Rural Health Information Hub Latest News

Suicidal Thoughts, Plans, and Attempts by Non-Metropolitan and Metropolitan Residence

Suicidal Thoughts, Plans, and Attempts by Non-Metropolitan and Metropolitan Residence. Using 2010-2016 data from the National Survey on Drug Use and Health, researchers from the Rural and Underserved Health Research Center found that the overall mean prevalence of suicidal thoughts among adults was significantly higher for non-metropolitan and small metropolitan counties.  This page on the Rural Health Research Gateway contains links to additional research on illicit drug and opioid use disorders in rural areas.

Trends in Meeting Physical Activity Guidelines Among Urban and Rural Dwelling Adults

Trends in Meeting Physical Activity Guidelines Among Urban and Rural Dwelling Adults.  In its latest Morbidity and Mortality and Weekly Report, the Centers for Disease Control and Prevention finds that the prevalence for physical activity remains low, especially for some rural subgroups with high incidences of chronic diseases.  The report recommends incorporating culturally appropriate strategies into local, evidence-based programs might help communities build on recent progress.

SAMHSA Behavioral Health Barometer

SAMHSA Behavioral Health Barometer.  In this newly-released report, the Substance Abuse and Mental Health Services Administration (SAMSHA) provides a broad overview of behavioral health in metropolitan and nonmetropolitan areas of the U.S. with an emphasis on illicit drug, alcohol, and tobacco use, as well as the estimated percentage of people living with serious mental illness. The report includes a special focus on the misuse of prescription pain relievers, heroin use, and medication-assisted therapy (MAT) for opioid addiction.   Significant rural-metropolitan differences found include past-month cigarette use among teenagers (2.8 percent urban vs. 5.1 percent rural) and past-year serious mental illness among adults aged 18 or older (4.4 percent urban vs. 5.2 percent rural).

Binge Drinking and Prescription Opioid Misuse

Binge Drinking and Prescription Opioid Misuse.  Research published in the American Journal of Prescription Medicine examined the relationship between alcohol and drug use and found that prevalence of prescription opioid misuse was similar among nondrinkers, but was 3.5 times higher among binge drinkers (Binge drinking refers to consuming four or more drinks within a couple of hours).  The research measured differences by race, gender, income and rural-urban location. Among the findings: binge drinkers in rural areas have a higher prevalence of prescription opioid misuse than binge drinkers in urban areas.

2018 Detailed Population Estimates Released

New data are available from the U.S. Census Bureau which provide estimates of the July 1, 2018 population for the nation, states, and counties by age, sex, race, and Hispanic origin. The latest brief from the Pennsylvania State Data Center highlights statewide trends in Pennsylvania’s changing population. As of 2018, Pennsylvania’s fastest growing populations include the population age 65 and over, the Hispanic or Latino population, and the non-Hispanic Asian population. Click here to read more.

FCC Advances $100 Million Telehealth Initiative at Event in Appalachia

(June 19, 2019)  Laurel Fork, VA—FCC Commissioner Brendan Carr visited a community health care clinic in rural Laurel Fork, Virginia which sits in the southwest corner of the state.  Carr announced that the FCC will be voting at its July 10th meeting to advance a $100 million Connected Care Pilot Program to support telehealth for low-income Americans across the country, including those living in rural areas and veterans.  At the clinic, two patients with diabetes demonstrated how they are using remote monitoring technologies to improve their health.

With advances in telemedicine, health care is no longer limited to the confines of traditional brick and mortar health care facilities,” said Commissioner Carr.  “With an Internet connection, patients can now access high-quality care right on their smartphones, tablets, or other devices regardless of where they are located.  I think the FCC should support this new trend towards connected care, which is the healthcare equivalent of moving from Blockbuster to Netflix.  That’s why the FCC will vote to advance my $100 million pilot program at our July 10 meeting.  It will focus on ensuring that low-income Americans and veterans can access this technology.  Particularly in rural communities like Laurel Fork, where the nearest hospital is in a different state, access to telehealth can make a life-saving difference.”

