Journal of Rural Health最新文献_第4页

A novel approach to incorporate frontier areas into urban–rural geographic classifications: Integrated Metropolitan-to-Frontier Area Codes 一种将边疆地区纳入城乡地理分类的新方法：综合大都市到边疆地区代码

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-11-29 DOI: 10.1111/jrh.70102

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.

制定一种城乡边界分类，将城市化和地理偏远性结合起来，捕捉传统编码方案中看不到的人口和土地面积分布的细微差别，从而提供一个框架，衡量从城市到边境的整个连续体的健康结果和获得保健的机会。方法将美国农业部经济研究局的前沿和偏远地区（FAR）代码与城乡通勤区（RUCA）代码相结合，建立了区域级综合大都市到边境地区代码（tIMFAC），并将区域划分为大都市、小城市、边境-小城市、小城镇/农村和边境-小城镇/农村。我们通过RUCA、FAR和tIMFAC比较了人口和土地面积分布以及到医疗机构类型的中位数距离，并按人口普查地区总结了tIMFAC到医疗机构的距离。结果tIMFAC大都市、小城市和小城镇/农村的人口密度（分别为312、74和27/m2）高于RUCA的人口密度（分别为304、54和11/m2）。tIMFAC边境-小城市和边境-小城镇/农村地区的密度（分别为23只/m2和4只/m2）远低于小城市和小城镇/农村。跨tIMFAC的旅行距离出现了三种模式：(1)从大都市到边境小城镇/农村地区（例如内科-外科重症监护病房）的距离稳步增加；(2)边境-小城市和小城市之间、边境-小城镇/农村和边境-小城镇/农村之间的距离相似（如产科）；(3)无论城市化程度如何，边境地区（如儿科icu和指定创伤中心）的距离都更长。tIMFAC提供了一种与政策相关的方法来确定城市与边境连续体之间的健康差异，支持更好地了解和解决独特的农村和边境健康挑战。

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引用次数: 0

Risk factors for sedentary time and their mediation by sleep disturbances among depressed rural patients with cardiovascular disease: A path analysis 农村抑郁症合并心血管疾病患者久坐时间的危险因素及其睡眠障碍的调节作用：一项通径分析

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-11-24 DOI: 10.1111/jrh.70095

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.

目的：本研究的目的是：(1)确定久坐时间的预测因素，(2)确定与久坐时间相关的社会人口危险因素是否与年轻人的睡眠障碍有关(方法：患有心血管疾病的农村抑郁症患者完成调查，并佩戴ActiGraph GT9X Link监测仪来测量久坐时间和睡眠参数（总睡眠时间和睡眠后醒来时间[WASO]）。我们进行了层次回归分析以确定与久坐时间相关的因素，随后进行了多组路径分析，以检验回归中确定的重要因素与久坐时间的相关性，比较两个年龄组，以及这种相关性是否由反映睡眠障碍的参数介导。研究结果：参与者（n = 222）主要是白人，平均年龄为58岁，52%的人因病失业。年龄、就业状况和WASO与久坐时间显著相关。通径分析显示，年龄对年轻组的久坐时间有显著的中介作用（n = 115）。然而，WASO对年龄和久坐时间之间关系的中介作用在老年组中不显著（n = 107）。结论：研究结果强调了年龄和睡眠障碍在促进缺乏身体活动方面的关键作用，睡眠障碍对年轻患者的影响尤其大。按年龄组定制干预措施可能会增强降低与不活动相关的心血管疾病风险的策略。

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引用次数: 0

County-level vulnerability is associated with mental health and substance use treatment among rural suicide decedents: A national multi-year cross-sectional study 县级脆弱性与农村自杀者的心理健康和药物使用治疗有关：一项全国多年横断面研究。

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-11-06 DOI: 10.1111/jrh.70094

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.

