Whitney E. Zahnd, PhD

Deputy Director, RUPRI Center for Rural Health Policy Analysis

Email: whitney-zahnd@uiowa.edu
X: @WhitneyZahnd

Health Management and Policy
University of Iowa
145 N. Riverside Drive
Iowa City, IA 52242

Current Projects - (2)
Completed Projects - (3)
Publications - (42)

Current Projects - (2)

Concordance Between Social Needs Screening Provision, Programming, and Partnerships in Rural PPS Hospitals
This study will examine how rural Prospective Payment System (PPS) hospitals differ from urban hospitals concerning social needs screening practices and alignment between social needs screening performance and corresponding programs/strategies and/or community partnerships to address social needs.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health services, Hospitals and clinics, Medicare Prospective Payment System (PPS), Networking and collaboration, Social determinants of health
Retention and Expansion of Hospital Services Offered by Rural Hospitals After Enrollment in 340B
The 340B Federal program is designed to provide hospitals with financial stability through provision of drug discounts which may, in turn, allow hospitals to maintain or expand their service line offerings. Using a series of event study analyses over an 11-year period, this study will examine the impact of enrollment in the 340B program on discontinuing services, maintaining services, and adding new services in eligible rural hospitals.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Critical Access Hospitals (CAHs), Health services, Hospitals and clinics, Pharmacy and prescription drugs

Completed Projects - (3)

Clinical-Community Linkages in Non-Metropolitan and Metropolitan Hospitals: COVID-19 Impacts and Trends
This study examined trends in partnerships between hospitals and public health departments and other community linkages in both non-metropolitan and metropolitan hospitals with a particular focus on the impact of the COVID-19 pandemic.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Coronavirus Disease 2019 (COVID-19), Critical Access Hospitals (CAHs), Health services, Hospitals and clinics, Networking and collaboration, Public health, Social determinants of health
Rural and Racial/Ethnic Disparities in COVID-19 Mortality Rates and Associations with Community Characteristics
This project examined rural and racial/ethnic disparities in COVID-19 mortality rates during the peak of COVID-19 deaths (December 2020-January 2021). Researchers examined mortality rates across non-metropolitan and metropolitan counties overall and stratified by racial/ethnic composition and U.S. census region, and spatial regression methods were used to identify community characteristics (e.g., rurality, sociodemographic, health conditions, and health care access) associated with mortality rates at the county level.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Coronavirus Disease 2019 (COVID-19), Health disparities and health equity, Healthcare access
Rural-Urban Differences in Three Domains of Access to Health Care Services
This study proposed to leverage 2018 and 2019 Behavioral Risk Factor Surveillance System data to examine rural-urban and racial/ethnic differences within rural in three domains of access to health care services (affordability, accommodation, and acceptability) that are less frequently examined in population-based surveys.
Research center: Rural and Minority Health Research Center
Topics: Health disparities and health equity, Healthcare access, Minority health

Publications - (42)

2024

Health Care Access Barriers Among Metropolitan and Nonmetropolitan Populations of Eight Geographically Diverse States, 2018
Journal Article
Rural and Minority Health Research Center
Date: 06/2024
This research focused on differences in barriers to health care access across metropolitan, micropolitan, and noncore populations. More access and cost related barriers are experienced by micropolitan respondents. These populations experience health care disparities and financial burdens that emphasize the need to mitigate these barriers.
Partnerships to Address Social Needs Across Metropolitan and Non-Metropolitan Prospective Payment System Hospitals and Critical Access Hospitals
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 03/2024
This policy brief used American Hospital Association survey data to examine partnerships between hospitals and external organizations to address social needs.
Prevent or Treat: Availability of Diabetes Self-Management Education and Dialysis in High Need Rural Counties
Policy Brief
Rural and Minority Health Research Center
Date: 03/2024
In this brief, researchers assess the availability of in-county diabetes self-management education and dialysis across rural and urban counties.

