Journal of Rural Health最新文献

{"title":"Weight status underestimation and weight management goals among adults in the rural South of the United States.","authors":"Haakim A Waraich, Michael D Wirth, Serge Wandji, Janessa M Graves, Demetrius A Abshire","doi":"10.1111/jrh.12892","DOIUrl":"https://doi.org/10.1111/jrh.12892","url":null,"abstract":"<p><strong>Purpose: </strong>To examine factors associated with weight status underestimation and the relationship between weight status underestimation and weight loss as a weight management goal among adults living in the rural South.</p><p><strong>Methods: </strong>An anonymous survey was distributed at six primary care clinics and two churches in rural, South Carolina counties. Weight status underestimation was determined based on the difference between perceived weight status using standard body mass index (BMI) categories (underweight, normal weight, overweight, and obese) and BMI category from self-reported height and weight. Participants reported whether their weight management goal was to lose, maintain, or gain weight. Chi-square and binary logistic regressions were used for data analysis.</p><p><strong>Findings: </strong>A total of 185 respondents (76% female) at least partially completed the survey. Nearly 60% underestimated their weight status. Increasing BMI was associated with higher odds of weight status underestimation (OR: 1.10, 95%: 1.04, 1.15) and perceptions of being in fair or poor health was associated with lower odds of weight status underestimation relative to perceiving health as good or better (OR: 0.21, 95% CI: 0.06, 0.66). Among those with overweight and obesity, the association between underestimating weight status and having weight loss as a weight management goal was strong but not statistically significant (OR: 0.20, 95% CI: 0.04, 1.04).</p><p><strong>Conclusions: </strong>Underestimating weight status was common among adults in the rural US South and was related to BMI and health status. Research is needed to determine if improving the accuracy of weight perceptions can promote weight management in the rural South.</p>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512024","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":"Social needs and health outcomes in two rural Veteran populations.","authors":"Hannah R Friedman, Ida Griesemer, Leslie R M Hausmann, Gemmae M Fix, Justeen Hyde, Deborah Gurewich","doi":"10.1111/jrh.12893","DOIUrl":"https://doi.org/10.1111/jrh.12893","url":null,"abstract":"<p><strong>Background: </strong>Addressing social needs is a priority for many health systems, including the Veterans Health Administration (VA). Nearly a quarter of Veterans reside in rural areas and experience a high social need burden. The purpose of this study was to assess the prevalence and association with health outcomes of social needs in two distinct rural Veteran populations.</p><p><strong>Methods: </strong>We conducted a survey (n = 1150) of Veterans at 2 rural VA sites, 1 in the Northeast and 1 in the Southeast (SE), assessing 11 social needs (social disconnection, employment, finance, food, transportation, housing, utilities, internet access, legal needs, activities of daily living [ADL], and discrimination). We ran weighted-logistic regression models to predict the probability of experiencing four outcomes (poor access to care, no-show visits, and self-rated physical and mental health) by individual social need.</p><p><strong>Findings: </strong>More than 80% of Veterans at both sites reported ≥1 social need, with social disconnection the most common; Veterans at the SE site reported much higher rates. A total of 9 out of 11 needs were associated with higher probability of poor physical and mental health, particularly financial needs (average marginal effect [AME]: 0.21-0.32, p < 0.001) and ADL (AME: 0.27-0.34, p < 0.001). We found smaller associations between social needs and poor access to care and no-show visits.</p><p><strong>Conclusion: </strong>High prevalence of social needs in rural Veteran population and significant associations with four health outcomes support the prioritization of addressing social determinants of health for health systems. Differences in the findings between sites support tailoring interventions to specific patient populations.