Joshua Kennedy MPH, Lisa Wexler PhD, Tara Schmidt MPH, Suzanne Rataj MPH, Josie Garnie AAS, Roberta Moto BSW, Zinan Tao MSW, Lauren White MPH, MSW, Diane McEachern PhD
Purpose
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.
Method
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.
Finding
According to short surveys (n = 199) and interviews done with randomly selected recipients (n = 24), adults who received the PC CARES care packages were very satisfied with the contents and found them useful.
Conclusion
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.
{"title":"Care packages to promote universal suicide prevention for remote Alaska Native communities: What worked?","authors":"Joshua Kennedy MPH, Lisa Wexler PhD, Tara Schmidt MPH, Suzanne Rataj MPH, Josie Garnie AAS, Roberta Moto BSW, Zinan Tao MSW, Lauren White MPH, MSW, 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}
Jessica R. Thompson PhD, Courtney J. Walker PhD, John C. Flunker PhD, W. Jay Christian PhD, Wayne T. Sanderson PhD, Nancy E. Schoenberg PhD, Steven R. Browning PhD
Purpose
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.
Methods
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 (N = 456), we estimated prevalence ratios of the association between individual-level characteristics and lung function using log binomial regression.
Findings
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 <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 <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.
Conclusions
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.
{"title":"Identifying risk factors for adverse lung health outcomes among rural Appalachian women","authors":"Jessica R. Thompson PhD, Courtney J. Walker PhD, John C. Flunker PhD, W. Jay Christian PhD, Wayne T. Sanderson PhD, Nancy E. Schoenberg PhD, 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 <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 <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}
Katherine Hadlandsmyth PhD, Rena E. Courtney PhD, Jenna L. Adamowicz PhD, Mary A. Driscoll PhD, Jennifer L. Murphy PhD, Brian C. Lund PharmD
Purpose
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.
Methods
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.
Findings
Veterans with an initial pain clinic visit increased by 22.5% from 2015 (n = 95,549) to 2022 (n = 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).
Conclusions
The rural gap in continuity of specialty pain clinic services for veterans has improved across time, particularly in relation to pain clinic psychology visits.
{"title":"Continuity of pain clinic care among rural and urban veterans","authors":"Katherine Hadlandsmyth PhD, Rena E. Courtney PhD, Jenna L. Adamowicz PhD, Mary A. Driscoll PhD, Jennifer L. Murphy PhD, 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}
Chun-Pin Chang (Esther) PhD, Daren Huang MPH, Shane Lloyd MD, N. Lynn Henry MD, PhD, Brock O'Neil MD, Mia Hashibe PhD
Background
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.
Methods
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.
Results
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%; P-value <.001) and chronic obstructive pulmonary disease (COPD)/bronchiectasis (14.2% vs 10.5%; P-value <.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 >5 years after cancer diagnosis.
Conclusions
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.
背景农村前列腺癌患者面临着癌症治疗距离远、护理碎片化等挑战。很少有研究调查居住在农村地区的前列腺癌幸存者的不良健康后果。需要对农村前列腺癌患者的不良健康结果进行全面评估，以了解潜在的健康差异，并为干预措施提供科学证据。本研究的目的是调查美国农村老年前列腺癌幸存者与城市前列腺癌幸存者之间普遍和偶然的不良健康结果。方法使用SEER-Medicare关联数据库识别原发性前列腺癌幸存者。采用细灰色亚分布风险模型估计农村前列腺癌患者与城市前列腺癌患者的风险比（HR）和95%置信区间（CI）。结果共发现农村前列腺癌幸存者37126人，城市前列腺癌幸存者109176人。我们观察到，农村前列腺癌幸存者的类风湿关节炎/骨关节炎患病率较高(22.1% vs 20.9%；p值<；.001)和慢性阻塞性肺疾病(COPD)/支气管扩张(14.2% vs 10.5%；假定值& lt;措施)。与城市前列腺癌患者相比，农村前列腺癌患者在癌症诊断5年后发生急性心肌梗死、慢性阻塞性肺病/支气管扩张、髋部骨盆骨折和类风湿关节炎/骨关节炎的风险更高。结论本研究提供了农村老年前列腺癌幸存者患病率和不良健康结局发生率的重要结果。有必要进一步调查其他因素如何影响这些差异。
{"title":"Risks of adverse health outcomes among older rural prostate cancer survivors in the SEER-Medicare data","authors":"Chun-Pin Chang (Esther) PhD, Daren Huang MPH, Shane Lloyd MD, N. Lynn Henry MD, PhD, Brock O'Neil MD, 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 <.001) and chronic obstructive pulmonary disease (COPD)/bronchiectasis (14.2% vs 10.5%; <i>P</i>-value <.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 >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}
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.
