The Journal Of Rural Health[JOURNAL]
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200 papers
The provision of tele-behavioral health services by critical access hospitals and short-term acute care hospitals during the COVID-19 public health emergency.
Jonk Y, O'Connor H, Thomas S … +1 more , Shea CM
J Rural Health · 2025 Jun · PMID 40977594 · Publisher ↗
PURPOSE: This study examined how the telehealth (TH) flexibilities introduced during the COVID-19 public health emergency (PHE) affected in-person behavioral health (BH) and tele-behavioral health (TBH) patterns of use a...
PURPOSE: This study examined how the telehealth (TH) flexibilities introduced during the COVID-19 public health emergency (PHE) affected in-person behavioral health (BH) and tele-behavioral health (TBH) patterns of use among Medicare Fee-for-Service beneficiaries receiving care at critical access hospitals (CAHs) and non-CAH short-term acute care hospitals. METHODS: We used the 2019-2021 5% Medicare Limited Data Set Outpatient and Carrier files to explore differences in TBH usage trends by hospital type in the pre-pandemic year of 2019 and during the pandemic (2020-2021). FINDINGS: The percentage of hospitals providing TBH services significantly increased from 2019 to 2020-2021 (CAHs: 9% to 17%-23%; non-CAHs: 3% to 21%-22%). Although CAHs had higher TBH usage rates (i.e., the percentage of BH visits conducted through TH) than non-CAHs in the pre-pandemic period, usage rates among non-CAHs (7%-25%) outpaced CAHs (5%-16%) across all census regions-particularly in the Northeast-during the pandemic. In 2021, non-CAHs were able to sustain the use of TBH at higher levels than CAHs across all census regions except for the South. CONCLUSIONS: While both CAHs and non-CAHs took advantage of the PHE TH flexibilities and significantly increased the likelihood and levels of TBH services, non-CAHs realized higher TBH usage rates than CAHs. The increase in the use of TBH visits was not enough to curb the decline in in-person BH visits during the pandemic. Given efforts to expand broadband and improve digital literacy in rural areas, TH continues to have great potential to reduce rural-urban BH differences in access to BH services.
Rural-urban disparities in the prevalence of chronic pain in adults: Associations with demographic and socioeconomic characteristics.
Talbot JA, Jewell C, Holston B … +3 more , Plavin J, Rose GL, Ziller EC
J Rural Health · 2025 Jun · PMID 40977593 · Publisher ↗
PURPOSE: To explore rural-urban differences in chronic pain prevalence among adults in the United States. METHODS: This cross-sectional study analyzed pooled data from the 2019-2021 and 2023 National Health Interview Sur...
PURPOSE: To explore rural-urban differences in chronic pain prevalence among adults in the United States. METHODS: This cross-sectional study analyzed pooled data from the 2019-2021 and 2023 National Health Interview Survey. We used chi-square tests and logistic regression to determine how rurality of residence was associated with chronic pain prevalence among adults aged 18 and older before and after adjustment for demographic and socioeconomic variables. STROBE reporting guidelines were applied. FINDINGS: Unadjusted prevalence of chronic pain was 29% for rural adults and 21% for their urban counterparts (P <.0001). After control for covariates, rural-urban differences decreased but remained statistically significant. Adjusted odds of chronic pain were 9% higher in rural than in urban populations (P <.01). Adjusted chronic pain prevalence was 23% for rural and 22% for urban adults (P <.01). Multivariable analyses suggested that rural-urban prevalence differences were related to risk factors that were more common in rural populations, including older age, current or past married status, lower income, lower education levels, and non-Hispanic White race and ethnicity. CONCLUSIONS: The substantial rural-urban disparity in chronic pain prevalence is partly associated with demographic and socioeconomic risk factors correlated with rurality. Persisting rural-urban differences in adjusted chronic pain prevalence may also be correlated with barriers limiting rural residents' access to guideline-concordant pain management. Innovations in delivery systems and payment policies may help to reduce these barriers.
Trends in mental health care utilization in rural and nonrural areas, 2019-2023.
Stanley BJ
J Rural Health · 2025 Jun · PMID 40977591 · Full text
PURPOSE: The recent increase in mental health care providers offering telehealth may improve access by reducing travel costs, particularly for those in rural areas. This paper seeks to understand how mental health care u...
