The Journal Of Rural Health[JOURNAL]
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200 papers
Effectiveness of a self-care intervention addressing social determinants of health in reducing cardiovascular disease risk in rural populations.
Smith JL, Thapa A, Chung ML … +4 more , Lennie TA, Biddle M, Rayens MK, Moser DK
J Rural Health · 2025 Sep · PMID 41340542 · Publisher ↗
PURPOSE: HeartHealth is a multi-component cardiovascular disease (CVD) risk reduction intervention developed for rural Appalachia participants. Its effectiveness in reducing CVD risk factors has been demonstrated, and al...
PURPOSE: HeartHealth is a multi-component cardiovascular disease (CVD) risk reduction intervention developed for rural Appalachia participants. Its effectiveness in reducing CVD risk factors has been demonstrated, and although HeartHealth was developed to address the negative impact of social determinants of health (SDOH), it remains unclear whether its impact is modified by key SDOH. The aims of the study were to evaluate whether the intervention effect on the Framingham CVD Risk Score (FRS) differs by financial status, education level, sex, depressive symptoms, and health literacy. METHODS: A secondary analysis was conducted using data from a randomized controlled trial involving 349 participants (mean age: 43 ± 13, female 78%) from rural Appalachian Kentucky. Financial status, education level, and sex were measured using standard questionnaires, depressive symptoms were measured using the Patient Health Questionnaire-9, and health literacy was measured using the Newest Vital Sign. Repeated measures mixed modeling was employed to assess the impact of each SDOH while simultaneously evaluating the effects of time, intervention, and their interaction on FRS. FINDINGS: The interaction between time and intervention was significant, indicating a sustained reduction in FRS among intervention participants. None of the SDOH had moderating effects on the intervention's impact on reducing CVD risk factors. This demonstrates that the HeartHealth intervention remains effective despite the impact of selected SDOH. CONCLUSIONS: The HeartHealth intervention effectively reduces CVD risk factors in rural Appalachia populations. This remains true regardless of SDOH that are commonly seen in rural areas.
A novel approach to incorporate frontier areas into urban-rural geographic classifications: Integrated Metropolitan-to-Frontier Area Codes.
Gibson BJ, Dobis E, Cromartie J … +4 more , Grieshober L, Ulrich C, Onega T, Doherty J
J Rural Health · 2025 Sep · PMID 41317103 · Full text
PURPOSE: To develop an urban-rural-frontier classification that integrates urbanicity and geographic remoteness and captures nuances in population and land area distributions invisible in traditional coding schemes, ther...
PURPOSE: To develop an urban-rural-frontier classification that integrates urbanicity and geographic remoteness and captures nuances in population and land area distributions invisible in traditional coding schemes, thereby providing a framework to measure health outcomes and access to care across the full urban-to-frontier continuum. METHODS: We created tract-level Integrated Metropolitan-to-Frontier Area Codes (tIMFAC) by combining the US Department of Agriculture's Economic Research Service's Frontier and Remote Area (FAR) codes with Rural-Urban Commuting Area (RUCA) codes, classifying tracts as metropolitan, micropolitan, frontier-micropolitan, small town/rural, and frontier-small town/rural. We compared population and land area distributions and median distances to health care facility types by RUCA, FAR, and tIMFAC, and summarized distances to health care facilities across tIMFAC by Census regions. FINDINGS: tIMFAC metropolitan, micropolitan, and small town/rural categories had higher population densities (312, 74, and 27/m, respectively) than their RUCA counterparts (304, 54, and 11/m, respectively). Densities were much lower in tIMFAC frontier-micropolitan and frontier-small town/rural areas (23 and 4/m, respectively) than micropolitan and small town/rural. Three patterns emerged for travel distances across tIMFAC: (1) steadily increasing distances from metropolitan to frontier-small town/rural areas (e.g., medical-surgical intensive care units (ICUs)); (2) similar distances within frontier-micropolitan and micropolitan, and within frontier-small town/rural and small town/rural, respectively (e.g., obstetrics); and (3) longer distances for frontier areas regardless of urbanicity (e.g., pediatric ICUs and designated trauma centers). CONCLUSION: tIMFAC provides a policy-relevant approach to identifying health differences across the urban-to-frontier continuum, supporting efforts to better understand and address unique rural and frontier health challenges.
Risk factors for sedentary time and their mediation by sleep disturbances among depressed rural patients with cardiovascular disease: A path analysis.
