{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:01:20Z","timestamp":1789995680957,"version":"4.0.1"},"reference-count":37,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T00:00:00Z","timestamp":1786147200000},"content-version":"vor","delay-in-days":68,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Lung cancer screening enables earlier detection and improved outcomes, yet geographic inequities persist in access to low\u2010dose computed tomography (LDCT). We quantified tract\u2010level access to LDCT screening in Tennessee and examined disparities by rurality and Appalachian status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We compiled an inventory of LDCT\u2010capable sites and measured access using a 30\u2010min enhanced two\u2010step floating catchment area (E2SFCA) index with three banded decay weights. Access was compared across four strata (urban Appalachia, rural Appalachia, urban non\u2010Appalachia, and rural non\u2010Appalachia) using Kruskal\u2013Wallis and pairwise Wilcoxon tests (Holm adjustment). Rank\u2010based associations between E2SFCA and tract sociodemographics were evaluated using Spearman correlations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 198 LDCT sites in Tennessee. Urban residents account for 74.10% of those living within \u226420\u00a0min, whereas rural residents constitute the majority (63.50%) of the 30\u201345\u2010min band. Access differed across strata (Kruskal\u2013Wallis\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a0277.46,\n                      <jats:italic>p\u00a0<\/jats:italic>\n                      &lt;\u00a02.2\u00a0\u00d7\u00a010\n                      <jats:sup>\u221216<\/jats:sup>\n                      ): Medians (per 1000) were highest in urban non\u2010Appalachia (0.464) and urban Appalachia (0.430), and lower in rural Appalachia (0.210) and rural non\u2010Appalachia (0.197); all urban\u2013rural contrasts were significant. Regional patterns diverged: West Tennessee showed the largest coverage gap (13.9% zero\u2010access tracts), East Tennessee had the lowest capacity among served tracts (median\u00a0=\u00a00.339; overall median\u00a0=\u00a00.293), and Middle Tennessee showed the strongest overall access (overall median\u00a0=\u00a00.380; 73\/647 zero\u2010access; 11.3%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Rural communities face longer travel times to access LDCT screening sites with more zero\u2010access tracts than urban communities. Our findings support interventions such as adding service points in West Tennessee and expanding capacity in East Tennessee. Strengthening navigation and referral pathways for rural and Appalachian residents is also necessary.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.70202","type":"journal-article","created":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T09:58:42Z","timestamp":1786183122000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Geographic Access to Low\u2010Dose CT Lung Cancer Screening in Tennessee: Disparities by Socioeconomic Variables, Rurality, and Appalachian Status"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5217-5556","authenticated-orcid":false,"given":"Sima","family":"Namin","sequence":"first","affiliation":[{"name":"College of Medicine\u2014Knoxville Office of Research Support University of Tennessee Health Science Center  Knoxville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Whiteside","sequence":"additional","affiliation":[{"name":"Tennessee Department of Health Office of Cancer Surveillance  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1518-8072","authenticated-orcid":false,"given":"R. Eric","family":"Heidel","sequence":"additional","affiliation":[{"name":"College of Medicine\u2013Knoxville Department of Surgery University of Tennessee Health Science Center  Knoxville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5516-8578","authenticated-orcid":false,"given":"Jonathan S.","family":"Wall","sequence":"additional","affiliation":[{"name":"College of Medicine\u2013Knoxville Department of Medicine University of Tennessee Health Science Center  Knoxville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0902-0414","authenticated-orcid":false,"given":"Jennifer","family":"Ferris","sequence":"additional","affiliation":[{"name":"College of Medicine\u2014Knoxville Office of Research Support University of Tennessee Health Science Center  Knoxville Tennessee USA"},{"name":"College of Medicine\u2013Knoxville Department of Medicine University of Tennessee 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