PURPOSE: The recent increase in mental health care providers offering telehealth may improve access by reducing travel costs, particularly for those in rural areas. This paper seeks to understand how mental health care utilization changed from 2019 to 2023 for rural and nonrural areas. METHODS: This study uses data from the National Health Interview Survey for 2019 and 2021-2023 (n = 118,652). To adjust the utilization rates for sociodemographic factors, a probit model with survey weights is used. For each year, the adjusted percentage of rural and nonrural populations receiving any mental health care in the past year is reported. Changes in demographic characteristics of those receiving care are also discussed. FINDINGS: This study finds that both rural and nonrural populations experienced large increases in adjusted mental health care utilization rates from 2019 to 2023. Utilization rates in rural areas grew 3.72 percentage points, from 9.35% (95% CI: 8.85-9.84) in 2019 to 13.07% (95% CI: 12.86-13.28) in 2023. For nonrural areas, utilization rates increased 4.40 percentage points, from 12.06% (95% CI: 11.79-12.74) in 2019 to 16.46% (95% CI: 15.82-17.11) in 2023. CONCLUSION: Rural populations utilize less mental health care than nonrural populations, but both saw a substantial increase from 2019 to 2023. While telehealth may particularly benefit rural areas, these data suggest a larger increase in utilization for nonrural respondents. Future work is needed to better understand remote mental health care and rural populations.
A comparison of classifications for geographic location and their associations with tobacco use among US adults.
Ozga JE, Milstred A, Blank MD … +5 more , Rayens MK, Keller-Hamilton B, Roberts ME, Himelhoch S, Stanton CA
J Rural Health · 2025 Jun · PMID 40977590 · Full text
PURPOSE: This study compared two classifications of rurality and their associations with cigarette, e-cigarette, and smokeless tobacco (SLT) use among a nationally representative sample of 31,196 US adults. METHODS: Data...
PURPOSE: This study compared two classifications of rurality and their associations with cigarette, e-cigarette, and smokeless tobacco (SLT) use among a nationally representative sample of 31,196 US adults. METHODS: Data from Wave 1 of the Population Assessment of Tobacco and Health Study. Weighted descriptive statistics and multivariable logistic regressions assessed whether two classifications of rurality were differentially associated with past 30-day (P30D) cigarette, e-cigarette, or SLT use in separate models. Classifications were (1) the US Census Bureau's classification as urban/non-urban; and (2) the National Center for Education Statistic (NCES)'s classification as urban/suburban/town/rural. This study is reported in accordance with STROBE guidelines. FINDINGS: With the Census Bureau classification, 79.3% were in urban areas. With the NCES classification, 34.3% were in urban, 35.1% in suburban, 9.4% in town, and 21.1% in rural areas. With the Census Bureau classification, non-urban (vs. urban) residence was associated with reduced odds of e-cigarette use (AOR = 0.79; 95% CI = 0.70-0.88) and increased odds of SLT use (AOR = 2.32; 95% CI = 1.97-2.72). With the NCES classification with urban as reference, rural residence was associated with reduced odds of e-cigarette use (AOR = 0.77; 95% CI = 0.75-0.98); both town (AOR = 2.16; 95% CI = 1.69-2.78) and rural (AOR = 2.75; 95% CI = 2.16, 3.48) were associated with increased odds of SLT use. Location was not associated with cigarette use for either classification. CONCLUSIONS: Location was similarly associated with P30D e-cigarette and SLT use across both classifications in adjusted models. The use of classifications with more categories may be beneficial to understand nuanced location differences in tobacco use.
Understanding the influence of social determinants of health on symptom reporting in pediatric cancer.
Skeens MA, Booze A, Ranalli M … +1 more , Olsavsky A
J Rural Health · 2025 Jun · PMID 40977588 · Full text
PURPOSE: Children with cancer experience significant symptom burden, worsened by social deprivation. This study examines social determinants of health, including Appalachian residency, influence on symptom burden. METHOD...
PURPOSE: Children with cancer experience significant symptom burden, worsened by social deprivation. This study examines social determinants of health, including Appalachian residency, influence on symptom burden. METHODS: Caregiver-child dyads were recruited within 1 year of cancer treatment. Addresses were coded for social determinants of health (SDOH) measures: Area Deprivation Index (ADI), rurality, medically underserved areas (MUA), and Appalachian residency. Total child symptom scores (0-31) were calculated for dyad reports using the Memorial Symptom Assessment Scale. Provider matching symptom reports were extracted from electronic medical records. Descriptive statistics and correlations examined associations between child, caregiver, and provider symptom reports and SDOH. Significant correlations informed three multiple linear regression models examining SDOH predictors of child symptoms by reporter. FINDINGS: Fifty-five caregiver-child dyads were recruited. Caregivers were 65.5% female and 87.3% White. Children were 50.9% male, 85% White, an average of 12 years old, 30.9% rural, and 20.0% Appalachian. ADI scores (M = 4.22) indicated moderate disadvantage, and 14.5% were medically underserved. On average, children reported 8.61 symptoms, while caregivers reported 7.15, and providers recorded 1.87 child symptoms. For children, a bivariate association and significant regression model revealed Appalachian children experienced a higher number of symptoms. For caregivers, bivariate associations indicated a higher ADI was associated with more symptoms. For providers, bivariate associations revealed higher symptoms were associated with rurality, MUA, and Appalachian residency, though only Appalachian residency remained significant in the regression model. CONCLUSIONS: Results suggest Appalachian residency is associated with higher symptom burden for children with cancer. Findings support culturally sensitive care to minimize symptom burden.
