California Health Interview Survey Research Articles

Relationship Between Volunteering and Perceived General Health of Individuals with Serious Mental Illness

Volunteering has been found to be a significant predictor of improved health among the general population. Yet, little is known about the relationship between volunteering and perceived general health among individuals with serious mental illness (SMI). Using data obtained from the 2014 California Health Interview Survey (N = 1127), this study examined the extent to which volunteering is associated with perceived general health of individuals with SMI. Study findings indicate that individuals who engage in volunteering are more likely to report better health status when compared to those who do not engage in volunteering.

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.

Factors affecting psychological distress among Asian American and non-Hispanic White older adults

We examined factors affecting psychological distress in non-Hispanic White (n = 9,170) and Asian American (n = 1,417) older adults, using 2015–2016 California Health Interview Survey data. Multivariate logistic regression analyses revealed that disability, poor/fair health, and neighborhood environmental factors, such as unsafe neighborhoods and low social cohesion, were significantly associated with psychological distress in both ethnic groups. People aged between 65 and 69 years, women, nonhomeowners, and those living at less than 200% of the federal poverty level had increased odds of psychological distress among the non-Hispanic Whites. For Asian Americans, physical inactivity was associated with an increased rate of psychological distress. These findings indicate that multiple risk factors increase the probability of psychological distress in older adults. Further, important similarities and differences exist between older Asian Americans and non-Hispanic Whites, which have implications in screening and development of interventions for these ethnic groups.

Differences in health behaviors and health outcomes among non-Hispanic Whites and Arab Americans in a population-based survey in California

BackgroundFew population-based studies of Arab American health behaviors and outcomes exist outside of Michigan. We aimed to provide prevalence estimates of health behaviors and outcomes for Arab Americans and compare them to non-Hispanic Whites in California.MethodsWe used data from the 2003–2016 California Health Interview Surveys. We determined Arab American ethnicity using an algorithm that considered place of birth of the respondent or parent and use of Arabic language at home. Survey-weighted frequencies, chi-squared statistics, and logistic regression analyses were used to compare Arab Americans and non-Hispanic Whites on socioeconomic indicators, health behaviors and health outcomes. Multivariable models were adjusted for age, education level, and insurance status.ResultsArab Americans had higher prevalence of no insurance, living below the federal poverty level, and home ownership than non-Hispanic Whites despite high levels of education and low unemployment prevalence. Arab Americans had reduced odds of alcohol consumption (OR: 0.33, 95% CI: 0.24, 0.45), binge drinking (OR: 0.28, 95% CI: 0.19, 0.40), and suicidal ideation (OR: 0.41, 0.25, 0.66) when compared to non-Hispanic Whites in multivariable models. Arab Americans had decreased odds of hypertension (OR: 0.64, 95% CI: 0.50, 0.83) and increased odds of diabetes (OR: 2.03, 95% CI: 1.23, 3.34) when compared to non-Hispanic Whites in multivariable models.ConclusionsArab Americans in California participate in less risky health behaviors and have better health outcomes than non-Hispanic Whites, except with regards to diabetes. Future work aiming to understand the health of Arab Americans should allow for self-identification and less reliance on country of origin and language use at home for sample selection.

Changes in Perceptions of Discrimination in Health Care in California, 2003 to 2017

