Journal of Rural Health最新文献

{"title":"Sexualized drug use factors among rural sexual minority men","authors":"Christopher Owens PhD, MPH,&nbsp;Benjamin N. Montemayor PhD","doi":"10.1111/jrh.12917","DOIUrl":"10.1111/jrh.12917","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Although rural sexual minority men (SMM) use substances immediately before/during sex (i.e., sexualized drug use), the factors contributing to this behavior are unknown. We examined the factors associated with past year sexualized drug use among rural SMM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Rural SMM in the Southern region of the United States (<i>N</i> = 345) completed an online cross-sectional survey from February to March 23, 2024. Participants answered questions about their sexualized drug use behaviors, sexual behaviors, minority stressors, and demographics. We conducted a hierarchical logistic regression to estimate the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with past year sexualized drug use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Over three-quarters of participants (79.7%) used substances immediately before/during sex in the past year. Sexualized drug use was associated with exposure to sexual minority stressors, polysubstance use, sexually transmitted infection testing, having oral sex, receiving drugs from a man in exchange for sex, and older age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Sexualized drug use is prevalent among rural SMM, and sexual minority stressors and past year sexual risk and substance misuse behaviors were contributing factors. Rural primary care clinics, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) service organizations, and outpatient and inpatient substance use organizations should implement integrative sexual and substance use screening, counseling, and referral services for their rural clients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958012","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":"Determinants of HIV pre-exposure prophylaxis (PrEP) use among men who have sex with men (MSM) living in rural areas of the United States: A scoping review framed by the PrEP care continuum","authors":"Andrew M. O'Neil MPH,&nbsp;Randolph D. Hubach PhD, MPH,&nbsp;Christopher Owens PhD, MPH,&nbsp;Jennifer L. Walsh PhD,&nbsp;Katherine G. Quinn PhD,&nbsp;Steven A. John PhD, MPH","doi":"10.1111/jrh.12916","DOIUrl":"10.1111/jrh.12916","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>HIV pre-exposure prophylaxis (PrEP) is a highly effective intervention to prevent HIV transmission among men who have sex with men (MSM). Despite its effectiveness, PrEP uptake and adherence among MSM in the United States remain suboptimal, particularly in rural areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The present study presents a scoping review of the self-reported barriers and facilitators of PrEP use among MSM living in rural areas of the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Preferred Items for Systematic Reviews—Extension for Scoping Reviews (PRISMA-ScR) guidelines informed this review. Seven online databases were searched to identify papers published from 2012 to 2023 in English with keywords related the concepts of MSM, rural, and HIV PrEP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From an initial 340 articles, nine were selected. Awareness significantly impacts PrEP uptake in rural areas, with challenges including limited dissemination of information through mainstream channels and low perceived HIV risk among rural MSM. However, nonmainstream information sources can enhance PrEP awareness and use. Several barriers hinder rural residents from accessing PrEP, such as a lack of competent providers, geographic isolation, cost, and stigma. High PrEP care costs, lack of financial assistance for lab work, and limited telePrEP options are key challenges in retaining individuals in PrEP care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Suboptimal PrEP uptake in rural areas with high HIV burden remains a concern, hindered by limited information dissemination, low perceived HIV risk, geographic isolation, nonaffirming medical providers, and expensive PrEP care. Leveraging telePrEP, co-pay assistance, 340B drug pricing, and geospatial networking apps can enhance PrEP use. Multilevel interventions are crucial to combat the HIV epidemic in rural regions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958011","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":"Well-being interventions for rural health professionals: A scoping review","authors":"Skye McKennon PharmD, BCPS, ACSM-GEI,&nbsp;Suzanne Fricke DVM, MLIS,&nbsp;Dawn DeWitt MDMSc, CMedEd, MACP, FRACP, FRCP-London","doi":"10.1111/jrh.12909","DOIUrl":"10.1111/jrh.12909","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The objective of this scoping review is to identify interventions to promote well-being that have been tried or proven effective to prevent or address burnout in rural health