Report Poorer Health Status Research Articles

Profiles of physical frailty, social frailty, and cognitive impairment among older adults in rural areas of China: a latent profile analysis.

As China rapidly ages, it has now become a deeply aging society with the largest number of older individuals in the world. The issue is particularly severe in rural areas. With the aging population growing and the older population expanding, health problems are becoming more prevalent among older individuals, particularly frailty and cognitive impairments. This study aimed to identify the profiles of physical frailty, social frailty, and cognitive impairment among older adults and explore the influencing factors. In this cross-sectional study, participants were recruited from six villages in four cities in Shandong Province, China from July to October 2023 through cluster random sampling. Latent profile analysis was used to determine the profiles of physical frailty, social frailty, and cognitive impairment. Chi-square tests and Mann-Whitney U tests were used for univariate analysis, while binary logistic regression was used to analyze the related factors. Seven hundred and sixty-nine older adult care in rural areas showed two profiles: the "high cognitive function and low frailty" group (73.7%, n = 567) and the "low cognitive function and high frailty" group (26.3%, n = 202). A binary logistic regression found that older people were more likely to be aged 80 or older (OR = 2.253, p = 0.029), have a low income level (OR = 1.051, p = 0.007), have one or two (OR = 2.287, p = 0.004), or more than three chronic diseases (OR = 3.092, p = 0.002), and report moderate (OR = 3.406, p = 0.024) or poor health status (OR = 9.085, p < 0.001) in the "low cognitive function and high frailty" group. Meanwhile, older adults who have completed high school (OR = 0.428, p = 0.005) or junior college and above (OR = 0.208, p = 0.009), and engage in adequate physical activity (OR = 0.319, p < 0.001) were more likely to be in the "high cognitive function and low frailty" group. In the future, medical professors should increasingly prioritize promptly identifying and intervening in cognitive decline and frailty status in older individuals without delay.

HOW DO PEOPLE PERCEIVE THEIR OWN AGE?—SELF-REFLECTION ON HEALTH STATUS

Abstract Subjective age -- how old you feel -- is a simple, but inclusive indicator of how people experience their own aging. This hypothesis-generating study sought to assess how objective and subjective indicators of well-being differ by subjective age, in order to progress our understanding of how this metric internalizes physical and psychological information. Data were drawn from the Midlife in the United States in 2004-2006 (MIDUS 2). The sample represented adults aged 50 years and over (n=612) and was divided into two groups: 1) felt younger than chronological age, and 2) felt the same or older than chronological age. Nearly four in five older adults reported feeling younger than their chronological age. Chi-square statistics showed that subjective indicators differ by subjective age. Specifically, those that felt the same/older than their chronological age were more likely to have depression or functional limitations, and report poor health status than were feeling younger group. Interestingly, bio-marker (i.e., C-reactive protein), physical and cognitive ability (i.e., gaits and episodic memory), and chronic conditions did not differ by subjective age. The findings indicate that reports of subjective age correlate with perceived rather than objective health status. Subjective age may therefore function as an indicator that health problems or life stressors are becoming internalized and overcoming an individual’s capacity to cope. Future research is needed to understand how subjective age can act as a bellweather of subjective and objective health decline.

The impact of dentition status and barriers to dental care services on perceived oral health of medicare beneficiaries.

To examine the association among barriers to dental care services, dentition groups, and self-reported oral health status for Medicare beneficiaries. We used data from the 2017 to 2018 National Health and Nutrition Examination Survey (NHANES), which included participants aged ≥65 years who were enrolled in Medicare and had completed the oral health exam. We created a dentition group variable using the detailed dental examination data to account for the presence of natural, replaced, removable, or missing teeth. Through bivariate and logistic analyses, we explored the relationship between barriers to receiving dental care services, dentition groups, and reported oral and general health statuses, along with other control variables. For the total Medicare population as well as in the four subgroup analyses, we showed that those with barriers to dental care services were more likely to report fair or poor oral health status. Those who were edentulous, had complete dentures, or had less than a full mouth of teeth had greater barriers and worse oral and general health than did those with all-natural teeth. Among those who reported fair or poor general health, those with less than a full mouth of teeth showed similar levels of barriers to dental care services and worse perceived oral health than did those without any teeth. Helping the 65 years and older population retain their teeth in good condition will improve their overall health. Investment in oral hygiene and health for the current and future Medicare populations could improve their overall health.