目的：探讨农村自杀者心理健康和物质使用依赖（MHSUD）治疗的个体和县域因素之间的关系。方法：2013-2022年对全国暴力死亡报告系统和县健康排名进行横断面研究。主要暴露因素包括个人因素（人口统计学、临床状况）和县级因素（精神不健康天数的平均值、无保险成年人的百分比、精神保健提供者/县的比率、失业成年人的百分比、社会协会的比率、长通勤期间独自驾驶的成年人的百分比、初级保健医生/县的比率和收入不平等比率）。结果是接受了MHSUD治疗。我们使用多变量logistic回归来衡量个体和县级因素与MHSUD治疗接收之间的关联。结果：42021例农村自杀者中，30%接受过MHSUD治疗。与低MHSUD治疗相关的死亡因素包括男性、性别、年龄较大、种族/少数民族和居住在中西部或东北部。MHSUD治疗在易损性较高的农村县较低（例如，平均精神不健康天数较高[aOR = 0.75, 95% CI: 0.68, 0.81]，初级保健医生/县比例较低[aOR = 0.92, 95% CI: 0.85, 0.99]，精神卫生服务提供者/县比例较低[aOR = 0.76, 95% CI: 0.70, 0.81]）。结论：通过关注美国农村县，我们发现在自杀死者中MHSUD治疗的县级危险因素存在相当大的差异。研究和公共卫生工作除了改善弱势个人和县的MHSUD临床基础设施外，还可以考虑在定制农村自杀预防干预措施时分解县级因素。

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引用次数: 0

The impact of the removal of the low-wage index hospital policy on urban and rural hospitals 取消低工资指数医院政策对城乡医院的影响。

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-11-06 DOI: 10.1111/jrh.70090

Saleema A. Karim PhD, Kristie W. Thompson MA, George H. Pink PHD, George M. Holmes PhD

Purpose

The low-wage index hospital policy (LWIHP), implemented in fiscal year (FY) 2020, temporarily increased Medicare wage index values for hospitals in the lowest quartile to address geographic differences in reimbursement. Following a federal court ruling, the Centers for Medicare & Medicaid Services (CMS) rescinded the LWIHP in the FY 2025 Interim Final Rule and introduced a one-time transitional payment adjustment for hospitals experiencing wage index reductions greater than 5%. This study describes the characteristics of hospitals most affected by the removal of the LWIHP, stratified by urban and rural status.

Methods

Using publicly available CMS administrative datasets, we identified inpatient prospective payment system (IPPS) hospitals with reductions in their FY 2025 wage index from the removal of the LWIHP. Hospitals were grouped into three categories: no change, a reduction of 0%–5%, and a reduction of >5%. Descriptive statistics summarized financial, organizational, and community characteristics across the three wage index categories, stratified by urban and rural status.

Findings

Among 3152 IPPS hospitals, 46% of rural hospitals and 18.5% of urban hospitals experienced wage index reductions. Rural hospitals in the most affected category (>5% reduction) were more likely to be unaffiliated, government-owned, and located in counties with lower income, higher poverty, and lower population density.

Conclusion

Hospitals most affected by the removal of the LWIHP, particularly rural facilities, serve communities with limited economic resources. These findings highlight the importance of Medicare payment policies that consider geographic and structural disadvantages to maintain health care access in underserved areas.

目的：2020财政年度实施的低工资指数医院政策（LWIHP）暂时提高了最低四分位数医院的医疗保险工资指数值，以解决报销方面的地域差异。根据联邦法院的裁决，医疗保险和医疗补助服务中心（CMS）在2025财年临时最终规则中废除了LWIHP，并为工资指数下降超过5%的医院引入了一次性过渡支付调整。这项研究描述了受取消低卫生保健计划影响最大的医院的特点，按城市和农村状况分层。方法：使用公开可用的CMS管理数据集，我们确定住院患者预期支付系统（IPPS）医院，其2025财年工资指数因取消LWIHP而降低。医院被分为三类：没有变化、减少0%-5%和减少0.5%。描述性统计总结了三个工资指数类别的金融、组织和社区特征，并按城市和农村状况分层。结果：在3152家IPPS医院中，46%的农村医院和18.5%的城市医院出现工资指数下降。受影响最严重的乡村医院（减少5%）更可能是政府所有的非附属医院，并且位于收入较低、贫困程度较高和人口密度较低的县。结论：医院，特别是农村医院，由于经济资源有限，其服务的社区受取消低卫生保健计划的影响最大。这些发现强调了医疗保险支付政策的重要性，考虑到地理和结构上的劣势，以保持医疗服务不足地区的医疗服务。

