Personal Health Care Provider Research Articles

Vital Signs: Mammography Use and Association with Social Determinants of Health and Health-Related Social Needs Among Women - United States, 2022.

Approximately 40,000 U.S. women die from breast cancer each year. Mammography is recommended to screen for breast cancer and reduce breast cancer mortality. Adverse social determinants of heath (SDOH) and health-related social needs (HRSNs) (e.g., lack of transportation and social isolation) can be barriers to getting mammograms. Data from the 2022 Behavioral Risk Factor Surveillance System were analyzed to estimate the prevalence of mammography use within the previous 2 years among women aged 40-74 years by jurisdiction, age group, and sociodemographic factors. The association between mammography use and measures of SDOH and HRSNs was assessed for jurisdictions that administered the Social Determinants and Health Equity module. Among women aged 50-74 years, state-level mammography use ranged from 64.0% to 85.5%. Having health insurance and a personal health care provider were associated with having had a mammogram within the previous 2 years. Among women aged 50-74 years, mammography prevalence was 83.2% for those with no adverse SDOH and HRSNs and 65.7% for those with three or more adverse SDOH and HRSNs. Life dissatisfaction, feeling socially isolated, experiencing lost or reduced hours of employment, receiving food stamps, lacking reliable transportation, and reporting cost as a barrier for access to care were all strongly associated with not having had a mammogram within the previous 2 years. Identifying specific adverse SDOH and HRSNs that women experience and coordinating activities among health care providers, social services, community organizations, and public health programs to provide services that help address these needs might increase mammography use and ultimately decrease breast cancer deaths.

Social Processes and COVID-19 Vaccination of Children of Hesitant Mothers.

Investigate relationships between pediatric COVID-19 vaccination and social processes of healthcare provider recommendations and school encouragement to provide insights into social processes that may support pediatric COVID-19 vaccination among hesitant mothers. We analyzed survey data from a subsample (n = 509) of vaccine-hesitant mothers to child patients (ages 2 to 17) in regional clinics across Arkansas. Data were collected between September 16th and December 6th, 2022. Full information maximum likelihood multivariable logistic regression was conducted to evaluate associations with pediatric COVID-19 vaccination. Adjusted odds of pediatric COVID-19 vaccination were more than three times greater when a child's healthcare provider recommended vaccination compared to when they did not (aOR = 3.52; 95% CI[2.06, 6.01]). Adjusted odds of pediatric COVID-19 vaccination were 85% greater when a child's school encouraged parents to vaccinate compared to when the school did not (aOR = 1.85; 95% CI[1.13, 3.03]). For pediatric COVID-19 vaccination, having a personal healthcare provider is not significantly different from having no personal healthcare provider if they do not recommend the child be vaccinated. Clinical and public health interventions should consider social processes of healthcare provider recommendations and school encouragement.

Adverse Childhood Experiences Among U.S. Adults: National and State Estimates by Adversity Type, 2019–2020

Although adverse childhood experiences (ACEs) are associated with lifelong health harms, current surveillance data on exposures to childhood adversity among adults are either unavailable or incomplete for many states. In this study, recent data from a nationally representative survey were used to obtain the current and complete estimates of ACEs at the national and state levels. Current, complete, by-state estimates of adverse childhood experiences were obtained by applying small area estimation technique to individual-level data on adults aged ≥18 years from 2019-2020 Behavioral Risk Factor Surveillance System survey. The standardized questions about childhood adversity included in the 2019-2020 survey allowed for obtaining estimates of ACE consistent across states. All missing responses to childhood adversity questions (states did not offer such questions or offered them to only some respondents; respondents skipped questions) were predicted through multilevel mixed-effects logistic small area estimation regressions. The analyses were conducted between October 2022 and May 2023. An estimated 62.8% of U.S. adults had past exposure to ACEs (range: 54.9% in Connecticut; 72.5% in Maine). Emotional abuse (34.5%) was the most common; household member incarceration (10.6%) was the least common. Sexual abuse varied markedly between females (22.2%) and males (5.4%). Exposure to most types of adverse childhood experiences was lowest for adults who were non-Hispanic White, had the highest level of education (college degree) or income (annual income ≥$50,000), or had access to a personal healthcare provider. Current complete estimates of ACEs demonstrate high countrywide exposures and stark sociodemographic inequalities in the burden, highlighting opportunities to prevent adverse childhood experiences by focusing social, educational, medical, and public health interventions on populations disproportionately impacted.

