Use Of Preventive Health Care Research Articles

Utilization of Women's Preventive Health Services During the COVID-19 Pandemic.

The association of the COVID-19 pandemic with women's preventive health care use is unknown. To describe utilization of women's preventive health services. Cross-sectional study of women aged 18 to 74 years enrolled in a commercial health maintenance organization in Michigan. COVID-19 pandemic (2019-2020). Adjusted odds ratios (AORs) of receiving breast cancer screening, cervical cancer screening, sexually transmitted infection (STI) screening, long-acting reversible contraception (LARC) insertions, and pharmacy-obtained contraception, adjusted for month, age, county, zip code characteristics (per-capita income, non-White percentage of population, non-English-proficient percentage of population), and plan designation (primary plan holder vs dependent). The study population included 685 373 women aged 18 to 74 years, enrolled for 13 000 715 person-months, of whom 10 061 275 person-months (77.4%) were among women aged 25 to 64 years and 8 020 215 (61.7%) were the primary plan holder, with mean zip code per capita income of $33 708, 20.2% mean zip code non-White population, and 3.4% mean zip code non-English-speaking population. For services requiring an in-person visit (breast cancer screening, cervical cancer screening, STI testing, and LARC insertions), utilization declined by 60% to 90% during the spring of 2020, with a nadir in April 2020, after which utilization for all services recovered to close to 2019 levels by July 2020. Claims for pharmacy-obtained hormonal contraceptives in 2020 were consistently 15% to 30% lower than 2019. The AORs of a woman receiving a given preventive service in 2020 compared with 2019 were significantly lower for breast cancer screening (AOR, 0.80; 95% CI, 0.79-0.80), cervical cancer screening (AOR, 0.80; 95% CI, 0.80-0.81), STI screening (AOR, 0.83; 95% CI, 0.82-0.84), LARC insertion (AOR, 0.87; 95% CI, 0.84-0.90), and pharmacy-obtained contraception (AOR, 0.73; 95% CI, 0.72-0.74) (all P < .001). In this cross-sectional study of women enrolled in a large US commercial health maintenance organization plan, the COVID-19 pandemic was associated with large but transient declines in rates of breast cancer screening, cervical cancer screening, STI screening, and LARC insertions, and moderate persistent declines in pharmacy-obtained hormonal contraceptives. The overall odds of a woman receiving a given preventive service in 2020 was 20% to 30% lower than 2019. Further research into disparities in access to care and the health outcomes of decreased use of these key health services is warranted.

Macro-contextual determinants of cancer screening participation and inequalities: A multilevel analysis of 29 European countries

BackgroundLittle attention has been devoted to the role of macro-level determinants in preventive health inequalities, particularly in cancer screening participation. Research has evidenced inequalities in cancer screening uptake yet has mainly focused on the screening programmes’ moderating role at the macro-level. To address this gap, this study examines how welfare provision and healthcare system features modify cancer screening uptake and inequalities across European countries. MethodsData from 99 715 (Pap smear) and 54 557 (mammography) women in 29 countries from the European Health Interview Survey (EHIS) 2014 wave and Swiss Health Interview Survey (SHIS) 2012 wave was analysed. We estimated multilevel logistic regression models, including cross-level interactions, to examine whether social protection expenditure in particular policy areas and healthcare system characteristics explained cross-country differences in Pap smear and mammography uptake and inequalities. ResultsMain findings revealed that GP gatekeeping systems were associated with reduced screening uptake likelihood in both Pap smear and mammography, and so were stronger primary care systems in Pap smear, while higher expenditures on old age and survivors were associated with increased mammography uptake. Cross-level interactions showed that in countries with higher expenditures on sickness/healthcare, disability, social exclusion and public health, and a higher number of GPs, educational inequalities in both Pap smear and mammography uptake were smaller, while higher out-of-pocket payments had the opposite effect of increasing inequalities. ConclusionsOverall, our results show that social protection policies and healthcare system features affect cancer screening participation. We conclude that institutional and policy arrangements interact with individuals’ (educational) resources and, through the (re)distribution of valued goods and resources at the macro level, these arrangements may contribute to enhancing preventive healthcare use and mitigating screening uptake inequalities.

