 CRITICAL CONCEPTS FOR REACHING POPULATIONS AT RISK 
Rural Definitions for Health Policy and Research
The term “rural” suggests
many things to many people,
such as agricultural land-
scapes, isolation, small towns,
and low population density.
However, defining “rural”
for health policy and research
purposes requires research-
ers and policy analysts to
specify which aspects of ru-
rality are most relevant to the
topic at hand and then select
an appropriate definition.
Rural and urban taxonomies
often do not discuss impor-
tant demographic, cultural,
and economic differences
across rural places—differ-
ences that have major im-
plications for policy and
research. Factors such as ge-
ographic scale and region
also must be considered.
Several useful rural tax-
onomies are discussed and
compared in this article. Care-
ful attention to the definition
of “rural” is required for ef-
fectively targeting policy and
research aimed at improving
the health of rural Americans.
(Am J Public Health. 2005;95:
1149–1155. doi:10.2105/AJPH.
2004.042432)
July 2005, Vol 95, No. 7 | American Journal of Public Health
| L. Gary Hart, PhD, Eric H. Larson, PhD, and Denise M. Lishner, MSW
THE UNITED STATES HAS
evolved from a rural agricultural
society to a society dominated by
its urban population. Depending
on which definition is used,
roughly 20% of the US popula-
tion resides within rural areas.
Approximately three fourths of
the nation’s counties are rural, as
is 75% of its landmass. While the
rural population is in the minor-
ity, it is the size of France’s total
(rural and urban) population.
As important as the rural pop-
ulation and its resources are to
the nation, there is considerable
confusion as to exactly what rural
means and where rural popula-
tions reside. We will discuss
defining rural and why it is im-
portant to do so in the context of
health care policy and research.
WHAT DOES RURAL LOOK
LIKE?
Although many policymakers,
researchers, and policy analysts
would prefer one standardized,
all-purpose definition, “rural” is
a multifaceted concept about
which there is no universal
agreement. Defining rurality can
be elusive and frequently relies
on stereotypes and personal ex-
Hart et al. | Peer Reviewed | Critical Concepts for Reaching Populations at Risk | 1149
periences. The term suggests pas-
toral landscapes, unique demo-
graphic structures and settlement
patterns, isolation, low popula-
tion density, extractive economic
activities, and distinct sociocultu-
ral milieus. But these aspects of
rurality fail to completely define
“rural.” For example, rural cul-
tures can exist in urban places.1
Only a small fraction of the rural
population is involved in farm-
ing, and towns range from tens
of thousands to a handful of resi-
dents. The proximity of rural
areas to urban cores and services
may range from a few miles to
hundreds of miles. Generations
of rural sociologists, demogra-
phers, and geographers have
struggled with these concepts.2,3
Despite the theoretical limita-
tions of the concept of rurality, it
is very useful as a practical ana-
lytic and policy tool. Common
definitions of rurality are the
basis for many policy decisions,
including criteria for the alloca-
tion of the nation’s limited re-
sources. It is important to specify
which aspects of rurality are rele-
vant to the phenomenon being
examined and then use a defini-
tion that captures those elements.
Only by defining “rural” appropri-
ately to the situation at hand can
we discern differences in health
care concerns and outcomes
across rural areas and between
rural and urban locales. The defi-
nition of rurality used for one
purpose may be inappropriate or
inadequate for another.1
WHEN IS RURAL NOT SO
RURAL?
Rural and urban taxonomies,
researchers, policy analysts, and
legislation generally view all rural
areas as uniform in character.
However, there are, in fact, huge
variations in the demography,
economics, culture, and environ-
mental characteristics of different
rural places. Large rural towns
that are not too distant from
larger metropolitan areas often
have more in common with met-
ropolitan areas than they do with
remote and isolated small towns.
By treating these diverse types of
rural cities and towns and the
problems they confront similarly,
policy analysts may fail to iden-
tify each site’s distinct health care
concerns and effective methods
for resolving those problems. Ac-
cess to medical specialists and
surgical services is a case in point.
  CRITICAL CONCEPTS FOR REACHING POPULATIONS AT RISK 
The absence of certain services
in a small place is expected. The
lack of such services in a larger
rural place might be construed
as a critical provider shortage.
A small rural town’s population
base may only support 1 or 2
generalist physicians and a nurse
practitioner or physician assistant.
A larger rural town, whose geo-
graphic service area may include
the small town, may serve as a re-
gional center for accessing spe-
cialists and surgeons. Health plan-
ning, recruitment and retention,
and identifying and optimizing
the supply and mix of providers
are going to be different in each
place.1,4
HOW IS RURAL
DIFFERENT?
On average, rural populations
have relatively more elderly peo-
ple and children, higher unem-
ployment and underemployment
rates, and lower population den-
sity with higher percentages of
poor, uninsured, and underin-
sured residents. Rural populations
are more vulnerable than their
urban counterparts to economic
downturns because of their con-
centrated economic specializa-
tion. Other unique circumstances
include longer travel distances to—
and higher costs associated with—
needed health care services; disec-
onomies of scale; high rates of
fixed overhead per-patient rev-
enue; fewer health care providers
and a greater emphasis on gener-
alists; health care facilities with
limited scopes of service; econom-
ically fragile hospitals with high
closure rates; greater dependency
on Medicare and Medicaid reim-
bursement; higher rates of chronic
diseases; and different clinical
practice behaviors, practice
arrangements, and reimbursement
levels.5–8 Hong and Kindig9 found
1150 | Critical Concepts for Reaching Populations at Risk | Peer Reviewed | Hart et al.
that residents of counties with
larger numbers of workers who
commute out of the county and
who travel more than 30 minutes
each way to reach their care pro-
viders received substantially lower
levels of health resources. Access
to proximate services for care
often makes the difference be-
tween life and death.10
The environment in which
rural physicians and other provid-
ers practice also differs enor-
mously both across rural areas
and between rural and urban
areas.11–13 Physicians who practice
in smaller and more remote rural
towns practice in a medical care
delivery system characterized by
financially vulnerable medical or-
ganizations, small populations,
long distances to specialists and
tertiary hospitals, longer practice
hours, lack of collegial support,
limited access to advanced tech-
nologies, and relatively high fixed
costs per delivered service. This
milieu creates especially difficult
circumstances for rural providers
and populations.14 Rural physician
practice concerns—patient pri-
vacy, clinical adaptations in the
absence of nearby specialists, gen-
eralist scarcities, quality assurance
programs, compliance with the
Health Insurance Portability and
Accountability Act of 1996 regu-
lations, and continuing medical
education—are different from
those of their large city contempo-
raries, differences that have a po-
tential impact on health out-
comes. For example, studies have
shown substantial differences be-
tween rural and urban physicians
in clinical prenatal and intra-
partum practice styles for similar
low-risk patients, without appar-
ent differences in outcome,15 and
that physician attitudes regarding
physician-assisted suicide vary
dramatically by rural or urban
practice location and practitioner
gender.16 While there are many
common threads between urban
clinical medicine and its rural
cousin, there are many substan-
tive differences.7,8,17,18
HOW DO ACCURATE
DEFINITIONS HELP?
The federal government defines
“rural” in a variety of ways. The
Office of Management and Bud-
get’s (OMB) definition of metro-
politan and nonmetropolitan pop-
ulations and the Census Bureau’s
definition of rural and urban fail
to identify the same populations
as rural. When the 2 definitions
were cross-tabulated for the 2000
census, 72% of the population
was classified as both metropolitan
(OMB definition) and urban (Cen-
sus Bureau definition), while 10%
was classified as nonmetropolitan
and rural (Figure 1). However,
nearly 18% of the nation’s popula-
tion was divided between the 2
taxonomies: 11% were metropoli-
tan but rural, and 7% were non-
metropolitan but urban. Depend-
ing on how the categories are
combined, the rural population
can vary from 10% to 28% of the
nation’s total (i.e., a population of
29–79 million). Research findings
and policies may appear to con-
flict when those findings and poli-
cies are based on different rural
definitions and populations. The
use of noncongruent definitions
of rural may result in markedly
different conclusions and policy
implications.
Another problem associated
with defining “rural” is that con-
ventional definitions use a single
rural classification and thereby
fail to differentiate categories of
rurality. Rural areas are not ho-
mogeneous across the nation,
and aggregating rural areas of
differing sizes and levels of re-
moteness may obscure emerging
American Journal of Public Health | July 2005, Vol 95, No. 7
problems at the local level. As a
result, policies may fail to include
appropriate intrarural targeting.
Rural and urban taxonomies
have usually been developed
based on population size, density,
proximity, degree of urbaniza-
tion, adjacency and relationship
to a metropolitan area, principal
economic activity, economic and
trade relationships, and work
commutes. An appropriate
rural and urban taxonomy
should (1) measure something
explicit and meaningful; (2) be
replicable; (3) be derived from
available, high-quality data; (4) be
quantifiable and not subjective, and
(5) have on-the-ground validity.
To some extent, all definitions
will either underbound or over-
bound rurality. Some large coun-
ties, for example, have large
cities and less densely settled
areas that may be considered
rural in terms of economic activi-
ties, landscape, and service level.
However, because of the pres-
ence of a large urban core the
entire county is often considered
urban. In this case, “rural” is
being underbounded—areas that
might reasonably be called rural
are actually being classified as
urban. At the same time, “urban”
is being overbounded. A certain
amount of overbounding and un-
derbounding is inherent to any
definition of rurality; the re-
searcher must simply be aware
of this problem when evaluating
data across the rural and urban
dimension.1(p15)
Because numerous taxonomies
have been used to categorize the
rural/urban continuum, we ex-
amined the 4 that are most often
applied (Table 1).
OMB Metropolitan and
Nonmetropolitan Taxonomy
The federal government most
frequently uses the county-based
  CRITICAL CONCEPTS FOR REACHING POPULATIONS AT RISK 

the largest urban settlement

within the county. To qualify as
adjacent to a metropolitan
county, a nonmetropolitan county
must share a boundary with a
metropolitan county and must
meet a minimum work commut-
ing threshold.1 The UICs’ use of
the size of the largest town in a
county is as a taxonomic crite-
rion. The largest town, as used
for health care purposes, is asso-
ciated with the likelihood of local
availability of hospitals, clinics,
and specialty services. While the
codes are often used for research,
they are infrequently used in fed-
eral and state policies. In 2003,
the UICs were updated in accor-
dance with 2000 census data.

Census Bureau Rural and

Urban Taxonomy
The Census Bureau partitions
Note. “Metropolitan” and “nonmetropolitan” are Office of Management and Budget terminology; “urban” and “rural” are Census Bureau
terminology. urban areas into urbanized areas
a
n = 202 000 000. and urban clusters. The same
b
n = 30 000 000.
c census tract–based criteria are
n = 20 000 000.
d
n = 29 000 000. used for both; however, the ur-
banized areas have cores with
FIGURE 1—Comparison of metropolitan and nonmetropolitan classifications with urban and rural
populations of 50 000 or more,
classifications, by proportion of 2000 US population (N = 281 421 898): 2000 Census Bureau data.
and the urban clusters have
cores with populations that
range from 2500 to 49 999. All
OMB metropolitan and non- was measured by commuting to urban cores. The metropolitan other areas are designated as
metropolitan classifications as work. The United States has and nonmetropolitan taxonomy rural. The nation has more than
policy tools. These county-based 1090 metropolitan counties and was most recently updated in 65 000 census tracts that are
definitions are the foundation for 2052 nonmetropolitan counties 2003 in accordance with the made up of blocks and block
other, more detailed taxonomies (674 micropolitan and 1378 non- 2000 census data. groups. In 2000, 59 million resi-
and are used when determining core) that have (according to dents—21% of the US popula-
eligibility and reimbursement lev- 2002 census data) 239 million US Department of Agriculture tion—were deemed rural by the
els for more than 30 federal pro- metropolitan and 49 million non- Economic Research Service Census Bureau taxonomy. The
grams, including Medicare reim- metropolitan residents, of whom Urban Influence Codes Census Bureau’s rural and urban
bursement levels, the Medicare 29 million lived in micropolitan The Urban Influence Codes taxonomy is the source of much
Incentive Payment program, and counties and 20 million lived in (UIC) taxonomy is a county-based of the available demographic
programs designed to ameliorate noncore counties. Micropolitan definition that builds on the OMB and economic data. A weakness
provider shortages in rural areas.4 counties are those nonmetropoli- metropolitan and nonmetropoli- of this system with regard to
Metropolitan areas were de- tan counties with a rural cluster tan dichotomy. Counties are clas- health care policy is the paucity
fined in 2003 as central counties with a population of 10 000 or sified into 9 groups: 2 metropoli- of health-related data at the cen-
with 1 or more urbanized areas more. Noncore counties are the tan and 7 nonmetropolitan. The sus tract level. The Census Bu-
(cities with a population greater residual. The most significant nonmetropolitan counties are reau and others often aggregate
than or equal to 50 000) and problem with this taxonomy is grouped according to their adja- urban clusters with urbanized-
outlying counties that are eco- that county boundaries both cency and nonadjacency to met- area data. Depending on the
nomically tied to the core, which overbound and underbound their ropolitan counties and the size of purpose at hand, this may be

July 2005, Vol 95, No. 7 | American Journal of Public Health Hart et al. | Peer Reviewed | Critical Concepts for Reaching Populations at Risk | 1151
  CRITICAL CONCEPTS FOR REACHING POPULATIONS AT RISK 
TABLE 1—Comparison of Commonly Applied Rural Taxonomiesa
Geographical Unit Characteristics
OMB Metropolitan/ County This OMB definition is used extensively in federal
Nonmetropolitan policy. Significant 2003 update with 2000
census data. Counties are assigned as
metropolitan (n = 1090) or nonmetropolitan
(n = 2052). Nonmetropolitan counties are
now designated as micropolitan or noncore
based on the presence of an urban cluster
(areas with a population less than 50 000
but greater than 2500 people) with a
population of 10 000 or more.
In 2000, 17.4% of the US population
resided in nonmetropolitan counties.
ERS Urban Influence County Metropolitan counties are grouped into 2
Codes categories based on size of urban
population. Nonmetropolitan counties
are grouped into 7 categories based on
size of largest city in county and adjacency/
nonadjacency to a metropolitan county.
Updated with significant changes associated
with the OMB metropolitan/nonmetropolitan
definition changes in 2003 on the basis of
2000 census data.
Census Bureau Rural Census tract Census Bureau definition of rurality based on
and Urban census tracts. Rural census tracts are
those outside of urbanized areas and
clusters with populations of 2500 or
greater that do not have substantial
commuting
In 2000, 21% of the US population lived
in rural areas.
RUCA Census tract Multitiered taxonomy developed by University
of Washington and the Economic Research
Service, with funding from the Federal
Office of Rural Health Policy and the
Economic Research Service. Uses census
commuting data to classify census tracts
on the basis of geography and work
commuting flows between places.
Updated in spring 2005 with 2000 census data.
RUCA–zip code US Postal Multitiered system developed by University of
approximation Service zip Washington, with funding from the Office
code areas of Rural Health Policy. Census work
commuting data are used to classify census
tracts on the basis of geography and work
commuting activity between places.
Approximates the census tract RUCA codes
for 2000 zip codes.
Updated in spring 2005 with 2000 census data
and 2004 zip codes.
