Public health: Rural Health Research Products & Journal Articles

2024

Geographic Disparities in Availability of Hospital-Based Cardiac Services Across the United States
Journal Article
University of South Carolina Rural Health Research Center
Date: 12/2024
This project examined geographic disparities in the availability of essential cardiac care in counties across the United States.
Non-Urgent Use of Emergency Departments by Rural and Urban Adults
Policy Brief
Maine Rural Health Research Center
Date: 04/2024
This study provides updated information and addresses gaps in knowledge about rural non-urgent emergency department (ED) use. Understanding the rates of non-urgent ED use among rural adults and the factors associated with this use can inform policy and practice efforts to reduce inappropriate use of EDs in rural communities.

2023

State Priorities and Needs: The Role of Block Grants
Journal Article
ETSU/NORC Rural Health Research Center
Date: 11/2023
This study looks at state-level funding allocations for 5 federal block grant programs from 2015-2019, and associations with state-level measures of need that align with the purposes of each block grant program.
Opportunities and Challenges of Using Carve-Outs to Fund Rural Public Health Initiatives: Evidence From the COVID-19 Pandemic
Journal Article
Southwest Rural Health Research Center
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.
COVID-19 Vaccination Rates
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 03/2023
This rural data brief provides a longitudinal examination of completion of primary COVID-19 vaccination series in the age-eligible population in metropolitan, micropolitan, and noncore counties.
Rural Working-Age Adults Report More Cost Barriers to Health Care
Policy Brief
Maine Rural Health Research Center
Date: 03/2023
Using the 2019-2020 National Health Insurance Survey, this study examined rural-urban differences in affordability of care and cost-saving strategies among working-age adults.

2022

Changes in Access to Community Health Services Among Rural Areas Affected and Unaffected by Hospital Closures Between 2006 and 2018: A Comparative Interrupted Time Series Study
Journal Article
University of South Carolina Rural Health Research Center
Date: 07/2022
In this article, investigators compared access to Federally Qualified Health Centers and Rural Health Clinics by those in rural areas affected versus those in rural areas unaffected by hospital closures.

2021

Confirmed COVID-19 Cases, Metropolitan and Nonmetropolitan Counties
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 08/2021
This data brief shows the spread of COVID-19 confirmed cases across the U.S., highlighting metropolitan and nonmetropolitan counties with confirmed cases of, and deaths from, COVID-19.
Voices From the Field: A Qualitative Study of the Challenges and Promising Practices of Rural Public Health in Addressing HIV and Hepatitis C
Journal Article
Maine Rural Health Research Center
Date: 05/2021
Interviewing public health professionals from six rural states, researchers examined the challenges involving HIV, HCV, and serving rural people who inject drugs and determined strategies to address those challenges.
Capacity of Rural Counties to Address an HIV or Hepatitis C Outbreak
Policy Brief
Maine Rural Health Research Center
Date: 02/2021
This study examines rural-urban differences in state and local health department capacity to prevent, prepare for, and respond to an HIV or hepatitis C outbreak.
Opioid-Related Visits to Rural Emergency Departments
Policy Brief
Maine Rural Health Research Center
Date: 02/2021
The purpose of this project was to compare rural and urban opioid-related emergency department visits. Data from the Nationwide Emergency Department Sample were used to examine rural and urban opioid-related visits over time and to compare the outcomes of these visits.
Rural HIV Prevalence and Service Availability in the United States: A Chartbook
Chartbook
Maine Rural Health Research Center
Date: 02/2021
This chartbook examines 2016 HIV prevalence and the availability of HIV prevention, testing, and treatment services across the rural-urban continuum and by U.S. census region.
Rural-Urban Residence and Maternal Hepatitis C Infection, U.S.: 2010-2018
Journal Article
Maine Rural Health Research Center
Date: 02/2021
This study uses data from the U.S. natality files to examine rural-urban differences in county-level rates of maternal infection with hepatitis C virus (HCV) during 2010-2018. Findings can help inform implementation of community-level interventions to reduce maternal HCV infection and narrow rural-urban disparities.
Advancing Population Health in Rural Places: Key Lessons and Policy Opportunities
Report
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 01/2021
This paper advances policy discussion of population health in rural places, focusing on the role of rural healthcare organizations. Lessons from ongoing programs provide policy considerations. Medicare and Medicaid programs should prioritize staff and infrastructure development, flexibility in covered benefits, and further expansion of telehealth.

2020

Substance Use Among Rural and Urban Youth and Young Adults
Policy Brief
Maine Rural Health Research Center
Date: 11/2020
This study uses national data to examine rural-urban differences in the rates of substance use among youth and young adults. Findings can help inform rural-specific prevention strategies and research targeting rural communities.
Metropolitan/Nonmetropolitan COVID-19 Confirmed Cases and General and ICU Beds
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 05/2020
The spread of COVID-19 across rural areas has fueled concern about the availability of healthcare resources for dealing with the pandemic. This brief looks at a single measure of healthcare resources – hospital beds – and reports of current COVID-19 cases in a single week to assess the impact on rural facilities.