Barriers to accessing preventive health care among African-born individuals in King County, Washington: A qualitative study involving key informants.

Studies of African immigrant health in the U.S. have traditionally focused on infectious diseases. However, the rising burden of non-communicable diseases (NCDs) indicates the increasing importance of general preventive health care. As part of a series of community health events designed for African-born individuals in King County, Washington, we administered key informant interviews (KIIs) with 16 health event participants, medical professionals, and community leaders to identify barriers and facilitators to use of preventive health care among African-born individuals. We used descriptive thematic analysis to organize barriers according to the socio-ecological model. Within the individual domain, KII participants identified lack of knowledge and awareness of preventive health benefits as barriers to engagement in care. Within the interpersonal domain, language and cultural differences frequently complicated relationships with health care providers. Within the societal and policy domains, healthcare costs, lack of insurance, and structural racism were also reported as major barriers. Participants identified community outreach with culturally competent and respectful providers as key elements of interventions to improve uptake. In conclusion, African immigrant communities face several barriers, ranging from individual to policy levels, to accessing health services, resulting in substantial unmet need for chronic disease prevention and treatment. Community-centered and -led care may help facilitate uptake and engagement in care.

CONCEPTUALLY-THEORETICAL JUSTIFICATION AND UPDATING OF THE PREVENTIVE APPROACH IN THE IMPLEMENTATION OF A PHARMACIST’S INFORMATION CONSULTANCY SERVICES IN THE PUBLIC HEALTH SYSTEM

Public health protection is the most important law of the development of a civilized society. As participants in the health care system, pharmaceutical specialists must take upon themselves certain preventive tasks aimed at strengthening and maintaining the health of the population.The aim of the work was to substantiate and develop a methodology for implementing the professional role of pharmaceutical specialists in public health protection.Materials and methods. The search for information was carried out using the methods of address, thematic and factual search in the Scopus, The Cochrane Library, Pubmed, eLibrary databases. The analyzed body of information included systematic reviews, retrospective and randomized studies, and other applied developments on the topic of publication. The depth of the bibliographic search for scientific publications is about 20 years (2000-2019). The following keywords were used for the search: “a pharmacist in health protection”, “prevention of adverse drug reactions”, “functions of a pharmacist”, “pharmaceutical care”, “sanitary competence”, “a pharmacist’s role in the prevention of diseases”, “pharmacy services”, “patient compliance”, “collaboration in health care”, etc.Results. On the basis of the analysis, the demand for pharmacists in the health protection activities has been substantiated, the scientific and applied methodology of using pharmaceutical knowledge in the protection of public health has been updated and the necessary professional competencies (PC) of a pharmacist have been proposed for their implementation. The relevance of the preventive approach in the implementation of information and consultancy activities of a pharmacist has been substantiated, the essence of which is to prevent undesirable events associated with the use of medicinal preparations (MPs) and preventive health care in the society. The proposed methodology is based on the concept of “a pharmaceutical vigilance”, the practical implementation of which is proposed in the publication. The need for pharmacists to perform certain professional functions aimed at preserving and strengthening the health of the population has been updated, the functions have been proposed and the list of possible pharmaceutical services for the practical implementation of the proposed functions in the health care system has been provided.Conclusion. The following pharmaceutical services have been identified as relevant: pharmaceutical enlightenment of the population, patient-oriented pharmaceutical counseling and patronage of patients, pharmaceutical informing of medical specialists about drugs and social prevention of the problems affecting the public health. The definitions of pharmaceutical services have been specified, the methodology for providing the services has been substantiated, the efficiency of their provision has been updated and the professional competencies of pharmacists for their implementation in practical healthcare have been formed.