care professionals and trainees (HCPTs). Secondarily, we aimed to identify potentially applicable and feasible well-being interventions that could help rural HCPTs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and analysis</h3>\u0000 \u0000 <p>We used PRISMA guidelines to conduct a scoping review of peer-reviewed English language studies, from all countries, published in core health sciences databases. We focused on intervention studies for burnout and well-being in rural HCPTs published from July 2013 to January 2024. Searches identified 571 studies; 18 additional studies were identified from hand searches of websites, reviews, and bibliographies identified in the original search strategy. Two authors screened and extracted all data using Covidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>After deduplication, 507 studies were screened for inclusion, and 50 full-text studies were assessed for eligibility. After discussion and consensus, 30 studies were selected for inclusion. We included selected “applicable” studies, for example, online interventions. We excluded potentially applicable studies that would not be feasible in rural settings, that is, health system interventions requiring substantial personnel and infrastructure. Interventions included individual interventions (eg, mindfulness), increased support for professionals (eg, remote pharmacist assistance), and interventions to improve quality or teamwork.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Few interventional studies have been done to support well-being and prevent burnout in vulnerable rural HCPTs. While individual interventions, such as mindfulness, are most effective to date, studies replicating or extending these interventions, and to identify supports that address workload and systems issues are needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11701247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933401","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":"What cancers explain the growing rural-urban gap in human papillomavirus-associated cancer incidence?","authors":"Jason Semprini PhD, MPP,&nbsp;Whitney Zahnd PhD,&nbsp;Heather M. Brandt PhD","doi":"10.1111/jrh.12915","DOIUrl":"10.1111/jrh.12915","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Human papillomavirus (HPV) can cause cancers of the genital system, anus/rectum, and oropharynx. Prior research showed that HPV-associated cancer incidence was rising faster in nonmetro than in metro populations. Our study identified which cancers contributed to the widening disparity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Representing ∼93% of all cancers in the United States, we analyzed data from the North American Association of Central Cancer Registries (2000-2019). Restricting the analysis to HPV-associated cancers, we compared 5-year average age-adjusted incidence rates (per 100,000 population) for nonmetropolitan (Rural-Urban Continuum Codes 4-9) and metropolitan populations, by sex and cancer site. To quantify the rural-urban gap, we calculated rate ratios and absolute differences of incidence trends.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Although incidence was similar in 2000-2004 (nonmetropolitan = 9.9; metropolitan = 9.9), incidence in 2015-2019 was significantly higher in nonmetropolitan (12.3) than metropolitan (11.1) populations. The gap was widest for cervical cancers (females) in 2015-2019 (1.0 case per 100,000) but grew the most since 2000-2004 in oropharyngeal cancers among males (+1.1 cases per 100,000). The nonmetropolitan rate ratios for females (RR = 1.15, 95% C.I. = 1.13, 1.17) and males (RR = 1.07, 95% C.I. = 1.05, 1.09) in 2015-2019 were higher than the respective RRs for all other years. Since 2000, the nonmetropolitan disparity has significantly grown for anal and cervical cancers in females, and oropharyngeal cancers in both sexes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Although preventable, nonmetropolitan Americans have shouldered a growing burden of HPV-associated cancers. To address these cervical, anal, and oropharyngeal cancer disparities, it is imperative that HPV vaccination programs are effectively implemented at scale.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.12915","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933404","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":"Social determinants of contraception use among rural adolescents: Implications for addressing disparities","authors":"Asia S. Bishop MSW, PhD,&nbsp;Paula S. Nurius MSW, PhD,&nbsp;Ashley N. Rousson MSW, PhD,&nbsp;Anindita Bhattacharya MSW, PhD,&nbsp;Ella B. Baumgarten MPH","doi":"10.1111/jrh.12901","DOIUrl":"10.1111/jrh.12901","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Few studies have examined disparities in—and social determinants of—contraception use among rural adolescents despite evidence of higher teen birth rates and greater STI risk in rural communities. Guided by a social determinants of health (SDoH) framework, this cross-sectional study aimed to address these gaps.