Regular Source Of Health Care Research Articles

Association between Health Insurance Type and Genetic Testing and/or Counseling for Breast and Ovarian Cancer.

As genetic testing becomes increasingly incorporated into clinical practice to aid in both the diagnosis and risk assessment of genetic diseases, patients benefit from genetic counseling to support their understanding of test results either before and/or after genetic testing. Therefore, access to genetic testing and counseling is imperative for patient care. It is well established that health insurance coverage is a major determinant of access to health care in the United States as individuals without insurance are less likely to have a regular source of health care than their insured counterparts. Different health insurance plans and benefits also influence patients’ access to health care. Data on the association of health insurance and the uptake of genetic testing and/or counseling for cancer risk are limited. Using data from the National Health Interview Survey, we examined the uptake of genetic testing and/or counseling for breast/ovarian cancer risk by health insurance type. We found that only a small proportion of women undergo genetic testing and/or counseling for breast/ovarian cancer risk (2.3%), even among subgroups of women at risk due to family or personal history (6.5%). Women with health insurance were more likely to undergo genetic testing and/or counseling for breast/ovarian cancer risk, particularly those with military and private insurance plans, than those without health insurance after adjusting for various demographic, socioeconomic, and health risk covariates. Further investigations are needed to examine potential disparities in access and health inequities.

Genetic Testing and/or Counseling for Colorectal Cancer by Health Insurance Type.

Genetic testing is increasingly used in clinical practice to assist with the diagnosis of genetic diseases and/or provide information about disease risk, and genetic counseling supports patient understanding of test results before and/or after genetic testing. Therefore, access to genetic testing and counseling is important for patient care. Health insurance coverage is a major determinant of access to health care in the United States. Uninsured individuals are less likely to have a regular source of health care than their insured counterparts. Different health insurance types and benefits also influence access to health care. Data on the association of health insurance and uptake of genetic testing and/or counseling for cancer risk are limited. Using data from the National Health Interview Survey, we examined the uptake of genetic testing and/or counseling for colorectal cancer (CRC) risk by health insurance type. We found that only a small proportion of individuals undergo genetic testing and/or counseling for CRC risk (0.8%), even among subgroups of individuals at risk due to family or personal history (3.7%). Insured individuals were more likely to undergo genetic testing and/or counseling for CRC risk, particularly those with Military and Private insurance plans, after adjusting for various demographic, socioeconomic, and health risk covariates. Further investigations are warranted to examine potential disparities in access and health inequities.

Abstract PO-068: Cervical cancer and HPV knowledge and awareness: An educational intervention among college students in Guam

Abstract The incidence of cervical cancer (CCA) in Guam, a U.S. territory in the Western Pacific, is six times higher among Micronesians and over three times higher for CHamorus (Guam's indigenous people) and Caucasians living in Guam than the U.S. population. Educational interventions among college students who can still get the HPV vaccine, particularly among women below and about the age for initial CCA screening, is crucial. Our team designed and delivered a 20-30 minute presentation to college students in a classroom setting. Pre- and post-tests measured changes in knowledge and attitudes about CCA. Summary variables were computed for CCA and HPV Knowledge and Awareness. McNemar's test was used to compare knowledge and attitudes before and after the presentation. A total of 108 students completed the survey. Most participants were female (63.0%), juniors (44.4%), and identified as either CHamoru (36.1%) or Filipino (26.9%). A majority had a regular source of healthcare (77.8%), a primary physician (56.5%), and private health insurance (52.8%). Results show male and female students had similar pre- and posttest scores. Among ethnic groups, Caucasians had the highest pretest scores and non-CHamoru Pacific Islanders had the lowest. All ethnic groups had statistically significant increases in CCA Knowledge and Awareness scores after the presentation. Three individual one-way ANOVAs with gender, ethnicity and class level as the factors were performed using the different total scores of the CCA and HPV Knowledge and Awareness as the dependent variables. There was no significant difference interaction between gender (F=0.498, p=0.482), class level (F=0.371, p=0.774), or ethnicity (F=0.398, p=0.810). However, the results showed a significant main effect of Time on CCA Knowledge and Awareness (p<0.001). There was a significant increase for all independent variables in CCA and HPV Knowledge and Awareness from pre- to post-test. The McNemar test shows that there are significant positive differences in the proportion of correct responses to most of the questions between the pre- and posttest. The percentage of correct answers to questions related to symptoms and causes of CCA, the increased risk caused by HPV, and the prevention of CCA through routine screening was already high at pretest so the difference was not significant. Overall, study participants perceived the presentation an effective tool to educate individuals about CCA. Before the presentation, 63.9% rated their general knowledge about CC as neutral or unknowledgeable. After the presentation, this decreased to 11.1%. This type of educational intervention for CCA is critical for this age group, since most can still get the HPV vaccine and women are at the age of initial CCA screening. This study shows that the college setting is an appropriate venue to increase CCA and HPV awareness and potentially impact HPV vaccination for females. Future studies should test presentation paired with opportunities for HPV vaccination via college or public health services. Citation Format: Lilnabeth P. Somera, Tressa P. Diaz, Angelina Mummert, Jaeyung Choi, Kristian Ayson, Grazyna Badowski. Cervical cancer and HPV knowledge and awareness: An educational intervention among college students in Guam [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-068.

