Adolescents in mid-sized and rural communities: Foregone care, perceived barriers, and risk factors

Barbara A. Elliott, Jean T. Larson

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96 Scopus citations


Purpose To investigate the perceived health care needs, foregone care, barriers to care, and associated risk factors in a non-urban population of adolescents. Methods Tenth-grade students attending school and 15-17-year-old youth not attending school in a Midwestern county were surveyed or interviewed. Eighty-six percent provided usable data (n = 1948, 134 of whom were not in school). Nine focus groups (71 participants; 28 were not in school) were conducted in follow-up. Quantitative analysis included descriptive statistics, factor analysis, and logistic regression. Qualitative analysis of taped focus groups identified themes and interpreted findings. Results Although 91% had seen a physician in the past 2 years, 44% reported foregoing needed care in the last year. Barriers for specific health needs were: cost of care and lack of insurance coverage for injuries and illnesses; lack of knowledge, distrust, and stigma for depression; embarrassment and transportation for birth control and sexually transmitted infections (STIs); and not knowing where or how to access care for drug and alcohol use. Youth most likely to have foregone care included those involved with dangerous activities under peer pressure (1.8, CI: 1.44-2.13), sexual intercourse (1.4, CI: 1.25-1.67), marijuana use (1.4, CI: 1.17-1.67), anticipating parenthood before age 20 years (1.2, CI: 1.04-1.33), male gender (2.5, CI: 1.89-2.86) and perceiving good health (1.7, CI: 1.45-1.85). Conclusions Nearly half of this non-urban population (both in and out of school) reported foregoing needed care in the last year. The barriers to care include lack of information, lack of access, poor insurance coverage, parenting issues, and concern about confidentiality.

Original languageEnglish (US)
Pages (from-to)303-309
Number of pages7
JournalJournal of Adolescent Health
Issue number4
StatePublished - Oct 2004

Bibliographical note

Funding Information:
Funding for this project came from the Duluth-Superior Area Community Foundation, St. Louis County Health Department, and Minnesota Department of Health. In-kind support was also provided by the School of Medicine Duluth, Lutheran Social Services of Minnesota, First Plan of Minnesota, and the School Districts in St. Louis County. We are grateful for the assistance of many people in the completion of this project, especially Julie Burns, Jan Despot, Joan Gardner-Goodno, Ann Hyrkas, Anne Kinney, Nancy Ojard, Luzette Smargia, Larry Sundberg, and Vicki Topp. We also thank Kate Beattie for her statistical assistance. This project would not have been possible without the participation of the youth and schools in St. Louis County, and Lutheran Social Services' Outreach workers.


  • Access to care
  • Adolescent health care
  • Confidentiality
  • Risky behaviors
  • Rural health care
  • Unmet health needs


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