{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T15:32:58Z","timestamp":1782228778056,"version":"3.54.5"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["NHLBI U54 HL169191"],"award-info":[{"award-number":["NHLBI U54 HL169191"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["NHLBI U54 HL169191"],"award-info":[{"award-number":["NHLBI U54 HL169191"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["NHLBI U54 HL169191"],"award-info":[{"award-number":["NHLBI U54 HL169191"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["NHLBI U54 HL169191"],"award-info":[{"award-number":["NHLBI U54 HL169191"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["NHLBI U54 HL169191"],"award-info":[{"award-number":["NHLBI U54 HL169191"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["NHLBI U54 HL169191"],"award-info":[{"award-number":["NHLBI U54 HL169191"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["NHLBI U54 HL169191"],"award-info":[{"award-number":["NHLBI U54 HL169191"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["NHLBI U54 HL169191"],"award-info":[{"award-number":["NHLBI U54 HL169191"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["NHLBI U54 HL169191"],"award-info":[{"award-number":["NHLBI U54 HL169191"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Biol Sex Differ"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background and Aims<\/jats:title>\n            <jats:p>In the United States, cardiovascular disease (CVD) is the leading cause of death among both men and women; CVD and associated risk factors particularly affect women who live in rural areas. This mixed-methods analysis aims to explore cardiovascular health (CVH) risk factors and healthcare experiences among women in rural Georgia, to identify barriers to care, and to inform strategies for improving long-term health outcomes in rural communities.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A convergent mixed methods design was utilized to evaluate CVH prevalence and associated environmental risk factors among women living in rural GA. Quantitative data from 159 Georgia counties were analyzed to compare rural and urban rates of CVD-related conditions and healthcare provider availability. Comparative analyses were performed between counties, urban and rural areas, and on sex differences. Concurrently, semi-structured interviews were conducted with 56 women and 11 healthcare providers to explore knowledge of blood pressure (BP) management, access to preventive services, and barriers to care. Qualitative and quantitative findings were analyzed separately and integrated during interpretation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Rural counties have significantly higher prevalence of hypertension, obesity and stroke. General trends revealed higher rates of smoking, physical inactivity, and excessive alcohol consumption in rural counties compared to rates in urban counties of GA. Qualitative themes revealed affordability concerns, communication challenges between patients and providers, limited trust in telehealth, and the importance of delivering CVH education in community-based settings. Differences by age were also observed: younger women expressed less concern or awareness about CVH risks, while older women described greater engagement with care and health information. While the original aim included gaps in awareness and education, participants primarily described navigating systemic barriers across the care continuum.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Rural women face individual, provider, and structural barriers to cardiovascular health and care. This unique study identifies chronic disease disparities and risk factors, with a higher disease burden observed in rural counties. Contributing factors may include limited resources for promoting healthy lifestyle choices, and reduced access to healthcare providers. Integrated findings underscore the need for sex- and gender- informed, age-specific, and community tailored strategies that address both health system access, and communication to improve CVH outcomes in underserved rural populations.