Archived Research Publications

Rural health research publications
not available elsewhere online.

• Medicare Fee-for-Service Health Care Expenditures Among Rural and Urban Beneficiaries During 2009-2019
  Policy Brief
  University of South Carolina Rural Health Research Center
  Date: 01/2026
  CMS Medicare Geographic Variation Public Use files, the American Community Survey, and the Area Health Resource files were the data sources for research on whether, and to what extent, rural Medicare beneficiaries used health care differently from their urban counterparts from 2009-2019.
• Rural-Urban Comparisons of Nursing Staff Turnover Among Skilled Nursing Facilities
  Policy Brief
  University of South Carolina Rural Health Research Center
  Date: 09/2025
  This study assessed facility-level turnover rates for nursing and registered nurse personnel across levels of rurality and by region.
• Access and Quality of Mental Health Services in Rural and Urban America
  Policy Brief
  University of South Carolina Rural Health Research Center
  Date: 07/2025
  Access to and quality of mental health facilities is a significant concern in the United States. This research identified disparities in mental health access and care quality by residence rurality.
• 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.
• Agricultural Health Training for Rural America
  West Virginia Rural Health Research Center
  Date: 02/2013
  This report locates agricultural health programs and courses and describes collaborations that exist between clinicians and agriculture-related agencies.
• 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.
• 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.
• 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.
• 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 (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.
• 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.
• 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.
• The Impact of Freestanding Ambulatory Surgery Centers on Rural Community Hospital Performance, 1997-2006 (Final Report)
  Upper Midwest Rural Health Research Center
  Date: 10/2010
  This policy brief describes the impact of ambulatory surgery centers on rural hospital markets.
• Key Environmental Health Competencies for Rural Primary Care Providers
  Policy Brief
  West Virginia Rural Health Research Center
  Date: 05/2010
  Providing healthcare that considers environmental determinants of health, environmental impact on health, and outcomes attributed to environmental issues is complex because of the need for providers to be competent not only in social and health sciences, but also in environmental health concepts.
• 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.
• Assessment of the Mental Health Funding Marketplace in Urban vs. Rural Settings for Individuals With Serious Mental Illness (Findings Brief)
  WICHE Center for Rural Mental Health Research
  Date: 03/2010
  This study was designed to assess the impact of rurality on the source of payment for mental health treatments and determine whether urban-rural differences in payment sources vary for the seriously mentally ill relative to all other mental health conditions.
• Assessment of the Mental Health Funding Marketplace in Rural vs. Urban Settings (Working Paper)
  WICHE Center for Rural Mental Health Research
  Date: 02/2010
  Rural residents are less likely to have mental health services funded through private insurance and more likely through public sources than urban residents, suggesting that targeting policies through public funding sources could be the most effective method to reduce urban-rural disparities in mental healthcare.
• 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.

• Rural-Urban Differences in Depression Care (Working Paper)
  WICHE Center for Rural Mental Health Research
  Date: 10/2009
  This paper assesses the association between rurality and depression care. It reports that rural individuals are more reliant on pharmacotherapy than psychotherapy.
• Differences in Prescribing Patterns of Psychotropic Medication for Children and Adolescents Between Rural and Urban Prescribers
  WICHE Center for Rural Mental Health Research
  Date: 10/2009
  This study reports that prescriptions of all psychotropic drug categories increased for urban and rural populations during the 10-year study period. Urban youth were more likely to be prescribed psychotropic medications by psychiatrists. In contrast, rural youth were more likely to have psychotropics prescribed by generalists or other prescribers.
• Distance Education Training in Behavioral Health: A Rural Primary Care Needs Assessment and Pilot Webcast
  WICHE Center for Rural Mental Health Research
  Date: 08/2009
  Primary care providers (PCPs) are often the only resource for rural/frontier residents needing mental healthcare. Mental health training is not easily accessible for PCPs working in rural settings. Distance education offers a low-cost, convenient way for PCPs to obtain the information necessary to treat the mental health needs of their patients.
• Addressing Suicide Potential and Prevention in Rural and Frontier Areas: Suicide Prevention Toolkit for Rural Primary Care Providers
  WICHE Center for Rural Mental Health Research
  Date: 08/2009
  Suicide rates in rural areas are significantly higher than they are in urban areas for men of all ages and for young women. Research shows that many people visit their primary care physician instead of a mental health provider for mental health problems. A Suicide Prevention Toolkit for rural primary care providers is provided.
• The Association Between Rural Residence and the Use, Type, and Quality of Depression Care
  Policy Brief
  WICHE Center for Rural Mental Health Research
  Date: 05/2009
  The purpose of the project was to assess the association between rurality and the use, type (pharmacotherapy versus psychotherapy), and quality of care among individuals in the Medical Expenditure Panel Survey with self-reported depression.
