The Journal Of Rural Health[JOURNAL]
Sun
200 papers
Development of chronic pain and high-impact chronic pain across the US rural-urban continuum, 2019-2020.
Sun F, Yang Y, Nahin RL
J Rural Health · 2025 Mar · PMID 40405377 · Full text
PURPOSE: Rural health disadvantages are well documented in previous literature; however, research on rural-urban disparities in chronic pain outcomes is scarce. This paper fills this gap by examining pain prevalences and...
PURPOSE: Rural health disadvantages are well documented in previous literature; however, research on rural-urban disparities in chronic pain outcomes is scarce. This paper fills this gap by examining pain prevalences and longitudinal transitions across the rural-urban continuum (i.e., large central metro, large fringe metro, medium and small metro, and nonmetropolitan). METHODS: Based on the 2019-2020 National Health Interview Survey Longitudinal Cohort (NHIS-LC) data, we examined the disparities in pain prevalences and transitions among different pain statuses, including no pain, nonchronic pain, chronic pain, and high-impact chronic pain (HICP), across the rural-urban continuum and by age, sex, race/ethnicity, and region. A test for linear trend was conducted to examine the significance of linear changes across the rural-urban continuum. FINDINGS: The findings reveal significant linear increases in the prevalence of chronic pain and HICP, as well as transitions from no pain to nonchronic pain and from nonchronic pain to more severe pain conditions, along the continuum from metropolitan to nonmetropolitan areas. Subgroup analyses indicate that rural-urban gaps are most pronounced among middle-aged (45-64) groups and non-Hispanic Whites. CONCLUSIONS: This longitudinal analysis provides new evidence on rural-urban health disparities by focusing on pain, highlighting the urgent need to enhance health care services in remote and rural areas for effective pain prevention and management.
Care packages to promote universal suicide prevention for remote Alaska Native communities: What worked?
Kennedy J, Wexler L, Schmidt T … +6 more , Rataj S, Garnie J, Moto R, Tao Z, White L, McEachern D
J Rural Health · 2025 Mar · PMID 40375393 · Full text
PURPOSE: Alaska Native (AN) youth living in remote Alaska suffer disproportionately from suicide when compared to all other American youth. Promoting Community Conversations About Research to End Suicide (PC CARES) is an...
PURPOSE: Alaska Native (AN) youth living in remote Alaska suffer disproportionately from suicide when compared to all other American youth. Promoting Community Conversations About Research to End Suicide (PC CARES) is an intervention led by trained community facilitators, which shares scientific best practices to prevent youth suicide with community adults to spark feasible, culturally tailored personal and collective action. After training 34 AN facilitators to implement PC CARES in their home communities in late 2019, COVID-19 precluded in-person PC CARES activities, but the need to help adults support youth mental health during this period of quarantine and social distancing remained. METHOD: The resulting adapted "PC CARES at Home" intervention delivered mail-based mental wellness and suicide prevention information and resources to adult community members from June 2020 to July 2022. The project sent 1527 care packages to 492 participants. FINDING: According to short surveys (n = 199) and interviews done with randomly selected recipients (n = 24), adults who received the PC CARES care packages were very satisfied with the contents and found them useful. CONCLUSION: Both acceptance and utility of mental health and safety promotion care packages has implications for offering information and resources to adults in remote communities to support them in promoting youth mental wellness.
Identifying risk factors for adverse lung health outcomes among rural Appalachian women.
Thompson JR, Walker CJ, Flunker JC … +4 more , Christian WJ, Sanderson WT, Schoenberg NE, Browning SR
J Rural Health · 2025 Mar · PMID 40361270 · Full text
PURPOSE: Despite high rates of lung disease and lung cancer among women, few studies have focused on adverse lung health risk factors among rural Appalachian women. We aim to describe the prevalence of demographic, behav...
PURPOSE: Despite high rates of lung disease and lung cancer among women, few studies have focused on adverse lung health risk factors among rural Appalachian women. We aim to describe the prevalence of demographic, behavioral, and economic characteristics among a cohort of rural Appalachian women and ascertain the association between these risk factors and lung function. METHODS: Through a cross-sectional study in two rural Appalachian Kentucky counties (2015-2017), we collected demographics, health history/behaviors, and lung function via pulmonary function tests. Restricting to female participants with interpretable pulmonary function tests (N = 456), we estimated prevalence ratios of the association between individual-level characteristics and lung function using log binomial regression. FINDINGS: Reduced lung function was high among this sample, including 20.8% with restrictive function and 18.4% with obstructive function. After adjustment, those age 65+ had 7× the prevalence of obstructive function compared to those <45 years, and current smokers had 6× the prevalence of never-smokers. Conversely, those age 45-64 had over 5× the prevalence of restrictive function compared to those <45 years, and participants with an obese-classified BMI or 2+ co-morbidities had nearly 4× the prevalence of restrictive function compared to those with normal BMI or without a comorbid condition, respectively. CONCLUSIONS: This study highlights the high levels of reduced lung function among rural Appalachian women, including varying risk factors between those with restrictive and obstructive function. The high prevalence of restrictive function among middle-aged women with high BMI, poor cardiovascular health, and multiple comorbidities suggests the need for culturally tailored health behavior interventions.