In Laurel Fork, telehealth is already delivering results,” continued Carr.  “Diabetes patients here that participated in a remote telehealth program saw their A1C levels decline by 2.2 points on average, which significantly reduced their risk of renal disease, heart disease, and death caused by those conditions.  Through the Connected Care Pilot Program, the FCC can build on the success of projects like these, which are helping create a model for the adoption of connected care technologies and bridging the doctor divide in rural America.”

The FCC will vote on a Notice of Proposed Rulemaking at its July Open Meeting that seeks comment on:

  • Budgeting for $100 million in USF support for health care providers to defray the qualifying costs of connected care services for low-income patients, including people in medically underserved areas and veterans.
  • Targeting support for innovative pilot projects to respond to a variety of health challenges, including diabetes management, opioid dependency, high-risk pregnancies, pediatric heart disease, and cancer.
  • Providing an 85% discount on qualifying services for a three-year period with controls in place to measure and verify the benefits, costs, and savings associated with connected care technologies.
  • Collecting relevant data to enable stakeholders to better understand the impact of telehealth and consider broader reforms that can support the trend toward connected care.

Connected care has resulted in substantial savings, particularly in the management of chronic diseases, which account for over 85% of direct health care spending in the U.S.:

  • A remote patient monitoring trial in the Mississippi Delta resulted in nearly $700,000 in annual savings due to reductions in hospital readmissions alone.  Assuming just 20% of Mississippi’s diabetic population enrolled in this program, annual Medicaid savings in the state would be $189.
  • The Veterans Health Administration’s (VHA) remote patient monitoring program cost $1,600 per patient compared to more than $13,000 per patient for VHA’s home-based primary services.
  • A telehealth project in the Northeastern U.S. found that every $1 spent on remote monitoring resulted in a $3.30 return in savings.
  • Analysts estimate that the widespread use of remote patient technology and virtual doctor visits could save the American health care system $305 billion annually.

Connected care technologies are also improving health outcomes for patients:

  • A study of 20 remote patient monitoring trials found a 20% reduction in all-cause mortality and a 15% reduction in heart failure-related hospitalizations.
  • The VHA’s remote patient monitoring program resulted in a 25% reduction in days of inpatient care and a 19% reduction in hospital admission for more than 43,000 veterans with conditions like hypertension, congestive heart failure, chronic obstructive pulmonary disease, depression, and PTSD.
  • One remote patient monitoring initiative showed a 46% reduction in ER visits, a 53% reduction in hospital admissions, and a 25% shorter length of stay.


For press inquiries, contact Evan Swarztrauber at or (202) 418-2261.

Office of Commissioner Brendan Carr: (202) 418-2200

Twitter: @BrendanCarrFCC


Report: Pennsylvania employment strong, but job growth leaves regions, industries behind

UNIVERSITY PARK, Pa. — With the U.S. economy on track for potentially the longest expansion on record after the Great Recession of 2008-09, employment in Pennsylvania overall is strong. But the rosy statewide job numbers can mask persistent decline in various industries and regions across the state, according to economists in Penn State’s College of Agricultural Sciences.

Their conclusions are reflected in a report newly released by Penn State’s Center for Economic and Community Development, titled “Pennsylvania: Bust to Boom? Great Recession to Recovery & Beyond.” Through the liberal use of graphics, the report illustrates job growth and decline statewide and in five regions and 20 major industry sectors.

“While the Pennsylvania economy as a whole shows strength, it’s important to look at the distribution across the state,” said co-author Theodore Alter, professor of agricultural, environmental, and regional economics and the center’s co-director. “There’s a diversity of impact, and looking at the aggregate doesn’t give the correct picture.”Graphic on Pennsylvania employment numbers

The report’s findings mirror those of two companion reports on the geography of employment and population shifts — released by the center in 2018 and earlier this year, respectively — that showed a significant contrast between southeastern Pennsylvania, which enjoyed mainly job and population growth from 2000 to 2017, and the rest of the state, with primarily declines.

The trends woven through this trilogy of reports suggest the existence of “two Pennsylvanians,” noted co-author Theodore Fuller, development economist in the Department of Agricultural Economics, Sociology and Education.

