abstract: 'In the United States (US) and elsewhere, residents of low resource areas

  face health-related disparities, and may experience different outcomes

  throughout times of severe economic flux. We aimed to identify

  individual (e.g. sociodemographic) and environmental (e.g. region,

  rurality) factors associated with self reported health and forgone

  medical care due to the cost of treatment in the US across the Great

  Recession (2008-2009).

  We analyzed nationally representative data (2004-2010) using the

  Behavioral Risk Factor Surveillance System in the US. Individual and

  geospatial factors (rurality, census region) were used to identify

  differences in self-reported health and forgone medical care due to the

  cost.

  Adjusted-analyses taking into account individual and geospatial factors

  among those with incomes <\$50,000 identified multiple differences

  across time, sex, education, disability, rurality and Census Region for

  health. Similar analyses for forgone medical care found that those in

  the Recovery and the Recession were more likely to report forgone care

  than before the Recession. Having insurance and/or being employed

  (versus unemployed) was a protective factor in terms of reporting

  fair/poor health and having to forgo health care due to cost.

  Policies affecting improvements in health and access for vulnerable

  populations (e.g., low-income minority adults) are critical. Monitoring

  trends related to Social Determinants of Health, including the

  relationship between health and place (e.g. Census region, rurality), is

  necessary in efforts targeted towards ameliorating disparities. (C) 2017

  Elsevier Ltd. All rights reserved.'
affiliation: 'Towne, SD (Corresponding Author), Texas A\&M Univ, Sch Publ Hlth, Dept
  Hlth Promot \& Community Hlth Sci, College Stn, TX 77843 USA.

  Towne, Samuel D., Texas A\&M Univ, Sch Publ Hlth, Dept Hlth Promot \& Community
  Hlth Sci, College Stn, TX 77843 USA.

  Probst, Janice C., Univ South Carolina, South Carolina Rural Hlth Res Ctr, 220 Stoneridge
  Dr,Suite 204, Columbia, SC 29210 USA.

  Hardin, James W., Univ South Carolina, Dept Epidemiol \& Biostat, 915 Greene St,Room
  448, Columbia, SC 29208 USA.

  Bell, Bethany A., Univ South Carolina, Coll Social Work, Hamilton Coll 118, 1512
  Pendleton St, Columbia, SC 29208 USA.

  Glover, Saundra, Univ South Carolina, Inst Partnerships Eliminate Hlth Dispar, Discovery
  1, 915 Greene St, Columbia, SC 29208 USA.'
author: Towne, Samuel D. and Probst, Janice C. and Hardin, James W. and Bell, Bethany
  A. and Glover, Saundra
author-email: 'towne@sph.tamhsc.edu

  JPROBST@mailbox.sc.edu

  JHARDIN@mailbox.sc.edu

  BELLB@mailbox.sc.edu

  SGLOVER@mailbox.sc.edu'
author_list:
- family: Towne
  given: Samuel D.
- family: Probst
  given: Janice C.
- family: Hardin
  given: James W.
- family: Bell
  given: Bethany A.
- family: Glover
  given: Saundra
da: '2023-09-28'
doi: 10.1016/j.socscimed.2017.04.005
files: []
issn: 0277-9536
journal: SOCIAL SCIENCE \& MEDICINE
keywords: 'Health and place; Rural health; Recession; Access to care; Health

  disparities'
keywords-plus: 'RISK-FACTOR SURVEILLANCE; SERVICES UTILIZATION; MORTALITY; EXPANSIONS;

  BEHAVIORS'
language: English
month: JUN
number-of-cited-references: '57'
orcid-numbers: 'Hardin, James William/0000-0003-0506-5500

  Bell, Bethany/0000-0001-8225-6277

  Towne, Samuel/0000-0002-7310-5837'
pages: 30-44
papis_id: 17bfe5a1ed828384d39df665c29d3fdc
ref: Towne2017healthaccess
researcherid-numbers: 'Hardin, James William/P-4772-2019

  Bell, Bethany/AAV-6917-2021

  Towne, Samuel/AAE-1992-2021

  '
times-cited: '27'
title: 'Health & access to care among working-age lower income adults in the Great
  Recession: Disparities across race and ethnicity and geospatial factors'
type: article
unique-id: WOS:000402215400004
usage-count-last-180-days: '1'
usage-count-since-2013: '20'
volume: '182'
web-of-science-categories: 'Public, Environmental \& Occupational Health; Social Sciences,

  Biomedical'
year: '2017'