Journal of Rural Health最新文献

{"title":"Rural community members’ experiences and perceptions regarding lethal means safety in the context of suicide and accidental death rates","authors":"Molly E. Penzenik MPH,&nbsp;Alexandra L. Schneider BA,&nbsp;Claire A. Hoffmire PhD,&nbsp;Joanna R. Sells PhD,&nbsp;Kelly A. Stearns-Yoder MA,&nbsp;Lisa A. Brenner PhD","doi":"10.1111/jrh.70103","DOIUrl":"10.1111/jrh.70103","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Together with Veterans (TWV), a community-based suicide prevention intervention, is being implemented in rural locations across the United States, with individuals designing and implementing action plans based on community-specific strengths and needs. To increase understanding regarding lethal means safety (LMS) among those living in 3 diverse rural communities where TWV is being implemented (Mississippi [MS], New Mexico [NM], Oregon [OR]), demographic and mortality data were obtained, and a survey was conducted. Responses are presented in the context of demographics and mortality rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Demographic and mortality data were drawn from the American Community Survey and the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research database. In addition, a random survey sample was selected from the United States Postal Service delivery sequence file. Survey recruitment was conducted primarily by mail.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Notable differences exist between communities in terms of demographics and mortality rates (eg, average annual suicide mortality rates: MS 11.8/100,000; NM 33.0/100,000, OR 28.0/100,000). Across these communities, 3,846 individuals responded to the survey. Whereas most respondents were at least somewhat willing to discuss access to firearms with health care providers, only 3.8%-10.8% reported that any provider had asked about such access. A low proportion reported discussions with providers regarding safe storage of medications (14.1%-21.66%). Many respondents did not agree that gun locks and safes reduce suicide risk (16.9%-23.5%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Findings highlight room for growth in terms of education regarding the positive impact of LMS. It is recommended that strategies be guided by community-specific contextual factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146054718","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":"Text-messaging e-cigarette cessation intervention for young adults in rural areas: A feasibility randomized trial","authors":"Jovan Gwon PhD, RN, FIAAN,&nbsp;Vipavee Thongpriwan PhD, RN, CNE,&nbsp;Han-Joo Lee PhD,&nbsp;Young Ik Cho PhD,&nbsp;Suna Paek PhD,&nbsp;Redson Biswick Machongo MPhil, RN,&nbsp;Devon Noonan PhD, MPH, FNP-BC, CARN, FIAAN, FAAN","doi":"10.1111/jrh.70109","DOIUrl":"10.1111/jrh.70109","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Electronic Nicotine Delivery Systems (ENDS) use is disproportionately high among young adults (YAs) in rural US communities, where cessation support is limited. The REVIVE (Rural Vaping Free Intervention for Young Adults via Text Messaging) program was developed to address the unique cessation barriers experienced in these settings. The objectives of this study were to examine the feasibility, acceptability, and preliminary efficacy of the REVIVE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In a pilot randomized controlled trial, 39 YAs (ages 18-24) who used ENDS in rural areas were assigned to either the REVIVE intervention (<i>n</i> = 19) or standard care control (SCC; <i>n</i> = 20) over 9 months (June-August in 2023 and June-November in 2024). REVIVE participants received an 8-week targeted, interactive text-messaging cessation program. SCC participants received weekly links to general ENDS quitting resources. Feasibility (eg, retention rates), acceptability (eg, thought about quitting), and preliminary efficacy (self-reported 7-day point prevalence abstinence as the primary outcome and self-reported nicotine dependence as the secondary outcome) were assessed. Descriptive statistics, bivariate analyses, and logistic and multiple regression analyses were undertaken.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>REVIVE participants showed statistically significantly higher self-reported abstinence at 1-month follow-up compared to SCC (71.4% vs 35.7% [52.6% vs 25.0% by intent-treat analysis]). Nicotine dependence statistically significantly decreased in the REVIVE group (mean reduction = 5.09) versus SCC (mean reduction = 2.92). Retention rates were 73.7% in REVIVE and 70.0% in SCC, and 71.4% of REVIVE participants reported reading all text messages. Acceptability was high, with 92.9% indicating the program made them think about quitting and 85.7% saying they would recommend it to others. Participants confirmed the program's relevance, message timing, tone, and engagement features, while also highlighting areas for improvement, such as technical glitches and limited personalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>REVIVE was feasible, acceptable, and effective in reducing nicotine dependence among rural YAs. These findings support further development of targeted, culturally responsive digital interventions for ENDS cessation in underserved populations in rural areas.