Continuity of pain clinic care among rural and urban veterans.
Hadlandsmyth K, Courtney RE, Adamowicz JL … +3 more , Driscoll MA, Murphy JL, Lund BC
J Rural Health · 2025 Mar · PMID 40346745 · Full text
PURPOSE: In the context of increased access to multidisciplinary pain team care in the veterans health administration (VHA) in recent years, the current study sought to determine whether continuity of pain clinic care va...
PURPOSE: In the context of increased access to multidisciplinary pain team care in the veterans health administration (VHA) in recent years, the current study sought to determine whether continuity of pain clinic care varied for rural compared to urban veterans, following an initial pain clinic visit. Specifically, the frequency of general pain clinic visits and pain clinic psychology visits were contrasted between rural and urban veterans in 2015 and 2022. METHODS: National VHA administrative data were used to build two cohorts of veterans with an initial pain clinic visit in 2015 or 2022. Number of pain clinic visits and number of pain clinic psychology visits in the following year were calculated. Multivariable regression models examined rural/urban differences in receipt of follow-up pain clinic visits and receipt of follow-up pain psychology visits in both 2015 and 2022, after adjusting for demographic characteristics and psychiatric comorbidity. FINDINGS: Veterans with an initial pain clinic visit increased by 22.5% from 2015 (n = 95,549) to 2022 (n = 117,044) and included about one-third rural veterans in both years. Rural veterans had lower rates of follow-up pain clinic visits in 2015 (adjusted odds ratio [aOR]: 0.85; 95% confidence interval [CI]: 0.82-0.87) and this gap remained, but narrowed, by 2022 (aOR: 0.92; 95% CI: 0.90-0.95). The gap in pain psychology follow-up visits, however, disappeared between 2015 (adjusted incidence rate ratio [aIRR]: 0.88; 95% CI: 0.81-0.95) and 2022 (aIRR: 1.00; 95% CI: 0.93-1.08). CONCLUSIONS: The rural gap in continuity of specialty pain clinic services for veterans has improved across time, particularly in relation to pain clinic psychology visits.
Risks of adverse health outcomes among older rural prostate cancer survivors in the SEER-Medicare data.
Chang Esther CP, Huang D, Lloyd S … +3 more , Henry NL, O'Neil B, Hashibe M
J Rural Health · 2025 Mar · PMID 40344273 · Full text
BACKGROUND: Rural prostate cancer patients face challenges such as greater distance for cancer treatment and care fragmentation. There have been very few studies investigating adverse health outcomes among prostate cance...
BACKGROUND: Rural prostate cancer patients face challenges such as greater distance for cancer treatment and care fragmentation. There have been very few studies investigating adverse health outcomes among prostate cancer survivors residing in rural areas. A comprehensive evaluation of adverse health outcomes among rural prostate cancer patients is needed to understand potential health disparities and provide scientific evidence for interventions. The aims of this study were to investigate prevalent and incident adverse health outcomes among older rural prostate cancer survivors compared to urban prostate cancer survivors in the United States. METHODS: The SEER-Medicare linked database was used to identify first primary prostate cancer survivors. Fine-Gray subdistribution hazard models were utilized to estimate hazard ratios (HR) and 95% confidence intervals (CI), comparing rural prostate cancer patients to urban prostate cancer patients. RESULTS: A total of 37,126 rural prostate cancer survivors and 109,176 urban prostate cancer survivors were identified. We observed that rural prostate cancer survivors had a higher prevalence of rheumatoid arthritis/osteoarthritis (22.1% vs 20.9%; P-value <.001) and chronic obstructive pulmonary disease (COPD)/bronchiectasis (14.2% vs 10.5%; P-value <.001). A higher incident risk of acute myocardial infarction, COPD/bronchiectasis, hip pelvic fracture, and rheumatoid arthritis/osteoarthritis among rural prostate cancer was observed compared to their urban counterparts >5 years after cancer diagnosis. CONCLUSIONS: This study provides important results on the prevalence and incident adverse health outcomes among older rural prostate cancer survivors. Further investigation into how other factors influence these disparities is warranted.
The relationship between low social/emotional support and health care affordability among rural and urban residents.
