California Health Interview Survey Data Research Articles

Unmet Mental Health Needs Among California Workers Since the Start of the COVID-19 Pandemic.

We sought to identify worker groups with high prevalence of unmet mental health needs to inform employer benefits programs and outreach to increase access to care. We conducted a repeated cross-sectional study to understand unmet mental health needs among workers since the start of the COVID-19 pandemic using California Health Interview Survey data from 2013-2021. In 2021, 23.4% (CI: 22.4-24.4) reported unmet mental health needs, an absolute increase of 3.9% from 2019. Relative increases were highest among workers in the information industries (prevalence ratio [PR]: 1.89, CI: 1.4-2.5) and older workers (PR: 1.27, CI: 0.9-1.8). Increases in needing help were not met with comparable increases in seeking care. Unmet mental health needs increased for California workers during the pandemic. Employers should dedicate resources and implement strategies to increase access to care and promote worker well-being.

Health and economic cost estimates of short-term total and wildfire PM2.5 exposure on work loss: using the consecutive California Health Interview Survey (CHIS) data 2015–2018

InstructionTo help determine the health protectiveness of government regulations and policies for air pollutant control for Americans, our study aimed to investigate the health and economic impacts of work loss...

CONDUCTING A COUNTYWIDE ALZHEIMER’S DISEASE AND RELATED DEMENTIAS CAREGIVER LANDSCAPE ANALYSIS

Abstract In Los Angeles County (LAC), approximately 1 in 5 caregivers provide care to older adults with dementia and cognitive impairment. By 2040, a projected 1.5 million Californians will be living with Alzheimer’s disease and related dementias, foreshadowing an unprecedented need for family caregivers across the state. In 2021, the LAC Department of Public Health launched the Centers for Disease Control and Prevention-funded LA BOLD initiative with the intent of developing a strategic plan to address dementia awareness and care in LAC, including improving local infrastructure for supporting unpaid family caregivers. To support this effort, LA BOLD commissioned the University of Southern California Family Caregiver Support Center to conduct a landscape analysis of the caregiver population in LAC. The analysis used a multi-method approach that included: primary analysis of community-based organization surveys, stakeholder interviews, focus groups with family caregivers, and secondary analyses of California Health Interview Survey and California Caregiver Resource Center System CareNav™ data and an environmental scan of best-practice caregiving models in use in other states. Results informed the development of three functional recommendations specific to LAC caregivers: 1) Leverage existing infrastructure to strengthen and build family caregiver services and supports; 2) Promote health care payer, provider, and system recognition of and support for family caregivers; and 3) Increase respite services for caregivers. This presentation highlights the methods and the findings from the landscape analysis, providing insights into the barriers and opportunities that a growing caregiver population of persons with dementia may pose to LAC.

Exploring the characteristics and health outcomes of working from home: Analysis of 2021 California Health Interview Survey data.

Working from home (WFH) may affect health behaviors and mental health. The coronavirus disease-2019 (COVID-19) pandemic saw many USemployees transition to WFH, which has persisted in various job sectors and significantly impacted employees. However, its effects on health outcomes have remained unclear. We aimed to explore the characteristics and health outcomes of, and health-related differences between, WFH and not-WFH groups. Using the 2021 California Health Interview Survey data, we analyzed health behaviors (smoking, alcohol consumption, and fruit-related nutrition) and the mental health status of 12,438 individuals using descriptive statistics, Pearson's χ2 test, and regressions. A total of 39% were WFH and 61% were not-WFH. Overall, the WFH group had worse health behaviors and mental health than the not-WFH group. Age was associated with smoking in both groups (WFH: b = 0.37; not-WFH: b = 0.35), but with fruit-related nutrition only in the WFH group. Household income and occupation were associated with alcohol consumption in both groups. Age (WFH: b = -1.58; not-WFH: b = -1.39), household income (WFH: b = -0.75; not-WFH: b = -0.34), and job duration (WFH: b = -0.34; not-WFH: b = -0.40) were associated with mental health in both groups; those who were younger and had lower household incomes and job durations had worse mental health. Health management is a clear necessity for the WFH group. Irrespective of WFH status, young workers with shorter than 5 years'job duration reported mental distress, highlighting a need for distress assessment and management for the young workforce.

