE, Konrad TR, Rauner TE … +2 more , Fannell J, Shimmens M
J Rural Health · 2026 Jan · PMID 41579032 · Publisher ↗
PURPOSE: Physician turnover within Health Professional Shortage Areas (HPSAs), as in all settings, frequently occurs when physicians are dissatisfied with aspects of their work and employment. This study evaluates how ph...
PURPOSE: Physician turnover within Health Professional Shortage Areas (HPSAs), as in all settings, frequently occurs when physicians are dissatisfied with aspects of their work and employment. This study evaluates how physicians' assessments of 6 aspects of their work and jobs relate to whether they anticipate remaining in their urban and rural HPSA practices for more than 2 years, and assesses differences for physicians in urban and rural HPSAs. METHODS: Survey data on physicians' assessments of 6 facets of their work and jobs were obtained from 747 physicians working in urban HPSAs and 355 in rural HPSAs across 33 states (54.9% response rate). Separate hierarchical logistic regression models identified work and job factors independently associated with anticipated retention beyond 2 years for each group. Z-tests assessed differences between the urban and rural models in odds ratios for each work and job factor. FINDINGS: Anticipated retention was more likely in both urban and rural HPSAs when physicians felt they had good administration, they felt connected and supported at work, and work felt meaningful, and likely also if they provided their desired range of services, but in neither setting if they felt adequately compensated or not. Anticipated retention in rural but not urban HPSAs was more likely when physicians had a good work-life balance. CONCLUSIONS: Physicians' anticipated retention within HPSAs is associated with how they feel about various aspects of their work and jobs. These aspects of work and jobs are generally but not exactly the same in urban and rural HPSAs.
Evaluating rural healthcare workforce programs: Applying modified whole-of-person retention improvement framework in VHA programs.
Longacre MR, Kinney LM, Carluzzo KL … +2 more , Watts BV, Schifferdecker KE
J Rural Health · 2026 Jan · PMID 41556729 · Full text
PURPOSE: Healthcare workforce shortages are acute in rural areas. Using a holistic workforce retention framework, we examined evidence and identified gaps in recruitment and retention programs, using the Veterans Health...
PURPOSE: Healthcare workforce shortages are acute in rural areas. Using a holistic workforce retention framework, we examined evidence and identified gaps in recruitment and retention programs, using the Veterans Health Administration as a case study. METHODS: Rural workforce recruitment and retention initiatives were identified using VHA's 2023 Rural Recruitment and Hiring plan, and classified by rural focus, recruitment or retention, and strength of evidence. Initiatives were then mapped to a modified whole-of-person retention improvement framework (WoP-RIF) to assess coverage of domains: workplace/organizational, role/career, community/place, and financial. FINDINGS: Of 31 VHA initiatives, 19% exclusively focused on the rural workforce, 35% included rural, and 45% had no specific geographic target. One third (32%) focused on recruitment only, 48% focused on recruitment and retention, and 19% focused on retention only. Nearly three-quarters (71%) lacked sufficient evidence or were too early in implementation to assess effectiveness or ineffectiveness of the initiative. The strongest evidence existed for education loan repayment and nursing residency programs. For modified WoP-RIF domains, about half of initiatives focused on financial incentives (52%) or workplace/organizational programs (42%); 35% focused on role/career opportunities; and only three (10%) focused on community/place. CONCLUSION: While initiatives exist to address workforce shortages in rural areas, using the VHA as a case study, these are more focused on recruitment than retention, and few address important aspects of retention outside of financial or workplace domains. More rigorous and holistic evaluations of workforce initiatives using the modified WoP-RIF framework would bolster evidence across the span of recruitment to retention for rural workforce development.
Effects of hospital and obstetric unit closures on postpartum acute care across county racial composition in rural North Carolina.
Dissanayake MV, Jackson JW, Urrutia RP … +3 more , Martin CL, Funk MJ, Wood ME
J Rural Health · 2026 Jan · PMID 41549567 · Publisher ↗
PURPOSE: Hospital and obstetric unit closures are concentrated in the rural Southern United States, often where marginalized racial/ethnic groups reside and access to maternal health care is already strained. Given struc...
