Health Services Research Commons^™

Increased Rates Of Death From Unintentional Injury Among Non-Hispanic White, American Indian/Alaska Native, And Non-Metropolitan Communities, Lindsey R. Hammerslag, Jeffery Talbert, Tyrone F. Borders

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• Living in a nonmetropolitan area is associated with an increase in the age-adjusted death rate from unintentional injuries, from 46.2 in metropolitan areas to 59.2 in nonmetropolitan areas in 2018, with all races/ethnicity groups affected except for non-Hispanic Black.
• The ratio of unintentional injury deaths in nonmetropolitan areas, compared to metropolitan areas, was 1.28 overall, ranging from 1.05 to 1.56 depending on race and ethnicity.
• American Indians and Alaska Natives have the highest rate of living in nonmetropolitan areas (39.5%), and this group has the greatest increase in death from unintentional injury associated with living in …

The Racial And Ethnic Diversity Of The Family Physician Workforce In Non-Metropolitan And Metropolitan Counties, Lars E. Peterson, Zachary J. Morgan

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• The family physician workforce is becoming more racially diverse; however, non-metropolitan family physicians are not.
• Using data from over 24,000 family physicians who either registered to continue their American Board of Family Medicine (ABFM) certification or completed the graduate survey from 2017 to 2019, we found that early career family physicians are more diverse than later career physicians (66.9% vs. 72.8% White; 58.3% vs. 44.0% female) but, in both groups, the percentage of White non-metropolitan family physicians was even higher (82.7% to 90.5%).
• Minority non-metropolitan family physicians, particularly Black and Native American/Alaska Native physicians, are more …

Non-Metropolitan And Metropolitan Trends In Mental Health Treatment Availability In Community Health And Community Mental Health Centers, Tyrone F. Borders, Timothy Williams, Katherine Youngen, Julia Cecil

Rural & Underserved Health Research Center Publications

Key Findings

The supply of community mental health centers (CMHCs) decreased substantially from 2000 to 2019 and became nearly non-existent in non-metropolitan counties.

• The number of CMHCs in non-metropolitan counties declined from 182 to 15.
• The number of CMHCs in metropolitan counties declined from 582 to 104.

The supply of community health centers (CHCs) offering mental health services increased substantially over the same time period, or from 2000 to 2019.

• The number of CHCs in non-metropolitan counties increased from 184 to 573.
• The number of CHCs in metropolitan counties increased from 126 to 797.

Bedside Nurses' Perceptions Of Effective Nurse-Physician Communication In General Medical Units: A Qualitative Study, Hirotaka Kato, Jessica M. Clouser, Preetham Talari, Nikita Vundi, Akosua Adu, Kishore Karri, Kathy B Isaacs, Mark V Williams, Romil Chadha, Jing Li

Center for Health Services Research Faculty Publications

Background

There is a dearth of research on successful interventions to improve nurse-physician communication (NPC). An important step is identifying what matters to bedside nurses and their perceptions of effective NPC communications and actions.

Methods

We conducted three focus groups with a total of 19 medical unit nurses across two hospitals in one academic medical center in the United States. Using a convenience sampling strategy, five to eight nurses voluntarily participated in each focus group. The recording was transcribed verbatim and two independent coders performed coding and resolved any discrepancies in codes. Qualitative content analysis was pursued to identify themes …

Changes In Adolescent Birth Rates Within Appalachian Subregions And Non-Appalachian Counties In The United States, 2012–2018, Nathan Hale, Kathleen Tatro, Sylvester Olubolu Orimaye, Michael Smith, Michael Meit, Kate E. Beatty, Amal Khoury

Journal of Appalachian Health

Background: Adolescent births are associated with numerous challenges. While adolescent birth rates have declined across the U.S., disparities persist and little is known about the extent to which broader declines are seen within Appalachia.

Purpose: The purpose of this study was to examine the extent to which adolescent birth rates have declined across the subregions of Appalachia relative to non-Appalachia.

Methods: We conducted a retrospective study of adolescent birth rates between 2012 and 2018 using county-level vital records data. Differences were examined across the subregions of Appalachia and among non-Appalachian counties. Multiple regression models were used to examine changes in …

Serious Mental Illness And Mental Health Treatment Utilization Among Adults Residing In Non-Metropolitan And Metropolitan Counties, Tyrone F. Borders, Timothy Williams

Rural & Underserved Health Research Center Publications

Key Findings

The past year prevalence of serious mental illness (SMI) was significantly higher among non-metropolitan than metropolitan (5.90% vs. 5.18%, P < .03) adults.

