Jennifer Lenardson, MHS

Maine Rural Health Research Center

Phone: 207.228.8399
Fax: 207.228.8138
Email: jennifer.lenardson@maine.edu

University of Southern Maine
PO Box 9300
34 Bedford Street
Portland, ME 04104-9300


Completed Projects - (3)

  • Access to Mental Health Services and Family Burden of Rural Children with Significant Mental Health Problems
    The needs of rural children with SED and the burden these needs place on their families are intertwined and may place these rural children and their families at "double jeopardy" of having their mental health and other needs go unmet. Using the National Survey of Children with Special Health Care Needs (NS-CSHCN) and information on community characteristics from the Area Resource File (ARF) we will examine the factors associated with whether children and their families have their needs meet across the rural continuum.
    Research center: Maine Rural Health Research Center
    Topics: Children, Mental health
  • Availability, Characteristics, and Role of Detoxification Services in Rural Areas
    This project will produce a comprehensive description of the distribution and characteristics of detoxification (detox) services across rural areas including a discussion of access issues, the role of detox services within local systems of care, barriers to the delivery of detox services by rural providers, and policy and regulatory incentives needed to encourage the development of rural detox services. Products will include a working paper and related journal articles addressing these topics.
    Research center: Maine Rural Health Research Center
    Topic: Substance abuse
  • Catastrophic Consequences: The Rise of Opioid Abuse in Rural Communities
    This project will analyze national data on the prevalence of opioids in rural and urban settings as well as describe state and local efforts to promote prevention and access to treatment.
    Research center: Maine Rural Health Research Center
    Topic: Substance abuse

Publications - (21)