COVID-19 Vaccination Messengers, Communication Channels, and Messages Trusted Among Black Communities in the USA: a Review.

Black and African American adults exhibited higher levels of mistrust and vaccine hesitancy and lower levels of vaccination throughout the COVID-19 pandemic. Vaccination and booster uptake remains disproportionately low among Black adults. We conducted a systematic review of empirical research published between February 2021 and July 2022 from five electronic databases and the grey literature. We screened studies that assessed COVID-19 vaccination information needs and preferences as well as communication strategies among Black adults in the USA. We extracted data, then analyzed and synthesized results narratively. Twenty-two articles were included: 2 interventions, 3 experimental surveys, 7 observational surveys, 8 qualitative inquiries, and 2 mixed methods studies. Studies reported credible and preferred COVID-19 vaccination information sources/messengers, channels, and content. Commonly trusted messengers included personal health care providers, social network connections, and church/faith leaders. Electronic outreach (e.g., email, text messages), community events (e.g., forums, canvassing), and social media were popular. Black communities wanted hopeful, fact-based messages that address racism and mistrust; persuasive messages using collective appeals about protecting others may be more influential in changing behavior. Future communication strategies aiming to increase vaccine confidence and encourage COVID-19 booster vaccination among Black communities should be developed in partnership with community leaders and local health care providers to disseminate trauma-informed messages with transparent facts and collective action appeals across multiple in-person and electronic channels.

Abstract 12487: Healthcare Access and Cardiovascular Risk Factor Management in Low-Income Working-Age Adults After the COVID-19 Pandemic

Background: Low-income working age adults disproportionately experienced disruptions in care and deepening financial hardship at the onset of the COVID-19 pandemic. Little is known about how health care access and cardiovascular (CV) risk factor management changed as the pandemic went on, and if these patterns differed by state Medicaid expansion status. Methods: We identified adults aged 18-64 using the CDC’s Behavioral Risk Factor Surveillance System. Low-income adults were defined as those with incomes <138% of the federal poverty level (FPL), and high-income adults >400% FPL. We fit logistic regression models to compare changes in measures of health care access and CV risk factor management in 2021 to a pre-pandemic baseline (2019), adjusted for age and sex. We included an interaction term for income level and year, to evaluate whether there was a differential change between low- and high-income adults. We also evaluated changes among low-income adults in Medicaid expansion vs. non-expansion states. Results: As shown in the Table , health insurance coverage, access to personal health care provider, and ability to afford care all improved in 2021 compared to pre-pandemic baseline (2019), although gains were more pronounced for high-income vs low-income groups. In contrast, the proportion of adults with a check-up in the past 12 months, or who received recommended cardiovascular risk factor screening, worsened in both low- and high-income groups. Among the low-income group, those in Medicaid expansion states experienced greater increases in insurance coverage than those in non-expansion states (OR 1.53 [1.40,1.68] vs 1.27 [1.11,1.46], p = 0.0283). Conclusion: In this national study, low- and high-income working-age adults experienced decreases in outpatient check-ups and CV risk factor screening in 2021 compared with pre-pandemic baseline. Public health initiatives are needed to improve screening for CV risk factor as the US emerges from the pandemic.

Intentions to receive COVID-19 vaccines in the united states: Sociodemographic factors and personal experiences with COVID-19.

