Managing Exercise in Eating Disorder Treatment and Adapting Treatment for Athletes.

The United States (US) is home to over 45 million immigrants, representing 14% of the US population []. Although most immigrants tend to live in or around major cities, recent decades have seen a shift, with more settling in rural areas [, ]. Between 2000 and 2018, immigrants accounted for 37% of overall population growth in rural counties, mirroring their growth in urban counties []. While the population of US-born residents in most rural counties declined, rural immigrants tend to be low-wage, unskilled workers without college degrees, and are less likely to be naturalized citizens or have health insurance []. While existing literature has highlighted disparities among US immigrants, it has focused primarily on urban immigrants [–]. Focusing exclusively on urban immigrants’ healthcare needs overlooks the unmet healthcare needs, disparities, and challenges of rural immigrants who are at the intersection of these communities. Rural residents have lower life expectancy, poorer health status, and less access to quality healthcare services than urban residents [, ]. Existing disparities in rural healthcare and mortality are further exacerbated by increasing hospital and nursing home closures in rural communities [, ]. While immigration status is a major driver of unequal healthcare coverage throughout the US, immigrants in rural areas face additional challenges such as lower education, high poverty, limited broadband access, language access barriers or interpretation services, and transportation and distance barriers that their living in rural areas may compound [–]. These may disproportionately affect immigrants who are Black or Hispanic, have limited English proficiency, have chronic conditions/disabilities, or are undocumented. Most existing studies examining the experiences of rural immigrants are qualitative, focus on a specific ethnic group, or are limited to a particular city or region [, ]. We fill this gap by using five years of data from the National Health Interview Survey (NHIS 2019–2023) to assess utilization patterns and differences in access to care and self-reported health status between rural and urban immigrants.