Rural Health Commons^™

Disparities In Access To Medicare-Approved Medical Specialists In Rural Kentucky, Logan Hurm, Jacob A. Welch, James Adkins

Journal of Appalachian Health

Introduction: Approximately 20% of the United States population resides in a rural community; however, only 10% of all healthcare resources and physicians are dedicated to these areas. Appalachia, and Kentucky (KY) in particular, have higher populations living in rural areas which leads to a greater number of individuals affected by medical access disparities. As of 2026, 21% of KY’s population is eligible for Medicare, making access to Medicare-accepting specialty physicians crucial for the state’s population.

Purpose: This research aims to quantify healthcare disparities among rural communities in KY through quantification of the potential distance required to travel to access specialty …

Rural/Urban Disparities In Utilization Of Diabetes Self-Management Training (Dsmt) To The Fee-For-Service Medicare Population, 2017–2024, Wanying Zhu, Aleksandr Taraskin, Jeffrerey Talbert

Rural & Underserved Health Research Center Publications

Key Report Highlights

• A significant rural DSMT access gap exists. Rural beneficiaries accounted for 20.1% of Medicare beneficiaries with diabetes but only 7.8% of DSMT participants.

• Geographic availability remains limited. Only 16.8% of counties with DSMT utilization were rural.

• Access, not demand, appears to be the primary challenge. Rural counties offering DSMT achieved utilization rates more than twice those observed in urban counties (6.0% vs. 2.5%).

• Expanding rural DSMT capacity may represent a high-impact opportunity to improve diabetes self-management support among underserved Medicare beneficiaries.

Non-Metropolitan Vs. Metropolitan Variations In Alcohol, Illicit Drug, And Prescription Therapeutic Drug Misuse, Tyrone F. Borders

Rural & Underserved Health Research Center Publications

Key Findings

Alcohol Use. The prevalence of past year and past 30-day drinking was lower among non-metropolitan (non-metro) than metropolitan (metro) residents. However, non-metro drinkers engaged in more frequent binge drinking than metro drinkers. Drinking 3-5, 6-19, and 20-30 days over the past 30 days were higher among non-metro than metro residents.

Illicit Drug Use. Hallucinogens were the mostly commonly used illicit drugs among non-metro as well as metro residents. Methamphetamine use was significantly higher among non-metro than metro residents.

Prescription Pain Reliever Use. The misuse of prescription pain killers, primarily prescription opioids, was higher among non-metro than …

Purchasing A Healthier Future: A Nutrition-Focused, Community-Centered Approach To Reduce Obesity And Diabetes In Graves County, Kentucky, Marissa Stephens

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Obesity and type 2 diabetes are among the most significant public health challenges in the United States, with Kentucky consistently ranking among the states with the highest prevalence of both conditions. Together, these conditions contribute to reduced quality of life, rising healthcare costs, and increased morbidity and mortality, underscoring the need for targeted, community-centered interventions. The disease burden of obesity and diabetes is particularly pronounced in rural areas, including the state’s westernmost region, the Jackson Purchase. Among rural populations, chronic disease risk is driven by a combination of factors, including low socioeconomic status, limited access to healthcare/supermarket options, and food …

Promoting Maternal And Infant Health In Franklin County, Ky: A Community-Based Physical Activity And Education Intervention, Subin Kim

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Maternal and infant health outcomes are key indicators of population health, yet persistent disparities exist in rural communities across the United States. In Kentucky, Franklin County reflects this pattern, with concerning maternal and infant health indicators despite relatively favorable socioeconomic conditions. Identified challenges include elevated rates of poor physical and mental health days, high drug overdose mortality, provider shortages, and ongoing reproductive health concerns such as tobacco use during pregnancy and increased infant mortality associated with elevated maternal body mass index.

To address these gaps, a three-pronged, community-based prenatal and postpartum physical activity and education program is proposed. The program …

Preventing Teen Pregnancy Through Expanded Contraceptive Access In Mccreary County, Kentucky, Dacey B. Chitwood

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

This capstone project proposes a school-based Condom Availability Program to reduce teen pregnancy risk by expanding discreet contraceptive access for adolescents in McCreary County, Kentucky. Teen pregnancy remains a persistent public health concern in rural communities where stigma, privacy concerns, transportation barriers, and limited healthcare access can prevent adolescents from obtaining reproductive health resources. McCreary County faces elevated teen birth rates, socioeconomic disadvantage, and limited maternal healthcare infrastructure, making teen pregnancy prevention an important local priority. The proposed program would place free latex and non-latex condoms in student restrooms at McCreary Central High School, with QR-code-linked information connecting students to …

Environmental Predictors Of Human Lyme Disease Incidence Across Appalachian Counties In Kentucky, Virginia, And West Virginia, 2000-2019, Karlie D. Rennison

Theses and Dissertations--Epidemiology and Biostatistics

This ecological study examined county-level environmental, landscape, and host-related predictors of Lyme disease incidence across Kentucky, Virginia, and West Virginia from 2000-2019. Lyme disease is an emerging public health concern in the Appalachian region, where geographic expansion and shifting ecological conditions may influence disease risk.

Lyme disease case rates (per 10,000 population) were analyzed in relation to climate variables, land cover metrics, host density measures, and rurality using publicly available data sources. Descriptive and regression analyses were conducted to evaluate associations between candidate predictors and disease incidence.

Substantial geographic variation in Lyme disease incidence was observed, with higher case rates …

Evaluation Of A Nicotine Prevention Program In A Third Grade Classroom, Jennifer A. Pile

DNP Projects

Purpose: The purpose of this project was to increase knowledge of nicotine products and promote negative perceptions of nicotine use among third-grade students through early prevention education.

Background: Prevention is key and to prevent nicotine use, there must be an educational program with that aim in a much younger population. Third grade encompasses 8-, 9-, and 10-year-olds. This group is in the middle childhood stage and begin more complex thinking and problem-solving skills. There is physical and emotional development among this group.

Methods: This is a quasi-experimental study among third grade students in Breckinridge County Kentucky with pretest and …

Advancing Rural Health Equity Through Systematic Sdoh Screening- A Quality Improvement Initiative, Laura C. Combs

DNP Projects

Background: Social determinants of health (SDoH) significantly affect health outcomes and healthcare utilization, particularly in rural communities. In 2024, the Centers for Medicare & Medicaid Services mandated SDoH screenings in the inpatient setting, with recommendation to implement in rural clinics without specifying a standardized tool, resulting in inconsistent identification of needs, e.g., food insecurity, housing instability, mental health concerns, financial strain, and transportation barriers.

Purpose: This quality improvement initiative implemented a standardized SDoH screening tool in a rural outpatient clinic to evaluate changes in referral rates to community-based resources pre- and post-implementation and to improve patient reporting of social needs. …

The Impact Of Medicaid Policy Limitations On Access To Eating Disorder Treatment: Uncovering The Consequences Of A System Built To Fail, Meghan Frost

DSW Capstone Projects

Individuals who rely on Medicaid face major barriers when trying to access eating disorder (ED) treatment, reflecting broader patterns of structural disadvantage in publicly funded health care. Research shows delayed diagnosis, limited access to ED specialists, and frequent denials for recommended services. These gaps occur because Medicaid policies do not match the needs of evidence based ED care, resulting in delayed or incomplete care for many individuals with eating disorders.

This issue is highly relevant to social work practice because the policies shaping these barriers are complex and difficult for clients and ED providers to navigate. Social workers across clinics, …