Journal of Rural Health最新文献_第7页

A comparison of classifications for geographic location and their associations with tobacco use among US adults 地理位置分类的比较及其与美国成年人吸烟的关系

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-08-05 DOI: 10.1111/jrh.70070

Jenny E. Ozga PhD, Andrea Milstred PhD, Melissa D. Blank PhD, Mary Kay Rayens PhD, Brittney Keller-Hamilton PhD, Megan E. Roberts PhD, Seth Himelhoch MD, MPH, Cassandra A. Stanton PhD

Purpose

This study compared two classifications of rurality and their associations with cigarette, e-cigarette, and smokeless tobacco (SLT) use among a nationally representative sample of 31,196 US adults.

Methods

Data from Wave 1 of the Population Assessment of Tobacco and Health Study. Weighted descriptive statistics and multivariable logistic regressions assessed whether two classifications of rurality were differentially associated with past 30-day (P30D) cigarette, e-cigarette, or SLT use in separate models. Classifications were (1) the US Census Bureau's classification as urban/non-urban; and (2) the National Center for Education Statistic (NCES)’s classification as urban/suburban/town/rural. This study is reported in accordance with STROBE guidelines.

Findings

With the Census Bureau classification, 79.3% were in urban areas. With the NCES classification, 34.3% were in urban, 35.1% in suburban, 9.4% in town, and 21.1% in rural areas. With the Census Bureau classification, non-urban (vs. urban) residence was associated with reduced odds of e-cigarette use (AOR = 0.79; 95% CI = 0.70–0.88) and increased odds of SLT use (AOR = 2.32; 95% CI = 1.97–2.72). With the NCES classification with urban as reference, rural residence was associated with reduced odds of e-cigarette use (AOR = 0.77; 95% CI = 0.75–0.98); both town (AOR = 2.16; 95% CI = 1.69–2.78) and rural (AOR = 2.75; 95% CI = 2.16, 3.48) were associated with increased odds of SLT use. Location was not associated with cigarette use for either classification.

Conclusions

Location was similarly associated with P30D e-cigarette and SLT use across both classifications in adjusted models. The use of classifications with more categories may be beneficial to understand nuanced location differences in tobacco use.

本研究比较了在31,196名美国成年人的全国代表性样本中，两类乡村性及其与香烟、电子烟和无烟烟草（SLT）使用的关系。方法烟草与健康人群评价研究第1期资料。加权描述性统计和多变量logistic回归在不同的模型中评估了两类农村性是否与过去30天（P30D）香烟、电子烟或SLT的使用存在差异。分类为(1)美国人口普查局的城市/非城市分类；(2)国家教育统计中心（NCES）对城市/郊区/城镇/农村的分类。本研究是按照STROBE指南报道的。根据人口普查局的分类，79.3%的人在城市地区。按NCES分类，城市占34.3%，郊区占35.1%，城镇占9.4%，农村占21.1%。根据人口普查局的分类，非城市（与城市）居住与电子烟使用几率降低相关(AOR = 0.79；95% CI = 0.70-0.88)，使用SLT的几率增加(AOR = 2.32；95% ci = 1.97-2.72)。在以城市为参照的NCES分类中，农村居民与电子烟使用几率降低相关(AOR = 0.77；95% ci = 0.75-0.98)；both town (AOR = 2.16；95% CI = 1.69-2.78)和农村(AOR = 2.75；95% CI = 2.16, 3.48)与SLT使用几率增加相关。在两种分类中，地点与吸烟无关。结论：在调整后的模型中，地理位置与P30D电子烟和SLT的使用相似。使用具有更多类别的分类可能有助于了解烟草使用的细微位置差异。

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引用次数: 0

Colorectal cancer screening barriers, facilitators, and promotion recommendations by Alaska Native people who are non-adherent to colorectal cancer screening 未坚持进行结直肠癌筛查的阿拉斯加原住民的结直肠癌筛查障碍、促进因素和推广建议

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-08-05 DOI: 10.1111/jrh.70067

Diana Redwood PhD, Melissa Toffolon PhD, Christie Flanagan MPH, Lauren Jeffries MPH, Danika Bailie , Lila Finney Rutten PhD, John Kisiel MD

Purpose

We examined barriers and facilitators to colorectal cancer (CRC) screening among Alaska Native individuals who had never been screened or were not up to date with screening guidelines.

Methods

As part of a larger study investigating the use of the multitarget stool DNA test in rural Alaska communities, we conducted focus groups and in-depth interviews with 28 never screened or not up-to-date Alaska Native people in two remote communities between November 2022 and July 2023. Participants shared their barriers to CRC screening and offered suggestions to improve programs to better reach those who are guideline discordant.