Methods
Using weighted data from the 2020 and 2021 National Health Interview Survey (n = 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.
Findings
Rural residents were more likely to report problems paying and inability to pay medical bills (13.0% vs. 10.2%, p < 0.001; 8.2% vs 6.2%, p < 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.
Conclusions
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.
社会/情感支持有助于缓冲医疗保健费用对健康和财务的影响。然而，很少有研究审查与医疗保健负担能力有关的社会/情感支持方面的差异，尽管农村/城市在健康和医疗保健获取方面存在差异，但按农村情况审查这些问题的研究就更少了。本研究通过考察农村和城市成年人在社会/情感支持和医疗保健负担能力问题上的差异来解决这些差距。方法利用2020年和2021年全国健康访谈调查（n = 44,987）的加权数据，研究了三个医疗负担能力问题的差异：担心医疗费用、支付医疗费用的问题和无力支付医疗费用。我们进行了双变量和多变量逻辑回归分析，通过农村性、社会/情感支持以及其他社会人口统计学和健康特征来比较这些问题，得出调整后的优势比并预测这些问题的概率。调查结果：农村居民更有可能报告支付问题和无力支付医疗费用(13.0%比10.2%,p <；0.001;8.2% vs 6.2%, p <；0.001)。社会人口统计学和健康协变量与医疗保健可负担性问题的调整几率存在差异，而低社会/情感支持与农村和城市地区所有三个医疗保健可负担性问题的调整几率和调整预测概率较高相关。结论低社会/情感支持与所有医疗负担能力问题的高几率和预测概率相关，与农村无关。未来旨在减少农村地区医疗债务的政策应考虑到社会/情感支持的有益影响。
{"title":"The relationship between low social/emotional support and health care affordability among rural and urban residents","authors":"Ingrid Jacobson MPH, Katie Rydberg MPH, Alexis Swendener PhD, Hannah MacDougall PhD, MSW, 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> < 0.001; 8.2% vs 6.2%, <i>p</i> < 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}
{"title":"Addressing the growing rural–urban divide in opioid prescribing for veterans","authors":"Suhanee Mitragotri , Kevan Shah MSM, MSc","doi":"10.1111/jrh.70030","DOIUrl":"https://doi.org/10.1111/jrh.70030","url":null,"abstract":"","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143905282","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}
Jingxi Sheng PhD, Sue P. Heiney PhD, Karen E. Wickersham PhD, Lan A. Nguyen PhD, Kartina W. Harrison MSN, Swann Arp Adams PhD
Purpose
Tyrosine kinase inhibitors (TKIs) improve chronic myeloid leukemia (CML) outcomes dramatically. However, limited research exists on patient-specific, medical, and psychosocial factors influencing TKI adherence. The purpose of the study was to better understand TKI adherence among rural CML patients, using a convergent parallel mixed-method design guided by the Information Motivation and Behavioral Skills Model.
Methods
Survivors with CML participated in semistructured interviews and completed self-reported questionnaires, including demographics, perceived stress, side effects, emotional support, and self-efficacy for managing chronic conditions. Qualitative and quantitative data were collected concurrently, analyzed separately, and then integrated.
Results
Sixteen participants aged 26 to 76 years completed the study. The duration of TKI therapy ranged from 0 to 12 years (mean ± standard deviation, 5.56 ± 4.08). While all reported adherence to TKI therapy, 31% held misconceptions about treatment duration, and 38% misunderstood reasons for blood tests prior to treatment or TKI refilled. Qualitative data yielded five major themes with descriptions of the shock of diagnosis, educational experiences regarding CML and its treatment, challenges in managing side effects and refills, the importance of social support, and strategies for maintaining remission and motivating adherence to TKI.
