Rural Health Commons^™

Pharmacy Access Is Out Of Reach For One In Six South Carolinians, Bryan L. Love Pharm.D., Tessa J. Hastings Phd, Abby Davies

CORE Research Briefs

A cross-sectional geospatial analysis mapped active South Carolina community pharmacies and used 2020 Census tract data to estimate the population residing within and beyond five-mile pharmacy service areas. About one in six South Carolinians lives more than five miles from an active community pharmacy, with limited access disproportionately affecting rural communities.

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 …

Assessing Aflatoxin Knowledge, Perceptions, And Related Practices, In A Rural Coastal Community: A Population-Based Cross-Sectional Survey, Rosebella Iseme, Joseph Abuodha, Anthony Ngugi, Innocent Abayo, Mansoor Saleh

Population Health, East Africa

Background

Aflatoxin contamination is a significant yet under-addressed food safety challenge in low-resource settings, driven by a complex interplay of environmental, agricultural, and socio-economic factors. Limited access to agricultural inputs, inadequate post-harvest handling and storage, and weak regulatory enforcement alongside food scarcity and climate change heighten the risk of contamination and exposure. Human exposure is associated with serious health consequences, including hepatocellular carcinoma, immune suppression, and childhood stunting. Although aflatoxin is increasingly recognized as a global food safety concern, little is known about community-level knowledge, risk perceptions, and preventive practices. This study examined household heads’ awareness, perceptions, and behaviours related …

Overcoming Challenges With Rural-Related Health Data: Lessons Learned From Published Studies, Casey P. Balio, Margaret M. Francisco, Nicole Galler, Olivia A. Sullivan, Kate E. Beatty, Michael E. Meit, Chyanne Morrison, Christiana Keinath, Stephanie M. Mathis

ETSU/NORC Rural Health Research Center Policy Briefs

No abstract provided.

Key Predictors Of Postpartum Depression And Anxiety Symptoms Among Mothers In Kilifi, Kenya: A Machine Learning Approach, Faith Benson, Rachel Odhiambo, Willie Brink, Anthony Ngugi, Akbar Waljee, Eileen Weinheimer-Haus, Cheryl Moyer, Ji Zhu, Amina Abubakar

Institute for Human Development, East Africa

Background:

The burden of maternal postpartum depression and anxiety is disproportionately high in sub-Saharan Africa (SSA), yet the use of advanced analytical methods to capture the complex interplay of variables influencing these conditions remains underexplored.

Objective:

To apply machine learning (ML) methods to predict depressive and anxiety symptoms in postpartum mothers and to identify key and actionable predictors.

Methods:

This cross-sectional study included 1,995 biological mothers of singleton infants aged 0–6 months, using survey data collected between March 2023 and March 2024 in Kaloleni and Rabai sub-counties, Kilifi County, Kenya, within the Kaloleni–Rabai Health and Demographic Surveillance …

Examining Rural Population Characteristics And Access To Care In 2022: A Study Of Health Professional Shortage Areas (Hpsas) And Medically Underserved Areas (Muas), Craig Holden, Shena Popat, Rachel Van Vleet, Shalanda Henderson, Carina Hoyer, Alana Knudson

ETSU/NORC Rural Health Research Center Policy Briefs

No abstract provided.

An Examination Of All-Payer Inpatient Rural Hospital Bypass, Craig D. Holden, Shena Popat, Alana Knudson, Marilyn G. Klug

ETSU/NORC Rural Health Research Center Policy Briefs

No abstract provided.

Social, Environmental And Policy Contexts Affecting The Feasibility And Acceptability Of Improving Household Flooring For Better Health In Rural Kenya, Ulrike Fillinger, Victoria Ochwal, Hugo Legge, Sharon Muli, Karisa Kazungu, Carlos Mcharo, Jacinta Mwongeli, Charles Mwandawiro, Katherine Halliday, Doris Njomo

Institute for Human Development, East Africa

Background Homes with unimproved floors (earth, sand, or clay) are associated with increased risks of soil-transmitted parasites and enteric infections, leading to higher morbidity and reduced quality of life. This study explored the enablers and barriers to adopting improved flooring (sealed, washable, and durable) in three culturally diverse regions of Kenya - Narok, Bungoma, and Kwale - to mitigate disease burdens.

Methods Between August 2021 and July 2022, we conducted 24 focus group discussions with homeowners, stratified by age, gender, and floor type. Additionally, 28 key informant interviews with local government officials, microfinance representatives, and masonry trainers in Kwale and …

Child Poverty And Nutritional Health In Rural And Non-Rural Ohio Counties, Viraj Chegu, Macy Puthoff

Scholarship in Medicine - All Papers

Child poverty is an ongoing issue in the United States, placing children at a risk of nutritional deficits. While community interventions and reduced price school lunch programs have improved food insecurity outcomes for children, there is limited knowledge of how these programs can alleviate potential health problems in rural versus urban areas. Thus, this project aims to compare various variables such as food environment index, food insecurity, and enrollment in reduced price school lunch among counties in Ohio of different poverty levels as well as whether the counties are rural or nonrural. Methods: Factors such as food insecurity, food environment …

