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.
{"title":"Perceptions of whole-body donation for biomedical research: An interview study with rural adults in Georgia","authors":"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","doi":"10.1111/jrh.70093","DOIUrl":"10.1111/jrh.70093","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432854","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}
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.
{"title":"Rural dwelling as a risk factor for mental health and well-being for LGBTQ+ youth: The mechanism of social support","authors":"Mackenzie Myer MA, Morgan E. Ellithorpe PhD","doi":"10.1111/jrh.70091","DOIUrl":"https://doi.org/10.1111/jrh.70091","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study surveyed LGBTQ+ emerging adults (<i>n</i> = 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145406720","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}
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.
{"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}
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.
{"title":"Breast cancer screening method prevalences in rural and urban women post-pandemic","authors":"Ingrid Jacobson MPH, Brooke Gully MS, Anika Eldien BS, Emily McGovern DO","doi":"10.1111/jrh.70089","DOIUrl":"10.1111/jrh.70089","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Rural women were less likely to have ever had a mammogram (60.8% vs. 64.6%, <i>p</i> = 0.017), and marginally less likely to have ever discussed genetic testing (8.9% vs. 10.3%, <i>p</i> = 0.093) or have ever gotten genetic testing for cancer risk (5.4% vs. 6.5%, <i>p</i> = 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).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145379612","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}
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。
{"title":"Community pharmacists’ engagement in opioid harm reduction: A rural–urban analysis from a rural state","authors":"Elizabeth Skoy PharmD, Oliver Frenzel PharmD, MPH, Elizabell Delgado BS, Jenna Gorder BS, Landon Woinarowicz BS, Heidi Eukel PharmD","doi":"10.1111/jrh.70087","DOIUrl":"https://doi.org/10.1111/jrh.70087","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>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).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367013","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}
Busse CE PhD, O'Hanlon K MPH, Kozhimannil KB PhD, Interrante JD PhD
Purpose
This study describes perspectives of rural hospital administrators regarding the financial context for operating obstetric units, including the unique challenges they face and the strategies they have implemented to maintain obstetric services.
Methods
In this mixed-methods study, we used data from a survey we conducted from March to August 2021 of administrators of rural hospitals that had maintained or closed their obstetric units. Key financial outcomes included general finances, size and equipment, payor mix, workforce, and other fixed costs, examined descriptively. We also conducted thematic content analysis of open-ended responses to financial questions.
Findings
Respondents from hospitals that closed obstetric services (n = 40) reported that physician shortages (67%), financial losses (62%), clinical safety (56%), liability insurance costs (51%), and nurse shortages (39%) influenced the decision to close obstetric units. Among hospitals with obstetrics (n = 88), more than half (55%) reported that their hospital was operating with a profit margin, but only 41% said their obstetric unit had more revenue than costs. Of the hospitals with obstetrics who responded about the future of their obstetric units, 77% (61/79) were confident that they would continue providing obstetric care in 10 years; their open-ended responses highlighted the importance of hospital leadership's commitment to maintaining obstetric services in their communities.
Conclusions
Rural hospitals cite clinical workforce challenges, high fixed costs, and declining birth volumes as financial challenges to providing obstetrics. Strategies for maintaining obstetric care in rural communities should account for lower birth volumes in rural facilities and these interrelated challenges.