Research in the early 2000s in California demonstrated that racial and ethnic minorities, immigrants, and those with limited English proficiency (LEP) experienced high rates of discrimination in health care. Less is known about how patients' perceptions of discrimination in health care have changed since then. To determine whether perceptions of discrimination in health care have changed overall and for specific vulnerable populations. This cross-sectional study used data from the California Health Interview Survey for state residents aged 18 years and older for 2 periods, 2003 to 2005 and 2015 to 2017. χ2 analyses and multivariate logistic regression were performed to compare recent discrimination in health care in late vs early periods controlling for race/ethnicity, poverty level, education, insurance status, usual source of care, self-reported health, and LEP. Additional subanalyses were performed by race/ethnicity, immigrant status, and LEP status. Jackknife replicate weights were provided by the California Health Interview Survey. Survey year was dichotomized as combined 2003 to 2005 and combined 2015 to 2017. Survey respondents were identified as having experienced recent discrimination in health care if they responded "yes" to the question, "Was there ever a time when you would have gotten better medical care if you had belonged to a different race or ethnic group?" and reported that this occurred within the last 5 years. There were 84 088 participants in 2003 to 2005 (51.0% female; 14.7% aged ≥65 years) and 63 242 participants in 2015 to 2017 (51.1% female; 18.0% aged ≥65 years). Rates of recent discrimination in health care decreased from 6.0% to 4.0% (difference, 2.0%; 95% CI, 1.5%-2.5%; P < .001). In adjusted analyses, perceptions of discrimination in health care decreased in 2015 to 2017 compared with 2003 to 2005 (odds ratio [OR], 0.60; 95% CI, 0.53-0.68; P < .001). There was a significant race × period interaction for Latino individuals (OR, 0.58; 95% CI, 0.40-0.83; P = .003) but not for Asian individuals (OR, 0.76; 95% CI, 0.50-1.16; P = .20) or African American individuals (OR, 1.24; 95% CI, 0.76-2.02; P = .40). There was a significant immigrant status × period interaction (OR, 0.55; 95% CI, 0.44-0.69; P < .001) and LEP status × period interaction (OR, 0.67; 95% CI, 0.51-0.89; P < .001). This study suggests that perceptions of discrimination in health care in California decreased between 2003 to 2005 and 2015 to 2017 among Latino individuals, immigrants, and those with LEP. African American participants reported consistently high rates of discrimination, indicating that interventions targeting health care discrimination are still necessary.

Disparities in Health Care Utilization Between Asian Immigrant Women and Non-Hispanic White Women in the United States.

Background: Asians accounted for 30% of all U.S. immigrants in 2014, of which 53% were women. Foreign-born Asian immigrant (FBAI) women experience difficulties in obtaining timely and needed health care due to multifaceted barriers. This study examined factors influencing health service utilization among FBAI women compared with native-born (non-Hispanic) White American (NBWA) women. Materials and Methods: A secondary data analysis was conducted using the 2014-2015 California Health Interview Survey. Guided by a modified version of Andersen's behavioral model of health service utilization, FBAI women aged 18 to 64 (n = 1,021) were compared with NBWA women of the same ages (n = 7,086). Outcome variables included having at least one doctor's visit in the past year and having an emergency room (ER) visit in the past year. Analyses included descriptive statistics, t-tests, chi-square tests, and multivariate logistic regressions. Results: FBAI women were significantly less likely to have at least one doctor's visit in the past year and were less likely to have a usual source of care than NBWA women. Significant predictors of having at least one doctor's visit for FBAI women were having high school education, having a usual source of care, having medical insurance, and having a chronic disease. The only significant predictor of having an ER visit for FBAI women was having a chronic disease. Conclusions: Health care providers must be aware of lower levels of health service utilization among FBAI women than NBWA women regardless of whether or not the FBAI women have chronic conditions. It is important to educate these women on the importance of regular health care visits.

Neighborhood-Level Predictors of Obesity Among African American Children in California

The increased prevalence of childhood obesity is a major public health concern nationally and globally. Childhood obesity is primarily caused by the imbalance between caloric intake and caloric expenditure; however, its increase over the past decades may be due to environmental and behavioral factors. The purpose of the current study was to examine if any relationships existed between childhood obesity, level of physical activity, and neighborhood-level risk factors. This study used the California Health Interview Survey 2009–2014 data sets for African American children aged 5–11 years (&lt;em&gt;n &lt;/em&gt;= 1,049). The dependent variable was body mass index (BMI) while the predictors included physical activity, neighborhood, walkability, support, safety, and the presence of parks. Potential confounds were gender and parental education level. Chi-square tests were used to evaluate the associations between BMI and age, educational attainment, neighborhood walkability, physical activity, built environment, neighborhood support, and neighborhood safety. Multivariate logistic regression was used to assess the relationship between BMI and physical activity; parental educational level; presence of parks, playground, or open spaces; neighborhood walkability; neighborhood safety; neighborhood support; and gender while adjusting for other known risk factors. Low physical activity levels were a significant risk factor for increased obesity. No associations were discovered between childhood obesity and neighborhood safety; parental educational level; presence of parks, playgrounds, or open spaces; neighborhood walkability; neighborhood safety; neighborhood support; and gender. This study reinforces the relationship between environmental policy and physical activity.

Diabetes and Diabetes Care among Nonobese Japanese-Americans: Findings from a Population-Based Study.