Cha G, Kang J, Thapa A … +7 more , Wu JR, Heebner NR, Biddle MJ, Bronas UG, Lin CY, Thompson J, Moser DK
J Rural Health · 2025 Sep · PMID 41277370 · Publisher ↗
PURPOSE: The purposes of this study were to (1) identify predictors of sedentary time and (2) determine whether sociodemographic risk factors associated with sedentary time are mediated by sleep disturbances in younger (...
PURPOSE: The purposes of this study were to (1) identify predictors of sedentary time and (2) determine whether sociodemographic risk factors associated with sedentary time are mediated by sleep disturbances in younger (<60) and older (≥60) depressed rural patients with CVD. METHODS: Depressed rural patients with CVD completed surveys and wore ActiGraph GT9X Link monitors to measure sedentary time and sleep parameters (total sleep time and wake-after-sleep-onset [WASO]). Hierarchical regression analysis was conducted to identify factors associated with sedentary time, followed by a multi-group path analysis to examine how significant factors identified in the regression were associated with sedentary time, comparing the two age groups, and whether this association was mediated by parameters reflecting sleep disturbances. FINDINGS: Participants (n = 222) were predominantly White with an average age of 58 years and 52% were unemployed due to illness. Age, employment status, and WASO were significantly associated with sedentary time. Path analysis showed a significant mediating effect of age on sedentary time through WASO in the younger group (n = 115). However, the mediating effect of WASO on the relationship between age and sedentary time was not significant in the older group (n = 107). CONCLUSIONS: The findings highlight the critical roles of age and sleep disturbances in promoting physical inactivity, with sleep disturbances being particularly influential in younger patients. Tailoring interventions by age groups may enhance strategies to mitigate CVD risk associated with inactivity.
County-level vulnerability is associated with mental health and substance use treatment among rural suicide decedents: A national multi-year cross-sectional study.
Vakkalanka JP, Soupene VA, Van Tiem J … +2 more , Blum JM, St Marie B
J Rural Health · 2025 Sep · PMID 41199495 · Full text
PURPOSE: To examine the relationship between individual- and county-level factors associated with mental health and substance use dependence (MHSUD) treatment among rural suicide decedents. METHODS: Cross-sectional study...
PURPOSE: To examine the relationship between individual- and county-level factors associated with mental health and substance use dependence (MHSUD) treatment among rural suicide decedents. METHODS: Cross-sectional study (2013-2022) study of the National Violent Death Reporting System and the County Health Rankings. Primary exposures included individual- (demographic, clinical conditions) and county-level (average number of mentally unhealthy days, percentage of uninsured adults, rate of mental health providers/county, percentage of unemployed adults, rate of social associations, percentage of adults driving alone during long commutes, rate of primary care physicians/county, and income inequality ratios) factors of the decedent. The outcome was ever receipt of MHSUD treatment. We used multivariable logistic regression to measure the association between individual- and county-level factors and MHSUD treatment receipt. RESULTS: Of 42,021 rural suicides, 30% had MHSUD treatment receipt. Decedent-level factors associated with lower MHSUD treatment included male, sex, older age, racial/ethnic minorities, and residence in the Midwest or Northeast. MHSUD treatment was lower in rural counties with greater vulnerability (e.g., higher average number of mentally unhealthy days [aOR = 0.75, 95% CI: 0.68, 0.81], lower rate of primary care physicians/county [aOR = 0.92, 95% CI: 0.85, 0.99], lower rate of mental health providers/county [aOR = 0.76, 95% CI: 0.70, 0.81]). CONCLUSIONS: By focusing within rural US counties, we found considerable variability in county-level risk factors for MHSUD treatment among suicide decedents. Research and public health efforts may consider disaggregating county-level factors when tailoring rural suicide prevention interventions in addition to improving MHSUD clinical infrastructure for both vulnerable individuals and counties.
The impact of the removal of the low-wage index hospital policy on urban and rural hospitals.
Karim SA, Thompson KW, Pink GH … +1 more , Holmes GM
J Rural Health · 2025 Sep · PMID 41199485 · Publisher ↗
PURPOSE: The low-wage index hospital policy (LWIHP), implemented in fiscal year (FY) 2020, temporarily increased Medicare wage index values for hospitals in the lowest quartile to address geographic differences in reimbu...