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s13293-025-00740-5","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T08:40:50Z","timestamp":1754901650000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A comprehensive mixed-methods analysis of women\u2019s cardiovascular health needs in Georgia, United States"],"prefix":"10.1186","volume":"16","author":[{"given":"Marlo","family":"Vernon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brianna","family":"McIndoe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Ryan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Behr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daria","family":"Ilatovskaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ananya","family":"Chakraborty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suma","family":"Yellamraju","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ara","family":"Idun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Sullivan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,11]]},"reference":[{"key":"740_CR1","doi-asserted-by":"publisher","first-page":"E84","DOI":"10.5888\/pcd19.220347","volume":"19","author":"F Coronado","year":"2022","unstructured":"Coronado F, et al. Global responses to prevent, manage, and control cardiovascular diseases. Prev Chronic Dis. 2022;19:E84.","journal-title":"Prev Chronic Dis"},{"key":"740_CR2","unstructured":"Shaver K. More adults in rural America are dying from cardiovascular diseases. 2024 November 15, 2024; Available from: https:\/\/www.heart.org\/en\/news\/2024\/11\/15\/more-adults-in-rural-america-are-dying-from-cardiovascular-diseases"},{"issue":"19","key":"740_CR3","doi-asserted-by":"publisher","first-page":"2145","DOI":"10.1161\/CIRCULATIONAHA.110.968792","volume":"124","author":"L Mosca","year":"2011","unstructured":"Mosca L, Barrett-Connor E, Wenger NK. Sex\/gender differences in cardiovascular disease prevention: what a difference a decade makes. Circulation. 2011;124(19):2145\u201354.","journal-title":"Circulation"},{"key":"740_CR4","unstructured":"Health GDoP, Heart. Disease. 2024 10\/3\/2024; Available from: https:\/\/dph.georgia.gov\/chronic-disease-prevention\/heart-disease#:~:text=Cardiovascular%20disease%20(CVD)%20is%20the,in%20Georgia%20due%20to%20CVD"},{"issue":"4","key":"740_CR5","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1016\/j.amepre.2023.11.009","volume":"66","author":"RC Woodruff","year":"2024","unstructured":"Woodruff RC, et al. Trends in cardiovascular disease mortality rates and excess deaths, 2010\u20132022. Am J Prev Med. 2024;66(4):582\u20139.","journal-title":"Am J Prev Med"},{"key":"740_CR6","unstructured":"Georgia Online Analytical Statistical Information System (OASIS). Mortality Web Query. 2024 1\/31\/2025 [cited 2025 1\/31]; Available from: https:\/\/oasis.state.ga.us\/"},{"key":"740_CR7","unstructured":"Association AH. The Facts about Women and Heart Disease. 2019; Available from: Www.goredforwomen.org. https:\/\/www.goredforwomen.org\/en\/about-heart-disease-in-women\/facts"},{"issue":"8","key":"740_CR8","doi-asserted-by":"publisher","first-page":"e347","DOI":"10.1161\/CIR.0000000000001209","volume":"149","author":"SS Martin","year":"2024","unstructured":"Martin SS, et al. 2024 heart disease and stroke statistics: A report of US and global data from the American heart association. Circulation. 2024;149(8):e347\u2013913.","journal-title":"Circulation"},{"key":"740_CR9","unstructured":"World Health Organization. Hypertension. 2023 16 March 2023; Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/hypertension"},{"key":"740_CR10","doi-asserted-by":"publisher","first-page":"117269","DOI":"10.1016\/j.atherosclerosis.2023.117269","volume":"384","author":"A Rajendran","year":"2023","unstructured":"Rajendran A, et al. Sex-specific differences in cardiovascular risk factors and implications for cardiovascular disease prevention in women. Atherosclerosis. 2023;384:117269.","journal-title":"Atherosclerosis"},{"issue":"4","key":"740_CR11","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1016\/S1751-4851(22)00151-9","volume":"26","author":"L National Heart","year":"2022","unstructured":"National Heart L, Institute B. Hypertensive disorders of pregnancy and future cardiovascular events. Nurs Women\u2019s Health. 2022;26(4):255\u201361.","journal-title":"Nurs Women\u2019s Health"},{"issue":"2","key":"740_CR12","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1007\/BF03086220","volume":"17","author":"AH Maas","year":"2009","unstructured":"Maas AH, Franke HR. Women\u2019s health in menopause with a focus on hypertension. Neth Heart J. 2009;17(2):68\u201372.","journal-title":"Neth Heart J"},{"issue":"3","key":"740_CR13","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1161\/HYPERTENSIONAHA.123.21354","volume":"81","author":"A Chaturvedi","year":"2024","unstructured":"Chaturvedi A, et al. Social determinants of health and disparities in hypertension and cardiovascular diseases. Hypertension. 2024;81(3):387\u201399.","journal-title":"Hypertension"},{"issue":"6","key":"740_CR14","doi-asserted-by":"publisher","first-page":"935","DOI":"10.1016\/j.amjcard.2010.11.012","volume":"107","author":"M Mujib","year":"2011","unstructured":"Mujib M, et al. Evidence of a heart failure belt in the southeastern united States. Am J Cardiol. 