Information regarding vaccination and the association with individuals' characteristics, experiences, and information sources is important for crafting public health campaigns to maximize uptake. Our objective was to investigate factors associated with intentions for COVID-19 vaccination among a sample of U.S. adults using a population-based cross-sectional survey. Data were collected via an online questionnaire administered nationwide from January 4, to January 7, 2021 following the emergency use authorization for two SARS-CoV-2 mRNA-based vaccines. Of 936 U.S. adult respondents, 66% stated an intention to be vaccinated once a COVID-19 vaccine was available to them; 14.7% responded "maybe" and 19.6% "no." Unadjusted and multivariate associations revealed "no/maybe" vaccination intentions were associated with younger age, female, Black race, lower income, history of not receiving the influenza vaccine, lower fear of COVID-19, suffering moderate to severe reduction in access to food/nutrition, and lower trust in health care authorities, personal health care providers, and/or traditional news media as sources of COVID-19 information. Of respondents "maybe" intending to be vaccinated, 65% reported "a lot" of trust in personal health care providers as sources of COVID-19 information. Respondents stating "no" intention to be vaccinated were skeptical of all COVID-19 information sources considered. Our findings confirm observations predating COVID-19 vaccine availability regarding sociodemographic characteristics associated with vaccine hesitancy in the United States. We further identify personal health care providers as the most trusted information source among people who "maybe" intend to get vaccinated and demonstrate the challenge in reaching people not intending to be vaccinated. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Disparities in Health Care Utilization Among Deaf and Hard of Hearing Adults

Purpose: A substantial literature exists, documenting differences in access to quality health care among individuals of different racial/ethnic, residence, income, and disability groups. However, little attention has been given to disparate utilization among those who are deaf or hard of hearing (DHH). The purpose of this study was to evaluate differences between individuals with and without hearing-related issues using a nationally representative survey of health care access outcomes to quantify the magnitude of these differences. Method: Using data from the 2021 Centers for Disease Control Behavioral Risk Factor Surveillance System survey, we compared health care utilization between individuals who reported being DHH and those without hearing-related issues. Logistic regression models were used to explore differences in access to care between DHH and non-DHH individuals controlling for sociodemographic characteristics. Results: The total Behavioral Risk Factor Surveillance System survey sample consisted of 412,427 respondents. Among those were 36,532 (6.85%) who identified as DHH. Logistic models indicated that DHH adults were less likely to have a personal health care provider (odds ratio [ OR ] = 0.91, 95% CI [0.83–2.03]) and less likely to have received a routine checkup within the last 2 years ( OR = 0.91, 95% CI [0.82–1.02]) but more likely to have forgone health care due to difficulty paying ( OR = 1.90, 95% CI [1.71–2.06]) compared to those without hearing difficulties. Differences were robust to race, sex, and other demographic factors. Conclusions: Significant differences in health care utilization were observed between DHH and non-DHH individuals. This is concerning given that DHH adults have a higher prevalence of many chronic conditions that require clinical management. These results indicate that health care providers and systems must offer greater communication options to facilitate better health-related outcomes.

Smokers with Access to Care are More Likely to Attempt Quitting Smoking

Objective: The Affordable Care Act (ACA) increased healthcare access and smoking cessation services. We examined the association between access to care and quit attempts after the ACA. Methods: We analyzed 2015-2018 Behavioral Risk Factor Surveillance System data (N = 209,213). Using logistic regression, independent variables included having a personal healthcare provider and time since last healthcare provider visit. The dependent variable included smoking cessation attempt in the past 12 months (yes or no). Interactions were examined for demographic variables. Results: Smokers with one (OR = 1.27, 95% CI=1.21, 1.33) or more (OR = 1.28, 95% CI=1.28, 1.48) providers were more likely to have a quit attempt versus no provider. Smokers with a recent check-up were more likely to have a quit attempt versus those who never had/had a check-up greater than 5 years ago (OR2-5 years = 1.19, 95% CI = 1.10, 1.29, OR1-2 years = 1.34, 95% CI = 1.25, 1.44, OR1 year = 1.50, 95% CI = 1.42, 1.58). Age and education modified these associations. Conclusions: Instead of disincentive measures, policies should promote healthcare system interactions to support cessation.

Primary and reproductive healthcare access and use among reproductive aged women and female family planning patients in 3 states.

