Behavioral Health Care Utilization Research Articles

Trends in Bundled Outpatient Behavioral Health Services in VA-Direct Versus VA-Purchased Care.

The Veterans Health Administration (VA) increasingly purchases community-based care (CC) to improve healthcare access, including behavioral health. In 2018, VA introduced standardized episodes of care (SEOCs) to guide authorization and purchase of CC services for specific indications in a defined timeframe without bundling payment. In this retrospective cross-sectional study, we describe trends in VA and CC behavioral healthcare utilization using the VA Outpatient Psychiatry SEOC definition. Counts of Outpatient Psychiatry SEOC-allowable service and procedure codes during fiscal years 2016-2019 were organized according to four SEOC-defined service types (evaluation and management, laboratory services, psychiatry services, transitional care) and measured as percentages of all included codes. Trends comparing behavioral healthcare utilization between Veterans using any CC versus VA only were analyzed using a linear mixed effects model. We identified nearly 3million Veterans who registered 60million qualifying service and procedure codes, with overall utilization increasing 77.8% in CC versus 5.2% in VA. Veterans receiving any CC comprised 3.9% of the cohort and 4.7% of all utilization. When examining service type as a percent of all Outpatient Psychiatry SEOC-allowable care among Veterans using CC, psychiatry services increased 12.2%, while transitional care decreased 8.8%. In regression analysis, shifts in service type utilization reflected descriptive results but with attenuated effect sizes. In sum, Outpatient Psychiatry SEOC-allowable service utilization grew, and service type composition changed, significantly more in CC than in VA. The role of SEOCs and their incentives may be important when evaluating future behavioral healthcare quality and value in bundled services.

Barriers and facilitators to healthcare utilisation by Arab sexual minority women migrants in the USA

Limited research on sexual minority women migrants demonstrate that they face elevated rates of mental health problems compared to their heterosexual and male counterparts, and less is known about their healthcare seeking behaviours. This study aimed to identify barriers and facilitators to mental and physical healthcare utilisation among first-generation (foreign-born) Arab sexual minority women migrants in the USA and to assess whether Penchansky and Thomas’ theory of access can be used to understand their healthcare utilisation behaviours. We conducted 20 semi-structured interviews via Zoom. Employing community-engaged research methods, four advisors, Arab sexual minority women migrants and a mental health service provider, assisted in recruitment and thematic data analysis providing a rich and nuanced understanding of study findings. Five main themes demonstrated the pivotal role of cultural humility from providers and access to medical insurance in shaping healthcare-seeking decisions. Difficulties finding therapists and navigating the referral process and wait times encouraged participants to seek care outside of the USA in their Arab countries of origin. Stigma and social support further influenced participants’ decisions to seek mental healthcare. The study findings inform policy and practice to foster the development of inclusive healthcare services grounded in cultural humility and to develop support groups specifically for Arab sexual minority women migrants to the USA.

Does supplemental private health insurance impact health care utilization and seeking behavior of residents covered by social health insurance? Evidence from China National Health Services Survey

