The Journal Of Rural Health[JOURNAL]
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200 papers
Community Health Worker-delivered tobacco cessation in a small rural county.
Hahn EJ, Bucher A, Wiggins AT … +5 more , Rademacher K, Beckett W, Taylor L, Darville A, Edward J
J Rural Health · 2025 Jan · PMID 40102195 · Publisher ↗
PURPOSE: We evaluated a Community Health Worker (CHW)-Tobacco Treatment Specialist (TTS) model for delivering tailored tobacco treatment counseling and support in a rural, low-resourced county. METHODS: This was an explo...
PURPOSE: We evaluated a Community Health Worker (CHW)-Tobacco Treatment Specialist (TTS) model for delivering tailored tobacco treatment counseling and support in a rural, low-resourced county. METHODS: This was an exploratory, prospective study of people 18 years or older who used any tobacco product including e-cigarettes or vapes in the past 30 days. The CHW assessed tobacco use, secondhand smoke exposure, and quit history; and collected an expired breath carbon monoxide sample and a brief health history before providing 4-6 in-person or phone-based sessions involving tailored tobacco treatment counseling and support. The CHW connected participants to a prescriber at a federally qualified health care center (FQHC) for cessation medications as needed and/or helped them obtain free or low cost medications as available. Six weeks after intake, the CHW conducted a final in-person assessment, carbon monoxide measurement, and tobacco treatment counseling. We then referred participants to the free Quit line and to their primary care provider or the FQHC for additional treatment. FINDINGS: Median cigarettes smoked per day decreased from 20 at intake to 4.5 at the final visit. Most participants reported at least one or more 24-h quit attempts, and 38% reported they had stopped smoking entirely after the final visit. There was a significant increase in participants' confidence in quitting from intake to final. CONCLUSIONS: Using a CHW-TTS-delivered tobacco treatment approach in a low-resourced rural community demonstrated promise in helping tobacco users quit.
Rural Health Research in the 21st Century: One Health Considerations.
Lengerich EJ
J Rural Health · 2025 Jan · PMID 40079687 · Full text
Abstract loading — click title to view on PubMed.
Rural-urban differences in opioid prescribing in the Veterans Health Administration.
Courtney RE, Lund BC, Hadlandsmyth K
J Rural Health · 2025 Jan · PMID 40062641 · Publisher ↗
PURPOSE: To determine whether higher rates of opioid prescribing among rural Veterans in the Veterans Health Administration (VHA), previously observed through 2016, persisted through 2023. METHODS: National VHA administr...
PURPOSE: To determine whether higher rates of opioid prescribing among rural Veterans in the Veterans Health Administration (VHA), previously observed through 2016, persisted through 2023. METHODS: National VHA administrative data were used to contrast opioid prescribing between urban and rural Veterans for annual veteran cohorts from 2016 through 2023. The primary prescribing metric was per capita volume expressed as morphine milligram equivalents (MME). Prescribing metrics were contrasted between urban and rural Veterans using Wilcoxon signed rank tests and odds-ratios. FINDINGS: Per capita opioid prescribing was 35% higher among rural Veterans (1275 MME) than urban Veterans (943 MME) in 2016. While overall volume decreased markedly by 2023, opioid prescribing remained higher among rural Veterans (391 MME vs. 270 MME), by 45%. The largest difference was attributable to long-term recipients, which accounted for 325 MME of the 332 MME difference (98%) during 2016 and 118 of the 121 MME difference (98%) in 2023. CONCLUSIONS: Higher rates of opioid prescribing among rural Veterans have persisted through 2023, largely driven by differences in long-term prescribing. This may indicate a need for enhanced access to nonpharmacological management options for chronic pain among rural Veterans. Leveraging existing resources within VHA such as the Whole Health System may enhance pain care for rural Veterans.
"I'm tired of seeing my friends die": Barriers and facilitators to participating in clinical trials among rural people who use drugs in the United States.