Objectives The objectives of this study are as follows: (1) to determine the prevalence of diabetes among nonobese Japanese-Americans and to determine the adjusted odds of diabetes among nonobese Japanese-Americans compared to non-Hispanic Whites (NHWs); (2) to identify the risk factors associated with having diabetes in a large sample of nonobese Japanese-Americans; and (3) to determine the prevalence and adjusted odds of diabetes management behaviors among nonobese Japanese-Americans with diabetes in comparison to NHWs with diabetes. Methods The combined 2007-2016 waves of the adult California Health Interview Survey (CHIS) were used to analyze a nonobese (BMI<30) sample of 2,295 Japanese-Americans and 119,651 NHWs. Chi-square and logistic regression analyses were performed using Stata. Results The findings of this representative community study of nonobese Californians indicate that the prevalence of diabetes among Japanese-American respondents was higher than their NHW counterparts (8.0% versus 4.5%). Prevalence increased markedly with age; one-quarter of nonobese Japanese Americans aged 80 and older had diabetes. Conclusions The prevalence of diabetes among nonobese Japanese-Americans is significantly higher than that among NHWs. There is an urgent need to develop appropriate intervention and prevention approaches with lifestyle modification specifically targeted towards nonobese Japanese-Americans.

The Relationship Between Educational Attainment and Health Care Access and Use Among Mexicans, Mexican Americans, and U.S.-Mexico Migrants.

The aim of the study was to assess the relationship between educational attainment and health care access and use among Mexican-origin populations. Data from the 2012 Mexican National Health and Nutrition Study, the 2013 Project Migrante Health Care Access and Utilization Survey, and the 2013-2014 California Health Interview Survey were used to examine educational gradients in health insurance, medical home, and hospitalization among Mexicans in Mexico, northbound, southbound, and deported migrants, and U.S.-and foreign-born Mexican Americans. College graduates had greater odds of being insured relative to those with less than a high school degree among Mexicans (AOR = 1.48, p < 0.001), northbound migrants (AOR = 3.69, p < 0.001), and the foreign-born (AOR = 2.01, p < 0.01), and of having a medical home among Mexicans (AOR = 1.95, p < 0.001) and the foreign-born (AOR = 2.14, p < 0.05). Eliminating differences by educational attainment in the U.S. will require policy changes like making immigrants eligible for public insurance. In Mexico, it will require targeted outreach to enroll underserved populations in existing public insurance programs.

Secular Trends in Soda Consumption, California, 2011-2016.

Consumption of sugar-sweetened carbonated beverages (including soda) has declined nationally, but trends by state are unknown. We used data from the California Health Interview Survey to assess overall changes in soda consumption among adults aged 18 or older from 2011 through 2016 and identified differences by education and income level. Frequency of soda consumption (times per week) declined from 2011 through 2014 by 16.5% but returned to 2011 levels in 2015 and 2016; trends did not differ by education or income. The proportion of the population that consumed soda did not change among adults with less than a high school diploma or equivalent, but declined significantly among those with at least a high school diploma. Our findings suggest that soda consumption remains a pressing public health problem in California.

Profiles of a Health Information-Seeking Population and the Current Digital Divide: Cross-Sectional Analysis of the 2015-2016 California Health Interview Survey.

BackgroundInternet use for health information is important, given the rise of electronic health (eHealth) that integrates technology into health care. Despite the perceived widespread use of the internet, a persistent “digital divide” exists in which many individuals have ready access to the internet and others do not. To date, most published reports have compared characteristics of internet users seeking health information vs nonusers. However, there is little understanding of the differences between internet users seeking health information online and users who do not seek such information online. Understanding these differences could enable targeted outreach for health interventions and promotion of eHealth technologies.ObjectiveThis study aims to assess population-level characteristics associated with different types of internet use, particularly for seeking online health information.MethodsThe 2015-2016 California Health Interview Survey datasets were used for this study. Internet use was classified as never used the internet (Never use), ever used the internet but not to search for health information in the last 12 months (Use not for health), and ever used the internet and have used it to search for health information in the last 12 months (Use for health). Weighted multinomial logistic regression was used to assess sociodemographic and health characteristics associated with types of internet use. Findings are reported as odds ratios (ORs) with 95% CIs.ResultsAmong 42,087 participants (weighted sample of 29,236,426), 19% reported Never Use of the internet, 27.9% reported Use not for health, and 53.1% reported Use for health. Compared to Never Use individuals, Use for health individuals were more likely to be younger (OR: 0.1, 95% CI 0.1-0.2 for ≥60 years vs <60 years), female (OR: 1.6, 95% CI 1.3-1.9 compared to males), and non-Hispanic white (OR: 0.54, 95% CI 0.4-0.7 for Latinos and OR: 0.2, 95% CI 0.2-0.4 for African Americans) and have a higher socioeconomic status (>400% of Federal Poverty Guidelines; OR: 1.3, 95% CI 1.4-2.4). Overall, characteristics for the Use not for health and Use for health groups were similar, except for those with lower levels of education and respondents not having visited a physician in the last year. For these two characteristics, the Use not for health group was more similar to the Never Use group.ConclusionsOur findings indicate that a digital divide characterized by sociodemographic and health information exists across three types of users. Our results are in line with those of previous studies on the divide, specifically with regard to disparities in use and access related to age, race/ethnicity, and socioeconomic status. Disparities in online health-seeking behavior may reflect existing disparities in health care access extending into a new era of health technology. These findings support the need for interventions to target internet access and health literacy among Never Use and Use not for health groups.

