Utilization Of Preventive Health Care Services Research Articles

Evaluating the Connection Between Rural Travel Time and Health: A Cross-Sectional Analysis of Older Adults Living in the Northeast United States.

To characterize the impact of rural patients' travel time to obtain healthcare on their reported utilization of preventive healthcare services and personal health outcomes. Online survey data from rural adults ages 50+ years living in the Northeastern United States were collected from February to August 2021. Study measures included self-reported travel time to obtain healthcare, use of preventive healthcare, and health outcomes. The associations between travel time with use of preventive care and health outcomes were assessed using linear, Poisson, and logistic regression analyses controlling for demographic variables. Our study population included 1052 rural adults, with a mean travel time of 18.5 min (range: 0-60). Travel time was greater for racial/ethnic minority participants and for higher-income participants (both P < .05), but it was not associated with use of preventive healthcare. Greater travel time was associated with poorer mental health and more comorbidities, including cancer and diabetes (all P < .05). Travel time varied by patient demographic factors, and it was associated with mental health and comorbidities. There was no association between travel time and preventive care use, suggesting that other barriers likely contribute to suboptimal use of these services within rural communities. Further research is needed to elucidate the causal pathways linking travel time to mental health and comorbidities within rural communities, as increased travel may exacerbate intrarural health disparities.

Health literacy and uptake of annual physical checkups among emerging adults in the United States: Findings from the Behavioral Risk Factor Surveillance System

AbstractPublic health literature is replete with evidence on the determinants of preventive healthcare utilization. However, gap exists in the relationship between health literacy, a key social determinant of health, and annual physical checkups, especially among younger adults in the United States. This age group is one of the least likely to utilize such services for screening and prevention of diseases, which can have a significant impact on their long‐term health as they progress through the life course. Using the Andersen Healthcare Utilization framework, this study investigated the association between health literacy, an enabling factor, and uptake of annual physical checkups among emerging adults aged 18–29. A binary logistic regression model was employed to achieve the study objective using data from the 2016 Behavioral Risk Factor Surveillance System data (N = 9515). Findings showed that 61% of young adults had physical checkups in the past year. After adjusting for predisposing, need, and other enabling factors, experiencing difficulties with oral and written health literacy and having difficulties obtaining medical information and advice were significantly associated with lower odds of physical checkups in the past year. These findings provide evidence for strategies like Healthy People 2030 that aim to increase preventive healthcare service utilization among emerging adults.

Determinants of COVID-19 vaccine uptake among healthcare workers and the general population in Cyprus

Abstract Background Vaccination is a critical intervention in the fight against the coronavirus disease 2019 (COVID-19) pandemic. Various levels of COVID-19 vaccination acceptance have been observed around the world. However, a high percentage of the general population and healthcare professionals (HCPs), refuse the COVID-19 vaccination. This study aims to examine the factors influencing COVID-19 vaccine uptake among HCPs and the general population in Cyprus. Methods An online cross-sectional study was conducted, using a self-administered questionnaire to collect information covering various potential determinants including sociodemographic and health-related characteristics, trust in the healthcare system, satisfaction with it, utilization of preventive healthcare services, COVID-19 vaccination information, and general vaccination knowledge. Results A total of 2582 participants completed the survey, with 53.5% of individuals in the general population, and 70.0% of the HCPs received the COVID-19 vaccination. We found that as the age increases by one year among the general population, the odds of being vaccinated against COVID-19 increase by 1.02 units (95% 1.00-1.03, p-value=0.035), whilst those with increased trust in national healthcare authorities’ guidelines (OR = 3.96, 95% CI: 3.41-4.61) and increased vaccination knowledge scores (OR = 1.11, 95% CI: 1.05-1.18) were significantly more likely to be vaccinated. Furthermore, male HCPs (OR = 1.91, 95% CI: 1.01-3.59), and those who reported increased trust in national healthcare authorities’ guidelines (OR = 5.38, 95% CI: 3.65-7.95) were significantly more likely to be vaccinated. Conclusions Public health policymakers can use national campaigns and long-term planning to build public trust in national healthcare authorities and educate and raise awareness about the benefits of vaccination. Such strategies could pave the way for adequate vaccine uptake and prepare the public for unfavorable scenarios, such as future pandemics. Key messages • Our results revealed the importance of vaccination knowledge and trust in healthcare system in respect to COVID-19 vaccination uptake. • The urgent need for national campaigns and long-term planning to build public trust in national healthcare authorities.