Jacobson I, Rydberg K, Swendener A … +2 more , MacDougall H, Henning-Smith C
J Rural Health · 2025 Mar · PMID 40339142 · Full text
PURPOSE: Social/emotional support can help to buffer the health and financial impacts of health care costs. However, little research examines differences in social/emotional support as it relates to health care affordabi...
PURPOSE: Social/emotional support can help to buffer the health and financial impacts of health care costs. However, little research examines differences in social/emotional support as it relates to health care affordability, and even less examines these issues by rurality despite rural/urban differences in health and health care access. This study addresses these gaps by examining differences in social/emotional support and health care affordability issues among rural and urban adults. METHODS: Using weighted data from the 2020 and 2021 National Health Interview Survey (n = 44,987), we examined differences in three health care affordability issues: worry about medical bills, problems paying medical bills, and inability to pay medical bills. We conducted bivariate and multivariate logistic regression analyses comparing these issues by rurality, social/emotional support, and other sociodemographic and health characteristics, generating adjusted odds ratios and predicted probabilities of these issues. FINDINGS: Rural residents were more likely to report problems paying and inability to pay medical bills (13.0% vs. 10.2%, p < 0.001; 8.2% vs 6.2%, p < 0.001). Sociodemographic and health covariates were differentially associated with adjusted odds of health care affordability issues, while low social/emotional support was associated with higher adjusted odds and adjusted predicted probabilities of all three health care affordability issues in both rural and urban areas. CONCLUSIONS: Low social/emotional support is associated with higher odds and predicted probabilities of all health care affordability issues regardless of rurality. Future policy aimed at reducing medical debt in rural areas should consider the beneficial impacts of social/emotional support.
Addressing the growing rural-urban divide in opioid prescribing for veterans.
Mitragotri S, Shah K
J Rural Health · 2025 Mar · PMID 40322872 · Publisher ↗
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Rural hospital closures and nursing home outcomes.
Keesee E, Malone T, Gurzenda S … +1 more , Pink G
J Rural Health · 2025 Mar · PMID 40285424 · Full text
PURPOSE: Rural hospital closures since 2005 reached 194 this year, raising concerns for rural health care access. Little is known about the effects of facility closures on the local long-term care sector. This analysis m...
PURPOSE: Rural hospital closures since 2005 reached 194 this year, raising concerns for rural health care access. Little is known about the effects of facility closures on the local long-term care sector. This analysis models the relationship between rural hospital closure and nursing homes in the same county. We explore nursing home-level outcomes related to utilization and resident health. METHODS: Centers for Medicare & Medicaid Services Healthcare Cost Report Information System, LTCFocus, and NC Rural Health Research Program hospital closure datasets are used to conduct a difference-in-differences study of closures from 2012 to 2019. FINDINGS: We do not find evidence that hospital closure impacted non-hospital-based nursing home occupancy rate, proportion of Medicare paying residents, or average resident ADL score. However, hospitalizations per resident year declined by 0.13 following closure (95% CI: -0.24, -0.02), representing a change of 0.33 standard deviations from the grand mean. It is unclear if reduced nursing home hospitalizations reflect a reduction in emergent, urgent, or elective admissions. CONCLUSIONS: Our results build on the existing body of hospital closure literature by highlighting the understudied role of hospitals in rural postacute and long-term care. To our knowledge, this was the first study examining the impacts of hospital closure on nursing homes. These findings are particularly relevant in the wake of COVID-19 as rural long-term care facilities and hospitals alike navigate exacerbated workforce and funding challenges.
Retaining CRNAs who provide obstetrics services in rural communities: Results from a national survey.
Anderson BL, Sawyer J, Palmer A … +2 more , Andrilla CHA, Beeson A
J Rural Health · 2025 Mar · PMID 40285418 · Publisher ↗
PURPOSE: Examine retention factors and challenges among CRNAs who provide obstetric services and assess whether these factors differ between rural or urban areas. METHODS: Cross-sectional analysis of weighted data from a...
PURPOSE: Examine retention factors and challenges among CRNAs who provide obstetric services and assess whether these factors differ between rural or urban areas. METHODS: Cross-sectional analysis of weighted data from a survey of CRNAs that are members of the American Association of Nurse Anesthesiology and provide obstetric anesthesia services. CRNAs selected reasons why they chose to work in their geographic area, factors that make them want to stay in their job, and challenges that make them want to leave their job. FINDINGS: Among all respondents (1213), 39% reported practicing in rural areas. Overall, 64% of respondents reported practicing in staffing models without medical direction, with 88% of those in rural areas working without medical direction. The following factors were "very important" for choosing to provide obstetric anesthesia services in a rural area: scope of practice (74%), job autonomy (72%), respect (64%), and work-life balance (62%). Controlling for staffing model, gender, and age, CRNAs practicing in rural areas were more likely to select "concern about care availability" as a reason factor and "the need to be on call" as a retention challenge. CONCLUSIONS: Findings indicate that CRNAs choose to work in rural areas because of concern for care availability and the sense of autonomy, scope of practice, and control they experience in these areas, among other factors.