{"title":"Financial challenges of providing obstetric services at rural US hospitals","authors":"Busse CE PhD, O'Hanlon K MPH, Kozhimannil KB PhD, Interrante JD PhD","doi":"10.1111/jrh.70082","DOIUrl":"10.1111/jrh.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study describes perspectives of rural hospital administrators regarding the financial context for operating obstetric units, including the unique challenges they face and the strategies they have implemented to maintain obstetric services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this mixed-methods study, we used data from a survey we conducted from March to August 2021 of administrators of rural hospitals that had maintained or closed their obstetric units. Key financial outcomes included general finances, size and equipment, payor mix, workforce, and other fixed costs, examined descriptively. We also conducted thematic content analysis of open-ended responses to financial questions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Respondents from hospitals that closed obstetric services (<i>n</i> = 40) reported that physician shortages (67%), financial losses (62%), clinical safety (56%), liability insurance costs (51%), and nurse shortages (39%) influenced the decision to close obstetric units. Among hospitals with obstetrics (<i>n</i> = 88), more than half (55%) reported that their hospital was operating with a profit margin, but only 41% said their obstetric unit had more revenue than costs. Of the hospitals with obstetrics who responded about the future of their obstetric units, 77% (61/79) were confident that they would continue providing obstetric care in 10 years; their open-ended responses highlighted the importance of hospital leadership's commitment to maintaining obstetric services in their communities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rural hospitals cite clinical workforce challenges, high fixed costs, and declining birth volumes as financial challenges to providing obstetrics. Strategies for maintaining obstetric care in rural communities should account for lower birth volumes in rural facilities and these interrelated challenges.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12539383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337876","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}
Alexis Swendener PhD, Mariana Tuttle MPH, Ingrid Jacobson MPH, Lisa I. Iezzoni MD, MSc, Robert Barclay MPH, Carrie Henning-Smith PhD, MPH, MSW
Purpose
Access to health care supports both individual and population health. Ample research demonstrates access barriers faced by rural residents and people with disabilities; however, less research has examined access barriers for rural residents by disability status or explored differences across multiple types of access barriers. This brief report addresses this gap by examining 11 financial and nonfinancial barriers to accessing health care among rural adults by disability status.
Methods
Using nationally representative data from the 2022 National Health Interview Survey and focusing on rural adults (n = 4,703), we conducted bivariate and multivariate logistic regression analyses comparing 11 separate access barriers by disability status and generated adjusted predicted probabilities of experiencing these barriers, controlling for sociodemographic characteristics.
Findings
Overall, compared to those without disabilities, rural people with disabilities had significantly higher adjusted predicted probabilities of 8 of the 11 access barriers. These include delaying multiple types of care due to cost, not being able to afford prescriptions, and delaying care due to facility hours, insurance acceptance, transportation, and travel time. Rural people with disabilities were, however, more likely than their nondisabled counterparts to report having a usual place for care.
Conclusions
Rural individuals with disabilities face more barriers to care than their peers without disabilities, including delaying care, which can potentially worsen health outcomes. Our findings provide important information for policymakers to improve access to care at the intersection of rurality and disability.
{"title":"Barriers to health care among rural adults by disability status","authors":"Alexis Swendener PhD, Mariana Tuttle MPH, Ingrid Jacobson MPH, Lisa I. Iezzoni MD, MSc, Robert Barclay MPH, Carrie Henning-Smith PhD, MPH, MSW","doi":"10.1111/jrh.70086","DOIUrl":"10.1111/jrh.70086","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Access to health care supports both individual and population health. Ample research demonstrates access barriers faced by rural residents and people with disabilities; however, less research has examined access barriers for rural residents by disability status or explored differences across multiple types of access barriers. This brief report addresses this gap by examining 11 financial and nonfinancial barriers to accessing health care among rural adults by disability status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using nationally representative data from the 2022 National Health Interview Survey and focusing on rural adults (n = 4,703), we conducted bivariate and multivariate logistic regression analyses comparing 11 separate access barriers by disability status and generated adjusted predicted probabilities of experiencing these barriers, controlling