Lancaster KE, Estadt AT, Enderle MN … +2 more , Korthuis TP, Young AM
J Rural Health · 2025 Jan · PMID 40045014 · Full text
PURPOSE: Participation in clinical trials among people who use drugs (PWUD) in rural areas remains disproportionately low compared to those in urban communities. Our objective was to describe the barriers and facilitator...
PURPOSE: Participation in clinical trials among people who use drugs (PWUD) in rural areas remains disproportionately low compared to those in urban communities. Our objective was to describe the barriers and facilitators to clinical trial participation among this understudied and underserved population. METHODS: We conducted semi-structured in-depth interviews among rural PWUD in Kentucky, Ohio, and Oregon. Using the Ickovics and Meisler framework, we classified factors associated with participation in clinical trials among rural PWUD into five categories: the individual, trial and intervention characteristics, participant-trial staff relationship, clinical trial setting, and features of the disease. We used inductive qualitative analysis methods to identify salient themes. FINDINGS: Thirty-five rural participants (median age: 39, 51% men) completed in-depth interviews. Facilitators for rural clinical trial participation were mainly situated within the individual, trial and intervention characteristics, and clinical trial setting. Individual characteristics, such as altruistic motivations to help their communities and peers, as well as trial and intervention characteristics like visit reminders and resource assistance, were the most frequently noted facilitators of clinical trial participation. In contrast, participation barriers were mainly related to participant-trial staff relationships and disease features. Judgmental and untrustworthy trial staff, along with involvement in the criminal legal system, were obstacles to clinical trial participation. CONCLUSIONS: Individual, intrapersonal, and logistical factors described by rural PWUD must be addressed to enhance the participation and retention of this population in clinical trials. Successful clinical trial participation may contribute to equitable access to essential health services by PWUD in rural communities.
Rural-urban differences in mental health and psychotherapy use among veterans with military sexual trauma: A retrospective cohort study.
Boykin DM, Haney L, Amspoker AB … +2 more , Walder A, Hundt N
J Rural Health · 2025 Jan · PMID 40032784 · Publisher ↗
PURPOSE: The present study examined differences in the mental health outcomes and psychotherapy use of rural Veterans with military sexual trauma (MST), as compared to their urban peers, given rural Veterans' increased r...
PURPOSE: The present study examined differences in the mental health outcomes and psychotherapy use of rural Veterans with military sexual trauma (MST), as compared to their urban peers, given rural Veterans' increased risk for delayed or missed care. METHODS: We analyzed Veterans Health Administration (VHA) administrative data for 311,917 Veterans with a history of MST. Veterans were classified as rural/highly rural (30.25%) or urban (69.75%) based on VHA Rural-Urban Commuting Area codes. Rural-urban differences were assessed for mental health disorders and service use across 4 VHA clinic types (i.e., integrated Primary Care-Mental Health Clinic, General Mental Health Clinic, Posttraumatic Stress Disorder Clinical Team, Substance Use Disorder Clinic) using logistic regression models adjusted for age. Analysis of covariance models compared differences in utilization intensity among Veterans with at least 1 encounter in the designated clinic. FINDINGS: Compared to urban Veterans with MST, rural Veterans with MST were more likely to be diagnosed with an anxiety disorder but less likely to be diagnosed with posttraumatic stress disorder, depression, bipolar disorder, alcohol use disorder, and other substance use disorder. As expected, rural Veterans with MST were less likely to receive individual and group psychotherapy services, regardless of the VHA clinic type, than their urban counterparts. Notably, rural Veterans remained in individual and group treatment longer than urban Veterans across nearly all clinics. CONCLUSION: Further investigation into challenges and opportunities to improve mental health care initiation among rural Veterans with MST is a critical next step in optimizing their well-being and quality of life.
Investigation of rural-urban differences in hospitalization for ambulatory care-sensitive conditions: Analysis of linked survey, hospitalization, and tax data from Canada.
Bai Y, Stranges S, Sarma S
J Rural Health · 2025 Jan · PMID 40029101 · Full text
BACKGROUND: Hospitalizations for ambulatory care sensitive conditions (ACSCs) reflect the efficiency of the primary care system, as these are preventable with timely and effective management of chronic conditions. We exa...