Findings

General screening barriers included lack of knowledge, fear of discovering you have cancer, and cultural health beliefs. Colonoscopy-specific barriers included embarrassment from knowing the local medical staff, having rectal area viewed or touched, fear of pain and injury, difficulty scheduling a procedure due to traditional food gathering activities, lack of provider referrals/reminders, and the high cost of air travel required to get to a colonoscopy facility. Stool DNA-specific concerns included not feeling that it was as good as colonoscopy, lack of privacy to do the test, and hesitancy collecting stool samples. Suggestions for increasing screening rates included increasing access via paid air transportation, using local indigenous languages, improving provider relationships and reminder systems, and providing CRC and screening education using trusted messengers.

Conclusions

This was the first exploration of the perceptions of CRC screening among guideline discordant Alaska Native people. Identified themes can be used to improve screening program outreach effectiveness in the future.

目的：我们研究了从未接受过筛查或未按照筛查指南进行筛查的阿拉斯加原住民中结直肠癌（CRC）筛查的障碍和促进因素。作为调查阿拉斯加农村社区多靶点粪便DNA检测使用情况的大型研究的一部分，我们在2022年11月至2023年7月期间对两个偏远社区的28名从未筛查或未更新的阿拉斯加原住民进行了焦点小组和深度访谈。参与者分享了他们进行结直肠癌筛查的障碍，并提出了改进方案的建议，以更好地覆盖那些不符合指南的人。一般的筛查障碍包括缺乏知识、害怕发现自己患有癌症和文化健康信仰。结肠镜检查特有的障碍包括不认识当地医务人员、检查或触摸直肠区域、害怕疼痛和受伤、由于传统的食物收集活动而难以安排手术、缺乏提供者推荐/提醒，以及前往结肠镜检查设施所需的高额航空旅行费用。粪便dna特异性的担忧包括感觉它不如结肠镜检查好，缺乏隐私进行测试，以及在收集粪便样本时犹豫不决。提高筛查率的建议包括通过付费航空运输增加获取机会，使用当地土著语言，改善提供者关系和提醒系统，以及使用可信赖的信使提供CRC和筛查教育。结论：这是第一次探索指南不一致的阿拉斯加原住民对CRC筛查的看法。确定的主题可以用来提高筛选项目的推广效果在未来。

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引用次数: 0

An analysis of syringe service programs across the rural-urban continuum in the United States 美国农村-城市连续体的注射器服务项目分析

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-08-04 DOI: 10.1111/jrh.70072

Nathan A. Dockery MPH, Qian Huang PhD, MA, MPA, Casey P. Balio PhD

Purpose

Syringe service programs (SSPs) have been proven to reduce transmission of viral infections, prevent substance use and overdose deaths, and help support public safety in operational areas. This study aims to provide a snapshot of the current distribution of SSPs across the United States and analyze them based on community characteristics.

Methods

SSP information was collected from state health department websites and the North American Syringe Exchange Network (NASEN) dashboard. Bivariate, multivariate, and geospatial analyses were conducted on the study population to observe significant differences between SSP presence and access between urban and rural populations and to see if community characteristics impact the presence of SSPs.

Findings

Findings showed that a greater proportion of urban counties had at least one SSP compared to rural counties (N = 353, 30% vs. N = 236, 12% respectively, p < 0.001). The logistic regression model showed that urban counties had 66% greater odds of having an SSP than their rural counterparts. Geospatial hot-spot analysis showed significant hot spots in the West and Northeast United States, and cold spots throughout the Midwest.

Conclusions

This research provides the most current and comprehensive look at the current count of SSPs in the United States and highlights an increased need in rural areas for SSP presence and access. This study could be used as a benchmark for policymakers and other decision-makers, especially in rural areas, to properly allocate resources for SSP creation and to ensure that policy does not restrict the creation of SSPs or their ability to function properly.

目的：注射器服务计划（ssp）已被证明可以减少病毒感染的传播，防止药物使用和过量死亡，并有助于支持操作区域的公共安全。本研究旨在提供当前美国ssp分布的快照，并基于社区特征对其进行分析。方法从国家卫生部门网站和北美注射器交换网络（NASEN）仪表板上收集SSP信息。对研究人群进行了双变量、多变量和地理空间分析，以观察城市和农村人口之间SSP存在和获取的显著差异，并了解社区特征是否影响SSP的存在。结果发现，城市县至少有一种SSP的比例高于农村县(N = 353,30% vs. N = 236,12%, p <；0.001)。逻辑回归模型显示，城市县拥有SSP的几率比农村县高66%。地理空间热点分析显示，美国西部和东北部地区是显著的热点地区，而中西部地区则是显著的冷区。本研究提供了当前美国SSP数量的最新和最全面的情况，并强调了农村地区对SSP存在和获取的需求日益增加。这项研究可以作为政策制定者和其他决策者的基准，特别是在农村地区，以适当地分配资源用于创建可持续发展计划，并确保政策不限制可持续发展计划的创建或其正常运作的能力。

