title: Health care avoidance among rural populations: results from a nationally representative survey.
abstract: BACKGROUND
  Previous research suggests that certain populations, including rural residents, exhibit health care avoidant behaviors more frequently than other groups. Additionally, health care avoidance is related to sociodemographics, attitudes, social expectations, ability to pay for care, and prior experiences with providers. However, previous studies have been limited to specific geographic areas, particular health conditions, or by analytic methods.
  
  
  METHODS
  The 2008 Health Information Trends Survey (HINTS) was used to estimate the magnitude of health care avoidance nationally and, while controlling for confounding factors, identify groups of people in the United States who are more likely to avoid health care. Chi-square procedures tested the statistical significance (P < .05) of bivariate relationships. Multivariable analysis was conducted through a weighted multiple logistic regression with backward selection.
  
  
  RESULTS
  For 6,714 respondents, bivariate analyses revealed differences (P < .05) in health care avoidance for multiple factors. However, multiple regression reduced the set of significant factors (P < .05) to rural residence (OR = 1.69), male sex (OR = 1.24), younger age (18-34 years OR = 2.34; 35-49 years OR = 2.10), lack of health insurance (OR = 1.43), lack of confidence in personal health care (OR = 2.24), lack of regular provider (OR = 1.49), little trust in physicians (OR = 1.34), and poor provider rapport (OR = 0.94).
  
  
  CONCLUSIONS
  The results of this study will help public health practitioners develop programs and initiatives targeted and tailored to specific groups, particularly rural populations, which seek to address avoidant behavior, thereby reducing the likelihood of adverse health outcomes.
authors.affiliation: Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Spleen
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Lengerich
authors.forename: Fabian T
authors.initials: FT
authors.lastname: Camacho
authors.forename: Robin C
authors.initials: RC
authors.lastname: Vanderpool
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States
keywords: HINTS; avoidance; health care; physician; utilization of health services