1567P Comparison of sociodemographic characteristics and physical and psychological health of adolescent and young adult (AYA) cancer survivors with those of the general population

Adolescent and Young Adult(AYA) cancer survivors have been highly reported psychosocial and physical burden. However, few research compared psychosocial and physical burden between AYA survivors and general population. This study aims to compare sociodemographic characteristics and physical and psychological health of AYA survivors with those of the general population. We conducted a cross-sectional study using the US and Korean National Health and Nutrition Examination Surveys from 2007 to 2018. We defined AYA survivors as adults who were diagnosed any type of cancer between aged 15 to 39 years. The comparison group was matched according to age, sex, race/ethnicity with 1:5 ratios. Sociodemographic, comorbidities, physical and psychosocial health were assessed using standardized questionnaires. Among 773 AYA cancer and 3865 matched general population, AYA survivors were more likely to be former drinkers and smokers (46.1% vs 35.5%, 12.5% vs 0.1%), more likely to be divorced (11.4% vs 7.6%); and have poor health (5.1% vs 2.6%). AYA survivors experienced asthma, angina, thyroid problem, and myocardial infraction 2 times more than those of the general population. Non-Hispanic White AYA survivors were more likely to be divorced than other race groups and Black AYA survivors were more likely to be unemployed. Hispanic AYA survivors had lower level of income. However, there were no significant differences in physical, mental, emotional limitation and physical activities between AYA survivors and general population. AYA cancer survivors were more likely to experience lower socio-economic status and report poor health status compared with those of the general population. Future studies and interventions are necessary to reduce the gap between AYA survivors and the general population.

How do gender based disparities affect women’s self-rated health and anxiety in the European Union?

ABSTRACT This study analyses the differences in self-rated health (SRH) and self-rated anxiety (SRA) among the countries of the Euro-Area through the European Working Conditions Survey (2015). The article, thus, proposes a grouping of countries based on the Global Gender Gap Index, developed by the World Economic Forum, to justify differences in SRH and SRA. The descriptive analysis demonstrates remarkable differences among countries. The gender response pattern is also different. The estimates, made using the odds ratio method, reveal that women are more likely to report higher anxiety than poor health (56% vs 25%). The estimates show that in those countries where the situation of women compares unfavourably to that of men, the probability of women reporting poorer health status is higher. The situation with SRA, however, is different. In those countries with greater economic and political equality, the probability of women suffering anxiety increases. It is feasible that economic gender equality, which often results in greater incorporation of women in the labour market, could negatively affect SRA if women assume increased workloads and responsibility while maintaining the tasks associated with caring for home and family.

Age-Related Difference in the Relationship Between Age Stereotypes and Health Behavior in Midlife Koreans

Aging stereotypes about health may affect the interpretation of health-related changes in midlife. The purposes of this study were to examine the influence of age-related stereotypic beliefs on health behavior linked to health status and stress and to investigate whether the relationship differs by age. This is a cross-sectional study using a convenience sample of 446 Korean middle-aged adults (mean age=50.7). Data were analyzed using the PROCESS macro approach of SPSS. Age-related stereotypic beliefs affected health behavior through the evaluation of health status (Index=-.006, 95% CI [-.002, -.001]) and related stress (Index=-.002, 95% CI [-.004, -.001]). The relationship between age-related stereotypic beliefs and health status significantly differed by age (β= -.02, p=.004), indicating that individuals with stronger age-related stereotypic beliefs tended to report poorer health status as they aged. With regard to the age difference, the influence of age-related stereotypic beliefs affecting health behavior through health status and related stress became relatively stronger when midlife individuals became older. The findings of this study highlight the importance of carefully assessing age-related beliefs based on consideration of age-related differences in middle-aged individuals. Developing psychoeducational strategies to modify the negative and erroneous aging-related beliefs and to improve health behavior is warranted.