PURPOSE: Hospital and obstetric unit closures are concentrated in the rural Southern United States, often where marginalized racial/ethnic groups reside and access to maternal health care is already strained. Given structural racism's role as a fundamental cause of inequities, we hypothesized that closure effects may vary by race and racial composition of county. METHODS: We used linked North Carolina birth certificates and Medicaid claims from births occurring to rural residents from 2014 to 2019. Using a Trial Emulation Policy Approach with a Difference-in-Difference analysis, we estimated the effects of hospital and obstetric closures on postpartum acute care (maternal emergency department visit or hospital admission) by race and county racial composition. We categorized rural counties as lower (LNHW, <80% White) or higher (HNHW, ≥80% White) Non-Hispanic White. FINDINGS: We found declines in postpartum acute care associated with closures: 3.6 percentage points in LNHW counties and 1.8 percentage points in HNHW counties. We also found that marginalized groups experienced the largest declines, for example, Black versus White birthing people in LNHW counties (-7.1 vs -2.5 percentage points). CONCLUSIONS: As hospitals and obstetric units continue to close, increasing support in the postpartum period will be crucial for maternal health.
Rural emergency hospitals: Emerging patterns of adaptation and community perception.
Van Sandt A, Line K, Gruber A … +3 more , Meier C, Carpenter C, Loveridge S
J Rural Health · 2026 Jan · PMID 41546444 · Full text
PURPOSE: Rural hospitals face persistent financial challenges that often threaten their survival. To address this, the 2023 "Rural Emergency Hospital" (REH) designation offers Critical Access Hospitals and hospitals with...
PURPOSE: Rural hospitals face persistent financial challenges that often threaten their survival. To address this, the 2023 "Rural Emergency Hospital" (REH) designation offers Critical Access Hospitals and hospitals with fewer than 50 beds enhanced Medicare reimbursement and annual facility payments if they discontinue inpatient services while maintaining outpatient care and a 24-hour emergency department. This study evaluates the characteristics of hospitals that choose REH conversion and examines the perceived community impact of the change. METHODS: We analyze Centers for Medicare & Medicaid Services cost report data to compare converting hospitals to eligible nonconverting hospitals. We also conduct a content analysis of 33 news articles and phone interviews with local rural residents to assess how REH conversions are presented in the media and perceived in communities. FINDINGS: Hospitals that converted to REH status had low inpatient volumes, occupancy rates, and revenues, suggesting they were positioned to benefit financially from eliminating inpatient services. Content analysis revealed that news articles were primarily neutral in tone (54.5%), with most (90%) describing the financial benefits of conversion. Interviews with rural residents highlighted negative perceptions of local health care and revealed that many preferred not to use their local REH even when available. CONCLUSIONS: REH designation may provide financial lifelines to rural hospitals with declining inpatient demand, but community skepticism and limited willingness to use REHs may constrain their role in sustaining health care access. The long-term effectiveness of this policy may depend on addressing both financial viability and community trust in rural health care delivery.
Improving health care access in rural communities in the United States.
Chan PA
J Rural Health · 2026 Jan · PMID 41546437 · Publisher ↗
Abstract loading — click title to view on PubMed.
Exploring the use of telemedicine to expand addiction and recovery resources in Great Plains Tribal Communities.
Harding MC, Kihlstrom AC, Kelliher A … +4 more , Rosa C, Kropp FB, Winhusen TJ, Warne DK
J Rural Health · 2026 Jan · PMID 41531285 · Full text
PURPOSE: Addressing substance use disorders remains a high priority for many Indigenous communities. Opioid misuse and deaths related to overdose have been increasing sharply in American Indian/Alaska Native populations....
