This cross-sectional study used data from the 2022–2023 National Survey of Children's Health to examine the prevalence of American youth meeting physical activity (PA) guidelines by sociodemographic subgroups defined by income, sex, urbanicity, and sports participation.
Methods
Weighted prevalence statistics were computed for meeting PA guidelines (≥60 min/day) for groups defined by income (0%–199% or ≥200% of Federal Poverty Level), sex (male, female), urbanicity (urban, rural), and past year sports participation (yes, no). Equity plots were generated to visualize the prevalence of meeting guidelines across subgroups (ref: high socioeconomic status (SES), urban male sports participants).
Findings
The final analytic sample included 61,740 youth (Mage = 11.6 years [SD = 3.2], 51.2% male). About 45% were sports participants, 88% were urban-dwelling, and <20% met PA guidelines. Meeting guidelines prevalences ranged from 13.2% (95% CI: 11.6%–15.0%) among high SES, urban female non-sport participants to 31.1% (95% CI: 25.5%–37.4%) among low SES, rural male non-sport participants. All comparisons were significantly different (versus reference group) except low SES, urban male sport participants; high SES, rural male non-sport participants; and low SES, rural females.
Conclusions
Most American youth fail to meet guidelines, with lowest prevalences among female non-sport participants, regardless of SES and urbanicity status. Sports may be more important for PA among urban versus rural youth. The findings, which show a complex interplay between sociodemographic factors, PA, and sport, can be used to identify populations needing targeted PA promotion programs.
{"title":"Prevalence of meeting youth physical activity guidelines across income, sex, urbanicity, and sport participation: 2022–2023 National Survey of Children's Health (NSCH)","authors":"Ashleigh Johnson DrPH","doi":"10.1111/jrh.70105","DOIUrl":"10.1111/jrh.70105","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This cross-sectional study used data from the 2022–2023 National Survey of Children's Health to examine the prevalence of American youth meeting physical activity (PA) guidelines by sociodemographic subgroups defined by income, sex, urbanicity, and sports participation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Weighted prevalence statistics were computed for meeting PA guidelines (≥60 min/day) for groups defined by income (0%–199% or ≥200% of Federal Poverty Level), sex (male, female), urbanicity (urban, rural), and past year sports participation (yes, no). Equity plots were generated to visualize the prevalence of meeting guidelines across subgroups (ref: high socioeconomic status (SES), urban male sports participants).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>The final analytic sample included 61,740 youth (<i>M</i><sub>age</sub> = 11.6 years [SD = 3.2], 51.2% male). About 45% were sports participants, 88% were urban-dwelling, and <20% met PA guidelines. Meeting guidelines prevalences ranged from 13.2% (95% CI: 11.6%–15.0%) among high SES, urban female non-sport participants to 31.1% (95% CI: 25.5%–37.4%) among low SES, rural male non-sport participants. All comparisons were significantly different (versus reference group) except low SES, urban male sport participants; high SES, rural male non-sport participants; and low SES, rural females.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Most American youth fail to meet guidelines, with lowest prevalences among female non-sport participants, regardless of SES and urbanicity status. Sports may be more important for PA among urban versus rural youth. The findings, which show a complex interplay between sociodemographic factors, PA, and sport, can be used to identify populations needing targeted PA promotion programs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844526","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}
School-based health centers (SBHCs) can function as patient-centered medical homes (PCMHs), but few studies examine how SBHCs fit the PCMH definition and address the challenges of rural health disparities among children and adolescents.
Methods
Note that 12 semi-structured interviews were conducted in four rural counties in New York State with school superintendents, SBHCs medical providers, and health care network administrators and between January 2024 and April 2024. Participants were identified using snowball sampling. Interviews were transcribed. Framework analysis was applied with thematic coding based on the PCMH framework. NVivo 14 was used to generate the final set of themes.
Findings
Our analysis confirms SBHCs fit the PCMH model—accessibility, comprehensive, family-centered, coordinated, continuous, and compassionate care—to improve health care access for rural children and empower children to advocate for their own health. We identify privacy and confidentiality as additional important elements in the PCMH model, which ensure children's empowerment. However, they present special challenges for rural SBHCs. Addressing these challenges requires attention to information sharing between SBHCs and schools and the need for trust and communication to empower children, while not alienating school partners and parents. This may explain why so few rural SBHCs are PCMH.
Conclusions
This qualitative thematic analysis shows SBHCs can serve as PCMHs in rural communities. It also highlights the importance of privacy, confidentiality, trust, and communication between SBHCs, schools, parents, and children.