THE EFFECTS OF SOCIAL HEALTH INSURANCE ON WOMEN’S HEALTHCARE USE: EVIDENCE FROM INDONESIA

To increase the use of healthcare services in Indonesia, the government of Indonesia introduced Askeskin, a subsidized social health insurance for the poor, in 2005. We examine the effects of this social health insurance on women’s healthcare use. Using propensity score matching, we find Askeskin induces women to use public healthcare facilities for birth delivery and antenatal checkup, discourages them from getting help from midwives for birth delivery, and makes them more likely to use contraceptives. The insurance seems to increase delivery care expenditure, however. We do not find evidence that it increases women’s preventive and curative healthcare use.

Neighborhood social cohesion and disease prevention in Asian immigrant populations

In the United States (US), chronic disease risk factors are highly prevalent among Asian immigrant communities, who also exhibit low health screening rates. Perceived neighborhood social cohesion (NSC) has been associated with preventive healthcare use in the general US population, although it remains unexplored among Asian Americans (AAs). The aim of this study is to evaluate the association between NSC and preventive screening for hypertension, high cholesterol, diabetes, and depression among East, South and Southeast Asian American (EAA, SAA, SEAA) communities in New York City (NYC) using cross-sectional, locally collected data from 2013 to 2016. NSC was assessed using a 4-question scale to create an additive score between 4 and 16 and was analyzed both as a continuous and categorial variable (High, Medium, and Low tertiles). Recent screening was defined as a check-up within the last year for each of the included health conditions. A one-unit increase in NSC score was associated with increased odds of recent screening for high cholesterol in EAAs (AOR = 1.09, 95%CI:1.00–1.20); for high cholesterol, diabetes, and depression in SAAs (AOR = 1.08, 95%CI:1.00–1.20; AOR = 1.07, 95%CI:1.00–1.15; AOR = 1.15, 95%CI:1.06–1.25); and with high cholesterol among SEAAs (AOR = 1.12, 95%CI:1.00–1.25). Overall, NSC was an important facilitator for preventive screening behaviors for specific conditions in different groups, though was consistently associated with screening for high cholesterol in our sample. Enhancing NSC through family and community-based programming may be one strategy to encourage screening for preventive behaviors, though more research is needed to elucidate a precise mechanism.

Patient and caregiver experiences at a specialized primary care center for autistic adults.

Background:Little is known about the extent to which patient-centered medical homes meet the needs of autistic adults.Materials & methods:We conducted a cross-sectional survey of autistic adult patients (n = 47) and caregivers of autistic adult patients (n = 66) receiving care through one patient-centered medical home specifically designed to meet the needs of this population. We performed post hoc comparisons of our results to previously published data from a national sample of autistic adults.Results:Participants reported high levels of satisfaction with care, frequent preventive healthcare use and few unmet healthcare needs. Autistic adults in our sample reported significantly higher satisfaction and fewer unmet healthcare needs.Conclusion:A patient-centered medical home tailored to the needs of autistic adults is a promising approach to healthcare delivery for meeting this population’s needs.

Neighborhood Disorder, Social Ties, and Preventive Healthcare Utilization among Urban-Dwelling Older Adults.

Objectives: This research examines whether perceived neighborhood disorder influences the use of preventive healthcare services (i.e. influenza vaccine, pneumonia vaccine, cholesterol screening, colonoscopy, and dental care) by older adults and whether social ties buffer the potential adverse effects of perceived neighborhood disorder. Methods: Using data from the 2012 wave of the Health and Retirement Study, binary logistic regression was used to generate odds ratio estimates of preventive healthcare use in the past 2years. Results: We find that greater levels of neighborhood disorder were associated with fewer dental care visits net of social and health factors. Regular participation in four or more social activities was associated with decreased odds of restricted use and increased odds of receiving a pneumonia vaccine and colonoscopy. Discussion: This research provides evidence that perceived neighborhood disorder may act as a barrier for specific preventive healthcare services and highlights the need for targeted intervention.