BackgroundSupplemental private health insurance (PHI) plays a crucial role in complementing China’s social health insurance (SHI). However, the effectiveness of incorporating PHI as supplementary coverage lacks conclusive evidence regarding its impact on healthcare utilization and seeking behavior among SHI-covered individuals. Therefore, investigating the effects of supplementary PHI on health care utilization and seeking behavior of residents covered by social health insurance is essential to provide empirical evidence for informed decision-making within the Chinese healthcare system.MethodsData from the 2018 China National Health Services Survey were analyzed to compare outpatient and inpatient healthcare utilization and choices between PHI purchasers and non-purchasers across three SHI schemes: urban employee-based basic medical insurance (UEBMI), urban resident-based basic medical insurance (URBMI), and the new rural cooperative medical scheme (NRCMS). Using the Andersen Healthcare Services Utilization Behavior Model as the theoretical framework,binary logistic regression and multinomial logistic regression (MNL) models were employed to assess the impact of PHI on healthcare utilization and provider preferences.ResultsAmong UEBMI, URBMI, and NRCMS participants with PHI, outpatient visit rates were 17.9, 19.8, and 21.7%, and inpatient admission rates were 12.4, 9.9, and 12.9%, respectively. Participants without PHI exhibited higher rates for outpatient visits (23.6, 24.3, and 25.6%) and inpatient admissions (15.2, 12.8, and 14.5%). Binomial logistic regression analyses revealed a higher probability of outpatient visits and inpatient admissions among UEBMI participants with PHI (p < 0.05). NRCMS participants with PHI showed a lower probability of outpatient visits but a higher probability of inpatient admissions (p < 0.05). Multinomial logistic regression indicated that NRCMS participants with PHI were more likely to choose higher-level hospitals, with a 17% increase for county hospitals and 27% for provincial or higher-level hospitals compared to primary care facilities.ConclusionThe findings indicate that the possession of PHI correlated with increased utilization of outpatient and inpatient healthcare services among participants covered by UEBMI. Moreover, for participants under the NRCMS, the presence of PHI is linked to a proclivity for seeking outpatient care at higher-level hospitals and heightened utilization of inpatient services. These results underscore the nuanced influence of supplementary PHI on healthcare-seeking behavior, emphasizing variations across individuals covered by distinct SHI schemes.

Racial and ethnic disparities in healthcare utilization among children in U.S. foster care: Recommendations to challenge the status quo based on a scoping review

Prior work has examined racial and ethnic disparities in the access to and utilization of healthcare services. However, evidence across studies is mixed, making it challenging to precisely identify where the racial and ethnic disparities in healthcare utilization are amongst children in foster care, and which race and ethnicity groups are most impacted by such disparities. As such, the purpose of the current study was to conduct a scoping review to synthesize evidence on the topic of racial and ethnic disparities in the physical and mental or behavioral healthcare utilization for children in the U.S. foster care system (PROSPERO ID: CRD42021272072). Comprehensive literature searches were conducted in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Psychology and Behavioral Sciences Collection. Of the 414 studies identified, 23 met inclusion criteria: peer-reviewed journal article, published between 1991 and 2023, written in English, examined healthcare access or utilization of children in the U.S. foster care system as outcomes, included and disaggregated results by children’s race and ethnicity, conducted quantitative analysis, and was observational in study design. In the physical healthcare utilization domain, Black children were less likely to utilize routine and preventative check-ups and more likely to utilize medical services for treating chronic illnesses such as asthma, compared to White children. In the mental or behavioral healthcare utilization domain, Black and Hispanic/Latine children were less likely to utilize both inpatient and outpatient mental health services, compared to White children. Furthermore, notable variations were observed by specific service types and continuity of services over time. Implications include additional research and education about racial and ethnic disparities in healthcare utilization amongst children in foster care, as well as implementing regulations and oversights that mandate racial equity in the child welfare and healthcare service pathways.

Parent SMART: Effects of residential treatment and an adjunctive parenting intervention on behavioral health services utilization

