Objectives. To examine change over time in cigarette smoking among rural and urban adolescents and to test whether rates of change differ by rural versus urban residence. Methods. We used the 2008 through 2010 and 2014 through 2016 US National Survey of Drug Use and Health to estimate prevalence and adjusted odds of current cigarette smoking among rural and urban adolescents aged 12 to 17 years in each period. To test for rural–urban differences in the change between periods, we included an interaction between residence and time. Results. Between 2008 to 2010 and 2014 to 2016, cigarette smoking rates declined for rural and urban adolescents; however, rural reductions lagged behind urban reductions. Controlling for socioeconomic characteristics, rural versus urban odds of cigarette smoking did not differ in 2008 through 2010; however, in 2014 through 2016, rural youths had 50% higher odds of smoking than did their urban peers. Conclusions. Differential reductions in rural youth cigarette smoking have widened the rural–urban gap in current smoking rates for adolescents. Public Health Implications. To continue gains in adolescent cigarette abstinence and reduce rural–urban disparities, prevention efforts should target rural adolescents.
Purpose Few studies have examined telehealth use among rural Medicaid beneficiaries. This study produced a descriptive overview of telehealth use in 2011, including the prevalence of telehealth use among rural and urban Medicaid beneficiaries, characteristics of telehealth users, types of telehealth services provided, and diagnoses associated with telehealth use. Methods Using data from the 2011 Medicaid Analytic eXtract (MAX), we conducted bivariate analyses to test the associations between rurality and prevalence and patterns of telehealth use among Medicaid beneficiaries. Findings Rural Medicaid beneficiaries were more likely to use telehealth services than their urban counterparts, but absolute rates of telehealth use were low—0.26% of rural nondual Medicaid beneficiaries used telehealth in 2011. Psychotropic medication management was the most prevalent use of telehealth for both rural and urban Medicaid beneficiaries, but the proportion of users who accessed nonbehavioral health services through telehealth was significantly greater as rurality increased. Regardless of telehealth users’ residence, mood disorders were the most common reason for obtaining telehealth services. As rurality increased, significantly higher proportions of telehealth users received services to address attention‐deficit/hyperactivity disorder (ADHD) and other behavioral health problems usually diagnosed in childhood. Conclusions These findings provide a baseline for further policy‐relevant investigations including examinations of changes in telehealth use rates in Medicaid since 2011. Reimbursement policies and unique rural service needs may account for the observed differences in rural‐urban Medicaid telehealth use rates.
State and federal policies have shifted long-term services and support (LTSS) priorities from nursing home care to home and community-based services (HCBS). It is not clear whether the rural LTSS system reflects this system transformation. Using the Medicare Current Beneficiary Survey, we examined nursing home use among rural and urban Medicare beneficiaries aged 65 and older. Study findings indicate that even after controlling for known predictors of nursing home use, rural Medicare beneficiaries exhibited greater odds of nursing home residence and that the higher odds of rural nursing home residence are, in part, associated with higher rural nursing home bed supplies. A complex interplay of policy, LTSS infrastructure, and social, cultural, and other factors may be influencing the observed differences. Federal and state efforts to build rural HCBS capacity may be necessary to mitigate stubbornly persistent rural-urban differences in the patterns of institutional and community-based LTSS use.
This study examined associations between state Medicaid telehealth policies and telebehavioral health (TBH) use among rural fee-for-service (FFS) beneficiaries with behavioral health needs and assessed relationships between beneficiary characteristics and TBH use. Data sources included the 2011 Medicaid Analytic eXtract, the Area Health Resources File, and a 2011 survey on state-level Medicaid telehealth policies. Specific policies studied included telehealth-specific informed consent requirements and facility fee payments to sites hosting TBH users. Participants included 70,459 rural FFS Medicaid beneficiaries who used outpatient behavioral health services; lived within 36 states whose Medicaid programs provided telehealth reimbursement in 2011; and who were not dually eligible for Medicare and Medicaid. Generalized estimating equations were used to examine how odds of TBH use were related to informed consent, facility fees, and the interaction between these variables after adjusting for covariates. Contrast analyses were performed to further specify the nature of the interaction. Although the overall prevalence of TBH use in the study sample was low (2.1%), TBH use was highest among beneficiaries with severe mental illness (3.2%), and those living in rural nonadjacent counties (2.6%) or in mental health professional shortage areas (2.2%). Where informed consent rules were present, the odds of TBH use were 327% greater among users in states that also had facility fees than for those in states without such fees (p Ͻ .0001). In the FFS Medicaid environment, engaging patients through informed consent within provider settings that receive facility fees may facilitate access to TBH services. Public Health Significance StatementUsing administrative claims data reflecting fee-for-service (FFS) Medicaid environments across multiple states, this study serves as an important reference for researchers and policymakers interested in understanding what policy levers support sustained use of telehealth services. Among rural Medicaid FFS beneficiaries with behavioral health needs, engaging patients through informed consent within provider settings that receive facility fees may facilitate improved access to telebehavioral health services.
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