Source. aAdapted from Larson and Hart.1
Note. OMB = Office of Management and Budget; RUCA = Rural–Urban Commuting Area.
1152 | Critical Concepts for Reaching Populations at Risk | Peer Reviewed | Hart et al.
Strengths
Useful for a general definition of rural status.
The methodology and county assignments
were significantly changed in 2003.
Underlying geographic unit (county) is
very stable over time.
Use of largest city criterion, which differentiates
counties with several small towns from
those with 1 or 2 large towns for grouping
nonmetropolitan counties, may be better
than RUCA method for suggesting level
of locally available services. Adjacency
criteria may be suggestive of degree of
economic integration with metropolitan
county.
Helps reduce problems of underbounding
and overbounding associated with
county-based terminology.
Use of work commuting data strongly
differentiates rural areas according to
their economic integration with urban
areas and other rural areas. Very sensitive
to demographic change. The structure of
the codes allows for many levels of
generalization—from 2 groups (rural and
urban) to 33.
Use of commuting data strongly differentiates
rural areas according to their economic
integration with urban areas and other rural
areas. Very sensitive to demographic
change. The structure of the codes allows
for many levels of generalization—from 2
groups (rural/urban) to 33. Use of the zip
code unit makes them useful with a wide
variety of data collected at that level,
including health data.
American Journal of Public Health | July 2005, Vol 95, No. 7
Weaknesses
Substantial underbounding of rurality in
many large metropolitan counties.
The large size of counties often
obscures intracounty differences.
Overbounding and underbounding occurs
just as in OMB metropolitan and
nonmetropolitan categories. Does not
differentiate metropolitan counties
as well as does RUCA. The large size
of counties often obscures intracounty
differences.
Data other than census data are infrequently
collected by census tract. Difficult to
apply to health data that are often
collected at the county or zip code
area levels. Lack of familiarity of most
data users with census tract geography
and terminology. Not stable across
census years—there were substantial
changes for the 2000 census.
Difficult to apply to health data
that are often collected at the
county or zip code area levels.
Will not be stable over time.
Complex structure of codes not
easy to master for casual users.
Complex structure of codes is not easy
to master for casual users. The
underlying geographic unit is
subject to some change by the
US Postal Service across time.
  CRITICAL CONCEPTS FOR REACHING POPULATIONS AT RISK 
misleading for rural health
policymakers. For example, a
town with a population of 3000
in a very remote area is consid-
ered urban under the Census
Bureau definition, but that same
town is often nonmetropolitan
under the OMB definition.
Rural/Urban Commuting-Area
Taxonomy
A recently developed taxon-
omy uses census tract–level de-
mographic and work-commuting
data to define 33 categories of
rural and urban census tracts.19
The Rural–Urban Commuting
Areas (RUCAs) were developed
and are maintained by the Uni-
versity of Washington Rural
Health Research Center and the
USDA Economic Research Ser-
vice (ERS), with the support of
the federal Health Resource
and Service Administration’s
Office of Rural Health Policy
and the ERS. (For more infor-
mation about RUCAs, see
http://www.fammed.washington.
edu/wwamirhrc and http://
www.ers.usda.gov.)
The RUCA categories are
based on the size of settlements
and towns as delineated by the
Census Bureau and the functional
relationships between places as
measured by tract-level work-
commuting data. For example, a
small town where the majority of
commuting is to a large city is
distinguished from a similarly
sized town where there is com-
muting connectivity primarily to
other small towns. Because 33
categories can be unwieldy, the
codes were designed to be aggre-
gated in various ways that high-
light different aspects of connec-
tivity, rural and urban settlement,
and isolation, aspects that facili-
tate better program intervention
targeting. The census tract ver-
sion of the RUCAs has been sup-
July 2005, Vol 95, No. 7 | American Journal of Public Health
plemented by a zip code–based
version. There are more than
30 000 zip code areas.
RUCAs range from the core
areas of urbanized areas to iso-
lated small rural places, where
the population is less than 2500
and where there is no meaning-
ful work commuting to urban-
ized areas. While the zip code
version of the RUCAs is slightly
less precise than the census tract
version, the RUCA zip codes
have an advantage in the health
field because they can be used
with zip code health-related data.
The RUCAs are widely used for
policy and research purposes
(e.g., by the Centers for Medicare
and Medicaid Services and many
researchers). RUCAs can identify
the rural portions of metropolitan
counties and the urban portions
of nonmetropolitan counties.
RUCAs are flexible and can be
grouped in many ways to suit par-
ticular analytic or policy purposes.
For example, there is a tool that
provides the road mileage and the
travel time along the fastest route
between each zip code area and
the nearest edge of a core in an
urbanized area and the closest
large rural city. When this tool is
used with the RUCA codes, users
can identify highly isolated “fron-
tier” areas—counties with 6 or
fewer persons per square mile—in
a more precise manner than with
previous definitions. The RUCA
taxonomy was updated in the
spring of 2005.
Other Taxonomies
Common taxonomies that
have been designed for related
purposes include (1) ERS’s
Rural–Urban Continuum Codes,
(2) ERS’s Economic Typology of
Nonmetropolitan Counties, and
(3) frontier areas, which is a
crude measure at best. The term
“frontier” is a problematic term
Hart et al. | Peer Reviewed | Critical Concepts for Reaching Populations at Risk | 1153
for research purposes, because it
has a very different meaning for
demographers and geogra-
phers.20 There also are many
rural and urban definitions de-
veloped by the states for various
geographic scales. For an intro-
duction to older rural and urban
taxonomies, see Hewitt.21 Other
taxonomies that lend themselves
to use with the rural and urban
taxonomies include the new
county-based amenity index.22
Other schemes regionalize
the nation or individual states for
diverse uses, for example, ambu-
latory care utilization via the
national Primary Care Service
Areas.23 The federal government
has used taxonomies and mea-
sures to allocate resources to
rural and urban areas. In these
schemes, factors such as physi-
cian-to-population ratios, infant
mortality rate, poverty, and resi-
dent age are used to rate geo-
graphic units (combinations of
counties, census tracts, facilities,
populations, etc.) and to delin-
eate those places and populations
most in need of federal health
care resources. These methods
(e.g., Health Professional Short-
age Areas) have significant flaws,
and efforts are being made to
substantially revise them.
How Have OMB and Census
Bureau Methodologies
Changed After the 2000
Census?
Despite the common assump-
tion that Census Bureau and
OMB methodologies change little
between decennial censuses,
about a quarter of the census
tract boundaries changed be-
tween the 1990 and 2000 cen-
suses, and the number of coun-
ties designated as metropolitan
by OMB in 2003 based on
2000 census data increased by
27%. Many of these changes
have important policy conse-
quences. For example, research-
ers and analysts who examine
data across years, when different
definitions were in place, need to
be aware of these changes and
adjust result analyses and inter-
pretations accordingly. (For more
detailed information about meth-
odological changes in the Census,
see the US Census Bureau and
ERS Web sites at http://www.
census.gov and http://www.ers.
usda.gov, and see Slifkin,
Randolph, and Ricketts.24–26 )
While it is beyond the scope of
this article to describe all of the
concerns associated with new
methodologies, 2 are most
noteworthy.
1. There is some confusion about
a new OMB metropolitan and
nonmetropolitan taxonomy
category: micropolitan—an
urban cluster with a popula-
tion that ranges from 10 000
to 49 999. While some of the
designation criteria have un-
dergone subtle changes, the
micropolitan counties have
historically been designated as
nonmetropolitan. Unfortu-
nately, the term micropolitan
has led some to think of these
counties as being urban or
metropolitan in nature. How-
ever, changing the terminol-
ogy does not make these
counties any more or any less
rural and urban than they
were before—historically rural,
albeit larger rural towns/cities.
Micropolitan counties could
just as well have been titled
macrorural or large rural
counties. A general problem
with the creation of so many
taxonomies is that they take
on a life of their own and are
often used without consider-
ing the suitability or meaning
of the category.27
  CRITICAL CONCEPTS FOR REACHING POPULATIONS AT RISK 
2. The 2003 update of the met-
ropolitan and nonmetropolitan
taxonomy resulted in a net
gain of 253 counties in the
metropolitan ranks (now
1090 counties). This also re-
sulted in a net loss of 7.3 mil-
lion residents who would have
been counted, in accordance
with the older definition, as
nonmetropolitan. Whether or
not the rural population is
shrinking depends on how the
question is asked. As rural
counties and cities grow, they
are designated as being met-
ropolitan and urban. Thus, be-
cause these rural populations
are no longer counted as non-
metropolitan or rural, it ap-
pears that the nation’s rural
population is shrinking or
stagnant. However, according
to Dr Calvin Beale (senior de-
mographer, ERS), if the 1993
nonmetropolitan definition is
held constant, the overall pop-
ulation change between 1990
and 2000 shows an 11% in-
crease compared with a 13%
increase for the nation (writ-
ten communication, March
2004). Nevertheless, some
rural areas are experiencing
population loss.28
GEOGRAPHIC SCALE AND
DATA AVAILABILITY
Another problem associated
with rural health research in-
volves the geographical level of
available data. Typical units used
for the collection of health and
demographic data include states,
counties, municipalities, census
tracts, and zip codes. The county
is a convenient and frequently
used unit of analysis, and many
health-related data are collected
at this level. However, the large
geographic size of counties, and
the failure to distinguish between
1154 | Critical Concepts for Reaching Populations at Risk | Peer Reviewed | Hart et al.
the demographic and economic
heterogeneity that often exists
within counties, can weaken the
meaningfulness of policy analy-
ses. Both the strengths and weak-
nesses of any given definition are
strongly rooted in the underlying
geographic unit used in the defi-
nition.1 As already noted, some
degree of overbounding and un-
derbounding is inherent in any
definition of rurality. It is impor-
tant to consider which way the
“error” goes when evaluating data
and policy.1 The more mixing of
diverse groups within units of anal-
ysis, the more difficult it is to show
real differences between groups.
Rural data from federal surveil-
lance systems and surveys are ex-
tremely limited,18 and funds for
rural surveys are scarce, both of
which impede rural health re-
search and policy analysis. Better
rural health research methods
and tools are needed to produce
meaningful findings. Substantial
progress has been made recently
in data procurement and methods
because of focused funding from
the Health Resource and Service
Administration’s Office of Rural
Health Policy, the Bureau of
Health Professions, and the Bu-
reau of Primary Health Care. To
maximize the utility of these new
methods, they must be widely
disseminated to state offices of
rural health, primary care officers,
and researchers and analysts.29–31
WHY ARE DIFFERENTIATED
LEVELS OF RURALITY NOT
GENERALLY USED?
Federal and state policies tend
to treat rural areas as a single en-
tity for several reasons. First, the
political process often requires
that a significant coalition be
formed to pass rural-related legis-
lation, and it is more expedient
to lump than to divide. Second,
policymakers and legislators
often do not understand rural
variability and diversity or the
methods for making these dis-
tinctions. Third, self-interest often
prevails, wherein people advo-
cate greater selectivity and more
effective targeting as long as they
do not lose anything in the pro-
cess—regardless of what they
may also gain. Finally, in some
cases the availability of data at
different geographic scales dic-
tates the geographic unit that is
used in policies.
WHY SHOULD WE CARE?
Definitions of rural are the
basis for targeting resources to
underserved rural populations.
If the only outcome of clarifying
the definition were an improved
mechanism for funneling health
care to where it is needed most,
the clarification would be well
worth the effort. Because there
are 50 to 60 million rural resi-
dents in the nation, decisions
about resource use have signifi-
cant ramifications in terms of
the dollars spent and the well-
being of rural populations. Inap-
propriate definitions may bias
research findings and policy
analyses and may result in dif-
ferent conclusions than those
that are based on another unit
of analysis (often called the
modifiable unit problem).32 The
more we aggregate different
types of rural areas, the less we
can pinpoint localized health
care and delivery problems at
the state, region, county, town,
or zip code levels.
We examined the 2000 Amer-
ican Medical Association Master-
file data on the nation’s physi-
cian distribution and found that
the most remote UIC subgroup
of counties had a generalist
physician–to-population ratio of
American Journal of Public Health | July 2005, Vol 95, No. 7
46.4 per 100 000 population.
When we examined these same
data with the census tract version
of the RUCA taxonomy, we
found a much lower ratio of
38.5 per 100 000 population—
17% lower. For resource alloca-
tion purposes, where money is
spent is clearly influenced by
how that locale is defined. A re-
cent study of acute myocardial in-
farction that used zip code–based
RUCAs10 found substantial rural
and urban and intrarural differ-
ences in the use of needed initial
hospital services, where a previ-
ous county-based study found lit-
tle difference.33 (For a compre-
hensive explanation of the policy
consequences of rural definitions,
see Hewitt.21) Health care re-
searchers focus great attention
and time on statistical methodolo-
gies; however, geographical meth-
odologies are often neglected.34
Expert geographic consultation
should be sought when determin-
ing the most appropriate geo-
graphical unit and rural definition
to use in a given analysis.
CONCLUSIONS
Deciding which rural defini-
tion to apply to an area depends
on the purpose at hand, the
availability of data, and the ap-
propriate and available taxon-
omy. There is no perfect rural
definition that meets all pur-
poses. Researchers must be de-
liberate and insightful when
defining rural and when apply-
ing the appropriate definition
and its associated taxonomy to
program targeting, intervention,
and research. It is recommended
that researchers familiarize
themselves with various rural
definitions and geographic meth-
odologies and then carefully
weigh the pros and cons of
available definitions. Defining
  CRITICAL CONCEPTS FOR REACHING POPULATIONS AT RISK 
rural and urban must be a meth-
odological priority at the start
of any project that examines
health-related concerns associ-
ated with the rural and urban
dimension. Grappling early and
systematically with the problems
of defining rurality will signifi-
cantly enhance the validity and
the utility of health research
work, which is essential in rural-
focused health research.
About the Authors
The authors are with the WWAMI Rural
Health Research Center, Department of
Family Medicine, University of Washing-
ton, Seattle, Wash.
Requests for reprints should be sent to
L. Gary Hart, PhD, WWAMI Rural
Health Research Center, Department of
Family Medicine, University of Washing-
ton, Box 354982, Seattle, WA,
98195–4982 (e-mail: garyhart@
u.washington.edu).
This article was accepted September 9,
2004.
Contributors
L. G. Hart originated the study and was
the principal writer. E. H. Larson helped
develop the study and wrote and edited
portions of the article. D. M. Lishner ed-
ited the article.
Human Participant Protection
No protocol approval was needed for
this study.
References
1. Larson EH, Hart LG. Rural health
workforce methods and analysis. In:
Larson EH, Johnson KE, Norris TE, et al.,
eds. State of the Health Workforce in
Rural America: State Profiles and Com-
parisons. Seattle, Wash: WWAMI Rural
Health Research Center, University of
Washington; 2003:15–22.
2. Miller MK, Luloff AE. Who is
rural? A typological approach to the
examination of rurality. Rural Sociol.
1981;46:608–625.
3. Miller KM, Farmer FL, Clarke LL.
Rural populations and their health. In:
Beaulieu JE, Berry DE, eds. Rural
Health Services: A Management Perspec-
tive. Ann Arbor, Mich: AUPHA Press/
Health Administration Press; 1994:
3–26.