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引用次数: 0

“It's not about me. It's about what's best for my community”: Factors impacting COVID-19 vaccine uptake among Native Americans and Latinos from two agricultural communities “这与我无关。这是关于什么对我的社区最好”：影响来自两个农业社区的美洲原住民和拉丁美洲人接种COVID-19疫苗的因素

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-08-04 DOI: 10.1111/jrh.70057

Lina Truong MPH, Alexandra K. Adams MD, PhD, Sonia Bishop BS, Virgil Dupuis BS, Lorenzo Garza , Thomas Quigley BS, Laurie Hassell BS, Paul K. Drain MD, MPH, Genoveva Ibarra , Anna Whiting Sorrell PhD, Teresa Warne MSc, Charlie Gregor MPH, Eliza Webber MPH, Linda K. Ko PhD

Purpose

While SARS-CoV-2 significantly impacts rural Native American and Latino communities, COVID-19 vaccines offer an effective and safe mitigation strategy. Vaccine uptake is disproportionately lower in rural communities than in urban communities across the nation. This study examined barriers and motivators of COVID-19 vaccine uptake in two Native American and Latino rural agricultural communities in eastern Washington and Montana.

Methods

We conducted 28 key informant interviews with trusted community members and six community focus groups with 39 participants from May 2021 to June 2021. Participants were from the Yakima Valley (WA) and Flathead Reservation (MT). The Social Cognitive Theory and Social Context Framework informed development of the interview and focus group moderator guides. We used deductive and inductive approach to code transcripts and thematic analysis to generate themes.

Findings

Barriers to COVID-19 vaccine uptake were misconceptions about COVID-19 vaccines shaped by misinformation, politicization of vaccines, historical trauma and mistrust in government, and structural barriers in rural agricultural communities. Having access to accurate and understandable COVID-19 vaccine information and receiving information from trusted sources were motivators of COVID-19 vaccine uptake. Protecting families, children, elders, and the community, and striving to return to normal life were also noted as motivators.

Conclusions

Understanding the community's perceptions and experiences around the COVID-19 vaccine is critical for successful implementation of strategies to increase vaccine uptake during future public health emergencies. Strategies for vaccine uptake among communities in the Flathead Reservation and Yakima Valley need to address barriers and highlight motivators of COVID-19 vaccine uptake.

虽然SARS-CoV-2对美洲原住民和拉丁裔农村社区产生了重大影响，但COVID-19疫苗提供了一种有效和安全的缓解策略。在全国范围内，农村社区的疫苗接种率不成比例地低于城市社区。本研究调查了华盛顿州东部和蒙大拿州两个美洲原住民和拉丁裔农村农业社区接种COVID-19疫苗的障碍和动机。方法从2021年5月至2021年6月，我们对28名受信任的社区成员和6个社区焦点小组的39名参与者进行了关键信息访谈。参与者来自亚基马山谷（WA）和平头保留地（MT）。社会认知理论和社会情境框架为访谈和焦点小组主持人指南的发展提供了信息。我们使用演绎和归纳的方法来编码文本和主题分析来生成主题。对COVID-19疫苗接种的障碍是由于错误信息、疫苗政治化、历史创伤和对政府的不信任以及农村农业社区的结构性障碍而形成的对COVID-19疫苗的误解。获得准确和可理解的COVID-19疫苗信息以及从可信来源接收信息是COVID-19疫苗接种的激励因素。保护家庭、儿童、老人和社区，努力恢复正常生活也被认为是激励因素。了解社区对COVID-19疫苗的看法和经验对于成功实施在未来突发公共卫生事件中增加疫苗接种率的战略至关重要。Flathead保留地和Yakima Valley社区的疫苗接种战略需要解决障碍并突出COVID-19疫苗接种的激励因素。

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引用次数: 0

Seeking connection: A qualitative study of psychosocial support needs of rural cancer survivors in Minnesota 寻求联系：明尼苏达州农村癌症幸存者心理社会支持需求的定性研究

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-08-04 DOI: 10.1111/jrh.70066

Morgan Gruner MD, Katherine Brown BS, Renee Anderson BS, Shaunequa James MSW, LICSW, Xuan Li MD, MS, Carrie Henning-Smith PhD, Anne Blaes MD, MS, Patricia Jewett PhD, Rachel I. Vogel PhD

Purpose

Individuals diagnosed with cancer have extensive and often unmet psychosocial support needs. We established a partnership between the University of Minnesota and Gilda's Club to identify survivorship issues, unmet psychosocial support needs, and barriers to receiving cancer support in rural Minnesota.