Only 67.58% of non-metropolitan and 64.29% of metropolitan adults with SMI received any mental health (MH) treatment in the past year.

Additional analyses revealed the following non-metropolitan/metropolitan treatment differences:

• A higher percentage of non-metropolitan than metropolitan adults with SMI received only medication for MH treatment (24.50% vs. 18.53%, P < .02).
• A higher percentage of metropolitan than non-metropolitan adults with SMI received inpatient, outpatient, and medication (5.42% vs. 2.63%, P < .02).
• A significantly higher percentage of non-metropolitan than metropolitan adults with …

The Impact Of Covid-19 On Collaboration And Turnover Among State Health Leadership, Kaylee Gouge

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

Background/Objectives: State Health Officials (SHOs), the physician-leaders of state public health departments in the US, have long been indicated as potential peacemakers between the fields of medicine and public health. However, the average term length of SHOs has declined in recent years. Meanwhile, the COVID-19 pandemic has increased public visibility of state public health departments and their leadership. Some have hypothesized that the political strain of the pandemic has further accelerated SHO turnover, compromising their leadership efficacy. Contrarily, others have suggested that the pandemic would force public health and organized medicine into closer collaborative alignment through a common enemy. …

Reported Barriers To Hepatitis C Treatment Among Pregnant And Early-Parenting Mothers Undergoing Substance Use Disorder Treatment In One U.S. State, Ayooluwatomiwa Deborah Adekunle, Kathi L. Harp, Zaynab G. Al-Abdali, Agatha S. Critchfield, Sheila Barnhart, Kathleen T. Winter

Health Management and Policy Faculty Publications

Nationwide, the prevalence of the hepatitis C virus (HCV) has risen in recent years. At least 90% of infected persons must be treated to achieve global elimination targets. The current study aimed to explore barriers to, and facilitators of, direct-acting antiviral (DAA) HCV treatment uptake amongst pregnant and early-parenting women undergoing comprehensive substance use treatment. Twenty participants with documented HCV antibody positivity were recruited from two substance use treatment centers in central Kentucky. Semi-structured interviews were conducted to explore knowledge about HCV, previous experiences, and intentions to seek care. Themes were extracted using an inductive analytical approach. Most participants were …

Persistent Polypharmacy And Fall Injury Risk: The Health, Aging And Body Composition Study, Lingshu Xue, Robert M. Boudreau, Julie M. Donohue, Janice C. Zgibor, Zachary A. Marcum, Tina Costacou, Anne B. Newman, Teresa M. Waters, Elsa S. Strotmeyer

Health Management and Policy Faculty Publications

Background

Older adults receive treatment for fall injuries in both inpatient and outpatient settings. The effect of persistent polypharmacy (i.e. using multiple medications over a long period) on fall injuries is understudied, particularly for outpatient injuries. We examined the association between persistent polypharmacy and treated fall injury risk from inpatient and outpatient settings in community-dwelling older adults.

Methods

The Health, Aging and Body Composition Study included 1764 community-dwelling adults (age 73.6 ± 2.9 years; 52% women; 38% black) with Medicare Fee-For-Service (FFS) claims at or within 6 months after 1998/99 clinic visit. Incident fall injuries (N = 545 in …

Access To Health Care In Appalachia: Perception And Reality, Michele Morrone, Cory E. Cronin, Kristin Schuller, Shannon E. Nicks

Journal of Appalachian Health

Introduction: Health disparities such as cancer and diabetes are well documented in Appalachia. These disparities contribute to health status, and by many indicators, Appalachian people are less healthy than those who live in other parts of the country. Access to health care is one factor that contributes to health disparities. Access to care is complex and involves both intrinsic and extrinsic aspects, including satisfaction with quality of care. This research sought to compare Appalachian to non-Appalachian communities in terms of perceptions of access to care.

Methods: We implemented a statewide survey to quantify perceptions of multiple components of …

Association Between Post-Hospital Clinic And Telephone Follow-Up Provider Visits With 30-Day Readmission Risk In An Integrated Health System, Huong Q. Nguyen, Aileen Baecker, Timothy Ho, Dan N. Huynh, Heather L. Watson, Jing Li, Ernest Shen

Center for Health Services Research Faculty Publications

BACKGROUND: Follow-up visits with clinic providers after hospital discharge may not be feasible for some patients due to functional limitations, transportation challenges, need for physical distancing, or fear of exposure especially during the current COVID-19 pandemic.