for sociodemographic characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Overall, compared to those without disabilities, rural people with disabilities had significantly higher adjusted predicted probabilities of 8 of the 11 access barriers. These include delaying multiple types of care due to cost, not being able to afford prescriptions, and delaying care due to facility hours, insurance acceptance, transportation, and travel time. Rural people with disabilities were, however, more likely than their nondisabled counterparts to report having a usual place for care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rural individuals with disabilities face more barriers to care than their peers without disabilities, including delaying care, which can potentially worsen health outcomes. Our findings provide important information for policymakers to improve access to care at the intersection of rurality and disability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12538111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337887","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}
Suzanne B. Daly PhD, Wei You MS, Elizabeth I. Merwin PhD
<p>Rural and urban differences in mortality and morbidity have been persistent.<span><sup>1-6</sup></span> Rural patients have higher rates of acute and chronic health problems such as obesity, diabetes, cardiovascular disease, and cancer.<span><sup>2, 7, 8</sup></span> Rural communities have higher numbers of uninsured individuals, rates of poverty and unemployment, lower rates of education, and greater difficulty accessing reliable transportation.<span><sup>2, 9</sup></span> They also have fewer hospitals and health care providers, and, despite numerous interventions, rural hospitals continue to close at a rapid rate, leaving rural patients facing increased challenges accessing health care.<span><sup>9, 10</sup></span> The combination of these factors has likely contributed to the gap between rural and urban morbidity and mortality that has continued to expand over the last several decades.</p><p>Rural hospitals are often the only source of care in their communities, as well as the largest employer, and closures threaten the health of rural communities.<span><sup>8, 11</sup></span> Medicaid expansion in 40 states and the District of Columbia has helped rural hospitals by providing compensation for care for patients who would otherwise be unable to pay.<span><sup>12, 13</sup></span> As shown in Figure 1, since 2005, 111 rural hospitals have completely closed, leaving many communities without local access to emergency, obstetric, and other medical services.<span><sup>14</sup></span> Over half of these closures have happened since 2014, the year Medicaid expansion coverage was available, with many closures occurring in states that had not or have not opted to expand Medicaid.<span><sup>13, 15</sup></span> Out of the top five states with the highest numbers of rural hospitals at risk of closure, only Oklahoma has chosen to expand Medicaid.<span><sup>12, 16</sup></span></p><p>In December 2020, a new federal payment program—the Rural Emergency Hospital (REH) program—was established by the Consolidated Appropriations Act, 2021<span><sup>17</sup></span> in an effort to provide financial stability for rural hospitals and ensure local access to care for rural residents.<span><sup>10, 18</sup></span> The first hospitals were eligible to convert to a REH on January 1, 2023, with over 1500 hospitals eligible for the new designation.<span><sup>19</sup></span> In 2023, 19 hospitals converted, 18 in 2024, and three so far in 2025, for a total of 40 REHs currently operating.<span><sup>20</sup></span></p><p>Rural communities can ill-afford to lose access to health care. The loss of a hospital is not only the loss of health care services to patients in the community, it is an economic blow for the community with rural communities seeing hospital and non-hospital job losses.<span><sup>15</sup></span> Shuttering inpatient beds and no longer providing that service is not an easy decision for rural hospital executives, and understanding why these decisions are made i
{"title":"The new Rural Emergency Hospital Designation Program: Will it improve access to care for rural Americans?","authors":"Suzanne B. Daly PhD, Wei You MS, Elizabeth I. Merwin PhD","doi":"10.1111/jrh.70079","DOIUrl":"10.1111/jrh.70079","url":null,"abstract":"<p>Rural and urban differences in mortality and morbidity have been persistent.<span><sup>1-6</sup></span> Rural patients have higher rates of acute and chronic health problems such as obesity, diabetes, cardiovascular disease, and cancer.<span><sup>2, 7, 8</sup></span> Rural communities have higher numbers of uninsured individuals, rates of poverty and unemployment, lower rates of education, and greater difficulty accessing reliable transportation.<span><sup>2, 9</sup></span> They also have fewer hospitals and health care providers, and, despite numerous interventions, rural hospitals continue to close at a rapid rate, leaving rural patients facing increased challenges accessing health care.<span><sup>9, 10</sup></span> The combination of these factors has likely contributed to the gap between rural and urban morbidity and mortality that has continued to expand over the last several decades.</p><p>Rural hospitals are often the only source of care in their communities, as well as the largest employer, and closures threaten the health of rural communities.