2019

Healthy People 2020: Rural Areas Lag in Achieving Targets for Major Causes of Death
Journal Article
Southwest Rural Health Research Center
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.
Preventive Health Service Use Among Rural Women
Policy Brief
Maine Rural Health Research Center
Date: 04/2019
This study used the National Health Interview Survey to examine differences in receipt of preventive health services among rural and urban women. It found that rural women are less likely to receive HPV vaccines and mammograms, even controlling for rural-urban sociodemographic and resource differences.
Rural-Urban Differences in the Decline of Adolescent Cigarette Smoking
Journal Article
Maine Rural Health Research Center
Date: 03/2019
Comparing survey data from 2008-2010 with 2014-2016, we examined change over time in cigarette smoking among rural and urban adolescents. We found that both rural and urban rates declined, but the decrease was smaller in rural counties, which widened the rural-urban gap in adolescent smoking rates.

2018

Rural-Urban Differences in Risk Factors for Motor Vehicle Fatalities
Journal Article
University of Minnesota Rural Health Research Center
Date: 09/2018
This study uses 2017 County Health Rankings data to run stratified regression models to estimate county-level correlates of motor vehicle fatalities (MVFs) by rural and urban location. We found that rural counties have higher rates of MVFs than urban counties (22 vs. 14 per 100,000, p<0.001).

2017

Rural-Urban Differences in Medicare Quality Outcomes and the Impact of Risk Adjustment
Journal Article
University of Minnesota Rural Health Research Center
Date: 09/2017
This study examined the differences in quality of care outcomes between rural and urban Medicare beneficiaries. It concluded that rurality should be considered when discussing risk-adjustment procedures.

2016

How Would Rural Hospitals Be Affected by Loss of the Affordable Care Act's Medicare Low-Volume Hospital Adjustment?
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 11/2016
Using data from the Hospital Market Service Area File, the Hospital Cost Report Information System, and Nielsen-Claritas Pop-Facts, this study examined the effect the low-volume hospital payment adjustment has on a hospital's finances. It also looked at the effects of losing the payment adjustment.
To What Extent Do Community Characteristics Explain Differences in Closure Among Financially Distressed Rural Hospitals?
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 11/2016
This study examined the differences between rural hospitals at high risk of financial distress that stayed open and those that closed.
Health-Related Quality of Life Among Adults 65 Years and Older in the United States, 2011-2012: A Multilevel Small Area Estimation Approach
Journal Article
University of South Carolina Rural Health Research Center
Date: 10/2016
This study compiled estimates, at the county level, of poor health-related quality of life among those ages 65 and older. The study examined physical and mental health and found significant differences in health across the United States.

2015

Implications of Rural Residence and Single Mother Status for Maternal Smoking Behaviors
Policy Brief
Maine Rural Health Research Center
Date: 11/2015
This study finds rural mothers are more likely than urban mothers to smoke. The authors suggest policymakers consider extending insurance for smoking cessation programs through the Affordable Care Act and Medicaid. Programs at the local, state, and national levels also could help reduce disparities in smoking-related morbidity and mortality.

2014

From Health Care Volume to Health Care Value - Success Strategies for Rural Health Care Providers
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 04/2014
Examines strategies that rural healthcare providers can use to improve healthcare quality for patients.

2013

The Current State of Agricultural Health Research and Practice: Critical Review (Final Report)
West Virginia Rural Health Research Center
Date: 09/2013
The report provides an overview of the present state of agricultural health research for healthcare policy makers and providers.
Rates of Black Lung Disease in Relationship to Black Lung Treatment Centers (Full Report)
West Virginia Rural Health Research Center
Date: 08/2013
This report investigates the rates of black lung disease among active miners in relationship to the location of Black Lung Clinics.
Promotion and Protection of Rural Miner Health: Are the Resources in Place? (Final Report)
West Virginia Rural Health Research Center
Date: 06/2013
This report shows that mining areas in the United States, compared to non-mining areas, have on average better supplies of safety net providers, hospitals, and practicing primary care physicians. However, the study results support the need to examine the availability of safety net provider types in selected geographic areas where mining is done.
The Rural H1N1 Experience: Lessons Learned for Future Pandemics
West Virginia Rural Health Research Center
Date: 06/2013
This report describes the rural H1N1 experience, including comparisons of rural versus urban H1N1 vaccination rates, and describes rural H1N1 incidence, care patterns, and mortality.