Metropolitan/nonmetropolitan differences of the impact of COVID-19 on cancer survivors' care.
Zahnd WE, Semprini JT, Vanderpool RC … +5 more , Nash SH, Van Blarigan EL, DeRouen MC, Meisner ALW, Wiggins C
J Rural Health · 2025 Jun · PMID 40977584 · Full text
PURPOSE: To evaluate pandemic-related changes in cancer-related care for cancer survivors residing in nonmetropolitan and metropolitan areas. METHODS: We used data from the Health Information National Trends-Surveillance...
PURPOSE: To evaluate pandemic-related changes in cancer-related care for cancer survivors residing in nonmetropolitan and metropolitan areas. METHODS: We used data from the Health Information National Trends-Surveillance Epidemiology End Results (HINTS-SEER) survey administered to cancer survivors from the Greater San Francisco Bay Area, Iowa, and New Mexico between January and August 2021. Respondents were queried on changes to their cancer-related care, including treatment, follow-up appointments, and routine cancer screening/preventive care. We calculated weighted percentages and Rao-Scott chi-square tests for reported differences between nonmetropolitan and metropolitan areas. FINDINGS: Compared to survivors residing in metropolitan areas, a higher proportion of those in nonmetropolitan areas reported that their cancer treatment or follow-up appointments were unaffected by the pandemic (38.6% vs 28.1%; P = .008). Survivors in metropolitan areas experienced more of a shift in cancer treatment or follow-up appointments to telehealth (12.5% vs 5.7%, P = .003), but there was no difference in appointment cancellations. More survivors residing in metropolitan versus nonmetropolitan areas reported shifts to telehealth for preventive care (8.2% vs 2.9%, P = .005). There was no difference across nonmetropolitan and metropolitan survivors reporting that cancer-related care was cancelled, that routine cancer screening or preventive care was unaffected by the pandemic, or that providers discussed COVID-19 risks. CONCLUSIONS: Survivors in nonmetropolitan compared to metropolitan areas had less perceived change in cancer follow-up and treatment schedules. It will be important to assess whether shifts in follow-up and preventive care to telehealth for cancer survivors in need of care during the COVID-19 pandemic affect their long-term outcomes.
Skill mix versus flexibility: Decoding nurse staffing impacts on critical access hospitals.
Pai DR, Bahalkeh E
J Rural Health · 2025 Jun · PMID 40873428 · Full text
OBJECTIVE: This study examines the effect of nurse staffing (skill mix and flexibility) on the financial sustainability, efficiency, and quality of care in Pennsylvania's critical access hospitals (CAHs) from 2000 to 202...
OBJECTIVE: This study examines the effect of nurse staffing (skill mix and flexibility) on the financial sustainability, efficiency, and quality of care in Pennsylvania's critical access hospitals (CAHs) from 2000 to 2023. METHODS: This retrospective longitudinal study utilized unbalanced panel data from Pennsylvania's CAHs (n = 357 hospital-year observations). We employed 2-way fixed effects regression models to analyze the relationship between nurse staffing variables (skill mix and flexibility) and hospital performance outcomes (total margin, cost per adjusted discharge [CPAD], cost per adjusted patient day [CPPD], average length of stay [ALOS], and readmission index). We controlled for hospital-specific, socioeconomic, and demographic factors. RESULTS: A higher registered nurse (RN) skill mix significantly reduced log(winsorized(CPAD)) (β = -0.495, p<0.01) and log(ALOS) (β = -0.571, p<0.01), indicating improved cost efficiency and patient throughput. Increased nurse flexibility significantly increased log(ALOS) (β = 0.315, p<0.05) but reduced the readmission index (β = -0.895, p<0.01). No significant associations were found between skill mix and total margin, CPPD, or readmission index, nor between flexibility and financial metrics. DISCUSSION: A richer RN skill mix enhances efficiency by reducing costs and length of stay, while increased staffing flexibility reduces readmissions but extends ALOS. These findings emphasize the complex interplay between nurse staffing and CAH performance. Strategic management of RN skill mix and flexibility is crucial for optimizing resource use and improving patient outcomes in rural hospitals. CONCLUSIONS: Policymakers and CAH administrators should strategically balance RN expertise and staffing flexibility to ensure both financial viability and clinical excellence in these essential rural health care institutions.
Rural and urban differences in treatment on demand for substance use treatment involving medications for opioid use disorder.
Lofaro RJ, Bohler RM, Spurgeon R … +1 more , Mase WA
J Rural Health · 2025 Jun · PMID 40855625 · Publisher ↗
PURPOSE: Research has found that the use of medications for opioid use disorder (MOUD) varies across the rural-urban divide; however, relationships between rurality, MOUD, and substance use treatment wait times remain un...