REDUCING DISPARITIES THROUGH HEALTH CARE REFORM: DISABILITY AND ACCESSIBLE MEDICAL EQUIPMENT

People with disabilities face multiple barriers to adequate health care and report poorer health status than people without disabilities. Although health care institutions, offices, and programs are required to be accessible, people with disabilities are still receiving unequal and in many cases inadequate care. The 2009 report by the National Council on Disability, The Current State of Health Care for People with Disabilities, reaffirmed some of these findings, concluding that people with disabilities experience significant health disparities and barriers to health care; encounter a lack of coverage for necessary services, medications, equipment, and technologies; and are not included in the federally funded health disparities research. The report also noted the absence of training in disability competence issues for health care practitioners.This Article highlights an often overlooked barrier, basic medical equipment that is not accessible to people with disabilities. Twenty years after passage of the Americans with Disabilities Act of 1990 (ADA), many people with mobility impairments cannot get on to examination tables and chairs, be weighed, or use X-ray and other imaging equipment. I introduced this issue into the legal literature in a prior writing focused on the delivery of traditional women’s health care services. However, it is equally relevant to the delivery of basic preventive health care services to millions of men and women with mobility impairments.Despite the seriousness of the problem, a review of all public and private enforcement activity brought to date reveals relatively few actions challenging inaccessible medical equipment under the ADA. Several recent settlements are promising, but have not yet generated meaningful and widespread changes in access to and provision of accessible equipment. As I have written previously, inaccessible medical equipment seems like a relatively specific and easily solved issue, but its persistence suggests a deeper, more complex problem for people with disabilities in the health care system.In my prior writing, I analyzed the possibilities and limits of an ADA-focused litigation approach to the problem of inaccessible medical equipment. In this Article, I argue that the Patient Protection and Affordable Care Act, as amended (PPACA) offers a new approach to these pervasive barriers. The provisions of the PPACA focus on expanding coverage, controlling costs, and improving the quality of the health care delivery system. The PPACA also includes several, lesser-known provisions aimed at improving access to health care for people with disabilities. In particular, the PPACA provides for a standard-setting process for accessible medical equipment, opportunities for disability education and training for medical professionals, and improved data collection on the health and health care of people with disabilities. This Article brings attention to these lesser-known provisions and offers guidance on how they can be implemented together to most effectively address the problem of accessible medical equipment, as well as some of its underlying causes. Part II of this Article reviews the health status of people with disabilities in general and examines the necessity of medical equipment such as examination tables, chairs, scales, and X-ray and other imaging equipment to the provision of basic preventive services to men and women with disabilities. Part III summarizes and evaluates the success of the ADA in ameliorating the unequal and inadequate care received by people with disabilities, and considers other proposed doctrinal reforms aimed at setting more specific standards for equipment. Unfortunately, it concludes that doctrinal reforms have not been as successful as hoped. Part IV introduces a new approach: structural and systemic reform through the PPACA, which includes a standard-setting process for accessible medical equipment, improved data collection based on disability, and opportunities for professional education about caring for patients with disabilities. The reframing of barriers and disparities faced by people with disabilities as an issue of health care access and quality under the PPACA - in addition to an issue of civil rights under the ADA - appears promising. Part V goes on to highlight a challenge in the development and implementation of equipment standards under the PPACA that has yet to be addressed. Specifically, in terms of accessible medical equipment in institutions - how much is enough? This part provides guidance on these issues, including suggestions on developing the PPACA’s data collection and provider education and training provisions to inform and reinforce the standard-setting process.