Black Cisgender Women's PrEP Knowledge, Attitudes, Preferences, and Experience in Chicago.

Although black cisgender women in Chicago continue to disproportionally account for new HIV diagnoses, few are on pre-exposure prophylaxis (PrEP). We used concurrent mixed-methods to understand women's PrEP knowledge, attitudes, experience, and preferences in Chicago. We surveyed 370 HIV(-) cisgender women visiting a sexually transmitted infection clinic (n = 120) or emergency department (n = 250). Two focus groups were conducted with PrEP-naive women, and interviews were conducted with 7 PrEP-experienced women. Quantitative data were analyzed using descriptive statistics and multivariable logistic regression, and qualitative data using thematic analysis. Majority of women identified as black (83.0%) and had a regular source of health care (70.0%). In the past 6 months, 84.1% had vaginal or anal sex, most with inconsistent condom use (94.2%). Only 30.3% had heard of PrEP, but once explained, one-quarter considered starting PrEP, with protecting health (76.4%) and reducing HIV worry (58.1%) the most common reasons. Factors associated with considering PrEP included being Latina [adjusted odds ratio (aOR): 3.30, 95% confidence interval (CI): (1.21 to 8.99)], recent sexually transmitted infection [aOR: 2.39, 95% CI: (1.25 to 4.59)], and higher belief in PrEP effectiveness [aOR: 1.85, 95% CI: (1.22 to 2.82)]. Most (81.1%) had concerns about taking PrEP with side effects a common concern. Qualitative themes aligned with survey results, revealing a disconnection from current PrEP marketing, need for community-level PrEP education/outreach, and importance of provider trust. Despite significant PrEP implementation work in Chicago, less than one-third of women in our study had heard of PrEP. Once informed, PrEP attitudes and interest were positive. Translating these results into interventions reflecting women's preferences and barriers is critical to increase PrEP uptake by cisgender women in Chicago and elsewhere.

Threat sensitivity is associated with the healthcare source used most often: doctor's office, emergency room, or none at all

A significant proportion of American adults do not have a regular source of healthcare and the reasons for this shortfall are not fully understood. The objective of this study was to examine the relationship between individual differences in threat sensitivity and healthcare utilization in a survey of 483 African American men. Demographics, psychological characteristics, and health behaviors were assessed. The primary outcomes were: 1) most frequent source of healthcare utilization (doctor's office or clinic vs. emergency room vs. no place), and 2) frequency of healthcare utilization (one or more vs. no healthcare visits in the previous year). Data were analyzed with multivariable logistic regression. Results showed that threat sensitivity, insurance status, and age were associated with the most frequent source of healthcare utilization. Compared to men who most commonly used a doctor's office or clinic, men who tended to use an emergency room had higher levels of threat sensitivity and those with no usual healthcare source had lower levels of threat sensitivity. These findings fit with leading neurobiological theories of personality regarding threat sensitivity. From a pragmatic standpoint, these findings may also lend insight to the tailoring of health marketing messages designed to optimize utilization of healthcare resources.