PURPOSE: Research has found that the use of medications for opioid use disorder (MOUD) varies across the rural-urban divide; however, relationships between rurality, MOUD, and substance use treatment wait times remain underexplored. This study analyzes associations between rurality, MOUD usage, and immediate access to outpatient treatment-that is, "treatment on demand"-in the United States. METHODS: Using 2021-2022 Treatment Episode Data Set Admissions (TEDS-A) data on outpatient treatment centers, we employ logistic regression to analyze treatment on demand (0-day wait time) as the outcome and rurality as the key predictor in models disaggregated into patients who utilized MOUD at intake and those who did not. Analyses are also disaggregated by Census region and division of the country. FINDINGS: Results show that rurality reduces the odds of treatment on demand in both MOUD (OR = .513, P <.001) and non-MOUD (OR = .593, P <.001) models, with slightly stronger effects in the former. Associations with rurality vary substantially by region of the country. MOUD models in the Midwest, West, and South show rurality has a significant negative effect; these negative associations held for non-MOUD models only in the South. Further, differences across Census divisions highlight rurality's spatial disparities at a more granular level. CONCLUSIONS: Understanding barriers to treatment on demand for evidence-based treatments is a crucial aspect of ensuring people who have opioid use disorder in rural regions receive the care they need. Policies should focus on increasing access to treatment to avoid delays while considering regional differences.
Rural patients' experiences with diagnosis and treatment of endometrial cancer.
Petermann VM, Taffe BD, Biru BM … +7 more , Leeman J, Leak Bryant A, Albright BB, Wheeler SB, Bae-Jump VL, Grainger L, Spees LP
J Rural Health · 2025 Jun · PMID 40844702 · Full text
BACKGROUND: Rural endometrial cancer (EC) patients are less likely to receive lymph node evaluation, high-quality surgical care, and adjuvant therapy compared to urban patients. Developing interventions to effectively ad...
BACKGROUND: Rural endometrial cancer (EC) patients are less likely to receive lymph node evaluation, high-quality surgical care, and adjuvant therapy compared to urban patients. Developing interventions to effectively address barriers to quality care requires understanding patient experiences across the cancer care continuum. Our objective was to understand the diagnostic and treatment experiences of rural EC patients. METHODS: We conducted semistructured interviews with 23 participants (22 patients, one caregiver) from rural counties in North Carolina. We developed a semistructured interview guide to examine the experiences of patients during diagnosis and treatment. Initial codes were derived from a multilevel conceptual framework of rural cancer control, and transcribed interviews were analyzed using thematic analysis. RESULTS: We identified six themes reflecting determinants of diagnosis and seven themes for treatment of EC for rural patients. Provider knowledge of EC symptoms, patient symptom normalization, and fear were all discussed as major factors impacting delays in EC diagnosis. Participants noted that social networks influenced them to seek care for symptoms they did not otherwise see as concerning. During treatment, participants experienced financial burdens, and many reported significant challenges traveling to treatment. Social networks were critical for financial support and transportation to and from treatment. Personal health care experiences and community perceptions about rural cancer care also influenced decisions about where to seek gynecologic cancer treatment. CONCLUSIONS: This study highlights the need to improve rural provider adherence to guidelines for EC detection, increase symptom knowledge among rural communities, and implement comprehensive assessments of unmet needs of rural patients during treatment.
Hearing aid acquisition patterns among US Veterans who use VA health care.
Coco L, Shields L, Phillips R … +5 more , Pesa S, Hamilton-Sutherland M, Carlson KF, Konrad-Martin DL, Reavis KM
J Rural Health · 2025 Jun · PMID 40820402 · Publisher ↗
PURPOSE: The primary objective of this observational study was to describe the population of Veterans who did and did not receive a hearing aid following an incident hearing loss diagnosis during the 12-year study period...
PURPOSE: The primary objective of this observational study was to describe the population of Veterans who did and did not receive a hearing aid following an incident hearing loss diagnosis during the 12-year study period. We also sought to measure the relationship between hearing loss severity and hearing aid acquisition and explore how this association differs according to Veterans' urban/rural residential status. Understanding associations of clinical or demographic characteristics with hearing aid acquisition by US Veteran health care users may contribute to more effective treatment of hearing loss. METHOD: We examined all Veteran electronic health records to identify participants with an incident (new) hearing loss diagnosis between January 2011 and June 2023. Hearing loss was identified using International Classification of Diseases diagnosis codes and audiogram results. Hearing aid fittings were identified using Current Procedural Terminology codes. Poisson regression models were used to compute rate ratios and 95% confidence intervals of hearing aid acquisition. RESULTS: Among 256,409 Veterans with an incident hearing loss diagnosis, the prevalence of hearing aid acquisition was 81% (n = 206,438) during the study period. Among Veterans who received hearing aids, a greater proportion were older, male, White, non-Hispanic, married, and from higher income groups. The average number of days between hearing loss diagnosis and hearing aid fitting was less than 1 year (M = 200 days; SD = 502 days). The association between hearing loss severity and hearing aid acquisition was stronger among urban Veterans compared to rural Veterans, and there was a significant interaction between hearing loss severity and urban/rural status (p < .0001). CONCLUSIONS: This large, national cohort study provides the first description of hearing aid acquisition patterns among Veterans using VA health care. Hearing aid uptake was high overall but varied by demographic and geographic factors. The observed differences may reflect structural challenges or variations in perceived need. These findings can help inform targeted VA programs aimed at improving timely uptake of hearing care, particularly among rural Veteran populations.
