{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T02:40:19Z","timestamp":1792118419403,"version":"4.4.0"},"reference-count":55,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Many individuals with chronic obstructive pulmonary disease (COPD) who continue to use tobacco do not receive the key intervention of tobacco dependence treatment (TDT). Rurality and drive time to health care services may affect the provision of TDT.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine associations of rurality and drive time to care with provision of TDT among individuals with COPD.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study included individuals with COPD who received care from Veterans Affairs (VA) between January 2012 and December 2019. Administrative data from the Veterans Health Administration were used. Individuals with at least 2 encounters with International Classification Disease <\/jats:italic>codes for COPD and current tobacco use were included. Data analysis was conducted in October 2023.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Rural vs urban home address and drive time to closest VA pulmonary specialty care facility using individual geocoded addresses.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The main outcome was prescription of TDT pharmacotherapy and\/or counseling. Multivariable logistic regression models were used to assess associations of rurality and drive time with prescription of TDT.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 238\u202f433 individuals with COPD and current tobacco use, the mean (SD) age was 64.1 (9.8) years; 81\u202f189 (93.9%) were male; 2560 (1.1%) were American Indian or Alaska Native, 34\u202f230 (14.3%) were Black or African American, and 185\u202f791 (77.9%) were White. Overall, 97\u202f253 (40.8%) lived in a rural area, and 65\u202f105 (27.4%) had drive times of 61 minutes or longer. Overall, TDT was prescribed to 86\u202f469 individuals (36.3%), but combined pharmacotherapy and counseling only to 10\u202f302 (4.3%). Prescription of any TDT decreased with longer drive times to the closest pulmonary care (eg, 42\u202f324 of 111\u202f126 individuals [38.1%] with drive times \u226430 minutes; 4689 of 14\u202f455 individuals [32.4%] with drive times &amp;gt;120 minutes). In models adjusted for sociodemographic characteristics (age, race and ethnicity, sex, and Area Deprivation Index) and comorbidities, individuals living in a rural area had lower probability of TDT compared with their urban counterparts (34.7% [95% CI, 34.4%-35.0%] vs 37.0% [95% CI, 36.7%-37.2%]). Prescription of TDT steadily decreased from drive time of 30 minutes or less (37.3% [95% CI, 37.0%-37.6%]) to drive times longer than 120 minutes (32.8% [95% CI, 32.1%-33.6%]).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study of individuals with COPD who smoke, the overall provision of TDT\u2014arguably the most important of all COPD interventions\u2014was low. Additionally, rural residence and longer drive time to specialty care were associated with lower likelihood of receiving TDT. These findings highlight the need to address TDT for all individuals with COPD, especially those facing geographic disparities, to improve health outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.28898","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T15:00:28Z","timestamp":1756220428000},"page":"e2528898","source":"Crossref","is-referenced-by-count":8,"title":["Geographic Disparities by Rural-Urban Status and Drive Time to Care in Tobacco Treatment for COPD"],"prefix":"10.1001","volume":"8","author":[{"given":"Arianne K.","family":"Baldomero","sequence":"first","affiliation":[{"name":"Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota"},{"name":"Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota Medical School, Minneapolis"},{"name":"Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne C.","family":"Melzer","sequence":"additional","affiliation":[{"name":"Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota"},{"name":"Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota Medical School, Minneapolis"},{"name":"Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken M.","family":"Kunisaki","sequence":"additional","affiliation":[{"name":"Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota"},{"name":"Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota Medical School, Minneapolis"},{"name":"Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris H.","family":"Wendt","sequence":"additional","affiliation":[{"name":"Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota"},{"name":"Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota Medical School, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orly","family":"Vardeny","sequence":"additional","affiliation":[{"name":"Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota"},{"name":"College of Pharmacy, University of Minnesota, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hildi J.","family":"Hagedorn","sequence":"additional","affiliation":[{"name":"Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota"},{"name":"Department of Psychiatry, University of Minnesota Medical School, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven S.","family":"Fu","sequence":"additional","affiliation":[{"name":"Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota"},{"name":"Department of Medicine, University of Minnesota Medical School, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Adams","family":"Dudley","sequence":"additional","affiliation":[{"name":"Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota"},{"name":"Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota Medical School, Minneapolis"},{"name":"Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"issue":"1","key":"zoi250813r1","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1378\/chest.13-0809","article-title":"COPD surveillance\u2014United States, 1999-2011.","volume":"144","author":"Ford","year":"2013","journal-title":"Chest"},{"issue":"1","key":"zoi250813r2","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1378\/chest.14-0972","article-title":"Total and state-specific medical and absenteeism costs of COPD among adults aged = 18 years in the United States for 2010 and projections through 2020.","volume":"147","author":"Ford","year":"2015","journal-title":"Chest"},{"issue":"5","key":"zoi250813r4","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1164\/rccm.202407-1379CI","article-title":"Current smoker: a clinical COPD phenotype affecting disease progression and response to therapy.","volume":"211","author":"Celli","year":"2025","journal-title":"Am J Respir Crit Care Med"},{"issue":"9434","key":"zoi250813r5","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1016\/S0140-6736(04)16855-4","article-title":"Burden and clinical features of chronic obstructive pulmonary disease (COPD).","volume":"364","author":"Pauwels","year":"2004","journal-title":"Lancet"},{"issue":"4","key":"zoi250813r7","doi-asserted-by":"publisher","first-page":"233","DOI":"10.7326\/0003-4819-142-4-200502150-00005","article-title":"The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial.","volume":"142","author":"Anthonisen","year":"2005","journal-title":"Ann Intern Med"},{"key":"zoi250813r8","doi-asserted-by":"crossref","DOI":"10.5888\/pcd19.220086","article-title":"Cigarette smoking among US adults with selected chronic diseases associated with smoking, 2010-2019.","volume":"19","author":"Loretan","year":"2022","journal-title":"Prev Chronic Dis"},{"issue":"3","key":"zoi250813r9","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00314-2024","article-title":"Low smoking exposure and development and prognosis of COPD over four decades: a population-based cohort study.","volume":"64","author":"\u00c7olak","year":"2024","journal-title":"Eur Respir J"},{"issue":"1","key":"zoi250813r10","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1183\/09031936.00092614","article-title":"Statement on smoking cessation in COPD and other pulmonary diseases and in smokers with comorbidities who find it difficult to quit.","volume":"46","author":"Jim\u00e9nez-Ruiz","year":"2015","journal-title":"Eur Respir J"},{"key":"zoi250813r11","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD002999","article-title":"Smoking cessation for chronic obstructive pulmonary disease.","author":"van de Meer","journal-title":"Cochrane Libr"},{"issue":"3","key":"zoi250813r12","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1159\/000398816","article-title":"Do we need tailored smoking cessation interventions for smokers with COPD? a comparative study of smokers with and without COPD regarding factors associated with tobacco smoking.","volume":"90","author":"van Eerd","year":"2015","journal-title":"Respiration"},{"issue":"3","key":"zoi250813r13","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1016\/j.rmed.2010.08.011","article-title":"Smoking prevalence, behaviours, and cessation among individuals with COPD or asthma.","volume":"105","author":"Vozoris","year":"2011","journal-title":"Respir Med"},{"issue":"2","key":"zoi250813r14","doi-asserted-by":"publisher","first-page":"e5","DOI":"10.1164\/rccm.202005-1982ST","article-title":"Initiating