PURPOSE: Addressing substance use disorders remains a high priority for many Indigenous communities. Opioid misuse and deaths related to overdose have been increasing sharply in American Indian/Alaska Native populations. Medications for opioid use disorder (MOUD) remain difficult to access in Great Plains Tribal Communities due to the paucity of treatment providers, among other factors. The present study explores the perceived barriers and facilitators to using telehealth to promote access to MOUD and recovery resources in Great Plains Tribal Communities. METHODS: This study employed qualitative methods to review policy considerations for using telemedicine to provide buprenorphine. We obtained qualitative data from 5 interviews with 8 total key informants (62.5% women, 25% with tribal affiliations) with local administrators, health care providers, and policymakers. Their responses were transcribed and coded with NVivo software. FINDINGS: After coding and analysis, 6 themes emerged: current access, acceptability in Tribal Communities, facilitators, barriers, payment considerations, and policies that support tele-MOUD. Participant responses-though specific to Great Plains Tribal Communities-mirrored other recommendations on telemedicine and substance use disorder services such as federal support of reciprocity of state licenses, permanent codification of the regulatory changes enacted during the COVID-19 public health emergency, increased funding for innovative delivery of services, and considerations of privacy; the need for culture- and trauma-informed providers was also noted. CONCLUSIONS: Telemedicine for the provision of MOUD appears, from this qualitative analysis, to be a feasible way to expand access to care for opioid use disorder in Great Plains Tribal Communities.
Patient, facility, and community determinants of timely follow up after abnormal screening mammograms in Appalachia: A multilevel analysis.
Anderson RT, Hillemeier MM, Harvey JA … +4 more , Camacho FT, Bonilla G, Safon CB, Louis C
J Rural Health · 2026 Jan · PMID 41502300 · Full text
PURPOSE: Examine the extent that community and organizational characteristics influence mammogram recall and biopsy rates in Appalachia. METHODS: We collected facility survey and Medicare claims (2016-2018) data on 191 F...
PURPOSE: Examine the extent that community and organizational characteristics influence mammogram recall and biopsy rates in Appalachia. METHODS: We collected facility survey and Medicare claims (2016-2018) data on 191 FDA-registered breast imaging organizations serving 2.65 million women in 5 Appalachian states (KY, OH, PA, VA, and WV). Primary outcomes were recall rates and time to recall and biopsy. Generalized linear mixed-effects models (GLMM) (patient level with facility random intercepts) and facility-level structural equation models were used to evaluate multilevel predictors of recall, biopsy, and timeliness. Imaging center service areas (SAs) were constructed using Medicare claims for patient, facility, and community characteristics utilization patterns. Mammogram service capacity was measured using a published tool (BIOPSI). FINDINGS: Rural centers had SAs with higher area deprivation index (ADI) scores, lower capacity despite possessing more machines per capita, and were less likely to offer 3D tomosynthesis (3DT). Recall (8%) and biopsy (∼22%) rates were similar by metropolitan status; however, rural centers were more likely to provide same-day exams (P = .021). In GLMM, patient-level predictors included younger age and nonuse of 3DT for recall; and higher ADI and use of 3DT for biopsy. Days to recall was lengthened with dual Medicaid insurance, 3DT, and screening by a stand-alone facility; while days to biopsy was lengthened without the use of 3DT. Community-level pathways were found for days to recall, with rural and smaller facilities achieving significantly fewer days. CONCLUSIONS: Characteristics of rural imaging centers influence efficiency through their resources and community contexts and should be considered in breast cancer screening outcomes research.
Financial status, fatalism, and self-care of cardiovascular disease risk factors among rural adults living in socioeconomically distressed areas.
Thapa A, Cha G, Hodges D … +5 more , Wu JR, Chung ML, Biddle MJ, Smith JL, Moser DK
J Rural Health · 2026 Jan · PMID 41472388 · Publisher ↗
PURPOSE: Adults with fewer financial resources often have poor self-care. Rural dwellers commonly have fewer financial resources than urban dwellers and are often stereotyped as fatalistic about health. We examined wheth...