BACKGROUND: Hospitalizations for ambulatory care sensitive conditions (ACSCs) reflect the efficiency of the primary care system, as these are preventable with timely and effective management of chronic conditions. We examined ACSC hospitalization trends in Canada's rural and urban areas, excluding Quebec, from 2007 to 2019. METHODS: The data came from Canadian Community Health Surveys linked with hospitalizations and household income tax records. The study focused on adults aged 18-74 years and used logit and zero-inflated Poisson models to analyze ACSC hospitalizations and costs. A non-linear decomposition method quantified explained and unexplained rural-urban gaps in ACSC hospitalizations and costs. RESULTS: We found persistent disparities in ACSC hospitalizations between rural and urban areas, although the gap has narrowed since 2010. Even after adjusting for socio-demographic factors, chronic conditions, and risky health behaviors, rural-urban disparities in ACSC rates remained, highlighting unequal access to primary care in rural areas. The decomposition results revealed that the disparities were driven mainly by differences in the observed characteristics. Further investigation revealed that disparities were due to populations with lower income and education, and residents in Atlantic provinces. CONCLUSIONS: This study underscores the importance of a strong primary care system to minimize ACSC-related hospitalizations in rural Canada. Our results highlight the benefits of primary care reforms undertaken by provinces over the past decade in reducing rural-urban gaps in ACSC hospitalizations. Future policy interventions targeting disadvantaged populations, such as those with lower income and education, are vital for reducing avoidable hospitalizations and enhancing population health outcomes in rural areas.
The rural disadvantage - prostate cancer outcomes of rural and urban patients over 25 years.
Albers P, Huang G, Bashir S … +6 more , Mookerji N, Bennett J, Broomfield S, Martín AM, Ghosh S, Kinnaird A
J Rural Health · 2025 Jan · PMID 40029038 · Full text
PURPOSE: Prostate cancer is a common malignancy among men, with disparities based on the geographic location. This study aims to evaluate long-term trends in prostate cancer outcomes among rural and urban populations wit...
PURPOSE: Prostate cancer is a common malignancy among men, with disparities based on the geographic location. This study aims to evaluate long-term trends in prostate cancer outcomes among rural and urban populations within a universal health care system, providing insights into the persistent disparities in cancer-specific mortality despite supposed equal access to medical coverage. METHODS: A retrospective cohort study was conducted using data from the Alberta Cancer Registry (January 1, 1999 to December 31, 2022) and the Alberta Prostate Cancer Research Initiative (APCaRI) (July 1, 2014 to June 7, 2024). There were 45,602,119 person-years from the Alberta Cancer Registry and 8932 men from APCaRI. The exposure was the place of residence, categorized as urban or rural, based on postal codes at the time of diagnosis and death. The primary outcome was prostate cancer-specific mortality. FINDINGS: Rural men were diagnosed at an older age (66.7 vs. 68.9, p<0.001) and had higher age-adjusted prostate cancer-specific mortality compared to urban men (52.0 vs. 37.6 deaths per 100,000, p<0.001). Though both groups showed improvements over time, rural areas consistently had higher age-adjusted mortality rates. Despite a 38% relative increase in prostate cancer specific mortality, rural patients had minimal, though statistically significant differences in PSA (9% vs. 11% >20, p = 0.008), stage (40% vs. 46% T2-T4, p<0.001) and Gleason Grade Group (11% vs. 14% ≥4, p<0.001) at diagnosis. CONCLUSIONS: The study reveals that rural men experienced significantly worse prostate cancer outcomes compared to urban men. These findings highlight the need for targeted health care interventions to improve access to care in rural areas.
Rural maternal health interventions: A scoping review and implications for best practices.
Gordon RD, Kishi A, Brown JA … +9 more , Voisin C, Thomas N, Riley SR, Fareed N, Bunger A, Gillespie SL, Venkatesh KK, Juckett L, Brill SB
J Rural Health · 2025 Jan · PMID 40029019 · Full text
PURPOSE: Maternal health outcomes in rural areas of the United States are persistently poor, with pregnant individuals in rural areas facing complex health care obstacles. Interventions adapted to the needs of rural pati...