Methods

We conducted six focus groups and 16 interviews (41 total participants) between November 2022 and January 2024 among cancer survivors living in rural Minnesota. Structured interview guides included questions about survivors’ definition of cancer support, what community support is desired and available, and barriers to obtaining support. Transcripts were analyzed using inductive thematic analysis.

Findings

The mean participant age was 57.1 ± 13.4 years; the majority were female (68%), non-Hispanic White (95%), and college graduates (58%), and they represented many cancer diagnoses, with hematologic (20%) and breast cancers (17%) most frequently reported. Most (73%) were under surveillance (median 4 years from diagnosis). Many participants mentioned extensive travel burdens due to lack of local care, and virtually all participants agreed emotional support was critical. Over half (56%) of participants wished for peer support that they did not have, and 44% said their cancer information needs were insufficiently addressed. Some emphasized that having nurses facilitating care coordination and options for local care made care feel more personalized. Participants identified virtual options for cancer support as potentially beneficial, particularly when meeting in person was not possible.

Conclusions

Lack of peer support, lack of local care, and travel burdens are significant concerns among rural cancer survivors. Participants expressed positive views about their rural residence and mentioned alternatives and rural strengths such as virtual support options, help from nurses, and caring relationships in their communities.

诊断为癌症的个体具有广泛且往往未得到满足的社会心理支持需求。我们在明尼苏达大学和吉尔达俱乐部之间建立了合作伙伴关系，以确定幸存者问题，未满足的社会心理支持需求，以及在明尼苏达州农村接受癌症支持的障碍。方法：我们在2022年11月至2024年1月期间对居住在明尼苏达州农村的癌症幸存者进行了6个焦点小组和16次访谈（共41名参与者）。结构化访谈指南包括幸存者对癌症支持的定义、需要和可用的社区支持以及获得支持的障碍等问题。对转录本进行归纳主题分析。参与者平均年龄为57.1±13.4岁；大多数是女性（68%），非西班牙裔白人（95%）和大学毕业生（58%），他们代表了许多癌症诊断，最常见的是血液病（20%）和乳腺癌（17%）。大多数患者（73%）接受监测（诊断后中位4年）。许多参与者提到，由于缺乏当地护理，旅行负担很大，几乎所有参与者都认为情感支持至关重要。超过一半（56%）的参与者希望得到他们没有的同伴支持，44%的人表示他们的癌症信息需求没有得到充分解决。一些人强调，让护士促进护理协调和选择当地护理使护理感觉更个性化。参与者认为癌症支持的虚拟选择可能是有益的，特别是在不可能亲自会面的情况下。结论：缺乏同伴支持、缺乏当地护理和旅行负担是农村癌症幸存者的主要问题。参与者对其农村住所表达了积极的看法，并提到了其他选择和农村优势，如虚拟支持选择、护士的帮助和社区内的关怀关系。

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引用次数: 0

Examining geographic disparities in access to no-cost naloxone in North Carolina: A cross-sectional survey of naloxone distribution programs 检视在北卡罗莱纳获得免费纳洛酮的地理差异：纳洛酮分配计划的横断面调查

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-08-04 DOI: 10.1111/jrh.70069

Grace Marley PharmD, Caroline Shubel MPh, Carolyn T. Thorpe PhD MPh, Izabela E. Annis M.S., Paul Delamater PhD, Delesha Carpenter PhD MSPh, Bayla Ostrach PhD, MA, CIP

Purpose

The objective of this study was to comprehensively identify the programs that distribute naloxone at no-cost in North Carolina, identify where and to whom these programs distribute naloxone, and evaluate disparities in reported naloxone distribution by geographic area.

Methods

A cross-sectional online survey was delivered to potential no-cost naloxone distributors in NC identified by a community advisory panel. Descriptive statistics and Fisher exact tests were utilized to identify disparities in naloxone access by population served (people who use drugs, people who inject drugs) and location of naloxone distribution (rural; urban/suburban).

Results

Approximately 76.5% (241/315) of respondents representing 341 different programs reported that their program(s) distributed no-cost naloxone to community members. Programs represented included health departments (n = 81), treatment programs/centers (n = 59), and syringe service programs(SSPs) (n = 41), among others. Programs reported distributing naloxone most frequently to people who use drugs (94.2%) and people with a substance use disorder history (94.3%). No-cost naloxone distribution was reported less frequently to all patient populations in rural ZIP codes when compared to urban ZIP codes, including justice-involved populations (86.4% vs. 98.3%) and individuals leaving treatment or detox (87.9% vs. 98.6%).

Conclusion

This study indicates that although most areas in NC were served by at least one no-cost naloxone program, distribution to rural populations may be limited, indicating a need for increased public investment in no-cost naloxone distribution to populations at greatest risk of overdose.