PURPOSE: The low-wage index hospital policy (LWIHP), implemented in fiscal year (FY) 2020, temporarily increased Medicare wage index values for hospitals in the lowest quartile to address geographic differences in reimbursement. Following a federal court ruling, the Centers for Medicare & Medicaid Services (CMS) rescinded the LWIHP in the FY 2025 Interim Final Rule and introduced a one-time transitional payment adjustment for hospitals experiencing wage index reductions greater than 5%. This study describes the characteristics of hospitals most affected by the removal of the LWIHP, stratified by urban and rural status. METHODS: Using publicly available CMS administrative datasets, we identified inpatient prospective payment system (IPPS) hospitals with reductions in their FY 2025 wage index from the removal of the LWIHP. Hospitals were grouped into three categories: no change, a reduction of 0%-5%, and a reduction of >5%. Descriptive statistics summarized financial, organizational, and community characteristics across the three wage index categories, stratified by urban and rural status. FINDINGS: Among 3152 IPPS hospitals, 46% of rural hospitals and 18.5% of urban hospitals experienced wage index reductions. Rural hospitals in the most affected category (>5% reduction) were more likely to be unaffiliated, government-owned, and located in counties with lower income, higher poverty, and lower population density. CONCLUSION: Hospitals most affected by the removal of the LWIHP, particularly rural facilities, serve communities with limited economic resources. These findings highlight the importance of Medicare payment policies that consider geographic and structural disadvantages to maintain health care access in underserved areas.
Perceptions of whole-body donation for biomedical research: An interview study with rural adults in Georgia.
Anglim CE, Waldner CE, Childs B … +10 more , Pentz RD, Dixon MD, Apongule K, Chalmers CD, Pierre K, Ross L, Reid-Croy A, Henderson T, Montgomery A, Carter DE
J Rural Health · 2025 Sep · PMID 41177956 · Publisher ↗
PURPOSE: This study aims to describe how rural residents in Georgia (USA) perceive organ donation and biomedical research on the recently deceased, the appropriate oversight and duration for this type of research, and th...
PURPOSE: This study aims to describe how rural residents in Georgia (USA) perceive organ donation and biomedical research on the recently deceased, the appropriate oversight and duration for this type of research, and the disclosures necessary for whole-body donation. METHODS: Researchers conducted interviews with adults residing in rural Georgia counties (determined by Rural-Urban Conintuum Codes (USDA)) and analyzed participants' perspectives for themes on organ donation and whole-body donation for research. Methods cohere with Standards for Reporting Qualitative Research. FINDINGS: Participants had positive views of organ donation and expressed willingness to consider donating their own or a family member's organs. Participants strongly supported first-person authorization for any type of organ or whole-body donation. About half of respondents expressed discomfort with or uncertainty about whole-body donation for biomedical research. A minority of respondents indicated that the family should have the right to override the patient's first-person authorization of whole-body donation. A minority of respondents indicated that requests for whole-body donation for research should occur after a grieving period. Most respondents were open to extending the 72-h limit on research on the recently deceased, but they generally capped the extension at 1 week. CONCLUSIONS: Rural Georgia adults were curious about and open to whole-body donation to research, though half expressed discomfort and wished to learn more before they could approve such research.
Degree of rurality moderates the association of sedentary time with cognitive function in rural patients with cardiac diseases and depressive symptoms.
Lin CY, Wu JR, Cha G … +7 more , Kang J, Biddle MJ, Chung ML, Thapa A, Rayens MK, Gibson-Young L, Moser DK
J Rural Health · 2025 Sep · PMID 41177933 · Publisher ↗
BACKGROUND: Prolonged sedentary time has been linked to impaired cognitive outcomes. However, the impact of sedentary time on cognitive function at different degrees of rurality is not yet well understood in patients wit...
BACKGROUND: Prolonged sedentary time has been linked to impaired cognitive outcomes. However, the impact of sedentary time on cognitive function at different degrees of rurality is not yet well understood in patients with cardiac diseases and depressive symptoms. PURPOSE: To determine whether degree of rurality moderates the relationship between sedentary time and cognitive function. METHODS: This study includes 135 coronary heart disease or heart failure patients, primarily residing in rural Kentucky, including Appalachian areas, United States. Sedentary time was measured by the average daily sedentary time (in minutes) using accelerometry (ActiGraph). Cognitive function was assessed using the Montreal Cognitive Assessment-Blind. Rurality was determined by Rural-Urban Commuting Area (RUCA) codes. Patients were categorized into two groups by rurality: (1) 89 patients in a less rural group (RUCA codes 4-6); and (2) 46 patients in a more rural group (RUCA codes 7-10). Data were collected May 2021-September 2022 and analyzed using the Hayes PROCESS macro in SPSS. RESULTS: Sedentary time predicted cognitive function (B = -0.006, p = 0.019), and this relationship was moderated by rurality (interaction term = 0.006, p = 0.022). Patients living in more rural areas had significantly worse cognitive function when sedentary for longer periods (p = 0.019); specifically, every 100-min increase in sedentary time was associated with a 0.6-point decrease in cognitive function score. However, this relationship was not observed in those living in less rural areas (p = 0.658). CONCLUSIONS: Testing the impact of interventions aimed at reducing sedentary time on cognitive function is warranted in this population, particularly for those living in highly rural areas.