pharmacologic treatment in tobacco-dependent adults: an official American Thoracic Society Clinical Practice Guideline.","volume":"202","author":"Leone","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"issue":"3","key":"zoi250813r16","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD008286.pub3","article-title":"Combined pharmacotherapy and behavioural interventions for smoking cessation.","volume":"3","author":"Stead","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"issue":"4","key":"zoi250813r18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2003.11.002","article-title":"Integrating smoking cessation treatment into primary care: an effectiveness study.","volume":"38","year":"2004","journal-title":"Prev Med (Baltim)"},{"issue":"1","key":"zoi250813r19","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1111\/jrh.12525","article-title":"Health care disparities across the urban-rural divide: a national study of individuals with COPD.","volume":"38","author":"Gaffney","year":"2022","journal-title":"J Rural Health"},{"issue":"2","key":"zoi250813r20","doi-asserted-by":"publisher","first-page":"80","DOI":"10.7326\/0003-4819-155-2-201107190-00003","article-title":"Geographic isolation and the risk for chronic obstructive pulmonary disease-related mortality: a cohort study.","volume":"155","author":"Abrams","year":"2011","journal-title":"Ann Intern Med"},{"issue":"7","key":"zoi250813r21","doi-asserted-by":"publisher","first-page":"808","DOI":"10.1513\/AnnalsATS.201710-837OC","article-title":"Rural residence and chronic obstructive pulmonary disease exacerbations.","volume":"15","author":"Burkes","year":"2018","journal-title":"Ann Am Thorac Soc"},{"issue":"0 1","key":"zoi250813r22","doi-asserted-by":"publisher","first-page":"s62","DOI":"10.1111\/jrh.12005","article-title":"Rural-urban disparities in quality of life among patients with COPD.","volume":"29","author":"Jackson","year":"2013","journal-title":"J Rural Health"},{"key":"zoi250813r23","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.ypmed.2017.03.011","article-title":"A growing geographic disparity: rural and urban cigarette smoking trends in the United States.","volume":"104","author":"Doogan","year":"2017","journal-title":"Prev Med"},{"issue":"11","key":"zoi250813r24","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.40290","article-title":"Drive time and receipt of guideline-recommended screening, diagnosis, and treatment.","volume":"5","author":"Baldomero","year":"2022","journal-title":"JAMA Netw Open"},{"key":"zoi250813r25","doi-asserted-by":"publisher","DOI":"10.1016\/j.lana.2023.100597","article-title":"Guideline-discordant inhaler regimens after COPD hospitalization: associations with rurality, drive time to care, and fragmented care\u2014a United States cohort study.","volume":"26","author":"Baldomero","year":"2023","journal-title":"Lancet Reg Health Am"},{"key":"zoi250813r27","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1016\/j.jsat.2019.09.004","article-title":"Impact of implementing a tobacco and recreational nicotine-free policy and enhanced treatments on programmatic and patient-level outcomes within a residential substance use disorder treatment program.","volume":"107","author":"Hemmy Asamsama","year":"2019","journal-title":"J Subst Abuse Treat"},{"issue":"1","key":"zoi250813r28","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1186\/s12913-019-4574-3","article-title":"Algorithms to identify COPD in health systems with and without access to ICD coding: a systematic review.","volume":"19","author":"Gothe","year":"2019","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"zoi250813r29","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/s12874-018-0501-2","article-title":"Validating the use of veterans affairs tobacco health factors for assessing change in smoking status: accuracy, availability, and approach.","volume":"18","author":"Melzer","year":"2018","journal-title":"BMC Med Res Methodol"},{"issue":"1","key":"zoi250813r30","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/s12874-018-0501-2","article-title":"Validating the use of Veterans Affairs Tobacco Health Factors for assessing change in smoking status: accuracy, availability, and approach.","volume":"18","author":"Melzer","year":"2018","journal-title":"BMC Med Res Methodol"},{"issue":"26","key":"zoi250813r34","doi-asserted-by":"publisher","first-page":"2456","DOI":"10.1056\/NEJMp1802313","article-title":"Making neighborhood-disadvantage metrics accessible\u2014the Neighborhood