{"title":"“Sacred ground for kids”: Institutional perspectives on rural school-based health centers as patient-centered medical homes","authors":"Xue Zhang PhD, Mildred E. Warner PhD","doi":"10.1111/jrh.70098","DOIUrl":"10.1111/jrh.70098","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>School-based health centers (SBHCs) can function as patient-centered medical homes (PCMHs), but few studies examine how SBHCs fit the PCMH definition and address the challenges of rural health disparities among children and adolescents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Note that 12 semi-structured interviews were conducted in four rural counties in New York State with school superintendents, SBHCs medical providers, and health care network administrators and between January 2024 and April 2024. Participants were identified using snowball sampling. Interviews were transcribed. Framework analysis was applied with thematic coding based on the PCMH framework. NVivo 14 was used to generate the final set of themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Our analysis confirms SBHCs fit the PCMH model—accessibility, comprehensive, family-centered, coordinated, continuous, and compassionate care—to improve health care access for rural children and empower children to advocate for their own health. We identify privacy and confidentiality as additional important elements in the PCMH model, which ensure children's empowerment. However, they present special challenges for rural SBHCs. Addressing these challenges requires attention to information sharing between SBHCs and schools and the need for trust and communication to empower children, while not alienating school partners and parents. This may explain why so few rural SBHCs are PCMH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This qualitative thematic analysis shows SBHCs can serve as PCMHs in rural communities. It also highlights the importance of privacy, confidentiality, trust, and communication between SBHCs, schools, parents, and children.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12717837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795235","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}
Erin E. Sullivan PhD, Mary Louise Gilburg MS, Morgan McDonald MD, Mark Deutchman MD
Purpose
To identify and analyze facility-level strategies that support the sustainability of rural maternity and delivery care programs in the United States.
Methods
This qualitative, cross-case study draws from data collected during the March 2024 Rural Maternity Innovation Summit in Clifton, Texas. Six rural health care organizations from diverse geographic regions shared their approaches to sustaining maternity and delivery services. Data include transcripts and presentation materials from summit sessions involving clinical, financial, and operational representatives of 6 rural hospitals. Thematic analysis was applied to identify cross-site strategies.
Findings
Three core themes emerged: financial sustainability, workforce development, and community engagement. Strategies included maximizing payment mechanisms, forming partnerships with Federally Qualified Health Centers, employing family physicians with obstetric training, establishing rural residency pipelines, and implementing culturally responsive community outreach. These practices were adapted to local contexts but shared a focus on aligning maternity and delivery services with broader organizational and community goals.
Conclusion
Sustaining rural maternity and delivery care requires an integrated approach that combines financial acumen, strategic workforce development, and strong patient and community engagement. Facility-level innovations offer replicable strategies for improving maternal health access and outcomes in rural settings.
{"title":"Innovating for success: Strengthening rural maternity care and delivery programs","authors":"Erin E. Sullivan PhD, Mary Louise Gilburg MS, Morgan McDonald MD, Mark Deutchman MD","doi":"10.1111/jrh.70099","DOIUrl":"10.1111/jrh.70099","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To identify and analyze facility-level strategies that support the sustainability of rural maternity and delivery care programs in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This qualitative, cross-case study draws from data collected during the March 2024 Rural Maternity Innovation Summit in Clifton, Texas. Six rural health care organizations from diverse geographic regions shared their approaches to sustaining maternity and delivery services. Data include transcripts and presentation materials from summit sessions involving clinical, financial, and operational representatives of 6 rural hospitals. Thematic analysis was applied to identify cross-site strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Three core themes emerged: financial sustainability, workforce development, and community engagement. Strategies included maximizing payment mechanisms, forming partnerships with Federally Qualified Health Centers, employing family physicians with obstetric training, establishing rural residency pipelines, and implementing culturally responsive community outreach. These practices were adapted to local contexts but shared a focus on aligning maternity and delivery services with broader organizational and community goals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Sustaining rural maternity and delivery care requires an integrated approach that combines financial acumen, strategic workforce development, and strong patient and community engagement. Facility-level innovations offer replicable strategies for improving maternal health access and outcomes in rural settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744396","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}
Daniel Maeng PhD, Virginia Sun PhD, RN, Matthew E. Nielsen MD, MS, Rebecca L. Hoffman MD, MSCE, Tullika Garg MD, MPH, Sarah M. Popek MD, Robert P. Sticca MD, Allison A. Aka MD, Walid M. Hesham MD, Marcia Grant PhD, RN, Michael Holcomb BS, Robert S. Krouse MD
Purpose
To assess the impact of a structured educational curriculum Ostomy Self-Management Telehealth (OSMT) treatment among cancer survivors residing in rural areas of the United States on selected measures of health care utilization, cost, and employment status.