IntroductionScant research has examined the impact of residential treatment on adolescent behavioral healthcare utilization post-discharge, even though behavioral healthcare utilization is major driver of healthcare costs. In the primary analyses of a pilot randomized trial, Parent SMART – a technology-assisted intervention for parents of adolescents in residential treatment – was found to improve parental monitoring and parent-adolescent communication, reduce adolescent drinking, and reduce adolescent school-related problems, relative to residential treatment as usual (TAU). The goal of this secondary analysis of the pilot randomized trial was to assess the effects of residential treatment and the adjunctive Parent SMART intervention on both the amount and type of subsequent behavioral healthcare utilization. MethodThe study randomized sixty-one parent-adolescent dyads to residential TAU (n = 31) or residential TAU plus Parent SMART (n = 30). Of the 61 dyads, 37 were recruited from a short-term residential facility and 24 were recruited from a long-term facility. Adolescents completed a structured clinical interview and self-reported their behavioral health-related visits to the emergency department, nights in residential/inpatient, and outpatient visits over the past 90 days, at baseline, 12-, and 24-weeks post-discharge. Generalized linear mixed models (GLMMs) examined both linear and non-linear (pre- to post- residential treatment) trends, pooled, and stratified by residential facility to examine behavioral health service utilization. ResultsBoth the linear and pre-post GLMMs revealed that behavioral health-related emergency department visits and residential/inpatient nights decreased across both residential facilities. GLMMs estimating change from the pre- to post period indicated that outpatient visits increased across both facilities. There were no significant effects of the Parent SMART adjunctive intervention in GLMMs, though bivariate tests and the direction of effects signaled that Parent SMART was associated with more nights of residential/inpatient utilization. ConclusionResidential substance use treatment may reduce adolescents' subsequent utilization of costly behavioral healthcare services such as emergency department visits and residential/inpatient nights, while increasing utilization of outpatient services. Parent SMART was not associated with significant changes in behavioral healthcare utilization, but the pattern of results was consistent with prior literature suggesting that stronger parenting skills are associated with greater utilization of non-emergency services.

Health Care Utilization and Care-seeking Behavior Among Vulnerabilized Sexual Minority Women: A Social-ecological Approach

Abstract: Sexual minority women (SMW) experience worse health than their heterosexual counterparts but have largely been omitted from health services research. To address this gap, we conducted 25 semi-structured, in-depth interviews with SMW. Transcripts were analyzed using thematic analysis, and findings were organized using a modified socioecological framework. Key themes at each socioecological level include (1) structural: stigma, sociocultural norms, health infrastructure; (2) organizational: stigma, patient-provider relationship, hours and location, linkage to care and co-location of services; (3) interpersonal: stigma and social support; (4) individual: internalized stigma, self-efficacy, socioeconomic status, health literacy, and intersecting identities. Stigma is the central theme affecting vulnerabilized SMW's experiences accessing care. Anti-stigma initiatives and factors that lead to personal resilience and can mitigate care access barriers were identified at each level. Interventions should focus on building inclusive policies/infrastructure and using SMW's unique social networks to empower and improve care access and health outcomes among vulnerabilized SMW.

Health Insurance Utilization and Financial Behaviour: A Study of Rashtriya Swasthya Bima Yojana (RSBY) in Kerala

This paper examines the health behaviour and health insurance landscape in Kerala, India, with a focus on the impact of the Rashtriya Swasthya Bima Yojana (RSBY) on healthcare utilization and financial behaviour. Using primary data collected from Mukkam municipality in Kozhikode district, Kerala, the study analyses the demographic profile of respondents, their health insurance status, and satisfaction levels with the RSBY scheme. The findings indicate a fairly balanced preference between government and private insurance schemes among households, with a significant majority possessing an insurance card. The RSBY scheme has been successful in enrolling a large proportion of households and providing satisfactory coverage at both government and private hospitals. However, there are variations in insurance coverage and satisfaction levels among different demographic subgroups, highlighting the need for targeted interventions and policy measures to improve access to healthcare and financial security among vulnerable populations.

Direct and vicarious exposure to healthcare discrimination and erasure among transgender and gender independent individuals: Testing the indirect effect of mistrust in healthcare on utilization behaviors