Low-Income Asian Americans: High Levels Of Food Insecurity And Low Participation In The CalFresh Nutrition Program.

Little is known about food insecurity and the extent of Supplemental Nutrition Assistance Program (SNAP) participation in the heterogeneous Asian American population. Using California Health Interview Survey data from the period 2011-20, we examined both issues among low-income Asian American adults from six origin groups: Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese. We found high and varied levels of overall food insecurity, with the highest burden among Filipino adults (40percent). Food insecurity by severity was also heterogenous; very low food security affected 2percent of Chinese adults but 9percent and 10percent of Filipino and Japanese adults, respectively. Participation in CalFresh (California-implemented SNAP) ranged from 11percent and 12percent among Korean and Chinese adults, respectively, to 20percent among Vietnamese adults. Compared with English-proficient low-income Asian American adults, those with limited English proficiency were no less likely to participate in CalFresh, possibly reflecting language assistance required by California law and provided by community-based organizations. These results underscore the importance of collecting and reporting disaggregated data by Asian origin group that could inform targeted outreach and interventions.

Short-Term total and wildfire fine particulate matter exposure and work loss in California

BackgroundFew studies investigated the impact of particulate matter (PM2.5) on some symptom exacerbations that are not perceived as severe enough to search for medical assistance. We aimed to study the association of short-term daily total PM2.5 exposure with work loss due to sickness among adults living in California. MethodsWe included 44,544 adult respondents in the workforce from 2015 to 2018 California Health Interview Survey data. Daily total PM2.5 concentrations were linked to respondents’ home addresses from continuous spatial surfaces of PM2.5 generated by a geostatistical surfacing algorithm. We estimated the effect of a 2-week average of daily total PM2.5 exposure on work loss using logistic regression models. ResultsAbout 1.69% (weighted percentage) of adult respondents reported work loss in the week before the survey interview. The odds ratio of work loss was 1.45 (odds ratio [OR] = 1.45, 95% confidence interval [CI]: 1.03, 2.03) when a 2-week average of daily total PM2.5 exposure was higher than 12 µg/m3. The OR for work loss was 1.05 (95% CI: 0.98, 1.13) for each 2.56ug/m3 increase in the 2-week average of daily total PM2.5 exposure, and became stronger among those who were highly exposed to wildfire smoke (OR = 1.06, 95% CI: 1.00, 1.13), compared to those with lower wildfire smoke exposure (OR = 1.04, 95% CI: 0.79, 1.39). ConclusionsOur findings suggest that short-term ambient PM2.5 exposure is positively associated with work loss due to sickness and the association was stronger among those with higher wildfire smoke exposure. It also indicated that the current federal and state PM2.5 standards (annual average of 12 µg/m3) could be further strengthened to protect the health of the citizens of California.

Long-term air pollution exposures on type 2 diabetes prevalence and medication use

BackgroundType 2 diabetes has raised great public health concerns due to its association with the increased risk of several adverse health outcomes. We aimed to investigate the association of criteria air pollutants and traffic density with the prevalence of type 2 diabetes and antidiabetic medication use in California. MethodsA cross-sectional study was conducted using 2005 California Health Interview Survey (CHIS) data, linked with criteria air pollutant exposure measures, including government-monitored ozone (O3), particulate matter (PM10, PM2.5) and nitrogen dioxide (NO2), residential traffic density, and land use regression modeled NOX, NO, and NO2 estimates for Los Angeles County only based on the respondents’ geocoded residential addresses. Weighted logistic regression models were used to examine the influences of 36-month average exposures to each air pollutant and traffic density on diabetes prevalence and medication use. ResultsAmong 31,483 CHIS 2005 state-wide respondents, 6.7% of adults reported having been diagnosed with type 2 diabetes. We observed type 2 diabetes prevalence was positively associated with exposures to O3, PM10, and PM2.5, and with NO, NO2, and NOx only in Los Angeles County. For each 10ppb increase in O3 or 10ug/m3 increase in PM10 or PM2.5, the odds of taking any medication increased by 40%, 56%, and 50%; taking pills increased by 33%, 31%, and 41%; taking insulin increased by 43%, 53%, and 46%; and taking both insulin and pills increased by 70%, 60%, and 88%, respectively. When traffic density within 750 feet of a respondent's home increased by one interquartile, 7% increase in odds of using any medication and taking pills was also observed. ConclusionThis study adds to evidence indicating greater air pollution exposure is associated with increased diabetes prevalence. It also provides new evidence demonstrating a strong association between pollutant exposure and antidiabetic medication use in adult Californians.