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041996","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":"Advancing rural cancer control: A portfolio analysis of research funded by the National Cancer Institute, 2016–2024","authors":"Anna Gaysynsky MPH,&nbsp;Sallie J. Weaver PhD,&nbsp;Robin C. Vanderpool DrPH,&nbsp;Irina A. Iles PhD,&nbsp;Amy Kennedy PhD,&nbsp;Shobha Srinivasan PhD,&nbsp;Kelly D. Blake ScD","doi":"10.1111/jrh.70120","DOIUrl":"10.1111/jrh.70120","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Given well-documented rural–urban disparities in cancer outcomes, we conducted a portfolio analysis to characterize rural cancer control-focused grants funded by the National Cancer Institute (NCI) between fiscal years 2016 and 2024 and to identify opportunities for future research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>ISearch, an NIH portfolio analysis tool, was used to identify rural-focused cancer control research grants funded by NCI. 128 grants were analyzed for key attributes, including grant characteristics (e.g., funding mechanism), cancer site, cancer control continuum phase, research topic, methods, setting, and intervention delivery channel. SAS version 9.4 was used to calculate code frequencies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>On average, 14 new grants focused on rural cancer control were awarded per year. Colorectal (<i>n</i> = 36) and breast cancer (<i>n</i> = 27) were the most frequently studied cancer sites. Prevention (<i>n</i> = 43) and treatment (<i>n</i> = 41) were the most frequently addressed phases of the cancer control continuum. Common research topics included quality of care (<i>n</i> = 30), quality of life/mental health (<i>n</i> = 26), and screening (<i>n</i> = 25). Most grants utilized randomized control trials (<i>n</i> = 78) and qualitative research methods (<i>n</i> = 77). Projects were most frequently set in the home (<i>n</i> = 68) or in health care settings (<i>n</i> = 47). Interventions were most frequently delivered through interpersonal interaction, either in-person (<i>n</i> = 40), over the phone (<i>n</i> = 36), or through videoconferencing (<i>n</i> = 27).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>NCI has supported an array of rural cancer control studies since 2016. However, opportunities were identified to further address rural cancer disparities, including efforts focused on understudied topics (e.g., financial toxicity), cancer sites (e.g., cervical cancer), phases of the cancer control continuum (e.g., end-of-life), and settings (e.g., community-based organizations).</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042000","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":"How physicians’ anticipated retention within urban and rural HPSA practices varies with their assessments of their work and jobs","authors":"Donald E. Pathman MD, MPH,&nbsp;Thomas R. Konrad PhD,&nbsp;Thomas E. Rauner MCRP,&nbsp;Jackie Fannell ,&nbsp;Mike Shimmens CPRP","doi":"10.1111/jrh.70117","DOIUrl":"10.1111/jrh.70117","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Physician turnover within Health Professional Shortage Areas (HPSAs), as in all settings, frequently occurs when physicians are dissatisfied with aspects of their work and employment. This study evaluates how physicians’ assessments of 6 aspects of their work and jobs relate to whether they anticipate remaining in their urban and rural HPSA practices for more than 2 years, and assesses differences for physicians in urban and rural HPSAs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Survey data on physicians’ assessments of 6 facets of their work and jobs were obtained from 747 physicians working in urban HPSAs and 355 in rural HPSAs across 33 states (54.9% response rate). Separate hierarchical logistic regression models identified work and job factors independently associated with anticipated retention beyond 2 years for each group. <i>Z</i>-tests assessed differences between the urban and rural models in odds ratios for each work and job factor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Anticipated retention was more likely in both urban and rural HPSAs when physicians felt they had good administration, they felt connected and supported at work, and work felt meaningful, and likely also if they provided their desired range of services, but in neither setting if they felt adequately compensated or not. Anticipated retention in rural but not urban HPSAs was more likely when physicians had a good work-life balance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Physicians’ anticipated retention within HPSAs is associated with how they feel about various aspects of their work and jobs. These aspects of work and jobs are generally but not exactly the same in urban and rural HPSAs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042094","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":"Evaluating rural healthcare workforce programs: Applying modified whole-of-person retention improvement framework in VHA programs","authors":"Meghan R. Longacre PhD, MS,&nbsp;Linda M. Kinney MPA,&nbsp;Kathleen L. Carluzzo MS,&nbsp;Bradley V. Watts MD, MPH,&nbsp;Karen E. Schifferdecker PhD, MPH","doi":"10.1111/jrh.70115","DOIUrl":"10.1111/jrh.70115","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Healthcare workforce shortages are acute in rural areas. Using a holistic workforce retention framework, we examined evidence and identified gaps in recruitment and retention programs, using the Veterans Health Administration as a case study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Rural workforce recruitment and retention initiatives were identified using VHA's 2023 Rural Recruitment and Hiring plan, and classified by rural focus, recruitment or retention, and strength of evidence. Initiatives were then mapped to