Abstract C24: Determinants of delays in care-seeking for ovarian cancer symptoms in African American women

Abstract Introduction: Ovarian cancer is the most deadly gynecologic cancer, and the mortality burden is disproportionately higher among African American women. Women diagnosed with stage IV disease have less than a 30% 5-year survival rate, compared to 90% 5-year survival in stage I disease, which highlights the importance of early diagnosis. Lack of financial means and limited access to care may contribute to delays in symptomatic women seeking treatment, with consequent later stage at diagnosis. However, several studies, performed in samples predominantly comprised of White women, suggest insurance and income do not sufficiently reflect access to care. Here, we examine whether delay in care-seeking (captured through duration of symptoms prior to diagnosis) among African American women is more strongly influenced by socioeconomic status, access to care, or social access barriers (discrimination and trust in physicians). Methods: This analysis includes data from 550 African American women with ovarian cancer enrolled in the African American Cancer Epidemiology Study (AACES). AACES is a case-control study spanning 11 geographic regions in the United States: North Carolina, South Carolina, Georgia, Alabama, Tennessee, Louisiana, Texas, New Jersey, Ohio, Chicago, and Detroit. Included in the phone-administered AACES survey were questions about symptoms associated with ovarian cancer such as abdominal lumps, changes in bowel habits, and abnormal vaginal bleeding, in the year prior to ovarian cancer diagnosis. If a woman indicated she had a symptom, duration of the symptom was recorded in months. Logistic regression was used to estimate the odds ratios between predictors of accessing care and the outcome of treatment delay. The outcome was defined as having any of the 10 symptoms for at least eight months prior to diagnosis (i.e., those exceeding the seven-month mean symptom duration in this population). Models were adjusted for region, age at diagnosis, histotype, first-degree family history of breast or ovarian cancer, marital status, body mass index, Charlson comorbidity score, pelvic-inflammatory disease history, education, and income. Access to care variables included regular source of health care, insurance, regular physician relationship, and experiencing a barrier to accessing health care. Perceived discrimination was evaluated using the mean response score for questions from Williams' Everyday Discrimination Scale. Trust in physicians was modeled using the mean response score from the Anderson Dedrick Trust in Physicians Scale. Results: 41% (n=227) of women reported having at least one symptom for eight months prior to diagnosis. After adjustment for confounders, trust in physicians was inversely associated with longer duration of symptoms. A one-unit increase in the mean trust score was associated with 0.73 times the odds of women reporting undiagnosed symptoms in the previous 8 months (OR 0.73 CI 0.55-0.96). Conversely, a one-unit increase in frequency of mean everyday discrimination score was associated with 1.56 times the odds of 8 months of undiagnosed symptoms (OR 1.56 CI 1.14-2.15), after adjustment for confounders. Access to care measures and socioeconomic variables were not associated with longer symptom length in this study population. Conclusions: Various studies have considered access to care mainly in terms of availability of health insurance. Our results suggest perceived discrimination and lack of trust in physicians are important barriers to African American women seeking treatment for their ovarian cancer symptoms, even after controlling for socioeconomic status, insurance, and source of care. Citation Format: Megan Mullins, Michele L. Cote, Sarah Abbott, Anthony J. Alberg, Elisa V. Bandera, Jill Barnholtz-Sloan, Melissa Bondy, Fabian Camacho, Ellen Funkhouser, Patricia G. Moorman, Lauren C. Peres, Ann G. Schwartz, Paul D. Terry, Frances Wang, Joellen M. Schildkraut, Edward S. Peters. Determinants of delays in care-seeking for ovarian cancer symptoms in African American women [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C24.

Patterns of buprenorphine use and risk for re-arrest among highly vulnerable opioid-involved women released from jails in rural Appalachia

Aims: Opioid use is common among correctional populations, yet few inmates receive treatment during incarceration or post-release, particularly in rural areas. This article examines associations of buprenorphine use, licit and illicit, health services use, and risk for re-arrest within 3 months of jail release among rural opioid-involved women.Methods: Women were randomly selected from three rural Appalachian jails. Those with moderate to severe opioid-involvement on the NM-ASSIST, and data on patterns of buprenorphine use (N = 188), were included in this analysis. Logistic regression analyses examined predictors of re-arrest within 3 months of release.Results: Median age was 32, all were White. At follow-up, 39 (22.7%) had been rearrested; 9 (5.2%) reported receiving MAT, all with buprenorphine. Significant risk factors for re-arrest included: number of days high, injection use, number of illicit buprenorphine days, and withdrawal symptoms in the follow-up period. The sole protective factor was having a regular source of healthcare at follow-up.Conclusions: Rural opioid-involved women released from jail are highly vulnerable to re-arrest, and lack access to supportive care systems for substance treatment. Innovations to integrate MAT into reentry to improve access is recommended.

