Rural-Urban Differences in Workers' Access to Paid Sick Leave.

Paid sick leave (PSL) is associated with health care access and health outcomes. The COVID-19 pandemic highlighted the importance of PSL as a public health strategy, yet PSL is not guaranteed in the United States. Rural workers may have more limited PSL, but research on rural PSL has been limited. We estimated unadjusted and adjusted PSL prevalence among rural versus urban workers and identified characteristics of rural workers with lower PSL access using the 2014-2017 Medical Expenditure Panel Survey. We found rural workers had lower access to PSL than urban workers, even after adjusting for worker and employment characteristics. Paid sick leave access was lowest among rural workers who were Hispanic, lacked employer-sponsored insurance, and reported poorer health status. Lower rural access to PSL poses a threat to the health and health care access of rural workers and has implications for the COVID-19 public health emergency and beyond.

Use of electronic health records to manage tobacco screening and treatment in rural primary care.

PURPOSE: Electronic health records (EHRs) can facilitate primary care providers' (PCPs) use of best practices in addressing tobacco dependence. It is unknown whether rural PCPs reap the same benefits as their urban counterparts when employing EHRs for this purpose. Our study examines this issue. METHODS: This cross-sectional investigation based on the 2012-2015 National Ambulatory Medical Care Survey used chi-square tests and adjusted logistic regression models to explore how rurality and use of tobacco-related EHR functions were related to smoking status documentation (SSD) and cessation treatment at adult primary care visits. FINDINGS: SSD rates were similar in visits to rural- and urban-based PCPs (88.2% rural-based vs 81.1% urban-based, P = .5819). Use of EHRs for SSD was associated with higher SSD odds at visits to both rural- and urban-based PCPs, but this increase was greater for visits to rural-based PCPs (428% vs 220% urban-based, P = .0443). Rates of cessation treatment at smokers' visits were low in rural and urban contexts (19.3% rural vs 19.6% urban, P = .9430). Odds of cessation treatment were 68% higher where EHRs were used to remind PCPs of treatment guidelines (P = .001), with no rural-urban difference in the size of the increase. Access to EHRs with tobacco-related functions was similar across rural and urban practices. CONCLUSIONS: Rural-based PCPs were at least as successful as urban-based PCPs in leveraging EHRs to enhance tobacco-related services. Even where EHRs are used, opportunities exist to expand cessation treatment in rural primary care.

Rural-urban residence and emergency contraception use, access, and counseling in the United States, 2006-2017.

OBJECTIVE: To estimate differences in emergency contraception (EC) use, access, and counseling by rural-urban residence among reproductive age women in the United States. STUDY DESIGN: We examined respondent data (2006-2017) from the National Survey of Family Growth for women ages 15-44 (n = 28,448) to estimate EC use, access, and counseling by rural-urban county of residence. Rural-urban prevalence ratios for EC outcome measures were estimated using predicted margins from logistic regression models, which were adjusted for demographic differences and current contraceptive method use. Changes in ever-use of EC over time were estimated for rural and urban respondents, separately, using Chi-square tests and trends were estimated using inverse variance weighted linear regression models. RESULTS: During 2006 to 2017, 10% of rural and 19% of urban women who had ever had sex reported ever using EC pills. Among rural women, ever-use increased from 6% in 2006-2008 to 15% in 2015-2017 (Chi-square p < 0.01; trend p-value < 0.01); among urban women, ever-use increased from 11% to 27% (Chi-square p < 0.01; trend p-value < 0.01). Rural and urban women were similarly likely to have obtained EC without a prescription and from a drug store. Rural women were less likely to have received EC counseling than urban women; however, counseling rates were low among all women. CONCLUSION: We observed differences in EC ever-use and receipt of EC counseling by rural-urban residence among US women ages 15 to 44, adding to the evidence that rural-urban residence is an important factor in reproductive health. More research is needed to explore factors contributing to rural-urban differences in EC use. IMPLICATIONS: Our key finding that EC use varied by rural-urban county residence offers additional evidence that rural-urban residence should be considered in reproductive health practice and policy. We discuss areas for future research into potential barriers to EC use in rural populations.