Rural dwelling as a risk factor for mental health and well-being for LGBTQ+ youth: The mechanism of social support.
Myer M, Ellithorpe ME
J Rural Health · 2025 Sep · PMID 41174992 · Publisher ↗
PURPOSE: Existing literature on LGBTQ+ social support often overlooks the experiences of rural dwellers, who may face obstacles related to access to mental health resources and in-person social support. This study seeks...
PURPOSE: Existing literature on LGBTQ+ social support often overlooks the experiences of rural dwellers, who may face obstacles related to access to mental health resources and in-person social support. This study seeks to address the gap by examining how social support varies across different geographic areas and how it relates to mental health outcomes for LGBTQ+ emerging adults. METHODS: This study surveyed LGBTQ+ emerging adults (n = 293) about their demographics, their sources of social support, their mental health and well-being, and their ZIP codes (current and when teenagers). Rurality was determined using Rural-Urban Commuting Area (RUCA) codes. FINDINGS: Mediation analyses found that the LGBTQ+ youth living in the most rural areas according to RUCA codes reported significantly lower social support as compared to those living in major metropolitan areas. Higher social support was significantly associated with lower depression, lower anxiety, and greater well-being. CONCLUSIONS: These results suggest that LGBTQ+ individuals living in rural areas may disproportionately receive less social support and experience worse mental health outcomes than their urban peers. This highlights the need for targeted interventions tailored to the unique challenges faced by LGBTQ+ rural dwellers.
What drives advanced practice nurses to stay in rural America? Insights from the 2022 National Survey of Registered Nurses.
Patel E, Gillette C, Ostermann J … +3 more , Everett C, Caviness D, Garvick S
J Rural Health · 2025 Sep · PMID 41157830 · Full text
PURPOSE: Recruiting and retaining a robust rural health care workforce is critical to advancing health outcomes in rural communities. Although increasing the rural provider workforce has been a policy focus for decades,...
PURPOSE: Recruiting and retaining a robust rural health care workforce is critical to advancing health outcomes in rural communities. Although increasing the rural provider workforce has been a policy focus for decades, rural access continues to worsen. Using a strengths-based approach, we identify factors that influence the decisions of advanced practice registered nurses (APRNs) to leave or stay in their jobs. METHODS: Secondary analysis of data from the 2022 National Sample Survey of Registered Nurses. We describe rates of turnover, retention, intention to leave, and reasons for leaving and staying by job rurality. We compare reasons by rurality using Pearson chi-squared tests with the Rao-Scott correction, applying survey weights to all analyses. FINDINGS: Our sample included 18,804 APRNs, of which one-fifth (19.1%, n = 3,589) worked in rural areas. The rural APRN workforce was, on average, older, less racially diverse, more experienced, and had a lower household income compared to the nonrural APRN workforce. Those who remained in rural jobs were more likely to report length of commute (P = .02), cost of living (P = .02), commitment to underserved communities (P = .001), and proximity to family (P<.001), compared to those who remained in urban jobs. Those who left nonrural jobs cited greater burnout (P = .02), stressful work environment (P = .05), career advancement (P = .01), and being laid off/downsized (P = .01) as reasons for leaving, compared to those who left rural jobs. CONCLUSIONS: We identified unique factors, including proximity to family, commitment to underserved populations, and less burnout, that contribute to APRN retention in rural areas. Leveraging these motivators can inform more effective, tailored strategies to support the rural health care workforce.
Breast cancer screening method prevalences in rural and urban women post-pandemic.
Jacobson I, Gully B, Eldien A … +1 more , McGovern E
J Rural Health · 2025 Sep · PMID 41146442 · Publisher ↗
BACKGROUND: Breast cancer, the second most commonly diagnosed and second leading cause of cancer death among US women, is detected by screening methods including mammograms, breast MRIs, and genetic testing. There are kn...