a modified whole-of-person retention improvement framework (WoP-RIF) to assess coverage of domains: workplace/organizational, role/career, community/place, and financial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Of 31 VHA initiatives, 19% exclusively focused on the rural workforce, 35% included rural, and 45% had no specific geographic target. One third (32%) focused on recruitment only, 48% focused on recruitment and retention, and 19% focused on retention only. Nearly three-quarters (71%) lacked sufficient evidence or were too early in implementation to assess effectiveness or ineffectiveness of the initiative. The strongest evidence existed for education loan repayment and nursing residency programs. For modified WoP-RIF domains, about half of initiatives focused on financial incentives (52%) or workplace/organizational programs (42%); 35% focused on role/career opportunities; and only three (10%) focused on community/place.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While initiatives exist to address workforce shortages in rural areas, using the VHA as a case study, these are more focused on recruitment than retention, and few address important aspects of retention outside of financial or workplace domains. More rigorous and holistic evaluations of workforce initiatives using the modified WoP-RIF framework would bolster evidence across the span of recruitment to retention for rural workforce development.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012464","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":"Effects of hospital and obstetric unit closures on postpartum acute care across county racial composition in rural North Carolina","authors":"Mekhala V. Dissanayake PhD,&nbsp;John W. Jackson PhD,&nbsp;Rachel Peragallo Urrutia MD,&nbsp;Chantel L. Martin PhD,&nbsp;Michele Jonsson Funk PhD,&nbsp;Mollie E. Wood PhD","doi":"10.1111/jrh.70114","DOIUrl":"10.1111/jrh.70114","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Hospital and obstetric unit closures are concentrated in the rural Southern United States, often where marginalized racial/ethnic groups reside and access to maternal health care is already strained. Given structural racism's role as a fundamental cause of inequities, we hypothesized that closure effects may vary by race and racial composition of county.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used linked North Carolina birth certificates and Medicaid claims from births occurring to rural residents from 2014 to 2019. Using a Trial Emulation Policy Approach with a Difference-in-Difference analysis, we estimated the effects of hospital and obstetric closures on postpartum acute care (maternal emergency department visit or hospital admission) by race and county racial composition. We categorized rural counties as lower (LNHW, &lt;80% White) or higher (HNHW, ≥80% White) Non-Hispanic White.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>We found declines in postpartum acute care associated with closures: 3.6 percentage points in LNHW counties and 1.8 percentage points in HNHW counties. We also found that marginalized groups experienced the largest declines, for example, Black versus White birthing people in LNHW counties (−7.1 vs −2.5 percentage points).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>As hospitals and obstetric units continue to close, increasing support in the postpartum period will be crucial for maternal health.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999617","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 emergency hospitals: Emerging patterns of adaptation and community perception","authors":"Anders Van Sandt PhD,&nbsp;Kaitlyn Line ,&nbsp;Anja Gruber PhD,&nbsp;Cris Meier PhD,&nbsp;Craig Carpenter PhD,&nbsp;Scott Loveridge PhD","doi":"10.1111/jrh.70112","DOIUrl":"10.1111/jrh.70112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Rural hospitals face persistent financial challenges that often threaten their survival. To address this, the 2023 “Rural Emergency Hospital” (REH) designation offers Critical Access Hospitals and hospitals with fewer than 50 beds enhanced Medicare reimbursement and annual facility payments if they discontinue inpatient services while maintaining outpatient care and a 24-hour emergency department. This study evaluates the characteristics of hospitals that choose REH conversion and examines the perceived community impact of the change.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyze Centers for Medicare &amp; Medicaid Services cost report data to compare converting hospitals to eligible nonconverting hospitals. We also conduct a content analysis of 33 news articles and phone interviews with local rural residents to assess how REH conversions are presented in the media and perceived in communities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Hospitals that converted to REH status had low inpatient volumes, occupancy rates, and revenues, suggesting they were positioned to benefit financially from eliminating inpatient services. Content analysis revealed that news articles were primarily neutral in tone (54.5%), with most (90%) describing the financial benefits of conversion. Interviews with rural residents highlighted negative perceptions of local health care and revealed that many preferred not to use their local REH even when available.