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Description of Study

Background and Overview of the Study:

  • Poverty rates and health disparities are among the highest in the Southern United States. Poor people in the South tend to die more from diseases like cancer, diabetes, and heart disease than people in other areas of the country.
  • People who are poor often have less knowledge of health risks and are less likely to protect themselves.  While there have been attempts to close these gaps, these attempts have generally not been successful.
  • Little research has been done to explain which health risks are worrisome to the poor and which they are more or less likely to do something about.  Little is also known about the barriers (for example, money or knowledge) that exist that prevent the poor from protecting themselves against risks. Additionally, researchers have studied only one risk at a time as opposed to studying how people make decisions among a wide variety of health risks (the focus of this study).

Research Goals and Design:

  • Our first goal was to understand what health risks worry people who are poor and their response to these risks.  We wanted to know about risks ranging from natural disasters and pandemic flu to cancer, arthritis and HIV.  Focus groups and interviews were held in the cities of Atlanta, Birmingham, and Jackson with White and African Americans.
  • Based on what people told us in the focus groups, we conducted a large phone survey (over 450 people) to find out more about why people respond to some health risks and not others even when they worried about them.  We also wanted more information about where people get information about health risks and how they process this information.


  • Focus groups revealed that participants think about risks in terms of their perception of control over those risks.  Risks such as car accidents and natural disasters people perceive they have no control over while risks such HIV/AIDS, alcohol and drug use people perceive total control over.  Chronic conditions (such diabetes, arthritis, cancer, heart disease) people perceive only some control over.  Still, individuals were most concerned about chronic conditions and the costs to treat these and other health conditions.
  • Personal & family experiences with risk influenced risk perceptions and feelings of control
  • Our phone survey revealed that low-income people were only somewhat worried about a wide variety of health risks.. They were worried most about cancer and car accidents. They were worried least about bird flu and HIV/AIDS.
  • Reported barriers to health protection behaviors: Family (72.5%), Insurance (61.2%), Money (51.5%), Knowledge (39.5%), Time (25%), Lack of Control (20.7%).
  • People rely primarily on interpersonal sources for health information including health professionals and family. 


This research contributes to existing scholarship on poverty and health disparities by illustrating that persistent poverty influences a wide variety of health risks and the decisions people make about how to address these risks. Our results show that the stressors of living in poverty (e.g. lack of money, time, competing demands, etc.) shape the decisions people make about how to manage existing conditions and their overall health. Campaigns targeted towards low-income individuals in the South should focus on increasing feelings of threat and worry, raise feelings of efficacy, and reduce barriers to engagement in health protection behaviors.



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