Colorectal cancer beliefs, knowledge, and screening among Filipino, Hmong, and Korean Americans.

To the authors' knowledge, there are few studies to date regarding colorectal cancer (CRC) beliefs, knowledge, and screening among multiple Asian American populations, who are reported to have lower CRC screening rates compared with white individuals. The current study was performed to assess knowledge and beliefs regarding the causes of CRC, its prevention, and factors associated with CRC screening among 3 Asian American groups. The authors conducted an in-language survey with Filipino (Honolulu, Hawaii), Hmong (Sacramento, California), and Korean (Los Angeles, California) Americans aged 50 to 75 years who were sampled through social networks. Bivariate and multivariable analyses were conducted to assess factors associated with CRC screening. The sample of 981 participants was 78.3% female and 73.8% reported limited proficiency in English. Few of the participants were aware that age (17.7%) or family history (36.3%) were risk factors for CRC; 6.2% believed fate caused CRC. Only 46.4% of participants knew that screening prevented CRC (74.3% of Filipino, 10.6% of Hmong, and 55.8% of Korean participants; P<.001). Approximately two-thirds of participants reported ever having undergone CRC screening (76.0% of Filipino, 72.0% of Hmong, and 51.4% of Korean participants; P<.001) and 48.6% were up to date for screening (62.2% of Filipino, 43.8% of Hmong, and 41.4% of Korean participants; P<.001). Factors found to be significantly associated with ever screening were being Korean (compared with Filipino), having a family history of CRC, having health insurance or a regular source of health care, and knowing that a fatty diet caused CRC. Believing that fate caused CRC and that praying prevented it were found to be negatively associated with ever screening. Factors associated with being up to date for CRC screening included being born in the United States, having a family history of CRC, and having access to health care. Knowledge regarding the causes of CRC and its prevention among Filipino, Hmong, and Korean individuals is low. However, health care access, not knowledge or beliefs, was found to be a key determinant of CRC screening. Cancer 2018;124:1552-9. © 2018 American Cancer Society.

Lay health educators increase colorectal cancer screening among Hmong Americans: A cluster randomized controlled trial.

Asian Americans have lower colorectal cancer (CRC) screening rates than non-Hispanic white individuals. Hmong Americans have limited socioeconomic resources and literacy. The current randomized controlled trial was conducted to determine whether bilingual/bicultural lay health educator (LHE) education could increase CRC screening among Hmong Americans. A cluster randomized controlled trial was conducted among Hmong Americans in Sacramento, California. LHEs and recruited participants were randomized to intervention or control groups. The intervention group received CRC education over 3 months delivered by an LHE. The control group received education regarding nutrition and physical activity delivered by a health educator. The outcomes were changes in self-reported ever-screening and up-to-date CRC screening after 6 months. All 329 participants were foreign-born with mostly no formal education, limited English proficiency, and no employment. The majority of the participants were insured and had a regular source of health care. The intervention group experienced greater changes after the intervention than the control group for ever-screening (P = .068) and being up-to-date with screening (P<.0001). In multivariable regression analyses, the intervention group demonstrated a greater increase than the control group in reporting ever-screening (adjusted odds ratio, 1.73; 95% confidence interval, 1.07-2.79) and being up-to-date with screening (adjusted odds ratio, 1.71; 95% confidence interval, 1.26-2.32). Individuals who had health insurance were found to have >4 times the odds of receiving screening, both ever-screening and up-to-date screening. A higher CRC knowledge score mediated the intervention effect for both screening outcomes. A culturally and linguistically appropriate educational intervention delivered by trained LHEs was found to increase CRC screening in an immigrant population with low levels of education, employment, English proficiency, and literacy. Cancer 2017;98-106. © 2016 American Cancer Society.

