Journal of Rural Health最新文献

{"title":"Rural-urban disparities in human papillomavirus vaccination: Findings from a cross-sectional survey of 13 southern US states, December 2019-January 2020","authors":"Lavanya Vasudevan PhD, MPH, CPH, Yunfei Wang DrPH, Jan Ostermann PhD, Valerie Yelverton PhD, MSc, Jingyi Yang MA, Laura J. Fish PhD, Sayward E. Harrison PhD, MA, CAS, Charnetta Williams MD, Emmanuel B. Walter MD, MPH","doi":"10.1111/jrh.12913","DOIUrl":"https://doi.org/10.1111/jrh.12913","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 si","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143801695","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":"Mapping maternity care deserts: Driving distance and health outcomes in North Carolina","authors":"Margaret Sugg MA, PhD,&nbsp;Shishir Shakya PhD,&nbsp;Sarah Ulrich MA,&nbsp;Jennifer Schroeder Tyson MPH, CPDM,&nbsp;Jennifer Runkle MPH, PhD","doi":"10.1111/jrh.70020","DOIUrl":"https://doi.org/10.1111/jrh.70020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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 &amp; 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143793786","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":"Examination of rural–urban disparities in utilization of preventive dental procedures in the US pediatric population: A cross-sectional study","authors":"Affan Ghaffari PhD,&nbsp;Katelyn Y. Graves PhD,&nbsp;Russell F. Bradbury MS,&nbsp;Jeffrey S. Harman PhD","doi":"10.1111/jrh.70022","DOIUrl":"https://doi.org/10.1111/jrh.70022","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>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 (<i>p</i> &gt; 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143749319","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":"Rural–urban differences in substance use during pregnancy","authors":"Emma Kathryn Boswell MPH,&nbsp;Olivia M. Hinds MPH,&nbsp;Cassie Odahowski PhD,&nbsp;Elizabeth Crouch PhD,&nbsp;Peiyin Hung PhD,&nbsp;Christina M. Andrews PhD","doi":"10.1111/jrh.70018","DOIUrl":"https://doi.org/10.1111/jrh.70018","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>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, <i>p</i> &lt; 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143689442","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":"Community Health Worker-delivered tobacco cessation in a small rural county","authors":"Ellen J. Hahn PhD,&nbsp;Amanda Bucher BA,&nbsp;Amanda Thaxton Wiggins PhD,&nbsp;Kathy Rademacher BA,&nbsp;Whitney Beckett MPH,&nbsp;LeeAnn Taylor BS,&nbsp;Audrey Darville PhD,&nbsp;Jean Edward PhD","doi":"10.1111/jrh.70017","DOIUrl":"https://doi.org/10.1111/jrh.70017","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Using a CHW-TTS-delivered tobacco treatment approach in a low-resourced rural community demonstrated promise in helping tobacco users quit.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646033","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":"Measuring disparities to emergency medicine with 200 million voter records: The case of rural hospital closures","authors":"Michael E. Shepherd PHD,&nbsp;Christian Cox PHD,&nbsp;Derek A. Epp PHD","doi":"10.1111/jrh.70019","DOIUrl":"https://doi.org/10.1111/jrh.70019","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646035","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":"Statewide implementation for medications for opioid use disorder (MOUD) in urban and rural emergency departments","authors":"Margaret Greenwood-Ericksen MD, MSc,&nbsp;Mary Blasi MS,&nbsp;Brandon J. Warrick MD,&nbsp;James Cotton MD,&nbsp;Eric Ketcham MD,&nbsp;Cindy Ketcham RN,&nbsp;Sally Wait BSN,&nbsp;Rachel Abeyta BFA,&nbsp;Douglas Ziedonis MD, MPH,&nbsp;Julie G. Salvador PhD","doi":"10.1111/jrh.70011","DOIUrl":"https://doi.org/10.1111/jrh.70011","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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 &amp; Implementation (D&amp;I) approach. This manuscript describes NM Bridge's outcomes in its first three years (2020–2023).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>NM Bridge offers partner hospitals a D&amp;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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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, &lt;25% <i>x</i>-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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Implementation facilitation of ED-based MOUD programs was successful across six diverse hospitals, in a highly rural state.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646039","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":"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","authors":"Katelyn F. Romm PhD,&nbsp;Erin A. Vogel PhD,&nbsp;Patricia A. Cavazos-Rehg PhD,&nbsp;Carla J. Berg PhD, MBA","doi":"10.1111/jrh.70016","DOIUrl":"https://doi.org/10.1111/jrh.70016","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646034","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":"Rural Health Research in the 21st Century: One Health Considerations","authors":"Eugene J. Lengerich VMD, MS","doi":"10.1111/jrh.70015","DOIUrl":"https://doi.org/10.1111/jrh.70015","url":null,"abstract":"&lt;p&gt;I read with interest the commentary on rural health research in the 21st century by Moloney and associates in the December 16, 2024 issue of Journal of Rural Health.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; In the commentary, the authors begin with the premise that “rural health research…has faced significant challenges in defining rural area, methodological constraints in studying dispersed populations, and complex social and cultural factors.” The authors present reasonable 21st-century digital and technologic solutions for these challenges.&lt;/p&gt;&lt;p&gt;The purpose of the present commentary is to offer additional considerations on rural health research in the 21st century, especially addressing the “complexity of rural socio-cultural dynamics.”&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The present commentary draws from my experience in the Commonwealth of Pennsylvania, where I currently conduct rural health research and, along with my wife, manage a small farm that has been in her family for over 50 years.&lt;/p&gt;&lt;p&gt;I agree that there is definitional inconsistency for “rural.”&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; While use of a quantified definition (e.g., based upon the US Census) of a geopolitical area offers objectivity, socioeconomic and cultural components are also important to a rural definition. First, areas not designated by the US Census or another organization as “rural” may have a “rural” economic base, such as agriculture. For example, greenhouse, nursery, and agritourism are often agriculture enterprises in non-rural areas. Second, classification of a geopolitical area may change even though the people who reside there may not. Six of the 67 counties in Pennsylvania classified by the 2013 Rural-Urban Continuum Codes (RUCC) classification as nonmetropolitan (RUCC designation of 4+) or metropolitan changed with the 2023 RUCC classification: one nonmetropolitan county changed to metropolitan status while five metropolitan counties changed to nonmetropolitan status.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Finally, rural identity may be associated with a sense of place, culture and longevity among the residents.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; While it is necessary to quantify characteristics (e.g., population density, health care facilities) of geopolitical areas, the socioeconomic and cultural characteristics of the people who reside there may be not be consistent with the area's designation and introduce misclassification bias.&lt;/p&gt;&lt;p&gt;Recently, the Federal Reserve Bank of Philadelphia created the Reliance Index to quantify the importance that hospitals and higher education institutions play in regional economies.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; While most of their 524 US regions are metropolitan, the initiative identifies nonmetropolitan regions, including the northern, southern, and western nonmetropolitan regions in Pennsylvania. The average Reliance Index for these three nonmetropolitan regions was 0.59, substantially lower than the 1.0 for the United States. These data quantify the lack of a traditional anchor","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143602532","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 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}