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引用次数: 0

Degree of rurality moderates the association of sedentary time with cognitive function in rural patients with cardiac diseases and depressive symptoms 乡村程度调节农村心脏病和抑郁症状患者久坐时间与认知功能的关系

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-11-02 DOI: 10.1111/jrh.70092

Chin-Yen Lin PhD, RN, Jia-Rong Wu PhD, RN, Geunyeong Cha PhD, RN, JungHee Kang PhD, MPH, RN, Martha J. Biddle PhD, APRN, Misook L. Chung PhD, RN, Ashmita Thapa PhD, RN, Mary Kay Rayens PhD, Linda Gibson-Young PhD, FAANP, Debra K. Moser PhD, RN

Background

Prolonged sedentary time has been linked to impaired cognitive outcomes. However, the impact of sedentary time on cognitive function at different degrees of rurality is not yet well understood in patients with cardiac diseases and depressive symptoms.

Purpose

To determine whether degree of rurality moderates the relationship between sedentary time and cognitive function.

Methods

This study includes 135 coronary heart disease or heart failure patients, primarily residing in rural Kentucky, including Appalachian areas, United States. Sedentary time was measured by the average daily sedentary time (in minutes) using accelerometry (ActiGraph). Cognitive function was assessed using the Montreal Cognitive Assessment-Blind. Rurality was determined by Rural-Urban Commuting Area (RUCA) codes. Patients were categorized into two groups by rurality: (1) 89 patients in a less rural group (RUCA codes 4−6); and (2) 46 patients in a more rural group (RUCA codes 7−10). Data were collected May 2021-September 2022 and analyzed using the Hayes PROCESS macro in SPSS.

Results

Sedentary time predicted cognitive function (B = −0.006, p = 0.019), and this relationship was moderated by rurality (interaction term = 0.006, p = 0.022). Patients living in more rural areas had significantly worse cognitive function when sedentary for longer periods (p = 0.019); specifically, every 100-min increase in sedentary time was associated with a 0.6-point decrease in cognitive function score. However, this relationship was not observed in those living in less rural areas (p = 0.658).

Conclusions

Testing the impact of interventions aimed at reducing sedentary time on cognitive function is warranted in this population, particularly for those living in highly rural areas.

背景：久坐与认知功能受损有关。然而，在患有心脏病和抑郁症状的患者中，久坐时间对不同乡村程度认知功能的影响尚不清楚。目的：确定乡村化程度是否调节久坐时间与认知功能之间的关系。方法：本研究纳入135例冠心病或心力衰竭患者，主要居住在美国肯塔基州农村，包括阿巴拉契亚地区。久坐时间是用加速度计（ActiGraph）测量的平均每日久坐时间（以分钟为单位）。认知功能评估采用蒙特利尔认知评估盲法。乡村性由城乡通勤区（RUCA）代码确定。患者按乡村性分为两组：(1)非乡村组89例（RUCA代码4-6）；(2)农村地区46例（RUCA代码7-10）。数据收集于2021年5月至2022年9月，使用SPSS中的Hayes PROCESS宏进行分析。结果：久坐时间对认知功能有预测作用（B = -0.006, p = 0.019），而乡村性对这种关系有调节作用（交互项= 0.006,p = 0.022）。生活在农村地区的患者，久坐时间越长，认知功能越差（p = 0.019）；具体来说，久坐时间每增加100分钟，认知功能评分就会下降0.6分。然而，在那些生活在较少农村地区的人中没有观察到这种关系（p = 0.658）。结论：测试旨在减少久坐时间的干预措施对认知功能的影响是有必要的，特别是对那些生活在高度农村地区的人群。

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引用次数: 0

Perceptions of whole-body donation for biomedical research: An interview study with rural adults in Georgia 生物医学研究对全身捐赠的看法：对格鲁吉亚农村成年人的访谈研究。

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-11-02 DOI: 10.1111/jrh.70093

Caroline E. Anglim PhD, Charles E. Waldner BS, Brian Childs PhD, Rebecca D. Pentz PhD, Margie D. Dixon BS, Kenya Apongule BS, Catherine Diop Chalmers BS, Kersten Pierre BS, Laura Ross PhD, Alika Reid-Croy PhD, Taliyah Henderson PhD, Anne Montgomery PhD, Donald E. Carter III DBe

Purpose

This study aims to describe how rural residents in Georgia (USA) perceive organ donation and biomedical research on the recently deceased, the appropriate oversight and duration for this type of research, and the disclosures necessary for whole-body donation.