2011;107(6):935\u20137.","journal-title":"Am J Cardiol"},{"issue":"2","key":"740_CR15","first-page":"133","volume":"24","author":"SK Davis","year":"2014","unstructured":"Davis SK, et al. Social determinants of cardiovascular health among black and white women residing in stroke belt and buckle regions of the South. Ethn Dis. 2014;24(2):133\u201343.","journal-title":"Ethn Dis"},{"issue":"19","key":"740_CR16","doi-asserted-by":"publisher","first-page":"1471","DOI":"10.1161\/CIR.0000000000001139","volume":"147","author":"LS Mehta","year":"2023","unstructured":"Mehta LS, et al. Cardiovascular disease risk factors in women: the impact of race and ethnicity: A scientific statement from the American heart association. Circulation. 2023;147(19):1471\u201387.","journal-title":"Circulation"},{"issue":"10","key":"740_CR17","doi-asserted-by":"publisher","first-page":"e615","DOI":"10.1161\/CIR.0000000000000753","volume":"141","author":"RA Harrington","year":"2020","unstructured":"Harrington RA, et al. Call to action: rural health: A presidential advisory from the American heart association and American stroke association. Circulation. 2020;141(10):e615\u201344.","journal-title":"Circulation"},{"issue":"2","key":"740_CR18","first-page":"10","volume":"32","author":"FA Gary","year":"2021","unstructured":"Gary FA, et al. Medical mistrust among black women in America. J Natl Black Nurses Assoc. 2021;32(2):10\u20135.","journal-title":"J Natl Black Nurses Assoc"},{"issue":"4","key":"740_CR19","first-page":"295","volume":"22","author":"JF Kilanowski","year":"2017","unstructured":"Kilanowski JF. Breadth of the socio-ecological model. J Agromed. 2017;22(4):295\u20137.","journal-title":"J Agromed"},{"issue":"5","key":"740_CR20","doi-asserted-by":"publisher","first-page":"e18","DOI":"10.1161\/CIR.0000000000001078","volume":"146","author":"DM Lloyd-Jones","year":"2022","unstructured":"Lloyd-Jones DM, et al. Life\u2019s essential 8: updating and enhancing the American heart association\u2019s construct of cardiovascular health: A presidential advisory from the American heart association. Circulation. 2022;146(5):e18\u201343.","journal-title":"Circulation"},{"key":"740_CR21","unstructured":"About High Blood Pressure. 2025 January 15, 2025; Available from: https:\/\/www.cdc.gov\/high-blood-pressure\/about\/index.html#:~:text=High%20blood%20pressure%2C%20also%20called,that%20is%20higher%20than%20normal.%26;text=Your%20blood%20pressure%20changes%20throughout%20the%20day%20based%20on%20your%20activities"},{"key":"740_CR22","doi-asserted-by":"crossref","unstructured":"Rodgers JL et al. Cardiovascular risks associated with gender and aging. J Cardiovasc Dev Dis, 2019. 6(2).","DOI":"10.3390\/jcdd6020019"},{"key":"740_CR23","unstructured":"Georgia Online Analytical Statistical Information System (OASIS). Data Analytics Center. 2024 1\/31\/2025 [cited 2025 1\/31]; Available from: https:\/\/oasis.state.ga.us\/"},{"key":"740_CR24","unstructured":"Centers for Disease Control and Prevention. Interactive Atlas of Heart Disease and Stroke. [cited 2024 9\/30]; Available from: http:\/\/nccd.cdc.gov\/DHDSPAtlas"},{"key":"740_CR25","unstructured":"University of Wisconsin Population Health Institute. County health rankings & roadmaps. 2024 [cited 2024 9\/12\/]; Available from: https:\/\/www.countyhealthrankings.org"},{"key":"740_CR26","unstructured":"Georgia All-Payer Claims Database. Condition explorer. [cited 2024 10\/15]; Available from: https:\/\/apcd.georgia.gov\/condition-explorer"}],"container-title":["Biology of Sex Differences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13293-025-00740-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13293-025-00740-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13293-025-00740-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T23:12:09Z","timestamp":1757373129000},"score":1,"resource":{"primary":{"URL":"https:\/\/bsd.biomedcentral.com\/articles\/10.1186\/s13293-025-00740-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,11]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["740"],"URL":"https:\/\/doi.org\/10.1186\/s13293-025-00740-5","relation":{},"ISSN":["2042-6410"],"issn-type":[{"value":"2042-6410","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,11]]},"assertion":[{"value":"31 January 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 August 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This study received exempt approval (#2094391) from the Augusta University Institutional Review Board.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Ethics approval and consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}}],"article-number":"62"}}