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data come from the 2018 Healthy Youth Survey, including <i>N</i> = 3757 sexually active, rural-based adolescents. Chi-square and independent samples <i>t</i>-tests examined group differences in rates of self-reported contraception use (condoms and any form of contraception) at last sex. Logistic regression models examined associations between SDoH factors (social/community, economic, and health care access) and contraception use outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Contraception use disparities were observed for rural-based youth identifying as Black, Asian, Indigenous, and Latino/a/x/e; lesbian, gay, bisexual, and questioning their sexual identity (LGBQ); and those experiencing poverty. Regression models accounting for youth characteristics found that SDoH factors across the social/community domain—but not economic or health care access—were the strongest predictors of contraception use outcomes. In these models, LGBQ status remained negatively associated with contraception use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rural disparities in contraception use, particularly for marginalized youth, call for service approaches that are relevant and responsive to diverse needs. Findings also suggest that rural disparities are influenced by a complex interplay of social factors, where existing health care resources may not sufficiently mitigate youths’ adverse living conditions. Addressing contraception use disparities in rural communities will require greater uptake of comprehensive sexuality education and multilevel service approaches that attend to youths’ social contexts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899922","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":"Addressing substance use disorder-related stigma in rural communities using Community Conversations","authors":"Lisham Ashrafioun PhD,&nbsp;Tedra Cobb MSEd,&nbsp;Ken Sayres MA,&nbsp;Christina Cretelle MBA","doi":"10.1111/jrh.12900","DOIUrl":"10.1111/jrh.12900","url":null,"abstract":"","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899894","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 divide in risk perception of LSD: Implications for psychedelic-assisted therapy","authors":"Melissa Bradley MPH,&nbsp;Daniel Grossman MA,&nbsp;Otto Simonsson PhD,&nbsp;Heith Copes PhD,&nbsp;Peter S. Hendricks PhD","doi":"10.1111/jrh.12906","DOIUrl":"10.1111/jrh.12906","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recent legislative initiatives in the United States have focused on the medical and legal status of psychedelics, prompting interest in understanding public perceptions of their risks. This study investigates rural-urban differences in the perception of LSD and cannabis risks using national survey data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from the National Survey of Drug Use and Health (NSDUH) between 2015 and 2021 were analyzed. Logistic regression models were used to compare risk perceptions of LSD and cannabis between rural and urban respondents, adjusting for relevant factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Rural residents were 1.2 to 1.4 times more likely to perceive using LSD once or twice as of great risk compared to urban residents during the survey period. However, the perception of monthly cannabis use as having great risk was slightly higher among rural residents only until 2019, with no significant differences observed in 2020 and 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study highlights a significant rural-urban divide in the perception of LSD risk, which could impact policymaking on psychedelic therapies. Understanding these differences is crucial for developing effective and equitable policies regarding psychedelic substances and treatments.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899911","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":"POSITION STATEMENT: Support policies to address opioid use disorder among rural communities","authors":"Lisa R. LaRowe PhD,&nbsp;Heather K. Hardin PhD, RN,&nbsp;Amy M. Goetzinger PhD,&nbsp;Kristen R. Fox PhD,&nbsp;Rebecca Kilpatrick PhD,&nbsp;Elizabeth K. Seng PhD,&nbsp;Roger Figueroa PhD, MPH, MSc","doi":"10.1111/jrh.12899","DOIUrl":"10.1111/jrh.12899","url":null,"abstract":"","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899910","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":"Medicare Advantage and rural hospital profitability","authors":"Young H. Kim MSPH,&nbsp;Kristin L. Reiter PhD,&nbsp;Kristie W. Thompson MA,&nbsp;George H. Pink PhD","doi":"10.1111/jrh.12905","DOIUrl":"10.1111/jrh.12905","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study compares 2018–2023 Medicare Advantage (MA) days as a percentage of total Medicare days in rural and urban hospitals, describes 2022–2023 operating profitability of rural and urban hospitals by quartiles of MA days as a percentage of