Usual Place For Health Care Research Articles

Changes in Health Care Access and Preventive Health Screenings by Race and Ethnicity

The COVID-19 pandemic led to unprecedented disruptions in health care. Little is known about whether health care access and preventive health screenings among US adults have recovered to prepandemic levels, and how patterns varied by race and ethnicity. To evaluate health care access and preventive health screenings among eligible US adults in 2021 and 2022 compared with prepandemic year 2019, overall and by race and ethnicity. This cross-sectional study used data from US adults aged 18 years or older who participated in the National Health Interview Survey in 2021 and 2022. Survey weights provided by the National Health Interview Survey were used to generate nationally representative estimates. Data were analyzed from May 23 to November 13, 2023. Measures of health care access included the proportion of adults with a usual place for care, those with a wellness visit, and those who delayed or did not receive medical care due to cost within the past year. Preventive health screening measures included eligible adults who received blood pressure, cholesterol, or blood glucose screening within the past year (2021), as well as colorectal, cervical, breast, and prostate cancer screenings based on US Preventive Services Task Force guidelines. The unweighted study population included 89 130 US adults. The weighted population included 51.6% females; 16.8% Hispanic, 5.9% non-Hispanic Asian (hereafter, Asian), 11.8% non-Hispanic Black (hereafter, Black), 62.8% non-Hispanic White (hereafter, White) individuals; and 2.9% individuals of other races and ethnicities (including American Indian, Alaska Native, Native Hawaiian or other Pacific Islander, or multiracial). After adjusting for age and sex, having a usual place for health care did not differ among adults in 2021 or 2022 vs 2019 (adjusted rate ratio [ARR] for each year, 1.00; 95% CI, 0.99-1.01). However, fewer participants had wellness visits in 2022 compared with 2019 (ARR, 0.98; 95% CI, 0.97-0.99), with the most pronounced decline among Asian adults (ARR, 0.95; 95% CI, 0.92-0.98). In addition, adults were less likely to delay medical care (ARR, 0.79; 95% CI, 0.73-0.87) or to not receive care (ARR, 0.76; 95% CI, 0.69-0.83) due to cost in 2022 vs 2019. Preventive health screenings in 2021 remained below 2019 levels (blood pressure: ARR, 0.95 [95% CI, 0.94-0.96]; blood glucose: ARR, 0.95 [95% CI, 0.93-0.96]; and cholesterol: ARR, 0.93 [95% CI, 0.92-0.94]). Eligible adults were also significantly less likely to receive colorectal cancer screening (ARR, 0.88; 95% CI, 0.81-0.94), cervical cancer screening (ARR, 0.86; 95% CI, 0.83-0.89), breast cancer screening (ARR, 0.93; 95% CI, 0.90-0.97), and prostate cancer screening (ARR, 0.86 [0.78-0.94]) in 2021 vs 2019. Asian adults experienced the largest relative decreases across most preventive screenings, while Black and Hispanic adults experienced large declines in colorectal cancer screening (ARR, 0.78; 95% CI, 0.67-0.91) and breast cancer screening (ARR, 0.83; 95% CI, 0.75-0.91), respectively. Differences in preventive screening rates across years persisted after additional adjustment for socioeconomic factors (income, employment status, and insurance coverage). Results of this cohort study suggest that, in the US, wellness visits and preventive health screenings have not returned to prepandemic levels. These findings support the need for public health efforts to increase the use of preventive health screenings among eligible US adults.

Population Attributable Fraction of Nonvaccination of COVID-19 Due to Vaccine Hesitancy, United States, 2021.

Understanding the extent of coronavirus disease 2019 (COVID-19) nonvaccination attributable to vaccine hesitancy versus other barriers can help prioritize approaches for increasing vaccination uptake. Using data from the Centers for Disease Control and Prevention's Research and Development Survey, a nationally representative survey fielded from May 1 to June 30, 2021 (n= 5,458), we examined the adjusted population attribution fraction (PAF) of COVID-19 vaccine hesitancy attributed to nonvaccination according to sociodemographic characteristics and health-related variables. Overall, the adjusted PAF of nonvaccination attributed to vaccine hesitancy was 76.1%. The PAF was highest among adults who were ≥50 years of age (87.9%), were non-Hispanic White (83.7%), had a bachelor's degree or higher (82.7%), had an annual household income of at least $75,000 (85.5%), were insured (82.4%), and had a usual place for health care (80.7%). The PAF was lower for those who were current smokers (65.3%) compared with never smokers (77.9%), those who had anxiety or depression (65.2%) compared with those who did not (80.1%), and those who had a disability (64.5%) compared with those who did not (79.2%). Disparities in PAF suggest areas for prioritization of efforts for intervention and development of messaging campaigns that address all barriers to uptake, including hesitancy and access, to advance health equity and protect individuals from COVID-19.

Social Determinants of Health in Community-Dwelling Dementia Patients Aged 65 and Over: Analysis of the 2019 National Health Interview Survey.