METHODS: The aim of the study was to determine the effects of post-hospital clinic (POSH) and telephone (TPOSH) follow-up provider visits versus no visit on 30-day readmission. We used a retrospective cohort design based on data from 1/1/2017 to 12/31/2019 on adult patients (n = 213,513) discharged home from 15 Kaiser Permanente Southern California hospitals. Completion of POSH or TPOSH provider visits within …

Development And Psychometric Properties Of Surveys To Assess Patient And Family Caregiver Experience With Care Transitions, Joann Sorra, Katarzyna Zebrak, Deborah Carpenter, Theresa Famolaro, John Rauch, Jing Li, Terry Davis, Huong Q. Nguyen, Megan Mcintosh, Suzanne Mitchell, Karen B. Hirschman, Carol Levine, Jessica Miller Clouser, Jane Brock, Mark V. Williams

Center for Health Services Research Faculty Publications

Background

The purpose of this study was to develop and administer surveys that assess patient and family caregiver experiences with care transitions and examine the psychometric properties of the surveys. The surveys were designed to ask about 1) the transitional care services that matter most to patients and their caregivers and 2) care outcomes, including the overall quality of transitional care they received, patient self-reported health, and caregiver effort/stress.

Methods

Survey items were developed based on a review of the literature, existing surveys, focus groups, site visits, stakeholder and expert input, and patient and caregiver cognitive interviews. We administered mail …

Content Analysis Of Digital Media Coverage Of The Human Papillomavirus Vaccine School-Entry Requirement Policy In Puerto Rico, Vivian Colón-López, Vilnery Rivera-Figueroa, Glizette O. Arroyo-Morales, Diana T. Medina-Laabes, Roxana Soto-Abreu, Manuel Rivera-Encarnación, Olga L. Díaz-Miranda, Ana P. Ortiz, Katelyn B. Wells, Coralia Vázquez-Otero, Pamela C. Hull

Behavioral Science Faculty Publications

BACKGROUND: In August 2018, Puerto Rico (PR) became the 4th state or territory in the United States to adopt a human papillomavirus (HPV) vaccine school-entry requirement, for students 11-12 years old. Evidence suggests that the content of media coverage may impact people's perception of HPV vaccine and their willingness to vaccinate. This study aimed to analyze the content of digital news coverage related to the implementation of the policy in PR.

METHODS: A content review was conducted of digital media published from January 2017 through December 2018. The content reviewed was carried out in two steps: 1) creating a matrix …

Factors That Influence Enrollment In Syringe Services Programs In Rural Areas: A Qualitative Study Among Program Clients In Appalachian Kentucky, Umedjon Ibragimov, Katherine E. Cooper, Evan Batty, April M. Ballard, Monica Fadanelli, Skylar B. Gross, Emma M. Klein, Scott Lockard, April M. Young, Hannah L. F. Cooper

Epidemiology and Environmental Health Faculty Publications

BACKGROUND: Enrolling sufficient number of people who inject drugs (PWID) into syringe services programs (SSP) is important to curtail outbreaks of drug-related harms. Still, little is known about barriers and facilitators to SSP enrollment in rural areas with no history of such programs. This study's purpose was to develop a grounded theory of the role of the risk environment and individual characteristics of PWID in shaping SSP enrollment in rural Kentucky.

METHODS: We conducted one-on-one semi-structured interviews with 41 clients of 5 SSPs that were established in rural counties in Appalachian Kentucky in 2017-2018. Interviews covered PWID needs, the process …

Planning Implementation Success Of Syncope Clinical Practice Guidelines In The Emergency Department Using Cfir Framework, Jing Li, Susan S. Smyth, Jessica M. Clouser, Colleen A. Mcmullen, Vedant A. Gupta, Mark V. Williams

Center for Health Services Research Faculty Publications

Background and Objectives: Overuse and inappropriate use of testing and hospital admission are common in syncope evaluation and management. Though guidelines are available to optimize syncope care, research indicates that current clinical guidelines have not significantly impacted resource utilization surrounding emergency department (ED) evaluation of syncope. Matching implementation strategies to barriers and facilitators and tailoring strategies to local context hold significant promise for a successful implementation of clinical practice guidelines (CPG). Our team applied implementation science principles to develop a stakeholder-based implementation strategy. Methods and Materials: We partnered with patients, family caregivers, frontline clinicians and staff, and health system administrators …