Determinants of COVID-19 vaccine Hesitancy: 2020 California Health Interview Survey

Although the COVID-19 vaccine is a key intervention against the ongoing COVID-19 pandemic, vaccine hesitancy is a barrier to vaccination coverage, leading to a higher risk of COVID-19-related morbidity and mortality. To reduce vaccine hesitancy, the factors affecting it must be addressed. Based on the determinants of health approach, this study aimed to investigate whether the distribution of determinants of health differed between the vaccine hesitancy group and the vaccine acceptance group and to identify determinants of participants’ hesitancy to receive the COVID-19 vaccine if it was available. This study utilized the 2020 California Health Interview Survey Data collected between May and December 2020. Data were collected using a population-based web and telephone health survey. Data from 21,949 participants in California were included, and 4,183 (23.4 %) showed vaccine hesitancy. The following determinants were positively associated with vaccine hesitancy: female sex, Black and American Indian/Alaskan Native ethnicity, smoking, poverty, U.S.-born citizen, frequent use of social media, food insecurity, and limited healthcare access. Older age, not having severe psychological distress, not having diabetes, and high perceived safety in the neighborhood were negatively associated with COVID-19 vaccine hesitancy. This study also found that higher use of social media potentially threatened vaccine uptake, whereas frequent internet use was negatively associated with vaccine hesitancy. Public health and other relevant service providers should address the determinants of vaccine hesitancy and develop effective strategies and interventions for vaccine-hesitant groups.

Association of Cost-Driven Residential Moves With Health-Related Outcomes Among California Renters

Unaffordable housing is associated with adverse health-related outcomes, but little is known about the associations between moving due to unaffordable housing and health-related outcomes. To characterize the association of recent cost-driven residential moves with health-related outcomes. This cross-sectional study involved a weighted multivariable regression analysis of California Health Interview Survey data from January 1, 2011, to December 31, 2017. A population-based sample of 52 646 adult renters and other nonhomeowners in California were included. Data were analyzed from March 2, 2021, to January 6, 2023. Cost-driven moves in the past 3 years relative to no move and to non-cost-driven moves. Five outcomes were assessed: psychological distress (low, moderate, or severe, as categorized by the 6-item Kessler Psychological Distress Scale), emergency department [ED] visits in the past year (any vs none), preventive care visits in the past year (any vs none), general health (poor or fair vs good, very good, or excellent), and walking for leisure in the past 7 days (in minutes). Among 52 646 adult renters and other nonhomeowners, 50.3% were female, 85.2% were younger than 60 years, 45.3% were Hispanic, and 55.1% had income lower than 200% of the federal poverty level. Overall, 8.9% of renters reported making a recent cost-driven move, with higher prevalence among Hispanic (9.9%) and non-Hispanic Black (11.3%) renters compared with non-Hispanic White renters (7.2%). In multivariable models, compared with not moving, cost-driven moving was associated with a 4.2 (95% CI, 2.6-5.7) percentage point higher probability of experiencing moderate psychological distress; a 3.2 (95% CI, 1.9-4.5) percentage point higher probability of experiencing severe psychological distress; a 2.5 (95% CI, 0-4.9) percentage point higher probability of ED visits; a 5.1 (95% CI, 1.6-8.6) percentage point lower probability of having preventive care visits; a 3.7 (95% CI, 1.2-6.2) percentage point lower probability of having good, very good, or excellent general health; and 16.8 (95% CI, 6.9-26.6) fewer minutes of walking for leisure. General health, psychological distress, and walking for leisure were also worse with cost-driven moves relative to non-cost-driven moves, with a 3.2 (95% CI, 1.7-4.7) percentage point higher probability of experiencing moderate psychological distress; a 2.5 (95% CI, 1.2-3.9) percentage point higher probability of experiencing severe psychological distress; a 4.6 (95% CI, 2.1-7.2) percentage point lower probability of having good, very good, or excellent general health; and 13.0 (95% CI, 4.0-21.9) fewer minutes of walking for leisure. However, the incidence of preventive care and ED visits did not differ between those who made cost-driven vs non-cost-driven moves. In this study, cost-driven moves were associated with adverse health-related outcomes relative to not moving and to non-cost-driven moves. These findings suggest that policies to improve housing affordability, prevent displacement, and increase access to health care for groups vulnerable to cost-driven moves may have the potential to improve population health equity, especially during the current national housing affordability crisis.