4. Council on Graduate Medical Edu-
cation. Tenth Report: Physician Distribu-
July 2005, Vol 95, No. 7 | American Journal of Public Health
tion and Health Care Challenges in Rural
and Inner-City Areas. Washington, DC:
Government Printing Office; 1998.
5. Hassenger EW, Hobbs DJ. Rural
society—the environment of rural health
care. In: Straub LA, Walzer N, eds.
Rural Health Care: Innovation in a
Changing Environment. Westport, Conn:
Praeger; 1992:178–190.
6. Ricketts TC III. The rural patient.
In: Geyman JP, Norris TE, Hart LG, eds.
Textbook of Rural Medicine. New York,
NY: McGraw-Hill; 2001:15–26.
7. Geyman JP, Norris TE, Hart LG.
Textbook of Rural Medicine. New York,
NY: McGraw-Hill; 2001.
8. Loue S, Quill BE. Handbook of
Rural Health. New York, NY: Kluwer
Academic/Plenum Publishers; 2001.
9. Hong W, Kindig DA. The relation-
ship between commuting patterns and
health resources in nonmetropolitan
counties of the United States. Med Care.
1992;30:1154–1158.
10. Baldwin L-M, MacLehose RF,
Hart LG, Beaver SK, Every N, Chan L.
Quality of care for acute myocardial in-
farction in rural and urban US hospitals.
J Rural Health. 2004;20:99–108.
11. Ricketts TC III, Johnson-Webb KD,
Randolph RK. Populations and places in
rural America. In: Ricketts TC III, ed.
Rural Health in the United States. New
York, NY: Oxford University Press;
1999.
12. Fuguitt GV, Brown DL, Beale CL.
Rural and Small Town America. New
York, NY: Russell Sage Foundation;
1989.
13. Hart JF. The Rural Landscape. Balti-
more, MD: John Hopkins University
Press; 1998.
14. Rosenblatt RA. The health of rural
people and the communities and envi-
ronments in which they live. In: Gey-
man JP, Norris TE, Hart LG, eds. Text-
book of Rural Medicine. New York, NY:
McGraw-Hill; 2001:3–14.
15. Hart LG, Dobi.e., SA, Baldwin LM,
Pirani MJ, Fordyce M, Rosenblatt RA.
Rural and urban differences in physi-
cian resource use for low-risk obstetrics.
Health Serv Res. 1996;31:429–452.
16. Hart LG, Norris TE, Lishner DM.
Attitudes of family physicians in Wash-
ington State toward physician-assisted
suicide. J Rural Health. 2003;19:
461–469.
17. Yawn BP, Bushy A, Yawn RA. Ex-
ploring Rural Medicine: Current Issues
and Concepts. Thousand Oaks, Calif:
Sage Publications; 1994.
18. Ricketts TC III, ed. Rural Health in
the United States. New York, NY: Oxford
University Press; 1999.
Hart et al. | Peer Reviewed | Critical Concepts for Reaching Populations at Risk | 1155
19. Morrill R, Cronmartie J, Hart LG. Medicare in Rural America. Washington,
Metropolitan, urban, and rural commut- DC: Medicare Payment Advisory Com-
ing areas: toward a better depiction of mission; 2001.
the US settlement system. Urban Geog-
34. Thomas R. Geomedical Systems: In-
raphy. 1999;20:727–748. tervention and Control. London, UK:
20. Popper DE, Lang RE, Popper FJ. Routledge; 1992.
From maps to myth: the census, Turner,
and the idea of the frontier. J Am Comp
Cult. 2000;Spring:91–102.
21. Hewitt M. Defining “Rural” Areas:
Impact on Health Care Policy and Re-
search. Washington, DC: US Govern-
ment Printing Office; 1989. US Office
of Technology Assessment Staff Paper.
22. McGranahan DA. Natural Ameni-
ties Drive Rural Population Change.
Washington, DC: Economic Research
Service, US Department of Agriculture;
1999. Agricultural Economic Report
No. 781.
23. Goodman DC, Mick SS, Bott D, et al.
Primary care service areas: a new tool
for the evaluation of primary care ser-
vices. Health Serv Res. 2003;38(1 Pt 1):
287–309.
24. Slifkin RT, Randolph R, Ricketts TC.
The changing metropolitan designation
process and rural America. J Rural
Health. 2004;20:1–6.
25. US Census Bureau. Census Bu-
reau Home Page. Available at: http://
www.census.gov. Accessed June 25,
2004.
26. Economic Research Service. Eco-
nomic Research Service—USDA. Avail-
able at: http://www.ers.usda.gov. Ac-
cessed June 25, 2004.
27. Ratcliffe MR. Creating metropoli-
tan and micropolitan statistical areas.
Paper presented at: American Sociologi-
cal Association Annual Meeting; August
19, 2002; Chicago, Ill.
28. McGranahan DA, Beale CL. Un-
derstanding rural population loss. Rural
Am. 2002;17:2–11.
29. Ricketts TC III, Savitz LA, Gesler
WM, Osborne DN. Geographic Methods
for Health Service Research. New York,
NY: University Press of America; 1994.
30. Hart LG, Taylor P. The emergence
of federal rural policy in the United
States. In: Geyman JP, Norris TE, Hart LG,
eds. Textbook of Rural Medicine. New
York, NY: McGraw-Hill; 2001:73–90.
31. Hart LG, Salsberg E, Phillips DM,
Lishner DM. Rural health care providers
in the United States. J Rural Health.
2002;18(suppl):211–232.
32. Openshaw S, Taylor PJ. The modi-
fiable areal unit problem. In: Wrigley N,
Bennet RJ, eds. Quantitative Geography:
a British View. London, UK: Routledge
& Kegan Paul; 1981:60–69.
33. Medicare Payment Advisory Com-
mission. Report to the Congress:
This article has been cited by:

1. April Sutton, Daniel T. Lichter, Sharon Sassler. 2019. Rural–Urban Disparities in Pregnancy Intentions, Births, and Abortions
Among US Adolescent and Young Women, 1995–2017. American Journal of Public Health 109:12, 1762-1769. [Abstract] [Full
Text] [PDF] [PDF Plus] [Supplemental Material]
2. John A. Nelson, Anna Kinder, Anna Satcher Johnson, H. Irene Hall, Xiaohong Hu, Donna Sweet, Alyssa Guido, Harold Katner,
Jennifer Janelle, Maribel Gonzalez, Natalia Martínez Paz, Charlotte Ledonne, Jason Henry, Theresa Bramel, Jeanne Harris. 2018.
Differences in Selected HIV Care Continuum Outcomes Among People Residing in Rural, Urban, and Metropolitan Areas-28
US Jurisdictions. The Journal of Rural Health 34:1, 63-70. [Crossref]
3. Liora Sahar, Rentonia Williams, Arthi Rao, Kassandra I. Alcaraz, Kenneth M. Portier. 2018. Using GIS Technology to Define and
Assess a Rurality Scheme Suitable for Decision Support in Health and Patient Services. International Journal of Applied Geospatial
Research 9:3, 1-17. [Crossref]
4. Aastha Chandak, Preethy Nayar, Ge Lin. 2018. Rural-Urban Disparities in Access to Breast Cancer Screening: A Spatial Clustering
Analysis. The Journal of Rural Health 11. . [Crossref]
5. Ines Weinhold, Sebastian Gurtner. 2018. How do determinants of patient satisfaction vary under different regional conditions?
Rural-urban differences in the relative importance of primary care attributes. Social Science & Medicine . [Crossref]
6. Steven A. Cohen, Sarah K. Cook, Trisha A. Sando, Natalie J. Sabik. 2018. What Aspects of Rural Life Contribute to Rural-Urban
Health Disparities in Older Adults? Evidence From a National Survey. The Journal of Rural Health 34:3, 293-303. [Crossref]
7. Jessica G. Smith. 2018. Does Missed Care in Isolated Rural Hospitals Matter?. Western Journal of Nursing Research 40:6, 775-778.
[Crossref]
8. Ana Dal’Asta, Raquel Lana, Silvana Amaral, Cláudia Codeço, Antônio Monteiro. 2018. The Urban Gradient in Malaria-Endemic
Municipalities in Acre: Revisiting the Role of Locality. International Journal of Environmental Research and Public Health 15:6,
1254. [Crossref]
9. Nina R. Joyce, Thomas G. McGuire, Stephen J. Bartels, Susan L. Mitchell, David C. Grabowski. 2018. The Impact of Dementia
Special Care Units on Quality of Care: An Instrumental Variables Analysis. Health Services Research 10. . [Crossref]
10. Stephanie Gilbertson-White, Chi W. Yeung, Seyedehtanaz Saeidzadeh, Hannah Tykol, Praveen Vikas, Ashley Cannon. 2018.
Engaging Stakeholders in the Development of an eHealth Intervention for Cancer Symptom Management for Rural Residents.
The Journal of Rural Health 84. . [Crossref]
11. Alice Chen, Anthony T. Lo Sasso, Michael R. Richards. 2018. Supply-side effects from public insurance expansions: Evidence
from physician labor markets. Health Economics 27:4, 690-708. [Crossref]
12. A. Cepeda-Benito, N.J. Doogan, R. Redner, M.E. Roberts, A.N. Kurti, A.C. Villanti, A.A. Lopez, A.J. Quisenberry, C.A.
Stanton, D.E. Gaalema, D.R. Keith, M.A. Parker, S.T. Higgins. 2018. Trend differences in men and women in rural and urban
U.S. settings. Preventive Medicine . [Crossref]
13. Candace I. J. Nykiforuk, Kerry Coupland, Laura M. J. Nieuwendyk, Jennifer Ann McGetrick. 2018. Universal Design for the
rural walks of life: operationalizing walkability in Bonnyville, Alberta, Canada. Critical Public Health 28:2, 213-224. [Crossref]
14. Rebecca M. Cantu, Christopher M. Pruitt, Nichole Samuy, Chang L. Wu. 2018. Predictors of emergency department discharge
following pediatric drowning. The American Journal of Emergency Medicine 36:3, 446-449. [Crossref]
15. Puja van Epps, Marissa Maier, Brian Lund, Matthew Bryant Howren, Brice Beck, Lauren Beste, Avy Skolnik, Mary Vaughan-
Sarrazin, Michael E. Ohl. 2018. Medication Adherence in a Nationwide Cohort of Veterans Initiating Pre-exposure Prophylaxis
(PrEP) to Prevent HIV Infection. JAIDS Journal of Acquired Immune Deficiency Syndromes 77:3, 272-278. [Crossref]
16. Emily Jordan Jensen, Tai Mendenhall. 2018. Call to Action: Family Therapy and Rural Mental Health. Contemporary Family
Therapy 23. . [Crossref]
17. Margaret Emmet, Quinn Stein, Erin Thorpe, MaryAnn Campion. 2018. Experiences of Genetic Counselors Practicing in Rural
Areas. Journal of Genetic Counseling 27:1, 140-154. [Crossref]
18. Margaret M. Weden, Regina A. Shih, Mohammed U. Kabeto, Kenneth M. Langa. 2018. Secular Trends in Dementia and
Cognitive Impairment of U.S. Rural and Urban Older Adults. American Journal of Preventive Medicine 54:2, 164-172. [Crossref]
19. Janice C. Probst, Judith C. Barker, Alexandra Enders, Paula Gardiner. 2018. Current State of Child Health in Rural America:
How Context Shapes Children's Health. The Journal of Rural Health 34, s3-s12. [Crossref]
20. Jennifer L. Holub, Cynthia Morris, Lyle J. Fagnan, Judith R. Logan, LeAnn C. Michaels, David A. Lieberman. 2018. Quality
of Colonoscopy Performed in Rural Practice: Experience From the Clinical Outcomes Research Initiative and the Oregon Rural
Practice-Based Research Network. The Journal of Rural Health 34, s75-s83. [Crossref]
21. Daniel E. Mauck, Diana M. Sheehan, Kristopher P. Fennie, Lorene M. Maddox, Mary Jo Trepka. 2018. Role of Gay Neighborhood
Status and Other Neighborhood Factors in Racial/Ethnic Disparities in Retention in Care and Viral Load Suppression Among
Men Who Have Sex with Men, Florida, 2015. AIDS and Behavior 66. . [Crossref]
22. Jean C. McSweeney, Christina Bricker, Martha Rojo, Brittany Beasley. Regional Differences in HD in Women 335-351. [Crossref]
23. Rafid Mustafa, Jared R. Brosch, Gil D. Rabinovici, Bradford C. Dickerson, Maria C. Carrillo, Bradley S. Glazier, Sujuan Gao,
Martha Tierney, Keith N. Fargo, Mary G. Austrom, Susan De Santi, David G. Clark, Liana G. Apostolova. 2018. Patient and
Caregiver Assessment of the Benefits From the Clinical Use of Amyloid PET Imaging. Alzheimer Disease & Associated Disorders
32:1, 35-42. [Crossref]
24. Hassan Hashemi, Payam Nabovati, Abbasali Yekta, Fereshteh Shokrollahzadeh, Mehdi Khabazkhoob. 2018. The prevalence of
refractive errors among adult rural populations in Iran. Clinical and Experimental Optometry 101:1, 84-89. [Crossref]
25. Eric L. Hurwitz, Kristi Randhawa, Paola Torres, Hainan Yu, Leslie Verville, Jan Hartvigsen, Pierre Côté, Scott Haldeman. 2017.
The Global Spine Care Initiative: a systematic review of individual and community-based burden of spinal disorders in rural
populations in low- and middle-income communities. European Spine Journal 59. . [Crossref]
26. John E. Snyder, Matthew Jensen, Nguyen X. Nguyen, Clara E. Filice, Karen E. Joynt. 2017. Defining Rurality in Medicare
Administrative Data. Medical Care 55:12, e164-e169. [Crossref]
27. Carolyn McAndrews, Kirsten Beyer, Clare E Guse, Peter Layde. 2017. Are rural places less safe for motorists? Definitions of urban
and rural to understand road safety disparities. Injury Prevention 23:6, 412-415. [Crossref]
28. Suzanne Rainsford, Roderick D MacLeod, Nicholas J Glasgow, Christine B Phillips, Robert B Wiles, Donna M Wilson. 2017.
Rural end-of-life care from the experiences and perspectives of patients and family caregivers: A systematic literature review.
Palliative Medicine 31:10, 895-912. [Crossref]
29. Alvaro Taype-Rondan, Antonio Bernabe-Ortiz, Germán F. Alvarado, Robert H. Gilman, Liam Smeeth, J. Jaime Miranda. 2017.