PURPOSE: Maternal health outcomes in rural areas of the United States are persistently poor, with pregnant individuals in rural areas facing complex health care obstacles. Interventions adapted to the needs of rural patients are critical to mitigate worsening health disparities. To inform future efforts in this field, we conducted a scoping review, given the complex and diverse nature of existing interventions, to synthesize the literature on rural maternal health interventions, analyze mechanisms to improve care, and identify barriers and facilitators to intervention implementation. METHODS: We conducted a scoping review of peer-reviewed literature across six databases for maternal health interventions in rural populations. Relevant studies were analyzed for study setting, intervention type, impact on maternal health outcomes, and facilitation and barriers of intervention implementation mapped to the Consolidated Framework for Implementation Research. FINDINGS: We identified 64 studies published between 2010 and 2024 through comprehensive database searches relevant to our review. We determined six proposed mechanisms of action via thematic analysis across the pregnancy continuum: increased care connection, social support, care frequency, education, self-efficacy, and positive reinforcement. While the facilitators and barriers to implementation varied across the six themes, common facilitators included state-level buy in, integration of community partnerships, cultural humility in study design, and dedicated interdisciplinary teams. Common barriers included lapses in insurance, transportation difficulties, and communication challenges. CONCLUSIONS: Our review shares lessons that future interventions and policies can build upon to improve peripartum care for individuals living in rural communities. Further work is needed to address intersectional disparities in rural maternal health and ensure equitable implementation.
Exploring access to critical health services for older adults in rural America from 1990 to 2020.
Bambury EA, Merdjanoff AA, Fergen JT … +1 more , Mueller JT
J Rural Health · 2025 Jan · PMID 40022451 · Full text
PURPOSE: Rural America has experienced a rapid loss of hospitals since the turn of the century, making access to high-quality health care the top rural health priority. Coinciding with this hospital decline is the growth...
PURPOSE: Rural America has experienced a rapid loss of hospitals since the turn of the century, making access to high-quality health care the top rural health priority. Coinciding with this hospital decline is the growth of a rural population age 65 years or older. The health needs of older adults can require specialty care to support healthy aging. To date, minimal research has been conducted on trends in aging-related health care services in rural areas beyond hospital closures. METHODS: This study uses a 30-year lookback of data from the Area Health Resource Files to describe the trends in local access to hospitals and critical health services important for conditions experienced by older adults in rural America. Results are presented across measures of rurality and population age. FINDINGS: Local aging-related access to services such as chemotherapy, oncology, emergency department, geriatric, and home health agencies have been stagnant or declining over time in rural areas. Concerningly, the most remote communities with the highest percent of older adults have the lowest service access. CONCLUSION: These findings shed light on the growing need for policies to support healthy aging among the increasingly older rural population.
On the importance of gradation in rural health designations.
Benton M
J Rural Health · 2025 Jan · PMID 40022450 · Publisher ↗
Abstract loading — click title to view on PubMed.
Evaluating implementation by rural clinics of evidence-based interventions to promote HPV vaccination.
Evett S, Walker S, Ryan GW … +5 more , Steere E, Daly E, Janio EA, Pedraza Marin S, Askelson NM
J Rural Health · 2025 Jan · PMID 39962360 · Full text
PURPOSE: Despite the well-established link between vaccination against human papillomavirus (HPV) and a decreased risk of cancer, HPV vaccine uptake in rural communities is low. Evidence-based interventions (EBIs) to pro...