Cervical and Breast Cancer Screening Among Mexican Migrant Women, 2013.

IntroductionInformation on cervical and breast cancer screening among Latinas in the United States is limited. Even less information is available on screening practices of migrant women who engage in circular migration. We examined rates of cervical and breast cancer screening and the extent to which sociodemographics and other characteristics explain screening practices of Mexican migrant women who return to Mexico from the United States.MethodsWe used data from a cross-sectional probability survey of Mexico-born migrant women who returned, through Tijuana, to Mexico from the United States in 2013. The sample consisted of women who returned involuntarily (via deportation) or voluntarily; 177 reported authorized documentation status, and 36 reported unauthorized documentation status in the previous 12 months. Descriptive statistics were calculated and logistic regressions were estimated.ResultsOf 36 undocumented migrant women, 8 (22.2%) had a Papanicolaou test and 11 (30.6%) had a mammogram in the previous year; of 177 documented migrants, 83 (46.9%) had a Papanicolaou test and 68 (38.4%) had a mammogram. Undocumented migrants were less likely than documented migrants to receive a Papanicolaou test (odds ratio [OR] = 0.29; 95% confidence interval [CI], 0.12–0.67); the likelihood was similar after adjustment for sociodemographic, migration, and acculturation factors (adjusted OR = 0.33; 95% CI, 0.12–0.90). Having health insurance (adjusted OR = 4.17; 95% CI, 1.80–9.65) and a regular source of health care (adjusted OR = 2.83; 95% CI, 1.05–7.65) were significant predictors of receiving a mammogram but not a Papanicolaou test.ConclusionPublic health programs are needed to improve access to cervical and breast cancer screenings for Latina migrant women in general and undocumented circular migrants in particular.

Correlates of clinical breast examination among lesbian, gay, bisexual, and queer women.

Lesbian, gay, bisexual, and queer (LGBQ) women have increased risk of breast cancer yet lower use of early detection screening than heterosexual women. This lower use may be due in part to sexual stigma. The study purpose was to explore correlates of past two-year clinical breast examination (CBE) among LGBQ women to better understand screening disparities, particularly among gender non-conforming LGBQ women. A cross-sectional Internet-based survey was conducted with LGBQ women in 2011-2012. We conducted multivariate logistic regression to assess the associations between individual, social/structural and health care factors and past two-year CBE among LGBQ women (n = 414), including a subsample of gender non-conforming LGBQ women (n = 148). In multivariate analyses, significant correlates of past two-year CBE among the full sample included sexually transmitted infection knowledge (OR: 1.12, 95% CI: 1.05, 1.19), sexual risk practices (OR: 0.92, 95% CI: 0.87, 0.98), past two-year Papanicolaou test (OR: 8.36, 95% CI: 4.24, 16.45), having a regular source of health care (OR: 4.84, 95% CI: 2.60, 9.01), and health care provider knowing one's sexual orientation (OR: 3.60, 95% CI: 2.29, 5.81). Among gender non-conforming LGBQ women, perceived gender non-conformity stigma (OR: 0.85, 95% CI: 0.74, 0.99) and belief that one's health care provider is uncomfortable with one's sexual orientation (OR: 0.33, 95% CI: 0.11, 1.00) were also associated with lower screening. These findings enhance understanding of individual, social/structural, and health care factors correlated with CBE among LGBQ women. More research is needed to understand the complex interplay of these factors to inform multi-level interventions to address screening disparities for diverse LGBQ women.

Aspirin therapy for colorectal cancer prevention: The evidence

While the use of aspirin for primary prevention of cardiovascular disease (CVD) has been downplayed recently, its potential role in reducing the risk of certain cancers, most notably colorectal cancer (CRC), has remained of signicant interest.

Perceptions of and preferences for federally-funded family planning clinics.