Determinants of COVID-19 vaccine uptake among healthcare professionals and the general population in Cyprus: A web-based cross-sectional survey.

ObjectiveThis study aims to examine the factors influencing COVID‐19 vaccine uptake among healthcare professionals (HCPs) and the general population in Cyprus.MethodsA web‐based cross‐sectional study was conducted (November 2021–January 2022), using a self‐administered, anonymous questionnaire to collect information covering a wide range of potential determinants including sociodemographic and health‐related characteristics, trust in the healthcare system, satisfaction with it, utilization of preventive healthcare services, COVID‐19 vaccination information and general vaccination knowledge.ResultsA total of 2582 participants completed the survey. Overall, 53.5% of participants representing the general population, and 70.0% of the HCPs received the COVID‐19 vaccination. We found that as the age increases by 1 year among the general population, the odds of being vaccinated against COVID‐19 increase by 1.02 units (95% 1.00, 1.03, p= 0.035). In addition, participants among the general population with increased trust in national healthcare authorities' guidelines (OR = 3.96, 95% CI: 3.41, 4.61), and increased vaccination knowledge scores (OR = 1.11, 95% CI: 1.05, 1.18) were significantly more likely to be vaccinated, while those who had underage children living in the household were significantly less likely to be vaccinated against COVID‐19 (OR = 0.68, 95% CI: 0.50, 0.91). Furthermore, male HCPs (OR = 1.91, 95% CI: 1.01, 3.59), and those who reported increased trust in national healthcare authorities' guidelines (OR = 5.38, 95% CI: 3.65, 7.95) were significantly more likely to be vaccinated.ConclusionPublic health policymakers can use national campaigns and long‐term planning to build public trust in national healthcare authorities and raise awareness about the benefits of vaccination. Such strategies could pave the way for adequate vaccine uptake and prepare the public for unfavourable scenarios, such as future pandemics.

Mandatory COVID-19 Vaccination for Healthcare Professionals and Its Association With General Vaccination Knowledge: A Nationwide Cross-Sectional Survey in Cyprus.

COVID-19 compulsory vaccination for healthcare professionals (HCPs) is a sensitive and controversial topic, with different support rates worldwide. Previous studies in Cyprus identified a low COVID-19 vaccination acceptance among HCPs, however, no studies have investigated their perceptions toward mandatory COVID-19 vaccination. This is the first study to investigate the attitudes of HCPs toward mandatory COVID-19 vaccination and its association with general vaccination knowledge. A cross-sectional study was conducted, using an online self-administered, anonymous questionnaire to collect data on sociodemographic and health-related characteristics, trust and satisfaction with the healthcare system, utilization of preventive healthcare services, COVID-19 vaccination information, vaccination knowledge, and attitudes among HCPs toward mandatory COVID-19 vaccination. A total of 504 HCPs participated in the survey, with 34% being in favor of mandatory COVID-19 vaccination. A sufficient vaccination knowledge score was identified among the HCPs, with higher scores being associated with mandatory vaccination support (p < 0.001). As age increases by one year, the odds of supporting mandatory vaccination increase by 1.03 units (95% CI: 1.01–1.06). In addition, as the general vaccination knowledge score increases by one unit, the odds of supporting mandatory COVID-19 vaccination increase by 1.55 units (95% CI: 1.33–1.81). Our findings show that about two-thirds of the HCPs in Cyprus were opposed to a mandatory COVID-19 vaccination policy. Older age and general vaccination knowledge were found to be the strongest predictors of mandatory vaccination support. To avoid unforeseen outcomes, mandatory vaccination policies should be implemented with caution and consultation.

Urban-Rural Differences: The Impact of Social Support on the Use of Multiple Healthcare Services for Older People.