Inequalities in the long-term impact of the economic recession on preventive healthcare use and health-related lifestyle in Spain (2006-2017).

Study of the long-term impact of economic recession on lifestyle according to socioeconomic groups is scarce. This study examines health-related lifestyle and preventive medical attendance in different socioeconomic groups in the Spanish adult population (18-64years of age) before, during and after an economic recession. Data were collected from three waves of the Spanish National Health Survey (2006, 2012 and 2017). Self-perceived health, health-related lifestyle and common preventive medical attendance were evaluated by means of multivariate logistic models. The increase in good self-perceived health in 2006-2012 was 7.1%, 6.9% and 8.3% for the high, middle and low group, respectively, and 5.2%, 5.9% and 7.9% for the high, middle and low group, respectively, in 2006-2017. In 2006-2012 and 2006-2017, the gap increased between people of the high and low groups in smoking prevalence (2.8%-4.7%), physical activity (2.0%-4.0%), daily fruit (1.0%-6.3%) and vegetable intake (2.5%-6.1%). The probability of women´s gynaecological attendance increased statistically significant for cytology in three groups in 2006-2012 and 2006-2017 (OR=1.35, 95% CI=1.08-1.67; OR=1.42, 95% CI=1.18-1.7; OR=1.34, 95% CI=1.21-1.47 for the high, middle and low groups, respectively, in 2006-2012 and OR=1.34, 95% CI=1.08-1.67; OR=1.62, 95% CI=1.35-1.95; OR=1.51, 95% CI=1.37-1.66 for the high, middle and low groups, respectively, in 2006-2017), but not for mammography. This study reveals long-term socioeconomic inequalities in lifestyle behaviours after the economic recession. Health policies must be emphasised in these population subgroups and in more disadvantaged populations.

Abstract B112: Influence of cholesterol screening on breast cancer detection and survival in the Breast Cancer Care in Chicago Study

Abstract Background: The utilization of non-cancer-related screening tests may result in a screening-related comorbidity that also serves as a marker for overall increased preventive health care use, including for breast cancer detection. Previous studies have found that a diagnosis of either hypertension or cholesterol has been associated with earlier stage at diagnosis for breast cancer. We sought to replicate these findings in a racially and ethnically diverse sample of patients in the population-based Breast Cancer Care in Chicago (BCCC) study. Methods: Participants included 989 non-Hispanic White (NHW), African American (AA), and Hispanic female breast cancer patients diagnosed between 2005 to 2008 who completed an interview. All patients resided in Chicago, Illinois, and were between the ages of 30-79 years at the time of their first primary in situ or invasive breast cancer diagnosis. Comorbid conditions were defined from interviews and medical record abstractions. Multivariable logistic regression and Cox proportional hazards (PH) models were used to estimate the associations of comorbid conditions with mode of detection (screen-detected vs. symptomatic), breast cancer-specific survival (BCSS), and overall survival (OS). Results: Overall, 33% of BC patients had hypertension and 9% had high cholesterol (HC). A diagnosis of hypertension was not associated with mode of breast cancer detection or survival. Screen-detection was nearly 30 percentage points higher for patients with vs. without a diagnosis of HC (78% vs. 49%, PD=0.29, 95% CI: 0.19, 0.39). HC was present in 9% of NHW BC patients and 8% of AA and Hispanic BC patients. The association of HC with screen-detection varied widely by race/ethnicity, being strongest among AA patients (PD=0.41, 95% CI: 0.28, 0.54), more moderate for NHW patients (PD=0.27, 95% CI: 0.14, 0.40), and absent among Hispanic patients (PD=0.05, 95% CI: -0.21, 0.31). With adjustment for age, race/ethnicity, income, education, affluence, disadvantage, insurance status, presence of a regular provider, and time of last clinical breast exam and last mammogram, HC remained associated with screen-detection (PD=0.21, 95%CI: 0.10, 0.32). A diagnosis of high cholesterol was associated with a large but imprecise reduction in age-adjusted BCSS (HR=0.43, 95% CI: 0.14, 1.3) and OS (HR=0.50, 95% CI: 0.21, 1.1). Multivariable-adjusted HRs were 0.54 (95% 0.17, 1.7) and 0.55 (0.24, 1.2), respectively. Conclusion: High cholesterol may be a potent marker for contact with a primary care physician and willingness to utilize preventive services. We found a particularly strong association of high cholesterol with early detection among AA patients. This association remained after robust control for preventive breast health care variables, suggesting that it is an independent predictor of screen-detected BC. A larger study is required to have sufficient sample to examine subsequent associations with BCSS and OS among racial/ethnic subgroups. Citation Format: Alpana Kaushiva, Susan Hong, Katherine Tossas-Milligan, Garth Rauscher. Influence of cholesterol screening on breast cancer detection and survival in the Breast Cancer Care in Chicago Study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B112.