Tobacco retailer density and rurality across four US states: California, Connecticut, North Carolina, and Ohio.
Webb E, Craigmile PF, Morean ME … +7 more , Kong G, Lee JGL, Martin RJ, Barrington-Trimis J, Qiang R, Spinola VB, Roberts ME
J Rural Health · 2025 Jun · PMID 40817627 · Full text
PURPOSE: Research has demonstrated many types of disparities in tobacco retailer density (TRD), but these analyses often fail to explore rural disparities. Given the substantial burden of rural tobacco use in the USA, th...
PURPOSE: Research has demonstrated many types of disparities in tobacco retailer density (TRD), but these analyses often fail to explore rural disparities. Given the substantial burden of rural tobacco use in the USA, this is a critical gap. The purpose of the present study was to estimate rural disparities in TRD across four US states. METHODS: For the states of California, Connecticut, North Carolina, and Ohio, we used spatial statistical methods to model per capita TRD at the census tract level. Rurality was defined by the US Department of Agriculture Rural-Uran Commuting Area (RUCA) codes and categorized into Metropolitan, Micropolitan, Small Town, and Rural. FINDINGS: Tobacco retailer count was highest in California (22,533), but TRD was highest in Connecticut (1.23 retailers per 1000 residents). In models for California, North Carolina, and Ohio (but not Connecticut), there was an association between rurality and TRD, such that rural census tracts had greater TRD than metropolitan census tracts. Micropolitan and small town (vs. metropolitan) census tracts also had greater TRD, although the association was not as strong. Models further showed associations between TRD and census tract poverty, racial and ethnic composition, and Appalachian designation. CONCLUSIONS: Although there are notable state-level differences, TRD is clearly associated with rurality. Given the literature on the impacts of living in tobacco-retailer-dense areas, rural disparities in TRD likely contribute to rural disparities in tobacco use. There is a need for further policies in rural areas of the USA that address the tobacco retailer environment.
Colorectal cancer screening barriers, facilitators, and promotion recommendations by Alaska Native people who are non-adherent to colorectal cancer screening.
Redwood D, Toffolon M, Flanagan C … +4 more , Jeffries L, Bailie D, Rutten LF, Kisiel J
J Rural Health · 2025 Jun · PMID 40765125 · Full text
PURPOSE: We examined barriers and facilitators to colorectal cancer (CRC) screening among Alaska Native individuals who had never been screened or were not up to date with screening guidelines. METHODS: As part of a larg...
PURPOSE: We examined barriers and facilitators to colorectal cancer (CRC) screening among Alaska Native individuals who had never been screened or were not up to date with screening guidelines. METHODS: As part of a larger study investigating the use of the multitarget stool DNA test in rural Alaska communities, we conducted focus groups and in-depth interviews with 28 never screened or not up-to-date Alaska Native people in two remote communities between November 2022 and July 2023. Participants shared their barriers to CRC screening and offered suggestions to improve programs to better reach those who are guideline discordant. FINDINGS: General screening barriers included lack of knowledge, fear of discovering you have cancer, and cultural health beliefs. Colonoscopy-specific barriers included embarrassment from knowing the local medical staff, having rectal area viewed or touched, fear of pain and injury, difficulty scheduling a procedure due to traditional food gathering activities, lack of provider referrals/reminders, and the high cost of air travel required to get to a colonoscopy facility. Stool DNA-specific concerns included not feeling that it was as good as colonoscopy, lack of privacy to do the test, and hesitancy collecting stool samples. Suggestions for increasing screening rates included increasing access via paid air transportation, using local indigenous languages, improving provider relationships and reminder systems, and providing CRC and screening education using trusted messengers. CONCLUSIONS: This was the first exploration of the perceptions of CRC screening among guideline discordant Alaska Native people. Identified themes can be used to improve screening program outreach effectiveness in the future.
"It's not about me. It's about what's best for my community": Factors impacting COVID-19 vaccine uptake among Native Americans and Latinos from two agricultural communities.
Truong L, Adams AK, Bishop S … +11 more , Dupuis V, Garza L, Quigley T, Hassell L, Drain PK, Ibarra G, Sorrell AW, Warne T, Gregor C, Webber E, Ko LK
J Rural Health · 2025 Jun · PMID 40757627 · Full text
PURPOSE: While SARS-CoV-2 significantly impacts rural Native American and Latino communities, COVID-19 vaccines offer an effective and safe mitigation strategy. Vaccine uptake is disproportionately lower in rural communi...