total Medicare days, and explores hospital characteristics that may be important for understanding the relationship between MA and profitability of rural hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Financial and hospital data were obtained from the Centers for Medicare &amp; Medicaid Services (CMS) Healthcare Cost Report Information System (HCRIS) for the years 2018 to 2023. Hospitals were assigned to quartiles based on MA days as a percentage of total Medicare days. Descriptive analyses were conducted to compare hospital characteristics and financial performance across quartiles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Between 2018–2019 and 2022–2023, the median percentage of total Medicare days from MA grew from 11.3% to 28.0% for rural hospitals. The 2022–2023 median operating margin varied from 0.0% for rural hospitals in Q1 (lowest MA days as a percentage of total Medicare days) to 3.4% for hospitals in Q4 (highest MA days as a percentage of total Medicare days).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Among rural hospitals, higher MA days as a percentage of total Medicare days was found to be associated with higher operating margin. However, results suggest that MA is not randomly distributed: rural hospitals with higher MA days as a percentage of total Medicare days exhibit distinct characteristics. This non-random distribution suggests that descriptive analysis may not fully capture the actual financial impact of MA on rural hospitals. Future research should recognize these complexities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899907","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":"A descriptive examination of rurality in the Environmental influences on Child Health Outcomes Cohort: Implications, illustrations, and future directions","authors":"Lacey A. McCormack PhD,&nbsp;Debra A. MacKenzie PhD,&nbsp;Arielle Deutsch PhD,&nbsp;Daniel Beene PhD,&nbsp;Christine W. Hockett PhD,&nbsp;Katherine Ziegler MPH,&nbsp;Emily A. Knapp PhD,&nbsp;Amii M. Kress PhD,&nbsp;Zone R. Li BS,&nbsp;Shivani Bakre MHS,&nbsp;Rima Habre ScD,&nbsp;Lisa Jacobson ScD,&nbsp;Margaret R. Karagas PhD,&nbsp;Kaja LeWinn ScD,&nbsp;Sara S. Nozadi PhD,&nbsp;Akram Alshawabkeh PhD,&nbsp;Izzuddin M. Aris PhD,&nbsp;Traci A. Bekelman PhD,&nbsp;Casper G. Bendixsen PhD,&nbsp;Carlos Camargo MD, DrPH,&nbsp;Andrea E. Cassidy-Bushrow PhD,&nbsp;Lisa Croen PhD,&nbsp;Ferrara Assiamira MD, PhD,&nbsp;Rebecca Fry PhD,&nbsp;Tebeb Gebretsadik MPH,&nbsp;Tina Hartert MD,&nbsp;Kelly A. Hirko PhD,&nbsp;Catherine J. Karr MD, PhD,&nbsp;Itai Kloog PhD,&nbsp;Christine Loftus PhD,&nbsp;Kelsey E. Magee PhD,&nbsp;Cindy McEvoy MD,&nbsp;Jenae M. Neiderhiser PhD,&nbsp;Thomas G. O'Connor PhD,&nbsp;Mike O'Shea MD,&nbsp;Jennifer K. Straughen PhD,&nbsp;Audrey Urquhart MPH,&nbsp;Rosalind Wright MD,&nbsp;Amy J. Elliott PhD,&nbsp;for the ECHO Cohort Consortium","doi":"10.1111/jrh.12908","DOIUrl":"10.1111/jrh.12908","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The Environmental influences on Child Health Outcomes (ECHO) Cohort has enrolled over 60,000 children to examine how early environmental factors (broadly defined) are associated with key child health outcomes. The ECHO Cohort may be well-positioned to contribute to our understanding of rural environments and contexts, which has implications for rural health disparities research. The present study examined the outcome of child obesity to not only illustrate the suitability of ECHO Cohort data for these purposes but also determine how various definitions of rural and urban populations impact the presentation of findings and their interpretation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This analysis uses data from children in the ECHO Cohort study who had residential address information between January 2010 and October 2023, including a subset who also had height and weight data. Several rural-urban classification schemes were examined with and without collapsing into binary rural/urban groupings (ie, the Rural-Urban Continuum Codes, 2010 Rural-Urban Commuting Area [RUCA] Codes, and Urban Influence Codes).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Various rural/urban definitions and classification schemes produce similar obesity prevalence (17%) when collapsed into binary categories (rural vs urban) and for urban participants in general. When all categories within a classification scheme are examined, however, the rural child obesity prevalence ranges from 5.8% to 24%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Collapsing rural-urban classification schemes into binary groupings erases nuance and context needed for interpreting findings, ultimately impacting health disparities research. Future work should leverage both individual- and community-level datasets to provide context, and all categories of classification schemes should be used when examining rural populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899892","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}