Methods
This was a multi-site randomized controlled trial comparing OSMT treatment group against a control group receiving usual care (UC) in rural populations. OSMT treatment consisted of virtual group sessions led by trained peer ostomates delivered once a week over a 5-week period via video conferencing platforms. Surveys related to health care utilization were administered up to four times: baseline, post-session, 3-month and 6-month follow-up.
Results
Compared to the UC group, the OSMT group was associated with lower frequencies of in-person nurse (–57.2%; p = 0.015) and physician (–76.1%; p = 0.024) visits in the post-session follow-up survey; no significant differences were observed in the subsequent follow-up surveys. Moreover, the OSMT treatment group was also associated with lower ostomy-related emergency department visits (–88.3%; p = 0.119), lower direct out-of-pocket health care (–25.8%; p = 0.405) and travel costs (–47.7%; p = 0.105), as well as higher probability of full-time employment (18.9% vs. 12.3%; p = 0.179) and lower probability of claiming disability (14.3% vs. 18.9%; p = 0.459) in the 6-month follow-up; these differences, however, were not statistically significant.
Conclusion
While not all statistically significant, the OSMT treatment was associated with some notable changes in the patterns of health care utilization and selected economic outcomes among ostomates residing in rural communities. This suggests that the OSMT treatment likely contributes to more efficient and cost-effective care in the target population.
Synopsis
Ostomy Self-Management Telehealth (OSMT) program seeks to reduce barriers to care and improve self-management skills especially among ostomates residing in rural communities. This study reports that OSMT was associated with lower in-person health care provider visits, suggesting OSMT may lead to more efficient and cost-effective care.
{"title":"Impact of Ostomy Self-Management Telehealth training for rural cancer survivors on health care utilization and economic outcomes in the United States","authors":"Daniel Maeng PhD, Virginia Sun PhD, RN, Matthew E. Nielsen MD, MS, Rebecca L. Hoffman MD, MSCE, Tullika Garg MD, MPH, Sarah M. Popek MD, Robert P. Sticca MD, Allison A. Aka MD, Walid M. Hesham MD, Marcia Grant PhD, RN, Michael Holcomb BS, Robert S. Krouse MD","doi":"10.1111/jrh.70096","DOIUrl":"10.1111/jrh.70096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To assess the impact of a structured educational curriculum Ostomy Self-Management Telehealth (OSMT) treatment among cancer survivors residing in rural areas of the United States on selected measures of health care utilization, cost, and employment status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a multi-site randomized controlled trial comparing OSMT treatment group against a control group receiving usual care (UC) in rural populations. OSMT treatment consisted of virtual group sessions led by trained peer ostomates delivered once a week over a 5-week period via video conferencing platforms. Surveys related to health care utilization were administered up to four times: baseline, post-session, 3-month and 6-month follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to the UC group, the OSMT group was associated with lower frequencies of in-person nurse (–57.2%; <i>p</i> = 0.015) and physician (–76.1%; <i>p</i> = 0.024) visits in the post-session follow-up survey; no significant differences were observed in the subsequent follow-up surveys. Moreover, the OSMT treatment group was also associated with lower ostomy-related emergency department visits (–88.3%; <i>p</i> = 0.119), lower direct out-of-pocket health care (–25.8%; <i>p</i> = 0.405) and travel costs (–47.7%; <i>p</i> = 0.105), as well as higher probability of full-time employment (18.9% vs. 12.3%; <i>p</i> = 0.179) and lower probability of claiming disability (14.3% vs. 18.9%; <i>p</i> = 0.459) in the 6-month follow-up; these differences, however, were not statistically significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While not all statistically significant, the OSMT treatment was associated with some notable changes in the patterns of health care utilization and selected economic outcomes among ostomates residing in rural communities. This suggests that the OSMT treatment likely contributes to more efficient and cost-effective care in the target population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Synopsis</h3>\u0000 \u0000 <p>Ostomy Self-Management Telehealth (OSMT) program seeks to reduce barriers to care and improve self-management skills especially among ostomates residing in rural communities. This study reports that OSMT was associated with lower in-person health care provider visits, suggesting OSMT may lead to more efficient and cost-effective care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745595","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}
Alice S. Yan MAcc, Teagan K. Maguire MA, Jie Chen PhD
Purpose
We assessed the adoption of telehealth, patient engagement (PE), and health information exchange (HIE) functionalities among hospitals in 2023, comparing adoption rates between rural and urban hospitals.