Smoking and heavy drinking patterns in rural, urban and rural-to-urban migrants: the PERU MIGRANT Study. BMC Public
Health 17:1. . [Crossref]
30. M. Helbich, V. Blüml, T. de Jong, P. L. Plener, M.-P. Kwan, N. D. Kapusta. 2017. Urban–rural inequalities in suicide mortality:
a comparison of urbanicity indicators. International Journal of Health Geographics 16:1. . [Crossref]
31. Valerie M. Hewell, Angel R. Vasquez, Inna D. Rivkin. 2017. Systemic and individual factors in the buprenorphine treatment-
seeking process: a qualitative study. Substance Abuse Treatment, Prevention, and Policy 12:1. . [Crossref]
32. Elham Emami, Naomi Kadoch, Sara Homayounfar, Hermina Harnagea, Patrice Dupont, Nicolas Giraudeau, Rodrigo Mariño.
2017. Patient satisfaction with E-Oral Health care in rural and remote settings: a systematic review protocol. Systematic Reviews
6:1. . [Crossref]
33. N.J. Doogan, M.E. Roberts, M.E. Wewers, C.A. Stanton, D.R. Keith, D.E. Gaalema, A.N. Kurti, R. Redner, A. Cepeda-Benito,
J.Y. Bunn, A.A. Lopez, S.T. Higgins. 2017. A growing geographic disparity: Rural and urban cigarette smoking trends in the
United States. Preventive Medicine 104, 79-85. [Crossref]
34. R. Andrew Glennie, Juliet Batke, Nader Fallah, Christiana L. Cheng, Carly S. Rivers, Vanessa K. Noonan, Marcel F. Dvorak,
Charles G. Fisher, Brian K. Kwon, John T. Street. 2017. Rural and Urban Living in Persons with Spinal Cord Injury and
Comparing Environmental Barriers, Their Health, and Quality-of-Life Outcomes. Journal of Neurotrauma 34:20, 2877-2882.
[Crossref]
35. Michael Khalemsky, David G. Schwartz. 2017. Emergency Response Community Effectiveness: A simulation modeler for
comparing Emergency Medical Services with smartphone-based Samaritan response. Decision Support Systems 102, 57-68.
[Crossref]
36. Demetria N. Cain, Chloe Mirzayi, H. Jonathon Rendina, Ana Ventuneac, Christian Grov, Jeffrey T. Parsons. 2017. Mediating
Effects of Social Support and Internalized Homonegativity on the Association Between Population Density and Mental Health
Among Gay and Bisexual Men. LGBT Health 4:5, 352-359. [Crossref]
37. Sidra Goldman-Mellor, Kristina Allen, Mark S. Kaplan. 2017. Rural/Urban Disparities in Adolescent Nonfatal Suicidal Ideation
and Suicide Attempt: A Population-Based Study. Suicide and Life-Threatening Behavior 11. . [Crossref]
38. Rebecca A. Seguin, Brian K. Lo, Urshila Sriram, Leah M. Connor, Alison Totta. 2017. Development and testing of a community
audit tool to assess rural built environments: Inventories for Community Health Assessment in Rural Towns. Preventive Medicine
Reports 7, 169-175. [Crossref]
39. Stephanie B. Wheeler, Melinda M. Davis. 2017. “Taking the Bull by the Horns”: Four Principles to Align Public Health, Primary
Care, and Community Efforts to Improve Rural Cancer Control. The Journal of Rural Health 33:4, 345-349. [Crossref]
40. Babatunde Edun, Medha Iyer, Helmut Albrecht, Sharon Weissman. 2017. The South Carolina rural–urban HIV continuum of
care. AIDS Care 29:7, 817-822. [Crossref]
41. Jeffrey Peppercorn, Nora Horick, Kevin Houck, Julia Rabin, Victor Villagra, Gary H. Lyman, Stephanie B. Wheeler. 2017. Impact
of the elimination of cost sharing for mammographic breast cancer screening among rural US women: A natural experiment.
Cancer 123:13, 2506-2515. [Crossref]
42. Xinling Xu, Suzanne W. McDermott, Joshua R. Mann, James W. Hardin, Chelsea B. Deroche, Dianna D. Carroll, Elizabeth A.
Courtney-Long. 2017. A longitudinal assessment of adherence to breast and cervical cancer screening recommendations among
women with and without intellectual disability. Preventive Medicine 100, 167-172. [Crossref]
43. Mesfin Awoke Bekalu, Steven Eggermont, K. ”Vish” Viswanath. 2017. HIV/AIDS Communication Inequalities and Associated
Cognitive and Affective Outcomes: A Call for a Socioecological Approach to AIDS Communication in Sub-Saharan Africa. Health
Communication 32:6, 685-694. [Crossref]
44. Samuel D. Towne, Janice C. Probst, James W. Hardin, Bethany A. Bell, Saundra Glover. 2017. Health & access to care among
working-age lower income adults in the Great Recession: Disparities across race and ethnicity and geospatial factors. Social Science
& Medicine 182, 30-44. [Crossref]
45. Jane M. Kolodinsky, Geoffrey Battista, Erin Roche, Brian H.Y. Lee, Rachel K. Johnson. 2017. Estimating the effect of mobility
and food choice on obesity in a rural, northern environment. Journal of Transport Geography 61, 30-39. [Crossref]
46. Olubode A. Olufajo, Joel T. Adler, Heidi Yeh, Steven B. Zeliadt, Roland A. Hernandez, Stefan G. Tullius, Leah Backhus, Ali
Salim. 2017. Disparities in kidney transplantation across the United States: Does residential segregation play a role?. The American
Journal of Surgery 213:4, 656-661. [Crossref]
47. Steven A. Cohen, Sarah K. Cook, Lauren Kelley, Julia D. Foutz, Trisha A. Sando. 2017. A Closer Look at Rural-Urban Health
Disparities: Associations Between Obesity and Rurality Vary by Geospatial and Sociodemographic Factors. The Journal of Rural
Health 33:2, 167-179. [Crossref]
48. Graham T. Atkins, Taeha Kim, Jeffrey Munson. 2017. Residence in Rural Areas of the United States and Lung Cancer Mortality.
Disease Incidence, Treatment Disparities, and Stage-Specific Survival. Annals of the American Thoracic Society 14:3, 403-411.
[Crossref]
49. Leslie R. Hawley, Natalie A. Koziol, James A. Bovaird. Defining and Communicating Rural 31-54. [Crossref]
50. John S. Humphreys, Geoff Solarsh. Populations at Special Health Risk: Rural Populations 599-608. [Crossref]
51. Alan N. West, William B. Weeks, Mary E. Charlton. 2017. Differences Among States in Rural Veterans’ Use of VHA and Non-
VHA Hospitals. The Journal of Rural Health 33:1, 32-40. [Crossref]
52. Carolyn McAndrews, Kirsten Beyer, Clare E. Guse, Peter Layde. 2016. How do the definitions of urban and rural matter for
transportation safety? Re-interpreting transportation fatalities as an outcome of regional development processes. Accident Analysis
& Prevention 97, 231-241. [Crossref]
53. Elizabeth Mertz, Cynthia Wides, Alexis Cooke, Paul E. Gates. 2016. Tracking workforce diversity in dentistry: importance,
methods, and challenges. Journal of Public Health Dentistry 76:1, 38-46. [Crossref]
54. Susan Crowther, Elizabeth Smythe. 2016. Open, trusting relationships underpin safety in rural maternity a hermeneutic
phenomenology study. BMC Pregnancy and Childbirth 16:1. . [Crossref]
55. Mark W. Vander Weg, Ashley J. Cozad, M. Bryant Howren, Margaret Cretzmeyer, Melody Scherubel, Carolyn Turvey, Kathleen
M. Grant, Thad E. Abrams, David A. Katz. 2016. An individually-tailored smoking cessation intervention for rural Veterans: a
pilot randomized trial. BMC Public Health 16:1. . [Crossref]
56. Gary G. Schwartz, Marilyn G. Klug. 2016. Motor neuron disease mortality rates in U.S. states are associated with well water use.
Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration 17:7-8, 528-534. [Crossref]
57. Nathan L. Hale, Tamar Klaiman, Kate E. Beatty, Michael B. Meit. 2016. Local Health Departments as Clinical Safety Net in
Rural Communities. American Journal of Preventive Medicine 51:5, 706-713. [Crossref]
58. Yi-Chun Lin, Alyce D. Fly. 2016. USDA Fresh Fruit and Vegetable Program Is More Effective in Town and Rural Schools Than
Those in More Populated Communities. Journal of School Health 86:11, 769-777. [Crossref]
59. Debajyoti Pati, Kristi Gaines, Shabboo Valipoor. 2016. Delivering Rural Health in a Changing Health Model. HERD: Health
Environments Research & Design Journal 10:1, 76-86. [Crossref]
60. Alan N. West, Mary E. Charlton. 2016. Insured Veterans’ Use of VA and Non-VA Health Care in a Rural State. The Journal
of Rural Health 32:4, 387-396. [Crossref]
61. Leslie R. Hawley, Natalie A. Koziol, James A. Bovaird, Carina M. McCormick, Greg W. Welch, Ann M. Arthur, Kirstie Bash.
2016. Defining and Describing Rural: Implications for Rural Special Education Research and Policy. Rural Special Education
Quarterly 35:3, 3-11. [Crossref]
62. Vignesh T. Packiam, Andrew J. Cohen, Charles U. Nottingham, Joseph J. Pariser, Sarah F. Faris, Gregory T. Bales. 2016. Open Vs
Minimally Invasive Adult Ureteral Reimplantation: Analysis of 30-day Outcomes in the National Surgical Quality Improvement
Program (NSQIP) Database. Urology 94, 123-128. [Crossref]
63. Michelle C. Roughton, Paul DiEgidio, Lei Zhou, Karyn Stitzenberg, Anne Marie Meyer. 2016. Distance to a Plastic Surgeon
and Type of Insurance Plan Are Independently Predictive of Postmastectomy Breast Reconstruction. Plastic and Reconstructive
Surgery 138:2, 203e-211e. [Crossref]
64. Andre L. Rodrigues, Jocasta Ball, Chantal Ski, Simon Stewart, Melinda J. Carrington. 2016. A systematic review and meta-
analysis of primary prevention programmes to improve cardio-metabolic risk in non-urban communities. Preventive Medicine 87,
22-34. [Crossref]
65. Emily L. Mueller, Matthew Hall, Samir S. Shah, Keith J. August, Mohamed A. Radhi, Michelle L. Macy. 2016. Characteristics
of Children With Cancer Discharged or Admitted From the Emergency Department. Pediatric Blood & Cancer 63:5, 853-858.
[Crossref]
66. Emily L. Mueller, Matt Hall, Aaron E. Carroll, Samir S. Shah, Michelle L. Macy. 2016. Frequent Emergency Department
Utilizers Among Children with Cancer. Pediatric Blood & Cancer 63:5, 859-864. [Crossref]
67. Margaret M. Sugg, Charles E. Konrad, Christopher M. Fuhrmann. 2016. Relationships between maximum temperature and heat-
related illness across North Carolina, USA. International Journal of Biometeorology 60:5, 663-675. [Crossref]
68. Megan E. Roberts, Nathan J. Doogan, Allison N. Kurti, Ryan Redner, Diann E. Gaalema, Cassandra A. Stanton, Thomas J.
White, Stephen T. Higgins. 2016. Rural tobacco use across the United States: How rural and urban areas differ, broken down
by census regions and divisions. Health & Place 39, 153-159. [Crossref]
69. Michael R. Richards, Brendan Saloner, Genevieve M. Kenney, Karin V. Rhodes, Daniel Polsky. 2016. Availability of New Medicaid
Patient Appointments and the Role of Rural Health Clinics. Health Services Research 51:2, 570-591. [Crossref]
70. Dina Izenstark, Ramona F. Oswald, Elizabeth G. Holman, Shawn N. Mendez, Kimberly A. Greder. 2016. Rural, Low-Income
Mothers' Use of Family-Based Nature Activities to Promote Family Health. Journal of Leisure Research 48:2, 134-155. [Crossref]
71. Cynthia A. Garcia, Poh-Sin Yap, Hye-Youn Park, Barbara L. Weller. 2016. Association of long-term PM2.5 exposure
with mortality using different air pollution exposure models: impacts in rural and urban California. International Journal of
Environmental Health Research 26:2, 145-157. [Crossref]
72. Landon R. Mueller, John P. Donnelly, Karen E. Jacobson, Jestin N. Carlson, N. Clay Mann, Henry E. Wang. 2016. National
Characteristics of Emergency Medical Services in Frontier and Remote Areas. Prehospital Emergency Care 20:2, 191-199. [Crossref]
73. Mary Jo Trepka, Kristopher P. Fennie, Diana M. Sheehan, Theophile Niyonsenga, Spencer Lieb, Lorene M. Maddox. 2016.
Racial-ethnic differences in all-cause and HIV mortality, Florida, 2000–2011. Annals of Epidemiology 26:3, 176-182.e1. [Crossref]
74. Sanae Inagami, Shasha Gao, Hassan Karimi, Martine M. Shendge, Janice C. Probst, Roslyn A. Stone. 2016. Adapting the Index
of Relative Rurality (IRR) to Estimate Rurality at the ZIP Code Level: A Rural Classification System in Health Services Research.
The Journal of Rural Health 32:2, 219-227. [Crossref]
75. Yaewon Seo, Bernice Yates, Louise LaFramboise, Bunny Pozehl, Joseph F. Norman, Melody Hertzog. 2016. A Home-Based
Diaphragmatic Breathing Retraining in Rural Patients With Heart Failure. Western Journal of Nursing Research 38:3, 270-291.
[Crossref]
76. Summer L. Martins, Katherine A. Starr, Wendy L. Hellerstedt, Melissa L. Gilliam. 2016. Differences in Family Planning Services
by Rural-urban Geography: Survey of Title X-Supported Clinics In Great Plains and Midwestern States. Perspectives on Sexual
and Reproductive Health 48:1, 9-16. [Crossref]
77. Li Peng, Shaoquan Liu, Lian Sun. 2016. Spatial–temporal changes of rurality driven by urbanization and industrialization: A case
study of the Three Gorges Reservoir Area in Chongqing, China. Habitat International 51, 124-132. [Crossref]
78. Mary Jo Trepka, Diana M. Sheehan, Kristopher P. Fennie, Theophile Niyonsenga, Spencer Lieb, Lorene M. Maddox. 2016.
Completeness of HIV reporting on death certificates for Floridians reported with HIV infection, 2000–2011. AIDS Care 28:1,
98-103. [Crossref]
79. Sally Lawrence Bullock, Stephanie B. Jilcott Pitts, Barb Listenfelt, Jared T. McGuirt, Karen Stanley, Diane Beth, Mary Bea
Kolbe, Jill Rushing, Qiang Wu, Rachel K. Ward, Mariel Leah Mayo Acheson, Ciarra J. M. Dortche, Alice S. Ammerman.
2016. Availability of Farmers’ Markets and Supplemental Nutrition Assistance Program/Electronic Benefit Transfer Systems
and Associations With Rurality, Poverty, Race/Ethnicity, and Obesity Among North Carolina Counties. Journal of Hunger &
Environmental Nutrition 11:1, 102-121. [Crossref]
 80. Whitney E. Zahnd, Georgia S. Mueller, Amanda J. Fogleman, Wiley D. Jenkins. 2016. Intrastate Variations in Rural Cancer Risk
and Incidence. Journal of Public Health Management and Practice 22:5, 472-478. [Crossref]
81. Nicholas M. Mohr, Terrence S. Wong, Brett Faine, Adam Schlichting, Joseph Noack, Azeemuddin Ahmed. 2016. Discordance
Between Patient and Clinician Experiences and Priorities in Rural Interhospital Transfer: A Mixed Methods Study. The Journal
of Rural Health 32:1, 25-34. [Crossref]
82. Larry R. Hearld, Nathaniel W. Carroll. 2016. Interorganizational Relationship Trends of Critical Access Hospitals. The Journal
of Rural Health 32:1, 44-55. [Crossref]
83. S. Lane Slabaugh, Jonathan R. Bouchard, Yong Li, Jean C. Baltz, Yunus A. Meah, D. Chad Moretz. 2015. Characteristics Relating
to Adherence and Persistence to Basal Insulin Regimens Among Elderly Insulin-Naïve Patients with Type 2 Diabetes: Pre-Filled
Pens versus Vials/Syringes. Advances in Therapy 32:12, 1206-1221. [Crossref]
84. Anush Yousefian Hansen, M. Renée Umstattd Meyer, Jennifer D. Lenardson, David Hartley. 2015. Built Environments and
Active Living in Rural and Remote Areas: a Review of the Literature. Current Obesity Reports 4:4, 484-493. [Crossref]
85. Liang Mao, Jeanne-Marie R. Stacciarini, Rebekah Smith, Brenda Wiens. 2015. An individual-based rurality measure and its
health application: A case study of Latino immigrants in North Florida, USA. Social Science & Medicine 147, 300-308. [Crossref]
86. Samuel D. Towne, Janice C. Probst, Jordan Mitchell, Zhimin Chen. 2015. Poorer Quality Outcomes of Medicare-Certified Home
Health Care in Areas With High Levels of Native American/Alaska Native Residents. Journal of Aging and Health 27:8, 1339-1357.