Undocumented Latino Immigrants and the Latino Health Paradox

Despite having worse healthcare access and other social disadvantages, immigrants have, on average, better health outcomes than U.S.-born individuals. For Latino immigrants, this is known as the Latino health paradox. It is unknown whether this phenomenon applies to undocumented immigrants. This study used restricted California Health Interview Survey data from 2015 to 2020. Data were analyzed to test the relationships between citizenship/documentation status and physical and mental health among Latinos and U.S.-born Whites. Analyses were stratified by sex (male/female) and length of U.S. residence (<15 years/>= 15 years). Undocumented Latino immigrants had lower predicted probabilities of reporting any health condition, asthma, and serious psychological distress and had a higher probability of overweight/obesity than U.S.-born Whites. Despite having a higher probability of overweight/obesity, undocumented Latino immigrants did not have probabilities of reporting diabetes, high blood pressure, or heart disease different from those of U.S.-born Whites after adjusting for having a usual source of care. Undocumented Latina women had a lower predicted probability of reporting any health condition and a higher predicted probability of overweight/obesity than U.S.-born White women. Undocumented Latino men had a lower predicted probability of reporting serious psychological distress than U.S.-born White men. There were no differences in outcomes when comparing shorter- with longer-duration undocumented Latino immigrants. This study observed that the Latino health paradox may express patterns for undocumented Latino immigrants that are different from those for other Latino immigrant groups, emphasizing the importance of accounting for documentation status when conducting research on this population.

Increases in Prevalent Depressed Mood and Suicidal Ideation among Workers during the COVID-19 Pandemic-Findings from the California Health Interview Survey.

Limited data exist on COVID-19's mental health impact on non-healthcare workers. We estimated the prevalence of depressed mood and suicidal ideation experienced in the past year among California workers and assessed whether the prevalence changed during the COVID-19 pandemic. We analyzed 2013-2020 California Health Interview Survey data using survey-weighted methods to assess the change in the prevalence of depressed mood and suicidal ideation from 2019 to 2020 for working adults by demographics and occupational groups. We used trend-adjusted quasi-Poisson regressions and report rate ratios (RR), comparing the prevalence of outcomes during 2020 to the pre-pandemic period (2013-2019). We identified priority occupation groups with a higher-than-average outcome prevalence in 2020 and rate increases after adjusting for pre-pandemic trends. Our analysis included 168,768 respondents, of which 65% were workers. Production and service workers were the priority occupation groups for depressed mood (RR: 1.46, CI: 1.1-1.9; RR: 1.23, CI: 1.1-1.4) and suicidal ideation (RR: 1.86, CI: 1.0-3.6; RR: 1.47, CI: 1.1-1.9). Workers aged 45-65 years experienced over a 30% relative increase in both outcomes from 2019 to 2020. Depressed mood and suicidal ideation in the past year increased for production, service, and older workers during the pandemic. These groups should be considered for mental health interventions.