BackgroundThere are many kinds of chronic diseases, high incidence and high hospitalization rate in older people caused by population aging. The increasing demand for healthcare services has become an increasingly prominent problem in Chinese society. The purpose of this paper is to explore the influence of social support on multiple healthcare services for older people and the urban-rural differences among them.MethodsThe data are from our field survey in Shaanxi province in 2019. Using the Anderson model as the basic explanatory framework, this paper uses the Tobit-model to analyses the impact of social support for older people on the utilization of therapeutic healthcare services, and the Logit-model to analyze the impact of living arrangements and social support on the utilization of preventive healthcare services for older people.ResultsThis paper examines the impact of formal and informal support on outpatient, inpatient, and preventive healthcare services for older people, provides an in-depth analysis of the differences in the impact of social support on healthcare service utilization between urban and rural older people and analyses the contribution of various factors to the impact. The coefficient effect is divided into two parts: the coefficient “premium” of urban older people relative to urban and rural older people as a whole, which accounts for 10.8% of the total difference; and the “premium” of urban and rural older people as a whole to rural older people, which accounts for 18.9% of the total difference. The coefficient effect accounts for 29.7 per cent of the total difference.ConclusionsRural older people place greater importance on the quantity of formal social support, while urban older people place greater importance on the quality of formal social support. The phenomenon of raising children for old age was evident in the use of healthcare services by rural older people, while the phenomenon of distant relatives being better than close neighbors was evident in the use of healthcare services by urban older people. Free preventive healthcare services in rural China have largely compensated for the lack of health benefits for rural older people.

Attitudes and Determinants of Mandatory Vaccination against COVID-19 among the General Population of Cyprus: A Nationwide Cross-Sectional Study.

Vaccinations for the prevention of coronavirus disease (COVID-19) are important to control the ongoing pandemic. A much-discussed strategy to increase vaccination coverage is mandatory vaccination; however, its legitimacy and effectiveness as a measure are doubtful. This study aims to investigate the attitudes of the general population of Cyprus towards COVID-19 mandatory vaccination and to identify the factors influencing individuals’ attitudes towards such policy. An online cross-sectional study was conducted, using a self-administered, anonymous questionnaire to collect information on sociodemographic and health-related characteristics, trust, and satisfaction about the healthcare system and utilization of preventive healthcare services, COVID-19 vaccination information, general vaccination knowledge, and attitudes towards mandatory vaccination. A total of 2140 participants completed the survey, with 27.8% being in favor of mandatory vaccination. We found that as the age increases by one year, the odds of supporting mandatory vaccination increase by 1.04 units (OR 1.04, 95% CI: 1.02–1.05). In addition, those who reported increased trust in national healthcare authorities’ guidelines and recommendations (OR 3.74, 95% CI: 3.11–4.49) and those satisfied with the healthcare system (OR 1.38, 95% CI: 1.16–1.65) and follow doctor’s instructions (OR 1.29, 95% CI: 1.03–1.61), were significantly more likely to support mandatory vaccination while those who had underage children living in the household were significantly less likely to support mandatory vaccination (OR 0.69, 95% CI: 0.50–0.94). Public health authorities need to develop well-organized vaccination campaigns in which accurate evidence-based information would be disseminated with respect to individuals’ autonomy.

The COVID-19 Pandemic Impact on Households of Young Children With Special Healthcare Needs.

ObjectiveThis study examined how the COVID-19 pandemic differently affected households of children with versus without special healthcare needs. We compared caregivers’ and children’s emotional well-being (Aim 1), the utilization of preventive healthcare services for young children (Aim 2), and the promotive effects of social support on well-being outcomes (Aim 3) during the pandemic between the two groups.MethodsData were drawn from an ongoing, large, longitudinal, and national survey that assessed the pandemic impact on households of young children (0–5). Analyses for Aims 1 and 2 were based on 10,572 households, among which 10.96% had children with special healthcare needs. Analyses for Aim 3 were based on a subsample of 821 families, among which 12.54% had children with special healthcare needs.ResultsCaregivers of children with special healthcare needs exhibited more emotional distress and reported higher levels of household children’s behavioral problems during the pandemic. The percentages of missed preventive healthcare visits and vaccinations were also higher in families of children with special healthcare needs due to structural barriers. Lastly, emotional social support was indirectly related to children’s decreased behavioral problems through caregivers’ reduced emotional distress, only among households of children without special healthcare needs. In other words, social support alone was not sufficient in promoting caregivers’ and children’s better well-being outcomes among households of children with special healthcare needs.ConclusionsThe pandemic has caused extensive burdens on families of children with special healthcare needs. Actions from policymakers and early intervention service providers are urgently needed to mitigate these impacts.