PURPOSE: Adults with fewer financial resources often have poor self-care. Rural dwellers commonly have fewer financial resources than urban dwellers and are often stereotyped as fatalistic about health. We examined whether fatalism mediates the association of financial status with cardiovascular disease (CVD) self-care in rural adults in economically distressed areas. We hypothesized that those with fewer financial resources would have poorer self-care, and fatalism would mediate this relationship. METHODS: We enrolled 1,122 adults (53 ± 15 years) at risk for CVD. Financial status was reflected by individuals' perceptions of how well they made "ends meet" with their financial resources, fatalism by the CVD-Fatalism Instrument, and self-care of CVD risk factors by the Medical Outcomes Study-Specific Adherence Scale. We used conditional process analysis with the PROCESS macro. FINDINGS: Financial status was directly associated with self-care. Those with enough (C'1 = -1.57, P = .016) and those with not enough to make ends meet (C'2 = -3.51, P = .003) compared to those with more than enough had worse self-care. Those with higher levels of fatalism had worse self-care (b = -1.78, P = .001). Financial status was indirectly associated with self-care through fatalism. Compared to those with more than enough, those with not enough (indirect effect = -.269, 95% confidence interval = -.609, -.021) and enough (indirect effect = -.182, 95% confidence interval =-.376, -.041) had higher fatalism levels and thus worse self-care. CONCLUSIONS: Poor financial status drives fatalism in rural dwellers, which in turn results in poor self-care.
Changes in telehealth usage among Medicaid beneficiaries with mental illnesses in a rural state: An analysis of Kentucky Medicaid dataset over 5 years (2018-2022).
Okoli CTC, Wang T, Abufarsakh B … +6 more , Seng S, Almogheer ZS, Al-Kayed J, Bhattarai P, Stith H, Makowski A
J Rural Health · 2026 Jan · PMID 41466503 · Publisher ↗
INTRODUCTION: Accessing mental health care remains challenging for Medicaid beneficiaries with mental illnesses (MI) in rural settings. The COVID-19 pandemic prompted telehealth service expansion through temporary policy...
INTRODUCTION: Accessing mental health care remains challenging for Medicaid beneficiaries with mental illnesses (MI) in rural settings. The COVID-19 pandemic prompted telehealth service expansion through temporary policy changes and shifts in health care delivery. Despite the increased availability of telehealth as a modality to address disparities in health care access, telehealth adoption and associated use are inadequately explored among Medicaid beneficiaries with MI in Kentucky. OBJECTIVE: To examine trends and factors associated with telehealth use by residence status among Kentucky Medicaid beneficiaries with MI. DESIGN: A retrospective analysis of Kentucky Medicaid claims data obtained from 174,354 beneficiaries aged 18 years or older and diagnosed with MI. Chi-square tests and logistic regression analyses were performed to examine telehealth use over time and factors associated with its use. RESULTS: Telehealth use increased significantly from 0.3% in 2018 to 1.0% in 2022. Telehealth use was higher among urban residents (from 0.5% in 2018 to 1.4% in 2022) versus rural residents (from 0.2% in 2018 to 0.6% in 2022). Factors associated with increased telehealth use were being female, younger age, White non-Hispanic, having serious MI (SMI) or concurrent SMI and substance use disorders, and having a fee-for-service payor type. Rural residents were less likely than urban residents to use telehealth despite a similar trend of year-to-year increase. CONCLUSION: Although telehealth use remains low, its utilization has increased among Medicaid beneficiaries with MI in Kentucky. Demographic characteristics, MI status, and payor type were associated with telehealth use, with notable disparities between urban and rural populations. These results highlight the need to further examine barriers that deter or promote telehealth use in rural states.
Prevalence of meeting youth physical activity guidelines across income, sex, urbanicity, and sport participation: 2022-2023 National Survey of Children's Health (NSCH).
Johnson A
J Rural Health · 2026 Jan · PMID 41454491 · Full text
PURPOSE: This cross-sectional study used data from the 2022-2023 National Survey of Children's Health to examine the prevalence of American youth meeting physical activity (PA) guidelines by sociodemographic subgroups de...