Race and Ethnicity Differences in Walking and Associations with Neighborhood Perceptions among Older Adults in California.

This paper estimates differences in walking and associations of walking with neighborhood perceptions among older adults in California. We analyzed the restricted-use California Health Interview Survey data merged with the American Community Survey data. Walking at least 10minutes for leisure in the last 7days and number of minutes walked were regressed on perceived neighborhood social cohesion scale (PNSCS) and neighborhood socioeconomic characteristics. We estimated ordinary least squares regression models. We found that positive neighborhood perceptions were significantly (p< 0.05) associated with walking among older Hispanic and Asian adults. Older Hispanic adults with above median PNSCS report that they walk 6.3 percentage points more than Non-Hispanic White adults. Older adults' perceptions of their neighbors and neighborhoods are positively correlated with walking. Policymakers can consider ways to improve neighborhood perceptions and relationships to help increase walking among minority older adults especially in low SES neighborhoods.

Informing California's Plan to Enhance HIV Screening in the Ending the HIV Epidemic Initiative.

The CDC recommends that everyone have at least one HIV test in their lifetime. However, analyses of California Health Interview Survey data showed that in 2017 only half of Californians had ever received an HIV test. Non-Hispanic Black (64.8%) and Hispanic adults (54.7%) had higher lifetime testing rates than non-Hispanic White adults (48.8%). In multivariable analyses non-Hispanic African American adults had twice and Hispanic adults 1.2 times the odds of lifetime HIV testing as non-Hispanic White adults. The CDC recommends annual HIV testing for higher-risk individuals. Independent of race/ethnicity, heterosexual men with multiple sex partners had lower annual testing rates than other high-risk individuals. Annual testing was unrelated to education level and poverty, but was related to number of doctor visits. HIV screening rates among heterosexual men with multiple partners could be increased by targeting HIV screening to non-medical settings in California's eight Ending the HIV Epidemic counties.

Behavioral Health Services use Among Racial and Ethnic Groups: Results from the California Health Interview Survey (CHIS).

Access and utilization of behavioral health services is a public health issue, yet disparities among racial/ethnic groups persist, resulting in fewer access points and lower utilization. Using pooled 2015 and 2016 California Health Interview Survey (N = 42,089) data of diverse adults, this study examines provider access points for behavioral health services use. Latinx (OR = 0.55, 95% CI, 0.38-0.80), Asian (OR = 0.32, 95% CI, 0.17-0.59), and first generation (OR = 0.56, 95% CI, .38-.83) individuals, reported lower odds of accessing specialty care behavioral health services, compared to no services. First generation adults reported lower odds accessing a primary care physician (OR = 0.66, 95% CI, 0.44-0.98), compared to none. Results advance knowledge of behavioral health services access points among racial, ethnic and immigrant groups, following passage of the California Mental Health Services Act. Findings suggest primary care may be an important entry point for behavioral health service use engagement among underserved populations.

Disparities in self-management outcomes by limited English proficiency among adults with heart disease.

There are significant disparities in cardiovascular health outcomes by limited English proficiency (LEP). Self-management plans (SMPs) are associated with better patient outcomes, however little is known about the association of LEP with having an SMP among adults with heart disease. This study examined this association using 2013–2016 California Health Interview Survey data. Among adults that received an SMP, we also examined whether they had a hard copy SMP (print or electronic vs. none), and whether they reported confidence in their ability to manage their heart disease. Our sample included a total of 9102 adults, including 1232 LEP and 7870 English proficient (EP) adults. LEP was associated with significantly lower odds of SMP receipt (Adjusted Odds Ratio [AOR] 0.46, 95% Confidence Interval [CI] 0.31 to 0.68). LEP and EP adults who received an SMP were similarly likely to have a hard copy SMP and report confidence in heart disease management. The finding that LEP adults were less likely than EP adults to receive an SMP may represent a missed opportunity to improve heart health outcomes for this group.

Asian, Latinx, or Multiracial? Assessing Filipinxs' Health Conditions and Outcomes by Aggregate Ethnic Category.