Development And Psychometric Properties Of Surveys To Assess Provider Perspectives On The Barriers And Facilitators Of Effective Care Transitions, Maurice C. Johnson Jr., Helen Liu, Joann Sorra, Jane Brock, Brianna Gass, Jing Li, Jessica Miller Clouser, Karen Hirschman, Deborah Carpenter, Huong Q. Nguyen, Mark V. Williams

Center for Health Services Research Faculty Publications

Background
The quality of the discharge process and effective care transitions between settings of care are critical to minimize gaps in patient care and reduce hospital readmissions. Few studies have explored which care transition components and strategies are most valuable to patients and providers. This study describes the development, pilot testing, and psychometric analysis of surveys designed to gain providers’ perspectives on current practices in delivering transitional care services.

Methods
We underwent a comprehensive process to develop items measuring unique aspects of care transitions from the perspectives of the three types of providers (downstream, ambulatory, and hospital providers). The process …

Measuring The Impact Of The Affordable Care Act Medicaid Expansion On Access To Primary Care Using An Interrupted Time Series Approach, Elizabeth A. Brown, Brandi M. White, Walter J. Jones, Mulugeta Gebregziabher, Kit N. Simpson

Health and Clinical Sciences Faculty Publications

BACKGROUND: The Patient Protection and Affordable Care Act of 2010, commonly referred to as the Affordable Care Act (ACA), was created to increase access to primary care, improve quality of care, and decrease healthcare costs. A key provision in the law that mandated expansion of state Medicaid programme changed when states were given the option to voluntarily expand Medicaid. Our study sought to measure the impact of ACA Medicaid expansion on preventable hospitalization (PH) rates, a measure of access to primary care.

METHODS: We performed an interrupted time series analysis of quarterly hospitalization rates across eight states from 2012 to …

Loss Of Obstetric Services In Rural Appalachia: A Qualitative Study Of Community Perceptions, Caroline R. Efird, David Dry, Rachel F. Seidman

Journal of Appalachian Health

Background: As rural hospitals across the United States increasingly downsize or close, the availability of inpatient obstetric services continues to decline in rural areas. In rural Appalachia, the termination of obstetric services threatens to exacerbate the existing risk of adverse birth outcomes for women and infants, yet less is known about how the cessation of these services affects the broader community.

Purpose: The purpose of this paper is to explain how the loss of local obstetric services affects perceptions of healthcare among multi-generational residents of a remote, rural Appalachian community in western North Carolina.

Methods: An interdisciplinary team of researchers …

Medicare-Paid Naloxone: Trends In Non-Metropolitan And Metropolitan Areas, Chris Delcher, Yue Cheng, Minji Sohn, Jeffery C. Talbert, Patricia R. Freeman

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• Medicare pays for the largest share (> 30%) of naloxone dispensed from retail pharmacies in non-metropolitan areas.
• Medicare-paid dispensing has grown since 2013, but from 2017-2018 dispensing growth in non-metropolitan areas slowed considerably compared to metropolitan areas (42% v 121%, respectively).
• As of 2018, the rate of naloxone dispensing to Medicare enrollees in metropolitan areas was approximately double that in non-metropolitan areas (4.9 v 2.9 per 1,000 enrollees, respectively).

Evaluation Of Glutaminase Expression In Prostate Adenocarcinoma And Correlation With Clinicopathologic Parameters, Zin W. Myint, Ramon C. Sun, Patrick J. Hensley, Andrew C. James, Peng Wang, Stephen E. Strup, Robert J. Mcdonald, Donglin Yan, William H. St. Clair, Derek B. Allison

Internal Medicine Faculty Publications

High Glutaminase (GLS1) expression may have prognostic implications in colorectal and breast cancers; however, high quality data for expression in prostate cancer (PCa) are lacking. The purpose of this study is to investigate the status of GLS1 expression in PCa and correlated expression levels with clinicopathologic parameters. This study was conducted in two phases: an exploratory cohort analyzing RNA-Seq data for GLS1 from The Cancer Genome Atlas (TCGA) data portal (246 PCa samples) and a GLS1 immunohistochemical protein expression cohort utilizing a tissue microarray (TMA) (154 PCa samples; 41 benign samples) for correlation with clinicopathologic parameters. In the TCGA cohort, …