BACKGROUND: Breast cancer, the second most commonly diagnosed and second leading cause of cancer death among US women, is detected by screening methods including mammograms, breast MRIs, and genetic testing. There are known disparities in rural cancer care, including observed disparities in breast cancer screening. The COVID-19 pandemic worsened the rural cancer gap overall. This study aims to estimate the prevalence of various breast cancer screening methods among rural and urban women post-pandemic. METHODS: We used weighted data from the 2023 National Health Interview Survey on 15,745 women, including 2,432 rural women. We obtained unadjusted sociodemographic predictors of breast cancer screenings as well as six unadjusted breast cancer screening outcomes. We then built Firth penalized regressions estimating adjusted odds of all six outcomes in rural versus urban women in our sample. RESULTS: Rural women were less likely to have ever had a mammogram (60.8% vs. 64.6%, p = 0.017), and marginally less likely to have ever discussed genetic testing (8.9% vs. 10.3%, p = 0.093) or have ever gotten genetic testing for cancer risk (5.4% vs. 6.5%, p = 0.05). After adjustment, odds of ever discussing genetic testing with a doctor remained marginally lower for rural than urban women (aOR: 0.87, 95% CI: 0.74-1.02). CONCLUSIONS: Rural-urban differences in breast cancer screening outcomes were attenuated after adjustment for sociodemographic factors, suggesting these factors primarily drive observed disparities. Addressing these upstream social determinants of health could help improve rural breast cancer screening disparities.
Community pharmacists' engagement in opioid harm reduction: A rural-urban analysis from a rural state.
Skoy E, Frenzel O, Delgado E … +3 more , Gorder J, Woinarowicz L, Eukel H
J Rural Health · 2025 Sep · PMID 41137415 · Publisher ↗
PURPOSE: To evaluate disparities in opioid misuse risk and pharmacist-led harm reduction interventions by comparing rural and urban community pharmacies participating in an opioid misuse and accidental overdose preventio...
PURPOSE: To evaluate disparities in opioid misuse risk and pharmacist-led harm reduction interventions by comparing rural and urban community pharmacies participating in an opioid misuse and accidental overdose prevention program in North Dakota. METHODS: The ONE Program is a statewide opioid harm reduction initiative that screens patients receiving opioid prescriptions for risk of opioid use disorder and opioid overdose. Pharmacists delivered interventions based on risk stratification, including naloxone education/dispensing, prescriber contact, and community support referrals. Risk and outcomes were analyzed comparing rural and urban pharmacy settings using odds ratios (ORs) with 95% confidence intervals. FINDINGS: Between April 2022 and July 2024, a total of 21,295 patient opioid risk screenings were conducted across 63 pharmacies (32 rural, 31 urban). Urban pharmacies screened a higher proportion of at-risk patients (26.2%) compared to rural pharmacies (17.1%). While naloxone was recommended at similar rates, rural patients were significantly less likely to accept naloxone (11.2% vs. 20.7%, OR = 0.49). Urban pharmacies were more likely to contact prescribers (9.9% vs. 1.9%, OR = 0.18) and introduce medication take-back programs (OR = 6.65). Conversely, rural pharmacies were more likely to provide partial opioid fills (OR = 1.67) and education on community support services (OR = 3.95). Overall, rural patients were 24% less likely to receive at least one of six critical interventions defined by the ONE Program. (OR = 0.76). CONCLUSION: The ONE Program effectively identifies at-risk patients and delivers harm reduction interventions in both rural and urban pharmacy settings. However, significant differences in intervention delivery highlight the need for tailored strategies to address geographic disparities in opioid harm reduction.
Financial challenges of providing obstetric services at rural US hospitals.
Ce B, K O, Kb K … +1 more , Jd I
J Rural Health · 2025 Sep · PMID 41117605 · Full text
PURPOSE: This study describes perspectives of rural hospital administrators regarding the financial context for operating obstetric units, including the unique challenges they face and the strategies they have implemente...