[Crossref]
87. Mandy Maredza, Melanie Y Bertram, Stephen M Tollman. 2015. Disease burden of stroke in rural South Africa: an estimate of
incidence, mortality and disability adjusted life years. BMC Neurology 15:1. . [Crossref]
88. Robert J. Reid, Melissa L. Anderson, Paul A. Fishman, Jennifer B. McClure, Ron L. Johnson, Sheryl L. Catz, Beverly B. Green.
2015. Relationship between cardiovascular risk and lipid testing in one health care system: a retrospective cohort study. BMC
Health Services Research 15:1. . [Crossref]
89. Maija Toivakka, Tiina Laatikainen, Timo Kumpula, Markku Tykkyläinen. 2015. Do the classification of areas and distance
matter to the assessment results of achieving the treatment targets among type 2 diabetes patients?. International Journal of Health
Geographics 14:1. . [Crossref]
90. Steven A. Cohen, Lauren Kelley, Allison E. Bell. 2015. Spatiotemporal Discordance in Five Common Measures of Rurality for
US Counties and Applications for Health Disparities Research in Older Adults. Frontiers in Public Health 3. . [Crossref]
91. K. B. Egan, M. Suh, R. C. Rosen, A. L. Burnett, X. Ni, D. G. Wong, K. T. McVary. 2015. Rural vs. urban disparities in association
with lower urinary tract symptoms and benign prostatic hyperplasia in ageing men, NHANES 2001-2008. International Journal
of Clinical Practice 69:11, 1316-1325. [Crossref]
92. Arina Chesnokova, Benjamin French, Douglas Weibe, Deepa R. Camenga, Katherine Yun. 2015. Association between
Neighborhood-Level Smoking and Individual Smoking Risk: Maternal Smoking among Latina Women in Pennsylvania. Public
Health Reports 130:6, 672-683. [Crossref]
93. Mesfin Awoke Bekalu, Steven Eggermont. 2015. Socioeconomic and socioecological determinants of AIDS stigma and the
mediating role of AIDS knowledge and media use. Journal of Communication in Healthcare 8:4, 316-324. [Crossref]
94. Neale R. Chumbler, Samir P. Desai, Justin B. Ingels, Kevin K. Dobbin. Race and Socioeconomic Status: Public Perceptions toward
Quality and Access to Care in the Affordable Care Act 209-228. [Crossref]
95. Marica Cassarino, Annalisa Setti. 2015. Environment as ‘Brain Training’: A review of geographical and physical environmental
influences on cognitive ageing. Ageing Research Reviews 23, 167-182. [Crossref]
96. Katy B. Kozhimannil, Michelle M. Casey, Peiyin Hung, Xinxin Han, Shailendra Prasad, Ira S. Moscovice. 2015. The Rural
Obstetric Workforce in US Hospitals: Challenges and Opportunities. The Journal of Rural Health 31:4, 365-372. [Crossref]
97. Rachel J. Riesgraf, Patricia McCarthy Veach, Ian M. MacFarlane, Bonnie S. LeRoy. 2015. Perceptions and Attitudes About Genetic
Counseling Among Residents of a Midwestern Rural Area. Journal of Genetic Counseling 24:4, 565-579. [Crossref]
98. Kristi McClary King, Jiying Ling. 2015. Results of a 3-year, nutrition and physical activity intervention for children in rural, low-
socioeconomic status elementary schools. Health Education Research 30:4, 647-659. [Crossref]
99. Viktor V. Chirikov, Fadia T. Shaya, Charles D. Howell. 2015. Contextual analysis of determinants of late diagnosis of hepatitis
C virus infection in Medicare patients. Hepatology 62:1, 68-78. [Crossref]
100. Craig Anne Heflinger, Virginia Shaw, Charmaine Higa-McMillan, Laurel Lunn, Ana Maria Brannan. 2015. Patterns of Child
Mental Health Service Delivery in a Public System: Rural Children and the Role of Rural Residence. The Journal of Behavioral
Health Services & Research 42:3, 292-309. [Crossref]
101. Vishal Saundankar, Jeffrey Ellis, Elsie Allen, Tony DeLuzio, Chad Moretz, Yunus Meah, Brandon Suehs, Jonathan Bouchard.
2015. Type 2 Diabetes Mellitus Patients’ Healthcare Costs Related to Inpatient Hospitalizations: A Retrospective Administrative
Claims Database Study. Advances in Therapy 32:7, 662-679. [Crossref]
102. Jacob C. Warren, K. Bryant Smalley, K. Nikki Barefoot. 2015. Recruiting rural and urban LGBT populations online: differences
in participant characteristics between email and Craigslist approaches. Health and Technology 5:2, 103-114. [Crossref]
103. Joseph F. Donnermeyer. 2015. The social organisation of the rural and crime in the United States: Conceptual considerations.
Journal of Rural Studies 39, 160-170. [Crossref]
104. James Allen Johnson, Asal Mohamadi Johnson. 2015. Urban-Rural Differences in Childhood and Adolescent Obesity in the
United States: A Systematic Review and Meta-Analysis. Childhood Obesity 11:3, 233-241. [Crossref]
105. Timothy J. Anderson, Daniel M. Saman, Martin S. Lipsky, M. Nawal Lutfiyya. 2015. A cross-sectional study on health differences
between rural and non-rural U.S. counties using the County Health Rankings. BMC Health Services Research 15:1. . [Crossref]
106. Alan N. West, Mary E. Charlton, Mary Vaughan-Sarrazin. 2015. Dual use of VA and non-VA hospitals by Veterans with multiple
hospitalizations. BMC Health Services Research 15:1. . [Crossref]
107. Thomas P. Frye, Daniel J. Sadowski, Whitney E. Zahnd, Wiley D. Jenkins, Danuta I. Dynda, Georgia S. Mueller, Shaheen R.
Alanee, Kevin T. McVary. 2015. Impact of County Rurality and Urologist Density on Urological Cancer Mortality in Illinois.
The Journal of Urology 193:5, 1608-1614. [Crossref]
108. I. Ruiz-Perez, C. Vives-Cases, V. Escriba-Aguir, M. Rodriguez-Barranco, A. Nevot-Cordero. 2015. How Does Intimate Partner
Violence Differ Depending on Level of Rurality of Residential Area in Spain?. Health & Social Work 40:2, 108-119. [Crossref]
109. Nathan L. Hale, Michael Smith, James Hardin, Amy Brock-Martin. 2015. Rural Populations and Early Periodic Screening,
Diagnosis, and Treatment Services: Challenges and Opportunities for Local Public Health Departments. American Journal of
Public Health 105:S2, S330-S336. [Abstract] [Full Text] [PDF] [PDF Plus]
110. Mesfin Awoke Bekalu, Steven Eggermont. 2015. Exposure to HIV/AIDS-Related Media Content and HIV Testing Intention:
Applying the Integrative Model of Behavioral Prediction. Mass Communication and Society 18:2, 144-164. [Crossref]
111. J. Pascal, N. Johnson, V. Dickson-Swift, A. Kenny. 2015. Returning home: psychosocial care during the re-entry phase of cancer
survivorship in rural Australia. European Journal of Cancer Care 24:1, 39-49. [Crossref]
112. Page Klitzman, Bridget Armstrong, David M. Janicke. 2015. Distance as a Predictor of Treatment Attendance in a Family Based
Pediatric Weight Management Program in Rural Areas. The Journal of Rural Health 31:1, 19-26. [Crossref]
113. Katherine Yun, Arina Chesnokova, Justine Shults, Andres Pinto, David M. Rubin. 2014. Use of Preventive Dental Care Among
Medicaid-Enrolled, School-Aged US Children in Immigrant and Nonimmigrant Families: Trends in Pennsylvania From 2005
Through 2010. American Journal of Public Health 104:12, 2400-2408. [Abstract] [Full Text] [PDF] [PDF Plus] [Supplemental
Material]
114. M. A. Bekalu, S. Eggermont. 2014. Media use and HIV/AIDS knowledge: a knowledge gap perspective. Health Promotion
International 29:4, 739-750. [Crossref]
115. Carlos H Martinez, Marilyn L Moy, Huong Q Nguyen, Miriam Cohen, Reema Kadri, Pia Roman, Robert G Holleman, Hyungjin
Myra Kim, David E Goodrich, Nicholas D Giardino, Caroline R Richardson. 2014. Taking Healthy Steps: rationale, design and
baseline characteristics of a randomized trial of a pedometer-based internet-mediated walking program in veterans with chronic
obstructive pulmonary disease. BMC Pulmonary Medicine 14:1. . [Crossref]
116. Elizabeth A Cook, Kathleen M Schneider, Jennifer Robinson, June Wilwert, Elizabeth Chrischilles, Jane Pendergast, John Brooks.
2014. Field methods in medical record abstraction: assessing the properties of comparative effectiveness estimates. BMC Health
Services Research 14:1. . [Crossref]
117. Ines Weinhold, Sebastian Gurtner. 2014. Understanding shortages of sufficient health care in rural areas. Health Policy 118:2,
201-214. [Crossref]
118. Emily J. Hauenstein, Doris F. Glick, Catherine Kane, Pamela Kulbok, Edie Barbero, Kathleen Cox. 2014. A Model to Develop
Nurse Leaders for Rural Practice. Journal of Professional Nursing 30:6, 463-473. [Crossref]
119. Walid A. Afifi, Tamara D. Afifi, Annie Merrill. 2014. Uncertainty and Control in the Context of a Category-Five Tornado.
Research in Nursing & Health 37:5, 358-366. [Crossref]
120. Sunarin Chanta, Maria E. Mayorga, Laura A. McLay. 2014. Improving emergency service in rural areas: a bi-objective covering
location model for EMS systems. Annals of Operations Research 221:1, 133-159. [Crossref]
121. Manorama M. Khare, Abby Koch, Kristine Zimmermann, Patricia A. Moehring, Stacie E. Geller. 2014. Heart Smart for Women:
A Community-Based Lifestyle Change Intervention to Reduce Cardiovascular Risk in Rural Women. The Journal of Rural Health
30:4, 359-368. [Crossref]
122. Mesfin Awoke Bekalu, Steven Eggermont. 2014. The Relative Persuasiveness of Gain-Framed Versus Loss-Framed HIV Testing
Message: Evidence From a Field Experiment in Northwest Ethiopia. Journal of Health Communication 19:8, 922-938. [Crossref]
123. Alyce S. Ashcraft, Donna C. Owen. 2014. From nursing home to acute care: Signs, symptoms, and strategies used to prevent
transfer. Geriatric Nursing 35:4, 316-320. [Crossref]
124. Daniel D. Cline, Victoria Vaughan Dickson, Christine Kovner, Marie Boltz, Ann Kolanowski, Elizabeth Capezuti. 2014. Factors
Influencing RNs’ Perceptions of Quality Geriatric Care in Rural Hospitals. Western Journal of Nursing Research 36:6, 748-768.
[Crossref]
125. Karen H. Wang, David A. Fiellin, William C. Becker. 2014. Source of prescription drugs used nonmedically in rural and urban
populations. The American Journal of Drug and Alcohol Abuse 40:4, 292-303. [Crossref]
126. Britt Lunde, Paul Smith, Manpreet Grewal, Tara Kumaraswami, Allison Cowett, Bryna Harwood. 2014. Long Acting
Contraception Provision by Rural Primary Care Physicians. Journal of Women's Health 23:6, 519-524. [Crossref]
127. Yoshio N. Hall, Ping Xu, Glenn M. Chertow, Jonathan Himmelfarb. 2014. Characteristics and Performance of Minority-Serving
Dialysis Facilities. Health Services Research 49:3, 971-991. [Crossref]
128. Sharon Weissman, Wayne A. Duffus, Medha Vyavaharkar, Ashok Varma Samantapudi, Kirk A. Shull, Teresa G. Stephens,
Hrishikesh Chakraborty. 2014. Defining the Rural HIV Epidemic: Correlations of 3 Definitions-South Carolina, 2005-2011. The
Journal of Rural Health 30:3, 275-283. [Crossref]
129. Mary Jo Trepka, Kristopher P. Fennie, Diana M. Sheehan, Khaleeq Lutfi, Lorene Maddox, Spencer Lieb. 2014. Late HIV
Diagnosis: Differences by Rural/Urban Residence, Florida, 2007–2011. AIDS Patient Care and STDs 28:4, 188-197. [Crossref]
130. Kristan Staudenmayer, Feng Lin, Robert Mackersie, David Spain, Renee Hsia. 2014. Variability in California triage from 2005 to
2009. Journal of Trauma and Acute Care Surgery 76:4, 1041-1047. [Crossref]
131. Richard Volpe. 2014. Supercenters, Unionized Labor, and Performance in Food Retail. Industrial Relations: A Journal of Economy
and Society 53:2, 325-355. [Crossref]
132. Jiying Ling, Kristi M. King, Barbara J. Speck, Seongho Kim, Dongfeng Wu. 2014. Preliminary Assessment of a School-Based
Healthy Lifestyle Intervention Among Rural Elementary School Children. Journal of School Health 84:4, 247-255. [Crossref]
133. Jayashri Sankaranarayanan, Fang Qiu, Shinobu Watanabe-Galloway. 2014. A registry study of the association of patient's residence
and age with colorectal cancer survival. Expert Review of Pharmacoeconomics & Outcomes Research 14:2, 301-313. [Crossref]
134. Matthew J. Giblin, George W. Burruss, Joseph A. Schafer. 2014. A Stone’s Throw from the Metropolis: Re-Examining Small-
Agency Homeland Security Practices. Justice Quarterly 31:2, 368-393. [Crossref]
135. Robert Hines, Talar Markossian, Asal Johnson, Frank Dong, Rana Bayakly. 2014. Geographic Residency Status and Census
Tract Socioeconomic Status as Determinants of Colorectal Cancer Outcomes. American Journal of Public Health 104:3, e63-e71.
