Journal of Rural Health最新文献

{"title":"An exploratory study to understand how rurality status and demographic characteristics are associated with enrollment, engagement, and retention in a digital health intervention targeting the Appalachian region","authors":"Donna-Jean P. Brock  ,&nbsp;Lee M. Ritterband  ,&nbsp;Wen You  ,&nbsp;Annie L. Reid  ,&nbsp;Kathleen J. Porter  ,&nbsp;Theresa Markwalter  ,&nbsp;Jamie M. Zoellner","doi":"10.1111/jrh.70042","DOIUrl":"https://doi.org/10.1111/jrh.70042","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Digital health studies exploring group disparities across research phases are limited. As a secondary aim of a larger digital health trial, this study explored how rurality and other sociodemographics were associated with enrollment, retention, and engagement in a randomized controlled sugar-sweetened beverage (SSB) reduction trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants from a primarily Appalachian sample were randomized into <i>i</i>SIPsmarter (experimental) or static Patient Education (control) websites. Enrollment, retention (6 months), and <i>i</i>SIPsmarter engagement (completion of metered program Core content and SSB and weight diaries) were collected from July 2021 to August 2023. Regression models assessed subgroup associations using Rural Urban Continuum Codes (RUCC), sex, race, age, income, education, and other sociodemographic predictors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Of the 509 eligible participants, 249 (49%) enrolled, and 218 (88%) were retained. Participants were predominantly White (89%), college-educated (59%) females (83%) with household incomes &lt;$55,000/year (52%). Rurality varied: RUCC 1-2 (medium-large metro) = 15%, RUCC 3 (small metro) = 45%, and RUCC 4-9 (nonmetro) = 41%. On average, <i>i</i>SIPsmarter participants (n = 127) completed 4.89/6 (SD = 1.69) Cores and 76% (SD = 29%) and 57% (SD = 31%) of SSB and weight diaries. Rurality was a nonsignificant predictor, but higher education and health literacy increased enrollment likelihood by 37% (95% CI = 1.12-1.67) and 23% (95% CI = 1.03-1.47), respectively. Greater education (OR = 1.51, 95% CI = 1.00-2.29), age (OR = 1.04, 95% CI = 1.01-1.07), and income (OR = 1.13, 95% CI = 1.00-1.28) significantly predicted retention. Older age significantly (<i>P</i>&lt;.05) predicted the completion of Cores and diaries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Results suggested rurality was not significantly associated with enrollment, retention, or engagement, though this conclusion warrants caution. Future digital health studies targeting similar populations should consider additional sociodemographic differences.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281484","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":"Evolution of the US nonmetropolitan mortality disadvantage by sex, state, and year, 1999-2019","authors":"Eugenio Paglino PhD,&nbsp;Irma T. Elo PhD,&nbsp;Samuel H. Preston PhD,&nbsp;Katherine Hempstead PhD,&nbsp;Andrew C. Stokes PhD","doi":"10.1111/jrh.70040","DOIUrl":"https://doi.org/10.1111/jrh.70040","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To examine disparities in nonmetropolitan and metropolitan mortality by state and sex from 1999 to 2019.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We calculate age-standardized mortality rates for nonmetropolitan and metropolitan areas by state and sex and compute age-standardized differences in these rates within each state and relative to the national average. We further estimate the number of excess deaths in nonmetropolitan areas by state. These are deaths that would have been avoided if nonmetropolitan areas had the same age-specific death rates as metropolitan areas in the same state.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>We document increasing nonmetropolitan mortality disadvantage since 1999 along with significant variation in the magnitude and timing of its emergence by state. Although stagnation in mortality was observed nationally in the mid-2010s, this was not true in all states or in all metropolitan and nonmetropolitan areas. Additionally, mortality trends became progressively more discordant across and within states. Despite this heterogeneity, we document a steady increase in the number of nonmetropolitan excess deaths from 8,400 in 1999 to 47,000 in 2019, representing 9.0% of all nonmetropolitan deaths.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>National-level mortality trends mask geographic variation by nonmetropolitan and metropolitan areas within and across states. Further research is needed to identify factors that contribute to these divergent patterns.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281570","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":"Exploring telehealth adoption and financial outcomes for rural hospitals during the COVID-19 public health emergency","authors":"Saleema A. Karim PhD,&nbsp;J. Mick Tilford PhD,&nbsp;Cari A. Bogulski PhD,&nbsp;Corey J. Hayes MPH, PharmD, PhD,&nbsp;Hari Eswaran PhD","doi":"10.1111/jrh.70038","DOIUrl":"https://doi.org/10.1111/jrh.70038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To examine factors associated with rural hospital telehealth adoption during the COVID-19 public health emergency (PHE), and evaluate its relationship with rural hospital financial performance before and during the PHE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This panel study used retrospective data (2017–2021) from the American Hospital Association Annual Survey, the Centers for Medicare &amp; Medicaid Services Healthcare Cost Report Information Systems, and the Area Health Resource File. Rural hospitals were categorized as persistent adopters, persistent nonadopters, or switchers based on telehealth adoption status. Bivariate analyses assessed differences in subgroup means and frequencies, while a difference-in-difference model estimated the impact of telehealth adoption on rural hospital financial performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Telehealth adoption varied among rural hospitals. Before the PHE, 75% (751) of rural hospitals had adopted telehealth, while 25% (247) were nonadopters. Despite efforts to promote remote care delivery during the PHE, 58% (144) of pre-PHE nonadopters did not adopt telehealth. Among the 42% (103) that did adopt telehealth during the PHE, no statistically significant effect was observed on operating or total margins.