Uncertainty About DACA May Undermine Its Positive Impact On Health For Recipients And Their Children.

Undocumented immigrants and their children have worse self-reported health than documented immigrants and US citizens do. Evidence suggests that the Deferred Action for Childhood Arrivals (DACA) program, which was created in 2012 by President Barack Obama and which granted some rights to undocumented immigrants who arrived as children, improved the well-being of recipients and their children in the first three years after the program's introduction. However, DACA is subject to executive discretion, and the US presidential campaign that began in 2015 introduced substantial uncertainty regarding the program's future. We examined whether DACA's health benefits persisted beyond 2015 using the 2007-17 waves of the California Health Interview Survey and dynamic treatment effects models. Our results show that self-reported health improved for Latina/o DACA-eligible immigrants and their children from 2012 to 2015 but worsened after 2015. Our results suggest that the political climate of the 2016 presidential election may have underscored the politically contingent nature of the DACA program and eroded the program's health benefits for eligible immigrants and their children.

MON-012 Diabetes-Related Healthcare Exposure and Dietary Intake Among Food Pantry Clients

Background: Dietary self-management is a demanding aspect of diabetes mellitus (DM) care. To help identify optimal food choices, patients with DM need support from a healthcare team. Studies examining associations between DM-related healthcare utilization and dietary intake are rare, particularly in food insecure (FI) populations where dietary self-management is especially challenging. Purpose: To examine the association between DM healthcare utilization and dietary intake among FI adults with DM. We examined self-reported utilization of (1) a healthcare provider for DM management and (2) DM self-management education (DSME)-related services. Methods: We used baseline data from a randomized trial designed to improve glycemic control in food pantry clients with DM. Participants (A1c ≥ 7.5%, age ≥ 18, English/Spanish speaking) were recruited from pantries affiliated with 3 food banks. We dichotomized DM healthcare into more recent (< 12 months ago) versus less recent (≥ 12 months ago) or no utilization. Our primary outcome was intake frequency of vegetables, fruit, sugar-sweetened beverages (SSBs), and desserts, assessed by the California Health Interview Survey dietary screener. We used t-tests to examine unadjusted associations between DM healthcare utilization and dietary intake and multiple linear regression to determine if sociodemographic characteristics modified the relationships. Results: Among 523 participants (mean A1c 9.8%; BMI 34.6 kg/m2; 17.0% uninsured), recent utilization of a provider for DM management and/or DSME-related services were associated with increased vegetable intake frequency in unadjusted analyses and after adjusting for DM duration, race/ethnicity, education, health insurance status, and medication adherence (additional 0.4 times/day for all comparisons; p < 0.01). Recent utilization of a provider for DM management was associated with increased fruit consumption frequency in adjusted analyses (additional 0.2 times/day; p = 0.03). Neither healthcare utilization variable was associated with decreased SSB or dessert intake. Conclusions: Among food pantry users, messaging from traditional healthcare settings to increase healthy intake may be more successful than messaging to decrease unhealthy intake. Environmental cues for sugar intake may supersede messaging from healthcare settings, particularly in low-income areas where cues may be more pervasive and healthier options less available. It may also be that clients with healthcare access are better able to prioritize healthy intake than clients without access are, as access may indicate increased resources overall. Given the negative health consequences added sugar intake has on DM management, approaches that increase access to DM-appropriate foods (including at food pantries) and education efforts focused on reducing sugar intake may be effective in vulnerable populations.