PURPOSE: While SARS-CoV-2 significantly impacts rural Native American and Latino communities, COVID-19 vaccines offer an effective and safe mitigation strategy. Vaccine uptake is disproportionately lower in rural communities than in urban communities across the nation. This study examined barriers and motivators of COVID-19 vaccine uptake in two Native American and Latino rural agricultural communities in eastern Washington and Montana. METHODS: We conducted 28 key informant interviews with trusted community members and six community focus groups with 39 participants from May 2021 to June 2021. Participants were from the Yakima Valley (WA) and Flathead Reservation (MT). The Social Cognitive Theory and Social Context Framework informed development of the interview and focus group moderator guides. We used deductive and inductive approach to code transcripts and thematic analysis to generate themes. FINDINGS: Barriers to COVID-19 vaccine uptake were misconceptions about COVID-19 vaccines shaped by misinformation, politicization of vaccines, historical trauma and mistrust in government, and structural barriers in rural agricultural communities. Having access to accurate and understandable COVID-19 vaccine information and receiving information from trusted sources were motivators of COVID-19 vaccine uptake. Protecting families, children, elders, and the community, and striving to return to normal life were also noted as motivators. CONCLUSIONS: Understanding the community's perceptions and experiences around the COVID-19 vaccine is critical for successful implementation of strategies to increase vaccine uptake during future public health emergencies. Strategies for vaccine uptake among communities in the Flathead Reservation and Yakima Valley need to address barriers and highlight motivators of COVID-19 vaccine uptake.
Seeking connection: A qualitative study of psychosocial support needs of rural cancer survivors in Minnesota.
Gruner M, Brown K, Anderson R … +6 more , James S, Li X, Henning-Smith C, Blaes A, Jewett P, Vogel RI
J Rural Health · 2025 Jun · PMID 40757615 · Full text
PURPOSE: Individuals diagnosed with cancer have extensive and often unmet psychosocial support needs. We established a partnership between the University of Minnesota and Gilda's Club to identify survivorship issues, unm...
PURPOSE: Individuals diagnosed with cancer have extensive and often unmet psychosocial support needs. We established a partnership between the University of Minnesota and Gilda's Club to identify survivorship issues, unmet psychosocial support needs, and barriers to receiving cancer support in rural Minnesota. METHODS: We conducted six focus groups and 16 interviews (41 total participants) between November 2022 and January 2024 among cancer survivors living in rural Minnesota. Structured interview guides included questions about survivors' definition of cancer support, what community support is desired and available, and barriers to obtaining support. Transcripts were analyzed using inductive thematic analysis. FINDINGS: The mean participant age was 57.1 ± 13.4 years; the majority were female (68%), non-Hispanic White (95%), and college graduates (58%), and they represented many cancer diagnoses, with hematologic (20%) and breast cancers (17%) most frequently reported. Most (73%) were under surveillance (median 4 years from diagnosis). Many participants mentioned extensive travel burdens due to lack of local care, and virtually all participants agreed emotional support was critical. Over half (56%) of participants wished for peer support that they did not have, and 44% said their cancer information needs were insufficiently addressed. Some emphasized that having nurses facilitating care coordination and options for local care made care feel more personalized. Participants identified virtual options for cancer support as potentially beneficial, particularly when meeting in person was not possible. CONCLUSIONS: Lack of peer support, lack of local care, and travel burdens are significant concerns among rural cancer survivors. Participants expressed positive views about their rural residence and mentioned alternatives and rural strengths such as virtual support options, help from nurses, and caring relationships in their communities.
Examining geographic disparities in access to no-cost naloxone in North Carolina: A cross-sectional survey of naloxone distribution programs.
Marley G, Shubel C, Thorpe CT … +4 more , Annis IE, Delamater P, Carpenter D, Ostrach B
J Rural Health · 2025 Jun · PMID 40757604 · Full text
PURPOSE: The objective of this study was to comprehensively identify the programs that distribute naloxone at no-cost in North Carolina, identify where and to whom these programs distribute naloxone, and evaluate dispari...
PURPOSE: The objective of this study was to comprehensively identify the programs that distribute naloxone at no-cost in North Carolina, identify where and to whom these programs distribute naloxone, and evaluate disparities in reported naloxone distribution by geographic area. METHODS: A cross-sectional online survey was delivered to potential no-cost naloxone distributors in NC identified by a community advisory panel. Descriptive statistics and Fisher exact tests were utilized to identify disparities in naloxone access by population served (people who use drugs, people who inject drugs) and location of naloxone distribution (rural; urban/suburban). RESULTS: Approximately 76.5% (241/315) of respondents representing 341 different programs reported that their program(s) distributed no-cost naloxone to community members. Programs represented included health departments (n = 81), treatment programs/centers (n = 59), and syringe service programs(SSPs) (n = 41), among others. Programs reported distributing naloxone most frequently to people who use drugs (94.2%) and people with a substance use disorder history (94.3%). No-cost naloxone distribution was reported less frequently to all patient populations in rural ZIP codes when compared to urban ZIP codes, including justice-involved populations (86.4% vs. 98.3%) and individuals leaving treatment or detox (87.9% vs. 98.6%). CONCLUSION: This study indicates that although most areas in NC were served by at least one no-cost naloxone program, distribution to rural populations may be limited, indicating a need for increased public investment in no-cost naloxone distribution to populations at greatest risk of overdose.