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Rural hospitals in economically disadvantaged and sparsely populated areas, which stand to benefit the most from telehealth adoption, often face substantial barriers that limit their ability to adopt this technology. Financial constraints and limited resources continue to hinder adoption, underscoring the need for targeted policies and investments to expand telehealth access and improve health care outcomes in rural communities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148581","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":"Obstetric care in rural critical access hospitals: A domestic application of the World Health Organization Emergency Obstetric Care framework in rural communities","authors":"Annie L. Glover PhD, MPH, MPA,&nbsp;Diane Brown MPH,&nbsp;Carly Holman MS,&nbsp;Megan Nelson MSW","doi":"10.1111/jrh.70037","DOIUrl":"https://doi.org/10.1111/jrh.70037","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Pregnancy-related mortality has increased steadily over the last 30 years in the United States; during the same period, rural communities have lost access to care as rural hospitals and obstetric units have shut their doors. Rural critical access hospitals (CAHs) are often the only option for a pregnant person in a rural community needing emergency care. This study aimed to apply a uniform assessment of the capacity of hospitals that do not have obstetric units to meet the emergency obstetric care needs of the rural communities they serve, with the goal of facilitating ongoing obstetric emergency readiness assessments that can be used in the rural context.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study team conducted facility assessments across Montana's statewide system of hospital care. The Centers for Disease Control and Prevention (CDC) Levels of Care Assessment Tool (LOCATe) was used in hospitals with an obstetrics unit (<i>N</i> = 25). The team adapted the World Health Organization (WHO) Emergency Obstetric Care (EmOC) framework to assess readiness in hospitals without an obstetrics unit (<i>N</i> = 34) but with Emergency Medical Treatment and Labor Act (EMTALA)-based obligations to patients presenting to emergency departments with obstetric emergencies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>None of the responding hospitals without obstetric units met criteria indicating readiness to provide comprehensive emergency obstetric care (CEmOC), and only one hospital met criteria indicating readiness to provide basic emergency obstetric care (BEmOC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Significant work must be done to bring CAHs up to a level of readiness where they can safely and effectively screen, stabilize, and transfer or accept an obstetric emergency. The WHO EmOC framework can provide a starting point for assessing the capacity of hospitals without obstetric units, but a standardized assessment, such as LOCATe, should be developed to improve readiness for obstetric emergencies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144125964","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":"Development of chronic pain and high-impact chronic pain across the US rural–urban continuum, 2019–2020","authors":"Feinuo Sun PhD,&nbsp;Yulin Yang PhD,&nbsp;Richard L. Nahin MPH, PhD","doi":"10.1111/jrh.70036","DOIUrl":"https://doi.org/10.1111/jrh.70036","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Rural health disadvantages are well documented in previous literature; however, research on rural–urban disparities in chronic pain outcomes is scarce. This paper fills this gap by examining pain prevalences and longitudinal transitions across the rural–urban continuum (i.e., large central metro, large fringe metro, medium and small metro, and nonmetropolitan).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Based on the 2019–2020 National Health Interview Survey Longitudinal Cohort (NHIS-LC) data, we examined the disparities in pain prevalences and transitions among different pain statuses, including no pain, nonchronic pain, chronic pain, and high-impact chronic pain (HICP), across the rural–urban continuum and by age, sex, race/ethnicity, and region. A test for linear trend was conducted to examine the significance of linear changes across the rural–urban continuum.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>The findings reveal significant linear increases in the prevalence of chronic pain and HICP, as well as transitions from no pain to nonchronic pain and from nonchronic pain to more severe pain conditions, along the continuum from metropolitan to nonmetropolitan areas. Subgroup analyses indicate that rural–urban gaps are most pronounced among middle-aged (45–64) groups and non-Hispanic Whites.