Methods

Researchers conducted interviews with adults residing in rural Georgia counties (determined by Rural-Urban Conintuum Codes (USDA)) and analyzed participants’ perspectives for themes on organ donation and whole-body donation for research. Methods cohere with Standards for Reporting Qualitative Research.

Findings

Participants had positive views of organ donation and expressed willingness to consider donating their own or a family member's organs. Participants strongly supported first-person authorization for any type of organ or whole-body donation. About half of respondents expressed discomfort with or uncertainty about whole-body donation for biomedical research. A minority of respondents indicated that the family should have the right to override the patient's first-person authorization of whole-body donation. A minority of respondents indicated that requests for whole-body donation for research should occur after a grieving period. Most respondents were open to extending the 72-h limit on research on the recently deceased, but they generally capped the extension at 1 week.

Conclusions

Rural Georgia adults were curious about and open to whole-body donation to research, though half expressed discomfort and wished to learn more before they could approve such research.

目的：本研究旨在描述美国乔治亚州的农村居民如何看待器官捐赠和对刚去世的人进行生物医学研究，这类研究的适当监督和持续时间，以及对全身捐赠的必要披露。方法：研究人员对居住在佐治亚州农村县的成年人进行了访谈（由农村-城市连续规范（USDA）确定），并分析了参与者对器官捐赠和全身捐赠主题的看法。方法符合定性研究报告标准。调查结果：参与者对器官捐赠持积极态度，并表示愿意考虑捐赠自己或家人的器官。与会者强烈支持第一人称授权任何类型的器官或全身捐赠。大约一半的受访者对生物医学研究的全身捐赠表示不舒服或不确定。少数受访者表示，家属应该有权推翻患者对全身捐赠的第一人称授权。少数受访者表示，为研究捐献全身的请求应该在悲伤时期之后提出。大多数受访者对延长对最近去世的人进行研究的72小时限制持开放态度，但他们通常将延长限制在1周内。结论：乔治亚州农村地区的成年人对全身捐献进行研究感到好奇并持开放态度，尽管有一半人表示不舒服，并希望在批准此类研究之前了解更多。

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引用次数: 0

Rural dwelling as a risk factor for mental health and well-being for LGBTQ+ youth: The mechanism of social support 农村居住作为LGBTQ+青年心理健康和福祉的风险因素：社会支持的机制

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-11-01 DOI: 10.1111/jrh.70091

Mackenzie Myer MA, Morgan E. Ellithorpe PhD

Purpose

Existing literature on LGBTQ+ social support often overlooks the experiences of rural dwellers, who may face obstacles related to access to mental health resources and in-person social support. This study seeks to address the gap by examining how social support varies across different geographic areas and how it relates to mental health outcomes for LGBTQ+ emerging adults.

Methods

This study surveyed LGBTQ+ emerging adults (n = 293) about their demographics, their sources of social support, their mental health and well-being, and their ZIP codes (current and when teenagers). Rurality was determined using Rural-Urban Commuting Area (RUCA) codes.

Findings

Mediation analyses found that the LGBTQ+ youth living in the most rural areas according to RUCA codes reported significantly lower social support as compared to those living in major metropolitan areas. Higher social support was significantly associated with lower depression, lower anxiety, and greater well-being.

Conclusions

These results suggest that LGBTQ+ individuals living in rural areas may disproportionately receive less social support and experience worse mental health outcomes than their urban peers. This highlights the need for targeted interventions tailored to the unique challenges faced by LGBTQ+ rural dwellers.