Atlas.","volume":"378","author":"Kind","year":"2018","journal-title":"N Engl J Med"},{"issue":"11","key":"zoi250813r35","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.","volume":"43","author":"Quan","year":"2005","journal-title":"Med Care"},{"issue":"2","key":"zoi250813r37","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1111\/1475-6773.12712","article-title":"Log odds and the interpretation of logit models.","volume":"53","author":"Norton","year":"2018","journal-title":"Health Serv Res"},{"issue":"4","key":"zoi250813r38","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1056\/NEJMcp2032393","article-title":"Tobacco Addiction.","volume":"387","author":"Selby","year":"2022","journal-title":"N Engl J Med"},{"issue":"5","key":"zoi250813r39","doi-asserted-by":"publisher","first-page":"257","DOI":"10.3961\/jpmph.18.119","article-title":"National trends in smoking cessation medication prescriptions for smokers with chronic obstructive pulmonary disease in the United States, 2007-2012.","volume":"51","author":"Kwak","year":"2018","journal-title":"J Prev Med Public Health"},{"issue":"4","key":"zoi250813r40","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1002\/jhm.2519","article-title":"Utilization and effectiveness of pharmacotherapy for tobacco use following admission for exacerbation of COPD.","volume":"11","author":"Melzer","year":"2016","journal-title":"J Hosp Med"},{"issue":"5","key":"zoi250813r41","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1016\/j.amepre.2018.02.011","article-title":"Proactive tobacco treatment for smokers using Veterans Administration mental health clinics.","volume":"54","author":"Rogers","year":"2018","journal-title":"Am J Prev Med"},{"key":"zoi250813r42","doi-asserted-by":"publisher","article-title":"Smoking cessation for people with chronic obstructive pulmonary disease.","journal-title":"Cochrane Libr","DOI":"10.1002\/14651858.CD010744.pub2"},{"issue":"5","key":"zoi250813r43","doi-asserted-by":"publisher","first-page":"2038","DOI":"10.1016\/j.chest.2020.05.599","article-title":"Variation in patient smoking cessation rates among health-care providers: an observational study.","volume":"158","author":"Almaaitah","year":"2020","journal-title":"Chest"},{"issue":"9","key":"zoi250813r45","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1001\/jama.295.9.1042","article-title":"Shortages of medical personnel at community health centers: implications for planned expansion.","volume":"295","author":"Rosenblatt","year":"2006","journal-title":"JAMA"},{"issue":"11","key":"zoi250813r46","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.45995","article-title":"Clinician distribution and type in rural and urban areas of the National Health Services Corps.","volume":"7","author":"Baker","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"3","key":"zoi250813r47","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1016\/j.chest.2016.05.014","article-title":"Geographic accessibility of pulmonologists for adults with COPD: United States, 2013.","volume":"150","author":"Croft","year":"2016","journal-title":"Chest"},{"issue":"12","key":"zoi250813r48","doi-asserted-by":"publisher","first-page":"2843","DOI":"10.1007\/s11606-023-08118-2","article-title":"Challenges and recommendations for improving access to evidence-based COPD management among rural veterans: rural primary care provider perspectives.","volume":"38","author":"Wilson","year":"2023","journal-title":"J Gen Intern Med"},{"issue":"11","key":"zoi250813r49","doi-asserted-by":"publisher","first-page":"2079","DOI":"10.1007\/s11606-024-08834-3","article-title":"Clinician views of proactive tobacco treatment programs: a qualitative evaluation.","volume":"39","author":"Melzer","year":"2024","journal-title":"J Gen Intern Med"},{"key":"zoi250813r50","doi-asserted-by":"publisher","first-page":"2673","DOI":"10.2147\/COPD.S216274","article-title":"The attitudes of pulmonologists regarding smoking behavior of their patients with advanced COPD: a qualitative research.","volume":"14","author":"Mooren","year":"2019","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"issue":"6","key":"zoi250813r51","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1016\/S0091-7435(03)00044-6","article-title":"Distribution of daily smokers by stage of change: Current Population Survey results.","volume":"36","author":"Wewers","year":"2003","journal-title":"Prev Med"},{"issue":"8","key":"zoi250813r52","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.25326","article-title":"Trends in rural and urban cigarette smoking quit ratios in the US from 2010 to 