RationaleDirect exposure to gender identity-related discrimination and erasure among the transgender and gender independent (TGI) population are associated with healthcare underutilization, which may further exacerbate the health disparities that exist between this population and cisgender individuals in the United States (U.S.). Although the impacts of direct exposure to healthcare discrimination and erasure may have on TGI individuals are known, exposure to such harm vicariously (i.e., through observation or report) is underexplored. ObjectiveThe present study examined the relationships among direct and vicarious gender identity-related healthcare discrimination and erasure exposure and past-year healthcare utilization. MethodGender identity-based mistrust in healthcare was also assessed, as a mechanism through which direct and vicarious gender identity-related healthcare discrimination and erasure predict healthcare utilization behaviors among a sample (N = 385) of TGI adults in the U.S., aged 18 to 71 recruited online. ResultsResults indicated direct lifetime and vicarious healthcare discrimination and erasure exposure significantly predicted past-year healthcare underutilization when participants anticipated encountering gender identity-related healthcare discrimination. Mediational analyses indicated that higher levels of exposure to direct lifetime and vicarious healthcare discrimination and erasure were related to higher levels of mistrust in healthcare, through which past-year underutilization was significantly related. ConclusionsThese findings are vital to informing healthcare practice and policy initiatives aimed at ensuring the barriers that deleteriously influence the accessibility of healthcare among TGI individuals are ameliorated.

Knowledge, attitude, and utilization of traditional medicine within the plural medical system in West Java, Indonesia

BackgroundThe concept of ‘medical pluralism’ has become more popular among scholars in applied health science and prevalent in societies where one medical system alone cannot adequately meet the health care needs of the entire population.MethodsThe data collection is focused on the knowledge-belief-practice and the utilization of three medical systems in Kabupaten Bandung, West Java, Indonesia. Participants were purposively selected from households with at least one member experienced one of the listed diseases in the questionnaire. The extensive survey using a structured questionnaire has been undertaken to collect data on people’s health care utilization behaviour. The dataset is further analyzed using multivariate analysis through non-canonical correlation, with the analytical data provided by Statistical Package for Social Sciences (SPSS).ResultsWith regards to the total utilization by patients, the traditional medical system presents as the dominant medical system in the research area, accounting for 59.3% (n = 419) of total utilization, followed by the modern medical system (33.0%, n = 233), and transitional medical system (7.7%, n = 54). This study identified that village category, illness, illness duration, occupation, belief in traditional medicine, knowledge of modern medicine, accessibility, cost, proximity to the medical service, and insurance have significant (χ2 = 0.000) relationship with the utilization of medical systems. The results of the multivariate analysis show that the block of the predisposing socio-demographic factors and the block of the predisposing psycho-social factors correlate strongly with the utilization of medical systems.ConclusionsIn general, people in Kabupaten Bandung, West Java, Indonesia seeks treatment from various sources, which in the context of the medical system, consists of the traditional, transitional, and modern medical system; therefore, it adopts the patterns of transcultural health care utilization. In terms of the knowledge, beliefs, and practices of traditional medicine in West Java, the inhabitants of the five research villages were commonly familiar with medicinal plants and speak profoundly about their knowledge of traditional medicine, which in the research area is perceived as accessible, efficacious, affordable and culturally appropriate with Sundanese community.

Pediatric behavioral health care utilization in integrated primary care and hospital-based clinics during the pandemic – Implications for virtual care

Introduction: The COVID-19 pandemic forced health care organizations and providers to adapt innovative approaches to ensure patient care needs are met. In particular, improving patient access to behavioral health services is essential to improving population health. &#x0D; Methods and Aims: Clinical visit volume and utilization data were analyzed via the Tableau platform for behavioral health visits by providers within the division of Pediatric Psychology at the University of Michigan Health (UM) during the pandemic through the present. UM is a publicly funded academic medical center that manages a total of approximately 2.5 million patient visits per year. Psychologists provide care within hospital-based specialty clinics or primary care clinics, both of which utilize integrated models of care. Unprecedented changes were made with regards to care delivery format and workforce allocation, and the present paper examines the corresponding impact on patient behavior health care. &#x0D; Results: During Fiscal Year 22 (July 2021 to June 2022), 24 pediatric psychology providers completed a total of 8,252 visits within 12,802 available patient slots, a utilization rate of 64.5%. Utilization was significantly higher in primary care clinics (80.9%) than in hospital-based clinics (51.6%), Z = 34.47, p &lt; .00001. Services were delivered virtually in 100% of the 4549 visits completed in primary care and 72.6% of the 3703 completed hospital visits. These data are currently being analyzed for the present Fiscal Year 23. Patient satisfaction data revealed barriers impacting access to care, including scheduling issues, setting up virtual care and managing, technology problems. &#x0D; Conclusions: Utilization data provides strong support for delivery of behavioral health services in primary care via virtual care means. However, patients area likely to encounter significant barriers to initiating and participating in care when systems are designed to exclusively or primarily support remote users. &#x0D;

