Journal of Rural Health最新文献

{"title":"Rural–urban differences in opioid prescribing in the Veterans Health Administration","authors":"Rena E. Courtney PhD,&nbsp;Brian C. Lund PharmD,&nbsp;Katherine Hadlandsmyth PhD","doi":"10.1111/jrh.70014","DOIUrl":"https://doi.org/10.1111/jrh.70014","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To determine whether higher rates of opioid prescribing among rural Veterans in the Veterans Health Administration (VHA), previously observed through 2016, persisted through 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“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","authors":"Kathryn E. Lancaster PhD,&nbsp;Angela T. Estadt PhD,&nbsp;Madison N. Enderle MPH,&nbsp;Todd P. Korthuis MD,&nbsp;April M. Young PhD","doi":"10.1111/jrh.70009","DOIUrl":"https://doi.org/10.1111/jrh.70009","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143554939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The rural disadvantage – prostate cancer outcomes of rural and urban patients over 25 years","authors":"Patrick Albers MD,&nbsp;Guocheng Huang MD,&nbsp;Safaa Bashir MBBS,&nbsp;Nikhile Mookerji MD,&nbsp;Jacob Bennett BSc,&nbsp;Stacey Broomfield PhD,&nbsp;Anaïs Medina Martín PhD,&nbsp;Sunita Ghosh PhD,&nbsp;Adam Kinnaird MD, PhD","doi":"10.1111/jrh.70008","DOIUrl":"https://doi.org/10.1111/jrh.70008","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Rural men were diagnosed at an older age (66.7 vs. 68.9, <i>p</i>&lt;0.001) and had higher age-adjusted prostate cancer-specific mortality compared to urban men (52.0 vs. 37.6 deaths per 100,000, <i>p</i>&lt;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% &gt;20, <i>p</i> = 0.008), stage (40% vs. 46% T2–T4, p&lt;0.001) and Gleason Grade Group (11% vs. 14% ≥4, <i>p</i>&lt;0.001) at diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural–urban differences in mental health and psychotherapy use among veterans with military sexual trauma: A retrospective cohort study","authors":"Derrecka M. Boykin Ph.D.,&nbsp;Laura Haney Ph.D.,&nbsp;Amber B. Amspoker Ph.D.,&nbsp;Annette Walder M.S.,&nbsp;Natalie Hundt Ph.D.","doi":"10.1111/jrh.70013","DOIUrl":"https://doi.org/10.1111/jrh.70013","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation of rural–urban differences in hospitalization for ambulatory care-sensitive conditions: Analysis of linked survey, hospitalization, and tax data from Canada","authors":"Yihong Bai PhD,&nbsp;Saverio Stranges MD, PhD,&nbsp;Sisira Sarma PhD","doi":"10.1111/jrh.70010","DOIUrl":"https://doi.org/10.1111/jrh.70010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural maternal health interventions: A scoping review and implications for best practices","authors":"Rachel D'Amico Gordon MD, MPH,&nbsp;Alyson Kishi BS,&nbsp;Jordyn A Brown MPH,&nbsp;Christiane Voisin MSLS,&nbsp;Nicole Thomas PhD, MS,&nbsp;Sean R Riley MSc, MA,&nbsp;Naleef Fareed PhD,&nbsp;Alicia Bunger PhD,&nbsp;Shannon L Gillespie PhD, RN,&nbsp;Kartik K Venkatesh MD, PhD,&nbsp;Lisa Juckett PhD, OTR/L,&nbsp;Seuli Bose Brill MD","doi":"10.1111/jrh.70007","DOIUrl":"https://doi.org/10.1111/jrh.70007","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On the importance of gradation in rural health designations","authors":"Mark Benton PhD","doi":"10.1111/jrh.70012","DOIUrl":"https://doi.org/10.1111/jrh.70012","url":null,"abstract":"","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143521769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring access to critical health services for older adults in rural America from 1990 to 2020","authors":"Elizabeth A. Bambury BS,&nbsp;Alexis A. Merdjanoff PhD,&nbsp;Joshua T. Fergen PhD,&nbsp;J. Tom Mueller PhD","doi":"10.1111/jrh.70004","DOIUrl":"https://doi.org/10.1111/jrh.70004","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These findings shed light on the growing need for policies to support healthy aging among the increasingly older rural population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143521770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating implementation by rural clinics of evidence-based interventions to promote HPV vaccination","authors":"Stephanie Evett MPH,&nbsp;Shelley Walker  ,&nbsp;Grace W. Ryan MPH, PhD,&nbsp;Eliza Steere MPH,&nbsp;Eliza Daly MPH, CHES,&nbsp;Emily A. Janio MPH,&nbsp;Stephanie Pedraza Marin AA,&nbsp;Natoshia M. Askelson MPH, PhD","doi":"10.1111/jrh.70006","DOIUrl":"https://doi.org/10.1111/jrh.70006","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143431537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with multiple-death suicides among rural US decedents","authors":"Victor A. Soupene PhD, MS,&nbsp;Timothy Hays BS, BA,&nbsp;Jonathan Davis PhD,&nbsp;J. Priyanka Vakkalanka PhD","doi":"10.1111/jrh.70003","DOIUrl":"https://doi.org/10.1111/jrh.70003","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To identify contributing circumstances to multiple-death suicides in rural US counties from law enforcement and coroner/medical examiner narratives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Among all multiple-death suicides (<i>n</i> = 50 multiple-death suicides, 99 suicide decedents), decedents were mostly non-Hispanic White (<i>n</i> = 90; 91%), were male (<i>n</i> = 54; 54%), and had a high school diploma or less (<i>n</i> = 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).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143431134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}