BackgroundThe Title X family planning program provides affordable access to a range of sexual and reproductive health services, with a priority for low-income people. The disproportionate burden of unintended pregnancy, breast and cervical cancer, and sexually transmitted diseases among minority groups, teens, and young adults in the US underscore the need for affordable access to such services. However, increased access to sexual and reproductive health services, resulting from the Affordable Care Act (ACA) create questions regarding the continued need for this program.MethodsA study was conducted to assess clients’ perceptions of Title X-funded family planning clinics and their preferences for these clinics for a range of sexual and reproductive health services. An anonymous, self-administered, paper-and-pencil survey was administered to 696 clients who received services from one of eight Title X-funded family planning clinics in Northeast Ohio.ResultsThe majority of participants stated very positive perceptions of the Title X-funded clinics; that they “Always” go to the Title X-funded clinic for birth control, STD/HIV testing, and pregnancy testing; and that the Title X-funded clinic was their regular source of health care. Females were more likely than males to prefer the Title X clinic for birth control, physical exams, pregnancy testing, and health information and more teens under the age of 18 preferred to use the Title X clinic for STD/HIV testing, physical exams, pregnancy testing, and health information.ConclusionsFindings indicate that these Title X-funded family planning clinics successfully reached populations in need of sexual and reproductive health services and suggest that these facilities can help play an important role in reducing disparities even after full implementation of the Affordable Care Act. However, more research is needed to fully quantify the need and value of Title X-funded family planning clinics and its relation to the changing health care environment in the US.

Association between individual and geographic factors and nonadherence to mammography screening guidelines.

This study investigates factors that are associated with nonadherence to mammography screening guidelines in Utah, a state where mammography screening rates have remained consistently lower than national averages. We examined data on reported mammography use among women aged 40-74 years from the 2008 and 2010 Utah Behavioral Risk Factor Surveillance System (n=5,197, weighted n=417,064). Logistic regression models were used to estimate the effects of individual-level and geographic (travel time to nearest mammography facility, geographic accessibility, and rural/urban residence) factors on the odds of a woman not reporting receiving a mammogram in the last 2 years. In 2008 and 2010, a disproportionate number of women aged 40-49 (43.1%, 95% confidence interval [CI] 39.9%-46.3%) reported not receiving a mammogram within the last 2 years compared to women 50-74 (26.8%, 95% CI 24.9%-28.7%). None of the geographic factors were significant predictors of screening adherence. Based on covariate adjusted models, statistically significant (p<0.05) factors associated with increased odds of not receiving mammogram within the last 2 years included not having a regular physician, no health insurance, being aged 40-49, income less than $25,000, and the presence of three or more children in the home. Mammography screening efforts in Utah should focus on improving access to insurance or a regular source of health care. Future research should also consider how best to address extreme time demands and competing priorities that present potential barriers for women with large families, resulting in lower screening levels among these women.

The Critical Link Between Health Care And Jails

As a group, jail-involved individuals, which we define here as people with a history of arrest and jail admission in the recent past, carry a heavy illness burden, with high rates of infectious and chronic disease as well as mental illness and substance use. Because these people have tended to also be uninsured, jail frequently has been their only regular source of health care. Three thousand three hundred local and county jails processed 11.6 million admissions during the twelve-month period ending midyear 2012. The Urban Institute estimated as much as 30 percent of some local corrections budgets is allocated to inmate health care services. This investment is largely lost when people are released back into the community, where they typically do not get treatment. For people with untreated substance use or mental illness, this issue reaches beyond public health, because without treatment, these people are at heightened risk of cycling into and out of jail for low-level, nonviolent offenses. This article offers eight policy recommendations to build a continuum of care that will ensure that jail-involved people get the care they need, regardless of where they reside. With the expansion of Medicaid eligibility under the Affordable Care Act, there is now a critical opportunity to bring the jail-involved population into the mainstream health care system, which benefits the health care and criminal justice systems and society at large.

Completion of Advance Directives Among U.S. Consumers

Current, ongoing national surveys do not include questions about end-of-life (EOL) issues. In particular, population-based data are lacking regarding the factors associated with advance directive completion. To characterize U.S. adults who did and did not have an advance directive and examine factors associated with their completion, such as the presence of a chronic condition and regular source of health care. Data were analyzed in 2013 from adults aged 18 years and older who participated in the 2009 or 2010 HealthStyles Survey, a mail panel survey designed to be representative of the U.S. population. Likelihood ratio tests were used to examine the associations between advance directive completion and demographic and socioeconomic variables (education, income, employment status); presence of a chronic condition; regular source of health care; and self-reported EOL concerns or discussions. Multiple logistic regression analyses identified independent predictors related to advance directive completion. Of the 7946 respondents, 26.3% had an advance directive. The most frequently reported reason for not having one was lack of awareness. Advance directive completion was associated with older age, more education, and higher income and was less frequent among non-white respondents. Respondents with advance directives also were more likely to report having a chronic disease and a regular source of care. Advance directives were less frequent among those who reported not knowing if they had an EOL concern. These data indicate racial and educational disparities in advance directive completion and highlight the need for education about their role in facilitating EOL decisions.