Predictors of Early Retirement Intentions in Croatia

In this paper, we use the SHARE (Survey of Health, Ageing and Retirement in Europe) Wave 6 dataset to look into the socio-demographic, health, well-being, financial and work- -related predictors of intended early retirement in Croatia. We estimate logit regression models. Based on our research, early retirement seems to be more appealing to people who work in the private sector, who have poor quality of life, who are less educated, or report poor health status. Amending the pension system in terms of making early retirement a less attractive choice is not enough. Many Croatian employees would be ready to work longer if they had better jobs, education, and health. These are the policy areas where Croatia needs large improvements.

Comparing women with and without disabilities in five-site “Healthy Weight” interventions for lesbian/bisexual women over 40

BackgroundLesbian/bisexual women with physical disabilities (LBPD) are an under-studied population. ObjectivesThis study compared LBPD to LB women without physical disabilities as defined by the Americans with Disabilities Act on socio-demographic variables, health characteristics, and quality of life, physical activity, weight, and nutrition outcomes following a health intervention. MethodsData came from the Healthy Weight in Lesbian and Bisexual Women Study (HWLB) where 376 LB women were recruited into five geographically dispersed interventions. Baseline data were examined to compare women with and without physical disabilities as defined by the ADA, and pre/post intervention data were analyzed for differences in treatment outcomes including quality of life, physical activity, nutrition, and body size. ResultsCompared to women without disability, LBPD were more likely to be bisexual or another sexual identity than lesbian, single, report poor or fair health status, postmenopausal, and had a higher body mass index and waist circumference to height ratio. LBPD women were less likely to work and to drink heavily, and reported reduced physical and mental health quality of life. In spite of these differences, after the intervention, LBPD had similar outcomes to women without disabilities on most measures, and were more likely to show improvements in physical quality of life and consumption of fruits/vegetables. ConclusionsAlthough different from women without disabilities on many socio-demographic and health variables at baseline, the study suggests that LBPD have similar outcomes to women without disabilities, or may even do better, in group health interventions.

Balancing Act: Approaches to Healthy Eating and Physical Activity Among Boston Public Housing Residents

Boston public housing residents are more likely to report fair or poor health status, been diagnosed with obesity, and to be physically inactive compared with other Boston residents (Digenis-Bury, Brooks, Chen, Ostrem, & Horsburgh, 2008). Little is known about perceptions of and opportunities for healthy eating and physical activity in this population. We conducted eight focus groups at public housing developments to explore residents’ views regarding opportunities and barriers to healthy eating and physical activity. Sixty-seven English- and Spanish-speaking residents participated. Transcripts were analyzed using qualitative content analysis. All residents described the challenge of balancing considerations of food quality, access, and affordability. Other findings included underutilized nutritional resources; abundant availability of unhealthy food; and economic and structural barriers to exercise. Transportation-related challenges were a dominant theme. Building opportunities for physical activity and providing access to affordable and quality food choices may be important interventions for promoting health among public housing residents.

Disability levels and correlates among older mobile home dwellers, an NHATS analysis

BackgroundAlthough remarkably understudied, manufactured or mobile homes are the housing choice for nearly 20 million Americans and little is known about the health of older persons living in mobile homes. ObjectiveWe sought to investigate disability levels and other health correlates among older adults living in mobile or manufactured homes compared to their counterparts living in other types of homes. MethodsWe sampled non-institutional adults aged 65 years or older (n = 7609), of whom 344 lived in mobile homes, from the 2011 National Health and Aging Trends Study (NHATS). ResultsRespondents living in mobile homes (average age = 75.1 years; SD = 0.5) had lower education and income and medical insurance than older adults living in other types of community residence (average age = 77.5 years; SD = 0.2). They were more likely to smoke, have lung and heart disease, and report fair or poor general health status. Mobile home dwellers reported more difficulty or inability in performing the following activities of daily living when compared to their counterparts: stooping and kneeling (64.9% vs 60.8%, p = 0.007), walking 6 blocks (46.5% vs 41.5%, p = 0.001), walking 3 blocks (37.7% vs 33.5%, p = 0.002), and climbing up to 20 stairs (39.2% vs 34.8%, p = 0.02). Among those reporting disability, mobile home dwellers had fewer bathroom safety modifications. ConclusionThere is higher prevalence of chronic conditions, functional and cognitive impairment in older mobile home dwellers compared to older adults living in other types of housing.