Public funding plays a key role in reducing cost barriers to sexual and reproductive health (SRH) care in the United States. In this analysis, we examine sociodemographic and healthcare seeking profiles of individuals in three states where public funding for health services has recently changed: Arizona, Iowa, and Wisconsin. In addition, we examine associations between individuals' health insurance status and whether they experienced delays or had trouble in obtaining their preferred contraception. This descriptive study draws on data collected between 2018 to 2021 in two distinct cross-sectional surveys in each state, one among a representative sample of female residents aged 18-44 and the other among a representative sample of female patients ages eighteen and older seeking family planning services at healthcare sites that receive public funding to deliver this care. The majority of reproductive-aged women and female family planning patients across states reported having a personal healthcare provider, had received at least one SRH service in the preceding 12 months, and were using a method of birth control. Between 49-81% across groups reported receiving recent person-centered contraceptive care. At least one-fifth of each group reported wanting healthcare in the past year but not getting it, and between 10-19% reported a delay or trouble getting birth control in the past 12 months. Common reasons for these outcomes involved cost and insurance-related issues, as well as logistical ones. Among all populations except Wisconsin family planning clinic patients, those with no health insurance had greater odds of being delayed or having trouble getting desired birth control in the past 12 months than those with health insurance. These data serve as a baseline to monitor access and use of SRH services in Arizona, Wisconsin, Iowa in the wake of drastic family planning funding shifts that changed the availability and capacity of the family planning service infrastructure across the country. Continuing to monitor these SRH metrics is critical to understand the potential effect of current political shifts.

Preventing nosocomial bloodstream infections (NBSIs) by implementing hospitalwide, department-level, self-investigations: A NBSIs frontline ownership intervention.

Nosocomial bloodstream infections (NBSIs) are adverse complications of hospitalization. Most interventions focus on intensive care units. Data on interventions involving patients' personal care providers in hospitalwide settings are limited. To evaluate the impact of department-level NBSI investigations on infection incidence. Beginning in 2016, positive cultures, classified as suspected of being hospital acquired, were prospectively investigated by patients' unit-based personal healthcare providers using a structured electronic questionnaire. After analyzing the conclusions of the investigation, a summary was sent quarterly to the departments and to hospital management. NBSI rates and clinical data during a 5-year period (2014-2018) were calculated and compared before and after the intervention (2014-2015 versus 2016-2018), using interrupted time-series analysis. Among 4,135 bloodstream infections (BSIs), 1,237 (30%) were nosocomial. The rate of NBSI decreased from 4.58 per 1,000 admissions days in 2014 and 4.82 in 2015, to 3.81 in 2016, 2.94 in 2017 and 2.86 in 2018. Following a 4-month lag after introducing the intervention, the NBSI rate per 1000 admissions dropped significantly by 1.33 (P = .04; 95% CI, -2.58 to -0.07). The monthly NBSI rate continued to decrease significantly by 0.03 during the intervention period (P = .03; 95% CI, -0.06 to -0.002). Detailed department-level investigations of NBSI events performed by healthcare providers, increased staff awareness and frontline ownership and were associated with a decrease in NBSI rates hospitalwide.

Vital Signs: Influenza Hospitalizations and Vaccination Coverage by Race and Ethnicity-United States, 2009-10 Through 2021-22 Influenza Seasons.