Abstract PR011: Exploring factors influencing preventive cancer screenings for Native Hawaiian and Pacific Islander adults in Hawaiʻi

Abstract Background: This study aims to investigate cancer-related knowledge, attitudes, and beliefs among Pacific Islanders and Native Hawaiians in Hawaiʻi by examining social factors that influence healthcare utilization behaviors for cancer screenings. The National Cancer Institute developed the Health Information National Trends Survey (HINTS) to collect national data about the use of cancer-related information, access, as well as changing patterns and communications trends regarding health practices. However, HINTS data are not sufficient to address historically excluded demographic subpopulations as each year, an average of 7,393 Hawai‘i residents are diagnosed with invasive cancer and rates are disproportionate ethnically. Methods: We administered a cross-sectional survey during 2017-2018 to Native Hawaiians, Chuukese, and Marshallese in Hawaiʻi using Respondent Driven Sampling (RDS) to recruit these geographically hard-to-reach groups. The modified HINTS survey included questions about cancer knowledge, attitudes, behaviors, social interactions, and cultural practices. A total of 515 Native Hawaiians, 305 Chuukese, and 180 Marshallese completed the survey. Differences were found across a variety of cancer and health-related attitudes, knowledge, and behaviors. The Gelberg and Anderson (2000) Behavioral Model for Vulnerable Populations and biculturalism guided the theoretical and conceptual models for analysis. Logistic regression analysis was used adjusting for age, income, health insurance, and occupational status, to measure social constructs of interest and their interaction with colorectal, pap test, and mammography cancer screenings. To triangulate these findings, key thematic analyses were included from thirteen interviews with adults living within the communities first surveyed. Results: Significant multivariable influences on not having a pap test included never being married (P=.004) and having no health insurance (P&amp;lt;.0001); while influences over having a pap test included a high ethnic identity (P=.001). Significant influences over not having a mammogram included never being married (P=.04), having no health insurance (P&amp;lt;.0001), and not currently employed (P=.009). Significant influences on never having a test for colon cancer included being semi-religious (P=.0001), having no health insurance (P=.005), and not being able to rely on physicians (P=.02). Key findings relating to cancer screenings from the interviews included fear of finding out, lack of language assistance, limited discussion within social circles relating to health and cancer practices, and a belief in a higher intervening power. Conclusion: Cancer prevention education and culturally tailored programs are greatly needed for Pacific Islander and Native Hawaiians in Hawaiʻi. This study provides insight into influences, both positive and negative, on cancer screenings for these communities and areas for future cancer prevention/intervention efforts. Citation Format: Mark L. Willingham Jr., Kevin D. Cassel, Angela Sy, Munirih Taafaki, Tressa P. Diaz, Angelina G. Mummert, Wei Zhang. Exploring factors influencing preventive cancer screenings for Native Hawaiian and Pacific Islander adults in Hawaiʻi [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr PR011.

The effects of parental retirement on adult children's health: Evidence from China.

Using representative data from China, we examine the causal effects of parental retirement on the health of adult children. To do so, we adopt a fuzzy regression discontinuity design and exploit the mandatory retirement ages in China as cut-off points. We find no evidence that parental retirement has significant effects on the mental health, healthcare utilization, or risky health behaviors of adult children. However, paternal retirement and maternal retirement have different effects on adult children's Self-reported health (SRH). Paternal retirement has a significantly negative effect only on the SRH of sons, while maternal retirement does not induce such effects. Potential mechanisms of intergenerational transfer through which parental retirement might affect adult children's health are also explored.