PURPOSE: Despite the well-established link between vaccination against human papillomavirus (HPV) and a decreased risk of cancer, HPV vaccine uptake in rural communities is low. Evidence-based interventions (EBIs) to promote HPV vaccination exist but are not universally implemented in rural settings due to various challenges. To understand the support needed by rural clinics in implementing EBIs, the University of Iowa partnered with the American Cancer Society (ACS) to evaluate an ACS HPV Vaccinating Adolescents against Cancers Quality Improvement Learning Collaborative that was delivered to six clinics in two rural health systems. The study aimed to assess the effectiveness of the learning collaborative approach for helping rural clinics implement EBIs aimed at increasing HPV vaccine uptake. METHODS: Semistructured interviews were conducted with clinic staff at six time points throughout the 2-year intervention. Interviews were conducted over the phone and were recorded and transcribed. Members of the research team coded the interviews using codebooks informed by the interview guides. The analysis compared the health systems and identified the changes they made in response to assistance provided by the collaborative. RESULTS: Clinic staff implemented the following EBIs: utilizing the immunization registry, strong provider recommendation, and provider education. Implementation of scheduling next dose fluctuated during the intervention. Differences were noted in the two health systems' implementation using electronic health records for patient and provider reminders. CONCLUSION: Small, rural clinics can implement effective EBIs, given proper support. This is important as such EBIs can increase HPV vaccination rates and help prevent HPV-associated cancers.
Patient perspectives of the impact of a rural health center closure: A cross-sectional survey.
Trombetta M, Suchy N, Irwin AN
J Rural Health · 2025 Jan · PMID 39962356 · Publisher ↗
PURPOSE: To describe the impact from the closure of a rural community's only health center on chronic health conditions, access to care, and quality of care received from the patient's perspective. METHODS: This was a cr...
PURPOSE: To describe the impact from the closure of a rural community's only health center on chronic health conditions, access to care, and quality of care received from the patient's perspective. METHODS: This was a cross-sectional telephone survey. Adult patients established with a rural health center participated in a 19-item survey at 6 months post-closure to collect data on perceived impacts. Data were summarized using descriptive statistics. FINDINGS: There were 249 patients contacted, with 131 participants (52.6% response rate). Participants had a median age of 63 years (interquartile range, 44.5-73.0), and the majority were female (n = 82; 62.6%) and had been established with the health center for over 10 years (n = 79; 60.3%). At 6 months, the majority of participants had established care with another health center (n = 91; 69.5%). Most participants felt that the closure made it more difficult to access care (n = 106; 80.9%) but did not feel the closure reduced the quality of care they were receiving (n = 42; 32.1%). There was no impact perceived on the management of most health conditions, except chronic pain where worsening was the most selected option. CONCLUSIONS: Patients were able to successfully transition care after closure of their local health center, and most did not perceive an impact on the quality of care received. However, participants reported reduced access to care. Future research might repeat this process, perhaps using a mixed-method approach, to intentionally capture nuances in patient behavior, experiences, and attitudes following the loss of primary care services in rural communities.
Factors associated with multiple-death suicides among rural US decedents.
Soupene VA, Hays T, Davis J … +1 more , Vakkalanka JP
J Rural Health · 2025 Jan · PMID 39962337 · Full text
PURPOSE: To identify contributing circumstances to multiple-death suicides in rural US counties from law enforcement and coroner/medical examiner narratives. METHODS: We identified multiple-death suicides as multiple sui...
PURPOSE: To identify contributing circumstances to multiple-death suicides in rural US counties from law enforcement and coroner/medical examiner narratives. METHODS: We identified multiple-death suicides as multiple suicides (i.e., two or more decedents) from the National Violent Death Reporting System (NVDRS) between 2013 and 2021. We identified rural decedents from their residence in NVDRS using federal information processing codes linked to Rural-Urban Continuum Codes. Quantitatively, we described demographic characteristics and circumstances leading to the suicide. From narrative law enforcement and coroner/medical examiner reports, we generated codes describing demographic and circumstance information using Dedoose software. We then used inductive content analysis to identify themes related to multiple-death suicides. FINDINGS: Among all multiple-death suicides (n = 50 multiple-death suicides, 99 suicide decedents), decedents were mostly non-Hispanic White (n = 90; 91%), were male (n = 54; 54%), and had a high school diploma or less (n = 51; 56%). We identified four themes: meticulous and considerate planning (e.g., with notes, reasons, and next steps), mutual dependency (e.g., decedents were in separable), unbearable health conditions (e.g., pain, poor quality of life from chronic illnesses), and social factors of despair (e.g., financial strain, legal problems, and interpersonal violence). CONCLUSION: Developing strategies for discussing suicidal ideation and improving access to financial resources and health care may reduce multiple-death suicides in the rural United States, particularly among older adults with chronic health problems. Improving other public health initiatives such as interpersonal violence and chronic disease prevention and management may further prevent multiple-death suicides.