2023

Availability of Primary Care Safety Net Providers in Minoritized Racial/Ethnic Group Areas
Policy Brief
Rural and Minority Health Research Center
Date: 08/2023
This brief is one of a series of findings briefs documenting disparities in geographic access to health services for ZIP code tabulation areas containing a high proportion of minoritized racial/ethnic residents. This report looks at the distance to the nearest primary care safety net provider.
Accommodation and Acceptability of Health Care by Non-Metropolitan/Metropolitan and Race/Ethnicity Status
Policy Brief
Rural and Minority Health Research Center
Date: 07/2023
This research examined rural-urban (i.e., non-metropolitan/metropolitan) differences in accommodation and acceptability of health care by operationalizing two survey questions from the health care access optional module of the Behavioral Risk Factor Surveillance System survey.
Spatial Clustering of COVID-19 Mortality Rates Across Counties and by Noncore, Micropolitan, and Metropolitan County Characteristics, December 2020–January 2021
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 06/2023
This policy brief identifies spatial clusters of high COVID-19 mortality rates across counties in the United States between December 2020 and January 2021 and describes the characteristics of counties with high COVID-19 mortality rates.
The COVID-19 Pandemic Impact on Independent and Provider-Based Rural Health Clinics' Operations and Cancer Prevention and Screening Provision in the United States
Journal Article
Rural and Minority Health Research Center
Date: 03/2023
The provision of Rural Health Clinic (RHC) cancer prevention and screening services was examined to identify any changes pre- and peri-pandemic. The research examined overall provision of cancer prevention and screening services by RHCs and the provision of these services by independent RHCs and by provider-based RHCs .
COVID-19 Mortality Rates Across Noncore, Micropolitan, and Metropolitan Counties by Community Characteristics, December 2020-January 2021
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 01/2023
This policy brief examines differences in COVID-19 mortality rates across rural-urban designations and stratifications by geography, county-level sociodemographic factors, and county-level healthcare factors.
Variations in Affordability of Health Care by Non-Metropolitan/Metropolitan and Race/Ethnicity Status Across Eight Geographically Dispersed States
Policy Brief
Rural and Minority Health Research Center
Date: 01/2023
This research examined rural-urban (i.e., non-metropolitan/metropolitan) differences in affordability inclusive of insurance coverage and cost barriers. The research also examined forgoing medical care/medication and medical debt using Behavioral Risk Factor Surveillance System survey data from the healthcare access optional module.

2022

The Impact of the COVID-19 Pandemic on Rural Health Clinics' Operations and Cancer Prevention and Control Efforts
Policy Brief
Rural and Minority Health Research Center
Date: 11/2022
This study surveyed a stratified random sample of Rural Health Clinics throughout the country to examine how the pandemic has affected their overall operations and provision of cancer prevention and control services.
Rural Health Clinic Colorectal Cancer Screening Toolkit: A Toolkit for Implementing Evidence-Based Colorectal Cancer Screening Interventions in Rural Health Clinics
Rural and Minority Health Research Center
Date: 11/2022
The purpose of this project is to provide evidence-based interventions and other resources to Rural Health Clinics, throughout the United States, to improve colorectal cancer screening among their patient population.
Rural Health Clinic Colorectal Cancer Screening Toolkit: A Toolkit for Implementing Evidence-Based Colorectal Cancer Screening Interventions in South Carolina Rural Health Clinics
Rural and Minority Health Research Center
Date: 11/2022
The purpose of this project is to provide evidence-based interventions and other resources to Rural Health Clinics, throughout South Carolina, to improve colorectal cancer screening among their patient population.
The Involvement of Rural Health Clinic Practitioners in Cancer Treatment Decisions and Survivorship Care
Policy Brief
Rural and Minority Health Research Center
Date: 10/2022
This study examined Rural Health Clinics' practitioner involvement in cancer treatment decisions, management of side effects, surveillance, and survivorship care.
Availability of Hospital-Based Cancer Services Before and After Rural Hospital Closure, 2008-2017
Journal Article
Rural and Minority Health Research Center
Date: 09/2022
Using American Hospital Association survey data from 2008 to 2017, the changes in access to cancer-related screening and treatment services were examined to determine the impact of hospital closures across hospital service areas.
Availability of Hospital-Based Emergency Department and Trauma Services in Minoritized Racial/Ethnic Group Areas
Policy Brief
Rural and Minority Health Research Center
Date: 09/2022
This brief is one of a series of findings briefs documenting disparities in geographic access to health services for ZIP code tabulation areas (ZCTAs) containing a high proportion of minoritized racial/ethnic residents. This report looks at the availability of hospital-based emergency department and trauma services at the ZCTA level.
Availability of Pharmacies in Minoritized Racial/Ethnic Areas
Policy Brief
Rural and Minority Health Research Center
Date: 08/2022
This brief is one of a series of findings briefs documenting disparities in geographic access to health services for ZIP code tabulation areas containing a high proportion of minoritized racial/ethnic residents. This report looks at access to pharmacies.
Spatial Access to Hospital-based Obstetric Units in Minoritized Racial/Ethnic Areas
Policy Brief
Rural and Minority Health Research Center
Date: 08/2022
This brief is one of a series of findings briefs documenting disparities in geographic access to health services for ZIP code tabulation areas containing a high proportion of minoritized racial/ethnic residents. This report looks at spatial access to hospital-based obstetric units in minoritized racial/ethnic areas.
Comparison of Cancer Treatment Services Across Hospitals
Fact Sheet
Rural and Minority Health Research Center
Date: 05/2022
This research compared the availability of comprehensive oncology, chemotherapy, and radiation therapy in Critical Access Hospitals and non-Critical Access Hospitals.
Colorectal and Cervical Cancer Prevention in Rural Health Clinics in South Carolina
Fact Sheet
Rural and Minority Health Research Center
Date: 02/2022
This study investigated the perceptions and practices of cervical and colorectal cancer prevention in Rural Health Clinics. An online survey was administered to all Rural Health Clinics in South Carolina. Quantitative survey findings and key takeaways were reported.
Perceptions and Practices for Colorectal and Cervical Cancer Prevention and Control in Rural Health Clinics in South Carolina
Fact Sheet
Rural and Minority Health Research Center
Date: 02/2022
This study investigated the perceptions and practices for colorectal and cervical cancer prevention and control in Rural Health Clinics in South Carolina. Health practitioner interviews were used to gather qualitative data.
The Problem of the Color Line: Place, Race, and Access to Health Care in America
Journal Article
Rural and Minority Health Research Center
Date: 02/2022
Using ZIP Code Tabulation Area boundaries and associated rural-urban commuting area codes, urban and rural places with the largest share of minoritized racial and ethnic groups were identified. A StoryMap was then created to illustrate disparities experienced based on where Indigenous populations and people of color reside spatially.