Associations between health risk behaviors and perceived health status among individuals with serious mental illness (SMI)

ABSTRACTIndividuals with Serious Mental Illness (SMI) suffer from chronic medical problems and have greater mortality rates than the general population. The combination of four health-risk behaviors (i.e., physical inactivity, poor diet, smoking, and excessive alcohol intake) may contribute to decreased health status. This study aims to investigate associations between four health risk behaviors and perceived health status of individuals with SMI, so as to provide a better understanding of the attribution of each health-risk behavior to perceived health status. A secondary data analysis of the 2013–2014 California Health Interview Survey was utilized. A total of 1,277 adults were selected based on the criteria of the Kessler Psychological Distress Scale. Hierarchical logistic regression analyses revealed that individuals with SMI who had unhealthy dietary behaviors and were physically inactive were more likely to rate their health status as poor, compared with their counterparts (OR = 0.23, 95% CI [0.10, 0.56] and OR = 0.31, 95% CI [0.10, 0.96], respectively). However, individuals with SMI who had episodes of binge drinking were less likely to rate their perceived health status as poor, but the counterparts tend to rate their health status as more than fair (OR = 2.56, 95% CI [0.10, 0.56]).

Differential Influence of Weight Status on Chronic Diseases by Reported Sexual Orientation Identity in Men.

This study examined whether the association between weight status and four chronic diseases (heart disease, hypertension, lifetime asthma, and type 2 diabetes) varied according to sexual orientation identity among adult men, controlling for demographic, socioeconomic, and other factors. Pooled data from male adult participants (n = 72,214) in the 2003-2012 California Health Interview Survey were used along with logistic regression models to estimate whether the associations between weight status and chronic diseases varied by sexual orientation identity. Weight status was positively associated with each of the chronic diseases (hypertension, heart disease, asthma, and diabetes) among both gay and bisexual men and heterosexual men; however, the associations varied significantly by sexual orientation identity. Among gay and bisexual men, the associations were stronger and statistically significant-with the exception of lifetime asthma-particularly for men in the obese classifications, before and after controlling for age, marital status, race/ethnicity, education, income, health insurance status, food security level, smoking, and nativity. Weight status had stronger detrimental associations with chronic disease among gay and bisexual men despite these men having greater socioeconomic advantage and lower body mass index than heterosexual men. Future research should examine mechanisms, including stress related to minority status, which may lead to greater risks for chronic diseases among sexual minority men.

Social cohesion and immigrant health: does language-efficacy matter?

Purpose While social cohesion is important for the promotion of immigrant health, language is a core component through which immigrant groups establish social connections. Since language is a vehicle through which immigrant groups establish social linkages and that English language proficiency has been established as a virtual requirement for full participation in US society, the purpose of this paper is to examine the role of language in establishing social cohesion affecting immigrant health. Design/methodology/approach Using the 2012 California Health Interview Survey, the authors investigated the role of language efficacy in the relationship between social cohesion and utilization of healthcare among immigrant groups with good and poor health statuses (n=11,134). Mediation analyses were conducted using PROCESS Macro. Findings The direct effect of social cohesion on healthcare utilization and the effect of English language efficacy on healthcare utilization were significant for both groups. English language efficacy was a significant mediator between social cohesion and healthcare utilization among immigrants with good health statuses. Research limitations/implications Limitations include generalizability issues across immigrant sub-populations, limited measures in terms of English language efficacy and limitations with measures variables such as length of stay. Social implications This study highlights that language is the channel that plays a crucial role not only to establish and maintain social cohesion for positive health outcomes, but also the ripple effects of promoting trust, belonging, opportunity of upward mobility and inclusion. Originality/value The findings of the study add value to other pertinent issues of linguistic diversity, positive social relationships and well-being of diverse communities.

Green space and serious psychological distress among adults and teens: A population-based study in California.