The Role of the Medicaid Expansion in the Use of Preventive Health Care Services in California Men.

Men’s use of preventive care services may be constrained due to a number of factors including lack of health care insurance. California used the Medicaid expansion provisions of the Affordable Care Act (ACA) to enroll low-income men between the ages of 18 and 64 years in publicly funded health insurance. Most studies on the effect of the ACA on health care services have focused on racial/ethnic differences rather than gender. Data from the California Health Interview Survey for the 2015–2016 survey period were used to model the use of preventive health care services in the year prior to interview. Population weights were used in the analysis which was done using PROC SURVEY LOGISTIC in SAS software, version 9.4. The sample consisted of men between the ages of 18 and 64 years (N = 6,180). Of these 66% (n = 4,088) reporting receiving any preventive care services in the year prior to interview. The largest proportions of respondents fell into the youngest group aged 18–25 (17%) followed by the oldest group aged 60–64 (16.9%); 43% reported they were married, 57% had incomes at greater than 300% of the federal poverty level. There was no effect of race or ethnicity on receiving preventive care services. Having a chronic condition such as hypertension or diabetes was associated with a greater odds of receiving preventive care. Expanding Medicaid to include low-income men below the age of 65 is associated with increased use of preventive health care, especially among those with chronic conditions.

Mass Incarceration and Subsequent Preventive Health Care: Mechanisms and Racial/Ethnic Disparities.

Objectives. To examine the associations and mechanisms between 2 indicators of mass incarceration and preventive health care use and whether these associations are moderated by race/ethnicity.Methods. We used 1997 to 2015-2016 data from the US National Longitudinal Survey of Youth 1997 (n = 7740) to examine the associations between arrest and incarceration at ages 18 to 27 years and cholesterol, blood sugar, and blood pressure screenings at age 29 years. Explanatory mechanisms included blocked access (health care coverage and medical checkup) and economic (education, employment, and income) factors. We used logistic regression to model main effects.Results. Arrest was associated with lower odds of getting blood cholesterol, blood sugar, and blood pressure tests; incarceration was associated with lower odds of getting cholesterol and blood sugar tests; blocked access and economic factors mediated 42% to 125% of these associations. These associations were mostly consistent across race/ethnicity.Conclusions. Mass incarceration contributes to decreases in preventive health care use, which are explained in part by blocked access and economic factors.Public Health Implications. The decreased use of preventive health care following mass incarceration may increase the prevalence of disease and the associated costs of treatment.