An analysis of syringe service programs across the rural-urban continuum in the United States.
Dockery NA, Huang Q, Balio CP
J Rural Health · 2025 Jun · PMID 40757541 · Publisher ↗
PURPOSE: Syringe service programs (SSPs) have been proven to reduce transmission of viral infections, prevent substance use and overdose deaths, and help support public safety in operational areas. This study aims to pro...
PURPOSE: Syringe service programs (SSPs) have been proven to reduce transmission of viral infections, prevent substance use and overdose deaths, and help support public safety in operational areas. This study aims to provide a snapshot of the current distribution of SSPs across the United States and analyze them based on community characteristics. METHODS: SSP information was collected from state health department websites and the North American Syringe Exchange Network (NASEN) dashboard. Bivariate, multivariate, and geospatial analyses were conducted on the study population to observe significant differences between SSP presence and access between urban and rural populations and to see if community characteristics impact the presence of SSPs. FINDINGS: Findings showed that a greater proportion of urban counties had at least one SSP compared to rural counties (N = 353, 30% vs. N = 236, 12% respectively, p < 0.001). The logistic regression model showed that urban counties had 66% greater odds of having an SSP than their rural counterparts. Geospatial hot-spot analysis showed significant hot spots in the West and Northeast United States, and cold spots throughout the Midwest. CONCLUSIONS: This research provides the most current and comprehensive look at the current count of SSPs in the United States and highlights an increased need in rural areas for SSP presence and access. This study could be used as a benchmark for policymakers and other decision-makers, especially in rural areas, to properly allocate resources for SSP creation and to ensure that policy does not restrict the creation of SSPs or their ability to function properly.
Rural-urban differences in health care access for postpartum parent and infant dyads.
Handley SC, Interrante JD, Gregory EF … +1 more , Kozhimannil KB
J Rural Health · 2025 Jun · PMID 40754893 · Full text
PURPOSE: To examine differences in perinatal health between rural and urban postpartum parents and infants and within postpartum parent-infant dyads. METHODS: Cross-sectional analysis of the National Health Interview Sur...
PURPOSE: To examine differences in perinatal health between rural and urban postpartum parents and infants and within postpartum parent-infant dyads. METHODS: Cross-sectional analysis of the National Health Interview Survey (NHIS) data. Accounting for the complex survey design, we calculated weighted proportions of measures of self-rated health, health care utilization, and barriers to care and used chi-squared tests to assess rural-urban differences between postpartum parents and between infants, and repeated measures to test postpartum parent-infant differences within households in rural and urban counties. FINDINGS: The study included 2019 rural postpartum parents, 2191 rural infants, 12,112 urban postpartum parents and 13,088 urban infants. Compared to urban postpartum parents, those living in rural areas were less likely to see an obstetrician-gynecologist (p = 0.002) had more emergency department (ED) visits (p = 0.030), reported more hospitalizations (p = 0.041), more frequently experienced uninsurance (p = 0.006), and lost Medicaid coverage after pregnancy (p = 0.006). While a higher proportion of urban infants were hospitalized than their rural counterparts (p = 0.019), other measures were similar. Accounting for dyad correlations, compared to infants, postpartum parents generally reported worse health (fair or poor self-rated health), and were more likely to experience ED visits, hospitalizations, loss of health care coverage, and barriers to care. CONCLUSIONS: Rural postpartum parents experience worse health than their urban counterparts and compared to their infants. Rural-urban differences in access were less common among infants, thus leveraging infant care systems for services to both the infant and postpartum parent may improve household health in all communities.
Route and efficiency analysis of cancer health care (REACH): Investigating sociodemographic and rurality of metastatic breast cancer patients at an NCI-designated facility.
Golden A, Humble S, Roy R … +3 more , Anbari AB, Peterson LL, Housten AJ
J Rural Health · 2025 Jun · PMID 40754887 · Full text
PURPOSE: Breast cancer is one of the most common malignancies affecting women worldwide. Metastatic breast cancer (MBC) patients experience unique challenges regarding access to care, particularly rural populations. Geog...