Methods
We used the linked 2023 American Hospital Association Annual Survey and Information Technology Survey data. We examined average adoption rates of eight telehealth, eight PE, and three HIE functionalities across metropolitan, micropolitan, and rural acute care hospitals. Multivariate regression models were used to assess differences in adoption, adjusting for hospital characteristics.
Findings
Rural and urban disparities in hospital health information technology (HIT) adoption persist in 2023. After adjusting for hospital characteristics, rural and urban differences in the likelihood of adopting any treatment-stage (e.g., psychiatric treatment and stroke care) or post-discharge (e.g., remote patient monitoring for chronic care) telehealth were not significant. However, overall, rural hospitals adopted an average of 0.24 fewer telehealth services (p < 0.05) and 0.25 fewer PE capabilities (p < 0.05). They were also less likely to have any HIE capabilities, relative to their urban peers.
Conclusions
Although overall adoption of hospital HIT has increased since 2018 and some rural and urban gaps have narrowed, disparities remain in 2023. Rural hospitals continue to lag behind in the adoption of telehealth, PE, and HIE functionalities. Future research should explore barriers to adoption among under-resourced hospitals. Policy efforts must prioritize tailored strategies to support rural hospitals and promote broader access to HIT adoption nationwide.
{"title":"Revisiting the rural and urban divide in hospital health information technology adoption: Evidence from 2023","authors":"Alice S. Yan MAcc, Teagan K. Maguire MA, Jie Chen PhD","doi":"10.1111/jrh.70100","DOIUrl":"10.1111/jrh.70100","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>We assessed the adoption of telehealth, patient engagement (PE), and health information exchange (HIE) functionalities among hospitals in 2023, comparing adoption rates between rural and urban hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used the linked 2023 American Hospital Association Annual Survey and Information Technology Survey data. We examined average adoption rates of eight telehealth, eight PE, and three HIE functionalities across metropolitan, micropolitan, and rural acute care hospitals. Multivariate regression models were used to assess differences in adoption, adjusting for hospital characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Rural and urban disparities in hospital health information technology (HIT) adoption persist in 2023. After adjusting for hospital characteristics, rural and urban differences in the likelihood of adopting any treatment-stage (e.g., psychiatric treatment and stroke care) or post-discharge (e.g., remote patient monitoring for chronic care) telehealth were not significant. However, overall, rural hospitals adopted an average of 0.24 fewer telehealth services (<i>p</i> < 0.05) and 0.25 fewer PE capabilities (<i>p</i> < 0.05). They were also less likely to have any HIE capabilities, relative to their urban peers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although overall adoption of hospital HIT has increased since 2018 and some rural and urban gaps have narrowed, disparities remain in 2023. Rural hospitals continue to lag behind in the adoption of telehealth, PE, and HIE functionalities. Future research should explore barriers to adoption among under-resourced hospitals. Policy efforts must prioritize tailored strategies to support rural hospitals and promote broader access to HIT adoption nationwide.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12696441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726622","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}
Michelle A. Mengeling PhD, MS, Adam Batten MS, M. Bryant Howren PhD, MPH, B. Josea Kramer PhD, Kelly R. Miell PhD, Heather Davila PhD, Anne G. Sadler PhD, MS, RN
Purpose
To assess whether women veterans accessed synchronous video telehealth for mental health (SVT-MH) similarly by (1) rurality, (2) race, and (3) race within rural and urban settings.
Methods
This retrospective cohort study used VA administrative data to examine temporal trends in outpatient VA mental health use from January 1, 2019, through December 31, 2022—a period spanning the pre- and post-COVID-19 pandemic. The cohort included VA-enrolled women veterans ages 18–60 years with at least one outpatient mental health visit delivered by a VA provider in-person (VA-MH) or via SVT-MH. Outcomes included (1) any SVT-MH use and (2) annual SVT-MH visit counts. Models adjusted for demographics and used Bayesian logistic and Poisson regression to estimate effects and interactions over time.
Findings
SVT-MH use increased from 7% in 2019 to 32% in 2022. Rural women Veterans initially had higher SVT-MH use, but by 2022, urban women had higher use and visit counts. Black and Hispanic women Veterans showed the largest increases, especially in urban areas. American Indian and Alaska Native (AIAN) women Veterans were the only group without significant rural-urban differences in 2022, though they had lower overall visit counts.