INTEREST GROUP SESSION—AGING AMONG ASIANS: RESEARCH METHODS IN AGING AMONG ASIANS

Asians are the largest and the fastest growing segment of the world population. Asian immigrants are the second largest immigrant population in the U.S. However, age-related social and health issues are understudied among late-life immigrant and the oldest old Asians. Little data exist to support public health promotion, policy studies and clinical practice in this population. To advance research into aging among Asians living in the U.S. and elsewhere in the world, sound methodologies can be adopted from those well-developed in other settings while novel methodologies are to be developed to meet the unique needs of Asian studies. This symposium brings together four abstracts that address a variety of common methodological issues in social and health studies among Asian older adults. The topics range from culturally and linguistically appropriate strategies for recruiting non-English speaking research participants, assessment of social isolation and transportation barriers using an ethnographical approach, development of a new culturally appropriate measure for successful aging among the oldest old Chinese in China, and evaluation of preventive healthcare use among faith-based first-generation Chinese immigrants using self-administered surveys in the U.S. These studies involve qualitative ethnographical analysis, mixed methods for instrument development, quantitative data analysis, use of geographic information systems and demography to plan participant recruitment, and use of staged community engagement to increase efficiency and representativeness of participant recruitment. Lessons learned from these studies are valuable to future studies on aging among Asians. This symposium is a collaborative effort of the GSA Aging Among Asians Interest Group.

Cluster Randomized Trial of a Pre/Interconception Health Intervention for Mothers in Pediatric Visits.

Recognizing that pediatric primary care focuses on family health and is an important location of contact for women of childbearing age, this project assessed the effectiveness of a pre/interconception women's health intervention delivered during pediatric primary care using a cluster randomized trial. Pediatric clinicians were randomized to a screening and brief educational intervention group or usual care comparison group. Intervention group clinicians received training on pre/interconception care, including recommended counseling and referral resources for needs identified. Women presenting to primary care with their child ≤12 months were enrolled and assigned to the group corresponding to the assignment of their child's clinician. Mothers seen by clinicians in the intervention group completed a pre/interconception health screening tool and discussed results with their child's clinician during the visit. These mothers were compared to mothers seen by comparison group clinicians who did not receive the screening tool or clinician discussion. All enrolled mothers (Intervention and Comparison) received written preconception health information and a 90-day supply of multivitamins. Primary outcomes at 6 and 12 months post enrollment included contraception use, pregnancy, and access to and use of preventive health care. Secondary outcomes included daily folic acid supplementation, smoking, and substance use. A total of 415 women were enrolled and those who had at least 1 follow-up assessment were included in the analysis (n = 383). There was no significant effect of the intervention on contraceptive use, pregnancy incidence, or use of preventive care. Assignment to the intervention increased the odds of daily folic acid use (odds ratio 1.82, 95% confidence interval 1.25, 2.63) during follow-up. Intervention mothers were less likely to smoke at 6, but not 12 months. Pediatric visits are an opportune location for addressing maternal health and this intervention demonstrated feasibility and improved outcomes for some but not all outcomes. Attention to maternal health needs in pediatric visits during infancy may be important for maintaining positive pre/interconception health behaviors.

The effect of the Affordable Care Act on patient out-of-pocket cost and use of preventive cancer screenings in Massachusetts.

In an effort to increase use of preventive health care, The Patient Protection and Affordable Care Act (ACA) eliminated cost-sharing for preventive cancer screening services for the privately insured. The impact on patient spending and use of these screenings is still poorly understood.We used an interrupted time series analysis with the Massachusetts All-Payer Claims Database (2009–2012) to assess changes in trends in costs and use of breast, cervical and colorectal cancer screenings after the ACA policy. We find that the ACA was associated with a 0.024 (95% CI: −0.031, −0.017, p < 0.001) and 0.424 (95% CI: −0.481, −0.368, p < 0.001) percentage point decrease in the likelihood of a copayment each week for preventive breast and cervical cancer screenings respectively. The likelihood of copayment for colon cancer screening declined throughout the study period, with the rate of decline slowing following the ACA (trend in percent of screenings with copayment −0.130 before vs −0.071 after ACA, p = 0.014). Overall, we find only weak evidence that the ACA policy increased screenings. We find no significant effect on utilization for cervical cancer or colon cancer screening. For breast cancer screening, we find a small immediate increase in the utilization rate in the month after the policy change, with no change in trend after the ACA policy. Policy makers may need to consider other complementary policy options to increase screening rates.