本研究的目的是全面确定在北卡罗来纳州免费分发纳洛酮的项目，确定这些项目在哪里和向谁分发纳洛酮，并评估按地理区域报告的纳洛酮分发的差异。方法对社区咨询小组确定的北卡罗来纳州潜在的无成本纳洛酮经销商进行横断面在线调查。采用描述性统计和Fisher精确检验来确定按服务人群（吸毒者、注射吸毒者）和纳洛酮分布地点(农村；城市/郊区)。结果在341个不同项目的受访者中，约有76.5%（241/315）的人报告他们的项目向社区成员分发了免费的纳洛酮。所代表的项目包括卫生部门（n = 81）、治疗项目/中心（n = 59）和注射器服务项目（n = 41）等。项目报告称，纳洛酮最常分发给吸毒者（94.2%）和有物质使用障碍史的人（94.3%）。与城市邮政编码相比，在农村邮政编码的所有患者人群中，无成本纳洛酮分发的频率较低，包括涉及司法的人群（86.4%对98.3%）和离开治疗或排毒的个人（87.9%对98.6%）。结论本研究表明，尽管北卡罗来纳州的大多数地区至少有一个免费纳洛酮项目，但向农村人口的分发可能有限，这表明需要增加公共投资，向用药过量风险最高的人群提供免费纳洛酮。

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引用次数: 0

Route and efficiency analysis of cancer health care (REACH): Investigating sociodemographic and rurality of metastatic breast cancer patients at an NCI-designated facility 癌症保健的途径和效率分析（REACH）：在nci指定的机构调查转移性乳腺癌患者的社会人口统计学和农村性

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-08-03 DOI: 10.1111/jrh.70063

Amanda Golden MD, Sarah Humble MS, Rachelle Roy BPH, Allison B. Anbari PhD, RN, CLT, Lindsay L. Peterson MD, MSCR, Ashley J. Housten OTD, MSCI

Purpose

Breast cancer is one of the most common malignancies affecting women worldwide. Metastatic breast cancer (MBC) patients experience unique challenges regarding access to care, particularly rural populations. Geographic location may increase travel, impacting time to treatment and adding to patient burden. This study aimed to evaluate the association between rurality and access to care by examining travel distance, time to treatment, and sociodemographic factors in patients with MBC.

Methods

We conducted a retrospective cohort study using data from Siteman Cancer Center (SCC) Oncology Data Services registry from 2011–2021 with 519 female MBC patients. Rurality was defined by state definition. We used Geographic Information Systems (GIS) software to calculate travel distances and times from patients’ homes to treatment site. We evaluated travel distance (miles) and time to treatment initiation (days) using t-tests and ANOVA and evaluated any differences based on sociodemographic characteristics.

Findings

We found that rural patients traveled farther for treatment compared to urban patients (mean 87.3 miles vs. 18.0 miles; p < 0.001). There was no statistically significant difference found with time to treatment initiation between groups (mean 36.1 vs. 35.0 days; p = 0.68). No difference in travel time or treatment initiation was found when comparing sociodemographic factors, including insurance status and comorbidity scores.

Conclusions

Rural MBC patients face longer travel times, which may contribute to barriers to care. However, we found no difference for time to treatment initiation. Future studies characterizing rural patients' experiences can contribute to the development of targeted interventions to mitigate rural patient burden and improve access to cancer care.

乳腺癌是世界范围内影响妇女最常见的恶性肿瘤之一。转移性乳腺癌（MBC）患者在获得护理方面面临着独特的挑战，特别是农村人口。地理位置可能会增加旅行，影响到治疗时间并增加患者负担。本研究旨在通过考察MBC患者的出行距离、治疗时间和社会人口因素来评估乡村性与医疗可及性之间的关系。方法采用Siteman癌症中心（SCC）肿瘤数据服务登记处2011-2021年的数据，对519名女性MBC患者进行了回顾性队列研究。乡村是由国家定义的。我们使用地理信息系统（GIS）软件来计算从患者家到治疗地点的旅行距离和时间。我们使用t检验和方差分析评估了旅行距离（英里）和开始治疗的时间（天），并评估了基于社会人口统计学特征的任何差异。我们发现，与城市患者相比，农村患者接受治疗的路程更远(平均87.3英里对18.0英里；p & lt;0.001)。两组患者开始治疗所需时间无统计学差异(平均36.1天vs. 35.0天；P = 0.68)。当比较社会人口因素，包括保险状况和合并症评分时，旅行时间和治疗开始没有差异。结论农村MBC患者出行时间较长，可能造成就医障碍。然而，我们发现开始治疗的时间没有差异。未来研究农村患者的经历特征有助于制定有针对性的干预措施，以减轻农村患者的负担，改善癌症治疗的可及性。

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引用次数: 0

Rural–urban differences in health care access for postpartum parent and infant dyads 产后父母和婴儿对保健服务的城乡差异

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-08-03 DOI: 10.1111/jrh.70062

Sara C. Handley MD, MSCE, Julia D. Interrante PhD, MPH, Emily F. Gregory MD, MHS, Katy B. Kozhimannil PhD, MPA

Purpose

To examine differences in perinatal health between rural and urban postpartum parents and infants and within postpartum parent–infant dyads.