Conclusions
SVT-MH use among women veterans increased substantially during the study period, with rural-urban gaps narrowing over time. These findings suggest SVT-MH differences may shift rapidly based on infrastructure, outreach, and policy implementation. Ongoing monitoring and tailored strategies are needed to ensure fair access to SVT-MH for all veterans, especially for AIAN and rural women veterans.
{"title":"Changing rural-urban and racial patterns in VA tele-mental health use among women Veterans, 2019–2022","authors":"Michelle A. Mengeling PhD, MS, Adam Batten MS, M. Bryant Howren PhD, MPH, B. Josea Kramer PhD, Kelly R. Miell PhD, Heather Davila PhD, Anne G. Sadler PhD, MS, RN","doi":"10.1111/jrh.70097","DOIUrl":"10.1111/jrh.70097","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To assess whether women veterans accessed synchronous video telehealth for mental health (SVT-MH) similarly by (1) rurality, (2) race, and (3) race within rural and urban settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study used VA administrative data to examine temporal trends in outpatient VA mental health use from January 1, 2019, through December 31, 2022—a period spanning the pre- and post-COVID-19 pandemic. The cohort included VA-enrolled women veterans ages 18–60 years with at least one outpatient mental health visit delivered by a VA provider in-person (VA-MH) or via SVT-MH. Outcomes included (1) any SVT-MH use and (2) annual SVT-MH visit counts. Models adjusted for demographics and used Bayesian logistic and Poisson regression to estimate effects and interactions over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>SVT-MH use increased from 7% in 2019 to 32% in 2022. Rural women Veterans initially had higher SVT-MH use, but by 2022, urban women had higher use and visit counts. Black and Hispanic women Veterans showed the largest increases, especially in urban areas. American Indian and Alaska Native (AIAN) women Veterans were the only group without significant rural-urban differences in 2022, though they had lower overall visit counts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SVT-MH use among women veterans increased substantially during the study period, with rural-urban gaps narrowing over time. These findings suggest SVT-MH differences may shift rapidly based on infrastructure, outreach, and policy implementation. Ongoing monitoring and tailored strategies are needed to ensure fair access to SVT-MH for all veterans, especially for AIAN and rural women veterans.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726601","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}
Jennifer L. Smith PhD, RN, Ashmita Thapa PhD, RN, Misook L. Chung PhD, RN, FAHA, FAAN, Terry A. Lennie PhD, RN, FAHA, FAAN, Martha Biddle PhD, RN, APRN, CCNS, FAHA, Mary Kay Rayens PhD, Debra K. Moser PhD, RN, FAHA, FAAN
Purpose
HeartHealth is a multi-component cardiovascular disease (CVD) risk reduction intervention developed for rural Appalachia participants. Its effectiveness in reducing CVD risk factors has been demonstrated, and although HeartHealth was developed to address the negative impact of social determinants of health (SDOH), it remains unclear whether its impact is modified by key SDOH. The aims of the study were to evaluate whether the intervention effect on the Framingham CVD Risk Score (FRS) differs by financial status, education level, sex, depressive symptoms, and health literacy.
Methods
A secondary analysis was conducted using data from a randomized controlled trial involving 349 participants (mean age: 43 ± 13, female 78%) from rural Appalachian Kentucky. Financial status, education level, and sex were measured using standard questionnaires, depressive symptoms were measured using the Patient Health Questionnaire-9, and health literacy was measured using the Newest Vital Sign. Repeated measures mixed modeling was employed to assess the impact of each SDOH while simultaneously evaluating the effects of time, intervention, and their interaction on FRS.
Findings
The interaction between time and intervention was significant, indicating a sustained reduction in FRS among intervention participants. None of the SDOH had moderating effects on the intervention's impact on reducing CVD risk factors. This demonstrates that the HeartHealth intervention remains effective despite the impact of selected SDOH.
Conclusions
The HeartHealth intervention effectively reduces CVD risk factors in rural Appalachia populations. This remains true regardless of SDOH that are commonly seen in rural areas.