CDC estimates that influenza resulted in 9-41 million illnesses, 140,000-710,000 hospitalizations, and 12,000-52,000 deaths annually during 2010-2020. Persons from some racial and ethnic minority groups have historically experienced higher rates of severe influenza and had lower influenza vaccination coverage compared with non-Hispanic White (White) persons. This report examines influenza hospitalization and vaccination rates by race and ethnicity during a 12-13-year period (through the 2021-22 influenza season). Data from population-based surveillance for laboratory-confirmed influenza-associated hospitalizations in selected states participating in the Influenza-Associated Hospitalization Surveillance Network (FluSurv-NET) from the 2009-10 through 2021-22 influenza seasons (excluding 2020-21) and influenza vaccination coverage data from the Behavioral Risk Factor Surveillance System (BRFSS) from the 2010-11 through 2021-22 influenza seasons were analyzed by race and ethnicity. From 2009-10 through 2021-22, age-adjusted influenza hospitalization rates (hospitalizations per 100,000 population) were higher among non-Hispanic Black (Black) (rate ratio [RR]=1.8), American Indian or Alaska Native (AI/AN; RR=1.3), and Hispanic (RR=1.2) adults, compared with the rate among White adults. During the 2021-22 season, influenza vaccination coverage was lower among Hispanic (37.9%), AI/AN (40.9%), Black (42.0%), and other/multiple race (42.6%) adults compared with that among White (53.9%) and non-Hispanic Asian (Asian) (54.2%) adults; coverage has been consistently higher among White and Asian adults compared with that among Black and Hispanic adults since the 2010-11 season. The disparity in vaccination coverage by race and ethnicity was present among those who reported having medical insurance, a personal health care provider, and a routine medical checkup in the past year. Racial and ethnic disparities in influenza disease severity and influenza vaccination coverage persist. Health care providers should assess patient vaccination status at all medical visits and offer (or provide a referral for) all recommended vaccines. Tailored programmatic efforts to provide influenza vaccination through nontraditional settings, along with national and community-level efforts to improve awareness of the importance of influenza vaccination in preventing illness, hospitalization, and death among racial and ethnic minority communities might help address health care access barriers and improve vaccine confidence, leading to decreases in disparities in influenza vaccination coverage and disease severity.

Clothes Make the Man-What Impact Does the Dress of Interprofessional Teams Have on Patients?

Physicians’ attire seems to play an important role in the success of patient treatment. The classic doctor’s white coat initiates a strong signal to the patient and can have a determining effect on a successful doctor–patient relationship. In a quantitative online questionnaire study comprising 52 questions, participants were shown four photos of an interprofessional German family medicine team in varying attire. One important study feature relating to the ongoing coronavirus pandemic was that the team was portrayed wearing FFP2 masks in one photo. We measured core values regarding the team’s perception in terms of sympathy, competence, trust, choosing the practice as a personal health care provider, and wanting to participate in the team. The questionnaire was posted online between March and May 2021. It was accessed 1435 times and 906 sheets were qualified for statistical analysis. For the first time in this field of research, a practice team’s attire was investigated. We found a significant influence of different clothing on the perception of sympathy, competence, trust, elective practice, and team participation. Wearing an FFP2 mask promotes feelings of security and competence. The study shows that in times of fast social changes due to rapid digitalization and an ongoing pandemic, we should present ourselves in different ways as a medical team depending on the patient groups we are targeting and the feelings we want to evoke.

Public Willingness to Engage With COVID-19 Contact Tracing, Quarantine, and Exposure Notification.

We conducted a survey to understand how people's willingness to share information with contact tracers, quarantine after a COVID-19 exposure, or activate and use a smartphone exposure notification (EN) application (app) differed by the person or organization making the request or recommendation. We analyzed data from a nationally representative survey with hypothetical scenarios asking participants (N = 2157) to engage in a public health action by health care providers, public health departments, employers, and others. We used Likert scales and ordered logistic regression to compare willingness to take action based on which person or organization made the request, and we summarized findings by race and ethnicity. The highest levels of willingness to engage in contact tracing (adjusted odds ratio [aOR] = 1.74; 95% CI, 1.55-1.96), quarantine (aOR = 1.91; 95% CI, 1.69-2.15), download/activate an EN app (aOR = 1.30; 95% CI, 1.16-1.46), and notify other EN users (aOR = 1.43; 95% CI, 1.27-1.60) were reported when the request came from the participant's personal health care provider rather than from federal public health authorities. When compared with non-Hispanic White participants, non-Hispanic Black participants reported significantly higher levels of willingness to engage in contact tracing (aOR = 1.32; 95% CI, 1.18-1.48), quarantine (aOR = 1.49; 95% CI, 1.37-1.63), download/activate an EN app (aOR = 2.19; 95% CI, 2.01-2.38), and notify other EN users (aOR = 1.63; 95% CI, 1.49-1.79). Partnering with individuals and organizations perceived as trustworthy may help influence people expressing a lower level of willingness to engage in each activity, while those expressing a higher level of willingness to engage in each activity may benefit from targeted communications.

