title: Update: health insurance and utilization of care among rural adolescents.
abstract: BACKGROUND
  Adolescence is critical for the development of adult health habits. Disparities between rural and urban adolescents and between minority and white youth can have life-long consequences.
  
  
  OBJECTIVE
  To compare health insurance coverage and ambulatory care contacts between rural minority adolescents and white and urban adolescents.
  
  
  METHODS
  Cross-sectional design using data from the 1999-2000 National Health Interview Survey, a nationally representative sample of US households. Analysis was restricted to white, black, and Hispanic children aged 12 through 17 (8,503 observations). Outcome measures included health insurance, ambulatory visit within past year, usual source of care (USOC), and well visit within past year. Independent variables included race, residence, demographics, facilitating/enabling characteristics, and need.
  
  
  RESULTS
  Across races, rural adolescents were as likely to have insurance (86.8% vs 87.7%) but less likely to report a preventive visit (60.1% vs 65.5%) than urban children; residence did not affect the likelihood of a visit or a USOC. Minority rural adolescents were less likely than whites to be insured, report a visit, or have a USOC. Most race-based differences were not significant in multivariate analysis holding constant living situation, caretaker education, income, and insurance. Low caretaker English fluency, limited almost exclusively to Hispanics, was an impediment to all outcomes.
  
  
  CONCLUSIONS
  Most barriers to care among rural and minority youth are attributable to factors originating outside the health care system, such as language, living situation, caretaker education, and income. A combination of outreach activities and programs to enhance rural schools and economic opportunities will be needed to improve coverage and utilization among adolescents.
authors.affiliation: Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA. jprobst@gwm.sc.edu
authors.forename: Janice C
authors.initials: JC
authors.lastname: Probst
authors.forename: Charity G
authors.initials: CG
authors.lastname: Moore
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Baxley
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000191:economics / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D015999:Multivariate Analysis; D009819:Office Visits / Q000191:economics / Q000706:statistics & numerical data; D011314:Preventive Health Services / Q000191:economics / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000191:economics / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data