2021

Trends in Cancer Treatment Service Availability Across Critical Access Hospitals and Prospective Payment System Hospitals
Journal Article
Rural and Minority Health Research Center
Date: 08/2021
This study investigated trends in cancer services availability in urban and rural Prospective Payment System (PPS) hospitals and Critical Access Hospitals (CAHs). Compared with all PPS hospitals, CAHs offered fewer cancer treatment services and experienced a decline in service capability over time.
Trends in Spatial Access to Colonoscopy in South Carolina, 2000-2014
Journal Article
Rural and Minority Health Research Center
Date: 06/2021
This study looks at the availability of colonoscopy screenings in South Carolina between 2000 and 2014 with a focus on changes in spatial access for these preventive services.
Rural and Racial Disparities in Colorectal Cancer Incidence and Mortality in South Carolina, 1996 - 2016
Journal Article
Rural and Minority Health Research Center
Date: 05/2021
This study investigated how race and rurality impact colorectal cancer incidence and mortality in South Carolina.
Disparities in Meeting USPSTF Breast, Cervical, and Colorectal Cancer Screening Guidelines Among Women in the United States
Journal Article
Rural and Minority Health Research Center
Date: 04/2021
The US Preventive Services Task Force provides recommendations for breast, cervical, and colorectal cancer screening. This manuscript examines the sociodemographic characteristics associated with women meeting these recommendations.
The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States
Journal Article
Rural and Minority Health Research Center
Date: 02/2021
This manuscript summarizes how racism and social determinants of health disproportionately affect rural racial/ethnic minorities, offers a review of the cancer disparities rural racial/ethnic minorities face, and recommends policy, research, and intervention to reduce these disparities.