Health care access and contraceptive use among adult women in the United States in 2017

ObjectiveTo examine the relationship between insurance status and contraceptive use, with health care access as a mediating variable. Study DesignThis study uses data from the 2017 Behavioral Risk Factor Surveillance Survey to determine whether having a personal healthcare provider and experiencing cost as a barrier to care mediate the relationship between health insurance status and contraceptive use among women at risk of unintended pregnancy. Contraceptive use is measured 3 ways: as a binary variable (use vs non-use), by prescription status, and by tiered effectiveness. ResultsHaving insurance increases the odds of using all categories of contraception. Having a personal health care provider mediates this relationship, with having a personal health care provider increasing the odds of using any contraceptive, using a prescription method, and using a tier I or tier II method. Experiencing cost as a barrier to care is not associated with contraceptive use in weighted multivariable models but does mediate the relationship between having insurance and using tier-II methods. ConclusionsThese findings suggest that having health insurance and an ongoing relationship with a health care provider are key to ensuring consistent access to the full range of contraceptive options. This is particularly relevant in light of the ongoing policy debates regarding laws intended to increase health insurance access and decrease barriers to contraceptive use. ImplicationsThis paper updates and extends previous findings to show that the relationship between healthcare access and contraceptive use persists after the implementation of the Affordable Care Act and that having a personal provider partially explains this relationship.

Causes and Consequences of Not Having a Personal Healthcare Provider Among American Indian Elders: A Mixed-Method Study.

Having a regular relationship with a healthcare provider contributes to better health outcomes and greater satisfaction with care for older adults. Although members of federally recognized American Indian tribes have a legal right to healthcare, American Indian Elders experience inequities in healthcare access that may compromise their ability to establish a relationship with a healthcare provider. This multi-year, community-driven, mixed-method study examines the potential causes and consequences of not having a personal healthcare provider among American Indian Elders. Quantitative surveys and qualitative interviews were conducted with 96 American Indian Elders (age 55 and over) in two states in the Southwestern United States. Quantitative and qualitative data were analyzed separately and then triangulated to identify convergences and divergences in data. Findings confirmed that having a consistent healthcare provider correlated significantly with self-rated measures of health, confidence in getting needed care, access to overall healthcare, and satisfaction with care. Lack of a regular healthcare provider was related to interconnected experiences of self-reliance, bureaucratic and contextual barriers to care, and sentiments of fear and mistrust based in previous interactions with medical care. Increasing health equity for American Indian Elders will thus require tailored outreach and system change efforts to increase continuity of care and provider longevity within health systems and build Elders' trust and confidence in healthcare providers.

A Multidisciplinary, Family-Oriented Approach to Caring for Parents After Miscarriage: The Integrated Behavioral Health Model of Care.

Miscarriage is increasingly gaining recognition, both in scientific literature and media outlets, as a loss that has significant and lasting effects on parents, though often disenfranchised and overlooked by both personal support networks and healthcare providers. For both men and women, miscarriage can usher in intense grief, despair, and difficulty coping, and for women in particular, there is evidence of increased prevalence of depression, anxiety, and post-traumatic stress. Additionally, miscarriage can contribute to decreased relationship satisfaction and increased risk of separation, all while stigma and disenfranchisement create a sense of isolation. Despite this increased need for support, research indicates that many parents experience their healthcare providers as dismissive of the significance of the loss and as primarily focusing only on the physical elements of care. Research exploring the barriers to providers engaging in more biopsychosocial-oriented care has identified time constraints, lack of resources, lack of training in addressing loss, and compassion fatigue as key areas for intervention. This paper will review the biopsychosocial elements of miscarriage and discuss a multidisciplinary, family-oriented approach that can be implemented in healthcare settings to ensure a high quality and holistic level of care for individuals, couples, and families experiencing pregnancy loss.