Impact of Medicaid expansion on stage of diagnosis of lung cancer for rural and urban patients in New Hampshire.
Carter B, Denny J, Lohrer A
J Rural Health · 2025 Jan · PMID 39930334 · Full text
PURPOSE: This study examines the impact of Medicaid expansion under the Affordable Care Act on the stage of lung cancer diagnosis among rural and urban patients in New Hampshire. METHODS: Data from the New Hampshire Stat...
PURPOSE: This study examines the impact of Medicaid expansion under the Affordable Care Act on the stage of lung cancer diagnosis among rural and urban patients in New Hampshire. METHODS: Data from the New Hampshire State Cancer Registry spanning 2010-2019 were analyzed to compare lung cancer diagnosis stages before and after the July 2014 Medicaid expansion. Rural-urban categorization utilized Rural-Urban Continuum Codes, and logistic regression with difference-in-difference analysis assessed the differential effects of Medicaid expansion on late-stage diagnoses between rural and urban patients. FINDINGS: Post-expansion, there was a significant decrease in the proportion of late-stage lung cancer diagnoses statewide. Rural patients initially had higher rates of late-stage diagnoses compared to urban patients, but post-expansion, this disparity diminished significantly. Logistic regression indicated reduced odds of late-stage diagnosis among rural patients after expansion (OR = 0.719, P = .035), demonstrating a greater benefit in rural areas. CONCLUSIONS: Medicaid expansion in New Hampshire was associated with a substantial reduction in late-stage lung cancer diagnoses, particularly benefiting rural patients who historically faced higher barriers to health care access. These findings underscore the potential of Medicaid expansion to mitigate rural-urban disparities in cancer care outcomes.
Sleep well and live well: Impact of sleep hygiene intervention on sleep duration in a rural community: A randomized controlled trial (THE SWELL STUDY).
Sharma S, Stansbury R, Ramadan J … +5 more , Rojas E, Finomore V, Pham C, Quan SF, Wen S
J Rural Health · 2025 Jan · PMID 39930329 · Publisher ↗
INTRODUCTION: Sleep is a key component of a healthy lifestyle and the Center for Disease Control (CDC) and prevention recommends that adults get at least 7 hours of sleep each night. Within the United States, West Virgin...
INTRODUCTION: Sleep is a key component of a healthy lifestyle and the Center for Disease Control (CDC) and prevention recommends that adults get at least 7 hours of sleep each night. Within the United States, West Virginia is among the most sleep-deprived states with 42% of the population reporting insufficient sleep per the CDC. Sleep insufficiency in rural populations is linked to disparities in health and accessibility to health care services. The study evaluated the impact of sleep hygiene (SH) education on sleep duration and quality. METHODS: A 12-week randomized controlled trial of participants residing in Harrison County, WV. Baseline data included the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, and sleep duration as recorded by a sleep wearable. The intervention included an SH video on weeks 3 and 5. The control arm did not receive intervention but were allowed to cross over and receive intervention at week 8. RESULTS: A total of 100 participants (61 females) were recruited from the community. No changes in sleep duration were observed in intention to treat analysis between Arm 1 and Arm 2 at 7 weeks. In the treatment analysis, the compliant cohort demonstrated a significant increase of 31 minutes mean sleep duration (P = .01) as well as an improvement in the PSQI (6.30 to 5.68 by week 12, P = .05). CONCLUSION: The study demonstrates that the introduction of a modest SH intervention may have a beneficial effect on the duration and quality of sleep in a rural community. CLINICALTRIALS: gov Identifier: NCT04849572.
The U.S dementia belt: Commentary on "Alzheimer's disease and related dementia among Medicare beneficiaries aged ≥ 65 years in rural America, by census region and select demographic characteristics: 2020".
Huang Q
J Rural Health · 2025 Jan · PMID 39912454 · Publisher ↗
Abstract loading — click title to view on PubMed.