  • Access to Mental Health Services and Family Impact of Rural Children with Mental Health Problems
    Maine Rural Health Research Center
    Date: 10/2010
    Mental health problems have considerable impact on children and their families and some of these impacts are higher in rural than urban areas. Rural children are slightly but significantly more likely to have a mental health problem than urban children, are more likely to have a behavioral difficulty, and are more likely to be usually or always affected by their condition. Compared to urban children, rural children are more likely to go without access to all parent-reported needed mental health services and their families spend more time coordinating their care.
  • Adolescent Alcohol Use: Do Risk and Protective Factors Explain Rural-Urban Differences? (Policy Brief)
    Maine Rural Health Research Center
    Date: 03/2012
    After controlling for a broad range of key risk and protective factors, it is clear that an unexplained rural effect persists with rural adolescents still exhibiting higher alcohol use than their urban counterparts
  • Adolescent Alcohol Use: Do Risk and Protective Factors Explain Rural-Urban Differences? (Working Paper)
    Maine Rural Health Research Center
    Date: 03/2012
    Rural adolescent alcohol use is a complex social problem. Using data from the 2008-2009 National Survey of Drug Use and Health, this study by the Maine Rural Health Research Center examines alcohol use among rural and urban adolescents between the ages of 12 and 17. After controlling for a broad range of key risk and protective factors, it is clear that an unexplained rural effect persists with rural adolescents still exhibiting higher alcohol use than their urban counterparts. Our findings suggest that rural adolescents who start drinking at an earlier age are more likely to engage in problem drinking behavior as they get older, leading to a need for interventions that target pre-teens and younger adolescents. Moreover, we found urban-rural differences in specific protective factors, which may be the most promising for evidence-based, rural-specific prevention strategies targeting parents, schools, and churches.
  • Availability, Characteristics, and Role of Detoxification Services in Rural Areas
    Maine Rural Health Research Center
    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. Analyses are based on a 2008 survey of rural detox facilities conducted by the Maine Rural Health Research Center.
  • Distribution of Substance Abuse Treatment Facilities Across the Rural - Urban Continuum
    Maine Rural Health Research Center
    Date: 10/2007
    Considering recent growth in substance abuse among rural populations and the documented scarcity of rural health resources, this study examines the distribution of substance abuse treatment services across the continuum of rural and urban counties, identifying the type and intensity of services provided. Using the 2004 National Survey of Substance Abuse Treatment Services linked to the 2003 Rural-Urban Continuum Codes, we found few substance abuse treatment facilities operating outside of urban and rural adjacent areas and limited availability of intensive services across rural areas. This situation is particularly striking for opioid treatment programs, which are nearly absent in rural areas. The narrow range of services available in rural areas may preclude an individualized treatment approach and long-term follow-up recommended by professional organizations and other experts. The greater proportion of rural-based facilities accepting public payers and providing discounted care may reflect higher rates of uninsurance and underinsurance.
  • Distribution of Substance Abuse Treatment Facilities Across the Rural - Urban Continuum (Research & Policy Brief No. 35B)
    Maine Rural Health Research Center
    Date: 02/2008
    This Research & Policy Brief highlights findings from a recent study examining the distribution of substance abuse treatment facilities in rural and urban counties and identifying the type and intensity of services provided. Key findings include:
    • Access to substance abuse treatment is limited in rural areas by fewer treatment beds.
    • Less populated rural areas contain a small proportion of facilities offering a range of core services and varying levels of outpatient and intensive services.
    • Opioid treatment programs are nearly absent in rural areas.
  • Few and Far Away: Detoxification Services in Rural Areas (Research & Policy Brief)
    Maine Rural Health Research Center
    Date: 12/2009
    Based on Working Paper #41: Availability, Characteristics, and Role of Detoxification Services in Rural Areas. Findings: 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.
  • Health Care Access and Use Among the Rural Uninsured
    Maine Rural Health Research Center
    Date: 08/2012
    Examines whether uninsured rural residents have different patterns of healthcare use than their urban counterparts, and the factors associated with any differences.
  • Health Care Access and Use Among the Rural Uninsured (Policy Brief)
    Maine Rural Health Research Center
    Date: 11/2011
    Using data from the 2002-2007 Medical Expenditure Panel Survey (MEPS), this study examined access to care and service use among non-elderly, uninsured rural and urban residents. Key Findings include:
    • Uninsured residents of both rural and urban areas face serious barriers to care compared to those with health insurance coverage.
    • The rural uninsured are more likely to have a usual source of care and to have used ambulatory care in the past year than the urban uninsured.
    • Insured or not, rural residents have difficulty accessing after hours care and traveling to see their usual provider
  • Health Insurance Profile Indicates Need to Expand Coverage in Rural Areas (Policy Brief)
    Maine Rural Health Research Center
    Date: 07/2009
    Rural residents-particularly in the most remote rural communities-are in greater need of health reform, as demonstrated by an uninsured rate higher than that of urban residents. The rural-urban disparity in coverage is driven by higher uninsured rates among rural adults, a group that should be part of any strategic effort to improve coverage. 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.
  • High Deductible Health Insurance Plans in Rural Areas
    Maine Rural Health Research Center
    Date: 05/2014

    Enrollment in high deductible health plans (HDHPs) has increased amid concerns about growing healthcare costs to patients, employers, and insurers. Prior research indicates that rural individuals are more likely than their urban counterparts to face high out-of-pocket healthcare costs relative to income, despite coverage through private health insurance, a difference related both to the lower income of rural residents generally and to the quality of the private plans through which they have coverage. Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in HDHPs and the implications for evolving Affordable Care Act Health Insurance Marketplaces.

    Rural residents with private insurance are more likely to have an HDHP than are urban, especially when they live in remote, rural areas. Among those covered by an HDHP, rural residents are more likely to have low incomes and more limited educational attainment than urban residents, suggesting that it will be important to monitor HDHP enrollment, plan affordability, and health plan literacy among plans available through the Health Insurance Marketplaces.