Methods

Cross-sectional analysis of the National Health Interview Survey (NHIS) data. Accounting for the complex survey design, we calculated weighted proportions of measures of self-rated health, health care utilization, and barriers to care and used chi-squared tests to assess rural–urban differences between postpartum parents and between infants, and repeated measures to test postpartum parent–infant differences within households in rural and urban counties.

Findings

The study included 2019 rural postpartum parents, 2191 rural infants, 12,112 urban postpartum parents and 13,088 urban infants. Compared to urban postpartum parents, those living in rural areas were less likely to see an obstetrician–gynecologist (p = 0.002) had more emergency department (ED) visits (p = 0.030), reported more hospitalizations (p = 0.041), more frequently experienced uninsurance (p = 0.006), and lost Medicaid coverage after pregnancy (p = 0.006). While a higher proportion of urban infants were hospitalized than their rural counterparts (p = 0.019), other measures were similar. Accounting for dyad correlations, compared to infants, postpartum parents generally reported worse health (fair or poor self-rated health), and were more likely to experience ED visits, hospitalizations, loss of health care coverage, and barriers to care.

Conclusions

Rural postpartum parents experience worse health than their urban counterparts and compared to their infants. Rural–urban differences in access were less common among infants, thus leveraging infant care systems for services to both the infant and postpartum parent may improve household health in all communities.

目的探讨农村和城市产后父母与婴儿以及产后亲子双体内围产儿健康状况的差异。方法对全国健康访谈调查（NHIS）数据进行横断面分析。考虑到复杂的调查设计，我们计算了自评健康、医疗保健利用和护理障碍的加权比例，并使用卡方检验来评估产后父母和婴儿之间的城乡差异，并使用重复测量来测试农村和城市县家庭内产后父母-婴儿差异。研究对象包括2019名农村产后父母、2191名农村婴儿、12112名城市产后父母和13088名城市婴儿。与城市产后父母相比，生活在农村地区的父母看妇产科医生的可能性更小（p = 0.002），急诊科（ED）就诊次数更多（p = 0.030），住院次数更多（p = 0.041），更频繁地经历无保险（p = 0.006），并且在怀孕后失去医疗补助（p = 0.006）。虽然城市婴儿住院的比例高于农村婴儿（p = 0.019），但其他措施相似。考虑到二元相关性，与婴儿相比，产后父母通常报告的健康状况较差（一般或较差的自我评估健康），并且更有可能经历急诊科就诊、住院、失去医疗保险和护理障碍。结论农村产后父母的健康状况较城市产后父母差，与婴儿的健康状况相比也差。城乡之间在婴儿获得服务方面的差异不太常见，因此利用婴儿护理系统为婴儿和产后父母提供服务可以改善所有社区的家庭健康。

{"title":"Rural–urban differences in health care access for postpartum parent and infant dyads","authors":"Sara C. Handley MD, MSCE, Julia D. Interrante PhD, MPH, Emily F. Gregory MD, MHS, Katy B. Kozhimannil PhD, MPA","doi":"10.1111/jrh.70062","DOIUrl":"https://doi.org/10.1111/jrh.70062","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To examine differences in perinatal health between rural and urban postpartum parents and infants and within postpartum parent–infant dyads.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Cross-sectional analysis of the National Health Interview Survey (NHIS) data. Accounting for the complex survey design, we calculated weighted proportions of measures of self-rated health, health care utilization, and barriers to care and used chi-squared tests to assess rural–urban differences between postpartum parents and between infants, and repeated measures to test postpartum parent–infant differences within households in rural and urban counties.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>The study included 2019 rural postpartum parents, 2191 rural infants, 12,112 urban postpartum parents and 13,088 urban infants. Compared to urban postpartum parents, those living in rural areas were less likely to see an obstetrician–gynecologist (<i>p</i> = 0.002) had more emergency department (ED) visits (<i>p</i> = 0.030), reported more hospitalizations (<i>p</i> = 0.041), more frequently experienced uninsurance (<i>p</i> = 0.006), and lost Medicaid coverage after pregnancy (<i>p</i> = 0.006). While a higher proportion of urban infants were hospitalized than their rural counterparts (<i>p</i> = 0.019), other measures were similar. Accounting for dyad correlations, compared to infants, postpartum parents generally reported worse health (fair or poor self-rated health), and were more likely to experience ED visits, hospitalizations, loss of health care coverage, and barriers to care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rural postpartum parents experience worse health than their urban counterparts and compared to their infants. Rural–urban differences in access were less common among infants, thus leveraging infant care systems for services to both the infant and postpartum parent may improve household health in all communities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767509","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