A proposed theoretical model of help‐seeking among Korean‐American women with urinary incontinence

ABSTRACTThere is no integrated theoretical model explaining help‐seeking for urinary incontinence (UI) that links individual factors to socio‐cultural and systemic factors among Korean‐American women. The purpose of this article was to develop a theoretical model derived from a systemic perspective to explain the help‐seeking among Korean‐American women with UI. The Behavioural Model for Vulnerable Populations derived from a systemic perspective was adapted to develop a theoretical model. Individual factors (i.e. biological risk factors, health beliefs, social structure, income, a regular source of health care and perceived need), systemic factors (i.e. social support and transportation), and unique cultural factors (i.e. acculturation, family tradition and authority, and the preference of a health care provider) were included in the theoretical model. A proposed theoretical model in this article will give an opportunity to understand the relationships among factors that influence to help‐seeking among Korean‐American women with UI. This will be helpful to design culturally competent UI care intervention for Korean‐American women.

Health and Cultural Determinants of Voluntary HIV Testing and Counseling Among Middle-Aged and Older Latina Women

The rate of cases of HIV/AIDS in older people is increasing; indeed one out of every four people with HIV/AIDS is over age 50. This study describes the correlates of HIV Voluntary Counseling and Testing (VCT) using structural equation modeling techniques for a sample of 135 middle-aged and middle-aged and older Latinas in South Florida. Over 60% of participants had been tested for HIV. Provider endorsement was found to be the strongest predictor of VCT (odds ratio [OR] = 6. 38), followed by having a clinic as a regular source of healthcare (OR = 3.88). Social work implications are provided.

Increasing Public Awareness of Direct-to-Consumer Genetic Tests: Health Care Access, Internet Use, and Population Density Correlates

Uncertainty around the value of and appropriate regulatory models for direct-to-consumer (DTC) genetic testing underscores the importance of tracking public awareness of these services. We analyzed nationally representative, cross-sectional data from the Health Information National Trends Survey in 2008 (n = 7, 674) and 2011 (n = 3, 959) to assess population-level changes in awareness of DTC genetic testing in the U.S. and to explore sociodemographic, health care, Internet use, and population density correlates. Overall, awareness increased significantly from 29% in 2008 to 37% in 2011. The observed increase in awareness from 2008 to 2011 remained significant (OR = 1.39) even when adjusted for sociodemographic variables, health care access, Internet use, and population density. Independent of survey year, the odds of awareness of DTC genetic tests were significantly higher for those aged 50–64 (OR = 1.64), and 65–74 (OR = 1.60); college graduates (OR = 2.02); those with a regular source of health care (OR = 1.27); those with a prior cancer diagnosis (OR = 1.24); those who use the Internet (OR = 1.27); and those living in urban areas (OR = 1.25). Surveillance of awareness—along with empirical data on use of and response to genetic risk information—can inform public health and policy efforts to maximize benefits and minimize risks of DTC genetic testing.

Factors Influencing Healthcare Utilization Within a Free Community Clinic

The purpose was to explore the relationship between the presence of a free community clinic and factors associated with utilization of healthcare through a secondary data analysis. Using a descriptive correlational design, results were analyzed to explore relationships between potential utilization of healthcare, identification of a regular source of healthcare, and health insurance status. Most subjects would not seek healthcare if the free community clinic was not available. Subjects with health insurance were significantly more likely to have a regular source of healthcare and seek healthcare in the absence of the free community clinic. Subjects with a regular source of healthcare were significantly more likely to seek healthcare in the absence of the free community clinic. Emergency room utilization was not impacted by regular source of healthcare or health insurance. This study supports the need for free community clinics in areas with high percentages of uninsured, immigrant, and refugee populations.