title: The impact of rural health care accessibility on cancer-related behaviors and outcomes.
abstract: BACKGROUND
  This research seeks to identify the relationship between economic factors related to the ability to receive and pay for health services and adverse cancer outcomes, as well as preventative screening and behavioral factors that influence the risk of cancer. We focus on the Northern High Plains region, where we are able to compare regions with extremely low access to health services with those with relatively high levels of access.
  
  
  OBJECTIVE
  This study aims to identify health disparities in rural communities, particularly among Native American populations, and, thereby, begin to determine the most effective means by which to deliver health services to areas where geography, economics, and culture might prevent traditional models of health delivery from providing sufficient incentives for the prevention of adverse cancer-related outcomes.
  
  
  METHODS
  The Health Care Accessibility Index (HCAI) is computed through the use of principal component analysis and includes economic variables as well as variables concerning institutional and geographic access to health care. Index values are then regressed onto cancer outcomes, cancer-prevention outcomes, and cancer-related risk, using weighted least squares and quantile regressions.
  
  
  RESULTS
  Counties with relatively poor access to health care (low HCAI) also have statistically (1) lower breast cancer screening rates, (2) higher smoking prevalence, (3) higher obesity prevalence, and (4) higher cancer-related mortality rates. Breast cancer screening is found to be especially sensitive to areas of low health accessibility.
  
  
  CONCLUSIONS
  Empirical results provide support for policy efforts to increase the accessibility of health care services that are targeted to areas with low mammography screening rates, high obesity rates, high smoking prevalence, as well as areas near Native American reservation territories.
authors.affiliation: Montana State University, P.O. Box 172920, Bozeman, MT, 59717-2920, USA, eric.belasco@montana.edu.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Belasco
authors.forename: Gordon
authors.initials: G
authors.lastname: Gong
authors.forename: Barbara
authors.initials: B
authors.lastname: Pence
authors.forename: Ethan
authors.initials: E
authors.lastname: Wilkes
mesh_terms: D005260:Female; D015438:Health Behavior / Q000208:ethnology; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000208:ethnology; D006801:Humans; D007198:Indians, North American; D008297:Male; D009369:Neoplasms / Q000208:ethnology / Q000628:therapy*; D015205:Northwestern United States; D017063:Outcome Assessment, Health Care; D025341:Principal Component Analysis; D019035:Rural Health Services