Firearm ownership and access to healthcare in the U.S.: A cross-sectional analysis of six states

Provider-led firearm storage counseling is a form of firearm suicide prevention intervention. Little research examines whether barriers to healthcare access for at-risk individuals limit this intervention's impact. This study explores the relationship between household firearm presence/storage practices and healthcare access/utilization using a cross-sectional analysis of the 2017 Behavioral Risk Factor Surveillance System (BRFSS), which included state-representative data from six states that completed the Firearm Safety and Healthcare Access Modules: California, Idaho, Kansas, Oregon, Texas, and Utah. Exposures were household firearm presence and firearm storage practices. Outcomes were lacking health insurance, not having a healthcare provider, inability to afford care, and no recent routine checkup. Logistic regression models adjusted for age, sex, education, employment, children in the household, and state of residency. Our analysis included 31,888 individuals; 31.1% reported a household firearm. Compared to those in firearm-owning households, those in non-firearm-owning households had higher odds of being uninsured (aOR 1.99, 95%CI 1.60–2.48), not having a provider (aOR 1.40, 95%CI 1.18–1.67), and reporting cost as a barrier to care (aOR 1.37, 95%CI 1.13–1.67). Among firearm-owning households, those with firearms stored loaded and unlocked had higher odds of lacking a personal healthcare provider (aOR 1.52, 95%CI 1.07–2.15) compared to individuals in homes where firearms were stored unloaded. Results indicate that while individuals in firearm-owning households are more likely than non-firearm owning households to have healthcare access, those in homes with the riskiest firearm storage practices had less access. Provider-led counseling may have limited reach for individuals in homes with risky firearm storage practices.

A Qualitative Study Exploring the Experiences and Perspectives of Australian Aboriginal Women on Oral Health during Pregnancy.

The aim of this study was to explore whether oral health was an important consideration for Aboriginal and Torres Strait Islander women during pregnancy, whether oral health could be promoted by Aboriginal health staff, and strategies that would be appropriate to use in a new model of care. A qualitative descriptive methodology underpinned the study. All participants in this study identified as Aboriginal, with no Torres Strait Islander participants, and were from New South Wales, Australia. The interviews were analysed using inductive thematic analysis. From the data, two themes were constructed. The first theme identified that oral health was not always the first priority for participants as poor accessibility alongside other competing commitments were challenges to accessing oral health services. The second theme highlighted how relationships with personal networks and healthcare providers were essential and could be used to support maternal oral health during pregnancy. Effective strategies to promote oral health during pregnancy for Aboriginal and Torres Strait Islander women should involve key stakeholders and health care providers, like Aboriginal Health Workers, to facilitate culturally safe support and tailored oral health advice.

DNA-based screening and personal health: a points to consider statement for individuals and health-care providers from the American College of Medical Genetics and Genomics (ACMG)

DNA-based screening and personal health: a points to consider statement for individuals and health-care providers from the American College of Medical Genetics and Genomics (ACMG)

Health Care Access Among Essential Critical Infrastructure Workers, 31 States, 2017-2018.

Essential workers in the United States need access to health care services for preventive care and for diagnosis and treatment of illnesses (coronavirus disease 2019 [COVID-19] or other infectious or chronic diseases) to remain healthy and continue working during a pandemic. This study evaluated access to health care services among selected essential workers. We used the most recent data from the Behavioral Risk Factor Surveillance System, 2017-2018, to estimate the prevalence of 4 measures of health care access (having health insurance, being able to afford to see a doctor when needed, having a personal health care provider, and having a routine checkup in the past year) by broad and detailed occupation group among 189 208 adults aged 18-64. Of all occupations studied, workers in farming, fishing, and forestry occupations were most likely to have no health insurance (46.4%). Personal care aides were most likely to have been unable to see a doctor when needed because of cost (29.3%). Construction laborers were most likely to lack a personal health care provider (51.1%) and to have not had a routine physical checkup in the past year (50.6%). Compared with workers in general, workers in 3 broad occupation groups-food preparation and serving; building and grounds cleaning and maintenance; and construction trades-had significantly lower levels of health care access for all 4 measures. Lack of health insurance and underinsurance were common among subsets of essential workers. Limited access to health care might decrease essential workers' access to medical testing and needed care and hinder their ability to address underlying conditions, thereby increasing their risk of severe outcomes from some infectious diseases, such as COVID-19. Improving access to health care for all workers, including essential workers, is critical to ensure workers' health and workforce stability.