</p>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512023","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":"Association between obesogenic environments and childhood overweight/obesity across the United States: Differences by rurality.","authors":"Kara Davis, Demetrius A Abshire, Courtney Monroe, Caroline Rudisill, Andrew T Kaczynski","doi":"10.1111/jrh.12891","DOIUrl":"https://doi.org/10.1111/jrh.12891","url":null,"abstract":"<p><strong>Purpose: </strong>Childhood obesity is more prevalent in rural compared to urban communities and may be related to urban-rural differences in environmental factors known to affect obesity. However, understanding of how environmental factors impact childhood obesity in rural settings remains limited. This study aimed to address this gap by exploring the relationship between obesogenic environments and childhood overweight/obesity rates, including variations across the urban-rural continuum.</p><p><strong>Methods: </strong>This study analyzed data for counties in the United States (N = 3140). Linear regression models were employed to examine the relationship between the Childhood Obesogenic Environment Index, which consisted of ten variables from a variety of sources associated with physical activity and healthy eating, and childhood overweight/obesity rates estimates derived from the 2016 National Survey of Children's Health. County rurality was categorized using Rural-Urban Continuum Codes and a moderation analysis was conducted to identify potential variations by rurality.</p><p><strong>Findings: </strong>There was a significant positive association between the COEI and childhood overweight/obesity rates nationally, with notable variations across the urban-rural continuum for specific index components. Neighborhood walkability showed a significant positive association across rurality, indicating that childhood overweight/obesity rates were higher in less walkable communities. Full-service restaurants exhibited an inverse relationship with childhood overweight/obesity rates across all RUCC levels.</p><p><strong>Conclusions: </strong>These results underscore the obesogenic environmental factors associated with childhood overweight/obesity rates nationally and how they vary across the urban-rural continuum. This study highlights the importance of considering these variations when designing interventions to address childhood obesity.</p>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479344","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":"Facilitators and barriers to implementing the Diabetes Prevention Program in rural church settings: A qualitative study using the Consolidated Framework for Implementation Research.","authors":"Smita Rawal, Caleb A Snead, Frantz D Soiro, Jeffery Lawrence, Brian M Rivers, Henry N Young","doi":"10.1111/jrh.12888","DOIUrl":"https://doi.org/10.1111/jrh.12888","url":null,"abstract":"<p><strong>Purpose: </strong>The CDC's Diabetes Prevention Program (DPP) is an effective lifestyle intervention to prevent type 2 diabetes (T2D). However, DPP implementation in rural areas is limited. This study sought to address this gap by implementing DPP in rural church settings through a community-academic partnership and identifying implementation facilitators and barriers.</p><p><strong>Methods: </strong>This was a cross-sectional qualitative study. Semistructured interviews guided by the Consolidated Framework for Implementation Research (CFIR) assessed church leaders' and lifestyle coaches' perceptions of implementing DPP in rural churches. Thematic analysis was used to identify key themes through an inductive approach; then, these emergent themes were deductively linked to CFIR constructs. COREQ guidelines were used to report study findings.</p><p><strong>Findings: </strong>Twenty-five stakeholders participated. Facilitators to implementing DPP included its evidence-based effectiveness in preventing T2D, as well as support from the academic partner in terms of funding, training, and communication. Additionally, DPP's alignment with community needs, along with the active engagement of pastors in participant recruitment, supported implementation. Several barriers hindered DPP implementation, including transportation and childcare issues, as well as program participants' medical conditions/disabilities limiting their participation. Furthermore, rural residents' reluctance to adopt lifestyle changes and loyalty to family churches posed challenges to their engagement in DPP.</p><p><strong>Conclusions: </strong>This study identified contextual factors influencing DPP implementation in rural communities. Findings highlight the importance of tailored strategies that leverage facilitators while proactively addressing barriers, including rural residents' reluctance to attend programs outside their church, resistance to lifestyle changes, and transportation issues to ensure successful DPP implementation in rural areas.