PURPOSE: This cross-sectional study used data from the 2022-2023 National Survey of Children's Health to examine the prevalence of American youth meeting physical activity (PA) guidelines by sociodemographic subgroups defined by income, sex, urbanicity, and sports participation. METHODS: Weighted prevalence statistics were computed for meeting PA guidelines (≥60 min/day) for groups defined by income (0%-199% or ≥200% of Federal Poverty Level), sex (male, female), urbanicity (urban, rural), and past year sports participation (yes, no). Equity plots were generated to visualize the prevalence of meeting guidelines across subgroups (ref: high socioeconomic status (SES), urban male sports participants). FINDINGS: The final analytic sample included 61,740 youth (M = 11.6 years [SD = 3.2], 51.2% male). About 45% were sports participants, 88% were urban-dwelling, and <20% met PA guidelines. Meeting guidelines prevalences ranged from 13.2% (95% CI: 11.6%-15.0%) among high SES, urban female non-sport participants to 31.1% (95% CI: 25.5%-37.4%) among low SES, rural male non-sport participants. All comparisons were significantly different (versus reference group) except low SES, urban male sport participants; high SES, rural male non-sport participants; and low SES, rural females. CONCLUSIONS: Most American youth fail to meet guidelines, with lowest prevalences among female non-sport participants, regardless of SES and urbanicity status. Sports may be more important for PA among urban versus rural youth. The findings, which show a complex interplay between sociodemographic factors, PA, and sport, can be used to identify populations needing targeted PA promotion programs.
The interaction of tobacco retailer density and rurality with tobacco use prevalence in Kentucky.
Rose SW, Christian WJ, Venne JV … +4 more , Mattingly D, Fennell BS, Feizy S, Rayens MK
J Rural Health · 2026 Jan · PMID 41454484 · Full text
PURPOSE: Tobacco retailer density is a key correlate of tobacco use prevalence in the United States, but this relationship has typically been examined in urban areas. We examined the relationship between retailer density...
PURPOSE: Tobacco retailer density is a key correlate of tobacco use prevalence in the United States, but this relationship has typically been examined in urban areas. We examined the relationship between retailer density and tobacco use across Kentucky counties, a state with high smoking rates and a substantial rural population. METHODS: We obtained a list of tobacco retailers from the 2021 Kentucky Synar program, used for minor's access inspections. We merged these data with county-level prevalence estimates for cigarette and smokeless tobacco use for each county in Kentucky, calculated using pooled 3-year estimates (2017-2019) of Kentucky Behavioral Risk Factor Surveillance System data. We modeled county-level frequency of each outcome among adults as a function of tobacco retailer density and the Index of Relative Rurality, and interactions using ANCOVA, controlling for county percent of adult population and percent with an advanced degree. FINDINGS: We observed significant interactions between retailer density and rurality for both cigarette and smokeless tobacco use. Post-hoc protected pairwise comparisons demonstrated that within the 40 most urban counties, cigarette and smokeless tobacco use were significantly higher among counties with the highest retailer density, compared to low-density counties. Retailer density was not associated with the prevalence of cigarette and smokeless tobacco use within the 2 more rural tertiles of counties. CONCLUSIONS: Consistent with prior research, policies limiting tobacco retailer density could be most beneficial in urban and urban-adjacent areas, while other policies may need to be considered for rural areas, even within a relatively rural state such as Kentucky.
"Sacred ground for kids": Institutional perspectives on rural school-based health centers as patient-centered medical homes.
Zhang X, Warner ME
J Rural Health · 2025 Sep · PMID 41420555 · Full text
BACKGROUND: School-based health centers (SBHCs) can function as patient-centered medical homes (PCMHs), but few studies examine how SBHCs fit the PCMH definition and address the challenges of rural health disparities amo...
BACKGROUND: School-based health centers (SBHCs) can function as patient-centered medical homes (PCMHs), but few studies examine how SBHCs fit the PCMH definition and address the challenges of rural health disparities among children and adolescents. METHODS: Note that 12 semi-structured interviews were conducted in four rural counties in New York State with school superintendents, SBHCs medical providers, and health care network administrators and between January 2024 and April 2024. Participants were identified using snowball sampling. Interviews were transcribed. Framework analysis was applied with thematic coding based on the PCMH framework. NVivo 14 was used to generate the final set of themes. FINDINGS: Our analysis confirms SBHCs fit the PCMH model-accessibility, comprehensive, family-centered, coordinated, continuous, and compassionate care-to improve health care access for rural children and empower children to advocate for their own health. We identify privacy and confidentiality as additional important elements in the PCMH model, which ensure children's empowerment. However, they present special challenges for rural SBHCs. Addressing these challenges requires attention to information sharing between SBHCs and schools and the need for trust and communication to empower children, while not alienating school partners and parents. This may explain why so few rural SBHCs are PCMH. CONCLUSIONS: This qualitative thematic analysis shows SBHCs can serve as PCMHs in rural communities. It also highlights the importance of privacy, confidentiality, trust, and communication between SBHCs, schools, parents, and children.