Patient perceptions of rural telehealth diabetes control program in Department of Veteran's Affairs.
Leonard C, Kenney RR, Syed A … +7 more , Hess E, Wilson C, Smith A, Schihl C, Lai J, Reaven P, Behari G
J Rural Health · 2025 Mar · PMID 40285416 · Publisher ↗
PURPOSE: The prevalence of diabetes mellitus in the Department of Veteran's Affairs (VA) is higher than in the general public, with nearly 25% of Veterans enrolled in VA care diagnosed with diabetes. VA cares for over 2....
PURPOSE: The prevalence of diabetes mellitus in the Department of Veteran's Affairs (VA) is higher than in the general public, with nearly 25% of Veterans enrolled in VA care diagnosed with diabetes. VA cares for over 2.7 million Veterans in rural areas who may face barriers to accessing specialty care for diabetes management. The goal of this study was to understand Veteran patient experiences with a novel telehealth diabetes program designed to improve diabetes care for Veterans in rural areas. METHODS: We conducted a qualitative evaluation of Veteran's experiences as part of a larger mixed methods evaluation of the VA Telediabetes program. We conducted semistructured interviews with rural Veterans enrolled in the program to understand their experiences and perceptions. We conducted an inductive-deductive content analysis to identify salient themes related to diabetes control, perceptions of telehealth for diabetes care, and previous experiences with diabetes management. Methods are described according to the SRQR checklist for qualitative research. FINDINGS: We conducted interviews with 26 rural Veterans enrolled in the Telediabetes program between April 2022 and March 2023 and identified three themes related to their experience in the program: (1) Telediabetes care is more frequent and comprehensive than previous diabetes care; (2) Telediabetes care is convenient and thorough, but there are some barriers; and (3) Patients describe that their diabetes control as better in Telediabetes program compared to diabetes management in primary care. CONCLUSIONS: Veterans perceived that Telediabetes had a positive impact on their diabetes control and described the quality of care as excellent. Programs like Telediabetes bring together a group of interdisciplinary specialists to provide care for rural patients have the potential to alleviate barriers to specialty care in rural areas.
Health care, social support, and pregnancy-related anxiety in urban and rural and remote Australian women.
Boyd-Bais RL, Papps FA, Sipes J
J Rural Health · 2025 Mar · PMID 40285413 · Publisher ↗
INTRODUCTION: Anxiety is the most prevalent mental health condition in the perinatal period and may be experienced more by rural and remote pregnant women, who, compared with urban counterparts, have fewer available and...
INTRODUCTION: Anxiety is the most prevalent mental health condition in the perinatal period and may be experienced more by rural and remote pregnant women, who, compared with urban counterparts, have fewer available and less access to maternity health care services. Research has yet to examine the relationship between pregnancy-related anxiety and access to and availability of health care services and social support for pregnant women, how relationships are affected by telehealth usefulness, satisfaction, and online social support, and whether relationships are different for rural and remote women compared with those in urban areas. METHOD: We used a quantitative cross-sectional design and online survey to collect data from 174 pregnant women living in urban and rural and remote regions of Australia. Data were collected from January to May 2023. RESULTS: Compared with urban pregnant women, rural and remote pregnant women reported greater pregnancy-related anxiety, lower accessibility and availability of health services, and lower levels of social and online social support. Controlling for all variables, lower reported social support (b = -0.34, 95% BCaCI [-0.56, -0.14]) and online social support (b = -0.17, 95% BCaCI [-0.30, -0.04]) were significantly associated with higher pregnancy-related anxiety for rural and remote pregnant women, but only no previously reported pregnancies was associated with higher pregnancy-related anxiety for urban women (b = -5.04, 95% BCaCI [-7.88, -2.02]). CONCLUSION: Future research could further investigate individual, social-cultural, and location-specific factors to determine the specific needs of women during pregnancy with the view to shaping targeted pregnancy-related interventions.
Living with chronic myelogenous leukemia in rural communities: Exploring factors related to tyrosine kinase inhibitors adherence with a mixed methods approach.
Sheng J, Heiney SP, Wickersham KE … +3 more , Nguyen LA, Harrison KW, Adams SA
J Rural Health · 2025 Mar · PMID 40285411 · Full text
PURPOSE: Tyrosine kinase inhibitors (TKIs) improve chronic myeloid leukemia (CML) outcomes dramatically. However, limited research exists on patient-specific, medical, and psychosocial factors influencing TKI adherence....