2020

Spatial Access to Vaccines for Children Providers in South Carolina: Implications for HPV Vaccination
Journal Article
Rural and Minority Health Research Center
Date: 12/2020
In South Carolina, rural children ages 13 to 17 years old have lower rates of HPV vaccination initiation. To better understand potential drivers of this rural-urban disparity, this study's objective was to examine spatial access to Vaccines For Children-enrolled clinics across rural and urban areas of the state.
Cervical Cancer Treatment Initiation and Survival: The Role of Residential Proximity to Cancer Care
Journal Article
Rural and Minority Health Research Center
Date: 10/2020
This study looked at the role drive time to cancer care facilities played on cancer treatment initiation and survival for cervical cancer patients.
Rural-Urban and Racial/Ethnic Trends and Disparities in Early-Onset and Average-Onset Colorectal Cancer
Journal Article
Rural and Minority Health Research Center
Date: 10/2020
The study's objective was to examine joint rural-urban differences in early onset colorectal cancer and average onset colorectal cancer incidence rates across racial/ethnic groups in the U.S.
Access to Colorectal Cancer Screening Programs for Underserved Populations in South Carolina
Fact Sheet
Rural and Minority Health Research Center
Date: 08/2020
This fact sheet identifies existing initiatives targeting colorectal cancer screening in rural South Carolina.
Cervical Cancer and HPV Vaccination Disparities in South Carolina
Fact Sheet
Rural and Minority Health Research Center
Date: 08/2020
This fact sheet identifies existing initiatives targeting cervical cancer prevention and control in rural South Carolina.
Rural and Racial Disparities In Colorectal Cancer Incidence and Mortality In South Carolina 1996 - 2016 (Fact Sheet)
Fact Sheet
Rural and Minority Health Research Center
Date: 08/2020
This fact sheet examines the burden of colorectal cancer among South Carolina residents by urban-rural status and race/ethnicity.
Expanding Access to HPV Vaccination in South Carolina Through Community Pharmacies: A Geospatial Analysis
Journal Article
Rural and Minority Health Research Center
Date: 06/2020
Human papillomavirus (HPV) rates are higher in rural areas. The uptake of HPV vaccination is lower among rural populations. Pharmacies may be ideal for improving vaccination access. Does spatial access to pharmacies among adolescents and young adults in South Carolina vary by rurality and geographic access to primary care providers?
Factors Associated With Perceived Job Preparedness Among RNs: Results From a National Survey
Journal Article
Rural and Minority Health Research Center
Date: 05/2020
This article examines perceived job preparedness by demographic and professional characteristics among practicing registered nurses who completed a national survey. Rural and male nurses felt less prepared for nursing practice and may benefit from tailored educational experiences to improve perceptions of being prepared for the workforce.
Rural-Urban Differences in Educational Attainment Among Registered Nurses: Implications for Achieving an 80% BSN Workforce
Journal Article
Rural and Minority Health Research Center
Date: 05/2020
Our primary objective was to provide updated information on rural-urban differences in educational attainment. We also examined rural-urban differences in employment type, salary, and demographics among registered nurses in different practice settings.
A Bivariate Mapping Tutorial for Cancer Control Resource Allocation Decisions and Interventions
Journal Article
Rural and Minority Health Research Center
Date: 01/2020
This study demonstrates how geographic information systems software, specifically ArcGIS, can be used to develop bivariate choropleth maps to inform resource allocation and public health interventions.

2019

Rural-Urban Differences in Financial Burden Among Cancer Survivors: An Analysis of a Nationally Representative Survey
Journal Article
Rural and Minority Health Research Center
Date: 12/2019
Rural cancer survivors may disproportionately experience financial problems due to their cancer because of greater travel costs, higher uninsured/underinsured rates, and other factors. Our objective was to examine rural-urban differences in reported financial problems due to cancer using a nationally representative survey.
Financial Hardship Among Rural Cancer Survivors: An Analysis of the Medical Expenditure Panel Survey
Journal Article
Rural and Minority Health Research Center
Date: 11/2019
This study examined contrasts in financial hardship among 1,419 rural and urban cancer survivors using the 2011 Medical Expenditure Panel Survey supplement the Effects of Cancer and Its Treatment on Finances.
Geographic Disparities in Residential Proximity to Colorectal and Cervical Cancer Care Providers
Journal Article
Rural and Minority Health Research Center
Date: 11/2019
Persistent rural‐urban disparities for colorectal and cervical cancers raise concerns regarding access to treatment providers. To the authors knowledge, little is known regarding rural‐urban differences in residential proximity to cancer specialists.
Multilevel Analysis in Rural Cancer Control: A Conceptual Framework and Methodological Implications
Journal Article
Rural and Minority Health Research Center
Date: 09/2019
Our objective was two-fold: 1) to develop a multilevel conceptual framework describing how rural residence and relevant micro, macro, and supra-macro factors can be considered in evaluating disparities across the cancer control continuum and 2) to outline the unique considerations of multilevel statistical modeling in rural cancer research.
Challenges of Using Nationally Representative, Population-Based Surveys to Assess Rural Cancer Disparities
Journal Article
Rural and Minority Health Research Center
Date: 08/2019
Population-based surveys provide important information about cancer-related health behaviors across the cancer care continuum. However, due to small rural sample sizes, varying sampling methods, and/or other study design or analytical concerns, there are challenges in using population-based surveys for rural cancer control research and practice.
Perceived Facilitators and Barriers to Rural Nursing Practice
Policy Brief
Rural and Minority Health Research Center
Date: 08/2019
A web-based survey was disseminated to a geographically diverse sample of nurses throughout the U.S. to assess perceived barriers and facilitators to nursing practice; job satisfaction; and self-identified challenges in nursing work environments and patient care. Of particular interest were nurses in ambulatory care practices.