{"title":"Effectiveness of a self-care intervention addressing social determinants of health in reducing cardiovascular disease risk in rural populations","authors":"Jennifer L. Smith PhD, RN, Ashmita Thapa PhD, RN, Misook L. Chung PhD, RN, FAHA, FAAN, Terry A. Lennie PhD, RN, FAHA, FAAN, Martha Biddle PhD, RN, APRN, CCNS, FAHA, Mary Kay Rayens PhD, Debra K. Moser PhD, RN, FAHA, FAAN","doi":"10.1111/jrh.70101","DOIUrl":"10.1111/jrh.70101","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>HeartHealth is a multi-component cardiovascular disease (CVD) risk reduction intervention developed for rural Appalachia participants. Its effectiveness in reducing CVD risk factors has been demonstrated, and although HeartHealth was developed to address the negative impact of social determinants of health (SDOH), it remains unclear whether its impact is modified by key SDOH. The aims of the study were to evaluate whether the intervention effect on the Framingham CVD Risk Score (FRS) differs by financial status, education level, sex, depressive symptoms, and health literacy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A secondary analysis was conducted using data from a randomized controlled trial involving 349 participants (mean age: 43 ± 13, female 78%) from rural Appalachian Kentucky. Financial status, education level, and sex were measured using standard questionnaires, depressive symptoms were measured using the Patient Health Questionnaire-9, and health literacy was measured using the Newest Vital Sign. Repeated measures mixed modeling was employed to assess the impact of each SDOH while simultaneously evaluating the effects of time, intervention, and their interaction on FRS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>The interaction between time and intervention was significant, indicating a sustained reduction in FRS among intervention participants. None of the SDOH had moderating effects on the intervention's impact on reducing CVD risk factors. This demonstrates that the HeartHealth intervention remains effective despite the impact of selected SDOH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The HeartHealth intervention effectively reduces CVD risk factors in rural Appalachia populations. This remains true regardless of SDOH that are commonly seen in rural areas.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670423","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}
Brody J. Gibson BS, Elizabeth Dobis MS, PhD, John Cromartie MA, PhD, Laurie Grieshober MA, PhD, Cornelia Ulrich MS, PhD, Tracy Onega MA, MPAS, MS, PhD, Jennifer Doherty MS, PhD
Purpose
To develop an urban–rural–frontier classification that integrates urbanicity and geographic remoteness and captures nuances in population and land area distributions invisible in traditional coding schemes, thereby providing a framework to measure health outcomes and access to care across the full urban-to-frontier continuum.
Methods
We created tract-level Integrated Metropolitan-to-Frontier Area Codes (tIMFAC) by combining the US Department of Agriculture's Economic Research Service's Frontier and Remote Area (FAR) codes with Rural–Urban Commuting Area (RUCA) codes, classifying tracts as metropolitan, micropolitan, frontier–micropolitan, small town/rural, and frontier–small town/rural. We compared population and land area distributions and median distances to health care facility types by RUCA, FAR, and tIMFAC, and summarized distances to health care facilities across tIMFAC by Census regions.
Findings
tIMFAC metropolitan, micropolitan, and small town/rural categories had higher population densities (312, 74, and 27/m2, respectively) than their RUCA counterparts (304, 54, and 11/m2, respectively). Densities were much lower in tIMFAC frontier–micropolitan and frontier–small town/rural areas (23 and 4/m2, respectively) than micropolitan and small town/rural. Three patterns emerged for travel distances across tIMFAC: (1) steadily increasing distances from metropolitan to frontier–small town/rural areas (e.g., medical-surgical intensive care units (ICUs)); (2) similar distances within frontier–micropolitan and micropolitan, and within frontier–small town/rural and small town/rural, respectively (e.g., obstetrics); and (3) longer distances for frontier areas regardless of urbanicity (e.g., pediatric ICUs and designated trauma centers).
Conclusion
tIMFAC provides a policy-relevant approach to identifying health differences across the urban-to-frontier continuum, supporting efforts to better understand and address unique rural and frontier health challenges.