Association Between Prevalence of Chronic Obstructive Pulmonary Disease and Health-Related Quality of Life, South Carolina, 2011

IntroductionWe investigated the prevalence of chronic obstructive pulmonary disease (COPD) in various population subgroups in South Carolina and examined associations between COPD and 4 core measures of health-related quality of life (HRQOL).MethodsData from 12,851 participants of the 2011 South Carolina Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. COPD prevalence rates were age-adjusted to the 2000 standard US population. Logistic regression models were used to estimate adjusted odds ratios (AOR’s) and 95% confidence intervals (CIs).ResultsThe overall age-adjusted prevalence of self-reported diagnosis of COPD among community-dwelling adults in South Carolina in 2011 was 7.1% (standard error [SE] ±0.3). Prevalence of self-reported diagnosis of COPD was highest among women (8.9%; SE, ±0.5), those aged 65 years or older (12.9%; SE, ±0.5), current smokers (15.9%; SE, ±0.7), and those with low levels of education and income. Compared with community-dwelling adults without COPD, those with COPD were more likely to report fair or poor general health status (AOR, 3.97; 95% CI, 3.13–5.03), 14 or more physically unhealthy days (AOR, 2.10, 95% CI, 1.57–2.81), 14 or more mentally unhealthy days (AOR, 1.72; 95% CI, 1.21–2.43), and 14 or more days of activity limitation (AOR, 2.22; 95% CI, 1.53–3.22) within the previous 30 days.ConclusionCOPD is a highly prevalent disease in South Carolina, especially among older people and smokers, and it is associated with poor HRQOL. Future work aimed at reducing risk factors may decrease the disease prevalence, and increasing early detection and improving access to appropriate medical treatments can improve HRQOL for those living with COPD.

Disability and race: a comparative analysis of physical activity patterns and health status

Purpose: Minority groups, specifically African Americans (AAs), are more likely to be physically inactive than the general population. Although the aforementioned finding is well documented, there is a dearth of literature that examines levels of physical activity among AA adults with disabilities. The purpose of this article was to study the patterns of physical activity and health status among AA adults with disabilities in comparison with their White counterparts. Methods: Data from the Centers for Disease Control and Preventions 2007 Behavioral Risk Factor Surveillance System survey were used to conduct comparative analyses of physical activity patterns and health status among 7315 AAs and 82 482 Whites who self-reported a disability. Results: Significant differences (p < 0.05) were found between health status and physical activity patterns across racial groups. AAs with disabilities were less likely to engage in moderate and vigorous physical activity than their White counterparts. AAs were also less likely to engage in physical activity as health status declined in comparison with White respondents. Conclusion: When considering the health of minorities with disabilities, physical activity must be central to improving their health status. The authors of this study provide additional support for developing unique health programming for AAs with disabilities. Rehabilitation and health care professionals can gain insight into lifestyle patterns of minorities with disabilities, which can be useful in addressing health behaviors that may be counter to physical well-being.Implications for RehabilitationAfrican Americans with disabilities tend to report poorer health status and engage in less moderate and vigorous physical activity, even as health status decline, than their White counterparts.The use of a multilayered approach incorporating culturally tailored programming would be useful in improving health and physical activity outcomes of African Americans with disabilities.

Low-Income Uninsured Patient Health and Access to Health Care through a Community Health Program in NC

Project Access provides free primary and specialty care for low-income uninsured residents of Buncombe County, NC through a physician volunteer network. In 2010, we replicated a 1998 study investigating health issues among Project Access (PA) patients. Over 300 patients enrolled in PA in 2009 were surveyed by telephone. Currently, as compared to 1998, fewer patients were employed (31% vs. 44.2%, p < 0.05), more patients were unable to return to work (15.6% vs. 8%, p < 0.05), and patients were enrolled in PA for longer (24.5 months vs. 14 months). The SF-12 Physical Health score was worse in 2010 (p < 0.05). With the implementation of Health Reform, certain groups of people will still require PA services, but a significant portion will be covered by Medicaid; with our PA patients reporting poorer health status, Medicaid resources may be strained even more than anticipated.