PURPOSE: This study describes perspectives of rural hospital administrators regarding the financial context for operating obstetric units, including the unique challenges they face and the strategies they have implemented to maintain obstetric services. METHODS: In this mixed-methods study, we used data from a survey we conducted from March to August 2021 of administrators of rural hospitals that had maintained or closed their obstetric units. Key financial outcomes included general finances, size and equipment, payor mix, workforce, and other fixed costs, examined descriptively. We also conducted thematic content analysis of open-ended responses to financial questions. FINDINGS: Respondents from hospitals that closed obstetric services (n = 40) reported that physician shortages (67%), financial losses (62%), clinical safety (56%), liability insurance costs (51%), and nurse shortages (39%) influenced the decision to close obstetric units. Among hospitals with obstetrics (n = 88), more than half (55%) reported that their hospital was operating with a profit margin, but only 41% said their obstetric unit had more revenue than costs. Of the hospitals with obstetrics who responded about the future of their obstetric units, 77% (61/79) were confident that they would continue providing obstetric care in 10 years; their open-ended responses highlighted the importance of hospital leadership's commitment to maintaining obstetric services in their communities. CONCLUSIONS: Rural hospitals cite clinical workforce challenges, high fixed costs, and declining birth volumes as financial challenges to providing obstetrics. Strategies for maintaining obstetric care in rural communities should account for lower birth volumes in rural facilities and these interrelated challenges.
Barriers to health care among rural adults by disability status.
Swendener A, Tuttle M, Jacobson I … +3 more , Iezzoni LI, Barclay R, Henning-Smith C
J Rural Health · 2025 Sep · PMID 41116681 · Full text
PURPOSE: Access to health care supports both individual and population health. Ample research demonstrates access barriers faced by rural residents and people with disabilities; however, less research has examined access...
PURPOSE: Access to health care supports both individual and population health. Ample research demonstrates access barriers faced by rural residents and people with disabilities; however, less research has examined access barriers for rural residents by disability status or explored differences across multiple types of access barriers. This brief report addresses this gap by examining 11 financial and nonfinancial barriers to accessing health care among rural adults by disability status. METHODS: Using nationally representative data from the 2022 National Health Interview Survey and focusing on rural adults (n = 4,703), we conducted bivariate and multivariate logistic regression analyses comparing 11 separate access barriers by disability status and generated adjusted predicted probabilities of experiencing these barriers, controlling for sociodemographic characteristics. FINDINGS: Overall, compared to those without disabilities, rural people with disabilities had significantly higher adjusted predicted probabilities of 8 of the 11 access barriers. These include delaying multiple types of care due to cost, not being able to afford prescriptions, and delaying care due to facility hours, insurance acceptance, transportation, and travel time. Rural people with disabilities were, however, more likely than their nondisabled counterparts to report having a usual place for care. CONCLUSIONS: Rural individuals with disabilities face more barriers to care than their peers without disabilities, including delaying care, which can potentially worsen health outcomes. Our findings provide important information for policymakers to improve access to care at the intersection of rurality and disability.
The new Rural Emergency Hospital Designation Program: Will it improve access to care for rural Americans?
Daly SB, You W, Merwin EI
J Rural Health · 2025 Sep · PMID 41088838 · Full text
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Rural-urban differences in dietary intake across pregnancy trimesters: A multisite prospective cohort study.
Crisp AH, Gibbs BB, Gallagher JB … +4 more , Wilhite KL, Trude ACB, Haggerty T, Whitaker KM
J Rural Health · 2025 Sep · PMID 41084900 · Full text
PURPOSE: Poor diet during pregnancy compromises maternal-fetal health and may reflect broader environmental and structural inequities. This study investigated differences in dietary intake across pregnancy among rural an...
PURPOSE: Poor diet during pregnancy compromises maternal-fetal health and may reflect broader environmental and structural inequities. This study investigated differences in dietary intake across pregnancy among rural and urban women in the United States and assessed whether socioeconomic status (SES) modified rural-urban differences. METHODS: In this prospective study, pregnant women (n = 495; 22.4% rural) from three sites (Iowa, Pennsylvania, West Virginia) had dietary intake estimated via the 26-item Dietary Screener Questionnaire (DSQ) during each trimester. Rural was defined as Rural-Urban Commuting Area (RUCA) code ≥ 4. A SES score was derived using Principal Component Analysis of education, annual household income, and insurance type. Adjusted robust linear mixed-effects models (controlled for site, age, minority status, pre-pregnancy BMI) compared dietary intakes between rural and urban participants, with trimester and SES interactions. FINDINGS: Compared to their urban counterparts, rural participants had higher predicted intakes of added sugars from sugar-sweetened beverages (SSBs) in the first (0.61 tsp eq/day; 95% CI: [0.04, 1.18]) and second trimesters (0.62 tsp eq/day [0.05, 1.21]), and less fiber across all trimesters (ranging from -0.90 g/day [-1.7, -0.1] to -1.2 g/day [-2.0, -0.3]). Women in the high-SES urban group had higher intakes of fiber and calcium, and lower intakes of SSBs compared to their low-SES counterparts in both rural and urban settings. CONCLUSIONS: Although rurality was associated with greater SSBs and lower fiber intake, differences were modest. Low-SES was related to a poorer diet regardless of geography, highlighting the need for targeted interventions for both rural and urban low-SES pregnant women.
