Rural Health
Research Gateway

Mariana Story Tuttle, MPH

University of Minnesota Rural Health Research Center

Phone: 612.626.8401
Email: tuttl090@umn.edu
X: @story_tuttle

Division of Health Policy and Management
University of Minnesota
2221 University Ave. SE, Suite 350
Minneapolis, MN 55414

Current Projects - (4)

  • Extent and Coverage of Rural PACE Services
    Supporting independent living and aging in place for rural residents is more important than ever. This project will provide information on the extent and coverage of rural Program of All-Inclusive Care for the Elderly (PACE) programs, along with insights into the unique challenges and opportunities faced by PACE programs operating in rural areas.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Aging, Disabilities, Health disparities and health equity, Healthcare access, Home health, Social determinants of health
  • Geographic and Socio-Demographic Correlates of Medical Debt Among Rural Residents
    Medical debt is widespread and impacts financial well-being and access to care. While research suggests that medical debt is higher among rural residents compared to urban residents, more work is needed to conclusively demonstrate rural/urban differences in medical debt and within-rural risk factors for greater medical debt by geography and socio-demographic characteristics.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health disparities and health equity, Healthcare access, Poverty, Public health, Rural statistics and demographics, Social determinants of health
  • Housing as a Social Determinant of Rural Health
    The purpose of this project is to identify rural/urban and within-rural differences in housing quality and its relationship to health and disability status, especially for individuals living in poverty. We will also identify rural-specific housing issues and innovative policy solutions to address housing challenges in order to improve rural health.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Disabilities, Environmental and agricultural health, Health disparities and health equity, Poverty, Public health, Rural statistics and demographics, Social determinants of health
  • Postpartum Morbidity and Mortality and Health Care Utilization in Rural vs. Urban Communities
    Using 2006-2018 data from the National Health Interview Survey linked to the National Death Index through 2019, this project will examine postpartum mortality among rural and urban residents. We will also evaluate differences in health, health care utilization, and barriers to care across rural and urban communities.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health disparities and health equity, Healthcare access, Maternal health, Medicaid and CHIP, Mental and behavioral health, Private health insurance, Social determinants of health, Uninsured and underinsured, Women

Completed Projects - (6)

  • Evaluating the Rural Health Network Development Planning Grant Program
    This project identified factors that facilitate and impede success of Rural Health Network Development grantees, based on discussions with grantees from the 2019 cohort and surveys of prior grantees dating back more than 10 years, as well as with technical assistance providers.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health services, Healthcare access, Healthcare financing, Networking and collaboration, Public health, Quality
  • Evaluating the Rural HIV/AIDS Planning Grant Program
    The Rural HIV/AIDS Planning Grant program is administered by the Federal Office of Rural Health Policy to plan and develop healthcare networks designed to address HIV/AIDS prevention and treatment in states disproportionately impacted by the virus. This project identified factors that facilitate and impede success of such planning efforts.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Care management, Chronic diseases and conditions, Health disparities and health equity, Healthcare access, Minority health, Networking and collaboration
  • Improving Racial Equity for Rural Mothers and Infants
    The purpose of this project was to assess differences in maternal and infant health outcomes and access to perinatal care, among urban and rural counties. We also compared health outcomes and availability of services, including evidence-based services and supports, between rural counties that are majority Black, Indigenous, and People of Color with those that are majority white.
    Research center: University of Minnesota Rural Health Research Center
    Topics: American Indians and Alaska Natives, Critical Access Hospitals (CAHs), Health disparities and health equity, Healthcare access, Hospitals and clinics, Maternal health, Minority health, Rural statistics and demographics, Social determinants of health, Women
  • Rural/Urban Differences in Health and Health Care Access for LGBT Adults
    The purpose of this project was to identify rural/urban differences in health and health care access for lesbian, gay, bisexual, and transgender (LGBT) adults. We also identified within-rural differences among LGBT adults by race, ethnicity, age, disability status, and socio-economic status. Finally, we identified examples of best practices supporting LGBT health and wellness in rural areas.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Aging, Cancer, Disabilities, Health disparities and health equity, Healthcare access, Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ+), Mental and behavioral health, Minority health, Poverty, Rural statistics and demographics, Social determinants of health
  • Rural/Urban Differences in Postpartum Health Insurance, Healthcare Use, and Health Outcomes
    The purpose of this project was to identify rural/urban differences in health insurance, healthcare use, and health outcomes among postpartum individuals, and to describe policy-relevant implications or strategies to improve insurance coverage, receipt of recommended healthcare, and, ultimately, health outcomes among rural residents who give birth. With a lens towards health equity, all analyses were stratified by race/ethnicity and income.
    Research center: University of Minnesota Rural Health Research Center
    Topics: American Indians and Alaska Natives, Health disparities and health equity, Healthcare access, Healthcare financing, Hispanics, Hospitals and clinics, Legislation and regulation, Maternal health, Medicaid and CHIP, Minority health, Private health insurance, Women
  • Safe Obstetric Care Access for All Rural Residents: Minimum Standards for Clinical, Workforce, and Financial Viability of Rural Obstetric Units
    The goal of this project was to analyze data from rural hospitals to understand the criteria by which hospitals and communities assess their need and capacity for obstetric care access in rural counties and to describe effective ways to operationalize minimum standards for clinical safety and financial viability for rural obstetric units.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Health disparities and health equity, Healthcare access, Hospitals and clinics, Maternal health, Women, Workforce