Evaluation of the Ask Suicide-Screening Questions (ASQ) tool, Item 9 of the Patient Health Questionnaire (PHQ), pain, and opioid screening to detect suicide risk among rural adult primary care patients 评估自杀筛查问题（ASQ）工具、患者健康问卷（PHQ）第9项、疼痛和阿片类药物筛查对农村成人初级保健患者自杀风险的影响

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-08-01 DOI: 10.1111/jrh.70064

Mary Christensen PhD, Stacey Culp PhD, John V. Campo MD, Jeffrey A. Bridge PhD, Lisa Horowitz PhD

Purpose

This study evaluated psychometric properties of the Ask Suicide-Screening Questions (ASQ) and Item Nine of the Patient Health Questionnaire (PHQ Item 9) to detect suicide risk in rural adult primary care and whether pain and opioid screening contributed to suicide risk detection.

Methods

A sample of adult rural primary care patients (N = 214) completed suicide risk, pain, and opioid screening measures electronically; 48% of participants also completed a follow-up survey. Using the Adult Suicidal Ideation Questionnaire (ASIQ) as the criterion measure, psychometric properties for the ASQ and the PHQ Item 9 were compared using McNemar's test for proportions. Bivariate and multivariable regression analyses explored associations between suicide risk, pain, opioid measures, and ASIQ results.

Findings

Approximately 4% (N = 8) of participants screened positive for suicide risk on the ASIQ relative to 11.7% (N = 25) on the ASQ and 3.7% (N = 8) on the PHQ Item 9. The ASQ had higher sensitivity (75.0%) than the PHQ Item 9 (50.0%); the difference was not statistically significant but may have clinical relevance. The PHQ Item 9 had significantly higher specificity (98.1%) than the full ASQ (91.0%, p < 0.001). The ASQ, PHQ Item 9, depression scores, and LGBTQ+ status were significant predictors of ASIQ scores. Pain and opioid misuse were not.

Conclusions

Findings from this small sample provide preliminary support for the ASQ and PHQ Item 9 as suicide risk screens in rural adult primary care, but psychometric studies in larger samples are needed.

目的本研究评估自杀筛查问题（Ask - screening Questions， ASQ）和患者健康问卷（Patient Health Questionnaire, PHQ Item 9）第九项的心理测量特性，以检测农村成人初级保健的自杀风险，以及疼痛和阿片类药物筛查是否有助于自杀风险检测。方法选取214例农村成人初级保健患者，通过电子方式完成自杀风险、疼痛和阿片类药物筛查；48%的参与者还完成了一项后续调查。以成人自杀意念问卷（ASIQ）为标准量表，采用McNemar比例检验对ASQ和PHQ第9项的心理测量特性进行比较。双变量和多变量回归分析探讨了自杀风险、疼痛、阿片类药物测量和ASIQ结果之间的关系。研究结果：大约4% （N = 8）的参与者在ASQ上筛选出自杀风险阳性，而在ASQ上筛选出11.7% （N = 25）的参与者和在PHQ项目9上筛选出3.7% （N = 8）的参与者。ASQ的灵敏度（75.0%）高于PHQ第9项（50.0%）；差异无统计学意义，但可能具有临床相关性。PHQ项目9的特异性（98.1%）显著高于全ASQ (91.0%, p <；0.001)。ASQ、PHQ项目9、抑郁得分和LGBTQ+状态是ASQ得分的显著预测因子。疼痛和阿片类药物滥用则没有。结论本研究结果为ASQ和PHQ第9项作为农村成人初级保健自杀风险筛查提供了初步支持，但需要在更大样本中进行心理测量学研究。