Spatial Analysis Of Health Care Utilization Among Medicare Beneficiaries With Coal Workers’ Pneumoconiosis And Other Related Pneumoconiosis, Ahmed A. Arif, Claudio Owusu, Rajib Paul, Christopher M. Blanchette, Ripsi P. Patel, Tyrone F. Borders

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• The states with the highest number of Medicare beneficiaries with coal workers’ pneumoconiosis (CWP) were Kentucky, West Virginia, Virginia, and Pennsylvania.
• Significant clustering of health care utilization rates for Medicare beneficiaries with CWP was observed in the central Appalachian states of Kentucky, West Virginia, and Virginia.
• Significant clustering of health care utilization rates for Medicare beneficiaries with Other Related Pneumoconiosis was observed in Appalachia and the southeast parts of Texas and Louisiana. This clustering merits additional research to understand underlying disease etiology.

Did Medicaid Slow Declines In Access To Health Care During The Great Recession?, Joseph A. Benitez, Victoria E. Perez, Jie Chen

Health Management and Policy Faculty Publications

OBJECTIVE: We examine whether broadened access to Medicaid helped insulate households from declines in health coverage and health care access linked to the 2007-2009 Great Recession.

DATA SOURCE: 2004-2010 Behavioral Risk Factor Surveillance System (BRFSS).

STUDY DESIGN: Flexible difference-in-difference regressions were used to compare the impact of county-level unemployment on health care access in states with generous Medicaid eligibility guidelines versus states with restrictive guidelines.

DATA COLLECTION/EXTRACTION METHODS: Nonelderly adults (aged 19-64) in the BRFSS were linked to county unemployment rates from the Bureau of Labor Statistics' Local Area Unemployment Statistics Program. We created a Medicaid generosity index by simulating …

Measurement Matters: Changing Penalty Calculations Under The Hospital Acquired Condition Reduction Program (Hacrp) Cost Hospitals Millions, Olga A. Vsevolozhskaya, Karina C. Manz, Pierre M. Zephyr, Teresa M. Waters

Biostatistics Faculty Publications

BACKGROUND: Since October 2014, the Centers for Medicare and Medicaid Services has penalized 25% of U.S. hospitals with the highest rates of hospital-acquired conditions under the Hospital Acquired Conditions Reduction Program (HACRP). While early evaluations of the HACRP program reported cumulative reductions in hospital-acquired conditions, more recent studies have not found a clear association between receipt of the HACRP penalty and hospital quality of care. We posit that some of this disconnect may be driven by frequent scoring updates. The sensitivity of the HACRP penalties to updates in the program's scoring methodology has not been independently evaluated.

METHODS: We used …

Improving Evidence-Based Grouping Of Transitional Care Strategies In Hospital Implementation Using Statistical Tools And Expert Review, Jing Li, Gaixin Du, Jessica Miller Clouser, Arnold J. Stromberg, Glen Mays, Joann Sorra, Jane Brock, Terry Davis, Suzanne Mitchell, Huong Q. Nguyen, Mark V. Williams

Center for Health Services Research Faculty Publications

BACKGROUND: As health systems transition to value-based care, improving transitional care (TC) remains a priority. Hospitals implementing evidence-based TC models often adapt them to local contexts. However, limited research has evaluated which groups of TC strategies, or transitional care activities, commonly implemented by hospitals correspond with improved patient outcomes. In order to identify TC strategy groups for evaluation, we applied a data-driven approach informed by literature review and expert opinion.

METHODS: Based on a review of evidence-based TC models and the literature, focus groups with patients and family caregivers identifying what matters most to them during care transitions, and expert …

Unboxing The Japanese Sojourning Mom’S Pediatric-Going Experience: A Phenomenological Study Of Culturally And Linguistically Appropriate Health Services, Carolyn Oldham

Theses and Dissertations--Education Sciences

This study explores how twelve former Lexington-area Japanese sojourning mothers define culturally and linguistically appropriate services and how culture, gender and language shaped their health care beliefs, behaviors and experiences in pediatric settings. It is a naturalistic, pragmatic line of inquiry born in collaboration with Japanese sojourning moms across cups of matcha 末茶 and mugicha 麦茶. Framed by constructivist and intersectionality research lenses, this phenomenological study seeks to understand how study participants perceived the cultural and linguistic appropriateness of their interactions with Lexington-area pediatric offices and to begin to ascertain the meanings they created based on their subjective experiences. Its …

Prevalence And Correlates Of Secondary Syringe Exchange (Sse) Among People Who Inject Drugs (Pwid) In Rural Kentucky, Jordan R. Wilson

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

Aim: To describe the prevalence of secondary syringe exchange (SSE) in a sample of syringe service program (SSP) clients in rural Appalachian Kentucky and to identify the correlates of SSE.