</p>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479345","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":"Travel burden and bypassing closest site for surgical cancer treatment for urban and rural oncology patients.","authors":"Tracy Onega, Niveditta Ramkumar, Gabriel A Brooks, Andrew P Loehrer, Nirav S Kapadia, A James O'Malley, Taressa K Fraze, Rebecca E Smith, Qianfei Wang, Sandra L Wong, Anna N A Tosteson","doi":"10.1111/jrh.12890","DOIUrl":"10.1111/jrh.12890","url":null,"abstract":"<p><strong>Purpose: </strong>We examined the relationship between travel burden for surgical cancer care and rurality, geographic bypass of the nearest surgical facility, cancer type, and mortality outcomes.</p><p><strong>Methods: </strong>Using Medicare claims and enrollment data (2016-2018) from beneficiaries with cancer of the colon, rectum, lung, or pancreas, we measured travel times to: the nearest surgical facility and facility used. For those who bypassed the nearest, we examined travel time and rurality in relation to surgical rates. Using multivariable regression modeling, we estimated associations of bypass with 90-day postoperative- and one-year mortality; rurality was examined as an effect modifier.</p><p><strong>Findings: </strong>Among 211,025 beneficiaries with cancer, 25.5% resided in non-metropolitan areas. About 66% of metropolitan/micropolitan, and 78% of small town/rural patients bypassed their closest facility. Increasing rurality was significantly associated with increased likelihood of bypass (Referent = metropolitan, OR; 95%CI: micropolitan 1.10; 1.04-1.16, small town/rural 2.08; 1.96-2.20. Bypassing the nearest facility was associated with decreased likelihood of both 90-day postoperative mortality (OR = 0.79; 95%CI 0.74-0.85) and 1-year mortality (OR = 0.81; 95%CI 0.77-0.86). The greatest decrement in 1-year mortality was for pancreatic cancer across all rural-urban categories (OR; 95%CI: metropolitan 0.63; 0.53-0.76; micropolitan 0.53; 0.29-0.97); small town/rural 0.46; 0.25-0.86).</p><p><strong>Conclusions: </strong>Most Medicare beneficiaries with lung, colon, rectal, or pancreatic cancer bypassed the closest facility providing surgical cancer care, especially rural patients. Bypassing was associated with a lower likelihood of 90-day postoperative, and 1-year mortality. Understanding determinants of bypassing, particularly among rural patients, may reveal potential mechanisms to improve cancer outcomes and reduce rural cancer disparities.</p>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479346","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":"Factors associated with early sexual onset and delaying sex in rural middle school youth.","authors":"Teresa M Imburgia, Devon J Hensel, Abby Hunt, Rebecca James, Jianjun Zhang, Michele L Cote, Mary A Ott","doi":"10.1111/jrh.12889","DOIUrl":"https://doi.org/10.1111/jrh.12889","url":null,"abstract":"<p><strong>Purpose: </strong>Early sexual onset contributes to poor health outcomes through the life course. We use the social behavioral model to examine the behaviors and attitudes associated with early sexual onset and the intention to delay sex in middle school youth.</p><p><strong>Methods: </strong>Youth in rural communities with high rates of hepatitis C and HIV filled out a survey prior to implementation of an evidence-based sex education program. Participants were asked if they had ever had sex and whether they planned to abstain from sex until the end of high school. We collected demographics, attitudes about abstinence, agency for sexual refusal, parent communication, sexual health knowledge, and history of system involvement. Logistic regression was utilized to examine factors associated with each outcome.</p><p><strong>Findings: </strong>Our sample included 6,799 students, 12.7 years old ± 0.9 and 50.3% female. 5.1% had ever had sex and 73.9% planned to abstain until the end of high school. Early sexual onset was associated with older age, negative attitudes toward abstinence, lower agency for sexual refusal, more frequent parent communication about sex, history of child welfare, and history of juvenile involvement. Planning to abstain until the end of high school was associated with being younger, female, positive attitudes toward abstinence, higher agency for sexual refusal, less communication with parents about sex, more communication with parents about relationships, not having a history of foster involvement, and not having a history of juvenile involvement.</p><p><strong>Conclusions: </strong>Age, agency, and parent communication were all associated with both outcomes. Our findings highlight the importance of early comprehensive, trauma-informed sex education.