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This longitudinal analysis provides new evidence on rural–urban health disparities by focusing on pain, highlighting the urgent need to enhance health care services in remote and rural areas for effective pain prevention and management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144117888","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":"Care packages to promote universal suicide prevention for remote Alaska Native communities: What worked?","authors":"Joshua Kennedy MPH,&nbsp;Lisa Wexler PhD,&nbsp;Tara Schmidt MPH,&nbsp;Suzanne Rataj MPH,&nbsp;Josie Garnie AAS,&nbsp;Roberta Moto BSW,&nbsp;Zinan Tao MSW,&nbsp;Lauren White MPH, MSW,&nbsp;Diane McEachern PhD","doi":"10.1111/jrh.70032","DOIUrl":"https://doi.org/10.1111/jrh.70032","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Alaska Native (AN) youth living in remote Alaska suffer disproportionately from suicide when compared to all other American youth. Promoting Community Conversations About Research to End Suicide (PC CARES) is an intervention led by trained community facilitators, which shares scientific best practices to prevent youth suicide with community adults to spark feasible, culturally tailored personal and collective action. After training 34 AN facilitators to implement PC CARES in their home communities in late 2019, COVID-19 precluded in-person PC CARES activities, but the need to help adults support youth mental health during this period of quarantine and social distancing remained.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>The resulting adapted “PC CARES at Home” intervention delivered mail-based mental wellness and suicide prevention information and resources to adult community members from June 2020 to July 2022. The project sent 1527 care packages to 492 participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Finding</h3>\u0000 \u0000 <p>According to short surveys (<i>n</i> = 199) and interviews done with randomly selected recipients (<i>n</i> = 24), adults who received the PC CARES care packages were very satisfied with the contents and found them useful.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Both acceptance and utility of mental health and safety promotion care packages has implications for offering information and resources to adults in remote communities to support them in promoting youth mental wellness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144074484","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":"Identifying risk factors for adverse lung health outcomes among rural Appalachian women","authors":"Jessica R. Thompson PhD,&nbsp;Courtney J. Walker PhD,&nbsp;John C. Flunker PhD,&nbsp;W. Jay Christian PhD,&nbsp;Wayne T. Sanderson PhD,&nbsp;Nancy E. Schoenberg PhD,&nbsp;Steven R. Browning PhD","doi":"10.1111/jrh.70035","DOIUrl":"https://doi.org/10.1111/jrh.70035","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Despite high rates of lung disease and lung cancer among women, few studies have focused on adverse lung health risk factors among rural Appalachian women. We aim to describe the prevalence of demographic, behavioral, and economic characteristics among a cohort of rural Appalachian women and ascertain the association between these risk factors and lung function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Through a cross-sectional study in two rural Appalachian Kentucky counties (2015–2017), we collected demographics, health history/behaviors, and lung function via pulmonary function tests. Restricting to female participants with interpretable pulmonary function tests (<i>N</i> = 456), we estimated prevalence ratios of the association between individual-level characteristics and lung function using log binomial regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Reduced lung function was high among this sample, including 20.8% with restrictive function and 18.4% with obstructive function. After adjustment, those age 65+ had 7× the prevalence of obstructive function compared to those &lt;45 years, and current smokers had 6× the prevalence of never-smokers. Conversely, those age 45–64 had over 5× the prevalence of restrictive function compared to those &lt;45 years, and participants with an obese-classified BMI or 2+ co-morbidities had nearly 4× the prevalence of restrictive function compared to those with normal BMI or without a comorbid condition, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study highlights the high levels of reduced lung function among rural Appalachian women, including varying risk factors between those with restrictive and obstructive function. The high prevalence of restrictive function among middle-aged women with high BMI, poor cardiovascular health, and multiple comorbidities suggests the need for culturally tailored health behavior interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143944425","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":"Continuity of pain clinic care among rural and urban veterans","authors":"Katherine Hadlandsmyth PhD,&nbsp;Rena E. Courtney PhD,&nbsp;Jenna L. Adamowicz PhD,&nbsp;Mary A. Driscoll PhD,&nbsp;Jennifer L. Murphy PhD,&nbsp;Brian C. Lund PharmD","doi":"10.1111/jrh.70031","DOIUrl":"https://doi.org/10.1111/jrh.70031","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>In the context of increased access to multidisciplinary pain team care in the veterans health administration (VHA) in recent years, the current study sought to determine whether continuity of pain clinic care varied for rural compared to urban veterans, following an initial pain clinic visit. Specifically, the frequency of general pain clinic visits and pain clinic psychology visits were contrasted between rural and urban veterans in 2015 and 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>National VHA administrative data were used to build two cohorts of veterans with an initial pain clinic visit in 2015 or 2022. Number of pain clinic visits and number of pain clinic psychology visits in the following year were calculated. Multivariable regression models examined rural/urban differences in receipt of follow-up pain clinic visits and receipt of follow-up pain psychology visits in both 2015 and 2022, after adjusting for demographic characteristics and psychiatric comorbidity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Veterans with an initial pain clinic visit increased by 22.5% from 2015 (<i>n</i> = 95,549) to 2022 (<i>n</i> = 117,044) and included about one-third rural veterans in both years. Rural veterans had lower rates of follow-up pain clinic visits in 2015 (adjusted odds ratio [aOR]: 0.85; 95% confidence interval [CI]: 0.82–0.87) and this gap remained, but narrowed, by 2022 (aOR: 0.92; 95% CI: 0.90–0.95). The gap in pain psychology follow-up visits, however, disappeared between 2015 (adjusted incidence rate ratio [aIRR]: 0.88; 95% CI: 0.81–0.95) and 2022 (aIRR: 1.00; 95% CI: 0.93–1.08).