A comparison of traumatic injury characteristics in rural and urban adults living in Wisconsin.
Kallies KJ, Koehne WJ, Tomas CW … +4 more , Tarima S, Beckman MA, Beyer KM, Cassidy L
J Rural Health · 2025 Jan · PMID 39910720 · Publisher ↗
PURPOSE: Rural compared to urban populations have higher age-adjusted injury mortality rates. We sought to describe differences in traumatic injury mechanisms, severity, and mortality in Wisconsin adults in rural and urb...
PURPOSE: Rural compared to urban populations have higher age-adjusted injury mortality rates. We sought to describe differences in traumatic injury mechanisms, severity, and mortality in Wisconsin adults in rural and urban areas. METHODS: State trauma registry data were analyzed for adult patients injured in 2021-2022. The Wisconsin Health Innovation Program's rural and urban classification scheme, consisting of urban advantaged, urban, urban underserved, rural advantaged, rural, and rural underserved groups, was used. Multivariable logistic regression models for in-hospital injury mortality and prolonged length of stay (LOS) were developed. FINDINGS: Overall, 47,460 patients were included; 14.3% in rural, 9.5% in rural advantaged, 4.1% in rural underserved areas, 35.4% in urban, 22.0% in urban advantaged, and 14.8% in urban underserved areas. Firearm and pedestrian injuries were more common in urban areas, and motor vehicle/transportation injuries were common in rural areas. Lower odds of prolonged LOS were observed in those residing in rural advantaged (OR = 0.70, 95%CI: 0.55-0.90; p = 0.004), rural (OR = 0.66, 95%CI: 0.53-0.82; p < 0.001), and rural underserved (OR = 0.64, 95%CI: 0.50-0.82; p < 0.001) compared to urban advantaged areas. Those in rural underserved areas had higher odds of in-hospital mortality (OR = 1.48, 95%CI: 1.15-1.91; p = 0.003) compared to urban advantaged areas. CONCLUSIONS: Patients in rural Wisconsin experienced different injury mechanisms than in urban areas. Those in urban areas were more likely to have a prolonged hospital LOS, but those in rural underserved areas had higher in-hospital mortality. Rural populations may benefit from injury prevention specific to the mechanisms of injury in that area and resource allocation to enhance trauma services.
"It was a good opportunity for us to be in touch with public health": Independent community pharmacists' experiences working with public health before and during COVID-19.
Rubinstein EB, Preugschas AH, Skoy E … +2 more , Nagel L, Larson M
J Rural Health · 2025 Jan · PMID 39894964 · Publisher ↗
PURPOSE: Pharmacies have been a significant part of improving population health since before the COVID-19 pandemic. However, little is known about the working relationships between pharmacies and public health entities....
PURPOSE: Pharmacies have been a significant part of improving population health since before the COVID-19 pandemic. However, little is known about the working relationships between pharmacies and public health entities. This exploratory study describes independent community pharmacists' perceptions during COVID-19 of both pre-existing and newly created relationships with public health. METHODS: This paper is based on 42 qualitative interviews conducted as part of a broader study on North Dakota pharmacy's role in the COVID-19 pandemic. Authors analyzed interview data both deductively (based on a priori interview questions) and inductively (based on emergent themes). We used key quotes to map working relationships between pharmacy and public health on two axes: personal interactions and service provision. FINDINGS: Interviewees worked at 42 pharmacies (21 urban and 21 rural) and described relationships with public health entities that fell into four categories: (i) service provision with personal interactions predating the pandemic; (ii) service provision without personal interactions predating the pandemic; (iii) personal interactions that evolved during the pandemic; and (iv) service provision that evolved during the pandemic. Rural pharmacists described personal interactions and pre-pandemic service provision more often than urban pharmacists. Most urban pharmacists developed working relationships with public health entities solely because of the pandemic. CONCLUSIONS: This study begins mapping the range of relationships that can exist between community pharmacies and public health entities. Our data suggest it may be possible to leverage pharmacists to extend public health's reach and improve the health of medically underserved, rural populations.