Filipinxs are the second-largest Asian subgroup in the USA. While Filipinxs are most often considered Asian when constructing aggregate ethnic categories, recent research has identified a trend of a small portion of Filipinxs identifying as Latinx or multiracial. However, little research had addressed how identification with different aggregate ethnic categories may have implications for identifying health disparities among Filipinxs and how these compare to non-Hispanic whites. Bivariate and multivariable regression analyses using 2011-2018 California Health Interview Survey data, comparing Asian Filipinxs, Latinx Filipinxs, and multiracial Filipinxs. In bivariate analyses, Asian Filipinxs had a higher prevalence of diabetes than Latinx or multiracial Filipinxs. After controlling for sociodemographics, Latinx Filipinxs had significantly lower odds of having diabetes or heart disease than Asian Filipinxs. Compared to non-Latinx Whites, Asian Filipinxs reported higher odds of being in fair/poor health, obese or overweight, high blood pressure, and diabetes, multiracial Filipinxs reported higher odds of being obese or overweight, and Latinx Filipinxs reported lower odds of heart disease. These findings suggest emerging differences in health linked to identification with different ethnic categories, underscoring the need to investigate nuances among Filipinxs in future research as well as highlighting the utility of emerging sociological insights in health research.

Health‐Related Influences of Extending Marital Benefits to Same‐Sex Couples: Results From the California Health Interview Survey

ObjectiveTo explore how incremental California legal changes toward the implementation of same‐sex marriage influenced self‐reported mental and physical health among adult Californians in legal same‐sex marriages and partnerships.MethodsWe analyzed California Health Interview Survey data from 2005 to 2015 to assess the relationship between self‐reported mental and physical health and legal same‐sex marital/partnership status. Physical health was measured using a single self‐report question, mental health using the six‐item Kessler distress scale. Independent variables were sexual identity and legal marital/partner status. Bivariate analyses compared mental and physical health before and after the 2008 California Supreme Court decision affirming marriages as a basic civil or human right. Multivariate analyses tested relationships between marital/partnered status, sexual identity by year after adjusting for sociodemographics.ResultsReports of poor and fair health decreased, reports of very good health increased, and psychological distress scores decreased for legally coupled gay men and lesbians but increased slightly for single lesbians and gay men. Household income increased among espoused lesbians and gay men and decreased among unmarried counterparts.ConclusionsEspoused gay and lesbian respondents were more likely to be employed and to have college educations than unmarried counterparts, perhaps a continuing influence of 2005 California legislation requiring private employers to provide health insurance benefits to employees' same‐sex partners. Our findings suggest that physical and mental health improved for lesbians and gay men once same‐sex marriage became legal throughout California.ImplicationsThese findings demonstrate a need for survey questions to elicit information about marital status and the sex/gender of a respondent's spouse inclusive of sexual and gender identities.

Self-Care Confidence and eHealth Education in Adults with Asthma: Do They Reduce Healthcare Utilization?

Abstract Introduction: The purpose of this research was to analyze personal characteristics and behaviors associated with adults with asthma. Does self-care confidence or eHealth education reduce their healthcare utilization to decrease medical costs? Methods: Using 2015 California Health Interview Survey (CHIS) data, the study examined the data of adults (n = 3380) with asthma. Chi-square tests calculated differences for eight personal characteristics and behaviors: gender, age, education, online health information searching, self-reported health status, physical activity limitations, emergency room visits, and hospitalization related to asthma. Individuals very confident to manage their asthma were compared to those feeling less empowered to manage their health. Individuals who recently used the Internet to find health information were compared to those who did not go online for resources. Results: CHIS data showed a lack of full self-care confidence in a quarter of surveyed asthmatics. Better self-reported health status correlated with increased self-care confidence. Women, those with less education, and those with physical activity limitations were less confident to manage their health. Fewer people who were fully self-confident visited emergency rooms for asthma. Self-confidence had no effect on the rate of hospitalization. The use of eHealth education was significantly more frequent in people under 70 years old, those with less than a high school education, and those without physical activity limitations. Better self-reported health status correlated with increased eHealth education use. More people who used eHealth education visited emergency rooms for asthma. eHealth education had no effect on the rate of hospitalization. Conclusions: It is possible to identify individuals with asthma with an increased risk of not feeling confident about their ability to manage their disease. Health care professionals can plan extra in-person efforts to educate asthmatics who feel insecure about managing their health. Women, individuals in poor or fair health, and those with physical activity limitations should be assessed for self-care confidence soon after diagnosis and monitored at regular intervals. Full self-care confidence correlated with fewer visits to ERs. eHealth education was not shown to play a role in reduced healthcare utilization. Keywords: Self-Care Confidence, Asthma, Health Promotion, eHealth Education, Physical Activity Limitations