2020.","volume":"5","author":"Parker","year":"2022","journal-title":"JAMA Netw Open"},{"key":"zoi250813r53","doi-asserted-by":"publisher","first-page":"S555","DOI":"10.1080\/14622200701673480","article-title":"Transdisciplinary Tobacco Use Research Center (TTURC) Tobacco Dependence. Time to first cigarette in the morning as an index of ability to quit smoking: implications for nicotine dependence.","volume":"9","author":"Barker","year":"2007","journal-title":"Nicotine Tob Res"},{"issue":"8","key":"zoi250813r54","doi-asserted-by":"publisher","DOI":"10.2196\/38663","article-title":"Proactive electronic visits for smoking cessation and chronic obstructive pulmonary disease screening in primary care: randomized controlled trial of feasibility, acceptability, and efficacy.","volume":"24","author":"Dahne","year":"2022","journal-title":"J Med Internet Res"},{"issue":"11","key":"zoi250813r55","doi-asserted-by":"publisher","first-page":"1412","DOI":"10.4187\/respcare.05445","article-title":"Inhaler Training Delivered by Internet-Based Home Videoconferencing Improves Technique and Quality of Life.","volume":"62","author":"Thomas","year":"2017","journal-title":"Respir Care"},{"key":"zoi250813r3","unstructured":"Murphy? SL, Xu? J, Kochanek? KD, Arias? E. Mortality in the United States, 2017. National Center for Health Statistics. Accessed August 6, 2025. https:\/\/www.cdc.gov\/nchs\/products\/databriefs\/db328.htm"},{"key":"zoi250813r6","unstructured":"US Department of Health and Human Services. The health consequences of smoking\u201450 years of progress: a report of the surgeon general. Accessed July 23, 2025. https:\/\/www.hhs.gov\/sites\/default\/files\/consequences-smoking-exec-summary.pdf"},{"key":"zoi250813r15","unstructured":"Tobacco Use and Dependence Guideline Panel. Treating Tobacco Use and Dependence: 2008 Update. US Department of Health and Human Services; 2008. Accessed July 23, 2025. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK63952\/"},{"key":"zoi250813r17","doi-asserted-by":"crossref","unstructured":"Patnode? CD, Henderson? JT, Melnikow? J, Coppola? EL, Durbin? S, Thomas? R. Interventions for Tobacco Cessation in Adults, Including Pregnant Women: An Evidence Update for the US Preventive Services Task Force. Agency for Healthcare Research and Quality (US); January 2021. Accessed July 23, 2025. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK567066\/","DOI":"10.1001\/jama.2020.23541"},{"key":"zoi250813r26","unstructured":"VA Information Resource Center. VIReC research users guide. Accessed July 23, 2025. https:\/\/www.virec.research.va.gov\/RUGs\/RUGs-Index.htm"},{"key":"zoi250813r31","unstructured":"US Department of Agriculture, Economic Research Service. Rural-urban community area codes, version 2010. Updated May 5, 2025. Accessed July 23, 2025. https:\/\/www.ers.usda.gov\/data-products\/rural-urban-commuting-area-codes\/"},{"key":"zoi250813r32","unstructured":"Geospatial Outcomes Division, VHA Office of Rural Health, U.S. Department of Veterans Affairs. Chapter 1: overview and location of VHA medical facilities. A Rural Veterans Health Care Atlas Series, 2nd ed. Published online 2015. Accessed July 28, 2025. https:\/\/web.archive.org\/web\/20230421135231\/https:\/\/www.ruralhealth.va.gov\/docs\/atlas\/CHAPTER_01_Overview_Location_Medical_Facilities.pdf\"https:\/\/www.ruralhealth.va.gov\/docs\/atlas\/CHAPTER_01_Overview_Location_Medical_Facilities.pdf\"?"},{"key":"zoi250813r33","unstructured":"US Department of Veterans Affairs. Estimating travel costs. Updated February 13, 2025. Accessed July 23, 2025. https:\/\/www.herc.research.va.gov\/include\/page.asp?id=travel-costs"},{"key":"zoi250813r36","unstructured":"National Institute of Mental Health. Mental illness. Updated September 2024. Accessed July 23, 2025. https:\/\/www.nimh.nih.gov\/health\/statistics\/mental-illness"},{"key":"zoi250813r44","unstructured":"US Centers for Disease Control and Prevention. Smoking cessation\u2014the role of healthcare professionals and health systems. Accessed July 23, 2025. https:\/\/www.cdc.gov\/tobacco\/sgr\/2020-smoking-cessation\/fact-sheets\/pdfs\/healthcare-professionals-health-systems-h.pdf"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2838027\/baldomero_2025_oi_250813_1755628381.60776.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T15:00:30Z","timestamp":1756220430000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2838027"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,26]]},"references-count":55,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.28898","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,26]]}}}