Publications - (37)

2023

  • Key Informant Perspectives on Rural Housing and Health
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2023
    In this policy brief, using content analysis of interview data, researchers share rural-specific housing barriers, including those that are related to health, as well as policy recommendations for addressing housing challenges to improve rural health.
  • Differences in Residential Stability by Rural/Urban Location and Socio-Demographic Characteristics
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 08/2023
    This policy brief identifies rural/urban differences in residential stability and examines rural/urban differences in regional, socio-demographic, and health characteristics associated with living in the same home for more than 20 years.
  • Eight Postpartum Support Programs in Rural Communities Across the United States
    University of Minnesota Rural Health Research Center
    Date: 08/2023
    This case study series highlights locally focused organizations working to improve postpartum health for rural residents across the United States. Interviews were conducted with eight unique organizations working in their local rural communities to support postpartum health.
  • Two National-Level Organizations Supporting Rural Postpartum Health Across the United States
    University of Minnesota Rural Health Research Center
    Date: 07/2023
    The purpose of this case study series is to highlight national-level organizations working in innovative ways to improve postpartum health for rural residents across the United States. These may serve as examples to others considering this work.
  • Crowded Housing and Housing Cost Burden by Disability, Race, Ethnicity, and Rural-Urban Location
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 03/2023
    Housing is closely tied to health outcomes and well-being; however, little research examines housing factors by location. In this policy brief, we examine rates of crowded housing and housing cost burden by rural-urban location, as well as at the intersections of race, ethnicity, and disability status.
  • Indicators of Familial Social Support by Rurality and Gender Identity
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 03/2023
    Social and emotional support from family significantly contributes to positive health outcomes. Understanding how familial social support differs for those with overlapping marginalized identities is critical to advance population health and health equity. This brief examines differences in familial social support by rurality and gender identity.
  • Rural School- and Community-Based Programs Supporting LGBTQ+ Youth
    University of Minnesota Rural Health Research Center
    Date: 02/2023
    The purpose of this case series is to highlight youth-focused and school- and community-based organizations that affirm and support LGBTQ+ individuals in their rural communities. These may serve as examples to others considering this work.

2022

2021

2020

  • Emergency Obstetric Training Needed in Rural Hospitals Without Obstetric Units
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2020
    This policy brief discusses the types of training identified by respondents and how those trainings may or may not meet the needs of those managing emergency obstetric situations in rural communities.
  • Local Capacity for Emergency Births in Rural Hospitals Without Obstetrics Services
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 11/2020
    As increasing numbers of rural hospitals stop offering maternity care, limited information is available about local preparedness to address obstetric emergencies. This paper explores the capacity to treat obstetric emergencies encountered among rural hospitals without obstetric units.
  • Obstetric Emergencies in Rural Hospitals: Challenges and Opportunities
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 09/2020
    The purpose of this policy brief is to describe the challenges rural hospitals face in providing emergency obstetric care and to highlight resources that could help rural hospitals more safely respond to obstetric emergencies.
  • Characteristics of U.S. Rural Hospitals by Obstetric Service Availability, 2017
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 08/2020
    This study described characteristics of rural U.S. hospitals by whether they provide labor and delivery care for pregnant patients. Researchers used the 2017 American Hospital Association Annual Survey to identify rural hospitals and detail their characteristics based on whether they provide obstetric services.
  • Rural-Urban Differences Among Older Adults
    Chartbook
    University of Minnesota Rural Health Research Center
    Date: 08/2020
    This chartbook presents the characteristics of older adults in rural counties, as well as rural-urban differences among older adults, across four domains: demographics, socioeconomic characteristics, healthcare access and use, and health characteristics.
  • Changes in Hospital-Based Obstetric Services in Rural U.S. Counties, 2014-2018
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 07/2020
    In 2014, 54% of rural U.S. counties had no hospital-based obstetric services, following a steady decrease during the previous decade. Loss of rural maternity care is tied to adverse maternal and infant health outcomes. This study shares hospital-based obstetric service losses in rural U.S. counties from 2014 to 2018.
  • Loss of Hospital-Based Obstetric Services in Rural Counties in the United States, 2004-2018
    University of Minnesota Rural Health Research Center
    Date: 07/2020
    The purpose of this infographic is to show the loss of hospital-based obstetric services from 2004-2018 and how this differs by county type (micropolitan vs. noncore).
  • Supporting the Health and Wellbeing of Middle-Aged Adults Living Alone in Rural Counties
    University of Minnesota Rural Health Research Center
    Date: 06/2020
    This report shares insights from healthcare providers in 14 rural counties with the highest rates of middle-aged adults living alone in order to inform policy and practice in how best to support the health and well-being of this demographic.
  • Rates of Living Alone by Rurality and Age
    University of Minnesota Rural Health Research Center
    Date: 04/2020
    In this infographic, we identify rates of living alone for all adults and within specific age groups using two classifications of rurality.

2019

  • Access to Specialty Care for Medicare Beneficiaries in Rural Communities
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 12/2019
    Access to care is a challenge in many rural communities for both primary care services and specialty care services. We present findings from an online survey of Rural Health Clinics describing access issues for rural Medicare beneficiaries in seeking care from specialty care providers.