Predictors of never having a mammogram among Chinese, Vietnamese, and Korean immigrant women in the U.S.

BackgroundBreast cancer is the most common cancer among Asian women in the U.S. The first objective was to investigate predictors (including ethnicity) of never having a mammogram in middle-aged and older Chinese, Vietnamese, and Korean immigrant women (main effects). The second objective was to explore whether relationships between predictors and never having a mammogram varied across the three groups (moderation effects of ethnicity).MethodsMerged (2005-2007-2009-2011) California Health Interview Survey data were utilized. Unweighted sample was 3,710 Asian women ages 40 years and older (Chinese = 1,389; Vietnamese = 1,094; Korean = 1,227). Replicate weighted total sample size was 1,710,233 (Chinese = 940,000; Vietnamese = 410,000; Korean = 360,000). Replicate-weighted multivariate logistic regression was applied. Interaction effects (moderator role of ethnicity) were also examined, using multivariate logistic regression, for the second objective.ResultsFor the first objective, odds of never having a mammogram were higher for women who were Korean (Ref = Vietnamese), unmarried, or a non-U.S. citizen. Odds were lower in women ages 50–59 or 60–69 (Ref = 70–85). Regarding the second objective, only for Chinese women, odds of never having a mammogram were lower as the number of physician visits got higher.ConclusionCulturally-sensitive outreach and services should be developed to target higher-risk groups. Patient-centered healthcare strategies tailored for the three groups could be effective. For Chinese women, in particular, regular information sessions or education programs could be provided for enhancing their physician visits.

Asian American Access to Care in the Affordable Care Act Era: Findings from a Population-Based Survey in California

Though Asian Americans made gains in coverage following the Affordable Care Act (ACA), substantial variations in access to care remain across different ethnic subgroups. Several states are considering adoption of policies to collect health data for Asian Americans that is disaggregated by ethnic subgroup, which may identify disparities in access to care. We examined coverage and access to care between non-Hispanic White and Asian American adults following the ACA in California. We first compared outcomes in non-Hispanic White adults with all Asian Americans in our sample, and then evaluated whether we detect disparities when data is disaggregated into five of the most populous ethnic subgroups (Chinese, Korean, Filipino, Vietnamese, and Japanese). Cross-sectional California Health Interview Survey data were collected between January 2014 and December 2016. Our sample included 19,201 non-Hispanic White and 3077 Asian American non-elderly adults age 18 to 64 living in California. Our outcomes were (1) being uninsured, (2) having a usual source of care, (3) delaying necessary medical care, and (4) delaying necessary prescription medications. Using multivariable logistic regression models, we examined our outcomes, adjusting for predisposing, enabling, need, and acculturation factors. Compared with non-Hispanic Whites, some subgroups of Asian Americans reported significantly worse access to care: disaggregated, adjusted analyses revealed that Koreans were significantly less likely to report a usual source of care (adjusted odds ratio [AOR] = 0.31, p < 0.01) relative to non-Hispanic Whites. Chinese (AOR = 0.42, p < 0.01) and Vietnamese (AOR = 0.34, p < 0.01) adults were significantly less likely to delay necessary care. Disaggregated analyses identified differences in access to care for Asian American subgroups following the ACA. State policies to collect disaggregated health data for Asian Americans may reveal heterogeneity in experiences of care and inform specific policies to reduce disparities in access to care.