Conclusions
This study describes the knowledge, motivations, challenges, and skills related to TKI adherence among rural patients with CML. A patient-centered approach is recommended for health care providers to improve adherence and enhance outcomes for CML patients on TKI therapy.
{"title":"Living with chronic myelogenous leukemia in rural communities: Exploring factors related to tyrosine kinase inhibitors adherence with a mixed methods approach","authors":"Jingxi Sheng PhD, Sue P. Heiney PhD, Karen E. Wickersham PhD, Lan A. Nguyen PhD, Kartina W. Harrison MSN, Swann Arp Adams PhD","doi":"10.1111/jrh.70028","DOIUrl":"https://doi.org/10.1111/jrh.70028","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Tyrosine kinase inhibitors (TKIs) improve chronic myeloid leukemia (CML) outcomes dramatically. However, limited research exists on patient-specific, medical, and psychosocial factors influencing TKI adherence. The purpose of the study was to better understand TKI adherence among rural CML patients, using a convergent parallel mixed-method design guided by the Information Motivation and Behavioral Skills Model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Survivors with CML participated in semistructured interviews and completed self-reported questionnaires, including demographics, perceived stress, side effects, emotional support, and self-efficacy for managing chronic conditions. Qualitative and quantitative data were collected concurrently, analyzed separately, and then integrated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixteen participants aged 26 to 76 years completed the study. The duration of TKI therapy ranged from 0 to 12 years (mean ± standard deviation, 5.56 ± 4.08). While all reported adherence to TKI therapy, 31% held misconceptions about treatment duration, and 38% misunderstood reasons for blood tests prior to treatment or TKI refilled. Qualitative data yielded five major themes with descriptions of the shock of diagnosis, educational experiences regarding CML and its treatment, challenges in managing side effects and refills, the importance of social support, and strategies for maintaining remission and motivating adherence to TKI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study describes the knowledge, motivations, challenges, and skills related to TKI adherence among rural patients with CML. A patient-centered approach is recommended for health care providers to improve adherence and enhance outcomes for CML patients on TKI therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143875485","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}
Rebecca L. Boyd-Bais M.IntTdeComLaw, B.Com, B.PsychSc (Hons), Fiona Ann Papps PhD, Jessica Sipes PhD
Introduction
Anxiety is the most prevalent mental health condition in the perinatal period and may be experienced more by rural and remote pregnant women, who, compared with urban counterparts, have fewer available and less access to maternity health care services. Research has yet to examine the relationship between pregnancy-related anxiety and access to and availability of health care services and social support for pregnant women, how relationships are affected by telehealth usefulness, satisfaction, and online social support, and whether relationships are different for rural and remote women compared with those in urban areas.
Method
We used a quantitative cross-sectional design and online survey to collect data from 174 pregnant women living in urban and rural and remote regions of Australia. Data were collected from January to May 2023.
Results
Compared with urban pregnant women, rural and remote pregnant women reported greater pregnancy-related anxiety, lower accessibility and availability of health services, and lower levels of social and online social support. Controlling for all variables, lower reported social support (b = −0.34, 95% BCaCI [−0.56, −0.14]) and online social support (b = −0.17, 95% BCaCI [−0.30, −0.04]) were significantly associated with higher pregnancy-related anxiety for rural and remote pregnant women, but only no previously reported pregnancies was associated with higher pregnancy-related anxiety for urban women (b = −5.04, 95% BCaCI [−7.88, −2.02]).
Conclusion
Future research could further investigate individual, social–cultural, and location-specific factors to determine the specific needs of women during pregnancy with the view to shaping targeted pregnancy-related interventions.