UTILIZATION OF PREVENTIVE HEALTH CARE SERVICES AMONG ACADEMIC STAFF IN UNIVERSITY OF MAIDUGURI, BORNO STATE, NIGERIA

This study was conducted to assess utilization of preventive healthcare services among academic staff in University of Maiduguri, Borno State, Nigeria. Two hypotheses guided the study. Descriptive survey research design was used for the study; simple random sampling technique was also used for the study. A sample of 200 academic staff was drawn from seven faculties in the university. Data were collected using self-structured questionnaire with two sections, demographic data and utilization of preventive healthcare services. Data were analyzed using descriptive statistics of frequency counts and percentage while inferential statistics of one sample t-test and independent t- test was used to test hypotheses at 0.05 significance level. The result showed among others that there is significance difference in utilization preventive healthcare services and there is significant difference in gender utilization of preventive healthcare services. It was recommended among others that periodic public campaigns should be organized by the department of Physical and Health Education on the need for preventive measures to prevent preventable diseases.

Preventive health care services utilization and its associated factors among older adults in rural communities in Anambra State, Nigeria.

Introductionquality of life and life expectancy of people are improved when preventive health care services are utilized because these identify treatable health problems and puts life-threatening diseases in check. Morbidity and mortality associated with age-related chronic disease among the older adults is on the increase, therefore, this study aims at determining preventive health care services utilization among older adults in rural communities in Anambra State.Methodsa cross sectional design adopted for this study was carried out on older adults from the ages of 65 years and above in rural communities in Anambra State from October 2019 to January 2020. Data were collected through researcher-administered structured questionnaire. Data were analysed using univariable and multivariable regression analysis.Resultsa total of 1944 older adults participated with an overall cluster percentage of 40.6% older adults utilizing investigated preventive health care services. The results of the multivariable analysis indicates that the following factors were associated with utilization of preventive healthcare services: male gender (aOR: 0.443, 95%CI: 0.281 - 5.472, p=0.47), level of education; primary (aOR: 1.536, 95%CI: 1.201 - 5.261, p=0.00), secondary (aOR: 4.516, 95%CI: 3.192 - 6.242, p=0.00), and tertiary (aOR: 3.407, 95%CI: 3.199 - 5.666, p=0.00)], income of N50,000-N100,000 (aOR: 2.754, 95%CI: 1.066 - 10.766, p=0.01), and N100,000 and above (aOR: 4.233, 95%CI: 1.846 - 12.811, p=0.00)], and health insurance [aOR: 0.691, 95%CI: 0.422 - 1.945, p=0.03].Conclusionpreventive health care services were under-utilized. Creating awareness on the importance of utilizing preventive health care services is highly recommended since most age-related chronic diseases once established may last a lifetime and affect quality of life and wellbeing.

Pneumococcal Pneumonia Vaccination Among Older African American and Hispanic Men With Chronic Conditions

The CDC estimates that 70% of adults ages 65 years and older received the pneumococcal pneumonia vaccination (PPV). However, documented PPV rates are substantially lower for men, especially non-white men. This study examined common and unique factors associated with PPV among racial/ethnic minority men age 65 and older with one or more chronic conditions. Data were analyzed from a national sample of 470 African American (n=267) and Hispanic (n=203) males using an internet-delivered questionnaire. Two binary logistic regression models were fitted to compare factors associated with PPV. On average, participants were age 70.1(±4.5) years and reported 3.9(±2.6) chronic conditions. PPV rates were 56.8% and 43.2% among African American and Hispanic males, respectively. Across models, men who received vaccines for influenza (P<0.001) and shingles (P<0.01) were more likely to receive the PPV; whereas, those who reported more disease self-care barriers were less likely to receive the PPV (P<0.05). Among African American males, those who were widowed (OR=3.80, P=0.022) and had an annual eye examination (OR=3.10, P=0.001) were more likely to receive the PPV; whereas, divorced/separated men were less likely to receive the PPV (OR=0.33, P=0.003). Among Hispanic males, those who took more medications daily (OR=1.36, P=0.005), reported higher disease self-management efficacy (OR=1.15, P=0.011), and had a colon cancer test in the past 12 months (OR=3.55, P=0.007) were more likely to receive the PPV. Findings suggest the need for culturally tailored education and self-management interventions to increase PPV and preventive healthcare service utilization among older racial/ethnic minority men.