{"title":"Evaluation of the Ask Suicide-Screening Questions (ASQ) tool, Item 9 of the Patient Health Questionnaire (PHQ), pain, and opioid screening to detect suicide risk among rural adult primary care patients","authors":"Mary Christensen PhD, Stacey Culp PhD, John V. Campo MD, Jeffrey A. Bridge PhD, Lisa Horowitz PhD","doi":"10.1111/jrh.70064","DOIUrl":"https://doi.org/10.1111/jrh.70064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study evaluated psychometric properties of the Ask Suicide-Screening Questions (ASQ) and Item Nine of the Patient Health Questionnaire (PHQ Item 9) to detect suicide risk in rural adult primary care and whether pain and opioid screening contributed to suicide risk detection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A sample of adult rural primary care patients (<i>N</i> = 214) completed suicide risk, pain, and opioid screening measures electronically; 48% of participants also completed a follow-up survey. Using the Adult Suicidal Ideation Questionnaire (ASIQ) as the criterion measure, psychometric properties for the ASQ and the PHQ Item 9 were compared using McNemar's test for proportions. Bivariate and multivariable regression analyses explored associations between suicide risk, pain, opioid measures, and ASIQ results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Approximately 4% (<i>N</i> = 8) of participants screened positive for suicide risk on the ASIQ relative to 11.7% (<i>N</i> = 25) on the ASQ and 3.7% (<i>N</i> = 8) on the PHQ Item 9. The ASQ had higher sensitivity (75.0%) than the PHQ Item 9 (50.0%); the difference was not statistically significant but may have clinical relevance. The PHQ Item 9 had significantly higher specificity (98.1%) than the full ASQ (91.0%, <i>p</i> < 0.001). The ASQ, PHQ Item 9, depression scores, and LGBTQ+ status were significant predictors of ASIQ scores. Pain and opioid misuse were not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Findings from this small sample provide preliminary support for the ASQ and PHQ Item 9 as suicide risk screens in rural adult primary care, but psychometric studies in larger samples are needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144751527","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}

引用次数: 0

Understanding the influence of social determinants of health on symptom reporting in pediatric cancer 了解健康的社会决定因素对儿童癌症症状报告的影响

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-08-01 DOI: 10.1111/jrh.70071

Micah A. Skeens PhD, Adelaide Booze BA, Mark Ranalli MD, Anna Olsavsky PhD

Purpose

Children with cancer experience significant symptom burden, worsened by social deprivation. This study examines social determinants of health, including Appalachian residency, influence on symptom burden.

Methods

Caregiver-child dyads were recruited within 1 year of cancer treatment. Addresses were coded for social determinants of health (SDOH) measures: Area Deprivation Index (ADI), rurality, medically underserved areas (MUA), and Appalachian residency. Total child symptom scores (0–31) were calculated for dyad reports using the Memorial Symptom Assessment Scale. Provider matching symptom reports were extracted from electronic medical records. Descriptive statistics and correlations examined associations between child, caregiver, and provider symptom reports and SDOH. Significant correlations informed three multiple linear regression models examining SDOH predictors of child symptoms by reporter.

Findings

Fifty-five caregiver-child dyads were recruited. Caregivers were 65.5% female and 87.3% White. Children were 50.9% male, 85% White, an average of 12 years old, 30.9% rural, and 20.0% Appalachian. ADI scores (M = 4.22) indicated moderate disadvantage, and 14.5% were medically underserved. On average, children reported 8.61 symptoms, while caregivers reported 7.15, and providers recorded 1.87 child symptoms. For children, a bivariate association and significant regression model revealed Appalachian children experienced a higher number of symptoms. For caregivers, bivariate associations indicated a higher ADI was associated with more symptoms. For providers, bivariate associations revealed higher symptoms were associated with rurality, MUA, and Appalachian residency, though only Appalachian residency remained significant in the regression model.

Conclusions

Results suggest Appalachian residency is associated with higher symptom burden for children with cancer. Findings support culturally sensitive care to minimize symptom burden.

目的癌症患儿有明显的症状负担，社会剥夺加重了症状负担。本研究探讨健康的社会决定因素，包括阿巴拉契亚居住，对症状负担的影响。方法在癌症治疗1年内招募照顾者-儿童二人组。根据健康的社会决定因素（SDOH）措施对地址进行编码：地区剥夺指数（ADI）、乡村性、医疗服务不足地区（MUA）和阿巴拉契亚居民。使用记忆症状评估量表计算儿童症状总分（0-31分）。从电子医疗记录中提取提供者匹配症状报告。描述性统计和相关性检验了儿童、照料者和提供者症状报告与SDOH之间的关系。报告者通过三个多元线性回归模型检验儿童症状的SDOH预测因子，发现了显著的相关性。研究结果：共招募了55对照顾者-儿童的夫妇。照顾者中女性占65.5%，白人占87.3%。儿童中男性占50.9%，白人占85%，平均12岁，农村占30.9%，阿巴拉契亚地区占20.0%。ADI评分（M = 4.22）显示中度劣势，14.5%的患者医疗服务不足。平均而言，儿童报告了8.61种症状，而护理人员报告了7.15种，提供者记录了1.87种儿童症状。对于儿童，双变量关联和显著回归模型显示阿巴拉契亚儿童经历了更多的症状。对于护理人员，双变量关联表明较高的ADI与更多的症状相关。对于医疗服务提供者而言，双变量关联显示较高的症状与乡村性、MUA和阿巴拉契亚地区居住有关，尽管只有阿巴拉契亚地区居住在回归模型中仍然显著。结论阿巴拉契亚地区居住与癌症儿童较高的症状负担相关。研究结果支持文化敏感性护理以减少症状负担。

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引用次数: 0