{"title":"A novel approach to incorporate frontier areas into urban–rural geographic classifications: Integrated Metropolitan-to-Frontier Area Codes","authors":"Brody J. Gibson BS, Elizabeth Dobis MS, PhD, John Cromartie MA, PhD, Laurie Grieshober MA, PhD, Cornelia Ulrich MS, PhD, Tracy Onega MA, MPAS, MS, PhD, Jennifer Doherty MS, PhD","doi":"10.1111/jrh.70102","DOIUrl":"https://doi.org/10.1111/jrh.70102","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To develop an urban–rural–frontier classification that integrates urbanicity and geographic remoteness and captures nuances in population and land area distributions invisible in traditional coding schemes, thereby providing a framework to measure health outcomes and access to care across the full urban-to-frontier continuum.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We created tract-level Integrated Metropolitan-to-Frontier Area Codes (tIMFAC) by combining the US Department of Agriculture's Economic Research Service's Frontier and Remote Area (FAR) codes with Rural–Urban Commuting Area (RUCA) codes, classifying tracts as metropolitan, micropolitan, frontier–micropolitan, small town/rural, and frontier–small town/rural. We compared population and land area distributions and median distances to health care facility types by RUCA, FAR, and tIMFAC, and summarized distances to health care facilities across tIMFAC by Census regions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>tIMFAC metropolitan, micropolitan, and small town/rural categories had higher population densities (312, 74, and 27/m<sup>2</sup>, respectively) than their RUCA counterparts (304, 54, and 11/m<sup>2</sup>, respectively). Densities were much lower in tIMFAC frontier–micropolitan and frontier–small town/rural areas (23 and 4/m<sup>2</sup>, respectively) than micropolitan and small town/rural. Three patterns emerged for travel distances across tIMFAC: (1) steadily increasing distances from metropolitan to frontier–small town/rural areas (e.g., medical-surgical intensive care units (ICUs)); (2) similar distances within frontier–micropolitan and micropolitan, and within frontier–small town/rural and small town/rural, respectively (e.g., obstetrics); and (3) longer distances for frontier areas regardless of urbanicity (e.g., pediatric ICUs and designated trauma centers).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>tIMFAC provides a policy-relevant approach to identifying health differences across the urban-to-frontier continuum, supporting efforts to better understand and address unique rural and frontier health challenges.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626872","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}
Geunyeong Cha PhD, RN, JungHee Kang PhD, RN, Ashmita Thapa PhD, RN, Jia-Rong Wu PhD, RN, Nicholas R. Heebner PhD, ATC, Martha J. Biddle PhD, RN, Ulf G. Bronas PhD, ATC, Chin-Yen Lin PhD, RN, Jessica Thompson PhD, RN, Debra K. Moser PhD, RN
Purpose
The purposes of this study were to (1) identify predictors of sedentary time and (2) determine whether sociodemographic risk factors associated with sedentary time are mediated by sleep disturbances in younger (<60) and older (≥60) depressed rural patients with CVD.
Methods
Depressed rural patients with CVD completed surveys and wore ActiGraph GT9X Link monitors to measure sedentary time and sleep parameters (total sleep time and wake-after-sleep-onset [WASO]). Hierarchical regression analysis was conducted to identify factors associated with sedentary time, followed by a multi-group path analysis to examine how significant factors identified in the regression were associated with sedentary time, comparing the two age groups, and whether this association was mediated by parameters reflecting sleep disturbances.
Findings
Participants (n = 222) were predominantly White with an average age of 58 years and 52% were unemployed due to illness. Age, employment status, and WASO were significantly associated with sedentary time. Path analysis showed a significant mediating effect of age on sedentary time through WASO in the younger group (n = 115). However, the mediating effect of WASO on the relationship between age and sedentary time was not significant in the older group (n = 107).
Conclusions
The findings highlight the critical roles of age and sleep disturbances in promoting physical inactivity, with sleep disturbances being particularly influential in younger patients. Tailoring interventions by age groups may enhance strategies to mitigate CVD risk associated with inactivity.
{"title":"Risk factors for sedentary time and their mediation by sleep disturbances among depressed rural patients with cardiovascular disease: A path analysis","authors":"Geunyeong Cha PhD, RN, JungHee Kang PhD, RN, Ashmita Thapa PhD, RN, Jia-Rong Wu PhD, RN, Nicholas R. Heebner PhD, ATC, Martha J. Biddle PhD, RN, Ulf G. Bronas PhD, ATC, Chin-Yen Lin PhD, RN, Jessica Thompson PhD, RN, Debra K. Moser PhD, RN","doi":"10.1111/jrh.70095","DOIUrl":"10.1111/jrh.70095","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The purposes of this study were to (1) identify predictors of sedentary time and (2) determine whether sociodemographic risk factors associated with sedentary time are mediated by sleep disturbances in younger (<60) and older (≥60) depressed rural patients with CVD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Depressed rural patients with CVD completed surveys and wore ActiGraph GT9X Link monitors to measure sedentary time and sleep parameters (total sleep time and wake-after-sleep-onset [WASO]). Hierarchical regression analysis was conducted to identify factors associated with sedentary time, followed by a multi-group path analysis to examine how significant factors identified in the regression were associated with sedentary time, comparing the two age groups, and whether this association was mediated by parameters reflecting sleep disturbances.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Participants (<i>n</i> = 222) were predominantly White with an average age of 58 years and 52% were unemployed due to illness. Age, employment status, and WASO were significantly associated with sedentary time. Path analysis showed a significant mediating effect of age on sedentary time through WASO in the younger group (<i>n</i> = 115). However, the mediating effect of WASO on the relationship between age and sedentary time was not significant in the older group (<i>n</i> = 107).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings highlight the critical roles of age and sleep disturbances in promoting physical inactivity, with sleep disturbances being particularly influential in younger patients. Tailoring interventions by age groups may enhance strategies to mitigate CVD risk associated with inactivity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589583","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}
J Priyanka Vakkalanka PhD, Victor A Soupene PhDMS, Jennifer Van Tiem PhD, James M Blum MD, Barbara St. Marie PhD
Purpose
To examine the relationship between individual- and county-level factors associated with mental health and substance use dependence (MHSUD) treatment among rural suicide decedents.