Low Rates of Preventive Healthcare Service Utilization Among Adolescents and Adults With Down Syndrome

People with Down syndrome have health risks that require specific lifelong preventive health care. With increasing life expectancy, people with Down syndrome also face health conditions typical of their unaffected peers and thus need coordinated health care. The purpose of this study is to describe rates of age/sex- and Down syndrome-specific preventive healthcare activities among adolescents and adults with Down syndrome. Using Medicaid claims (2006-2010) in California, Colorado, Michigan, and Pennsylvania, the cohort was defined as people with Down syndrome aged ≥12 years seen by primary care providers and enrolled in Medicaid for ≥45 of 60 months without dual Medicare enrollment (n=3,501). Age focus-consistent primary care providers were defined as having a focus concordant with a patient's age: 12-17 years, child or mixed-focus; ≥26 years, adult or mixed-focus; 18-25 years, any focus. Differences in healthcare activities were evaluated using Pearson's chi-square, Fisher's exact, and Kruskal-Wallis tests. Analyses were performed in 2015-2017. Of the cohort, 79% had an age focus-consistent primary care provider. However, 40% of adults aged ≥26 years received care from a child-focused primary care provider. Only 43% with an age focus-consistent provider had ≥1 well examination (age focus-inconsistent primary care provider: 35%, p<0.001). Most preventive activities had poor rates (<50%) regardless of age focus consistency between provider and patient age or whether they were age/sex- or Down syndrome-specific (well examinations; vaccinations; sleep apnea; hearing; and breast, cervical, and colon cancer screenings). Lipids, vision, and thyroid screenings reached moderate levels (50% to <80%). Rates of age/sex- and Down syndrome-specific preventive recommendations were low among adolescents and adults with Down syndrome, regardless of the age focus consistency of their primary care provider. This represents a significant opportunity to improve primary care in this vulnerable population.

LENGTH OF STAY IN U.S. AN ANOMALY: PREVENTIVE HEALTHCARE UTILIZATION AMONG FAITH-BASED FIRST-GENERATION CHINESE

Limited knowledge exists on preventive healthcare services utilization (PHSU) among Chinese immigrants. This study examined factors related to PHSU among faith-based first-generation Chinese. A self-administered survey was conducted in five Chinese churches in southeastern US.(n=184). Mean age was 43 (SD=14) and 50% were males. Comparing with recent immigrants (<10 years), those who lived in the US for more than 10 years were more likely to be married (94.6% vs. 50.0%), have annual exams (74.5% vs. 39.6%), report doctors recommending cancer screenings (35.3% vs. 12.5%), have talked to doctors about screenings (25.5% vs. 4.2%), and perceive higher cancer knowledge (20.0% vs. 2.1%) (all p<.05). Considering all factors together, regressions showed perceived knowledge was the only significant predictor on having talked to doctors (OR=3.11) and doctor recommending screening (OR=2.15). Married status was the only strong predictor on annual exam (OR=29.13). Our findings highlight the urgent need for promoting PHSU in this population.

Are Nigerian Women Pro-Active about Noncommunicable Disease Prevention? A Quantitative Survey.

