ArticleThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association2018
Rural and Appalachian Disparities in Neonatal Abstinence Syndrome Incidence and Access to Opioid Abuse Treatment.
Article in The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers, 1 of them a synthesis that pooled it.
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Who cites it
43 citing papers in PubMed, 1 synthesis or guideline pooled it, 94 citations in OpenAlex.
- The opioid and related drug epidemics in rural Appalachia: A systematic review of populations affected, risk factors, and infectious diseases.Substance abuse · 2020Pooled it
- The Impact of Remoteness on the Outcomes of Children With Prenatal Drug Exposure: A Population-Based Cohort Study.Journal of paediatrics and child health · 2026Article
- Site-randomised trial of a multilevel digital intervention to reduce maternal morbidity and mortality: a study protocol.BMJ open · 2025Article
- "There are only so many fires you can put out": nonprofit structural constraints on service delivery for pregnant and postpartum women who use drugs in Appalachian North Georgia.Harm reduction journal · 2025Article
- A study protocol for a site-randomized trial of a multi-level digital intervention to reduce maternal morbidity & mortality.medRxiv : the preprint server for health sciences · 2025Article
- Well-Child Visits and Immunization Encounters in South Carolina Medicaid: A 3-Year Retrospective Comparison Between Rural and Urban Children with a History of Neonatal Opioid Withdrawal Syndrome, 2006-2014.Healthcare (Basel, Switzerland) · 2025Article
- Rural-urban differences in substance use during pregnancy.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
- County-level neonatal opioid withdrawal syndrome rates and real-world access to buprenorphine during pregnancy: An audit ("secret shopper") study in Missouri.Drug and alcohol dependence reports · 2024Article
- Recent and lifetime maternal substance use: Rurality and economic distress.Research in nursing & health · 2023Article
- Breastfeeding Experiences in Women from Ten States Reporting Opioid Use Before or During Pregnancy: PRAMS, Phase 8.Maternal and child health journal · 2023Article
- Access to tablet injectable opioid agonist therapy in rural and smaller urban settings in British Columbia, Canada: a qualitative study.Substance abuse treatment, prevention, and policy · 2023Article
- How the rural risk environment underpins hepatitis C risk: Qualitative findings from rural southern Illinois, United States.The International journal on drug policy · 2023Article
- Cumulative barriers to retention in methadone treatment among adults from rural and small urban communities.Addiction science & clinical practice · 2022Article
- Individual, interpersonal, and neighborhood measures associated with opioid use stigma: Evidence from a nationally representative survey.Social science & medicine (1982) · 2022Article
- Development of opioid rapid response system: Protocol for a randomized controlled trial.Contemporary clinical trials · 2022Article
- A qualitative examination of recent increases in methamphetamine use in a cohort of rural people who use drugs.Drug and alcohol dependence · 2021Article
- Hemorrhagic stroke outcomes of KApSR patients with co-morbid diabetes and Alzheimer's disease.Annals of translational medicine · 2021Article
- Disparities in neonatal abstinence syndrome and health insurance status: A statewide study using non-claims real-time surveillance data.Paediatric and perinatal epidemiology · 2021Article
- Contraceptive Needs Among Women Recently Incarcerated at a Rural Appalachian Jail.Women's health reports (New Rochelle, N.Y.) · 2021Article
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveIncidence of neonatal abstinence syndrome (NAS) is increasing due to the rise in opioid use. Rural states like Kentucky have been disproportionally impacted by opioid abuse, and this study determines NAS burden nationally and in Kentucky while quantifying differences in access to care between Appalachian and non-Appalachian counties.
methodsNAS rates were calculated using National (2013) and Kentucky (2008-2014) National Inpatient Sample discharge data. Births were identified using International Classification of Diseases v9 code 779.5 and live birth codes V30.x-V38.x. Counties were classified as rural, micropolitan, or metropolitan using census data. Proximity analysis was conducted via mapping from ZIP code centroid to nearest opioid treatment facility. Distance to treatment facilities was calculated and then compared using nonparametric testing for counties by rural and Appalachian status.
resultsNAS cases tripled from 2008 to 2014 in Kentucky counties, with a 2013 NAS rate more than double the national NAS rate. Rural and Appalachian counties experienced an NAS increase per 1,000 births that was 2-2.5 times higher than urban/non-Appalachian counties, with a greater number of NAS births overall in Appalachian counties. All opioid treatment facility types were further from rural patients than micropolitan/metropolitan patients (P < .001), as well as further for Appalachians versus non-Appalachians (P < .001, all facility types).
conclusionsNAS burden disparately affects rural and Appalachian Kentucky counties, while treatment options are disproportionately further away for these residents. Policy efforts to increase NAS prevention and encourage opioid abuse treatment uptake in pregnant women should address rural and Appalachian disparities.
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