现有关于LGBTQ+社会支持的文献往往忽视了农村居民的经历，他们在获得心理健康资源和面对面的社会支持方面可能面临障碍。本研究旨在通过研究社会支持在不同地理区域的差异以及它与LGBTQ+新兴成年人心理健康结果的关系来解决这一差距。方法对293名LGBTQ+新兴成人（n = 293）进行人口统计、社会支持来源、心理健康和幸福感、邮政编码（青少年时期和青少年时期）等调查。采用城乡通勤区（RUCA）编码确定乡村性。中介分析发现，根据RUCA规范，生活在大多数农村地区的LGBTQ+青年报告的社会支持明显低于生活在大城市地区的LGBTQ+青年。更高的社会支持与更低的抑郁、更低的焦虑和更大的幸福感显著相关。结论生活在农村地区的LGBTQ+个体获得的社会支持可能比城市同龄人少，心理健康状况也更差。这凸显了针对LGBTQ+农村居民所面临的独特挑战采取针对性干预措施的必要性。

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引用次数: 0

What drives advanced practice nurses to stay in rural America? Insights from the 2022 National Survey of Registered Nurses 是什么驱使高级实习护士留在美国农村？来自2022年全国注册护士调查的见解。

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-10-28 DOI: 10.1111/jrh.70088

Esita Patel PhD, RN, Chris Gillette PhD, Jan Ostermann PhD, Chris Everett PhD, MPH, PA-C, Dawn Caviness MD, BSN, Sarah Garvick MS, MPAS, PA-C

Purpose

Recruiting and retaining a robust rural health care workforce is critical to advancing health outcomes in rural communities. Although increasing the rural provider workforce has been a policy focus for decades, rural access continues to worsen. Using a strengths-based approach, we identify factors that influence the decisions of advanced practice registered nurses (APRNs) to leave or stay in their jobs.

Methods

Secondary analysis of data from the 2022 National Sample Survey of Registered Nurses. We describe rates of turnover, retention, intention to leave, and reasons for leaving and staying by job rurality. We compare reasons by rurality using Pearson chi-squared tests with the Rao-Scott correction, applying survey weights to all analyses.

Findings

Our sample included 18,804 APRNs, of which one-fifth (19.1%, n = 3,589) worked in rural areas. The rural APRN workforce was, on average, older, less racially diverse, more experienced, and had a lower household income compared to the nonrural APRN workforce. Those who remained in rural jobs were more likely to report length of commute (P = .02), cost of living (P = .02), commitment to underserved communities (P = .001), and proximity to family (P<.001), compared to those who remained in urban jobs. Those who left nonrural jobs cited greater burnout (P = .02), stressful work environment (P = .05), career advancement (P = .01), and being laid off/downsized (P = .01) as reasons for leaving, compared to those who left rural jobs.

Conclusions

We identified unique factors, including proximity to family, commitment to underserved populations, and less burnout, that contribute to APRN retention in rural areas. Leveraging these motivators can inform more effective, tailored strategies to support the rural health care workforce.

目的：招募和留住一支强大的农村卫生保健队伍对于提高农村社区的卫生成果至关重要。尽管几十年来，增加农村医疗服务提供者的劳动力一直是政策重点，但农村医疗服务的可及性仍在恶化。使用基于优势的方法，我们确定影响高级执业注册护士（aprn）决定离开或留在他们的工作的因素。方法：对2022年全国注册护士抽样调查数据进行二次分析。我们描述了流动率、留任率、离职意向以及离职和留任的原因。我们使用Pearson卡方检验和Rao-Scott校正来比较乡村性的原因，对所有分析应用调查权重。结果：我们的样本包括18804名APRNs，其中五分之一（19.1%,n = 3589）在农村地区工作。与非农村APRN劳动力相比，农村APRN劳动力平均年龄更大，种族多样性更少，经验更丰富，家庭收入更低。那些留在农村工作的人更有可能报告通勤长度（P = 0.02）、生活成本（P = 0.02）、对服务不足社区的承诺（P = 0.001）和与家人的接近程度(P)。结论：我们确定了一些独特的因素，包括与家人的接近程度、对服务不足人群的承诺和更少的倦怠，这些因素有助于APRN在农村地区的保留。利用这些激励因素可以为更有效、更有针对性的战略提供信息，以支持农村卫生保健工作人员。

