Southwest Rural Health Research Center: Rural Health Research Products & Journal Articles

2023

Travel for Medical or Dental Care by Race/Ethnicity and Rurality in the U.S.: Findings From the 2001, 2009 and 2017 National Household Travel Surveys
Journal Article
Date: 10/2023
This study examines trends in the travel distance and time for medical/dental care trips. Using 2001 to 2017 data from the National Household Travel Survey, our analysis found that travel distance and time increased for rural residents relative to urban residents.
Opportunities and Challenges of Using Carve-Outs to Fund Rural Public Health Initiatives: Evidence From the COVID-19 Pandemic
Journal Article
Date: 06/2023
This project explores the impact and lessons learned from the first large-scale rural carve out of a CDC funding initiative. Based on stakeholder interviews, our analysis found they supported this funding mechanism and that the funds were being used in interesting and creative ways.
Factors Associated With Hospitalizations for Co-occurring HIV and Opioid-related Diagnoses: Evidence From the National Inpatient Sample, 2009-2017
Journal Article
Date: 05/2023
This study explores trends in co-occurring HIV and opioid-related hospitalizations and identifies key risk factors.
Rural Healthy People 2030: Common Challenges, Rural Nuances
Policy Brief
Date: 05/2023
This study analyzes the most important Healthy People 2030 priorities for rural America. Data collected from a survey found mental health, substance use, health care access, and economic stability were among the most important priorities. This information could be used to accelerate health improvements in rural America.
Analysis of an Innovative Approach to Target Rural Communities in Public Health Funding
Policy Brief
Date: 03/2023
The CDC launched a new initiative to address COVID-19 related health disparities and to advance health equity among underserved and at-risk populations. Based on stakeholder interviews, this project explores the formation of this initiative, its impact on rural health, and lessons learned that can be applied to future rural-focused funds.
Rural Healthy People 2030: New Decade, New Challenges
Journal Article
Date: 03/2023
This study reports the findings of Rural Healthy People 2030, a companion piece to the Healthy People 2030 initiative with a focus on health priorities of rural populations. Data was collected from a survey given to rural stakeholders. Mental health, substance use, health care access, and economic stability were among the most important priorities.

2022

Disparities in Prenatal Immunization Rates in Rural and Urban U.S. Areas by Indicators of Access to Care
Journal Article
Date: 02/2022
This study evaluates variations in immunization rates among pregnant women across the urban-rural continuum. Results indicate pregnant women in rural areas more commonly rely on Medicaid to fund prenatal care but are less likely to have full or expanded access to Medicaid. This finding may contribute to immunization uptake disparities.

2021

Rural Urban Variation in Travel Burdens for Care: Findings From the 2017 National Household Travel Survey (Executive Summary)
Supplement
Date: 12/2021
This project focuses on geographic access to medical and dental care, knowing that travel distances can keep people from getting necessary care. The study examines how rural residents' travel behaviors vary by socio-demographic and geographic characteristics and evaluates factors associated with a higher travel burden for medical and dental care.
Community Health Worker Roles and Their Evolving Interprofessional Relationships in the United States
Journal Article
Date: 10/2021
This project analyzes the evolving integration of Community Health Workers (CHWs) into the United States healthcare system. CHWs can aid patients in navigating the complex nature of medical services. Through focus groups with CHWs, three stages in the interprofessional relationships between CHWs and other care providers were identified.
Racial, Rural, and Regional Disparities in Diabetes-Related Lower-Extremity Amputation Rates, 2009–2017
Journal Article
Date: 09/2021
This study examines race, rurality, and regional disparities in diabetes-related lower-extremity amputations (LEA) among adult hospitalizations from 2009-2017. Findings indicate rising minor LEA rates among Asians/Pacific Islanders and rising major LEA rates among hospitalized diabetes patients in the Midwest.
Rural-Urban Variations in Travel Burdens for Care: Findings From the 2017 National Household Travel Survey (Policy Brief)
Policy Brief
Date: 07/2021
This project focuses on geographic access to medical and dental care, knowing that travel distances can keep people from getting necessary care. The study examines how rural residents' travel behaviors vary by socio-demographic and geographic characteristics and evaluates factors associated with a higher travel burden for medical and dental care.
The Co-occurrence of HIV and Opioid Mortality in Rural and Urban America From 1999-2018
Policy Brief
Date: 06/2021
This project evaluates trends in mortality from human immunodeficiency virus (HIV) and opioid use in rural and urban areas of the U.S. It explores whether HIV and opioid deaths appear to be related over time in rural and urban areas.
Disparities in Maternal Immunization Among Women Residing in Rural and Urban Areas of the United States
Journal Article
Date: 06/2021
This study evaluates disparities in urban-rural influenza vaccination rates of women prior to and during pregnancy using 2016-2018 Pregnant Risk Assessment Monitoring System data. Findings indicate women residing in rural areas have lower vaccination rates with the greatest differences seen in Hispanic women and women with no health insurance.
Community Health Worker Sustainability: Funding, Payment, and Reimbursement Laws in the United States
Journal Article
Date: 04/2021
Recent changes have been made to community health worker (CHW) funding at the federal level, but payment structures vary from state to state. This paper aims to identify funding mechanisms that would enable CHW programs to sustain a robust workforce.
Influenza and Pertussis Vaccination Rates Among Pregnant Women in Rural and Urban Areas
Policy Brief
Date: 04/2021
This policy brief evaluates the receipt of influenza and pertussis vaccines from 2012-2018 among pregnant women in rural and urban areas of the U.S. Furthermore, it examines whether pregnant women during this this same period received influenza vaccine recommendations from their healthcare providers.
Trends in Singleton Preterm Births by Rural Status in the U.S., 2012-2018
Policy Brief
Date: 04/2021
This brief examines singleton preterm birth rates by rurality and across census regions in the U.S. It also studies the relationship between singleton preterm birth and several maternal characteristics among women who lived in counties with various rurality levels from 2012-2018.