Bridging the gaps: Rural recovery community centers and their role in addressing substance use disorders.
Bohler RM, Lofaro RJ, Smith KD … +4 more , Johnson JA, Shehaj B, Kite B, Mase WA
J Rural Health · 2025 Sep · PMID 41070922 · Publisher ↗
PURPOSE: Recovery community centers (RCCs) offer a range of non-clinical services for individuals in recovery from substance use disorder (SUD). RCCs may play an important role in addressing rural service gaps. This stud...
PURPOSE: Recovery community centers (RCCs) offer a range of non-clinical services for individuals in recovery from substance use disorder (SUD). RCCs may play an important role in addressing rural service gaps. This study aims to increase our understanding of how rural RCCs address SUD, including how they serve individuals receiving medications for opioid use disorder (MOUD). METHODS: We conducted a mixed methods study consisting of pre-interview surveys and semi-structured interviews with 12 RCC directors in rural Georgia. The surveys examined organizational and participant characteristics and MOUD attitudes, and the interviews explored rural challenges, strategies to overcome challenges, and community collaborations. We conducted descriptive analyses of the survey data and analyzed interviews using thematic analysis. RESULTS: RCCs serviced an average of 41 new members per month and had an annual budget of $225,407. RCCs provided in-house or linked to many services that addressed social determinants of health. Most participants were in early recovery (<1 year), had criminal legal involvement, and lacked a high school education. In the thematic analysis, transportation and housing were commonly reported challenges. Additionally, RCCs provided essential treatment linkage, were the primary naloxone distributor in the area, and provided in-house mutual help organizations representing alternative recovery pathways. Collaboration with MOUD providers was minimal despite RCC efforts. Directors generally had positive attitudes towards MOUD. CONCLUSION: Rural RCCs address a range of social determinants of health and may fill gaps in the SUD continuum of care, including harm reduction services, linkage to treatment, and expansion of recovery pathways.
The roles of COVID-19 pandemic exposure and telehealth in prenatal care access for rural and racial minority communities in the United States: A retrospective cohort study.
Hung P, Yu J, Promiti AB … +6 more , Campbell BA, Boghossian NS, Chatterjee A, Cai B, Liu J, National COVID Cohort Collaborative Consortium
J Rural Health · 2025 Sep · PMID 41024439 · Full text
PURPOSE: To examine how COVID-19 public health emergency (PHE) exposure during pregnancy and telehealth use were associated with rural-urban and racial/ethnic differences in prenatal care initiation timing and frequency....
PURPOSE: To examine how COVID-19 public health emergency (PHE) exposure during pregnancy and telehealth use were associated with rural-urban and racial/ethnic differences in prenatal care initiation timing and frequency. METHODS: This retrospective cohort study of 349,682 pregnancies to birthing individuals who received both prenatal and intrapartum care at the 75 health systems in the United States contributing to the National Clinical Cohort Collaborative (N3C) from 6/1/2018 through 5/31/2022. Outcomes included prenatal care initiation timing and the number of prenatal care visits. Prenatal periods were categorized into 3 PHE exposure groups: (1) never, (2) partially, and (3) fully exposed to the PHE. The full-exposure group was further categorized into telehealth users and those with exclusively in-person care. FINDINGS: The full-exposure group with telehealth uptake had the earliest prenatal care initiation (median: 9 weeks [interquartile range: 7-13]) and the most visits (19 visits [12-20]). In contrast, the full-exposure group without telehealth use initiated care the latest (11 weeks [8-21]) and had the fewest visits (13 visits [6-22]). Rural-urban disparities persisted; however, telehealth users in both groups had earlier initiation and more visits. Racial and ethnic disparities in timeliness to initiation were most pronounced among the full-exposure group with telehealth (Black-White: adjusted hazard ratio [aHR]: 0.76, 95% CI, 0.70-0.83; Hispanic-White: aHR: 0.62, 95% CI, 0.58-0.68), compared to the full-exposure group with exclusively in-person care (Black-White: 0.95 [0.93-0.94]; Hispanic-White: 0.80 [0.80-0.81]). CONCLUSIONS: Prenatal telehealth care improved early initiation but also exacerbated racial/ethnic disparities in the timeliness of prenatal care access. However, rural-urban disparities persisted.
