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Using the records of 2,171 rural residents of Illinois who received inpatient treatment for mental illness or substance abuse, this paper examines factors that influence the tendency to seek service from a distant rather than a local hospital. Results indicate that the age and insurance coverage of the individual, the per capita income of the community area, surrogates for the service orientation of the local hospital and the proximity of the patient's residence to an urban center are significant influences. With the exceptions of drug abuse requiring detoxification or other symptomatic treatment, drug abuse accompanied by comorbidity and psychosocial disorders, psychosis, and childhood disorders, the primary diagnosis of the individual failed to have a significant effect on the propensity to bypass local sources of inpatient treatment.

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Health locus of control, the extent to which one believes he or she can affect his or her health status, usually is viewed as one of the factors that predisposes individuals to use medical services. However, some social theorists outside the area of utilization studies suggest that locus of control beliefs also are consequences of health-related behaviors and events such as utilization. The authors address this issue by investigating the relationship between health locus of control and utilization of medical services in a sample of 298 elderly community-dwellers surveyed at three points in time. They found that health locus of control was affected by serious medical care encounters and that, for two dimensions of health locus of control, there was a reciprocal relationship between control beliefs and utilization.

This paper explores the long-term effects of a nuclear accident on residents' perceptions of their physical and mental health, their trust of public officials, and their attitudes toward the future risks of nuclear power generation In their community. We find that in the period after the accident at Three Mile Island that there are constant or Increasing levels of distress reported by community residents. We conclude that the effects of a technological disaster may often be more enduring than those natural disaster and that greater research efforts should be made to Investigate the long-term consequences of man-made catastrophies of all types.

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The question whether the "Harry and Louise" campaign ads, sponsored by the Health Insurance Association of America (HIAA) during the 1993-1994 health care reform debate, influenced public opinion has particular relevance today since interest groups are increasingly choosing commercial-style mass media campaigns to sway public opinion about health policy issues. Our study revisits the issue of the Harry and Louise campaign's influence on public opinion, comparing the ad campaign's messages to changes in opinion about health care reform over a twenty-six-month period in Oklahoma. Looking at the overall trends just prior to the introduction of the Harry and Louise campaign, public opinion was going in the "wrong" direction, from the HIAA perspective. Moreover, public opinion continued in the wrong direction until the mid-point of the campaign. However, in either the turning point of the campaign in terms of message content and tone or in the lag period following it, public opinion reversed on each health reform issue and returned to pre-campaign levels. It appears from these findings that the campaign captured public opinion when support for issues that were unfavorable to HIAA members was increasing and turned public opinion back to pre-campaign levels. The campaign may result in many more such marriages of political interest groups and commercial advertisers for the purpose of demobilizing public support for health policy initiatives that are unfavorable to special interests.

With funding from the 21st Century Challenge Fund, the West Virginia Rural Health Access Program created Transportation for Health, a demonstration project for rural nonemergency medical transportation. The project was implemented in 3 sites around the state, building on existing transportation systems--specifically, a multicounty transit authority, a joint senior center/transit system, and a senior services center. An evaluation of the project was undertaken to answer 3 major questions: (1) Did the project reach the population of people who need transportation assistance? (2) Are users of the transportation project satisfied with the service? (3) Is the program sustainable? Preliminary results from survey data indicate that the answers to questions 1 and 2 are affirmative. A break-even analysis of all 3 sites begins to identify programmatic and policy issues that challenge the likelihood of financial sustainability, including salary expenses, unreimbursed mileage, and reliance on Medicaid reimbursement.