{"title":"Health care, social support, and pregnancy-related anxiety in urban and rural and remote Australian women","authors":"Rebecca L. Boyd-Bais M.IntTdeComLaw, B.Com, B.PsychSc (Hons), Fiona Ann Papps PhD, Jessica Sipes PhD","doi":"10.1111/jrh.70025","DOIUrl":"https://doi.org/10.1111/jrh.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Anxiety is the most prevalent mental health condition in the perinatal period and may be experienced more by rural and remote pregnant women, who, compared with urban counterparts, have fewer available and less access to maternity health care services. Research has yet to examine the relationship between pregnancy-related anxiety and access to and availability of health care services and social support for pregnant women, how relationships are affected by telehealth usefulness, satisfaction, and online social support, and whether relationships are different for rural and remote women compared with those in urban areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We used a quantitative cross-sectional design and online survey to collect data from 174 pregnant women living in urban and rural and remote regions of Australia. Data were collected from January to May 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared with urban pregnant women, rural and remote pregnant women reported greater pregnancy-related anxiety, lower accessibility and availability of health services, and lower levels of social and online social support. Controlling for all variables, lower reported social support (<i>b</i> = −0.34, 95% BCaCI [−0.56, −0.14]) and online social support (<i>b</i> = −0.17, 95% BCaCI [−0.30, −0.04]) were significantly associated with higher pregnancy-related anxiety for rural and remote pregnant women, but only no previously reported pregnancies was associated with higher pregnancy-related anxiety for urban women (<i>b</i> = −5.04, 95% BCaCI [−7.88, −2.02]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Future research could further investigate individual, social–cultural, and location-specific factors to determine the specific needs of women during pregnancy with the view to shaping targeted pregnancy-related interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143875486","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}
Chelsea Leonard PhD, Rachael R. Kenney MA, Adnan Syed BA, Edward Hess MS, Chris Wilson MS, Ashlyn Smith MMS, PA-C, Cynthia Schihl MSN, RN, Janee Lai MS-RN, MPH, MA, CDCES, CPT, Peter Reaven MD, Gauri Behari MD
Purpose
The prevalence of diabetes mellitus in the Department of Veteran's Affairs (VA) is higher than in the general public, with nearly 25% of Veterans enrolled in VA care diagnosed with diabetes. VA cares for over 2.7 million Veterans in rural areas who may face barriers to accessing specialty care for diabetes management. The goal of this study was to understand Veteran patient experiences with a novel telehealth diabetes program designed to improve diabetes care for Veterans in rural areas.
Methods
We conducted a qualitative evaluation of Veteran's experiences as part of a larger mixed methods evaluation of the VA Telediabetes program. We conducted semistructured interviews with rural Veterans enrolled in the program to understand their experiences and perceptions. We conducted an inductive-deductive content analysis to identify salient themes related to diabetes control, perceptions of telehealth for diabetes care, and previous experiences with diabetes management. Methods are described according to the SRQR checklist for qualitative research.
Findings
We conducted interviews with 26 rural Veterans enrolled in the Telediabetes program between April 2022 and March 2023 and identified three themes related to their experience in the program: (1) Telediabetes care is more frequent and comprehensive than previous diabetes care; (2) Telediabetes care is convenient and thorough, but there are some barriers; and (3) Patients describe that their diabetes control as better in Telediabetes program compared to diabetes management in primary care.
Conclusions
Veterans perceived that Telediabetes had a positive impact on their diabetes control and described the quality of care as excellent. Programs like Telediabetes bring together a group of interdisciplinary specialists to provide care for rural patients have the potential to alleviate barriers to specialty care in rural areas.