PURPOSE: Tyrosine kinase inhibitors (TKIs) improve chronic myeloid leukemia (CML) outcomes dramatically. However, limited research exists on patient-specific, medical, and psychosocial factors influencing TKI adherence. The purpose of the study was to better understand TKI adherence among rural CML patients, using a convergent parallel mixed-method design guided by the Information Motivation and Behavioral Skills Model. METHODS: Survivors with CML participated in semistructured interviews and completed self-reported questionnaires, including demographics, perceived stress, side effects, emotional support, and self-efficacy for managing chronic conditions. Qualitative and quantitative data were collected concurrently, analyzed separately, and then integrated. RESULTS: Sixteen participants aged 26 to 76 years completed the study. The duration of TKI therapy ranged from 0 to 12 years (mean ± standard deviation, 5.56 ± 4.08). While all reported adherence to TKI therapy, 31% held misconceptions about treatment duration, and 38% misunderstood reasons for blood tests prior to treatment or TKI refilled. Qualitative data yielded five major themes with descriptions of the shock of diagnosis, educational experiences regarding CML and its treatment, challenges in managing side effects and refills, the importance of social support, and strategies for maintaining remission and motivating adherence to TKI. CONCLUSIONS: This study describes the knowledge, motivations, challenges, and skills related to TKI adherence among rural patients with CML. A patient-centered approach is recommended for health care providers to improve adherence and enhance outcomes for CML patients on TKI therapy.
Critical access hospitals: Lessons from the Frontier Community Health Integration Project.
Romaire MA, Banger A, Rutledge R … +1 more , Haque S
J Rural Health · 2025 Mar · PMID 40260848 · Publisher ↗
PURPOSE: In 2016, the Centers for Medicare & Medicaid Services implemented the Frontier Community Health Integration Project (FCHIP) to test the impact of a Medicare payment change for telehealth and ambulance services a...
PURPOSE: In 2016, the Centers for Medicare & Medicaid Services implemented the Frontier Community Health Integration Project (FCHIP) to test the impact of a Medicare payment change for telehealth and ambulance services and a policy change for skilled nursing facility (SNF) beds for critical access hospitals (CAHs) treating Medicare fee-for-service patients in frontier regions. We evaluated the impact of FCHIP on ambulance, SNF, and telehealth service delivery. METHODS: We conducted a primarily qualitative evaluation, with some descriptive analyses, of 10 CAHs in Montana, Nevada, and North Dakota that participated in FCHIP. Key informant interviews and program documents were thematically analyzed to understand how CAHs implemented their interventions. Analyses of Medicare fee-for-service ambulance, SNF, and telehealth claims from August 2013 through July 2019 described service use over time at participating CAHs. FINDINGS: CAHs used the demonstration to develop their workforce, even when staff turnover was a primary concern, and the demonstration gave CAHs a reason to change care delivery and improve partnerships with other hospitals or specialists treating their patients. Technical assistance supported CAHs in transforming care. CAH staff reported that FCHIP payment and policy changes had little impact on hospital finances. Changes in service use over time varied by FCHIP service. CONCLUSION: Despite notable challenges like staffing shortages, CAHs remain committed to meeting community need by making improvements in care delivery. With low population volume and thus minimal demand for certain services, expectations that volume-based payment policies can financially bolster CAHs may need to be tempered.
Rural-urban disparities in human papillomavirus vaccination: Findings from a cross-sectional survey of 13 southern US states, December 2019-January 2020.
Vasudevan L, Wang Y, Ostermann J … +6 more , Yelverton V, Yang J, Fish LJ, Harrison SE, Williams C, Walter EB
J Rural Health · 2025 Mar · PMID 40200105 · Full text
BACKGROUND: Rural adolescents in the United States lag behind their urban counterparts in the uptake of the human papillomavirus (HPV) vaccine. However, a systematic assessment of factors associated with rural-urban disp...