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>REH designation may provide financial lifelines to rural hospitals with declining inpatient demand, but community skepticism and limited willingness to use REHs may constrain their role in sustaining health care access. The long-term effectiveness of this policy may depend on addressing both financial viability and community trust in rural health care delivery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12811699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991186","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":"Improving health care access in rural communities in the United States","authors":"Philip A. Chan MD, MS","doi":"10.1111/jrh.70116","DOIUrl":"10.1111/jrh.70116","url":null,"abstract":"","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the use of telemedicine to expand addiction and recovery resources in Great Plains Tribal Communities","authors":"Michael C. Harding MD,MPH,&nbsp;Anna C. Kihlstrom MPH,&nbsp;Allison Kelliher MD,&nbsp;Carmen Rosa MS,&nbsp;Frankie B. Kropp MS,&nbsp;T. John Winhusen PhD,&nbsp;Donald K. Warne MD,MPH","doi":"10.1111/jrh.70113","DOIUrl":"10.1111/jrh.70113","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Addressing substance use disorders remains a high priority for many Indigenous communities. Opioid misuse and deaths related to overdose have been increasing sharply in American Indian/Alaska Native populations. Medications for opioid use disorder (MOUD) remain difficult to access in Great Plains Tribal Communities due to the paucity of treatment providers, among other factors. The present study explores the perceived barriers and facilitators to using telehealth to promote access to MOUD and recovery resources in Great Plains Tribal Communities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study employed qualitative methods to review policy considerations for using telemedicine to provide buprenorphine. We obtained qualitative data from 5 interviews with 8 total key informants (62.5% women, 25% with tribal affiliations) with local administrators, health care providers, and policymakers. Their responses were transcribed and coded with NVivo software.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>After coding and analysis, 6 themes emerged: current access, acceptability in Tribal Communities, facilitators, barriers, payment considerations, and policies that support tele-MOUD. Participant responses—though specific to Great Plains Tribal Communities—mirrored other recommendations on telemedicine and substance use disorder services such as federal support of reciprocity of state licenses, permanent codification of the regulatory changes enacted during the COVID-19 public health emergency, increased funding for innovative delivery of services, and considerations of privacy; the need for culture- and trauma-informed providers was also noted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Telemedicine for the provision of MOUD appears, from this qualitative analysis, to be a feasible way to expand access to care for opioid use disorder in Great Plains Tribal Communities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12800889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967666","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":"Patient, facility, and community determinants of timely follow up after abnormal screening mammograms in Appalachia: A multilevel analysis","authors":"Roger T. Anderson PhD,&nbsp;Marianne M. Hillemeier PhD,&nbsp;Jennifer A. Harvey MD,&nbsp;Fabian T. Camacho MA,&nbsp;Gloribel Bonilla MPH,&nbsp;Cara B. Safon PhD,&nbsp;Chris Louis PhD","doi":"10.1111/jrh.70104","DOIUrl":"10.1111/jrh.70104","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Examine the extent that community and organizational characteristics influence mammogram recall and biopsy rates in Appalachia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We collected facility survey and Medicare claims (2016-2018) data on 191 FDA-registered breast imaging organizations serving 2.65 million women in 5 Appalachian states (KY, OH, PA, VA, and WV). Primary outcomes were recall rates and time to recall and biopsy. Generalized linear mixed-effects models (GLMM) (patient level with facility random intercepts) and facility-level structural equation models were used to evaluate multilevel predictors of recall, biopsy, and timeliness. Imaging center service areas (SAs) were constructed using Medicare claims for patient, facility, and community characteristics utilization patterns. Mammogram service capacity was measured using a published tool (BIOPSI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Rural centers had SAs with higher area deprivation index (ADI) scores, lower capacity despite possessing more machines per capita, and were less likely to offer 3D tomosynthesis (3DT). Recall (8%) and biopsy (∼22%) rates were similar by metropolitan status; however, rural centers were more likely to provide same-day exams (<i>P</i> = .021). In GLMM, patient-level predictors included younger age and nonuse of 3DT for recall; and higher ADI and use of 3DT for biopsy. Days to recall was lengthened with dual Medicaid insurance, 3DT, and screening by a stand-alone facility; while days to biopsy was lengthened without the use of 3DT. Community-level pathways were found for days to recall, with rural and smaller facilities achieving significantly fewer days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Characteristics of rural imaging centers influence efficiency through their resources and community contexts and should be considered in breast cancer screening outcomes research.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12780644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919108","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}