"Under-utilization of preventive health care services may result in failures to identify treatable health care problems and prevent potentially life-threatening diseases," says lead study author Michelle M. Casey, M.S., of the University of Minnesota Rural Health Research Center in Minneapolis.
Using a database assembled by the Centers for Disease Control and U.S. states on health behaviors, Casey and colleagues compared the urban and rural use of screening tests for colon, cervical and breast cancer, and vaccinations for the flu and pneumonia. They also analyzed a database on healthcare availability on a county-by-county basis.
In general, Americans are behind in receiving preventive services recommended by the American Cancer Society, the U.S. Preventive Services Task Force and the Healthy People 2010 national health goals. But residents from rural areas, even those adjacent to cities, are farther behind than urban residents, the researchers found.
The study results are published in the current issue of The American Journal of Preventive Medicine.
Flu and pneumonia vaccinations for those aged 65 or older were the only preventive services for which the researchers found no significant urban-rural differences. This may be because such vaccinations are covered by Medicare and are often available in pharmacies and clinics as well as doctors' offices.
Cancer screens such as mammograms, by contrast, require specialists and specialized equipment that may be less accessible in rural areas. Rural access to preventive health care may also be hampered by long travel times to health care facilities. In addition, rural residents generally have lower incomes, and are more likely to be uninsured or to have insurance with high co-payments or deductibles for preventive services like mammographies, Pap tests and colon cancer screening tests.
Cultural differences may also play a role in the disparity in the use of preventive health services between urban and rural residents.
"Traditional rural values such as self-reliance, individualism, a preference for informal support networks and reluctance to seek medical care unless seriously ill may make rural residents hesitant to seek preventive services," Casey says.
The researchers recommended a three-step approach to encourage rural residents to obtain preventive care: reducing the cost of preventive services for low-income individuals lacking adequate insurance, increasing the number of rural healthcare providers and increasing the recognition among rural populations of the importance of preventive care.
This study was supported by the Office of Rural Health Policy, Health Resources and Services Administration.
The American Journal of Preventive Medicine, sponsored by the Association of Teachers of Preventive Medicine and the American College of Preventive Medicine, is published eight times a year by Elsevier Science. The Journal is a forum for the communication of information, knowledge and wisdom in prevention science, education, practice and policy. For more information about the Journal, contact the editorial office at 619-594-7344.
Posted by the Center for the Advancement of Health http://www.cfah.org. For more research news and information, go to our special section devoted to health and behavior in the "Peer-Reviewed Journals" area of Eurekalert!, http://www.eurekalert.org/restricted/reporters/journals/cfah/. For information about the Center, call Ira Allen, iallen@cfah.org 202-387-2829.
Journal
American Journal of Preventive Medicine