PURPOSE: Breast cancer is one of the most common malignancies affecting women worldwide. Metastatic breast cancer (MBC) patients experience unique challenges regarding access to care, particularly rural populations. Geographic location may increase travel, impacting time to treatment and adding to patient burden. This study aimed to evaluate the association between rurality and access to care by examining travel distance, time to treatment, and sociodemographic factors in patients with MBC. METHODS: We conducted a retrospective cohort study using data from Siteman Cancer Center (SCC) Oncology Data Services registry from 2011-2021 with 519 female MBC patients. Rurality was defined by state definition. We used Geographic Information Systems (GIS) software to calculate travel distances and times from patients' homes to treatment site. We evaluated travel distance (miles) and time to treatment initiation (days) using t-tests and ANOVA and evaluated any differences based on sociodemographic characteristics. FINDINGS: We found that rural patients traveled farther for treatment compared to urban patients (mean 87.3 miles vs. 18.0 miles; p < 0.001). There was no statistically significant difference found with time to treatment initiation between groups (mean 36.1 vs. 35.0 days; p = 0.68). No difference in travel time or treatment initiation was found when comparing sociodemographic factors, including insurance status and comorbidity scores. CONCLUSIONS: Rural MBC patients face longer travel times, which may contribute to barriers to care. However, we found no difference for time to treatment initiation. Future studies characterizing rural patients' experiences can contribute to the development of targeted interventions to mitigate rural patient burden and improve access to cancer care.
Evaluation of the Ask Suicide-Screening Questions (ASQ) tool, Item 9 of the Patient Health Questionnaire (PHQ), pain, and opioid screening to detect suicide risk among rural adult primary care patients.
Christensen M, Culp S, Campo JV … +2 more , Bridge JA, Horowitz L
J Rural Health · 2025 Jun · PMID 40746258 · Publisher ↗
PURPOSE: This study evaluated psychometric properties of the Ask Suicide-Screening Questions (ASQ) and Item Nine of the Patient Health Questionnaire (PHQ Item 9) to detect suicide risk in rural adult primary care and whe...
PURPOSE: This study evaluated psychometric properties of the Ask Suicide-Screening Questions (ASQ) and Item Nine of the Patient Health Questionnaire (PHQ Item 9) to detect suicide risk in rural adult primary care and whether pain and opioid screening contributed to suicide risk detection. METHODS: A sample of adult rural primary care patients (N = 214) completed suicide risk, pain, and opioid screening measures electronically; 48% of participants also completed a follow-up survey. Using the Adult Suicidal Ideation Questionnaire (ASIQ) as the criterion measure, psychometric properties for the ASQ and the PHQ Item 9 were compared using McNemar's test for proportions. Bivariate and multivariable regression analyses explored associations between suicide risk, pain, opioid measures, and ASIQ results. FINDINGS: Approximately 4% (N = 8) of participants screened positive for suicide risk on the ASIQ relative to 11.7% (N = 25) on the ASQ and 3.7% (N = 8) on the PHQ Item 9. The ASQ had higher sensitivity (75.0%) than the PHQ Item 9 (50.0%); the difference was not statistically significant but may have clinical relevance. The PHQ Item 9 had significantly higher specificity (98.1%) than the full ASQ (91.0%, p < 0.001). The ASQ, PHQ Item 9, depression scores, and LGBTQ+ status were significant predictors of ASIQ scores. Pain and opioid misuse were not. CONCLUSIONS: Findings from this small sample provide preliminary support for the ASQ and PHQ Item 9 as suicide risk screens in rural adult primary care, but psychometric studies in larger samples are needed.
Urban-rural differences in the age of US physicians.
Crowley RJ, Lally JS, Kline DM … +1 more , Bunting AM
J Rural Health · 2025 Jun · PMID 40734197 · Full text
PURPOSE: To assess county-level and specialty-level age differences between urban and rural physicians. METHODS: We linked the 2008-2021 Medicare Data on Provider Practice and Specialty (MD-PPAS) dataset with the 2024 Do...
PURPOSE: To assess county-level and specialty-level age differences between urban and rural physicians. METHODS: We linked the 2008-2021 Medicare Data on Provider Practice and Specialty (MD-PPAS) dataset with the 2024 Doctors and Clinicians national downloadable file. We assessed specialty-level differences in the age of rural versus urban physicians using Rural-Urban Continuum Codes (RUCC) with four groups: urban (RUCC 1-3), large rural (RUCC 4-5), small rural (RUCC 6-7), and isolated rural (RUCC 8-9). We analyzed the relationship between rurality and physician age using choropleth graphs, spatial clustering, and univariable regression. FINDINGS: Our final cohort comprised 571,886 physicians. The mean ages of physicians were higher in rural counties (large rural: 53.1 years; small rural: 53.3 years; isolated rural: 53.5 years) than urban counties (52.5 years; p value <0.001). Some specialties including medical oncology, palliative care, and thoracic surgery showed particularly large age differences with older physicians in more rural areas. There were clusters of older physicians in the South and clusters of younger physicians in the Mountain West and Midwest. Rurality was strongly associated with clusters of older physicians (odds ratio [OR]: 3.8; 95% confidence interval [CI], 2.6-5.5), and the percentage of households with broadband internet subscription was strongly associated with clusters of younger physicians (OR: 2.6; 95% CI, 2.2-3.0). CONCLUSIONS: Rural physicians were older than urban physicians with certain specialties and regions demonstrating large age disparities. The aging of rural physicians could worsen existing urban-rural health care disparities. Initiatives focusing on recruiting and retaining rural physicians should target specific regions and specialties to ameliorate these inequities.
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