  • Implications of Rurality and Psychiatric Status for Diabetic Preventive Care Use among Adults with Diabetes
    Policy Brief
    Maine Rural Health Research Center
    Date: 05/2014
    Examines patterns of diabetic preventive care use among adults with diabetes to determine whether these patterns vary according to respondents’ rural/urban residence or psychiatric status (i.e. the presence/absence of a mental health diagnosis).
  • Knowledge of Health Insurance Concepts and the Affordable Care Act among Rural Residents
    Policy Brief
    Maine Rural Health Research Center
    Date: 07/2017
    Health insurance literacy is central to identifying eligibility for coverage and subsidies, choosing a plan, and using optimal healthcare services. This study examined rural-urban differences in knowledge and/or use of the Affordable Care Act Marketplaces; subsidies; the health insurance mandate; and health insurance terms and concepts.
  • Mental Health Problems Have Considerable Impact on Rural Children and their Families (Policy Brief)
    Maine Rural Health Research Center
    Date: 10/2010
    Mental health problems have considerable impact on children and their families and some of these impacts are higher in rural than urban areas. Rural children are slightly but significantly more likely to have a mental health problem than urban children, are more likely to have a behavioral difficulty, and are more likely to be usually or always affected by their condition. Compared to urban children, rural children are more likely to go without access to all parent-reported needed mental health services and their families spend more time coordinating their care. This policy brief provides information on prevalence of children's mental health needs and associated access to care and family impact across rural and urban areas. Analyses are based on the 2005-06 National Survey of Children with Special Health Care Needs.
  • Patterns of Care for Rural and Urban Children with Mental Health Problems
    Maine Rural Health Research Center
    Date: 06/2013
    Reports that rural children are significantly less likely to be diagnosed and treated for non-ADHD mental health problems than urban children and are less likely to receive mental health counseling.
  • Profile of Rural Health Insurance Coverage: A Chartbook
    Maine Rural Health Research Center
    Date: 06/2009
    As the nation considers whether and how to reform the healthcare system, it is important to consider differences in health insurance coverage for those living in rural and urban areas. Analyses of persons under age 65 from the 2004-05 Medical Expenditure Panel Survey reveal a greater proportion of rural residents than urban residents who are uninsured or covered through public sources, especially among those living in remote areas. Rural adults are at high risk of being uninsured compared to rural children. Uninsured rates are highest among adults over age 50 in the most remote rural places. Compared to urban adults, rural adults are less likely to be in employment situations where private coverage is offered.
  • Profile of Rural Residential Care Facilities: A Chartbook
    Chartbook
    Maine Rural Health Research Center
    Date: 05/2014

    As federal and state policymakers consider their most cost-effective options for strengthening rural long-term services and supports (LTSS), more information is needed about the current system of care. Using data from the 2010 National Survey of Residential Care Facilities, this chartbook presents information on a slice of the rural LTSS continuum—the rural residential care facility (RCF). Survey results identify important national and regional differences between rural and urban RCFs, focusing on the facility, resident and service characteristics of RCFs and their ability to meet the LTSS needs of residents. Rural RCFs are more likely to have private pay patients compared to urban facilities and their residents have fewer disabilities as measured by their functional assistance needs. Compared to urban facilities, the policies of rural RCFs appear less likely to support aging-in-place.

  • The Role of Public versus Private Health Insurance in Ensuring Health Care Access & Affordability for Low-Income Rural Children
    Policy Brief
    Maine Rural Health Research Center
    Date: 01/2017
    Medicaid and CHIP have played a critical role in ensuring access to health coverage among children –particularly rural children. This study examines rural-urban differences in children’s access to care, and their families’ perceived affordability of that care among those enrolled in Medicaid or CHIP, and those with private insurance plans.
  • Rural Children Don't Receive the Mental Health Care They Need (Policy Brief)
    Maine Rural Health Research Center
    Date: 01/2009
    Just over one-third of all children with a mental health problem received a mental health visit in the past year. 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.
  • Rural Opioid Abuse: Prevalence and User Characteristics
    Policy Brief
    Maine Rural Health Research Center
    Date: 02/2016
    Opioid abuse is the fastest growing substance abuse problem in the nation and the primary cause of unintentional drug overdose deaths. This study examined the rural-urban prevalence of non-medical use of pain relievers and heroin in the past year and the socio-economic characteristics associated with their use and other risky behavior.
  • Rural-Urban Differences in Health Care Access Vary Across Measures
    Maine Rural Health Research Center
    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. Rural residents were more likely than urban residents to have a usual source of healthcare (USC), particularly among the uninsured. Despite this, rural adults were somewhat less likely to receive certain preventive care services compared to urban adults. Additionally, rural residents were somewhat more likely to report long travel times to reach their USC and greater difficulty in reaching their provider after hours.