TY - JOUR
T1 - Disparities in Alcohol, Drug Use, and Mental Health Condition Prevalence and Access to Care in Rural, Isolated, and Reservation Areas
T2 - Findings From the South Dakota Health Survey
AU - Davis, Melinda M.
AU - Spurlock, Margaret
AU - Dulacki, Kristen
AU - Meath, Thomas
AU - Li, Hsin Fang Grace
AU - McCarty, Dennis
AU - Warne, Donald
AU - Wright, Bill
AU - McConnell, K. John
N1 - Publisher Copyright:
© 2015 National Rural Health Association.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - PURPOSE: 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.METHODS: 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.FINDINGS: 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.CONCLUSION: 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.
AB - PURPOSE: 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.METHODS: 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.FINDINGS: 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.CONCLUSION: 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.
KW - health disparities
KW - health services research
KW - mental health
KW - rural health
KW - substance use
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U2 - 10.1111/jrh.12157
DO - 10.1111/jrh.12157
M3 - Article
C2 - 26515583
AN - SCOPUS:84978505247
SN - 0890-765X
VL - 32
SP - 287
EP - 302
JO - The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association
JF - The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association
IS - 3
ER -