“Employment change in Pennsylvania’s five regions over the 10 years [2008-2018] covered in this report ranged from solid growth in southeastern Pennsylvania to widespread decline in western counties, and a mix of growth and decline in central, northern and northeastern Pennsylvania,” Fuller said. “This pattern was most stark during the recession and recovery but continued into the post-recovery growth years of 2015 to 2018.”

As an example, he pointed out that the 15 counties designated as southeastern Pennsylvania gained 133,000 jobs from 2015 to 2018, with 80,000 of that increase coming in the five-county Philadelphia metropolitan statistical area. In contrast, the 19-county western region gained only 3,000 jobs. While employment increased by 16,000 in the seven-county Pittsburgh MSA during this period, the other western counties combined lost a net of 13,000 jobs.

Fuller added that two major industrial developments underway that soon could bolster job creation and stimulate the economy of western Pennsylvania are construction by Royal Dutch Shell of a natural gas “cracker” plant in Beaver County — expected to be operational in the early 2020s — and a $1 billion investment by U.S. Steel to upgrade its Mon Valley Works by 2022.

In addition to regional changes in employment, there were winners and losers among industries, the report showed. Manufacturing and retail trade were in the top three industries in total employment in 2018, but they lost, by far, the most jobs among the 20 major sectors between 2008 and 2018. Manufacturing employment fell by nearly 80,000 and retail trade jobs declined by more than 28,000 over the 10-year period. Other industries with significant job losses were wholesale trade and educational services.

On the other hand, the state’s largest employment sector, health care and social services, gained more than 165,000 jobs during 2008-2018. In 2018, almost one in five Pennsylvanians was employed in this sector. Other growth industries included accommodation and food services, transportation and warehousing, and professional and technical services.

Pennsylvania’s top employment sector, health care and social services, gained 165,000 jobs in the 10-year period ending in 2018, but the largest number of those jobs were categorized as low-wage positions.

However, employment change doesn’t tell the whole story, the researchers said. Examining the average weekly wages of the jobs gained and lost provides additional insight.  For instance, of all the jobs added in health care and social services between 2008 and 2018, by far the largest number were categorized as low-wage positions.

Across all the sectors analyzed, the greatest growth was in low-wage jobs, and the greatest losses came in middle-wage jobs, fueled by the decline in manufacturing employment.  “Since 2008, we’ve seen a hollowing out of that middle-wage area,” Alter said. “And that suggests widening inequality, which could have profound implications for Pennsylvania’s economy going forward.”

The report is available on the Center for Economic and Community Development website.

Other contributors to this report were undergraduate research associates Raymond Hoy, Nolan Martino and Tessa Sontheimer; and Cristy Halerz Schmidt, applied research educator, Center for Economic and Community Development, Penn State. The U.S. Department of Agriculture’s National Institute of Food and Agriculture supported this work.


New Resource: Management Methodologies and Value-Based Strategies: An Overview for Rural Health Care Leaders

The Rural Health Value team has released a new resource outlining eight commonly used change management methodologies that are rural-relevant. It is intended as a guide to help rural health care leaders identify which approach(es) might be most useful to them and their organizations.

Management Methodologies and Value-Based Strategies: An Overview for Rural Health Care LeadersOffers rural health leaders an overview of eight commonly used management methodologies to help guide change, plus additional resources and references for further exploration. (June 2019)

Top resources on the Rural Health Value website:

  • Value-Based Care Assessment – Assess capacity and capabilities to deliver value-based care. Receive an eight category readiness report.
  • Physician Engagement – Score current engagement and build effective relationships to create a shared vision for a successful future.
  • Board and Community Engagement – Hold value-based care discussions as part of strategic planning and performance measurement.
  • Social Determinants of Health – Learn and encourage rural leaders/care teams to address issues to improve their community’s health.

Contact information:

Keith J. Mueller, Ph.D.

Co-Principal Investigator

Rural health could be a powerful issue in the 2020 election

The views expressed by contributors are their own and not the view of The Hill

As former senators from rural states, we’ve seen firsthand the importance of providing affordable, quality care to those living in rural areas. The isolation that exists in some parts of South Dakota and Maine means residents have limited access to care.