Preventive oral health care use and oral health status among US children: 2016 National Survey of Children’s Health

BackgroundResearch has identified significant gaps in preventive oral health care among certain subpopulations of US children. The authors of this study sought to estimate children’s preventive oral health care use and oral health and investigate associations with child, family, and health care characteristics. MethodsData for this observational, cross-sectional study came from the 2016 National Survey of Children’s Health. Children aged 2 through 17 years were included (n = 46,100). Caregiver-reported measures were preventive dental visits, prophylaxis, toothbrushing or oral health care instructions, fluoride, sealants, fair or poor condition of the teeth, and problems with carious teeth or caries. Univariate, bivariate, and multivariable logistic regression analyses were conducted. ResultsAs reported by parents or caregivers, 8 in 10 children had a preventive dental visit in the past year but lower rates of specific services: 75% prophylaxis, 46% fluoride, 44% instructions, and 21% sealants. In addition, 12% had carious teeth or caries and 6% had fair or poor condition of the teeth. In adjusted analyses, young children (aged 2-5 years), children with no health insurance, and those from lower-income and lower-educated households had decreased likelihood of a preventive dental visit as well as specific preventive services. Children with preventive health care visits and a personal physician or nurse had increased likelihood of receiving preventive oral health care. ConclusionsPreventive oral health services are lagging among young children and children from lower socioeconomic backgrounds. Further studies are needed to identify interventions that encourage use of specific preventive services. Practical ImplicationsDentists should work with caregivers and primary care providers to promote preventive oral health care, especially among young children and those from lower socioeconomic backgrounds.

Relationship of health literacy with utilization of health-care services in a general Japanese population.

Many studies have explored the association between health literacy and health-care utilization; however, the majority assessed functional health literacy in terms of basic skills. Japan's health-care and medical examination system in workplaces is different from that of other major countries. This study examined the relationship of health literacy with health-care use (emergency visit, hospitalization, dental checkup, and health checkup or cancer screening); it focused on differences by occupation and health-care service utilization among general Japanese using the communicative and critical health literacy scale. We conducted a cross-sectional observational study of 1002 Japanese residents. Through a questionnaire, we investigated socioeconomic status, health status, health-care use, and health literacy. Among all participants and non-workers, logistic regression analyses revealed that health literacy was significantly associated with health checkup or cancer screening after adjusting for sex, age, marital status, education, and having a disease or disorder (adjusted odds ratio [OR] = 1.431, 95% confidence interval [CI], 1.131–1.810; adjusted OR = 1.614, 95% CI, 1.114–2.339, respectively). Among workers, we observed no significant association between health literacy and health-care utilization. These results indicate that health literacy is closely related to use of preventive health-care. Japan's health-care system in workplaces may promote use of preventive health-care services regardless of health literacy, whereas improving health literacy may be more critical among non-workers.

Sense of Mission and Subsequent Health and Well-Being Among Young Adults: An Outcome-Wide Analysis.

Purpose in life is potentially a modifiable “health asset” that enhances health and well-being. However, the association between purpose and health in younger populations remains understudied. In this study, we prospectively examined an aspect of purpose in life—specifically having a sense of mission—and a wide range of outcomes related to psychosocial well-being, mental health, health behaviors, and physical health in young adults. Longitudinal data from the Growing Up Today Study (2007–2010 or 2007–2013, depending on outcome; mean baseline age = 22.97 years) were analyzed using generalized estimating equations. Sample sizes ranged from 6,323 to 7,463, depending on outcome. Bonferroni correction was used to correct for multiple testing. All models controlled for sociodemographic characteristics, religious service attendance, maternal attachment, and prior values of the outcome variables. Greater sense of mission was associated with greater psychological well-being (including life satisfaction, positive affect, self-esteem, emotional processing, and emotional expression), greater use of preventive health care, more volunteer activities, and possibly fewer depressive symptoms. However, there was little association with physical health or other behavioral outcomes. The formation of a sense of mission may provide a novel target for promoting multiple facets of psychological well-being, prosocial character, and possibly mental health among young adults.

