Background Previous research suggests that certain populations, including rural residents, exhibit health care avoidant behaviors more frequently than other groups. Additionally, health care avoidance is related to sociodemographics, attitudes, social expectations, ability to pay for care, and prior experiences with providers. However, previous studies have been limited to specific geographic areas, particular health conditions, or by analytic methods. Methods The 2008 Health Information Trends Survey (HINTS) was used to estimate the magnitude of health care avoidance nationally and, while controlling for confounding factors, identify groups of people in the US who are more likely to avoid health care. Chi-square procedures tested the statistical significance (P < .05) of bivariate relationships. Multivariable analysis was conducted through a weighted multiple logistic regression with backward selection. Results For 6,714 respondents, bivariate analyses revealed differences (P < .05) in health care avoidance for multiple factors. However, multiple regression reduced the set of significant factors (P < .05) to rural residence (OR=1.69), male sex (OR=1.24), younger age (18-34 years OR=2.34; 35-49 years OR=2.10), lack of health insurance (OR=1.43), lack of confidence in personal health care (OR=2.24), lack of regular provider (OR=1.49), little trust in physicians (OR=1.34), and poor provider rapport (OR=0.94). Conclusion The results of the current study will help public health practitioners develop programs and initiatives targeted and tailored to specific groups, particularly rural populations, which seek to address avoidant behavior, thereby reducing the likelihood of adverse health outcomes.

Completion of the Human Papillomavirus (HPV) vaccine series is a national priority. This study not only identified correlates of intent to complete the vaccine series and actual series completion, but also tested the efficacy of a DVD intervention to promote series completion. Women's beliefs that all three doses reduced cancer risk predicted intent and completion. Intention predicted completion, as did the belief that having a friend accompany the woman would promote completion. Beyond these effects, women assigned to the intervention were 2.44 times more likely than women in the control group to complete the series. Thus, in controlled analyses, a theory-grounded DVD intervention successfully promoted HPV series completion in a community setting. This method of intervention has high translational potential.

The purpose of this study was to examine human papillomavirus (HPV) knowledge and vaccine acceptability in a convenience sample of immigrant Hispanic men, many of whom are parents of adolescents. Data on 189 male callers were collected from the National Cancer Institute’s Cancer Information Service Spanish-language call center. Most participants were willing to vaccinate their adolescent son (87.5 %) or daughter (78.8 %) against HPV. However, among this sample, awareness of HPV was low and knowledge of key risk factors varied. These findings can help guide the development of culturally informed educational efforts aimed at increasing informed decision-making about HPV vaccination among Hispanic fathers.

Appalachians experience increased rates of cancer incidence and mortality and high-risk health behaviors. Additionally, Appalachians are often characterized by lower socioeconomic status, geographic isolation, and cultural beliefs such as fatalism. The purpose of this descriptive analysis is to identify cancer-related risk perceptions, beliefs, and physician avoidance behaviors among Appalachians as compared with non-Appalachians using data from the National Cancer Institute's 2008 Health Information National Trends Survey (HINTS), which contained a newly created "Appalachia" variable. Results suggest that compared with non-Appalachians, Appalachians have a significantly higher perceived risk of developing cancer in the future and are significantly more likely to associate cancer with death; believe individuals can tell they have cancer before a diagnosis; believe everything causes cancer; and admit to avoiding their physician even when they suspect they should plan a visit. Both Appalachians and non-Appalachians share similar mistaken beliefs about cancer prevention, screening, and curability, and frustration over the abundance of cancer prevention recommendations. In a geographic region recognized for cancer health disparities, development of tailored communication strategies and educational interventions designed to increase cancer knowledge may help to accurately explain cancer risk and incidence, dispel negative cancer beliefs, and promote a positive image of the doctor-patient relationship.

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