Health risk behaviors in insured and uninsured community health center patients in the rural US South

Jeffrey Klibert,K Bryant Smalley,Jacob Warren

doi:10.22605/rrh2123

Abstract

The impact of health behaviors on the leading causes of death across the USA has been well demonstrated. However, limited focus has been placed on the leading health risk behaviors of rural Federally-Qualified Health Center (FQHC) patients, a particularly underserved group. The current study was undertaken to examine the most common risk-taking behaviors of rural FQHC patients and to examine if risk-taking behaviors vary between insured and uninsured patients. A convenience sample of 199 patients was recruited at an FQHC in the rural US South. Participants completed a battery of demographic and health risk behavior assessments. The most common risk behaviors were eating fried foods, not eating five servings of vegetables per day, not eating three servings of fruit per day, drinking caloric beverages, not exercising regularly, not wearing a seatbelt, having sex without a condom and smoking. Uninsured patients were more likely to talk on their cell phones while driving (p<0.001), more likely to text while driving (p=0.007), more likely to have unprotected sex (p=0.004), more likely to drink alcohol (p=0.043) and more likely to not seek medical care when needed (p=0.005). Rural FQHC patients demonstrated high levels of behavioral and health risk-taking, including dietary-, exercise- and traffic-related risks, in a context where traditional prevention methods have failed to penetrate. Differences exist between insured and uninsured patients, indicating that the reasons behind behavioral risk-taking may be context-specific and need to be explored further to help identify intervention targets that are culturally and situationally appropriate for diverse rural groups.

Highlights

The impact of health behaviors on the leading causes of death across the USA has been well demonstrated
In a sequence of comprehensive examinations of behavioral risk-taking differences between rural and urban groups in 1998 National Health Interview Survey (NHIS) data, Patterson and colleagues found that tobacco use and heavy drinking were comparable or higher in rural settings, that seat belt use was lower in rural settings across all racial/ethnic groups, and that rural residents were less likely to engage in recommended levels of daily physical activity[8,9]
The Federally-Qualified Health Center (FQHC) clinic is located in a federally-recognized rural county that is both a Health Professional Shortage Area (HPSA) and a Medically Underserved Area (MUA)

Summary

Introduction

The impact of health behaviors on the leading causes of death across the USA has been well demonstrated. Behavioral interventions (frequently developed in urban research centers) sometimes fail to reach the populations most at need – populations that are rural and uninsured Both of these populations have repeatedly been demonstrated to have poorer health status and less access to regular physician services regardless of income level[5,6,7], and the need for interventions tailored to the unique cultural and contextual realities of these groups has been repeatedly articulated[8,9,10]. Because of the unique cultural realities of rural living such as increased religiosity, higher rates of poverty, lower access to care and more permissive attitudes toward substance use, differences in risk behaviors indicate the strong need for rural-focused interventions designed to reach populations most at-risk[11]. Because of the lower rates of health literacy and decreased access to care seen in uninsured populations, they represent an especially underserved group in all areas, but in rural settings[10]

Methods

Results

Conclusion