{"title":"What drives advanced practice nurses to stay in rural America? Insights from the 2022 National Survey of Registered Nurses","authors":"Esita Patel PhD, RN, Chris Gillette PhD, Jan Ostermann PhD, Chris Everett PhD, MPH, PA-C, Dawn Caviness MD, BSN, Sarah Garvick MS, MPAS, PA-C","doi":"10.1111/jrh.70088","DOIUrl":"10.1111/jrh.70088","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Recruiting and retaining a robust rural health care workforce is critical to advancing health outcomes in rural communities. Although increasing the rural provider workforce has been a policy focus for decades, rural access continues to worsen. Using a strengths-based approach, we identify factors that influence the decisions of advanced practice registered nurses (APRNs) to leave or stay in their jobs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Secondary analysis of data from the 2022 National Sample Survey of Registered Nurses. We describe rates of turnover, retention, intention to leave, and reasons for leaving and staying by job rurality. We compare reasons by rurality using Pearson chi-squared tests with the Rao-Scott correction, applying survey weights to all analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Our sample included 18,804 APRNs, of which one-fifth (19.1%, n = 3,589) worked in rural areas. The rural APRN workforce was, on average, older, less racially diverse, more experienced, and had a lower household income compared to the nonrural APRN workforce. Those who remained in rural jobs were more likely to report length of commute (<i>P</i> = .02), cost of living (<i>P</i> = .02), commitment to underserved communities (<i>P</i> = .001), and proximity to family (<i>P</i><.001), compared to those who remained in urban jobs. Those who left nonrural jobs cited greater burnout (<i>P</i> = .02), stressful work environment (<i>P</i> = .05), career advancement (<i>P</i> = .01), and being laid off/downsized (<i>P</i> = .01) as reasons for leaving, compared to those who left rural jobs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We identified unique factors, including proximity to family, commitment to underserved populations, and less burnout, that contribute to APRN retention in rural areas. Leveraging these motivators can inform more effective, tailored strategies to support the rural health care workforce.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145394802","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}

引用次数: 0

Breast cancer screening method prevalences in rural and urban women post-pandemic 大流行后农村和城市妇女乳腺癌筛查方法的流行情况。

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-10-27 DOI: 10.1111/jrh.70089

Ingrid Jacobson MPH, Brooke Gully MS, Anika Eldien BS, Emily McGovern DO

Background

Breast cancer, the second most commonly diagnosed and second leading cause of cancer death among US women, is detected by screening methods including mammograms, breast MRIs, and genetic testing. There are known disparities in rural cancer care, including observed disparities in breast cancer screening. The COVID-19 pandemic worsened the rural cancer gap overall. This study aims to estimate the prevalence of various breast cancer screening methods among rural and urban women post-pandemic.

Methods

We used weighted data from the 2023 National Health Interview Survey on 15,745 women, including 2,432 rural women. We obtained unadjusted sociodemographic predictors of breast cancer screenings as well as six unadjusted breast cancer screening outcomes. We then built Firth penalized regressions estimating adjusted odds of all six outcomes in rural versus urban women in our sample.

Results

Rural women were less likely to have ever had a mammogram (60.8% vs. 64.6%, p = 0.017), and marginally less likely to have ever discussed genetic testing (8.9% vs. 10.3%, p = 0.093) or have ever gotten genetic testing for cancer risk (5.4% vs. 6.5%, p = 0.05). After adjustment, odds of ever discussing genetic testing with a doctor remained marginally lower for rural than urban women (aOR: 0.87, 95% CI: 0.74–1.02).

Conclusions

Rural–urban differences in breast cancer screening outcomes were attenuated after adjustment for sociodemographic factors, suggesting these factors primarily drive observed disparities. Addressing these upstream social determinants of health could help improve rural breast cancer screening disparities.

背景：乳腺癌是美国妇女中第二大常见诊断和第二大癌症死亡原因，通过筛查方法检测，包括乳房x光检查、乳房核磁共振成像和基因检测。在农村癌症护理方面存在着已知的差距，包括在乳腺癌筛查方面观察到的差距。2019冠状病毒病大流行总体上加剧了农村癌症差距。本研究旨在估计大流行后农村和城市妇女中各种乳腺癌筛查方法的流行程度。方法：采用2023年全国健康访谈调查的加权数据，对15745名妇女进行调查，其中包括2432名农村妇女。我们获得了未经调整的乳腺癌筛查的社会人口学预测因子以及6个未经调整的乳腺癌筛查结果。然后，我们建立了费斯惩罚回归，估计我们样本中农村妇女与城市妇女所有六种结果的调整几率。结果：农村妇女接受过乳房x光检查的可能性较低（60.8%对64.6%,p = 0.017），讨论过基因检测的可能性较低（8.9%对10.3%,p = 0.093），或接受过癌症风险基因检测的可能性较低（5.4%对6.5%,p = 0.05）。调整后，农村妇女与医生讨论基因检测的几率仍然略低于城市妇女（aOR: 0.87, 95% CI: 0.74-1.02）。结论：调整社会人口因素后，乳腺癌筛查结果的城乡差异减弱，表明这些因素主要驱动观察到的差异。解决这些健康的上游社会决定因素可能有助于改善农村乳腺癌筛查的差距。