Health status and use of health services among recently arrived men with refugee backgrounds: a comparative analysis of urban and regional settlement in South-east Queensland

Approximately one-third of refugee and humanitarian entrants to Australia are adult men. Many of these men and their families settle in regional areas. Little is known about the health status of refugee men and the use of health services, and whether or not there are differences between those living in urban and regional areas. This paper reports on the cross-sectional differences in health status and use of health services among a group of 233 recently arrived refugee men living in urban and regional areas of South-east Queensland. Overall, participants reported good levels of subjective health status, moderate to good levels of well-being, and low prevalence of mental illness. Men living in urban areas were more likely to have a long-standing illness and report poorer health status than those settled in regional areas. In contrast, men living in regional areas reported poorer levels of well-being in the environment domain and were more likely to visit hospital emergency departments. Targeted health promotion programs will ensure that refugee men remain healthy and develop their full potential as members of the Australian community. Programs that facilitate refugees' access to primary health care in regional areas may promote more appropriate use of hospital emergency departments by these communities.

Self‐rated health, psychosocial functioning, and health‐related behavior among Thai adolescents

Despite the popularity of self-rated health (SRH) in Western countries as a useful public health tool, it has only rarely been used in Asian countries. The purpose of the current study was to determine whether measures of psychosocial functioning and health-related factors differ according to SRH in a school-based sample of Thai adolescents. The survey was given to 2519 adolescents attending 10 coeducational secondary high schools in Chiang Mai Province, Thailand and included measures of psychosocial functioning (loneliness, hopelessness, shyness, perceptions of social status, self-rated happiness, and perception of physical attractiveness) and certain health-related factors (height/weight, physical activity, eating breakfast, sleep). The proportion of boys (5.1%) reporting that they were not healthy was similar to the proportion of girls (4.6%) making the same rating. These adolescents showed a pattern of overall poor health risk. Compared to adolescent peers who rated their health as healthy or very healthy, they were less physically active, got less sleep, were more likely to be overweight, and scored lower on loneliness, shyness, hopelessness, and self-rated happiness. The present pattern of poor health risk warrants attention and supports the merit of using SRH in adolescent health assessment. SRH is easy to obtain and simple to assess and single-item assessments of SRH appear to be valid measures of health status in adults and adolescent. Interventions, such as health counseling, mental health counseling, and health education, can target adolescents who rate themselves as 'not healthy' or report poor health status.

Serious psychological distress and health outcomes for persons with epilepsy in poverty

Epidemiology literature demonstrates socioeconomic status as an important variable for outcomes in persons with epilepsy. However, no previous studies have analyzed the association between poverty and epilepsy in the United States. Forty-one percent (246/604) of persons with a history of epilepsy (PWHE) in the 2005 California Health Interview Survey ( n = 43,020) had an annual income <200% Federal Poverty Level (FPL), adjusted lifetime prevalence rate 0.5% [98.33% CI 0.4–0.7]. Four groups are presented in the analyses: (1) those with a history of epilepsy <200% FPL, (2) those with a history of epilepsy ≥200% FPL, (3) those not reporting a history of epilepsy <200% FPL and (4) those not reporting a history of epilepsy ≥200% FPL. PWHE in poverty reported significantly higher amounts of serious psychological distress, based on the validated Kessler 6 (K6) scale, than both non-epilepsy populations. After adjusting for demographics and other comorbid conditions, logistic regression analyses show PWHE in poverty are significantly more likely to report fair or poor self-rated health status when compared to the PWHE not in poverty and both non-epilepsy populations. PWHE in poverty are also more likely to report ≥14 generally unhealthy days and ≥14 physically unhealthy days in the past 30 days compared to the PWHE not in poverty and both non-epilepsy populations. Psychological well-being needs to be incorporated into any comprehensive treatment strategy for managing epilepsy.