Methods
Cross-sectional study (2013–2022) study of the National Violent Death Reporting System and the County Health Rankings. Primary exposures included individual- (demographic, clinical conditions) and county-level (average number of mentally unhealthy days, percentage of uninsured adults, rate of mental health providers/county, percentage of unemployed adults, rate of social associations, percentage of adults driving alone during long commutes, rate of primary care physicians/county, and income inequality ratios) factors of the decedent. The outcome was ever receipt of MHSUD treatment. We used multivariable logistic regression to measure the association between individual- and county-level factors and MHSUD treatment receipt.
Results
Of 42,021 rural suicides, 30% had MHSUD treatment receipt. Decedent-level factors associated with lower MHSUD treatment included male, sex, older age, racial/ethnic minorities, and residence in the Midwest or Northeast. MHSUD treatment was lower in rural counties with greater vulnerability (e.g., higher average number of mentally unhealthy days [aOR = 0.75, 95% CI: 0.68, 0.81], lower rate of primary care physicians/county [aOR = 0.92, 95% CI: 0.85, 0.99], lower rate of mental health providers/county [aOR = 0.76, 95% CI: 0.70, 0.81]).
Conclusions
By focusing within rural US counties, we found considerable variability in county-level risk factors for MHSUD treatment among suicide decedents. Research and public health efforts may consider disaggregating county-level factors when tailoring rural suicide prevention interventions in addition to improving MHSUD clinical infrastructure for both vulnerable individuals and counties.
{"title":"County-level vulnerability is associated with mental health and substance use treatment among rural suicide decedents: A national multi-year cross-sectional study","authors":"J Priyanka Vakkalanka PhD, Victor A Soupene PhDMS, Jennifer Van Tiem PhD, James M Blum MD, Barbara St. Marie PhD","doi":"10.1111/jrh.70094","DOIUrl":"10.1111/jrh.70094","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To examine the relationship between individual- and county-level factors associated with mental health and substance use dependence (MHSUD) treatment among rural suicide decedents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Cross-sectional study (2013–2022) study of the National Violent Death Reporting System and the County Health Rankings. Primary exposures included individual- (demographic, clinical conditions) and county-level (average number of mentally unhealthy days, percentage of uninsured adults, rate of mental health providers/county, percentage of unemployed adults, rate of social associations, percentage of adults driving alone during long commutes, rate of primary care physicians/county, and income inequality ratios) factors of the decedent. The outcome was ever receipt of MHSUD treatment. We used multivariable logistic regression to measure the association between individual- and county-level factors and MHSUD treatment receipt.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 42,021 rural suicides, 30% had MHSUD treatment receipt. Decedent-level factors associated with lower MHSUD treatment included male, sex, older age, racial/ethnic minorities, and residence in the Midwest or Northeast. MHSUD treatment was lower in rural counties with greater vulnerability (e.g., higher average number of mentally unhealthy days [aOR = 0.75, 95% CI: 0.68, 0.81], lower rate of primary care physicians/county [aOR = 0.92, 95% CI: 0.85, 0.99], lower rate of mental health providers/county [aOR = 0.76, 95% CI: 0.70, 0.81]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>By focusing within rural US counties, we found considerable variability in county-level risk factors for MHSUD treatment among suicide decedents. Research and public health efforts may consider disaggregating county-level factors when tailoring rural suicide prevention interventions in addition to improving MHSUD clinical infrastructure for both vulnerable individuals and counties.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460501","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}
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