[Abstract] [Full Text] [PDF] [PDF Plus]
136. Mark P. McGovern, Chantal Lambert-Harris, Heather J. Gotham, Ronald E. Claus, Haiyi Xie. 2014. Dual Diagnosis Capability
in Mental Health and Addiction Treatment Services: An Assessment of Programs Across Multiple State Systems. Administration
and Policy in Mental Health and Mental Health Services Research 41:2, 205-214. [Crossref]
137. 2014. Committee Opinion No. 586. Obstetrics & Gynecology 123:2, PART 1, 384-388. [Crossref]
138. Veronica B. Searles, Morgan A. Valley, Holly Hedegaard, Marian E. Betz. 2014. Suicides in Urban and Rural Counties in the
United States, 2006–2008. Crisis 35:1, 18-26. [Crossref]
139. Natalie D. Dautovich, Kristy D. Shoji, Ashley M. Stripling, Joseph M. Dzierzewski. 2014. Clinical Geropsychology: Treatment
and Research Approaches With Rural Older Adults. Clinical Gerontologist 37:1, 64-75. [Crossref]
140. Elaine C. Khoong, Wesley S. Gibbert, Jane M. Garbutt, Walton Sumner, Ross C. Brownson. 2014. Rural, Suburban, and Urban
Differences in Factors That Impact Physician Adherence to Clinical Preventive Service Guidelines. The Journal of Rural Health
30:1, 7-16. [Crossref]
141. Michael S. Phipps, Huanguang Jia, Neale R. Chumbler, Xinli Li, Jaime G. Castro, Jennifer Myers, Linda S. Williams, Dawn
M. Bravata. 2014. Rural-Urban Differences in Inpatient Quality of Care in US Veterans With Ischemic Stroke. The Journal of
Rural Health 30:1, 1-6. [Crossref]
142. Ashish Malhotra, Mary Vaughan-Sarrazin, Mary Elizabeth Charlton, Gary E. Rosenthal. 2014. Comparison of Colorectal Cancer
Screening in Veterans Based on the Location of Primary Care Clinic. Journal of Primary Care & Community Health 5:1, 24-29.
[Crossref]
143. Mesfin Bekalu, Steven Eggermont. 2014. The role of communication inequality in mediating the impacts of socioecological
and socioeconomic disparities on HIV/AIDS knowledge and risk perception. International Journal for Equity in Health 13:1, 16.
[Crossref]
144. Z. Joyce Fan, Michael P. Foley, Eddy Rauser, David K. Bonauto, Barbara A. Silverstein. 2013. Effects of Residential Location and
Work-Commuting on Long-Term Work Disability. Journal of Occupational Rehabilitation 23:4, 610-620. [Crossref]
145. Alfredo Borda-Olivas, Pablo Fernández-Navarro, Laura Otero-García, Belén Sanz-Barbero. 2013. Rurality and avoidable
hospitalization in a Spanish region with high population dispersion. European Journal of Public Health 23:6, 946-951. [Crossref]
146. Amanda Kenny, Nerida Hyett, John Sawtell, Virginia Dickson-Swift, Jane Farmer, Peter O’Meara. 2013. Community participation
in rural health: a scoping review. BMC Health Services Research 13:1. . [Crossref]
147. Mesfin Awoke Bekalu, Steven Eggermont. 2013. HIV/AIDS-related information needs of urban and rural residents of northwest
Ethiopia: alerting the rural populace and meeting the progressive needs of the urban populace. Information Development 29:4,
323-332. [Crossref]
148. Tim Baker, Samantha L. Dawson. 2013. What small rural emergency departments do: A systematic review of observational
studies. Australian Journal of Rural Health 21:5, 254-261. [Crossref]
149. B. G. Danaher, H. H. Severson, J. A. Andrews, M. S. Tyler, E. Lichtenstein, T. G. Woolley, J. R. Seeley. 2013. Randomized
Controlled Trial of MyLastDip: A Web-Based Smokeless Tobacco Cessation Program for Chewers Ages 14-25. Nicotine &
Tobacco Research 15:9, 1502-1510. [Crossref]
150. Rose Corrigan. 2013. The New Trial by Ordeal: Rape Kits, Police Practices, and the Unintended Effects of Policy Innovation.
Law & Social Inquiry 38:4, 920-949. [Crossref]
151. Leanne Townsend, Arjuna Sathiaseelan, Gorry Fairhurst, Claire Wallace. 2013. Enhanced broadband access as a solution to the
social and economic problems of the rural digital divide. Local Economy 28:6, 580-595. [Crossref]
152. Kelly M. Doran, Maria C. Raven, Robert A. Rosenheck. 2013. What Drives Frequent Emergency Department Use in an Integrated
Health System? National Data From the Veterans Health Administration. Annals of Emergency Medicine 62:2, 151-159. [Crossref]
153. Mesfin Awoke Bekalu, Steven Eggermont. 2013. Determinants of HIV/AIDS-Related Information Needs and Media Use: Beyond
Individual-Level Factors. Health Communication 28:6, 624-636. [Crossref]
154. Rachel K. Jones, Jenna Jerman. 2013. How Far Did US Women Travel for Abortion Services in 2008?. Journal of Women's Health
22:8, 706-713. [Crossref]
155. Britt Lunde, Kristin Rankin, Bryna Harwood, Noel Chavez. 2013. Sterilization of Rural and Urban Women in the United States.
Obstetrics & Gynecology 122:2, PART 1, 304-311. [Crossref]
156. Susan C. McKernan, Raymond A. Kuthy, Golnaz Kavand. 2013. General Dentist Characteristics Associated With Rural Practice
Location. The Journal of Rural Health 29:s1, s89-s95. [Crossref]
157. Jane M. Kolodinsky, Thomas Patrick DeSisto, David Propen, Matthew E. Putnam, Erin Roche, William R. Sawyer. 2013. It is
not how far you go, it is whether you can get there: modeling the effects of mobility on quality of life in rural New England.
Journal of Transport Geography 31, 113-122. [Crossref]
158. Jessica D. Bellinger, Heather M. Brandt, James W. Hardin, Shalanda A. Bynum, Patricia A. Sharpe, Dawnyéa Jackson. 2013.
The Role of Family History of Cancer on Cervical Cancer Screening Behavior in a Population-based Survey of Women in the
Southeastern United States. Women's Health Issues 23:4, e197-e204. [Crossref]
159. Mary Jo Trepka, Theophile Niyonsenga, Lorene M. Maddox, Spencer Lieb. 2013. Rural AIDS Diagnoses in Florida: Changing
Demographics and Factors Associated With Survival. The Journal of Rural Health 29:3, 266-280. [Crossref]
160. Joseph L. Riley, Elizabeth A. Pomery, Virginia J. Dodd, Keith E. Muller, Yi Guo, Henrietta L. Logan. 2013. Disparities in
Knowledge of Mouth or Throat Cancer Among Rural Floridians. The Journal of Rural Health 29:3, 294-303. [Crossref]
161. Rohit P. Ojha, S. Cristina Oancea, Kirsten K. Ness, Jennifer Q. Lanctot, D. Kumar Srivastava, Leslie L. Robison, Melissa M.
Hudson, James G. Gurney. 2013. Assessment of potential bias from non-participation in a dynamic clinical cohort of long-term
childhood cancer survivors: Results from the St. Jude lifetime cohort study. Pediatric Blood & Cancer 60:5, 856-864. [Crossref]
162. Kevin A. Henry, Recinda Sherman, Steve Farber, Myles Cockburn, Daniel W. Goldberg, Antoinette M. Stroup. 2013. The joint
effects of census tract poverty and geographic access on late-stage breast cancer diagnosis in 10 US States. Health & Place 21,
110-121. [Crossref]
163. J. Kolodinsky, E. Roche, T. DeSisto, W. Sawyer, D. Propen. 2013. Understanding quality of life in a northern, rural climate.
Community Development 44:2, 161-172. [Crossref]
164. Heather J. Gotham, Jessica L. Brown, Joseph E. Comaty, Mark P. McGovern, Ronald E. Claus. 2013. Assessing the Co-occurring
Capability of Mental Health Treatment Programs: the Dual Diagnosis Capability in Mental Health Treatment (DDCMHT)
Index. The Journal of Behavioral Health Services & Research 40:2, 234-241. [Crossref]
165. Jerome J. Federspiel, Sally C. Stearns, Laura P. D'Arcy, Kimberley H. Geissler, Christopher A. Beadles, Daniel J. Crespin, Timothy
S. Carey, Joseph S. Rossi, Brett C. Sheridan. 2013. Resource Use Trajectories for Aged Medicare Beneficiaries with Complex
Coronary Conditions. Health Services Research 48:2pt2, 753-772. [Crossref]
166. Jerome J. Federspiel, Sally C. Stearns, Kristin L. Reiter, Kimberley H. Geissler, Matthew A. Triplette, Laura P. D'Arcy, Brett C.
Sheridan, Joseph S. Rossi. 2013. Disappearing and reappearing differences in drug-eluting stent use by race. Journal of Evaluation
in Clinical Practice 19:2, 256-262. [Crossref]
167. Daniel F. Brossart, Monica L. Wendel, Timothy R. Elliott, Helene E. Cook, Linda G. Castillo, James N. Burdine. 2013. Assessing
Depression in Rural Communities. Journal of Clinical Psychology 69:3, 252-263. [Crossref]
168. Jeremy P. Cetnar, John M. Hampton, Amy A. Williamson, Tracy Downs, Dian Wang, Jean B. Owen, Byron Crouse, Nathan
Jones, J. Frank Wilson, Amy Trentham-Dietz. 2013. Place of Residence and Primary Treatment of Prostate Cancer: Examining
Trends in Rural and Nonrural Areas in Wisconsin. Urology 81:3, 540-547. [Crossref]
169. Jennifer S. McCall-Hosenfeld, Cynthia H. Chuang, Carol S. Weisman. 2013. Prospective Association of Intimate Partner Violence
with Receipt of Clinical Preventive Services in Women of Reproductive Age. Women's Health Issues 23:2, e109-e116. [Crossref]
170. Tushar Trivedi, Jihong Liu, Janice C. Probst, Amy Brock Martin. 2013. The Metabolic Syndrome: Are Rural Residents at
Increased Risk?. The Journal of Rural Health 29:2, 188-197. [Crossref]
171. Adam P. Goode, Janet K. Freburger, Timothy S. Carey. 2013. The Influence of Rural Versus Urban Residence on Utilization and
Receipt of Care for Chronic Low Back Pain. The Journal of Rural Health 29:2, 205-214. [Crossref]
172. Theophile Niyonsenga, Mary Jo Trepka, Spencer Lieb, Lorene M. Maddox. 2013. Measuring Socioeconomic Inequality in the
Incidence of AIDS: Rural–Urban Considerations. AIDS and Behavior 17:2, 700-709. [Crossref]
173. Michael E. Ohl, Eli Perencevich, D. Keith McInnes, Nancy Kim, David Rimland, Kathleen Akgun, David A. Fiellin, Melissa
Skanderson, Karen Wang, Amy Justice. 2013. Antiretroviral Adherence Among Rural Compared to Urban Veterans with HIV
Infection in the United States. AIDS and Behavior 17:1, 174-180. [Crossref]
174. E. Jennifer Edelman, Kirsha Gordon, William C. Becker, Joseph L. Goulet, Melissa Skanderson, Julie R. Gaither, Jennifer
Brennan Braden, Adam J. Gordon, Robert D. Kerns, Amy C. Justice, David A. Fiellin. 2013. Receipt of Opioid Analgesics by
HIV-Infected and Uninfected Patients. Journal of General Internal Medicine 28:1, 82-90. [Crossref]
175. Karen H. Wang, William C. Becker, David A. Fiellin. 2013. Prevalence and correlates for nonmedical use of prescription opioids
among urban and rural residents. Drug and Alcohol Dependence 127:1-3, 156-162. [Crossref]
176. Chantal Lambert-Harris, Elizabeth C. Saunders, Mark P. McGovern, Haiyi Xie. 2013. Organizational Capacity to Address Co-
occurring Substance Use and Psychiatric Disorders. Journal of Addiction Medicine 7:1, 25-32. [Crossref]
177. Alexa Gallagher, Jihong Liu, Janice C. Probst, Amy B. Martin, Jeffrey W. Hall. 2013. Maternal Obesity and Gestational Weight
Gain in Rural Versus Urban Dwelling Women in South Carolina. The Journal of Rural Health 29:1, 1-11. [Crossref]
178. Marizen Ramirez, Lisa Roth, Tracy Young, Corinne Peek-Asa. 2013. Rural Roadway Safety Perceptions Among Rural Teen
Drivers Living in and Outside of Towns. The Journal of Rural Health 29:1, 46-54. [Crossref]
179. David C. Landy, Michael A. Gorin, Robert J. Rudock, Mark T O’Connell. 2013. Increasing Access to Cholesterol Screening in
Rural Communities Catalyzes Cardiovascular Disease Prevention. The Journal of Rural Health 59, no-no. [Crossref]
180. Matthew Lee Smith, Justin B. Dickerson, Monica L. Wendel, SangNam Ahn, Jairus C. Pulczinski, Kelly N. Drake, Marcia G.
Ory. 2013. The Utility of Rural and Underserved Designations in Geospatial Assessments of Distance Traveled to Healthcare
Services: Implications for Public Health Research and Practice. Journal of Environmental and Public Health 2013, 1-11. [Crossref]
181. Saugar Maripuri, T. Alp Ikizler, Kerri L. Cavanaugh. 2013. Prevalence of Pre-End-Stage Renal Disease Care and Associated
Outcomes among Urban, Micropolitan, and Rural Dialysis Patients. American Journal of Nephrology 37:3, 274-280. [Crossref]
182. Jonathan M. Snowden, Yvonne W. Cheng, Caitlin P. Kontgis, Aaron B. Caughey. 2012. The association between hospital obstetric
volume and perinatal outcomes in California. American Journal of Obstetrics and Gynecology 207:6, 478.e1-478.e7. [Crossref]
183. Matthew J. Giblin, George W. Burruss, Nicholas Corsaro, Joseph A. Schafer. 2012. Self-Protection in Rural America. Criminal
Justice Policy Review 23:4, 493-517. [Crossref]
184. M Nawal Lutfiyya, Linda F Chang, Martin S Lipsky. 2012. A cross-sectional study of US rural adults’ consumption of fruits and
vegetables: do they consume at least five servings daily?. BMC Public Health 12:1. . [Crossref]
185. Richard A. Crosby, Carrie B. Oser, Carl G. Leukefeld, Jennifer R. Havens, April Young. 2012. Prevalence of HIV and risky sexual
behaviors among rural drug users: does age matter?. Annals of Epidemiology 22:11, 778-782. [Crossref]
186. May Nawal Lutfiyya, Joel Emery McCullough, Irina V. Haller, Stephen C. Waring, Joseph A. Bianco, Martin Stephen Lipsky.
2012. Rurality as a Root or Fundamental Social Determinant of Health. Disease-a-Month 58:11, 620-628. [Crossref]
187. Ji-Hong Liu, Sonya J. Jones, Han Sun, Janice C. Probst, Anwar T. Merchant, Philip Cavicchia. 2012. Diet, Physical Activity, and
Sedentary Behaviors as Risk Factors for Childhood Obesity: An Urban and Rural Comparison. Childhood Obesity 8:5, 440-448.