Health-related quality of life and hypertension status, awareness, treatment, and control: National Health and Nutrition Examination Survey, 2001--2004.

We examined health-related quality of life measures by hypertension status, awareness, treatment, and control. Five unfavorable health-related quality of life measures were analyzed among 8303 adults aged 20 years or older who participated in the 2001--2004 National Health and Nutrition Examination Survey. Multivariable logistic regression analyses examined differences in health-related quality of life with adjustment for age, race, sex, healthcare coverage, and other medical conditions. The 30% of respondents with hypertension were more likely to report fair or poor health status (adjusted odds ratio 1.72, 95% confidence interval 1.44-2.05), 14 or more unhealthy days in the past 30 days (1.23, 1.06-1.43), 14 or more physically unhealthy days (1.39, 1.15-1.67), and 14 or more activity-limited days (1.55, 1.17-2.04) than those without hypertension. Among adults with hypertension, the 73.2% who were aware of their condition were more likely to report fair or poor health status (2.19, 1.54-3.12), 14 or more unhealthy days (1.53, 1.12-2.09), 14 or more physically unhealthy days (1.49, 1.10-2.03), 14 or more mentally unhealthy days (1.70, 1.05-2.75), and 14 or more activity-limited days (2.38, 1.39-4.05) than those who were unaware. Among those aware they had hypertension, 14 or more physically unhealthy days (0.50, 0.28-0.90) was associated with current treatment. Health-related quality of life measures did not differ by blood pressure control status. Having hypertension and being aware of it was related to lower health-related quality of life. Antihypertensive medication was associated with more physically unhealthy days, while there were no differences in health-related quality of life by control status. Further study is needed to examine these differences including: disease severity, sex and racial/ethnic differences, comorbidities not examined, and impact of health-related quality of life and its changes on outcomes.

Use of a Population-Based Survey to Describe the Health of Boston Public Housing Residents

We compared the health of public housing residents with other Boston residents through a random-digit-dial survey. We used data from the Boston Behavioral Risk Factor Surveillance System collected in 2001 and 2003 to make crude and demographically adjusted comparisons between public housing residents and other city residents on measures of health status, access and utilization, and health behaviors. Public housing residents were more likely to report fair or poor overall health status, ever-diagnosed hypertension, current asthma, ever-diagnosed diabetes, obesity, disability, loss of 6 or more teeth, and feelings of depression for 15 days or more in the past month. Public housing residents were slightly more likely than others to be without health insurance or report financial barriers to medical care. Public housing residents reported more smoking and physical inactivity, less past-month binge drinking and past-year marijuana use, and similar levels of lifetime drug use. Public housing residents reported substantially poorer health than did other city residents across a variety of conditions but similar levels of access to and utilization of health care. Public health departments may be able to use established surveys to measure health among public housing residents.

Implications of Medicaid coverage in a program for Latino substance users

Background This cross-sectional study explored baseline differences between Medicaid covered and uninsured clients ( n=368) in the Project La Voz, a community outreach program targeting Latino substance users. Methods Independent variables included client demographics, health status and health service use; the dependent variable was Medicaid coverage vs. uninsured. Bi-variate analyses and three binomial logistic regression models were conducted. Results The first logistic regression model examining client characteristics indicated that La Voz enrollees with Medicaid coverage were more likely to be women, reside in stable housing, and report poor health status. Employment and educational status were not significantly associated with having Medicaid. A second model, examining the association between health care utilization in the past 30 days and Medicaid coverage, indicated that LaVoz enrollees with Medicaid were significantly more likely to have entered substance use treatment. In the third model, client characteristics and health care use were examined in one model; all variables remained significant except for gender. Implications for program planning Massachusetts recent health care reform efforts include substance abuse treatment benefits through Medicaid. Specific strategies are needed to ensure that Latinos substance abusers, particularly those who are homeless, gain Medicaid coverage and then have access to needed services.