Background:Noncommunicable diseases (NCDs) continue to cause significant morbidity and mortality worldwide with incidence increasing rapidly in developing countries. Poor utilization of preventive healthcare services contributes to this high burden.Objective:To assess the knowledge and utilization of preventive healthcare services among women in Lagos, Nigeria.Methods:This was a cross-sectional descriptive study carried out at Mainland Local Government Area (LGA) between May and July 2014. Respondents were selected using the multistage sampling method. A pretested, interviewer-administered questionnaire was used to obtain information. Data were analyzed using Epi info software version 7. Summary and inferential statistics were done and the level of significance was set at <5% (p < 0.05).Findings:Awareness of specified NCDs among the 322 respondents was 82.61% and of preventive healthcare services for the NCDs was 65.22%. Virtually all (99.05%) of the respondents had poor knowledge of these preventive services. Utilization rates were equally poor. Most common screening/tests done were Blood Pressure measurement (78.18%), Self breast examination (69.96%) and blood sugar test (58.33%). Much lower utilization rates were recorded for lipid profile (37.57%), Pap smear (26.11%), Visual Inspection with Acetic Acid (VIA) (19.72%), Human Papilloma Virus (HPV) immunization (16.55%) and mammography (14.72%).Conclusions:Respondents were aware of specified NCDs and preventive healthcare services. They considered routine medical check-up important, however they had poor knowledge of the preventive health services for NCDs and hardly utilized them. Women should be given detailed information on the preventive healthcare services to improve their knowledge and utilization so as to reduce the NCD burden.

Identifying Barriers to Access and Utilization of Preventive Health-Care Services by Young Adults in Vermont

PurposeThe objective of this study was to examine barriers to accessing and utilizing routine preventive health-care checkups for Vermont young adults. MethodsA population-based analysis was conducted using aggregated data from the 2011–2014 Behavioral Risk Factor Surveillance System (BRFSS) surveys of Vermont young adults aged 18–25 years (N = 1,329). Predictors analyzed as barriers were classified county of residence, health-care coverage, and annual household income level, as well as covariates, with the outcome of the length of time since the last routine checkup. ResultsA total of 81.1% of Vermont young adults reported having a routine checkup in the past 2 years. Health-care coverage was a predictor of undergoing routine checkups within the past 2 years, with 85.2% of insured respondents undergoing checkups compared with 56.3% of uninsured respondents (p < .001). Additionally, 81.9% of respondents from Vermont counties classified as mostly rural reported undergoing a checkup within the past 2 years (p < .05). A total of 80.8% of respondents from the middle level (p < .05) and 89.0% of respondents from the highest level (p < .001) of annual household incomes reported undergoing a checkup in the past 2 years. Finally, age (p < .001) and sex (p < .01) were shown to indicate receipt of routine preventive checkups more often. ConclusionsFor Vermont young adults, health-care coverage, classified county of residence, and household income level were shown to be indicators of undergoing routine preventive health care more often. Further investigation is needed to examine how these barriers may impede preventive screenings, thereby contributing to the ongoing development of health-care guidelines and policies for young adults in rural settings.

Numeracy and Preventive Health Care Service Utilization among Middle-Aged and Older Adults in the U.S.

ABSTRACTObjectives: Determine whether a specific numeracy skill cut-point(s) reflects an empirical threshold in the context of preventive health service utilization, and identify associations between numeracy and preventive health services utilization among middle-aged and older adults in the United States.Methods: A nationally representative sample (n = 2,989) of adults 45 years and older from the International Assessment of Adult Competencies (PIAAC) was analyzed. Binary logistic regression was used to examine the utilization of dental checkup, vision screening, influenza vaccination, and osteoporosis screening, using multiple numeracy level classifications.Results: A dichotomous classification of numeracy skill levels (low vs. moderate to high proficiency) was associated with dental checkup utilization, but vision screening, influenza vaccination, and osteoporosis screening.Conclusions: Middle-aged and older adults with sufficient numeracy skills are more likely to have had a dental check up in the past 12 months. Findings suggest that numeracy may be more relevant for long-term vs. short-term risk assessment in determining preventive health care service utilization.Clinical Implications: Two-level numeracy categories are recommended in preventive health contexts. Numeracy proficiency-sensitive risk communication by health care providers and education programs may enhance awareness of preventive health care and promote the utilization of specific preventive health service utilization among older adults.

Correlation between pediatrician supply and public health in Japan as evidenced by vaccination coverage in 2010: secondary data analysis.