2020

Long-Term Care Planning, Preparedness, and Response Among Rural Long-Term Care Providers
Journal Article
Date: 09/2020
This manuscript explores how rural long-term care providers plan, prepare, and respond to slowly or rapidly unfolding disasters (i.e., hurricanes, wildfires, and environmental spills) in three U.S. geographic areas. Data includes secondary sources and semi-constructed interviews with long-term care facilities and disaster management organizations.
Rural Versus Urban Prevalence of Intimate Partner Violence-Related Emergency Department Visits, 2009-2014
Policy Brief
Date: 08/2020
This project examines rural-urban disparities in the prevalence of intimate partner violence-related emergency department visits using a nationally representative sample of emergency room visits for the years 2009-2014.
Post-Acute Skilled Nursing Care Availability in Rural United States
Policy Brief
Date: 07/2020
This policy brief explores factors related to variations in the availability of post-acute skilled nursing care in rural areas in the U.S. The focus of this analysis is on swing bed program hospitals and skilled nursing facility post-acute skilled nursing care.
Factors Affecting the Likelihood of a Hospitalization Following a Diabetes-Related Emergency Department Visit: A Regional and Urban-Rural Analysis
Journal Article
Date: 05/2020
This study examines place-based and individual-level predictors of diabetes-related hospitalizations using 2009-2014 data from the National Inpatient Sample. Our findings indicate a higher incidence of these hospitalizations in residents of noncore areas in the South and Midwest, racial and ethnic minorities, and the uninsured population.
Healthy People 2020 Progress for Leading Causes of Death in Rural and Urban America: A Chartbook
Chartbook
Date: 03/2020
The purpose of this project is to conduct a midterm examination of urban versus rural disparities in meeting Healthy People 2020 mortality objectives for the top 10 leading causes of death in the U.S.
Are Rural Infants Benefiting From Woman, Infants, and Children (WIC) Food Package Rule Changes? Breastfeeding and Infant Feeding Behaviors
Policy Brief
Date: 02/2020
This study compared breastfeeding initiation for rural and urban Women, Infants, and Children (WIC) participants before and after the changes in WIC Food Packages (WIC-FPs). In addition, changes in breastfeeding and infant feeding practices before and after changes in WIC program benefits were explored.