There has been mounting evidence for the beneficial effect of green space on mental health among adults, but studies on the same topics are lacking for teens in the US. This study aimed to fill in this research gap by utilizing data from California Health Interview Survey (CHIS) 2011-2014. A total of 81,102 households (composed of 4538 teens and 81,102 adults) were retained for main analyses. Surrounding greenness was assessed by the Normalized Difference Vegetation Index (NDVI) within varying buffers of home residence. Survey logistic regressions accounted for sampling weights and design were conducted to examine the effects of greenness on serious psychological distress (SPD), adjusted for major socio-demographic factors, neighborhood socioeconomic status (SES) and co-respondent's psychological distress level within the same household. An inter-quartile increment of NDVI in 350 m buffer predicted decreased odds of SPDs by 36% in teens (OR = 0.64, 95% CI = [0.46, 0.91]). Mediation analyses revealed that this association remained almost unchanged even after adjusting for social cohesion. The NDVI-SPD association of adults was found to be significant only in the older group (OR = 0.81, 95% CI = [0.68, 0.95]). This study is one of the first population-based US studies extending the epidemiological evidence for benefits of green space on mental health from adults to teens.

Mental health status and dietary intake among California adults: a population-based survey

California Health Interview Survey (2005–2015) data were used to examine the association between dietary intake frequencies and mental health – Kessler-6 scores categorised as no/low (NLPD), moderate (MPD) or serious psychological distress (SPD). The 245,891 surveys represented 27.7 million adults annually, with 13.2% having MPD and 3.7% SPD. Survey-adjusted regression adjusting for gender, age, race, education, poverty, marital status, BMI, geography and year found MPD and SPD associated with lower consumption of fruits (adjusted odds ratio 0.79 and 0.65, respectively), vegetables (AOR 0.81 and 0.68), and increased consumption of French fries (AOR 1.24, 1.30), fast food (AOR 1.32, 1.27), soda (AOR 1.23, 1.26) and variance-adjusted daily teaspoons of sugar (coefficients 3.05, 4.21), all p-values less than 0.001. In this large population-based sample, moderate and SPD were independently associated with unhealthy diet. Targeted public health interventions could focus on young adults and those with less than 12 years of education.

Impact of Perceived Racism on Healthcare Access Among Older Minority Adults

Older minority individuals are less likely to receive adequate health care than their white counterparts. This study investigates whether perceived racism is associated with delayed/forgone care among minority older adults, and whether poor doctor communication mediates this relationship. Study cohort consisted of minority participants, aged ≥65 years, in the 2015 California Health Interview Survey (N=1,756). Authors obtained data in November 2017, and statistical analyses were performed from February to April 2018. Multivariable logistic regression analyses were conducted with relevant covariates, including insurance coverage, years living in the U.S., and language. A mediation analysis was also performed. Among minority older individuals, perceived racism was significantly associated with delayed/forgone care (AOR=3.92, 95% CI=1.38, 11.15, p=0.010). Poor doctor communication significantly and partially mediated the relationship (AOR=3.64, 95% CI=1.30, 10.21, p=0.014), accounting for 9.9% of the total effect. Perceived racism may contribute to health disparities for older minority individuals in part through doctors communicating messages that discourage adequate utilization of health care. Future research should explore culturally sensitive communication skills that reduce this barrier to receiving adequate health care.

Association Between Rural Residence and Nonfatal Suicidal Behavior Among California Adults: A Population-Based Study.

Suicide mortality rates in rural areas of the United States are twice that of rates in urban areas, and identifying which factors-eg, higher rates of suicidal distress, lower rates of help-seeking behaviors, or greater access to firearms-contribute to this rural/urban disparity could help target interventions. Using 2015-2016 data on adult respondents to the California Health Interview Survey (n = 40,041), we examined associations between residence in a rural (vs nonrural) census tract and nonfatal suicidal ideation and attempt. We found that living in a rural area was not associated with nonfatal suicidal behavior (OR for past-year suicidal ideation = 0.87, 95% CI: 0.63-1.20; OR for past-year suicide attempt = 0.55, CI: 0.20-1.48). Women living in rural areas had higher odds of lifetime suicidal ideation compared to women living in nonrural areas, but this difference was not significant (OR = 1.17, CI: 0.94-1.44). We also found that, among individuals reporting suicidal behavior, there were few rural/nonrural differences in perceived need for treatment, such as seeing a physician or taking a prescription for mental health problems. Our results do not suggest higher suicidal distress or lower treatment-seeking behaviors as explanations for the rural/urban disparity in suicide mortality rates. Further attention is needed to the unique risk factors driving suicidality in rural areas, as well as exploring heterogeneity in these factors across different rural contexts.