Examining the Impact of Child Adversity on Use of Preventive Health Care among Children.

Child adversity has a negative impact on child and adult health. The present study aimed to determine whether adverse family experiences (AFEs) were associated with use of preventive health care (PHC) among children and whether insurance status affected this association. This study examined data from the 2011-2012 National Survey of Children's Health (N = 88,849) and included responses for children ages zero to 17 years. Logistic regression models were used to estimate odds of using PHC from AFEs. Results were stratified by insurance status and confounders were accounted for. Among the entire sample and the insured, most AFEs were not associated with use of PHC. Among the uninsured, several AFEs-lived with parents or guardians who were separated, lived with parent or guardian who was incarcerated, witnessing or experiencing violence in the household, and living with anyone who had substance abuse problems-and the sum of AFEs were associated with increased use of PHC. Findings are consistent with newer research showing that some disadvantage or adversity is associated with more optimal use of PHC. In addition, uninsured children with a history of AFEs would benefit from insurance, given their increased use of PHC.

Association Between Health Insurance Literacy and Avoidance of Health Care Services Owing to Cost

Navigating health insurance and health care choices requires considerable health insurance literacy. Although recommended preventive services are exempt from out-of-pocket costs under the Affordable Care Act, many people may remain unaware of this provision and its effect on their required payment. Little is known about the association between individuals' health insurance literacy and their use of preventive or nonpreventive health care services. To assess the association between health insurance literacy and self-reported avoidance of health care services owing to cost. In this survey study, a US national, geographically diverse, nonprobability sample of 506 US residents aged 18 years or older with current health insurance coverage was recruited to participate in an online survey between February 22 and 23, 2016. The validated 21-item Health Insurance Literacy Measure (HILM) assessed individuals' self-rated confidence in selecting and using health insurance (score range, 0-84, with higher scores indicating greater levels of health insurance literacy). Dependent variables included delayed or foregone preventive and nonpreventive services in the past 12 months owing to perceived costs, and preventive and nonpreventive use of services. Covariates included age, sex, race/ethnicity, income, educational level, high-deductible health insurance plan, health literacy, numeracy, and chronic health conditions. Analyses included descriptive statistics and bivariate and multivariable logistic regression. A total of 506 of 511 participants who began the survey completed it (participation rate, 99.0%). Of the 506 participants, 339 (67.0%) were younger than 35 years (mean [SD] age, 34 [10.4] years), 228 (45.1%) were women, 406 of 504 who reported race (80.6%) were white, and 245 (48.4%) attended college for 4 or more years. A total of 228 participants (45.1%) had 1 or more chronic health condition, 361 of 500 (72.2%) who responded to the survey item had seen a physician in the outpatient setting in the past 12 months, and 446 of the 501 (89.0%) who responded to the survey item had their health insurance plan for 12 or more months. One hundred fifty respondents (29.6%) reported having delayed or foregone care because of cost. The mean (SD) HILM score was 63.5 (12.3). In multivariable logistic regression, each 12-point increase in HILM score was associated with a lower likelihood of both delayed or foregone preventive care (adjusted odds ratio [aOR], 0.61; 95% CI, 0.48-0.78) and delayed or foregone nonpreventive care (aOR, 0.71; 95% CI, 0.55-0.91). This study's findings suggest that lower health insurance literacy may be associated with greater avoidance of both preventive and nonpreventive services. It appears that to improve appropriate use of recommended health care services, including preventive health services, clinicians, health plans, and policymakers may need to communicate health insurance concepts in accessible ways regardless of individuals' health insurance literacy. Plain language communication may be able to improve patients' understanding of services exempt from out-of-pocket costs.