2019

Congestive Heart Failure-Related Hospital Deaths Across the Urban-Rural Continuum in the United States
Journal Article
Date: 12/2019
This study examines congestive heart failure (CHF)-related, in-hospital mortality across six levels of rurality and four census regions. Results indicated CHF-related hospital admissions in small metropolitan, micropolitan, and noncore areas, compared to large central metropolitan areas, were more likely to result in death.
Healthy People 2020: Rural Areas Lag in Achieving Targets for Major Causes of Death
Journal Article
Date: 12/2019
For the period 2007-2017 rural death rates were higher than urban rates for the seven major causes of death analyzed, and disparities widened for five of the seven. In 2017 urban areas had met national targets for three of the seven causes, while rural areas had met none of the targets.
Community Health Worker Roles and Responsibilities in Rural and Urban America
Policy Brief
Date: 11/2019
The primary aim of this study was to understand the evolving profession of community health workers (CHWs) in the U.S. Through focus groups in rural and urban regions of four states, we explored CHW roles and responsibilities, the growing professionalization of the field, and evolving interactions between CHWs and other care providers.
The Development of Telehealth Laws in the U.S. from 2008 to 2015: A Legal Landscape
Policy Brief
Date: 11/2019
This study examines the scope and evolving nature of telehealth statutes and regulations in the U.S. Our research aims to understand changes in telehealth laws over time (2008-2015), variations in legal frameworks established across the U.S., and the extent that state laws regulate the primary care delivery through the use of telehealth.
Prevalence and Mortality of Heart Disease and Related Conditions: Disparities Affecting the South, Rural Areas, and American Indian and Alaska Natives
Policy Brief
Date: 11/2019
This policy brief identifies trends in the prevalence of stroke, heart disease, and heart attack while also assessing trends in mortality for heart disease and related conditions across the nation. The study examined whether disease-related mortality and prevalence varied across place and time.
The Changing Landscape of Diabetes Mortality in the United States Across Region and Rurality, 1999-2016
Journal Article
Date: 02/2019
This brief report examines place-based differences in diabetes mortality to understand whether disparities in diabetes mortality have changed across U.S. Census regions and levels of rurality over time. Reductions in diabetes mortality are lagging in rural areas, and the rural South in particular, relative to other areas of the country.
Diabetes-Related Hospital Mortality in the U.S.: A Pooled Cross-Sectional Study of the National Inpatient Sample
Journal Article
Date: 02/2019
This study examined place-based and individual-level variations in diabetes-related hospital deaths using the 2009-2015 National Inpatient Sample. Results show that place-based disparities exist. Targeted focus should be placed on the control of diabetic complications in the South, West, and Midwest census regions and among rural residents.

2018

Cancer Mortality in Rural America: 1999-2016
Policy Brief
Date: 11/2018
This policy brief details the differences in mortality from cancer at various levels of rurality in America. The primary aim of this study was to understand the scope of cancer mortality in urban and rural areas of the U.S. Common cancer types—breast, cervical, lung, prostate, and colon—were analyzed over an 18-year period from 1999-2016.
Individual- and County-Level Predictors of Cervical Cancer Screening: A Multi-Level Analysis
Journal Article
Date: 05/2018
Despite gains in cervical cancer screening, persistent socio-economic, geographical, racial, and ethnic disparities remain. The objective of this study was to examine the combined effect of individual- and county-level characteristics on the use of cervical cancer screening tests such as Papanicolaou (Pap) tests in Texas.
Diabetes-Related Hospital Mortality in Rural America: A Significant Cause for Concern
Policy Brief
Date: 03/2018
This brief is the third in a series prepared by the Southwest Rural Health Research Center on the topic of diabetes. The aim of this study was to examine trends and rates of diabetes-related deaths for persons hospitalized in the U.S., with emphasis on differences across the urban-rural continuum and across census regions.

2017

Diabetes and Forgone Medical Care Due to Cost in the U.S. (2011-2015): Individual-level and Place-Based Disparities
Policy Brief
Date: 08/2017
This brief is the first in a series prepared by the Southwest Rural Health Research Center on the topic of diabetes. The two aims of this study were to identify trends in diabetes rates and forgone medical care among persons with diabetes in the U.S. and to identify geographic determinants and other social determinants of health disparities.
Diabetes Mortality in Rural America: 1999-2015
Policy Brief
Date: 08/2017
This brief is the second in a series prepared by the Southwest Rural Health Research Center on the topic of diabetes. The primary aim of this study was to understand the scope of diabetes-related mortality in urban and rural America. We analyzed mortality caused by diabetes over a 16-year period and explored the roles played by rurality and race.
Assessing Diabetes and Factors Associated With Foregoing Medical Care Among Persons With Diabetes: Disparities Facing American Indian/Alaska Native, Black, Hispanic, Low Income, and Southern Adults in the U.S. (2011-2015)
Journal Article
Date: 04/2017
The purpose of this project was to identify individual- and place-based factors associated with diagnosed diabetes and foregone medical care among those diagnosed with diabetes. Diabetes prevalence and foregone medical care were found to be higher for those with lower incomes, for several racial/ethnic groups, and in the South versus other regions.

2006

Differences Between Newly Admitted Nursing Home Residents in Rural and Nonrural Areas in a National Sample
Journal Article
Date: 02/2006
This research investigates whether differences in acuity are a function of differences in resident payer status and occur for both individuals admitted for short stays, with Medicare as payer, and those needing chronic care.