Innovating for success: Strengthening rural maternity care and delivery programs.
Sullivan EE, Gilburg ML, McDonald M … +1 more , Deutchman M
J Rural Health · 2025 Sep · PMID 41388613 · Publisher ↗
PURPOSE: To identify and analyze facility-level strategies that support the sustainability of rural maternity and delivery care programs in the United States. METHODS: This qualitative, cross-case study draws from data c...
PURPOSE: To identify and analyze facility-level strategies that support the sustainability of rural maternity and delivery care programs in the United States. METHODS: This qualitative, cross-case study draws from data collected during the March 2024 Rural Maternity Innovation Summit in Clifton, Texas. Six rural health care organizations from diverse geographic regions shared their approaches to sustaining maternity and delivery services. Data include transcripts and presentation materials from summit sessions involving clinical, financial, and operational representatives of 6 rural hospitals. Thematic analysis was applied to identify cross-site strategies. FINDINGS: Three core themes emerged: financial sustainability, workforce development, and community engagement. Strategies included maximizing payment mechanisms, forming partnerships with Federally Qualified Health Centers, employing family physicians with obstetric training, establishing rural residency pipelines, and implementing culturally responsive community outreach. These practices were adapted to local contexts but shared a focus on aligning maternity and delivery services with broader organizational and community goals. CONCLUSION: Sustaining rural maternity and delivery care requires an integrated approach that combines financial acumen, strategic workforce development, and strong patient and community engagement. Facility-level innovations offer replicable strategies for improving maternal health access and outcomes in rural settings.
Impact of Ostomy Self-Management Telehealth training for rural cancer survivors on health care utilization and economic outcomes in the United States.
Maeng D, Sun V, Nielsen ME … +9 more , Hoffman RL, Garg T, Popek SM, Sticca RP, Aka AA, Hesham WM, Grant M, Holcomb M, Krouse RS
J Rural Health · 2025 Sep · PMID 41383087 · Full text
PURPOSE: To assess the impact of a structured educational curriculum Ostomy Self-Management Telehealth (OSMT) treatment among cancer survivors residing in rural areas of the United States on selected measures of health c...
PURPOSE: To assess the impact of a structured educational curriculum Ostomy Self-Management Telehealth (OSMT) treatment among cancer survivors residing in rural areas of the United States on selected measures of health care utilization, cost, and employment status. METHODS: This was a multi-site randomized controlled trial comparing OSMT treatment group against a control group receiving usual care (UC) in rural populations. OSMT treatment consisted of virtual group sessions led by trained peer ostomates delivered once a week over a 5-week period via video conferencing platforms. Surveys related to health care utilization were administered up to four times: baseline, post-session, 3-month and 6-month follow-up. RESULTS: Compared to the UC group, the OSMT group was associated with lower frequencies of in-person nurse (-57.2%; p = 0.015) and physician (-76.1%; p = 0.024) visits in the post-session follow-up survey; no significant differences were observed in the subsequent follow-up surveys. Moreover, the OSMT treatment group was also associated with lower ostomy-related emergency department visits (-88.3%; p = 0.119), lower direct out-of-pocket health care (-25.8%; p = 0.405) and travel costs (-47.7%; p = 0.105), as well as higher probability of full-time employment (18.9% vs. 12.3%; p = 0.179) and lower probability of claiming disability (14.3% vs. 18.9%; p = 0.459) in the 6-month follow-up; these differences, however, were not statistically significant. CONCLUSION: While not all statistically significant, the OSMT treatment was associated with some notable changes in the patterns of health care utilization and selected economic outcomes among ostomates residing in rural communities. This suggests that the OSMT treatment likely contributes to more efficient and cost-effective care in the target population. SYNOPSIS: Ostomy Self-Management Telehealth (OSMT) program seeks to reduce barriers to care and improve self-management skills especially among ostomates residing in rural communities. This study reports that OSMT was associated with lower in-person health care provider visits, suggesting OSMT may lead to more efficient and cost-effective care.