BackgroundIn industrialized countries, assessment of the causal effect of physician supply on population health has yielded mixed results. Since the scope of child vaccination is an indicator of preventive health service utilization, this study investigates the correlation between vaccination coverage and pediatrician supply as a reflection of overall pediatric health during a time of increasing pediatrician numbers in Japan.MethodsCross-sectional data were collected from publicly available sources for 2010. Dependent variables were vaccination coverage for measles and diphtheria, pertussis, and tetanus (DPT) by region. The primary predictor of interest was number of pediatricians per 10 000-child population (pediatrician density) at the municipality level. Multivariate logistic regression models were used to estimate associations of interest, conditional on a large range of demographic and infrastructure-related factors as covariates, including non-pediatric physician density, total population, per capita income, occupation, unemployment rate, prevalence of single motherhood, number of hospital beds per capita, length of roads, crime rate, accident rate, and metropolitan area code as urban/rural status. The percentage of the population who completed college-level education or higher in 2010 was included in the model as a proxy for education level.ResultsPediatrician density was positively and significantly associated with vaccination coverage for both vaccine series. On average, each unit of pediatrician density increased odds by 1.012 for measles (95% confidence interval, 1.010–1.015) and 1.019 for DPT (95% confidence interval, 1.016–1.022).ConclusionsPolicies increasing pediatrician supply contribute to improved preventive healthcare services utilization, such as immunizations, and presumably improved child health status in Japan.

Living alone, health and preventive care use among the elderly in Shanghai, China

ObjectiveThe purpose of the study was to compare the preventive care use and health between the elderly living alone and living with other individuals and identify strategies to improve the preventive care use among the elderly living alone. MethodsA questionnaire including socioeconomic characteristics, preventive care use, health status and Social Support Rate Scale was administered to 240 elderly living alone and 244 elderly living with other individuals in Shanghai, China. Lo gistic regression analysis was used to examine the predictors of preventive care use. ResultsThe elderly living alone were more likely to be single (never married, divorced, separated and widowed), have lower social support and income, utilize less routine physical check-up and blood glucose screenings, have worse self-reported health and have limitations in IADL compared to the elderly living with other individuals. Women, old age, high education, income and social support and close to medical institutions were positively associated with routine physical check-up among the elderly. ConclusionLiving alone was associated with less preventive care use and worse health. It was important to provide more social support and economic support for the elderly living alone to increase their preventive health care service utilization and improve their health status.

Obesity Disparities in Preventive Care: Findings From the National Ambulatory Medical Care Survey, 2005–2007

Obesity and its consequences are a major health concern. There are conflicting reports regarding utilization of preventive health-care services among obese patients. Our objective was to determine whether obese patients receive the same preventive care as normal weight patients. Weighted patient clinic visit data from the National Ambulatory Medical Care Survey (NAMCS) were analyzed for all adult patient visits with height/weight data (N = 866,415,856) from 2005 to 2007. Preventive care practice patterns were compared among different weight groups of normal, obese, and morbidly obese. Obese patients received the least number of preventive exams with a clear gradient present by weight. Obese patients were significantly less likely to receive cancer screening including breast examination (normal weight, reference, obese, odds ratio (OR), 0.8), mammogram (obese OR, 0.7), pap smear (obese OR, 0.7), pelvic exam (obese OR, 0.8), and rectal exam (obese OR, 0.7). The obese population also received less tobacco (obese OR, 0.7) and injury prevention education (obese OR, 0.7), yet significantly more diet, exercise, and weight reduction education. Significant differences in clinic practice patterns relative to normal weight patients were also evident with more physician referral (obese OR, 1.2) and less likely to see physician at the index clinic visit (obese OR, 0.8) and less likely to receive psychotherapy referral (obese OR, 0.6). Significant gaps in preventive care exist for the obese including cancer screening, tobacco cessation and injury prevention counseling, and psychological referral. Although obese patients received more weight-related education, this emphasis may have the consequence of de-emphasizing other needed preventive health measures.

The effect of local primary care physician supply on the utilization of preventive health services in the United States

Little research has examined the effect of physician supply on health-related measures at the individual and community level simultaneously. Using telephone survey data from six counties in upstate New York, a commuting radius was constructed between the zip codes of respondents and their primary care physicians. The relationships between local physician supply, the probability of having a primary care physician, and receiving preventive health care checks were analyzed. Both logistic regression and multilevel modeling results indicated the local supply of primary care physicians affects the probability of having a primary care physician, which in turn affects preventive healthcare service utilization.