title: Assessing the influence of health on rural outmigration in Alaska.
abstract: OBJECTIVE
  This formative study is intended to generate questions and hypotheses regarding the relationship between health and outmigration from Alaska's rural communities. This study is the first to provide perspectives of rural Alaskans in the context of health concerns and health care delivery as determinants of outmigration.
  
  
  METHODS
  The study collected secondary data through a comprehensive review of the literature and primary data through semi-structured interviews.
  
  
  METHODS
  The research design consisted of two iterative phases: a comprehensive review of published and gray literature relevant to rural health and migration in Alaska, and in-depth interviews with rural Alaskans who had recently moved from rural to urban settings. A total of 31 Alaskans aged 18+ from communities throughout the state were interviewed about the factors influencing their decision to move to an urban centre.
  
  
  RESULTS
  Three health-related determinants of outmigration from rural to urban Alaska emerged: (1) limited access to primary and specialized health care; (2) perceptions of health risks in rural communities; and (3) ripple effect migration of friends and family providing social support for rural Alaskans requiring health care. These determinants had disproportionate effects on young and female study participants.
  
  
  CONCLUSIONS
  We present data describing the growing influence of health concerns and health care delivery on outmigration in this underserved population, and conclude with recommendations for future avenues of research. Expanding the body of knowledge of the link between health and outmigration will provide rural Alaskans the opportunity to live and grow old in their own communities.
authors.affiliation: Institute for Circumpolar Health Studies, University of Alaska-Anchorage, 3211 Providence Drive, Anchorage, AK 99508, USA. afdld@uaa.alaska.edu
authors.forename: David
authors.initials: D
authors.lastname: Driscoll
authors.forename: Bruce
authors.initials: B
authors.lastname: Dotterrer
authors.forename: Jenny
authors.initials: J
authors.lastname: Miller
authors.forename: Hannah
authors.initials: H
authors.lastname: Voorhees
mesh_terms: D000328:Adult; D000413:Alaska; D004641:Emigration and Immigration / Q000639:trends*; D005260:Female; D006297:Health Services Accessibility; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D012196:Review Literature as Topic; D012424:Rural Population; D055815:Young Adult