BACKGROUND: Rural adolescents in the United States lag behind their urban counterparts in the uptake of the human papillomavirus (HPV) vaccine. However, a systematic assessment of factors associated with rural-urban disparities in HPV vaccination coverage to inform potential vaccination promotion interventions is lacking in the literature. Prioritizing HPV vaccination for rural adolescents is necessary for increasing overall HPV vaccination coverage for adolescents and for reducing the incidence of HPV infections and future HPV-related cancers. METHODS: We conducted a cross-sectional survey of caregivers of adolescents aged 9-17 years from 13 states located in the southern United States. Participants were recruited from a nationally representative online survey panel and self-administered the survey from December 2019 to January 2020. The survey assessed HPV vaccination initiation and series completion for rural and urban adolescents, and sought to systematically identify modifiable factors (eg, caregiver knowledge and attitudes about HPV/HPV vaccine, health care access) and nonmodifiable factors (eg, sociodemographic characteristics) that may be associated with rural-urban disparities in adolescent HPV vaccination. Rural versus urban residence status of respondents was determined using the US Census definition and Federal Information Processing System (FIPS) codes. RESULTS: Among 2,262 sampled caregivers, data from 987 respondents (43.6%) were included in the analysis; 193 respondents (19.6%) were from rural areas and 794 (80.4%) were from urban areas. Overall, 333 (33.7%) adolescents had received at least 1 dose of HPV vaccination and 259 (26.3%) adolescents had completed HPV vaccination. In comparison to urban adolescents, fewer rural adolescents had initiated (-7.7 percentage points) or completed (-14.9 percentage points) HPV vaccination. Uptake of tetanus, diphtheria, and acellular pertussis (Tdap), meningococcal (MenACWY), and influenza vaccines was similar between urban and rural adolescents. Caregiver attitudes, but not their knowledge about HPV infection or the HPV vaccine, were associated with disparities in HPV vaccination initiation. Rural caregivers were more likely to report concerns with the HPV vaccine, lower access to a pediatric primary care provider, longer travel times to reach health care providers, and HPV vaccination at age 11 years or older compared with age 9 or 10 years. When compared with urban caregivers, fewer rural caregivers reported discussing HPV vaccination with their adolescent's provider although difference in the receipt of a provider recommendation was not statistically significant between rural and urban adolescents. CONCLUSIONS: Our findings confirm rural-urban disparities in HPV vaccination coverage for adolescents living in the 13 southern US states. Future research efforts to reduce rural-urban disparities in HPV vaccination should evaluate the impacts of interventions that increase positive caregiver attitudes about HPV vaccination, expand access to vaccination services and pediatricians for rural adolescents, enable strong provider recommendations, and increase the window of HPV vaccination by promoting vaccination initiation at younger ages (9-10 years). While this analysis focused on rural-urban disparities, lower rates of HPV vaccination overall suggest that interventions in rural areas be implemented alongside broader efforts to promote adolescent HPV vaccination coverage in the southern United States.
Mapping maternity care deserts: Driving distance and health outcomes in North Carolina.
Sugg M, Shakya S, Ulrich S … +2 more , Tyson JS, Runkle J
J Rural Health · 2025 Mar · PMID 40197746 · Full text
OBJECTIVE: This study evaluated the association between maternal care deserts (MCDs)-defined by accessibility measures such as travel time and distance to obstetric and gynecological care-and maternal and infant health o...
OBJECTIVE: This study evaluated the association between maternal care deserts (MCDs)-defined by accessibility measures such as travel time and distance to obstetric and gynecological care-and maternal and infant health outcomes in North Carolina from 2016 to 2021. METHODS: This was a retrospective secondary data analysis examining residents of North Carolina from 2016 to 2021, using travel metrics from residential zip codes to the nearest clinical providers. Maternal and infant health outcomes were assessed using data from the National Plan and Provider Enumeration System (NPPES) from the Centers for Medicare & Medicaid Services (CMS) and inpatient hospitalization records for North Carolina. Outcomes of interest included cesarean delivery rates, severe maternal morbidity (SMM20 and SMM21), and hypertension, which were examined across rural-urban disparities based on RUCA codes. Statistical analyses were conducted to link travel metrics with health outcomes, adjusting for age, race, and insurance status to control for potential confounding factors. RESULTS: The study found that rural and low-income areas in North Carolina had fewer health care providers. Increased travel times and distances to clinical care were associated with higher cesarean delivery rates, increased severe maternal morbidity, preterm birth, and higher rates of gestational diabetes. These associations remained significant even after adjusting for age, race, and insurance status. CONCLUSION: Women living in maternal care deserts in North Carolina, often in rural locations, are more likely to experience adverse health outcomes, including severe maternal morbidity and hypertension, likely due to limited access to essential obstetric and gynecological care. These findings highlight the negative impact of health care inaccessibility on maternal and infant health in underserved regions.
Examination of rural-urban disparities in utilization of preventive dental procedures in the US pediatric population: A cross-sectional study.
Ghaffari A, Graves KY, Bradbury RF … +1 more , Harman JS
J Rural Health · 2025 Mar · PMID 40172205 · Publisher ↗
PURPOSE: To determine the extent to which there were disparities in access to recommended preventive oral services between US-based children living in rural versus urban areas. METHODS: The study used cross-sectional, pa...
