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.
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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