<span><sup>8, 11</sup></span> Medicaid expansion in 40 states and the District of Columbia has helped rural hospitals by providing compensation for care for patients who would otherwise be unable to pay.<span><sup>12, 13</sup></span> As shown in Figure 1, since 2005, 111 rural hospitals have completely closed, leaving many communities without local access to emergency, obstetric, and other medical services.<span><sup>14</sup></span> Over half of these closures have happened since 2014, the year Medicaid expansion coverage was available, with many closures occurring in states that had not or have not opted to expand Medicaid.<span><sup>13, 15</sup></span> Out of the top five states with the highest numbers of rural hospitals at risk of closure, only Oklahoma has chosen to expand Medicaid.<span><sup>12, 16</sup></span></p><p>In December 2020, a new federal payment program—the Rural Emergency Hospital (REH) program—was established by the Consolidated Appropriations Act, 2021<span><sup>17</sup></span> in an effort to provide financial stability for rural hospitals and ensure local access to care for rural residents.<span><sup>10, 18</sup></span> The first hospitals were eligible to convert to a REH on January 1, 2023, with over 1500 hospitals eligible for the new designation.<span><sup>19</sup></span> In 2023, 19 hospitals converted, 18 in 2024, and three so far in 2025, for a total of 40 REHs currently operating.<span><sup>20</sup></span></p><p>Rural communities can ill-afford to lose access to health care. The loss of a hospital is not only the loss of health care services to patients in the community, it is an economic blow for the community with rural communities seeing hospital and non-hospital job losses.<span><sup>15</sup></span> Shuttering inpatient beds and no longer providing that service is not an easy decision for rural hospital executives, and understanding why these decisions are made i","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12521877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145294289","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}
Alex H. Crisp PhD, Bethany Barone Gibbs PhD, Jacob B. Gallagher PhD, Katrina L. Wilhite PhD, Angela C. B. Trude PhD, Treah Haggerty PhD, Kara M. Whitaker PhD
Purpose
Poor diet during pregnancy compromises maternal–fetal health and may reflect broader environmental and structural inequities. This study investigated differences in dietary intake across pregnancy among rural and urban women in the United States and assessed whether socioeconomic status (SES) modified rural–urban differences.
Methods
In this prospective study, pregnant women (n = 495; 22.4% rural) from three sites (Iowa, Pennsylvania, West Virginia) had dietary intake estimated via the 26-item Dietary Screener Questionnaire (DSQ) during each trimester. Rural was defined as Rural–Urban Commuting Area (RUCA) code ≥ 4. A SES score was derived using Principal Component Analysis of education, annual household income, and insurance type. Adjusted robust linear mixed-effects models (controlled for site, age, minority status, pre-pregnancy BMI) compared dietary intakes between rural and urban participants, with trimester and SES interactions.
Findings
Compared to their urban counterparts, rural participants had higher predicted intakes of added sugars from sugar-sweetened beverages (SSBs) in the first (0.61 tsp eq/day; 95% CI: [0.04, 1.18]) and second trimesters (0.62 tsp eq/day [0.05, 1.21]), and less fiber across all trimesters (ranging from –0.90 g/day [–1.7, –0.1] to –1.2 g/day [–2.0, –0.3]). Women in the high-SES urban group had higher intakes of fiber and calcium, and lower intakes of SSBs compared to their low-SES counterparts in both rural and urban settings.
Conclusions
Although rurality was associated with greater SSBs and lower fiber intake, differences were modest. Low-SES was related to a poorer diet regardless of geography, highlighting the need for targeted interventions for both rural and urban low-SES pregnant women.
{"title":"Rural-urban differences in dietary intake across pregnancy trimesters: A multisite prospective cohort study","authors":"Alex H. Crisp PhD, Bethany Barone Gibbs PhD, Jacob B. Gallagher PhD, Katrina L. Wilhite PhD, Angela C. B. Trude PhD, Treah Haggerty PhD, Kara M. Whitaker PhD","doi":"10.1111/jrh.70085","DOIUrl":"10.1111/jrh.70085","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Poor diet during pregnancy compromises maternal–fetal health and may reflect broader environmental and structural inequities. This study investigated differences in dietary intake across pregnancy among rural and urban women in the United States and assessed whether socioeconomic status (SES) modified rural–urban differences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective study, pregnant women (<i>n</i> = 495; 22.4% rural) from three sites (Iowa, Pennsylvania, West Virginia) had dietary intake estimated via the 26-item Dietary Screener Questionnaire (DSQ) during each trimester. Rural was defined as Rural–Urban Commuting Area (RUCA) code ≥ 4. A SES score was derived using Principal Component Analysis of education, annual household income, and insurance type. Adjusted robust linear mixed-effects models (controlled for site, age, minority status, pre-pregnancy BMI) compared dietary intakes