PURPOSE: To determine the extent to which there were disparities in access to recommended preventive oral services between US-based children living in rural versus urban areas. METHODS: The study used cross-sectional, parent-reported National Survey of Children's Health data from 2022, which is the most current year of publicly available data when analyses were performed. Inclusion criteria included all children from the ages of 2 through 17. The US Census Bureau definition of rural was used to guide the analyses. Survey procedures within Stata were used to build the multiple regression models. To test the association between the main predictor variable (i.e., rural-urban designation) and outcome variable (i.e., percentage of those receiving five recommended preventive dental services), five sets of multiple logistic regressions were used, which controlled for the effects of all the other covariates. The STROBE checklist for cross-sectional studies was used for reporting purposes in this manuscript. FINDINGS: Controlling for the effects of covariates, there was no association of living in an urban area (as opposed to a rural area) and children receiving any of the five recommended services, including comprehensive oral examination, prophylaxis, sealants, radiographs, and fluoride treatments (p > 0.01). CONCLUSIONS: Our study demonstrated the lack of disparities in utilization of preventive dental procedures among US-based children, which may be attributable to factors such as innovative service delivery models integrating telehealth and community-based management in rural communities, COVID-19, and public insurance expansion. Future studies should be conducted to track whether the trend of eroding disparities remains consistent.
Rural-urban differences in substance use during pregnancy.
Boswell EK, Hinds OM, Odahowski C … +3 more , Crouch E, Hung P, Andrews CM
J Rural Health · 2025 Mar · PMID 40128129 · Full text
PURPOSE: Drug overdoses are now a leading cause of pregnancy-related deaths in the United States. Despite evidence of rural-urban disparities in substance use, there has not yet been a nationally representative examinati...
PURPOSE: Drug overdoses are now a leading cause of pregnancy-related deaths in the United States. Despite evidence of rural-urban disparities in substance use, there has not yet been a nationally representative examination of rural-urban differences in perinatal substance use. This study provides a comprehensive examination of rural-urban disparities in perinatal substance use. METHODS: This study uses cross-sectional data to examine 3499 pregnant women from the 2015-2019 National Survey on Drug Use and Health (NSDUH). Rural (nonmetro)-urban (metro) differences in past-month tobacco use, alcohol use, binge drinking, illicit drug use, and marijuana use were examined using Rao-Scott chi-square tests and multivariable logistic regression using complex survey weights. FINDINGS: In 2015-2019, past-month tobacco use varied geographically, as rural pregnant participants were more likely to have used tobacco than those in small and large urban areas (24.7% vs. 15.2% and 8.2%, respectively, p < 0.0001). After controlling for sociodemographic and health care needs, rural pregnant women were more likely to report tobacco use (adjusted odds ratio [aOR]: 2.32, 95% confidence interval [CI]: 1.66, 3.25) but were less likely to report alcohol use (aOR: 0.58, 95% CI: 0.34, 0.98) than their large urban counterparts. There were no rural-urban differences in the odds of binge drinking, illicit drug use, or marijuana-only use in the past month. CONCLUSIONS: Geographic variations in perinatal substance use highlight the need for tailored interventions targeting substance use prevention during pregnancy, prioritizing tobacco in rural areas and alcohol in urban areas.
Measuring disparities to emergency medicine with 200 million voter records: The case of rural hospital closures.
Shepherd ME, Cox C, Epp DA
J Rural Health · 2025 Jan · PMID 40103238 · Full text
PURPOSE: Distance to health service providers is related to increased mortality risk and decreased service utilization. However, existing studies of distance to services often rely either on aggregated measures of distan...
PURPOSE: Distance to health service providers is related to increased mortality risk and decreased service utilization. However, existing studies of distance to services often rely either on aggregated measures of distance or small samples of survey respondents. Nationwide individual data from 200 million Americans are used to assess various demographic groups' distances to open acute hospitals. METHODS: We gathered the exact location of every open acute hospital from the UNC Cecil G. Sheps Center and the Department of Health and Human Services. We merged this information with data on 200 million voters from the L2 voter file for 2020. We calculate each registered voters' distance to the nearest open hospital in kilometers by demographic, region, and state Medicaid expansion status. RESULTS: The average American adult is 5 miles from the nearest hospital. Native Americans and rural White Americans face the longest distances to medical services. Lower-income adults face longer distances than higher-income adults. Those over 65 are roughly 10% farther away in comparison to those 18-40. Registered Republicans are 30% farther than registered Democrats. Recent hospital closures in states that have yet to expand Medicaid have contributed to all of these disparities. CONCLUSIONS: Lower-income and older Americans, groups that tend to have worse health overall, face the longest travel distances to hospitals-perhaps contributing to income and age-based health disparities. Native Americans and rural whites, who themselves experience considerable health hardship, also have significant travel burdens to receive hospital care. Registered Republicans have longer travels to emergency care than Democrats, adding to recent research on partisan health disparities.