Changing rural-urban and racial patterns in VA tele-mental health use among women Veterans, 2019-2022.
Mengeling MA, Batten A, Howren MB … +4 more , Kramer BJ, Miell KR, Davila H, Sadler AG
J Rural Health · 2025 Sep · PMID 41376288 · Publisher ↗
PURPOSE: To assess whether women veterans accessed synchronous video telehealth for mental health (SVT-MH) similarly by (1) rurality, (2) race, and (3) race within rural and urban settings. METHODS: This retrospective co...
PURPOSE: To assess whether women veterans accessed synchronous video telehealth for mental health (SVT-MH) similarly by (1) rurality, (2) race, and (3) race within rural and urban settings. METHODS: This retrospective cohort study used VA administrative data to examine temporal trends in outpatient VA mental health use from January 1, 2019, through December 31, 2022-a period spanning the pre- and post-COVID-19 pandemic. The cohort included VA-enrolled women veterans ages 18-60 years with at least one outpatient mental health visit delivered by a VA provider in-person (VA-MH) or via SVT-MH. Outcomes included (1) any SVT-MH use and (2) annual SVT-MH visit counts. Models adjusted for demographics and used Bayesian logistic and Poisson regression to estimate effects and interactions over time. FINDINGS: SVT-MH use increased from 7% in 2019 to 32% in 2022. Rural women Veterans initially had higher SVT-MH use, but by 2022, urban women had higher use and visit counts. Black and Hispanic women Veterans showed the largest increases, especially in urban areas. American Indian and Alaska Native (AIAN) women Veterans were the only group without significant rural-urban differences in 2022, though they had lower overall visit counts. CONCLUSIONS: SVT-MH use among women veterans increased substantially during the study period, with rural-urban gaps narrowing over time. These findings suggest SVT-MH differences may shift rapidly based on infrastructure, outreach, and policy implementation. Ongoing monitoring and tailored strategies are needed to ensure fair access to SVT-MH for all veterans, especially for AIAN and rural women veterans.
Revisiting the rural and urban divide in hospital health information technology adoption: Evidence from 2023.
Yan AS, Maguire TK, Chen J
J Rural Health · 2025 Sep · PMID 41376270 · Full text
PURPOSE: We assessed the adoption of telehealth, patient engagement (PE), and health information exchange (HIE) functionalities among hospitals in 2023, comparing adoption rates between rural and urban hospitals. METHODS...
PURPOSE: We assessed the adoption of telehealth, patient engagement (PE), and health information exchange (HIE) functionalities among hospitals in 2023, comparing adoption rates between rural and urban hospitals. METHODS: We used the linked 2023 American Hospital Association Annual Survey and Information Technology Survey data. We examined average adoption rates of eight telehealth, eight PE, and three HIE functionalities across metropolitan, micropolitan, and rural acute care hospitals. Multivariate regression models were used to assess differences in adoption, adjusting for hospital characteristics. FINDINGS: Rural and urban disparities in hospital health information technology (HIT) adoption persist in 2023. After adjusting for hospital characteristics, rural and urban differences in the likelihood of adopting any treatment-stage (e.g., psychiatric treatment and stroke care) or post-discharge (e.g., remote patient monitoring for chronic care) telehealth were not significant. However, overall, rural hospitals adopted an average of 0.24 fewer telehealth services (p < 0.05) and 0.25 fewer PE capabilities (p < 0.05). They were also less likely to have any HIE capabilities, relative to their urban peers. CONCLUSIONS: Although overall adoption of hospital HIT has increased since 2018 and some rural and urban gaps have narrowed, disparities remain in 2023. Rural hospitals continue to lag behind in the adoption of telehealth, PE, and HIE functionalities. Future research should explore barriers to adoption among under-resourced hospitals. Policy efforts must prioritize tailored strategies to support rural hospitals and promote broader access to HIT adoption nationwide.
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