Investigating The Relationship Between Drug Overdose Deaths, Excessive Alcohol Drinking, And Adult Smoking In Urban And Rural Ohio Counties In 2025, Sumin Byoun, Anne Griffin

Scholarship in Medicine - All Papers

Deaths from drug overdoses have been increasing each year. Ohio ranks among states with the highest number of drug overdose deaths per year. There is a gap in the literature regarding discussions of how excessive alcohol drinking and cigarette smoking rates may predict drug overdose death rates in a community. First, this study investigates differences in excessive drinking, adult smoking, and drug overdose deaths between urban and rural counties in Ohio. Second, this study explores whether excessive drinking and smoking behaviors can predict drug overdose death rates in urban and rural Ohio counties. Data exclusive to Ohio counties was obtained …

Understanding The Impacts Of Food Insecurity On Education Outcomes In Ohio, Maria El Biri, Sreya Tummalapalli

Scholarship in Medicine - All Papers

Background: Food insecurity has been a growing concern in the United States, and prior research has shown how food insecurity in youth can correspond to negative psychosocial outcomes. Additionally, there are known disparities with access to food based on living in rural or urban counties. Objective: The goal of this study was to determine how differences in food security can impact youth educational outcomes in Ohio. Methods: Data from County Health Rankings & Roadmaps were obtained on variables such as access to healthy foods, food insecurity, high school graduation rates, average grade performance, and percentage of the population living in …

Infant Mortality In Ohio, Isabella Bacon, Alexis Jackson

Scholarship in Medicine - All Papers

Introduction: Infant mortality continues to occur at alarming rates that differ among various groups and states. Despite this, there has been a lack of intersectional examination of risk- and protective-factors. Methods: We examine how smoking status, education level, primary care to population ratio, teen birth rates, and urban vs rural status impact infant mortality rates in Ohio, Kentucky, Michigan, and Indiana using County Health Rankings data. Results: Ohio was shown to have no significant difference between urban and rural infant mortality rates; however,  risk-and-protective factors did differ. In urban counties, high school completion, teen birth rates, and primary care ratios …

Primary Care Access And Preventable Hospitalizations: A Multi-Variable Analysis Of Medicare Populations In California (2022–2025), Mariam Shenouda, Suchetha Shashi

Scholarship in Medicine - All Papers

Background: Based on prior literature, limited access to primary care has been linked to higher preventable hospitalization rate. Particularly, rural communities often face physician shortages, contributing to disparities in health outcomes. Objective: To understand the relationship between primary care access and preventable hospitalization rates among medicare populations in California. Methods: The data was gathered from County Health Rankings & Roadmaps for 56 California counties, excluding Sierra and Alpine. This study used unpaired t-tests to determine the difference in the PCP ratio and preventable hospitalization rate between rural and urban counties in California in 2025. A paired t-test was performed to …

Exploring Demographic Factors Relating To Low Birth Weight In Rural Vs Urban Ohio, Meghan Curran, Jessica Terrell

Scholarship in Medicine - All Papers

Although medical advancements have improved the outcomes for infants born with low birth weight (LBW), these interventions are very expensive and low birth weight still was attributed to 16.1% of infant deaths in the United States in 20201. By understanding the factors that influence the incidence of low birth weight in the United States, preventative measures can be implemented to reduce the need for costly interventions and enhance infant health outcomes. In this study, we focused on 38 counties in Ohio that had either 75% or greater rural regions or 30% or less rural regions. Additionally, we focused on four …

Facilitating Shared Reading Exposure To Promote Health Outcomes In A Rural Pediatric Primary Care Clinic, Meredith L. Longino

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of this scholarly project was to address a gap in early literacy promotion for rural children by incorporating the Reach Out and Read program. This program bolsters foundational literacy by providing a book and anticipatory guidance at every well-child visit from birth through age 5. This project was expected to decrease no-show well-child attendance rates and improve provider morale.

Background

The project was implemented in an established rural pediatric primary care clinic in Northeast Texas. 

Methodology

Process implementation was measured through books distributed and EHR documentation of the intervention. Process objectives were measured by no-show rates for …

Adult Healthy Habits, Belinda E. Vicuna, Mahtab Soleimani, Yvonnie Baik, Elena Martinez, Theresa H. Cruz

Reports & Documents

No abstract provided.

Distribution Of Block Grant Funding: Considerations For Rural Communities, Kate E. Beatty, Casey P. Balio, Margaret M. Francisco, Michael B. Meit, Stephanie M. Mathis

ETSU/NORC Rural Health Research Center Policy Briefs

No abstract provided.

A Rural Lens On Federal Block Grant Distribution, Casey P. Balio, Stephanie M. Mathis, Margaret M. Francisco, Michael Meit, Kate E. Beatty

ETSU/NORC Rural Health Research Center Policy Briefs

No abstract provided.

Rural And Urban Differences In Suicide In The United States, 2018-2021, Qian Huang, Nicole Galler, Michael Meit, Amy Wahlquist

ETSU/NORC Rural Health Research Center Policy Briefs

No abstract provided.