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The rural gap in continuity of specialty pain clinic services for veterans has improved across time, particularly in relation to pain clinic psychology visits.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143930234","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":"Risks of adverse health outcomes among older rural prostate cancer survivors in the SEER-Medicare data","authors":"Chun-Pin Chang (Esther) PhD,&nbsp;Daren Huang MPH,&nbsp;Shane Lloyd MD,&nbsp;N. Lynn Henry MD, PhD,&nbsp;Brock O'Neil MD,&nbsp;Mia Hashibe PhD","doi":"10.1111/jrh.70029","DOIUrl":"https://doi.org/10.1111/jrh.70029","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Rural prostate cancer patients face challenges such as greater distance for cancer treatment and care fragmentation. There have been very few studies investigating adverse health outcomes among prostate cancer survivors residing in rural areas. A comprehensive evaluation of adverse health outcomes among rural prostate cancer patients is needed to understand potential health disparities and provide scientific evidence for interventions. The aims of this study were to investigate prevalent and incident adverse health outcomes among older rural prostate cancer survivors compared to urban prostate cancer survivors in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The SEER-Medicare linked database was used to identify first primary prostate cancer survivors. Fine-Gray subdistribution hazard models were utilized to estimate hazard ratios (HR) and 95% confidence intervals (CI), comparing rural prostate cancer patients to urban prostate cancer patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 37,126 rural prostate cancer survivors and 109,176 urban prostate cancer survivors were identified. We observed that rural prostate cancer survivors had a higher prevalence of rheumatoid arthritis/osteoarthritis (22.1% vs 20.9%; <i>P</i>-value &lt;.001) and chronic obstructive pulmonary disease (COPD)/bronchiectasis (14.2% vs 10.5%; <i>P</i>-value &lt;.001). A higher incident risk of acute myocardial infarction, COPD/bronchiectasis, hip pelvic fracture, and rheumatoid arthritis/osteoarthritis among rural prostate cancer was observed compared to their urban counterparts &gt;5 years after cancer diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study provides important results on the prevalence and incident adverse health outcomes among older rural prostate cancer survivors. Further investigation into how other factors influence these disparities is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143925934","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":"The relationship between low social/emotional support and health care affordability among rural and urban residents","authors":"Ingrid Jacobson MPH,&nbsp;Katie Rydberg MPH,&nbsp;Alexis Swendener PhD,&nbsp;Hannah MacDougall PhD, MSW,&nbsp;Carrie Henning-Smith PhD, MPH, MSW","doi":"10.1111/jrh.70034","DOIUrl":"https://doi.org/10.1111/jrh.70034","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Social/emotional support can help to buffer the health and financial impacts of health care costs. However, little research examines differences in social/emotional support as it relates to health care affordability, and even less examines these issues by rurality despite rural/urban differences in health and health care access. This study addresses these gaps by examining differences in social/emotional support and health care affordability issues among rural and urban adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using weighted data from the 2020 and 2021 National Health Interview Survey (<i>n</i> = 44,987), we examined differences in three health care affordability issues: worry about medical bills, problems paying medical bills, and inability to pay medical bills. We conducted bivariate and multivariate logistic regression analyses comparing these issues by rurality, social/emotional support, and other sociodemographic and health characteristics, generating adjusted odds ratios and predicted probabilities of these issues.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Rural residents were more likely to report problems paying and inability to pay medical bills (13.0% vs. 10.2%, <i>p</i> &lt; 0.001; 8.2% vs 6.2%, <i>p</i> &lt; 0.001). Sociodemographic and health covariates were differentially associated with adjusted odds of health care affordability issues, while low social/emotional support was associated with higher adjusted odds and adjusted predicted probabilities of all three health care affordability issues in both rural and urban areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Low social/emotional support is associated with higher odds and predicted probabilities of all health care affordability issues regardless of rurality. Future policy aimed at reducing medical debt in rural areas should consider the beneficial impacts of social/emotional support.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143919896","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}