• Rural Adults Face Parity Problems and Other Barriers to Appropriate Mental Health Care
  Maine Rural Health Research Center
  Date: 11/2008
  The findings of this policy brief suggest that a multi-level approach is essential for meeting the mental health service needs of rural residents.
• Rural Inpatient Psychiatric Units Improve Access to Community-Based Mental Health Services, but Medicare Payment Policy a Barrier
  Maine Rural Health Research Center
  Date: 08/2007
  This study investigates the characteristics/admission processes of inpatient psychiatric units (IPUs) in rural hospitals with less than 50 beds and the community-based services available to them when discharging patients. Reasons for developing IPUs, barriers to opening and operating a rural IPU, and factors leading some to close are also explored.
• Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas (Final Report)
  Upper Midwest Rural Health Research Center
  Date: 06/2007
  The purpose of this project was to describe rural emergency department staffing nationally and to assess the potential implications of staffing for the quality of emergency care provided in rural areas.
• Preventing Hospitalizations in Depressed Rural Primary Care Patients
  WICHE Center for Rural Mental Health Research
  Date: 05/2007
  This study investigated the substitution of higher cost hospitalization for lower cost outpatient specialty care for depression and the extent to which insurance barriers impact service substitution patterns of outpatient specialty care for depression in rural and urban areas.
• Implementation of Pay-for-Performance in Rural Hospitals: Lessons From the Hospital Quality Incentive Demonstration Project
  Policy Brief
  Upper Midwest Rural Health Research Center
  Date: 11/2006
  This paper provides an overview of findings of a national study to identify institutional, organizational, and environmental factors that influence the experience of rural hospitals in the Hospital Quality Incentive Demonstration project.
• Implementation of Pay-for-Performance in Rural Hospitals: Lessons From the Hospital Quality Incentive Demonstration Project (Full Report)
  Upper Midwest Rural Health Research Center
  Date: 09/2006
  This report shares the findings of a national study designed to identify institutional, organizational, and environmental factors that influence the experience of rural hospitals in the Hospital Quality Incentive Demonstration Project.
• 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 Health Research in Progress in the Rural Health Research Centers Program, 10th Edition
  Maine Rural Health Research Center
  Date: 02/2006
  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 and provides a context for legislation that affects rural health services and populations.
• Mental Health and Rural America: 1994-2005
  WICHE Center for Rural Mental Health Research
  Date: 2006
  This report provides a summary of the current knowledge base surrounding mental health issues in America's rural and frontier areas and an overview of the environment of mental health in rural areas over three decades.
• Smallest Rural Hospitals Treat Mental Health Emergencies
  Maine Rural Health Research Center
  Date: 2006
  This research and policy brief discusses the extent to which rural emergency rooms encounter and treat mental health patients.
• Out-of-Pocket Health Care Spending and the Rural Underinsured
  Maine Rural Health Research Center
  Date: 12/2005
  This paper reports the results of a study to identify whether and to what extent there are rural-urban differences in underinsured rates among the privately insured, and, where differences exist, to understand what characteristics of rural residents are related to their likelihood of being underinsured.
• Community-Level Risk Factors for Depression Hospitalizations
  Policy Brief
  WICHE Center for Rural Mental Health Research
  Date: 09/2005
  This policy brief examines the association between depression hospitalization rates and community-level socio-demographic, economic, and healthcare system characteristics.
• Differential Effectiveness of Enhanced Depression Treatment for Rural and Urban Primary Care Patients
  WICHE Center for Rural Mental Health Research
  Date: 09/2005
  This paper explored whether a depression disease management program has a comparable impact on clinical outcomes over two years in patients treated in rural and urban primary care practices.
• Rural Health Research in Progress in the Rural Health Research Centers Program, 9th Edition
  Maine Rural Health Research Center
  Date: 02/2005
  This book provides policymakers 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 that affects rural health services and populations.
• 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.
• Obesity Prevalence in Rural Counties: A National Study
  WWAMI Rural Health Research Center
  Date: 01/2004
  Using a telephone survey of adults ages 18 and older residing in states participating in the Behavioral Risk Factor Surveillance System in 1994-96 and 2000-01, researchers found that the prevalence of obesity was 23% for rural adults and 20.5% for urban adults.
• Financially Distressed Rural Hospitals in Four States
  NORC Walsh Center for Rural Health Analysis
  Date: 01/2004
  The effect of the outpatient prospective payment system on the financial performance of rural hospitals was simulated in four states: Iowa, Texas, Washington, and West Virginia.