Differences in the travel burden for care between rural and urban patients with opioid use disorder by insurance type.
Andrilla CHA, Woolcock SC, Garberson LA … +1 more , Graves JM
J Rural Health · 2025 Sep · PMID 41020666 · Publisher ↗
PURPOSE: To compare the time and distance travel burden to access care for rural and urban Medicaid and commercially insured patients with opioid use disorder (OUD), and to understand where they travel for care. METHODS:...
PURPOSE: To compare the time and distance travel burden to access care for rural and urban Medicaid and commercially insured patients with opioid use disorder (OUD), and to understand where they travel for care. METHODS: We used Medicaid and the Health Care Cost Institute commercial insurance administrative claims data from 2019 to examine the travel burden to health care for adults ages 18 years and older with OUD. We calculated the one-way driving distance and travel time between the enrollee's residence and the provider's location. We used the 2013 Urban Influence Codes (UIC) to classify enrollees as either urban (UIC 1-2) or rural (UIC 3-12) based on the patient's residence county. FINDINGS: The median distance traveled for a visit by a rural Medicaid or rural commercially insured enrollee was more than twice as far as their urban counterparts (rural Medicaid: 45.9 miles, urban Medicaid: 13.9 miles; rural commercially insured: 32.9 miles, urban commercially insured: 12.4 miles). When we imputed zeros for care provided in the same ZIP Code as an enrollee's residence, these differences persisted. Rural Medicaid enrollees carried the largest travel burden spending an average of more than 60 min traveling to care, about 30 min more than rural commercially insured enrollees. Urban enrollees, regardless of insurance type received almost all of their care in an urban location while rural Medicaid and commercially insured patients traveled to an urban location for about half their visits. CONCLUSIONS: Rural and urban Medicaid and commercially insured enrollees experience different time and distance travel burdens.
Weaving the rural health safety net: Voices from the field.
Riley J, Dryden EM, Dawson CMP … +4 more , Kennedy MA, Moo LR, Pimentel CB, Hung W
J Rural Health · 2025 Sep · PMID 41020644 · Publisher ↗
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Adverse childhood experiences and preventive health care among rural US children: A cross-sectional examination of 2022 National Health Interview Survey data.
Labuhn M, Williams A
J Rural Health · 2025 Sep · PMID 41017060 · Full text
PURPOSE: Rural-residing children have poor access to preventive health care due to geographic and socioeconomic issues, yet the role of adverse childhood experiences (ACEs) in preventive care for rural children has been...
PURPOSE: Rural-residing children have poor access to preventive health care due to geographic and socioeconomic issues, yet the role of adverse childhood experiences (ACEs) in preventive care for rural children has been understudied. It is hypothesized that among rural-residing children, those with ≥1 ACE will have lower utilization of preventive health care, with differences by sex. METHODS: Data for 425 (weighted n = 3,949,102) children (aged 9-17) residing in "nonmetropolitan" (2013 NCHS Urban-Rural Classification) were drawn from the 2022 National Health Interview Survey. Physician visit in the past 12 months (yes/no), dental visit in the past 12 months (yes/no), COVID-19, flu, and HPV vaccination (yes/no) were self-reported. Participants self-reported (yes/no) to 6 ACEs (high ACEs ≥1). Logistic regression estimated odds ratios and 95% confidence intervals for associations between ACEs and preventive health outcomes, adjusted for demographic and health care factors. This manuscript adheres to STROBE guidelines. FINDINGS: Children with ≥1 ACE were 81% more likely (OR = 1.81, 95% CI 1.04, 3.18) to receive a flu vaccination and 184% (OR = 2.84, 95% CI 1.66, 4.85) more likely to receive an HPV vaccination compared to children with 0 ACEs. No significant associations were found between ACEs and other preventive health care. Boys with ≥1 ACE had decreased odds (OR = 0.34, 95% CI 0.13, 0.94) of visiting a dentist, while girls with ≥1 ACE had increased odds (OR = 3.87, 95% CI 1.56, 9.60) of receiving an HPV vaccination. CONCLUSIONS: Children with ≥1 ACE were more likely to receive a flu vaccination and HPV vaccination. The effect of ACEs on preventive health care may differ by sex among rural residents, yet additional research is warranted to inform prevention efforts in rural communities.
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