2005

The State of Rural Hospital Nursing and Allied Health Professional Shortages
Date: 12/2005
This study estimated shortages of nurses and allied health personnel among rural hospitals to gauge the difficulty experienced by rural hospitals in recruiting such personnel. The study also examined strategies these hospitals use in recruitment and retention of nurses and addressed strategies that might effectively address such shortages.
Community Health Worker (CHW) Certification and Training: A National Survey of Regionally and State-Based Programs
Date: 05/2005
This report details the results of a qualitative study of states providing a national overview of state policy and state involvement in the standardized training and certification of community health workers.
Assisted Living in Rural America: Results From a National Survey
Date: 03/2005
This article examines the assisted living industry in metropolitan and rural areas. Results indicate that assisted living was largely a private-pay form of long-term care and was more common in metropolitan than rural areas. Findings suggest that assisted living will make only a marginal contribution to meeting the needs in rural areas.
A National Study Comparing Resident Medication Use in Rural and Non-Rural Assisted Living Facilities
Date: 02/2005
In addition to comparing rural and non-rural assisted living residents' medication utilization, this study examined the prevalence of inappropriately prescribed medications and drug-to-drug interactions among residents of rural and non-rural assisted living facilities.

2004

Community Health Workers: Status of Certification and Training
Date: 11/2004
A national overview of state policy and state involvement in the standardized training and certification of Community Health Workers is provided.
Mujer y Corazon: Community Health Workers and Their Organizations in Colonias on the U.S.-Mexico Border
Date: 10/2004
This report shares the results of a study analyzing the community health worker (CHW) organizations and practices to learn how they work and why they are key resources in colonias for improving the health of the communities. The study also examined the relationships of the CHW with and their impact on the communities they serve.
Rurality and Nursing Home Quality: Results From a National Sample of Nursing Home Admissions
Journal Article
Date: 10/2004
There are higher percentages of elderly population in and the utilization rates of nursing homes are higher in rural areas. Overall, problems in rural nursing homes are at a much higher risk for poor outcomes, but it is most apparent in extremely isolated rural areas.
Mujer y Corazon: Community Health Workers and Their Organizations in Colonias on the US-Mexico Border: An Exploratory Study
Date: 08/2004
Study results are reported that analyzed the Community Health Worker (CHW) organizations and practices to learn how they work and why they are key resources in colonias for improving the health of the communities. The study also examined the relationships of the CHW with and their impact on the communities they serve.
Nursing Homes in Rural And Urban Areas, 2001
Date: 06/2004
This chartbook provides descriptive data on the entire population of longer-stay nursing home residents in the country in 2001 and categorizes them according to the rurality of the nursing homes in which they receive care in an effort to address questions related to residents' characteristics and quality of care.are.
Assisted Living: Is It an Option for Rural Areas?
Date: 05/2004
The key findings of a national survey on assisted living are highlighted, including supply, services, and affordability of assisted living facilities in rural areas.
Chronic Disease Management in Rural Areas
Date: 05/2004
This article describes a study of six chronic disease management programs throughout the United States. It discusses issues related to chronic disease management in rural areas.
Expanding Residential Care and Assisted Living in Rural America
Date: 05/2004
There is an undersupply of assisted living facilities in rural areas. This policy brief provides options for state policy makers and advocates to consider in expanding the availability and nature of assisted living and other types of housing with supportive services in rural areas.
Rural Healthy People 2010: A Companion Document to Healthy People 2010. Volume 3
Date: 04/2004
This report includes the overview of research and accompanying models for practice on five new focus areas in Rural Healthy People 2010, along with the more detailed literature reviews for each.
Chronic Disease Management in Rural Areas: A Research Update
Date: 2004
Rural implementation of chronic disease management is discussed. Included are a list of benefits and barriers related to disease management.

2003

Chronic Disease Management in Rural and Underserved Areas: Patient Responses and Outcomes
Date: 11/2003
Findings from site visits and interviews with six chronic disease management (DM) programs across the United States indicated DM programs were extremely important in the areas of patient healthcare and quality of care and resulted in positive clinical and financial outcomes.
Breast and Cervical Cancer Screening: Is It Reaching Rural and Rural Minority Women?
Date: 04/2003
This study examines whether the Texas Breast and Cervical Cancer Control Program is reaching rural women in general and rural minority women in particular.
Nursing Homes in Rural America
Date: 2003
This policy brief discusses the main findings of a 2000 survey of 17,000 nursing homes related to rural elderly.
Rural Healthy People 2010: A Companion Document to Healthy People 2010. Volume 1
Date: 2003
This report offers brief overviews of the top rural health concerns and objectives associated with Healthy People 2010 focus areas. Also included are references to key literature about these concerns and descriptions of models for practice that rural communities can draw upon to achieve key Healthy People 2010 objectives.
Rural Healthy People 2010: A Companion Document to Healthy People 2010. Volume 2
Date: 2003
This report detailed literature reviews and associated references for the top rural health concerns addressed in Vol. 1 of Rural Healthy People 2010.