</p>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394745","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":"Perceived risks and benefits of telePrEP interventions: An interview study with rural sexual minority men in Texas.","authors":"Christopher Owens, Elizabeth Buchanan, Celia B Fisher","doi":"10.1111/jrh.12886","DOIUrl":"https://doi.org/10.1111/jrh.12886","url":null,"abstract":"<p><strong>Purpose: </strong>Many rural areas lack brick-and-mortar HIV prevention resources despite the increasing rates of HIV. Although online HIV pre-exposure prophylaxis (PrEP) programs can potentially increase uptake among rural sexual minority men (SMM), their attitudes and preferences regarding telehealth-based PrEP (telePrEP) programming are uncertain. This qualitative study examined rural SMM's perceived risks and benefits of participating in a hypothetical telePrEP program.</p><p><strong>Methods: </strong>Twenty rural SMM living in Texas completed a semi-structured online videoconferencing interview between April 12 and June 14, 2023. Data were analyzed with reflexive thematic analysis.</p><p><strong>Findings: </strong>Four themes were constructed: (1) telePrEP interventions increase accessibility but completely online services might be inadequate; (2) telePrEP and mail-order interventions are convenient but face challenges; (3) telePrEP interventions need to address confidentiality and privacy within the context of the sociopolitical climate; and (4) telePrEP interventions need to address trustworthiness and transparency.</p><p><strong>Conclusions: </strong>Overall, our results indicate that rural SMM perceive telePrEP interventions that provide at-home and telehealth PrEP, HIV testing, and HIV care services as beneficial. However, overall utility and acceptability depend on perceptions of privacy, confidentiality, trustworthiness, and transparency. Given the HIV prevention and treatment service deserts in which many rural SMM live, telePrEP interventions must purposefully demonstrate how their operations and data will remain safe and secure. Further work should explore contextual or situational factors that influence the willingness and acceptability of rural SMM to participate in online HIV prevention intervention research studies.</p>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376259","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":"Impact of rurality on health care utilization among Australian residents from 2009 to 2021.","authors":"Engida Yisma, Martin Jones, Lee San Pauh, Sandra Walsh, Sara Jones, Esther May, Marianne Gillam","doi":"10.1111/jrh.12884","DOIUrl":"https://doi.org/10.1111/jrh.12884","url":null,"abstract":"<p><strong>Purpose: </strong>In Australia, there is limited research regarding the effect of rurality on health care utilization using longitudinal data.</p><p><strong>Methods: </strong>We analyzed data from four annual waves (2009, 2013, 2017, and 2021) of the longitudinal Household, Income and Labour Dynamics in Australia (HILDA) Survey to examine changes in the health care utilization over time among urban and rural residents. Poisson regression models estimated adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CIs) for rural versus urban residents, accounting for a range of health-related and sociodemographic characteristics. Health care utilization was measured using four key indicators: visits to family doctor or another general practitioner (GP visits from hereon), hospital admissions, total nights' stay in the hospital, and prescribed medications taken on a regular basis.</p><p><strong>Results: </strong>The aIRR for GP visits among rural versus urban Australian residents increased over time, from 0.89 (95% CI: 0.82 to 0.97) in 2009 to 0.96 (95% CI: 0.89 to 1.04) in 2021 although not consistently increased in a statistically significant manner. While there were no consistent temporal patterns, our analysis found that rural residents experienced higher number of hospital admissions (aIRR, 1.12 to 1.15) and number of nights in the hospital in the last 12 months (aIRR, 1.18 to 1.25) compared to urban residents. Moreover, rurality had little to no effect on the number of prescribed medications taken on a regualar basis in the 12 months preceding the HILDA Surveys in 2013, 2017, and 2021.</p><p><strong>Conclusions: </strong>This study found that GP visits were less frequent among rural residents compared to metropolitan residents in 2009, indicating health care access disparities between rural and urban areas in Australia. However, the differences in GP visits between rural and urban areas were less pronounced  from 2013 to 2021.