Statewide implementation for medications for opioid use disorder (MOUD) in urban and rural emergency departments.
Greenwood-Ericksen M, Blasi M, Warrick BJ … +7 more , Cotton J, Ketcham E, Ketcham C, Wait S, Abeyta R, Ziedonis D, Salvador JG
J Rural Health · 2025 Jan · PMID 40103210 · Publisher ↗
BACKGROUND: Medications for opioid use disorder (MOUD) programs in Emergency Departments (EDs) are feasible and effective, but uptake lags despite rising overdose deaths. NM Bridge partners with hospitals across highly r...
BACKGROUND: Medications for opioid use disorder (MOUD) programs in Emergency Departments (EDs) are feasible and effective, but uptake lags despite rising overdose deaths. NM Bridge partners with hospitals across highly rural New Mexico to guide implementation for ED-based MOUD using a Dissemination & Implementation (D&I) approach. This manuscript describes NM Bridge's outcomes in its first three years (2020-2023). METHODS: NM Bridge offers partner hospitals a D&I intervention called implementation facilitation (IF) to guide their implementation of ED-based MOUD. The IF intervention has three mechanisms: (1) trainings, (2) a guiding blueprint (implementation plan), and (3) biweekly meetings. Each hospital receives tailored trainings, builds a team of champions who lead the work in the blueprint and are supported in biweekly meetings by the NM Bridge team. Successful implementation is defined as hospitals completing trainings, prescribing buprenorphine from the ED, and providing a warm hand-off to outpatient treatment. Primary outcomes include buprenorphine prescriptions written, clinicians trained, and peer support workers (PSW) hired. RESULTS: From 10/2020 to 12/2023, NM Bridge recruited 34 hospitals, engaged 12, with six fully participating. In engaged hospitals (8 rural, 4 urban), 100% recognized MOUD as a vital practice, but all reported barriers of locums staffing, <25% x-waivered clinicians, and stigma. The six participating hospitals (4 rural, 2 urban) achieved 100% of IF mechanisms, variable blueprint (implementation plan) achievement, and 100% successfully implemented MOUD. This resulted in a 52.3% increase in buprenorphine prescriptions [728 patients (592 rural, 136 urban)], 144 clinicians trained, and 50% of EDs hiring a PSW. CONCLUSIONS: Implementation facilitation of ED-based MOUD programs was successful across six diverse hospitals, in a highly rural state.
Rural-urban movement and stability in relation to minority stress-related factors, tobacco norms, and tobacco use among a sample of US sexual minority-identifying young adults.
Romm KF, Vogel EA, Cavazos-Rehg PA … +1 more , Berg CJ
J Rural Health · 2025 Jan · PMID 40102197 · Full text
PURPOSE: Sexual minority young adults (SMYAs) residing in rural (vs. urban) areas report higher tobacco use rates. Less work has assessed associations of rural-urban residential movement/stability with SMYAs' tobacco use...
PURPOSE: Sexual minority young adults (SMYAs) residing in rural (vs. urban) areas report higher tobacco use rates. Less work has assessed associations of rural-urban residential movement/stability with SMYAs' tobacco use and factors driving these associations. METHODS: We analyzed 2023 survey data from 1082 US SMYAs (aged 18-34). Multivariable regressions controlling for sociodemographics examined associations of: (1) rural-urban movement/stability (urban stability, rural-urban movement, rural stability [REF]) with minority stress-related factors (mental health symptoms, internalized stigma), perceived tobacco norms (peer tobacco use, social acceptability of tobacco use), and tobacco use (past-month cigarette, e-cigarette, any tobacco use, number of products used); and (2) minority stress-related factors and tobacco norms with tobacco use. FINDINGS: Relative to SMYAs reporting rural stability, those reporting rural-urban movement and urban stability displayed lower odds of any tobacco use and mental health symptoms, and less peer tobacco use. Those reporting rural-urban movement also reported lower odds of cigarette use and less internalized stigma. Peer tobacco use was associated with higher odds of cigarette and any tobacco use; reporting ≥ moderate mental health symptoms and greater internalized stigma and social acceptability was associated with higher odds of cigarette use. CONCLUSIONS: These novel findings provide preliminary evidence that, relative to their SM peers who reside in rural areas, SMYAs who move from rural to urban areas may experience less minority stress-related factors and lower tobacco use norms, which may reduce risk for cigarette and other tobacco use. Findings highlight the need for public health messaging interventions targeting SMYAs in rural communities.
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