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引用次数: 0

Community pharmacists’ engagement in opioid harm reduction: A rural–urban analysis from a rural state 社区药剂师参与减少阿片类药物危害：来自农村州的农村-城市分析

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-10-24 DOI: 10.1111/jrh.70087

Elizabeth Skoy PharmD, Oliver Frenzel PharmD, MPH, Elizabell Delgado BS, Jenna Gorder BS, Landon Woinarowicz BS, Heidi Eukel PharmD

Purpose

To evaluate disparities in opioid misuse risk and pharmacist-led harm reduction interventions by comparing rural and urban community pharmacies participating in an opioid misuse and accidental overdose prevention program in North Dakota.

Methods

The ONE Program is a statewide opioid harm reduction initiative that screens patients receiving opioid prescriptions for risk of opioid use disorder and opioid overdose. Pharmacists delivered interventions based on risk stratification, including naloxone education/dispensing, prescriber contact, and community support referrals. Risk and outcomes were analyzed comparing rural and urban pharmacy settings using odds ratios (ORs) with 95% confidence intervals.

Findings

Between April 2022 and July 2024, a total of 21,295 patient opioid risk screenings were conducted across 63 pharmacies (32 rural, 31 urban). Urban pharmacies screened a higher proportion of at-risk patients (26.2%) compared to rural pharmacies (17.1%). While naloxone was recommended at similar rates, rural patients were significantly less likely to accept naloxone (11.2% vs. 20.7%, OR = 0.49). Urban pharmacies were more likely to contact prescribers (9.9% vs. 1.9%, OR = 0.18) and introduce medication take-back programs (OR = 6.65). Conversely, rural pharmacies were more likely to provide partial opioid fills (OR = 1.67) and education on community support services (OR = 3.95). Overall, rural patients were 24% less likely to receive at least one of six critical interventions defined by the ONE Program. (OR = 0.76).

Conclusion

The ONE Program effectively identifies at-risk patients and delivers harm reduction interventions in both rural and urban pharmacy settings. However, significant differences in intervention delivery highlight the need for tailored strategies to address geographic disparities in opioid harm reduction.

目的通过比较北达科他州农村和城市社区药房参与阿片类药物滥用和意外过量预防项目，评估阿片类药物滥用风险和药剂师主导的减少危害干预措施的差异。ONE项目是一项全州范围内的阿片类药物减少危害倡议，对接受阿片类药物处方的患者进行阿片类药物使用障碍和阿片类药物过量风险的筛查。药剂师根据风险分层提供干预措施，包括纳洛酮教育/配药、处方医师联系和社区支持转介。使用95%置信区间的优势比（ORs）对农村和城市药房设置的风险和结果进行分析。在2022年4月至2024年7月期间，共在63家药店（32家农村，31家城市）对21,295名患者进行了阿片类药物风险筛查。城市药房对高危患者的筛查比例（26.2%）高于农村药房（17.1%）。虽然纳洛酮的推荐率相似，但农村患者接受纳洛酮的可能性明显较低（11.2%对20.7%,OR = 0.49）。城市药房更有可能联系处方医师（9.9% vs. 1.9%, OR = 0.18）并引入药物回收计划（OR = 6.65）。相反，农村药房更有可能提供部分阿片类药物填充（OR = 1.67）和社区支持服务教育（OR = 3.95）。总体而言，农村患者接受one项目定义的六项关键干预措施中至少一项的可能性要低24%。（or = 0.76）。结论ONE项目在农村和城市药房都能有效识别高危患者，并提供减少危害的干预措施。然而，干预措施交付方面的显著差异突出表明，需要制定量身定制的战略，以解决减少阿片类药物危害方面的地域差异。

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引用次数: 0