</p>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373398","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":"An updated model of rural hospital financial distress.","authors":"Tyler L Malone, George H Pink, George M Holmes","doi":"10.1111/jrh.12882","DOIUrl":"https://doi.org/10.1111/jrh.12882","url":null,"abstract":"<p><strong>Purpose: </strong>To create a model that predicts future financial distress among rural hospitals.</p><p><strong>Methods: </strong>The sample included 14,116 yearly observations of 2311 rural hospitals recorded between 2013 and 2019. We randomly separated all sampled hospitals into a training set and test set at the start of our analysis. We used hospital financial performance, government reimbursement, organizational traits, and market characteristics to predict a given hospital's risk of experiencing one of three financial distress outcomes-negative cash flow margin, negative equity, or closure.</p><p><strong>Findings: </strong>The model's area under the receiver operating characteristic curve (AUC) equaled 0.87 within the test set, indicating good predictive ability. We classified 30.55% of the observations in our sample as lowest risk of experiencing financial distress over the next 2 years. In comparison, we classified 32.52% of observations as mid-lowest risk of distress, 26.40% of observations as mid-highest risk, and 10.52% of observations as highest risk. Among test set observations classified as lowest-risk, 5.78% experienced negative cash flow margin within 2 years, 1.50% experienced negative equity within 2 years, and zero observations experienced closure within 2 years. Within the highest-risk group, 61.57% of observations experienced negative cash flow margin, 43.02% experienced negative equity, and 3.33% experienced closure.</p><p><strong>Conclusions: </strong>Given the ongoing challenges and consequences of rural hospital unprofitability, there is a clear need for accurate assessments of financial distress risk. The financial distress model can be used by researchers, policymakers, and rural health advocates as a screening tool to identify at-risk rural hospitals for closer monitoring.</p>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373396","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":"Association of rurality and health professional shortages with the clinicopathologic characteristics of melanoma in North Carolina.","authors":"Michael Seth Flynn, Matthew Gayed, Jamie Lebhar, Jennifer Jacobs, Christian Bailey-Burke, Kristin Tissera, Beiyu Liu, Cynthia Green, Michelle B Pavlis, Paul J Mosca","doi":"10.1111/jrh.12881","DOIUrl":"https://doi.org/10.1111/jrh.12881","url":null,"abstract":"<p><strong>Purpose: </strong>To assess rural-urban and health professional shortage area (HPSA)-related influences on the characteristics of melanoma in North Carolina.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study of patients living in North Carolina with an available pathology report for invasive cutaneous melanoma seen in the Duke University Health System from 01/01/2014 to 12/31/2020. Multivariable logistic regression models were employed to compare patient and tumor characteristics between rural versus urban county residence as well between melanoma thicknesses dichotomized into thin (≤1.0 mm) and thicker (>1.0 mm) tumors.</p><p><strong>Findings: </strong>The cohort included 807 patients, and rural patients accounted for 177 (21.9%) of invasive cutaneous melanomas. Rural patients had significantly higher odds of having thicker tumors than urban patients (odds ratio [OR] = 1.78, 95% confidence interval [CI]: 1.17-2.71; P = .008). Rural patients were significantly more likely to be female (OR = 1.59, 95% CI: 1.10-2.28; P = .013) and located in a population-based (OR = 2.66, 95% CI: 1.84-3.84; P<.001) or geographic-based (OR = 8.21, 95% CI: 3.33-20.22; P<.001) HPSA. Living in a medium- or high-shortage population-based HPSA was associated with higher odds of thicker tumors (OR = 2.65, 95% CI: 1.85-3.80; P<.001).</p><p><strong>Conclusions: </strong>Patients living in rural North Carolina counties were more likely than those in urban counties to be diagnosed with melanomas >1.0 mm in thickness, a clinically significant difference with important prognostic implications. Interventions at the county- and state-level to address this disparity may include improving access to skin cancer screening and teledermatology programs, increasing partnerships with primary care providers, and targeting interventions to counties with health professional shortages.</p>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373397","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}