2012

Receipt of Recommended Radiation Therapy Among Rural and Urban Cancer Patients (Summary)
WWAMI Rural Health Research Center
Date: 10/2012
This study examines whether rural patients with cancer are less likely than their urban counterparts to receive recommended radiation therapy. The study also identifies factors influencing rural versus urban differences in radiation therapy receipt.
Childhood Asthma in Rural-Urban Areas
Policy Brief
West Virginia Rural Health Research Center
Date: 06/2012
This policy brief examines how asthma may be related to rural areas adjacent or non-adjacent to larger population centers, to variation in measures of air quality, to varying levels of agricultural and animal production, and to other characteristics such as obesity, race/ethnicity, or health insurance.
Childhood Asthma in Rural-Urban Areas (Final Report)
West Virginia Rural Health Research Center
Date: 05/2012
This report examines how asthma may be related to rural areas adjacent or non-adjacent to larger population centers, to variation in measures of air quality, to varying levels of agricultural and animal production, and to other characteristics such as obesity, race/ethnicity, or health insurance.
Water Fluoridation and Dental Health Indicators in Rural and Urban Areas of the United States
Policy Brief
West Virginia Rural Health Research Center
Date: 01/2012
This policy brief investigates the availability of fluoridated water across urban and rural settings.

2011

Environmental Workforce Characteristics in the Rural Public Health Sector
Policy Brief
West Virginia Rural Health Research Center
Date: 12/2011
This project analyzed the environmental workforce characteristics of the rural public health sector to inform policy relative to coordination of rural environmental health services.
Environmental Workforce Characteristics in the Rural Public Health Sector (Final Report)
West Virginia Rural Health Research Center
Date: 12/2011
This project analyzed the environmental workforce characteristics of the rural public health sector to inform policy relative to coordination of rural environmental health services.
Water Fluoridation and Dental Health Indicators in Rural and Urban Areas of the United States (Final Report)
West Virginia Rural Health Research Center
Date: 11/2011
This study investigated the availability of fluoridated water across urban-rural settings and relates measures of fluoride availability to national survey measures of dental health in adults and children.
A Rural Socioeconomic Vulnerability and Resiliency Index and Associated Health Outcomes
Policy Brief
West Virginia Rural Health Research Center
Date: 07/2011
These analyses provide evidence to support the development of programs and policies that foster educational development, and economic diversity and vitality, as means of public health improvement, especially in rural areas in selected regions of the country.
Patterns of Food Insecurity, Food Availability, and Health Outcomes Among Rural and Urban Counties
Policy Brief
West Virginia Rural Health Research Center
Date: 06/2011
This project will examine rural and urban food security/availability. It will test the hypotheses that food insecurity will differ significantly between rural/urban counties and that there will be a significant relationship between food insecurity and availability and selected adverse health outcomes in non-metropolitan counties.
Patterns of Food Insecurity, Food Availability, and Health Outcomes Among Rural and Urban Counties (Final Report)
West Virginia Rural Health Research Center
Date: 06/2011
Rural counties are disproportionately associated with high food insecurity risk relative to urban counties. Programs and policies may focus on improving food availability and access for rural populations.
Determining Satisfaction With Access and Financial Aspects of Care for Persons Exposed to Libby Amphibole Asbestos: Rural and National Environmental Policy Implications
Journal Article
Date: 05/2011
The rural community of Libby, Montana is the epidemiological epicenter of asbestos-related disease with mortality rates 40-80 times higher when compared to rates in Montana and the U.S. Findings indicated the Libby cohort was significantly less satisfied with access and financial aspects of care.
Psychosocial Health Status of Persons Seeking Treatment for Exposure to Libby Amphibole Asbestos
Journal Article
FORHP-funded Individual Grantees
Date: 05/2011
A cross-sectional exploratory study was conducted to describe the psychosocial health status of persons seeking healthcare for exposure to Libby amphibole asbestos.
Place-Based Policies and Public Health: The Road to Healthy Rural People and Places
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 03/2011
This paper identifies how the Patient Protection and Affordable Care Act of 2010 can influence the determinants of health and contribute to the prosperity, equity, sustainability, and livability of rural places.
A Rural Socioeconomic Risk and Resiliency Inventory and Associated Health Outcomes (Final Report)
West Virginia Rural Health Research Center
Date: 03/2011
Rural areas, especially in the Southeast, Appalachia, and parts of the West, have worse VRI (Vulnerability and Resiliency Index) scores, which are a measure of six socioeconomic indicators across counties in the United States.