필리핀 지역 유학생들의 의료이용 행태 및 의료이용의 적극성에 영향을 미치는 요인

Objectives: This study was conducted to investigate differences in health characteristics and healthcare utilization behaviors among Korean, Taiwanese, and Japanese students for language course (hereinafter referred to as ‘international students’) in two language schools in the Philippines. In addition, the study would identify the factors affecting their activeness of healthcare utilization and prepare measures to revitalize healthcare utilization in terms of health education. Methods: A questionnaire was prepared in three languages, Korean, traditional Chinese, and Japanese, and a survey was conducted from July 9 to July 16, 2019 in Philippines, and data from 115 participants were analyzed, using IBM Statistics Ver. 21.0. Results: Korean international students were more concerned about skin problems and suffered significantly more from symptoms than Taiwanese and Japanese international students did, and language barriers were picked up as the top reason for not visiting hospitals or external pharmacies when they were sick. Factors affecting their activeness to seek medical care were the severity of their symptoms and whether they had insurance for treatment. Conclusion: It is expected that the results of this study would contribute to the health promotion of international students by developing health education programs tailored to them.

Does health insurance solve health care utilization puzzle in Tanzania?

ObjectivesThe global target of achieving universal health coverage by 2030 is a nightmare in most developing countries. To seek in-depth reasons, this study examines the effects of health insurance on healthcare utilization in Tanzania. Study designThis study used a non-experimental research design. MethodsProbit model, negative binomial regression, and instrumental variable Poisson with generalized method of moments were used to solve the healthcare utilization puzzle by the use of Andersen Health Care Utilization Model by using the Tanzania Panel Survey data of 2020/21. ResultsThe findings showed that education level, income, age, residence, household size, insurance, and distance from homestead to health facilities are significant policy intervention factors for improving households' healthcare utilization behavior among households in Tanzania. ConclusionPrioritize should be made on interventions that ensure the affordability of health services without compromising the quality of services offered and expanding the share of the government budget on health sector.

Maternal Health Care Utilization Behavior, Local Wisdom, and Associated Factors Among Women in Urban and Rural Areas, Indonesia.

Maternal mortality is one problem that still affects countries like Indonesia and others globally. The World Health Organization (WHO) notes that Southeast Asian countries have a high MMR. Indonesia's maternal mortality ranks third highest in Southeast Asia, with a 177 maternal mortality rate per 100,000 live births in 2017. In 2018, the maternal mortality rate reached 91.45 per 100,000 live births. Pregnant women's deaths can be caused inadequate medical care due to how frequently they seek treatment. This study intends to identify and analyze how knowledge, education, and myths affect pregnant women's attitudes toward seeking health services. The study involved 175 pregnant and postpartum women who visited 10 health public centers in two cities in East Java by accidental sampling. Data regarding intrapersonal, interpersonal, and local wisdom were collected through surveys with structured instruments and in-depth interviews. Data statistics used pathway analysis with a p-value of >0.05. Intrapersonal, interpersonal, and local wisdom variables have a significant direct or indirect effect on utilizing health services. Knowledge was the variable with the greatest influence (t-value, 27.96). Myth and culture as local wisdom and intrapersonal factors significantly affect the pattern of utilizing health services.

