title: Disparities in Alcohol, Drug Use, and Mental Health Condition Prevalence and Access to Care in Rural, Isolated, and Reservation Areas: Findings From the South Dakota Health Survey.
abstract: Research on urban/rural disparities in alcohol, drug use, and mental health (ADM) conditions is inconsistent. This study describes ADM condition prevalence and access to care across diverse geographies in a predominantly rural state.
  
  
  
  Multimodal cross-sectional survey in South Dakota from November 2013 to October 2014, with oversampling in rural areas and American Indian reservations. Measures assessed demographic characteristics, ADM condition prevalence using clinical screenings and participant self-report, perceived need for treatment, health service usage, and barriers to obtaining care. We tested for differences among urban, rural, isolated, and reservation geographic areas, controlling for participant age and gender.
  
  
  
  We analyzed 7,675 surveys (48% response rate). Generally, ADM condition prevalence rates were not significantly different across geographies. However, respondents in isolated and reservation areas were significantly less likely to have access to primary care. Knowledge of treatment options was significantly lower in isolated regions and individuals in reservation areas had significantly lower odds of reporting receipt of all needed care. Across the sample there was substantial discordance between ADM clinical screenings and participant self-reported need; 98.1% of respondents who screened positive for alcohol or drug misuse and 63.8% of respondents who screened positive for a mental health condition did not perceive a need for care.
  
  
  
  In a predominantly rural state, geographic disparities in ADM conditions are related to differences in access as opposed to prevalence, particularly for individuals in isolated and reservation areas. Educational interventions about ADM condition characteristics may be as important as improving access to care.
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.|Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon.
authors.forename: Melinda M
authors.initials: MM
authors.lastname: Davis
authors.affiliation: Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon.|Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon.
authors.forename: Margaret
authors.initials: M
authors.lastname: Spurlock
authors.affiliation: Center for Outcomes Research & Education, Providence Health & Services, Portland, Oregon.
authors.forename: Kristen
authors.initials: K
authors.lastname: Dulacki
authors.affiliation: Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon.
authors.forename: Thomas
authors.initials: T
authors.lastname: Meath
authors.affiliation: Center for Outcomes Research & Education, Providence Health & Services, Portland, Oregon.
authors.forename: Hsin-Fang Grace
authors.initials: HF
authors.lastname: Li
authors.affiliation: Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: Dennis
authors.initials: D
authors.lastname: McCarty
authors.affiliation: Master of Public Health Program, North Dakota State University, Fargo, North Dakota.
authors.forename: Donald
authors.initials: D
authors.lastname: Warne
authors.affiliation: Center for Outcomes Research & Education, Providence Health & Services, Portland, Oregon.
authors.forename: Bill
authors.initials: B
authors.lastname: Wright
authors.affiliation: Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon.|Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon.|Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: K John
authors.initials: KJ
authors.lastname: McConnell
mesh_terms: D001294:Attitude to Health; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000592:standards*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration*; D011203:Poverty / Q000706:statistics & numerical data; D015995:Prevalence; D012423:Rural Health; D012424:Rural Population / Q000706:statistics & numerical data*; D013023:South Dakota / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*
keywords: health disparities; health services research; mental health; rural health; substance use