between rural and urban participants, with trimester and SES interactions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Compared to their urban counterparts, rural participants had higher predicted intakes of added sugars from sugar-sweetened beverages (SSBs) in the first (0.61 tsp eq/day; 95% CI: [0.04, 1.18]) and second trimesters (0.62 tsp eq/day [0.05, 1.21]), and less fiber across all trimesters (ranging from –0.90 g/day [–1.7, –0.1] to –1.2 g/day [–2.0, –0.3]). Women in the high-SES urban group had higher intakes of fiber and calcium, and lower intakes of SSBs compared to their low-SES counterparts in both rural and urban settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although rurality was associated with greater SSBs and lower fiber intake, differences were modest. Low-SES was related to a poorer diet regardless of geography, highlighting the need for targeted interventions for both rural and urban low-SES pregnant women.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287574","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}
Robert M. Bohler PhD, Ryan J. Lofaro PhD, Kenneth D. Smith PhD, J. Aaron Johnson PhD, Blerta Shehaj DrPH, Brian Kite CARES, CPS-AD, William A. Mase DrPH
Purpose
Recovery community centers (RCCs) offer a range of non-clinical services for individuals in recovery from substance use disorder (SUD). RCCs may play an important role in addressing rural service gaps. This study aims to increase our understanding of how rural RCCs address SUD, including how they serve individuals receiving medications for opioid use disorder (MOUD).
Methods
We conducted a mixed methods study consisting of pre-interview surveys and semi-structured interviews with 12 RCC directors in rural Georgia. The surveys examined organizational and participant characteristics and MOUD attitudes, and the interviews explored rural challenges, strategies to overcome challenges, and community collaborations. We conducted descriptive analyses of the survey data and analyzed interviews using thematic analysis.
Results
RCCs serviced an average of 41 new members per month and had an annual budget of $225,407. RCCs provided in-house or linked to many services that addressed social determinants of health. Most participants were in early recovery (<1 year), had criminal legal involvement, and lacked a high school education. In the thematic analysis, transportation and housing were commonly reported challenges. Additionally, RCCs provided essential treatment linkage, were the primary naloxone distributor in the area, and provided in-house mutual help organizations representing alternative recovery pathways. Collaboration with MOUD providers was minimal despite RCC efforts. Directors generally had positive attitudes towards MOUD.
Conclusion
Rural RCCs address a range of social determinants of health and may fill gaps in the SUD continuum of care, including harm reduction services, linkage to treatment, and expansion of recovery pathways.
{"title":"Bridging the gaps: Rural recovery community centers and their role in addressing substance use disorders","authors":"Robert M. Bohler PhD, Ryan J. Lofaro PhD, Kenneth D. Smith PhD, J. Aaron Johnson PhD, Blerta Shehaj DrPH, Brian Kite CARES, CPS-AD, William A. Mase DrPH","doi":"10.1111/jrh.70084","DOIUrl":"https://doi.org/10.1111/jrh.70084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Recovery community centers (RCCs) offer a range of non-clinical services for individuals in recovery from substance use disorder (SUD). RCCs may play an important role in addressing rural service gaps. This study aims to increase our understanding of how rural RCCs address SUD, including how they serve individuals receiving medications for opioid use disorder (MOUD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a mixed methods study consisting of pre-interview surveys and semi-structured interviews with 12 RCC directors in rural Georgia. The surveys examined organizational and participant characteristics and MOUD attitudes, and the interviews explored rural challenges, strategies to overcome challenges, and community collaborations. We conducted descriptive analyses of the survey data and analyzed interviews using thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>RCCs serviced an average of 41 new members per month and had an annual budget of $225,407. RCCs provided in-house or linked to many services that addressed social determinants of health. Most participants were in early recovery (<1 year), had criminal legal involvement, and lacked a high school education. In the thematic analysis, transportation and housing were commonly reported challenges. Additionally, RCCs provided essential treatment linkage, were the primary naloxone distributor in the area, and provided in-house mutual help organizations representing alternative recovery pathways. Collaboration with MOUD providers was minimal despite RCC efforts. Directors generally had positive attitudes towards MOUD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Rural RCCs address a range of social determinants of health and may fill gaps in the SUD continuum of care, including harm reduction services, linkage to treatment, and expansion of recovery pathways.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145272700","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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