[Crossref]
188. Stephen A. Tonks, Sohil Makwana, Amanda H. Salanitro, Monika M. Safford, Thomas K. Houston, Jeroan J. Allison, William
Curry, Carlos A. Estrada. 2012. Quality of Diabetes Mellitus Care by Rural Primary Care Physicians. The Journal of Rural Health
28:4, 364-371. [Crossref]
189. Jerome J. Federspiel, Sally C. Stearns, Brett C. Sheridan, Jack J. Kuritzky, Laura P. D'Arcy, Daniel J. Crespin, Timothy S. Carey,
Joseph S. Rossi. 2012. Evaluating the effectiveness of a rapidly adopted cardiovascular technology with administrative data: The
case of drug-eluting stents for acute coronary syndromes. American Heart Journal 164:2, 207-214. [Crossref]
190. Valerie J. King, Melinda M. Davis, Paul N. Gorman, J. Bruin Rugge, L. J. Fagnan. 2012. Perceptions of Shared Decision Making
and Decision Aids Among Rural Primary Care Clinicians. Medical Decision Making 32:4, 636-644. [Crossref]
191. Huanguang Jia, Diane C. Cowper, Yuhong Tang, Eric Litt, Lauren Wilson. 2012. Postacute Stroke Rehabilitation Utilization:
Are There Differences Between Rural-Urban Patients and Taxonomies?. The Journal of Rural Health 28:3, 242-247. [Crossref]
192. Lin Fan, Supriya Mohile, Ning Zhang, Kevin Fiscella, Katia Noyes. 2012. Self-Reported Cancer Screening Among Elderly
Medicare Beneficiaries: A Rural-Urban Comparison. The Journal of Rural Health 28:3, 312-319. [Crossref]
193. William F. Rayburn, Jeffrey C. Klagholz, Cristina Murray-Krezan, Lana E. Dowell, Albert L. Strunk. 2012. Distribution of
American Congress of Obstetricians and Gynecologists Fellows and Junior Fellows in Practice in the United States. Obstetrics &
Gynecology 119:5, 1017-1022. [Crossref]
194. Inka Milewski. 2012. Identifying At-Risk Communities for Action on Cancer Prevention: A Case Study in New Brunswick
(Canada) Communities. NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy 22:1, 79-107. [Crossref]
195. Joshua M. Bradley, James L. Werth, Sarah L. Hastings. 2012. Social Justice Advocacy in Rural Communities. The Counseling
Psychologist 40:3, 363-384. [Crossref]
196. Judy Gillespie, Rhea Redivo. 2012. Type of community as confounding variable in the satisfaction of rural child and youth mental
health clinicians: implications for evidence‐based workforce development. The Journal of Mental Health Training, Education and
Practice 7:1, 20-32. [Crossref]
197. Ishmael Williams, Amy L. Valderrama, Patricia Bolton, April Greek, Sophia Greer, Davis G. Patterson, Zefeng Zhang. 2012.
Factors Associated with Emergency Medical Services Scope of Practice for Acute Cardiovascular Events. Prehospital Emergency
Care 16:2, 189-197. [Crossref]
198. Nathan L. Hale, Janice C. Probst, Jihong Liu, Amy Brock Martin, Kevin J. Bennett, Saundra Glover. 2012. Postpartum Screening
for Diabetes among Medicaid-Eligible South Carolina Women with Gestational Diabetes. Women's Health Issues 22:2, e163-e169.
[Crossref]
199. Ann E. Teske. 2012. Advanced Practice Nurses in Ohio Community Hospitals. The Journal for Nurse Practitioners 8:2, 129-135.
[Crossref]
200. Ana Eliza Port Lourenço. 2012. The meaning of ‘rural’ in rural health: A review and case study from Brazil. Global Public Health
7:1, 1-13. [Crossref]
201. Barth L. Wilsey, Scott M. Fishman, Aaron M. Gilson, Carlos Casamalhuapa, Hassan Baxi, Tzu-Chun Lin, Chin-Shang Li. 2011.
An analysis of the number of multiple prescribers for opioids utilizing data from the California Prescription Monitoring Program.
Pharmacoepidemiology and Drug Safety 20:12, 1262-1268. [Crossref]
202. Md. Monir Hossain, James N. Laditka. 2011. The influence of rurality on the volume of non-urgent emergency department
visits. Spatial and Spatio-temporal Epidemiology 2:4, 311-319. [Crossref]
203. Michael B. Edwards, David Matarrita-Cascante. 2011. Rurality in Leisure Research: A Review of Four Major Journals. Journal
of Leisure Research 43:4, 447-474. [Crossref]
204. Tonelle E. Handley, Kerry J. Inder, Brian J. Kelly, John R. Attia, Frances J. Kay-Lambkin. 2011. Urban-rural influences on
suicidality: Gaps in the existing literature and recommendations for future research. Australian Journal of Rural Health 19:6,
279-283. [Crossref]
205. Michael E Ohl, Eli Perencevich. 2011. Frequency of human immunodeficiency virus (HIV) testing in urban vs. rural areas of the
United States: Results from a nationally-representative sample. BMC Public Health 11:1. . [Crossref]
206. Julie C. Jacobson Vann, Joanne Finkle, Alice Ammerman, Steven Wegner, Asheley Cockrell Skinner, John T. Benjamin, Eliana M.
Perrin. 2011. Use of a Tool to Determine Perceived Barriers to Children's Healthy Eating and Physical Activity and Relationships
to Health Behaviors. Journal of Pediatric Nursing 26:5, 404-415. [Crossref]
207. Nathan L. Hale, Janice C. Probst, Jihong Liu, Kevin J. Bennett, Amy Brock Martin, Saundra Glover. 2011. Variation in Excessive
Fetal Growth across Levels of Prenatal Care among Women with Gestational Diabetes. Journal of Primary Care & Community
Health 2:4, 225-228. [Crossref]
208. Lyle J. Fagnan, Scott A. Shipman, James A. Gaudino, Jo Mahler, Andrew L. Sussman, Jennifer Holub. 2011. To Give or Not
to Give: Approaches to Early Childhood Immunization Delivery in Oregon Rural Primary Care Practices. The Journal of Rural
Health 27:4, 385-393. [Crossref]
209. Lucy E. Wilson, Todd Korthuis, John A. Fleishman, Richard Conviser, Perrin B. Lawrence, Richard D. Moore, Kelly A. Gebo.
2011. HIV-related medical service use by rural/urban residents: a multistate perspective. AIDS Care 23:8, 971-979. [Crossref]
210. David C. Landy, Michael A. Gorin, Mark T. O'Connell. 2011. Student-Led Rural Health Fairs. Southern Medical Journal 104:8,
598-603. [Crossref]
211. Devika Singh, David N. Fine, Jeanne M. Marrazzo. 2011. Chlamydia trachomatis Infection Among Women Reporting Sexual
Activity With Women Screened in Family Planning Clinics in the Pacific Northwest, 1997 to 2005. American Journal of Public
Health 101:7, 1284-1290. [Abstract] [Full Text] [PDF] [PDF Plus]
212. C. S. Lim, K. W. Follansbee-Junger, M. S. Crawford, D. M. Janicke. 2011. Treatment Outcome Research in Rural Pediatric
Populations: The Challenge of Recruitment. Journal of Pediatric Psychology 36:6, 696-707. [Crossref]
213. J.P. Ehsani, C.R. Bingham, J.T. Shope. 2011. Driving exposure by driver age in Michigan. Journal of Safety Research 42:3, 193-197.
[Crossref]
214. Caleb Banta-Green, Jennifer Field. 2011. City-wide drug testing using municipal wastewater. Significance 8:2, 70-74. [Crossref]
215. John M. McLaughlin, James L. Fisher, Electra D. Paskett. 2011. Marital status and stage at diagnosis of cutaneous melanoma.
Cancer 117:9, 1984-1993. [Crossref]
216. Kathryn Rost, Yi-Ping Hsieh, Stan Xu, Jeffrey Harman. 2011. Gender Differences in Hospitalization After Emergency Room
Visits for Depressive Symptoms. Journal of Women's Health 20:5, 719-724. [Crossref]
217. Robin P. Newhouse, Laura Morlock, Peter Pronovost, Sara Breckenridge Sproat. 2011. Rural Hospital Nursing. JONA: The
Journal of Nursing Administration 41:3, 129-137. [Crossref]
218. Monica L. Wendel, Daniel F. Brossart, Timothy R. Elliott, Carly McCord, Manuel A. Diaz. 2011. Use of Technology to Increase
Access to Mental Health Services in a Rural Texas Community. Family & Community Health 34:2, 134-140. [Crossref]
219. Michael Ohl, Janet Tate, Mona Duggal, Melissa Skanderson, Matthew Scotch, Peter Kaboli, Mary Vaughan-Sarrazin, Amy
Justice. 2010. Rural Residence Is Associated With Delayed Care Entry and Increased Mortality Among Veterans With Human
Immunodeficiency Virus Infection. Medical Care 48:12, 1064-1070. [Crossref]
220. Weiyan Jian, Kit Yee Chan, Daniel D. Reidpath, Ling Xu. 2010. China’s Rural-Urban Care Gap Shrank For Chronic Disease
Patients, But Inequities Persist. Health Affairs 29:12, 2189-2196. [Crossref]
221. Steven B. Zeliadt, Richard M. Hoffman, Ruth Etzioni, Van Anh T. Ginger, Daniel W. Lin. 2010. What Happens After an
Elevated PSA Test: The Experience of 13,591 Veterans. Journal of General Internal Medicine 25:11, 1205-1210. [Crossref]
222. David D. Blaney, Regina T. Flynn, Nancy R. Martin, Ludmila Anderson. 2010. Establishing the Baseline Height and Weight
Status of New Hampshire Head Start Children, 2007–2008. NHSA Dialog 13:4, 217-224. [Crossref]
223. Anthony J. Cannon, Deborah L. Darrington, Helen E. McIlvain, Linda K. Bauer, Julie M. Vose, James O. Armitage, Fausto R.
Loberiza. 2010. Association of number of follow-up providers with outcomes in survivors of hematologic malignancies. Leukemia
& Lymphoma 51:10, 1862-1869. [Crossref]
224. Thad E. Abrams, Mary Vaughan-Sarrazin, Peter J. Kaboli. 2010. Mortality and Revascularization Following Admission for Acute
Myocardial Infarction: Implication for Rural Veterans. The Journal of Rural Health 26:4, 310-317. [Crossref]
225. Corby K. Martin, Jessica L. Thomson, Monique M. LeBlanc, Tiffany M. Stewart, Robert L. Newton, Hongmei Han, Alicia
Sample, Catherine M. Champagne, Donald A. Williamson. 2010. Children in School Cafeterias Select Foods Containing More
Saturated Fat and Energy than the Institute of Medicine Recommendations. The Journal of Nutrition 140:9, 1653-1660. [Crossref]
226. Vijaya Kancherla, Paul A. Romitti, Kristin M. Caspers, Soman Puzhankara, Jose A. Morcuende. 2010. Epidemiology of congenital
idiopathic talipes equinovarus in Iowa, 1997-2005. American Journal of Medical Genetics Part A 152A:7, 1695-1700. [Crossref]
227. K Paulson, P Lambert, C Bredeson, A Demers, J Nowatzki, E Richardson, M Rubinger, D Szwajcer, M D Seftel. 2010. Does
location matter? Rural vs urban outcomes after blood and marrow transplantation in a population-based Canadian cohort. Bone
Marrow Transplantation 45:7, 1167-1173. [Crossref]
228. Jessica L. Burris, Michael Andrykowski. 2010. Disparities in mental health between rural and nonrural cancer survivors: a
preliminary study. Psycho-Oncology 19:6, 637-645. [Crossref]
229. Steven Stern, Elizabeth Merwin, Emily Hauenstein, Ivora Hinton, Virginia Rovnyak, Melvin Wilson, Ishan Williams, Irma
Mahone. 2010. The effects of rurality on mental and physical health. Health Services and Outcomes Research Methodology 10:1-2,
33-66. [Crossref]
230. Kate Beatty, Jenine K. Harris, Priscilla A. Barnes. 2010. The Role of Interorganizational Partnerships in Health Services Provision
Among Rural, Suburban, and Urban Local Health Departments. The Journal of Rural Health 26:3, 248-258. [Crossref]
231. Ludmila Anderson, Nancy R. Martin, Arnie Burdick, Regina T. Flynn, David D. Blaney. 2010. Oral health status of New
Hampshire Head Start children, 2007-2008. Journal of Public Health Dentistry 70:3, 245-248. [Crossref]
232. Timothy M. Hale, Shelia R. Cotten, Patricia Drentea, Melinda Goldner. 2010. Rural-Urban Differences in General and Health-
Related Internet Use. American Behavioral Scientist 53:9, 1304-1325. [Crossref]
233. Janice P. Tzeng, Deborah Mayer, Alice R. Richman, Isaac Lipkus, Paul K. Han, Carmina G. Valle, Lisa A. Carey, Noel T. Brewer.
2010. Women's experiences with genomic testing for breast cancer recurrence risk. Cancer 116:8, 1992-2000. [Crossref]
234. Frederick Chen, Meredith Fordyce, Steve Andes, L. Gary Hart. 2010. Which Medical Schools Produce Rural Physicians? A 15-
Year Update. Academic Medicine 85:4, 594-598. [Crossref]
235. Talia R. Kahn, Amy Hagopian, Karin Johnson. 2010. Retention of J-1 Visa Waiver Program Physicians in Washington Stateʼs
Health Professional Shortage Areas. Academic Medicine 85:4, 614-621. [Crossref]
236. Therese Zink, Bruce Center, Deborah Finstad, James G. Boulger, Lillian A. Repesh, Ruth Westra, Raymond Christensen,
Kathleen Dwyer Brooks. 2010. Efforts to Graduate More Primary Care Physicians and Physicians Who Will Practice in Rural
Areas: Examining Outcomes From the University of Minnesota–Duluth and the Rural Physician Associate Program. Academic
Medicine 85:4, 599-604. [Crossref]
237. Fausto R. Loberiza, Stephanie J. Lee, John P. Klein, Anna Hassebroek, Jason G. Dehn, Haydar A. Frangoul, Theresa Hahn,
Gregory Hale, Hillard M. Lazarus, Charles F. LeMaistre, Richard T. Maziarz, J. Douglas Rizzo, Navneet S. Majhail. 2010.
Outcomes of Hematologic Malignancies after Unrelated Donor Hematopoietic Cell Transplantation According to Place of
Residence. Biology of Blood and Marrow Transplantation 16:3, 368-375. [Crossref]
238. Ali Johnson, Judy R. Rees, Molly Schwenn, Bruce Riddle, Castine Verrill, Maria O. Celaya, Dawn A. Nicolaides, Sai Cherala,
Melanie Feinberg, Ann Gray, Lisa Rutstein, Matthew S. Katz, Johannes C. Nunnink. 2010. Oncology Care in Rural Northern
New England. Journal of Oncology Practice 6:2, 81-89. [Crossref]
239. Stephanie S. Frost, R. Turner Goins, Rebecca H. Hunter, Steven P. Hooker, Lucinda L. Bryant, Judy Kruger, Delores Pluto. 2010.