A Study on Health-care Utilization and Health-care Seeking Behavior of People Approaching Two Institutions (Ayurveda and Allopathic PHCs) in Vengara Panchayat of Malappuram District, Kerala

Background: To make health for all a reality, we need individuals and communities with access to high-quality health services to take care of their health and of their families. There is a need to undertake a more systematic analysis to examine AYUSH and Allopathic care utilization across regional, socioeconomic, and demographic groups. In a country like India, which is home to many traditional medicine systems, it is also essential to understand how Ayush coexists with allopathic system. Methods: The study used a cross-sectional study design using a self-made questionnaire to find healthcare utilization and healthcare-seeking behaviour. Results: Factors determining health-care utilization such as prior experience in care (AOR 3.47; 95% CI 0.52–23.37), affordability (AOR 11.48; 95% CI 2.31–57.08), availability of essential medicines and their quality (AOR 35.28; 95% CI 5.32–234.20), and acceptability of treatment (AOR 4.51; 95% CI 0.91–22.41) were shown to be a positive predictor for choosing Allopathic PHC. At the same time, healthcare services such as screening and basic management of mental health ailments (AOR 0.20; 95% CI 0.02–2.26) and care in pregnancy and childbirth (AOR 0.54; 95% CI 0.12–2.32) were shown to be negative predictors for allopathic. Conclusion: The study findings highlighted the need for systematic information on the usage of healthcare services and people’s healthcare-seeking behaviours. It would help policymakers and stakeholders set up specific strategies to ensure the effective utilization and distribution of existing resources and enforce the country’s sufficient delivery of healthcare services.

Association between mental health and self-care behavior among older adults with diabetes according to Behavioral Risk Factor Surveillance System 2019

AimTo assess the association of mental health burden with diabetes-related self-care behaviors and healthcare utilization among older adults. MethodThis cross-sectional 2019 Behavioral Risk Factor Surveillance System (BRFSS) study included ≥ 65 years old adults with self-reported diabetes. Three groups were used based on the number of days in the past month affected by mental health: 0 days (no burden), 1–13 days (occasional burden), and 14–30 days (frequent burden). Primary outcome was performing ≥ 3 of 5 diabetes-related self-care behaviors. Secondary outcome was performing ≥ 3 of 5 healthcare utilization behaviors. Multivariable logistic regression was used in Stata/SE 15.1. ResultsOf 14,217 included individuals, 10.2 % reported frequent mental health burden. Compared to ‘no burden’, ‘occasional’ and ‘frequent burden’ groups included more female, obese, not married persons with younger age of diabetes diagnosis, and reported more comorbidities, insulin use, cost-related barriers to see doctors, and diabetes-related eye issues (p < 0.05). ’Occasional/frequent burden’ groups reported less self-care and healthcare utilization behaviors, except 30 % higher healthcare utilization was observed in the ‘occasional burden’ group compared to no burden (aOR 1.30, 95 %CI 1.08–1.58, p = 0.006). ConclusionsOverall, mental health burden was associated with reduced participation in diabetes-related self-care and healthcare utilization behaviors in a stepwise manner, except occasional burden was associated with higher healthcare utilization.

Abstract P651: Assessing the Pathway Between Health Care Utilization and Hypertensive Outcomes Among Young Adult African American Medicaid Beneficiaries in Delaware

Introduction: African Americans have been studied to underutilize medical care in comparison to other groups due to a variety of factors, including lack of access and medical mistrust, both attributable long-standing systemic oppression. Thus, African Americans bare a disproportionate burden of chronic conditions, including hypertension, which is more than two times more prevalent among African Americans in comparison to other groups. To date, the health care utilization behaviors of African American young adults, ages 18-30, are understudied. Addressing this relationship in a young sample may be informative in fostering long-term improvement of health outcomes for African Americans. Question: Among African Americans aged 18-30. is there an association between hypertension diagnosis and recent receipt of a general adult medical exam? Methods: We conducted a cross-sectional case control study using data from a sample of African American Medicaid recipients living in Delaware, aged 18-30. Following an assessment of demographic characteristics, we performed logistic regression adjusted for gender and zip code to investigate the association between hypertension diagnosis and receipt of a general adult medical exam within the study period. Results: Among patients aged 18-30, those with hypertension (n=2,506) had 1.4 times the odds of reporting to have received a general adult medical exam during the study period when compared to those without hypertension (n=24526; p&lt;.0001). The difference between the mean number of visits between strata (.379 vs. .302) is statistically significant (p&lt;.0001). Conclusion: Our findings suggest that young adult African American patients living with hypertension are more likely to have a general adult medical exam during the study period than clients of the same age group without hypertension. We believe this may implicate that those with poorer health tend to seek care more often, though further research is needed to better understand motivations for seeking care. Improved understanding of the pathway between health care utilization and hypertension through a younger lens will be critical in targeting self-advocacy programs that address aversion to care-seeking behaviors for generations to come.