Are Hcc Risk Scores A Reliable Health Status Indicator Across Rural And Urban Areas?, Craig D. Holden, Alana Knudson, Marilyn Klug, Samantha Augenbraun, Shena Popat

ETSU/NORC Rural Health Research Center Policy Briefs

No abstract provided.

Examining Differences In Rural And Urban Medicare Ffs Beneficiaries’ Emergency Department Use Before And During Covid-19, Alana Knudson, Craig D. Holden, Marilyn Klug, Tricia Stauffer, Shena Popat

ETSU/NORC Rural Health Research Center Policy Briefs

No abstract provided.

An Intersectional Approach To Quantifying The Impact Of Geographic Remoteness And Health Disparities On Quality-Adjusted Life Expectancy: Application To Australia, Peter Lee, Steven J. Bowe, Lidia Engel, Erica I. Lubetkin, Nancy Devlin, Lan Gao

Publications and Research

Objectives

Methods

Indian Health Service Strategic Plan 2006-2011, Indian Health Service

Native Health Database Full Text

The main health challenges currently faced by American Indian and Alaska Native people are the increasing health conditions and chronic diseases that are related to lifestyles issues such as obesity, physical inactivity, poor diet, substance abuse, and injuries. To help meet these challenges, the Indian Health Service (IHS) has launched a Health Promotion and Disease Prevention (HPj DP) Initiative to develop a coordinated and systematic approach to enhance preventive health approaches at the local, regional, and national levels. This Initiative is aligned with the President's HealthierUS, HHS Steps to a HealthierUS, and Healthy People 2010.

Cancer In Alaska Natives 1969-2003: 35-Year Report, C. Homan, J. Kelly, A. Lanier, J. Maxwell, T. Mcevoy

Native Health Database Full Text

Cancer incidence rates for all Alaska Natives (Eskimo, Indian, Aleut) were first reported in 1976. Since then numerous publications have documented the unusual cancer patterns in this population. These are the latest statistics for which there is complete data statewide, and provide the best estimates of cancer incidence in the Alaska Native population. Numbers of new (incident) cases and rates are given for all cancers and for specific sites. These numbers are presented by age, sex, ethnicity, geographic region, and service unit. Data have been collected, tabulated, and analyzed in accordance with procedures established by the National Cancer Institute Surveillance, …

Cancer Information Seeking Preferences Among Health Professionals Serving American Indians In Minnesota, North Dakota, And Wisconsin, K. Knutsen, R. Strickland, J. Matloub, P. Remington, J. Kaur

Native Health Database Full Text

This article identifies cancer information resources used by health professionals in tribal health departments or Indian Health Service clinics serving American Indian communities in Wisconsin, Minnesota and North Dakota.

2005 Navajo Middle And High School Youth Risk Behavior Survey Report, Primary Navajo Yrsb Team

Native Health Database Full Text

From 1997 to 2005, the Navajo Youth Risk Behavior Surveilance System (YRBS) was implemented to be used to monitor health-risk behaviors among youth in middle and high schools. Unhealthy risk behaviors can lead to unhealthy health conditions or injuries, and could enventually lead to health or social problems as chronic diseases, disability and drug or alcohol addictions.

People With Disabilities On Tribal Lands: Education, Health Care, Vocational Rehabilitation, And Independent Living, A. Kauffman, M. Whelshula, V. Paternoster, T. Spellman, W. Thompson, A. Walline

Native Health Database Full Text

This project examined research on health, rehabilitation, independent living, and education issues that affect people with disabilities living in Indian Country. The report discusses views and perspectives of American Indialaska Native people with disabilities, tribal leaders, and federal agency representatives identified as productive in meeting the needs of people with disabilities residing in tribal lands. This report also assesses and recommends government-to-government (state to sovereign tribal to U.S. government) improvements in relationships needed for effective coordination across existing federally funded projects/programs. In addition, a Toolkit guide providing resource information was developed for use by consumers, tribal communities, and people at …

Cancer Mortality Among American Indians And Alaska Natives: Regional Differences, 1994-1998, D.K. Espey, R.E. Paisano, N. Cobb

Native Health Database Full Text

This monograph delineates cancer mortality rates among American Indians and Alaska Native within the different regions served by the Indian Health Service (IHS). The table and charts depict broader geographic regions than in previous IHS cancer mortality monographs. The estimated IHS service population for each region and the cancer mortality rates from 1994 to 1998 are presented. Comparisons are made to the general U.S. population for the same time period. The intention of this publication is to provide detailed information about thew impact of cancer among Native American peoples, with a focus on the regional variability of cancer incidence for …

Final Report On Evaluation Of Indian Health Service Funded Community Alcohol Service Programs., Indian Health Service

Native Health Database Full Text

The IHS Strategic Plan is the product of a diverse workgroup with expertise in various facets of healthcare from clinical care to facilities construction. The IHS Strategic plan entails four goals: Build Healthy Communities, Achieve Parity in Access by 2010, Provide Compassionate Quality Health Care, and Embrace Innovation. Each of these goals are outlined alongside their respective strategies for accomplishment.