Many patients must travel great distances to even reach a hospital. Yet more and more rural hospitals are closing around the country. In fact, 106 of them have shut down since 2010. It is staggering to think of these challenges when, compared to people living in urban and suburban areas, rural Americans are generally older and poorer, more uninsured or underinsured, and therefore less healthy.

Rural health is a bipartisan issue that greatly concerns all Americans. While it has never been a top tier issue on the campaign trail, we believe it could be a powerful topic in the 2020 election and demands attention by policymakers and candidates.

Our survey with the American Heart Association conducted by Morning Consult, shows that 92 percent of Democrats and 93 percent of Republicans consider access to rural health an important issue. Perhaps even more encouraging, three in five voters say they are more likely to endorse a candidate who makes access to rural health care a priority.

At a time when Democrats and Republicans agree on little, it is clear rural health transcends political parties. However, efforts by lawmakers to revive rural America have been largely unsuccessful in recent years. People living in remote areas continue to face greater disparities and barriers to high-quality health care than those in non-rural communities.

More than half of the rural voters polled say access to medical specialists, such as cardiologists, oncologists and gynecologists, is a problem in their local community, compared to 33 percent of non-rural voters, and more than one-quarter (27 percent) say it is difficult to access behavioral health professionals, compared to 16 percent of non-rural voters. Forty-seven percent of rural voters also agree access to quality health care is a challenge, compared to 34 percent of non-rural voters.

In addition to our national poll, we surveyed adults living in three rural states that will be important in the 2020 election: Iowa, North Carolina, and Texas. When it comes to accessing medical services or treatment, rural voters are more likely than urban and suburban voters to agree that appointment availability (56 vs. 50 percent) and the distance to receive care (50 vs. 37 percent) are obstacles.

Today, nearly 60 million Americans live in rural communities. Data from the Centers for Disease Control and Prevention show these residents have a greater risk of dying from heart disease, cancer, stroke, and chronic lower respiratory disease, and that should prompt candidates and policymakers alike, to take action.

Four policy options could help rural communities receive the quality care they deserve:

First, allow rural communities to adjust their health care services to better suit the needs of their local area. Critical Access Hospitals and other rural inpatient facilities need pathways to transform, in order to focus on emergency and outpatient services, and primary and prevention-focused care.

In Texas alone, 17 hospitals have closed in the past nine years. One in five Texas voters say it is difficult to access hospitals, urgent care facilities, primary care physicians, and medical specialists in their community.

Second, create new payment mechanisms for rural providers that account for low patient volumes, growing health care needs, and demographic trends in rural communities. Facilitate alternative payment and care delivery models that could help hospitals transition to value-based care.

Third, build and support a sustainable and diverse workforce. The patient-to-primary care physician ratio in urban areas is 53 physicians per 100,000 people, while rural areas have only 40 physicians for the same number of residents.  

Indeed, our survey shows that one in three rural adults in North Carolina — and 46 percent in Iowa — believe that access to medical specialists and quality health care are problems in their communities. New workforce models should be designed with universities and community health centers to expose providers to rural environments and telemedicine. Nurse practitioners, physician assistants, and pharmacists could also help fill vital primary care roles.

Fourth, expand telemedicine services to virtually connect patients with medical professionals. To be an effective tool, rural areas need adequate broadband and reimbursement for services.

Geography should never be an impediment to quality care. Tackling the barriers to delivering high-quality and efficient health care to rural America is long overdue. With the 2020 election campaign underway, candidates and policymakers have an opportunity to create a health care system that better serves all Americans.

Tom Daschle is a former Senate majority leader from South Dakota and a co-founder of the Bipartisan Policy Center.  Olympia Snowe is a former Senator from Maine and a BPC board member and senior fellow. They co-chair BPC’s Rural Health Task Force.   

CDC Information on Syringe Services Programs

CDC Information on Syringe Services Programs.  The Centers for Disease Control and Prevention (CDC) recently updated information they provide on community-based prevention programs that can provide a range of services, including linkage to substance use disorder treatment; access to and disposal of sterile syringes and injection equipment; and vaccination, testing, and linkage to care and treatment for infectious diseases.