"Everything cannot be handled virtually": Understanding intention and use of digital health technologies among rural adults and rural cancer survivors.
Shi J, Robinson TA, Loomba P … +4 more , Murley B, Strong LL, Basen-Engquist K, Mama SK
J Rural Health · 2025 Jan · PMID 39878383 · Full text
PURPOSE: This qualitative study assessed internet access and use, barriers and facilitators to participating in digital health interventions or programs, and the engagement experience in virtual versus in-person health i...
PURPOSE: This qualitative study assessed internet access and use, barriers and facilitators to participating in digital health interventions or programs, and the engagement experience in virtual versus in-person health interventions among rural adults and rural cancer survivors. METHODS: Rural adults (n = 10) and rural cancer survivors (n = 10) were recruited from previous studies to participate in an in-depth interview. The interview guide contained eight open-ended questions related to participation in technology-based programs. Interviews were recorded and transcribed, and transcripts were analyzed for emergent themes using a thematic content analysis approach. FINDINGS: Rural adults were younger (M age = 37.9 ± 11.8 years), more likely to be non-Hispanic Black (90.0%), and reported higher educational attainment (50.0% earned a master's or doctoral degree) compared with rural cancer survivors (M age = 63.0 ± 9.1 years, 70.0% non-Hispanic White, and 20.0% earned a master's or doctoral degree). Participants discussed performance and effort expectancies related to using digital health technologies or participating in virtual programs and cited positive and negative aspects of in-person and virtual platforms. Participants emphasized the need for social connections and missed opportunities in current virtual offerings along with factors that influence their use of technologies (e.g., prior experience, tech anxiety). CONCLUSIONS: Findings from this qualitative study provide an in-depth understanding of the intricate experiences of rural adults and rural cancer survivors when engaging with digital health technologies. Integrating the experiences of rural adults and rural cancer survivors may aid in developing clinical and community-based interventions and policies that support increasing access to digital health services and programs for rural communities.
Medicare telehealth utilization by Rural Health Clinics and Federally Qualified Health Centers prior to and during the COVID-19 pandemic.
Jonk Y, O'Connor H, Gale J … +1 more , Thayer D
J Rural Health · 2025 Jan · PMID 39878380 · Publisher ↗
PURPOSE: To address the extent to which Federally Qualified Health Centers (FQHCs) and independent and provider-based Rural Health Clinics (RHCs) were using telehealth prior to and during the COVID-19 pandemic. METHODS:...
PURPOSE: To address the extent to which Federally Qualified Health Centers (FQHCs) and independent and provider-based Rural Health Clinics (RHCs) were using telehealth prior to and during the COVID-19 pandemic. METHODS: A nationally representative 5% sample of Medicare Fee-for-Service beneficiaries who used outpatient services at FQHCs and RHCs were identified within the 2019-2021 5% Medicare Limited Data Set Outpatient and Carrier files. Rural-Urban Continuum Codes were used to identify rural-urban clinic locations. Logistic regression included three-way interaction terms for time, rurality, and clinic type. FINDINGS: Telehealth use curbed the decline in outpatient visits for all clinic types during the pandemic. Telehealth use declined as the pandemic continued in 2021 yet remained higher than pre-pandemic levels. FQHCs had higher telehealth use (18%-31%) than RHCs (8%-14%) in 2020-2021. Across all years, tele-behavioral health was the primary venue for originating and distant site providers. Overall, 19%-34% of originating site providers were psychiatrists and 10%-31% were primary care providers. Likely due to patients sheltering-in-place (at home), 2020-2021 distant site providers were largely primary care providers. Urban FQHCs experienced the largest increase in telehealth use during the pandemic (24.6% increase in urban, 14.4%-15.8% in rural) followed by rural ID_RHCs (10.2%-11.7%). RHCs were less likely to provide telehealth services than FQHCs during the pandemic. CONCLUSIONS: Telehealth played a key role in facilitating access to health services during the height of the pandemic (2020-2021). Telehealth flexibilities were associated with greater telehealth use among FQHCs and RHCs but did not make up for the overall decline in health service use.
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