Appalachian health is among the worst in the country. Efforts to address the economic and social barriers to medical care have included increasing insurance access, establishment of rural clinics, and recruitment of outside physicians to the region. Rural areas outside Appalachia face similar concrete obstacles; yet, Appalachian health still lags behind its non-Appalachian rural counterparts. This study uses the Barriers to Help Seeking Scale to examine the health behaviors of undergraduates in regional Kentucky universities. Data indicate that students from rural Appalachian backgrounds are less likely to seek health care (P < .05), even with financial and other concrete barriers removed. In fact, cultural emphases on self-reliance (P = .007), resignation (P = .000), concrete barriers and distrust of caregivers (P = .000), and emotional control (P = .018) account for almost half of Appalachian reluctance to seek help (R2 = .477, P = .000). Appalachian health disparities cannot be completely addressed without increased awareness of these utilization concerns.

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