{"title":"Patient perceptions of rural telehealth diabetes control program in Department of Veteran's Affairs","authors":"Chelsea Leonard PhD, Rachael R. Kenney MA, Adnan Syed BA, Edward Hess MS, Chris Wilson MS, Ashlyn Smith MMS, PA-C, Cynthia Schihl MSN, RN, Janee Lai MS-RN, MPH, MA, CDCES, CPT, Peter Reaven MD, Gauri Behari MD","doi":"10.1111/jrh.70027","DOIUrl":"https://doi.org/10.1111/jrh.70027","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The prevalence of diabetes mellitus in the Department of Veteran's Affairs (VA) is higher than in the general public, with nearly 25% of Veterans enrolled in VA care diagnosed with diabetes. VA cares for over 2.7 million Veterans in rural areas who may face barriers to accessing specialty care for diabetes management. The goal of this study was to understand Veteran patient experiences with a novel telehealth diabetes program designed to improve diabetes care for Veterans in rural areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a qualitative evaluation of Veteran's experiences as part of a larger mixed methods evaluation of the VA Telediabetes program. We conducted semistructured interviews with rural Veterans enrolled in the program to understand their experiences and perceptions. We conducted an inductive-deductive content analysis to identify salient themes related to diabetes control, perceptions of telehealth for diabetes care, and previous experiences with diabetes management. Methods are described according to the SRQR checklist for qualitative research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>We conducted interviews with 26 rural Veterans enrolled in the Telediabetes program between April 2022 and March 2023 and identified three themes related to their experience in the program: (1) Telediabetes care is more frequent and comprehensive than previous diabetes care; (2) Telediabetes care is convenient and thorough, but there are some barriers; and (3) Patients describe that their diabetes control as better in Telediabetes program compared to diabetes management in primary care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Veterans perceived that Telediabetes had a positive impact on their diabetes control and described the quality of care as excellent. Programs like Telediabetes bring together a group of interdisciplinary specialists to provide care for rural patients have the potential to alleviate barriers to specialty care in rural areas.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143875670","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}
Britta L. Anderson PhD, Jared Sawyer MPH, Ashley Palmer PhD, C Holly A Andrilla MS, Alexa Beeson MPP
Purpose
Examine retention factors and challenges among CRNAs who provide obstetric services and assess whether these factors differ between rural or urban areas.
Methods
Cross-sectional analysis of weighted data from a survey of CRNAs that are members of the American Association of Nurse Anesthesiology and provide obstetric anesthesia services. CRNAs selected reasons why they chose to work in their geographic area, factors that make them want to stay in their job, and challenges that make them want to leave their job.
Findings
Among all respondents (1213), 39% reported practicing in rural areas. Overall, 64% of respondents reported practicing in staffing models without medical direction, with 88% of those in rural areas working without medical direction. The following factors were “very important” for choosing to provide obstetric anesthesia services in a rural area: scope of practice (74%), job autonomy (72%), respect (64%), and work–life balance (62%). Controlling for staffing model, gender, and age, CRNAs practicing in rural areas were more likely to select “concern about care availability” as a reason factor and “the need to be on call” as a retention challenge.
Conclusions
Findings indicate that CRNAs choose to work in rural areas because of concern for care availability and the sense of autonomy, scope of practice, and control they experience in these areas, among other factors.
{"title":"Retaining CRNAs who provide obstetrics services in rural communities: Results from a national survey","authors":"Britta L. Anderson PhD, Jared Sawyer MPH, Ashley Palmer PhD, C Holly A Andrilla MS, Alexa Beeson MPP","doi":"10.1111/jrh.70021","DOIUrl":"https://doi.org/10.1111/jrh.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Examine retention factors and challenges among CRNAs who provide obstetric services and assess whether these factors differ between rural or urban areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Cross-sectional analysis of weighted data from a survey of CRNAs that are members of the American Association of Nurse Anesthesiology and provide obstetric anesthesia services. CRNAs selected reasons why they chose to work in their geographic area, factors that make them want to stay in their job, and challenges that make them want to leave their job.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Among all respondents (1213), 39% reported practicing in rural areas. Overall, 64% of respondents reported practicing in staffing models without medical direction, with 88% of those in rural areas working without medical direction. The following factors were “very important” for choosing to provide obstetric anesthesia services in a rural area: scope of practice (74%), job autonomy (72%), respect (64%), and work–life balance (62%). Controlling for staffing model, gender, and age, CRNAs practicing in rural areas were more likely to select “concern about care availability” as a reason factor and “the need to be on call” as a retention challenge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Findings indicate that CRNAs choose to work in rural areas because of concern for care availability and the sense of autonomy, scope of practice, and control they experience in these areas, among other factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143875425","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}
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