Effects of the Built Environment on Physical Activity of Adults Living in Rural Settings. American Journal of Health Promotion
24:4, 267-283. [Crossref]
240. Pamela Payne Foster, Jessica H. Williams, Carlos A. Estrada, John C. Higginbotham, Mukesha L. Voltz, Monika M. Safford,
Jeroan Allison. 2010. Recruitment of Rural Physicians in a Diabetes Internet Intervention Study: Overcoming Challenges and
Barriers. Journal of the National Medical Association 102:2, 101-107. [Crossref]
241. Elisa Prieto-Lara, Ricardo Ocaña-Riola. 2010. Updating Rurality Index for Small Areas in Spain. Social Indicators Research 95:2,
267-280. [Crossref]
242. Laura Evans, Carol S. Weisman. 2010. Folic Acid Supplementation in Younger and Older Nonpregnant Women of Reproductive
Age. Women's Health Issues 20:1, 50-57. [Crossref]
243. Adam Gonzalez, Carol T. Miller, Sondra E. Solomon, Janice Yanushka Bunn, Daniel G. Cassidy. 2009. Size Matters: Community
Size, HIV Stigma, & Gender Differences. AIDS and Behavior 13:6, 1205-1212. [Crossref]
244. Matthew R. McGrail, John S. Humphreys. 2009. Measuring spatial accessibility to primary care in rural areas: Improving the
effectiveness of the two-step floating catchment area method. Applied Geography 29:4, 533-541. [Crossref]
245. MARIANNE BAERNHOLDT, BARBARA A. MARK. 2009. The nurse work environment, job satisfaction and turnover rates
in rural and urban nursing units. Journal of Nursing Management 17:8, 994-1001. [Crossref]
246. VICTORIA C. PLAUT, GLENN ADAMS, STEPHANIE L. ANDERSON. 2009. Does attractiveness buy happiness? âIt
depends on where youâre fromâ. Personal Relationships 16:4, 619-630. [Crossref]
247. Fausto R. Loberiza, Anthony J. Cannon, Dennis D. Weisenburger, Julie M. Vose, Matt J. Moehr, Martin A. Bast, Philip J.
Bierman, R. Gregory Bociek, James O. Armitage. 2009. Survival Disparities in Patients With Lymphoma According to Place of
Residence and Treatment Provider: A Population-Based Study. Journal of Clinical Oncology 27:32, 5376-5382. [Crossref]
248. Caleb J. Banta-Green, Jennifer A. Field, Aurea C. Chiaia, Daniel L. Sudakin, Laura Power, Luc de Montigny. 2009. The spatial
epidemiology of cocaine, methamphetamine and 3,4-methylenedioxymethamphetamine (MDMA) use: a demonstration using a
population measure of community drug load derived from municipal wastewater. Addiction 104:11, 1874-1880. [Crossref]
249. Cynthia H. Cassell, Julie Daniels, Robert E. Meyer. 2009. Timeliness of Primary Cleft Lip/Palate Surgery. The Cleft Palate-
Craniofacial Journal 46:6, 588-597. [Crossref]
250. Matthew R. McGrail, John S. Humphreys. 2009. A new index of access to primary care services in rural areas. Australian and
New Zealand Journal of Public Health 33:5, 418-423. [Crossref]
251. Adit A. Ginde, Ashley F. Sullivan, Carlos A. Camargo. 2009. National Study of the Emergency Physician Workforce, 2008. Annals
of Emergency Medicine 54:3, 349-359. [Crossref]
252. James N. Laditka, Sarah B. Laditka, Janice C. Probst. 2009. Health care access in rural areas: Evidence that hospitalization for
ambulatory care-sensitive conditions in the United States may increase with the level of rurality. Health & Place 15:3, 761-770.
[Crossref]
253. Jayashri Sankaranarayanan, Shinobu Watanabe-Galloway, Junfeng Sun, Fang Qiu, Eugene Boilesen, Alan G. Thorson. 2009.
Rurality and Other Determinants of Early Colorectal Cancer Diagnosis in Nebraska: A 6-Year Cancer Registry Study, 1998-2003.
The Journal of Rural Health 25:4, 358-365. [Crossref]
254. Martin C. Mahoney, Puthiery Va, Adrian Stevens, Amy R. Kahn, Arthur M. Michalek. 2009. Changes in Cancer Incidence
Patterns Among a Northeastern American Indian Population: 1955-1969 Versus 1990-2004. The Journal of Rural Health 25:4,
378-383. [Crossref]
255. Sara McLafferty, Fahui Wang. 2009. Rural reversal?. Cancer 115:12, 2755-2764. [Crossref]
256. H. Meng, B. Wamsley, D. Liebel, D. Dixon, G. Eggert, J. Van Nostrand. 2009. Urban-Rural Differences in the Effect of a
Medicare Health Promotion and Disease Self-Management Program on Physical Function and Health Care Expenditures. The
Gerontologist 49:3, 407-417. [Crossref]
257. Ethan M. Berke, Alan N. West, Amy E. Wallace, William B. Weeks. 2009. Practical and Policy Implications of Using Different
Rural-Urban Classification Systems: A Case Study of Inpatient Service Utilization Among Veterans Administration Users. The
Journal of Rural Health 25:3, 259-266. [Crossref]
258. Emily F. Shortridge, Jonathan R. Moore. 2009. Use of Emergency Departments for Conditions Related to Poor Oral Healthcare.
Journal of Public Health Management and Practice 15:3, 238-245. [Crossref]
259. Beth Epstein, Therese Grant, Melissa Schiff, Laurin Kasehagen. 2009. Does Rural Residence Affect Access to Prenatal Care in
Oregon?. The Journal of Rural Health 25:2, 150-157. [Crossref]
260. Charles Saunders, Gail R. Bellamy, Nir Menachemi, Askar S. Chukmaitov, Robert G. Brooks. 2009. Bypassing the Local Rural
Hospital for Outpatient Procedures. The Journal of Rural Health 25:2, 174-181. [Crossref]
261. Anobel Y. Odisho, Vincent Fradet, Matthew R. Cooperberg, Ardalan E. Ahmad, Peter R. Carroll. 2009. Geographic Distribution
of Urologists Throughout the United States Using a County Level Approach. The Journal of Urology 181:2, 760-766. [Crossref]
262. Amanda E. Young, Manuel Cifuentes, Radoslaw Wasiak, Barbara S. Webster. 2009. Urban-Rural Differences in Work Disability
Following Occupational Injury: Are They Related to Differences in Healthcare Utilization?. Journal of Occupational and
Environmental Medicine 51:2, 204-212. [Crossref]
263. Joy Wee, Rosemary Lysaght. 2009. Factors affecting measures of activities and participation in persons with mobility impairment.
Disability and Rehabilitation 31:20, 1633-1642. [Crossref]
264. Karen Hoover, Emilia H. Koumans, Daniel Montaño, Danuta Kasprzyk, Crystal Freeman, April Greek, Nidhi Jain, Kathleen
Irwin. 2009. Access of Black, Hispanic, and Nonprivately Insured Women to Liquid-Based Cytology, Human Papillomavirus
DNA Testing, and On-Site Colposcopy in the United States. Journal of Lower Genital Tract Disease 13:1, 17-27. [Crossref]
265. Mabel Hunsberger, Andrea Baumann, Jennifer Blythe, Mary Crea. 2009. Sustaining the Rural Workforce: Nursing Perspectives
on Worklife Challenges. The Journal of Rural Health 25:1, 17-25. [Crossref]
266. Cynthia H. Cassell, Robert Meyer, Julie Daniels. 2008. Health care expenditures among Medicaid enrolled children with and
without orofacial clefts in North Carolina, 1995-2002. Birth Defects Research Part A: Clinical and Molecular Teratology 82:11,
785-794. [Crossref]
267. Gwen Wagstrom Halaas, Therese Zink, Deborah Finstad, Keli Bolin, Bruce Center. 2008. Recruitment and Retention of Rural
Physicians: Outcomes From the Rural Physician Associate Program of Minnesota. The Journal of Rural Health 24:4, 345-352.
[Crossref]
268. Masatoshi Matsumoto, Kazuo Inoue, Eiji Kajii. 2008. Characteristics of medical students with rural origin: Implications for
selective admission policies. Health Policy 87:2, 194-202. [Crossref]
269. Marianne M. Hillemeier, Carol S. Weisman, Gary A. Chase, Anne-Marie Dyer. 2008. Mental Health Status Among Rural Women
of Reproductive Age: Findings From the Central Pennsylvania Women’s Health Study. American Journal of Public Health 98:7,
1271-1279. [Abstract] [Full Text] [PDF] [PDF Plus]
270. Matthew B. Klein, William Hollingworth, Frederick P. Rivara, C Bradley Kramer, Shelley W. Askay, David M. Heimbach, Nicole
S. Gibran. 2008. Hospital Costs Associated With Pediatric Burn Injury. Journal of Burn Care & Research 29:4, 632-637. [Crossref]
271. Laura Anne Nicholson. 2008. Rural mental health. Advances in Psychiatric Treatment 14:4, 302-311. [Crossref]
272. Robert C. Colligan, Norman H. Rasmussen, David C. Agerter, Kenneth P. Offord, Michael Malinchoc, Megan M. O’Byrne,
Joanne T. Benson. 2008. The MMPI-2: A Contemporary Normative Study of Midwestern Family Medicine Outpatients. Journal
of Clinical Psychology in Medical Settings 15:2, 98-119. [Crossref]
273. Diana L. Velott, Sara A. Baker, Marianne M. Hillemeier, Carol S. Weisman. 2008. Participant Recruitment to a Randomized
Trial of a Community-Based Behavioral Intervention for Pre- and Interconceptional Women. Women's Health Issues 18:3, 217-224.
[Crossref]
274. Tresza D. Hutcheson, K. Allen Greiner, Edward F. Ellerbeck, Shawn K. Jeffries, Laura M. Mussulman, Genevieve N. Casey. 2008.
Understanding Smoking Cessation in Rural Communities. The Journal of Rural Health 24:2, 116-124. [Crossref]
275. J.S. Humphreys, G. Solarsh. Populations at Special Health Risk: Rural Populations 242-253. [Crossref]
276. Holly Bante, Michael Elliott, Amanda Harrod, Debra Haire-Joshu. 2008. The Use of Inappropriate Feeding Practices by Rural
Parents and Their Effect on Preschoolers’ Fruit and Vegetable Preferences and Intake. Journal of Nutrition Education and Behavior
40:1, 28-33. [Crossref]
277. Keshav Rao, Deborah L. Darrington, Joseph J. Schumacher, Marcel Devetten, Julie M. Vose, Fausto R. Loberiza. 2007. Disparity
in Survival Outcome after Hematopoietic Stem Cell Transplantation for Hematologic Malignancies According to Area of Primary
Residence. Biology of Blood and Marrow Transplantation 13:12, 1508-1514. [Crossref]
278. Brian G Danaher, L Gary Hart, H Garth McKay, Herbert H Severson. 2007. Measuring participant rurality in Web-based
interventions. BMC Public Health 7:1. . [Crossref]
279. Catherine T. Baca, Dale C. Alverson, Jennifer Knapp Manuel, Greg L. Blackwell. 2007. Telecounseling in Rural Areas for Alcohol
Problems. Alcoholism Treatment Quarterly 25:4, 31-45. [Crossref]
280. Mona Saraiya, Kathleen L. Irwin, Linda Carlin, Xiao Chen, Nidhi Jain, Vicki Benard, Daniel E. Montano. 2007. Cervical cancer
screening and management practices among providers in the National Breast and Cervical Cancer Early Detection Program
(NBCCEDP). Cancer 110:5, 1024-1032. [Crossref]
281. Thomas C. Ricketts, Randy Randolph. 2007. Urban-Rural Flows of Physicians. The Journal of Rural Health 23:4, 277-285.
[Crossref]
282. Jeri L. Bigbee, Richard Abood, Sharon Cohen Landau, Nicole Monastersky Maderas, Diana Greene Foster, Susan Ravnan. 2007.
Pharmacy Access to Emergency Contraception in Rural and Frontier Communities. The Journal of Rural Health 23:4, 294-298.
[Crossref]
283. Joseph C. Gfroerer, Sharon L. Larson, James D. Colliver. 2007. Drug Use Patterns and Trends in Rural Communities. The
Journal of Rural Health 23:s1, 10-15. [Crossref]
284. Joanne E. Brady, Beth C. Weitzman. 2007. Inconsistencies in place definition: How different operational place definitions affect
estimates of adolescent smoking and drinking risk. Health & Place 13:2, 562-568. [Crossref]
285. Emily J. Hauenstein, Stephen Petterson, Virginia Rovnyak, Elizabeth Merwin, Barbara Heise, Douglas Wagner. 2007. Rurality
and Mental Health Treatment. Administration and Policy in Mental Health and Mental Health Services Research 34:3, 255-267.
[Crossref]
286. John Fortney, Gerard Rushton, Scott Wood, Lixun Zhang, Stan Xu, Fran Dong, Kathryn Rost. 2007. Community-Level Risk
Factors for Depression Hospitalizations. Administration and Policy in Mental Health and Mental Health Services Research 34:4,
343-352. [Crossref]
287. I. Peytremann-Bridevaux, D. Faeh, B. Santos-Eggimann. 2007. Prevalence of overweight and obesity in rural and urban settings
of 10 European countries. Preventive Medicine 44:5, 442-446. [Crossref]
288. Melissa Christiansen, Gretchen J. Carrougher, Loren H. Engrav, Shelley Wiechman-Askay, C Bradley Kramer, Nicole S. Gibran,
Matthew B. Klein. 2007. Time to School Re-Entry After Burn Injury Is Quite Short. Journal of Burn Care & Research 28:3,
478-481. [Crossref]
289. John A. Owen, Mark R. Conaway, Beth A. Bailey, Gregory F. Hayden. 2007. Predicting Rural Practice Using Different Definitions
to Classify Medical School Applicants as Having a Rural Upbringing. The Journal of Rural Health 23:2, 133-140. [Crossref]
290. Marianne M. Hillemeier, Carol S. Weisman, Gary A. Chase, Anne-Marie Dyer. 2007. Individual and Community Predictors of
Preterm Birth and Low Birthweight Along the Rural-Urban Continuum in Central Pennsylvania. The Journal of Rural Health
23:1, 42-48. [Crossref]
291. Frances M. Chevarley, Pamela L. Owens, Marc W. Zodet, Lisa A. Simpson, Marie C. McCormick, Denise Dougherty. 2006.
Health Care for Children and Youth in the United States: Annual Report on Patterns of Coverage, Utilization, Quality, and
Expenditures by a County Level of Urban Influence. Ambulatory Pediatrics 6:5, 241-264. [Crossref]
292. Denise Dougherty, Lisa A. Simpson, Marie C. McCormick. 2006. Rural Areas and Children’s Health Care Coverage, Use,
Expenditures, and Quality: Policy Implications. Ambulatory Pediatrics 6:5, 265-267. [Crossref]
293. Craig Anne Heflinger, Brian Christens. 2006. Rural behavioral health services for children and adolescents: An ecological and
community psychology analysis. Journal of Community Psychology 34:4, 379-400. [Crossref]
294. Susan A. Hall, Jay S. Kaufman, Thomas C. Ricketts. 2006. Defining Urban and Rural Areas in U.S. Epidemiologic Studies.
Journal of Urban Health 83:2, 162-175. [Crossref]
295. Susan M. Skillman, Lorella Palazzo, David Keepnews, L. Gary Hart. 2006. Characteristics of Registered Nurses in Rural Versus
Urban Areas: Implications for Strategies to Alleviate Nursing Shortages in the United States. The Journal of Rural Health 22:2,
151-157. [Crossref]