2010

Key Environmental Health Competencies for Rural Primary Care Providers (Final Report)
West Virginia Rural Health Research Center
Date: 03/2010
The purpose of this study was to develop a set of basic environmental health competencies that are needed by all rural primary care providers to direct healthcare and education policy.
Pollution Sources and Mortality Rates across Rural-Urban Areas in the United States
Policy Brief
West Virginia Rural Health Research Center
Date: 02/2010
Rural counties contain more than 65,000 EPA-recognized point pollution sources. A greater density of water and air pollution sources in rural counties is associated with higher cancer mortality rates, adjusting for other risks. Rural areas also experience mortality risks in association with coal mining activity.
Pollution Sources and Mortality Rates across Rural-Urban Areas in the United States (Final Report)
West Virginia Rural Health Research Center
Date: 02/2010
Rural counties contain more than 65,000 EPA-recognized point pollution sources. A greater density of water and air pollution sources in rural counties is associated with higher cancer mortality rates, adjusting for other risks. Rural areas also experience mortality risks in association with coal mining activity.
Toxics Release Inventory Discharges and Population Health Outcomes in Rural and Urban Areas of the United States
Policy Brief
West Virginia Rural Health Research Center
Date: 2010

Examined whether chemical releases from facilities monitored through the Toxics Release Inventory (TRI) program were associated with population mortality rates for both rural and urban populations.

2009

Rural Public Health Policy Models to Address an Evolving Environmental Asbestos Disaster
Journal Article
FORHP-funded Individual Grantees
Date: 2009
Describes the history and outcomes of asbestos exposure in the Libby, Montana community and discusses 3 models that provide public health policy insights related to rural health and health care for a community affected by both a sentinel and ongoing environmental event.

2008

Financing Rural Public Health Activities in Prevention and Health Promotion (Final Report)
NORC Walsh Center for Rural Health Analysis
Date: 06/2008
This is the final report of a study to determine whether the flow of federal resources, from federal agencies, through states, and to communities, is influenced by state- and local-level public health infrastructure.
Rural Public Health Financing: The Relationship Between Infrastructure and Local Program Funding
Policy Brief
NORC Walsh Center for Rural Health Analysis
Date: 06/2008
This study's purpose was to describe how federal funds for selected chronic disease prevention and health promotion activities are distributed to local health departments and non-governmental organizations at the local level and to identify infrastructure-related barriers that rural agencies may face in securing and using funds for such purposes.

2006

Local Public Health at the Crossroads: The Structure of Health Departments in Rural Areas (Issue Brief)
FORHP-funded Individual Grantees
Date: 03/2006
This issue brief provides an overview of findings from a study of the structure of rural local public health departments. It includes policy recommendations.
Local Public Health at the Crossroads: The Structure of Health Departments in Rural Areas (Report)
FORHP-funded Individual Grantees
Date: 03/2006
This report shares the results of a study on the structure of local health departments in rural areas. It includes case studies describing the structure of local health departments in rural areas in six geographically disparate states: Arizona, Georgia, Kansas, Louisiana, Pennsylvania, and Washington.
Rural Public Health Infrastructure: Case Studies to Assess the Impact of Structure on Service Delivery
NORC Walsh Center for Rural Health Analysis
Date: 01/2006
The purpose of this study is to contribute to a more thorough understanding of how public health governance affects how states structure and organize the delivery of public health services and how this influences the strategies adopted for meeting community public health needs in rural areas.
PTSD and Substance Use: Unrecognized Sequelae of Bioterrorism in Primary Care Providers
Journal Article
FORHP-funded Individual Grantees
Date: 2006
Study looks at rural primary care providers' knowledge of likely mental disorders, their risk factors, and preferred treatment options following a public health emergency.

2004

Rural Health Research in Progress in the Rural Health Research Centers Program, 8th Edition
Maine Rural Health Research Center
Date: 02/2004
This book provides policy makers with a concise source of rural health services research underway in the Rural Health Research Centers funded by the Office of Rural Health Policy. It provides a context for legislation current and proposed that affects rural health services and populations.

2002

Rural-Urban Differences in the Public Health Workforce: Findings From Local Health Departments in Three Rural Western States
Journal Article
WWAMI Rural Health Research Center
Date: 07/2002

Most local health departments or districts are small and rural; two thirds of the nation's 2832 local health departments serve populations smaller than 50,000 people. Rural local health departments have small staffs and slender budgets, yet they are expected to provide a wide array of services during a period when the healthcare system of which they are a part is undergoing change.

This study provided quantitative, population-based data on the supply and composition of the rural public health workforce in 3 extremely rural states: Alaska, Montana, and Wyoming. The study focused on the relative supply of personnel in the principal public health occupational categories, differences across states in staffing levels, and difficulties experienced in recruiting and retaining personnel.

2001

Local Health Districts and the Public Health Workforce: A Case Study of Wyoming and Idaho
Journal Article
WWAMI Rural Health Research Center
Date: 2001
Studies personnel in local health departments (LHDs) focused on two predominantly rural states: Idaho and Wyoming. Although in the same region of the country, the structure of local public health is different in each state.