Methods: Participants (n=338) completed interviewer-administered questionnaires. Only those who reported having ever exchanged syringes at a SSP (n=140) were included in analysis. SSE was measured through self-report of obtaining syringes for someone else at a SSP in the past 6 months. Prevalence and correlates of SSE were examined using bivariate analysis and multiple logistic regression.

Results: Overall, 30% of participants reported SSE. Participants in the second [aOR= 3.83; 95% CI: …

Leveraging Electronic Health Records Data For Enhanced Colorectal Cancer Screening Efforts, Adam D. Baus, Lauren E. Wright, Stephenie Kennedy-Rea, Mary E. Conn, Susan Eason, Dannell Boatman, Cecil Pollard, Andrea Calkins, Divya Gadde

Journal of Appalachian Health

Introduction: Colorectal cancer is the third most common type of cancer in the United States for men and women combined. While the current threat of disease nationally is significant, the majority of colorectal cancer cases and deaths could be prevented through established screening tests and guidelines. Within the Appalachian region and West Virginia in particular, colorectal cancer is a significant public health problem. A more systematic, comprehensive approach to preventing and controlling cancer is essential.

Methods: Through the West Virginia Program to Increase Colorectal Cancer Screening, primary care systems across the state received data-informed practice facilitation designed to increase screening …

Qualitative Analysis Of Maternal Barriers And Perceptions To Participation In A Federal Supplemental Nutrition Program In Rural Appalachian North Carolina, Sydeena E. Isaacs, Lenka H. Shriver, Lauren Haldeman

Journal of Appalachian Health

Background: Little is known about barriers to and perceptions of participation in the in Women, Infants, and Children (WIC) program in rural Appalachia.

Purpose: To gain a deeper understanding of maternal barriers and perceptions related to WIC participation in rural Appalachia

Methods: Pregnant women and mothers were recruited in-person and via flyers from WIC offices in three counties in Appalachian North Carolina. Four semi-structured focus groups were conducted between May to July 2018. Each focus group was approximately 60 minutes long and included open-ended questions about the overall WIC experience in rural Appalachia. Focus groups were audio-recorded, transcribed verbatim, and …

Risky Substance Use Behaviors Among Adults Residing In Non-Metropolitan And Metropolitan Counties In The United States, 2017-2018, Tyrone F. Borders, Michael D. Singleton, Katherine Youngen

Rural & Underserved Health Research Center Publications

Overview of Key Findings

Tobacco Use. Non-metropolitan adults had significantly higher prevalence rates of past year tobacco use (34.7% vs. 27.9%), daily cigarette use in the past 30 days (16.5% vs. 10.3%), and smoking at least 1 pack of cigarettes per day in the past 30 days (46.9% vs. 39.1%) than metropolitan adults.

Alcohol Use. Non-metropolitan adults had a lower prevalence rate of past year alcohol use (64.0% vs. 71.0%), past 30-day alcohol use (48.7% vs. 56.6%), and past 30-day binge drinking (24.5% vs. 26.7%) than metropolitan adults.

Illicit Drug Use. Overall illicit drug use was significantly …

Risky Substance Use Behaviors Among Adolescents Residing In Non-Metropolitan And Metropolitan Counties In The United States, 2017-2018, Tyrone F. Borders, Michael D. Singleton, Katherine Youngen

Rural & Underserved Health Research Center Publications

Overview of Key Findings

Tobacco Use. The prevalence of any past year tobacco use was significantly higher among non-metropolitan than metropolitan adolescents (13.9% vs. 8.3%). Daily cigarette use in the past 30 days was more than 3 times more prevalent among non-metropolitan than metropolitan adolescents (1.0% vs. 0.3%) and the difference was also statistically significant.

Alcohol Use. Alcohol was the most commonly used substance among both non-metropolitan and metropolitan adolescents, although the differences in prevalence rates for past year and past 30-day alcohol use were not statistically significant. In the past year, 21.8% of non-metropolitan and 21.7% of …