Maine Rural Health Research Center

Research Products & Journal Articles

Browse the full list of research publications from this Rural Health Research Center.

Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.

Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.



  • Acuity Differences Among Newly Admitted Older Residents in Rural and Urban Nursing Homes
    Date: 11/2020
    This study found newly admitted residents of rural nursing homes were more likely to have cognitive issues/problem behaviors than those in urban facilities. Yet rural facilities admitted less complex older (age 75+) residents than urban, raising questions about the rural long-term services and supports system and capacity of rural nursing homes.
  • Substance Use Among Rural and Urban Youth and Young Adults
    Policy Brief
    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.
  • Rural-Urban Residence and Mortality Among Three Cohorts of U.S. Adults
    Policy Brief
    Date: 05/2020
    Rural residents have a shorter life expectancy than urban residents. We analyzed national linked survey and death certificate data and found risk of death was 10% higher for rural than urban residents and has increased over time. Findings suggest the overall mortality penalty in rural areas may be partly driven by social determinants of health.
  • Health Care Use and Access Among Rural and Urban Nonelderly Adult Medicare Beneficiaries
    Policy Brief
    Date: 01/2020
    Little is known about the characteristics and healthcare use of rural residents with disabilities. This study compares access to and use of health services among rural and urban nonelderly Medicare beneficiaries with a disability and the factors associated with rural access issues.


  • Rural Health Clinic Costs and Medicare Reimbursement
    Policy Brief
    Date: 11/2019
    We used cost report data to examine Rural Health Clinic (RHC) services costs. The findings support the National Advisory Committee on Rural Health & Human Service's conclusion that the cost-based methodology used to determine Medicare reimbursement for RHCs is outdated and RHCs subject to the reimbursement cap are paid less than their costs.
  • Preventive Health Service Use Among Rural Women
    Policy Brief
    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
    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.
  • Long-Term Services and Supports Use Among Older Medicare Beneficiaries in Rural and Urban Areas
    Date: 01/2019
    Analyzing the Medicare Current Beneficiary Survey, authors from the Maine Rural Health Research Center found that compared to their urban counterparts, rural Medicare beneficiaries had higher odds of nursing home use after controlling for beneficiary characteristics and contextual factors including nursing home bed supply.






  • High Deductible Health Insurance Plans in Rural Areas
    Date: 05/2014
    Using the 2007-2010 National Health Interview Survey, this study examines rural residents' enrollment in high deductible health plans and the implications for evolving Affordable Care Act Health Insurance Marketplaces.
  • Implications of Rurality and Psychiatric Status for Diabetic Preventive Care Use Among Adults with Diabetes
    Policy Brief
    Date: 05/2014
    This brief examines patterns of diabetic preventive care use among adults with diabetes to determine whether these patterns vary according to respondents' rural/urban residence or the presence/absence of a mental health diagnosis.
  • Integrated Care Management in Rural Communities
    Date: 05/2014
    This study reviews the opportunities and challenges reform initiatives under the Affordable Care Act present for rural communities. The study assesses four types of organizational models for delivering integrated care management. Each model has different strengths and drawbacks, weighing for and against implementation in rural areas.
  • Profile of Rural Residential Care Facilities: A Chartbook
    Date: 05/2014
    This chartbook offers information on part of the rural long-term services and supports (LTSS) continuum—the residential care facility (RCF). Survey results identify national/regional differences between rural and urban RCFs, focusing on facilities, resident and service characteristics of RCFs, and the ability to meet the LTSS needs of residents.
  • Health Insurance Coverage of Low-Income Rural Children Increases and is More Continuous Following CHIP Implementation
    Policy Brief
    Date: 03/2014
    This study found that following the Children's Health Insurance Program's (CHIP) implementation, health insurance coverage and continuity increased among low-income children, particularly for those living in rural areas. By CHIP's maturity, coverage for rural children improved so much that their uninsured rate dropped below that of urban children.
  • Meaningful Use of the Electronic Health Records by Rural Health Clinics
    Date: 02/2014
    This paper identifies the rates of electronic health record adoption among a random national sample of rural health clinics (RHCs) and the extent to which RHCs that have adopted an EHR are likely to achieve Stage 1 meaningful use.






  • Availability, Characteristics, and Role of Detoxification Services in Rural Areas
    Date: 12/2009
    Few detox providers (n=235) serve rural America; 82% of rural residents live in a county without a detox provider. More than half of all rural detox providers serve patients across a 100-mile radius, making travel distances a barrier to outpatient care. Referral options to substance abuse treatment are limited, especially in isolated rural areas.
  • Few and Far Away: Detoxification Services in Rural Areas (Research & Policy Brief)
    Date: 12/2009
    This policy brief finds that few rural detox providers exist; 82% of rural residents live in a county without a detox provider. More than half of all rural detox providers serve a 100-mile radius. Travel distances are a barrier to outpatient detox models. Referral options to substance abuse treatment are limited, especially in isolated rural areas.
  • Mental Health Services in Rural Jails (Policy Brief)
    Policy Brief
    Date: 09/2009
    The prevalence of mental illness among prison and jail inmates has attracted increasing attention in both mental health and criminal justice circles.
  • Health Insurance Profile Indicates Need to Expand Coverage in Rural Areas (Policy Brief)
    Date: 07/2009
    This brief provides information on the health insurance status of rural Americans, summarized from a more detailed chartbook. Analyses are based on the 2004-05 Medical Expenditure Panel Survey.
  • Profile of Rural Health Insurance Coverage: A Chartbook
    Date: 06/2009
    Analyses of persons under age 65 from the 2004-05 Medical Expenditure Panel Survey reveal a greater proportion of rural vs. urban residents who are uninsured or covered through public sources. Uninsured rates are highest among adults over age 50 in the most remote rural places.
  • Rural-Urban Differences in Health Care Access Vary Across Measures
    Date: 06/2009
    Higher uninsured rates and workforce shortages in rural areas suggest that rural residents face greater barriers to accessing healthcare than their urban counterparts. Analysis of the 2006 Medical Expenditure Panel Survey found mixed results.
  • Private Health Insurance in Rural Areas: Challenges and Opportunities
    Policy Brief
    Date: 04/2009
    This brief discusses the challenges of expanding private coverage in rural areas and describes policy options to address them.
  • Rural Coverage Gaps Decline Following Public Health Insurance Expansions
    Policy Brief
    Date: 02/2009
    This brief uses the Medical Expenditure Panel Survey (MEPS) to compare the health insurance coverage of rural/urban residents in 1997 and 2005 to assess how uninsured rates and sources of coverage have changed since SCHIP was enacted. The authors also discuss characteristics of the rural uninsured and the implications for health insurance reform.
  • Rural Children Don't Receive the Mental Health Care They Need
    Policy Brief
    Date: 01/2009
    Controlling for other characteristics that affect access to care, rural children are 20% less likely to have a mental health visit than urban children. Having Medicaid or SCHIP increases the likelihood that a child will receive services, and this is pronounced in rural areas.