• Rural Health Research in Progress in the Rural Health Research Centers Program, 7th edition
  Maine Rural Health Research Center
  Date: 03/2003
  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.
• State of the Health Workforce in Rural America: Profiles and Comparisons
  WWAMI Rural Health Research Center
  Date: 01/2003
  This publication provides an overview of rural healthcare workforce issues. National and state-by-state data on the healthcare workforce, with rural-urban comparisons and interstate comparisons, are included, along with data on rural healthcare facilities.
• Federal Funding for Emergency Medical Services
  NORC Walsh Center for Rural Health Analysis
  Date: 07/2002
  This report includes recent trend data from 1994 to the present on aggregate federal spending on emergency medical services (EMS) and funding targeted explicitly to rural areas. It also discusses the role various federal agencies have played and traces the history of federal legislation to support EMS programs.
• State Licensure Laws and the Mental Health Professions: Implications for the Rural Mental Health Workforce
  Maine Rural Health Research Center
  Date: 05/2002
  This paper investigates whether and the extent to which licensure laws that determine the permissible scope of practice for each of these professions may affect the availability of mental health services, particularly in rural communities.
• Rural Research Focus: Rural Physician Shortages
  WWAMI Rural Health Research Center
  Date: 05/2002
  This paper discusses a model for understanding how many physicians a rural community can support, based on research at the WWAMI Rural Health Research Center.
• The Role of Community Mental Health Centers as Rural Safety Net Providers
  Maine Rural Health Research Center
  Date: 05/2002
  This paper investigates the extent to which those organizations formerly designated as community mental health centers currently act as a rural mental health safety net, e.g., provide mental health services for free or at reduced charges to rural populations not covered by public or private insurance or grants.
• Variance in the Profitability of Small-Town Rural Hospitals (Full Report)
  NORC Walsh Center for Rural Health Analysis
  Date: 02/2002
  This report documents the variance in profitability among small-town rural hospitals and evaluates the characteristics that distinguish highly profitable small-town hospitals from struggling ones. It also reports on strategies that small-town hospital administrators are using to achieve financial success.
• Diabetes and the Rural Safety Net
  Maine Rural Health Research Center
  Date: 01/2002
  This paper investigates the extent to which the rural safety net is able to meet the needs of people with diabetes.
• Patterns of Health Insurance Coverage Among Rural and Urban Children
  Maine Rural Health Research Center
  Date: 11/2001
  This study assesses differences in the patterns of insurance coverage and uninsured spells among rural and urban children in 20 states. It also examines the implications of those differences for the design and implementation of public insurance programs.
• Addressing Mental Health Workforce Needs in Underserved Rural Areas: Accomplishments and Challenges
  Maine Rural Health Research Center
  Date: 10/2001
  This study reviews efforts to address mental health workforce needs in rural areas and addresses the questions: How is workforce adequacy measured? How do characteristics of communities and the mental health service delivery system challenge methods for determining workforce adequacy? What role has government played in addressing workforce needs?
• Medicaid Managed Behavioral Health Programs in Rural Areas
  Policy Brief
  Maine Rural Health Research Center
  Date: 08/2001
  This research and policy brief studies which states have implemented Medicaid-managed behavioral health programs in rural areas. It describes the programs in terms of Medicaid populations served, program design, and implementation model and the experience of programs regarding access to/coordination of services.
• Admission Severity and Mortality Rates Among Rural and Urban Nursing Facility Residents With Dementia
  Maine Rural Health Research Center
  Date: 03/2001
  This study assesses whether the potentially higher utilization of nursing facility services in rural communities can be attributed to differences in use patterns by older adults with dementia. Specifically, it examines whether rural residents with dementia are less impaired when admitted to a nursing facility than their urban counterparts.
• Medicaid Managed Behavioral Health in Rural Areas
  Maine Rural Health Research Center
  Date: 01/2001
  This study of which states have implemented Medicaid managed behavioral health (MMBH) programs in rural areas describes these programs in terms of Medicaid populations served, program design, and implementation model. It also describes the experience of programs regarding access to and coordination of services.
• The Association Between Rural Residence and the Use, Type, and Quality of Depression Care (Final Paper)
  WICHE Center for Rural Mental Health Research
  Rural individuals are more reliant on pharmacotherapy than psychotherapy, which may be a concern if this is due to poor access to psychotherapy rather than a preference for antidepressants.
• Assessment of the Mental Health Funding Marketplace in Urban vs. Rural Settings (Summary Brief)
  WICHE Center for Rural Mental Health Research
  Data from the National Comorbidity Survey Replication show that rural individuals with mental health problems are significantly less likely to receive mental health services than individuals in urban and suburban areas.