Behaviors associated with HIV transmission risk among rural sexual and gender minority and majority residents

ABSTRACT Multiple rural states and communities experience elevated rates of human immunodeficiency virus (HIV), often associated with diminished healthcare access and increased drug use. Though a substantial proportion of rural populations are sexual and gender minorities (SGM), little is known of this group regarding substance use, healthcare utilization, and HIV transmission behaviors. During May–July 2021, we surveyed 398 individuals across 22 rural Illinois counties. Participants included cisgender heterosexual males (CHm) and females (CHf) (n = 110); cisgender non-heterosexual males and females (C-MSM and C-WSW; n = 264); and transgender individuals (TG; n = 24). C-MSM participants were more likely to report daily-to-weekly alcohol and illicit drug use prescription medication misuse (versus CHf; aOR = 5.64 [2.37–13.41], 4.42 [1.56–12.53], and 29.13 [3.80–223.20], respectively), and C-MSM participants more frequently reported traveling to meet with romantic/sex partners. Further, more C-MSM and TG than C-WSW reported healthcare avoidance and denial due to their orientation/identity (p < 0.001 and p = 0.011, respectively); 47.6% of C-MSM and 58.3% of TG had not informed their provider about their orientation/identity; and only 8.6% of C-MSM reported ever receiving a pre-exposure prophylaxis (PrEP) recommendation. More work is needed to explore the substance use and sexual behaviors of rural SGM, as well as their healthcare interactions, to better target health and PrEP engagement campaigns.

Deworming utilization among pregnant mothers with at least one antenatal care follow-up in Ethiopia, 2022:- A multilevel analysis.

Soil-transmitted helminthes (STHs) are the major public health problems that affect the health of pregnant women and their incoming newborns. In Ethiopia, about 33.35% of pregnant women were affected by these infections. Utilization of deworming medication during pregnancy is the main strategy endorsed by the World Health Organization (WHO) to reduce the burden of STH-induced anemia and its related complications. However, information related to the coverage and its individual as well as community-level factors on the utilization of deworming medication among pregnant mothers with at least one antenatal care (ANC) visit is limited in Ethiopia. A nationwide population-based cross-sectional study was conducted from January 18 to June 27, 2016. The information was obtained from the 2016 Ethiopian Demographic Health Survey (EDHS 2016), which can be accessed at: https://www.dhsprogram.com. A weighted sample of 4690 pregnant women selected using a two-stage stratified cluster sampling technique was included in the final analysis. A Multi-variable multilevel binary logistic regression model was fitted to identify the determinants of the utilization of deworming medication during pregnancy. Log-likelihood ration (LLR), deviance and Akaike's Information Criterion (AIC) were used to select the best fitted model in the multilevel analysis. Statistical significance was declared at p-value <0.05. From a total of 4690 mothers included in the final analysis, only 365 (7.8%) of them utilized deworming medication in pregnancy. After controlling for confounding effects, having four or more Antenatal care (ANC) visits, having functional working status, intake of iron folic acid (IFA) tablets and coming from a community with a low poverty level increases the odds of utilization of deworming medication during pregnancy. In this study, less than one in ten pregnant mothers takes deworming medication. Mothers with less than four ANC visits, who did not receive IFA tablets, who came from a community with a high poverty level, and mothers with no good functional status were at the greatest risk of not receiving deworming medication during pregnancy. Sustained efforts need to be undertaken to increase the socioeconomic status of the community and to scale up the health care utilization behaviors of pregnant mothers.