Alzheimer's Disease and related dementias affect 3.4 million community-dwelling adults in the United States. Given the burden of disease, a greater understanding of modifiable risk factors is crucial for targeted public health strategies. Social determinants of health (SDOH) are modifiable risk factors categorized in five domains: economic status, education, healthcare access, environment, and community context. Although individual SDOH have been linked to dementia, limited research exists on the interaction of SDOH with dementia across multiple domains. The aim of this study was to evaluate the association between SDOH across all five domains and dementia among community-dwelling adults in the United States. A cross-sectional study was performed on community-dwelling adults aged ≥65 years from the 2019 National Health Interview Survey (NHIS). Respondents (N = 9,277), of whom 303 (4%) self-reported positive dementia diagnosis, were predominantly female (55%), white (76%), and non-Hispanic (91%). Residing in a non-metropolitan area, having a usual place for healthcare, and receiving annual eye or dental exams were negatively associated with dementia. Minority compared to white status was not significantly associated with dementia, suggesting underdiagnosis of dementia within minority groups in the NHIS. We present the first comprehensive national view of SDOH among community-dwelling dementia patients in the United States.

The effect of emotional disorders on adherence to mammography screening guidelines.

Depression, anxiety, and other emotional disorders are highly prevalent; however, the impact of these on adherence to mammography screening guidelines remains unclear. We sought to determine the effect of feeling limited by emotional disorders on adherence to mammographic screening guidelines. Data from the 2018 National Health Interview Survey were used to evaluate whether women aged 50-74 who felt limited in some way by an emotional issue (EI; defined as depression, anxiety, or another emotional problem) were less likely to report having had a mammogram within the past two years than those who reported no such limitation. Of the 5815 women surveyed, 3.25% stated that they were limited in some way by EI. These women were significantly less likely to report having had a mammogram within the past two years compared to those without EI (68.28% vs. 79.36%, p = 0.002). Controlling for sociodemographic factors, EI no longer predicted worse mammography screening adherence (OR = 0.78; 95% CI: 0.54-1.12, p = 0.182). Rather, family income relative to poverty level, health insurance coverage, and having a usual place of healthcare were independent predictors of adherence to screening mammography guidelines. Women who feel limited by an EI tend to have lower mammography screening rates than those without such limitations; however, this isdriven primarily by socioeconomic factors such as income, insurance status, and access to healthcare.

Abstract PO-225: Patterns of colorectal cancer screening in the US: Analysis of the 2019 National Health Interview Survey

Abstract Introduction: Colorectal cancer (CRC) is the third most common cancer in the United States and, while there is growing conscience towards it, screening is still not widely adopted. Methodology: We used data from the 2019 National Health Interview Survey, which is a cross-sectional study that included 31,997 participants. We focused on the colorectal cancer screening module, and particularly on questions related to participants having ever had a colonoscopy (COL) or sigmoidoscopy (SIG). We then performed bivariate and multivariable analyses to assess the association between participants' variables and having had a COL or SIG. Results: In total, 22,025 participants answered the CRC screening module, and 13,383 participants (60.8%) had done a previous COL/SIG. Participants' sex was not associated with differences in the use of COL/SIG for CRC screening (OR=1.0, P=0.89). When assessing race, Hispanics (OR=0.9, P=0.03) and Asians (OR=0.7, P<0.001) had less odds for undergoing COL or SIG compared to Whites. In the education scope, participants with a college degree (63.2%), some college (62.8%), and high school graduates (58.6%) had undergone more COL or SIG than those with no school or incomplete high school (52.2%). Participants born in the U.S. had more COL or SIG performed than those who were not born in the U.S. (63.6% vs. 45.5%, respectively, P<0.05). Moreover, participants who do not have a usual place for healthcare underwent less COL/SIG for CRC screening (OR=0.3, P<0.001). When assessing insurance, participants with a private or military health insurance were at higher odds for having a COL or SIG, as opposed to any public insurance or no insurance at all (OR=0.8, 0.4, respectively; P<0.001 for both). On multivariable analysis, race, education, nativity in the U.S., insurance, and age were all independently associated with differences in the use of COL/SIG. Conclusions: Colonoscopy and sigmoidoscopy are widely used for CRC screening, however, differences in patterns of use still exist among various U.S. populations. Citation Format: Humberto R. Nieves-Jimenez, Isabela M. Bumanlag, Joseph Abi Jaoude, Ethan B. Ludmir, Cullen M. Taniguchi. Patterns of colorectal cancer screening in the US: Analysis of the 2019 National Health Interview Survey [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-225.

Surveillance of Vaccination Coverage Among Adult Populations -United States, 2018.

Surveillance of Vaccination Coverage Among Adult Populations -United States, 2018.

Evaluating the unevaluated: a secondary analysis of the National Survey for Family Growth (NSFG) examining infertile women who did not access care.

To characterize the demographic differences between infertile/sub-fertile women who utilized infertility services vs. those that do not. A retrospective analysis of cross-sectional data obtained during the 2011-2013, 2013-2015, and 2015-2017 cycles of National Survey for Family Growth from interviews administered in home for randomly selected participants by a National Center of Health Statistics (NCHS) surveyor was used to analyze married, divorced, or women with long-term partners who reported difficulty having biological children (sub-fertile/infertile women). Demographic differences such as formal marital status, education, race, and religion were compared between women who presented for infertility care vs. those that did not. The primary outcome measure was presenting for infertility evaluation and subsequently utilizing infertility services. Healthcare utilization trends such as having a usual place of care and insurance status were also included as exposures of interest in the analysis. Of the 12,456 women included in the analysis 1770 (15.3%) had used infertility services and 1011 (8.3%) said it would be difficult for them to have a child but had not accessed infertility services. On univariate analysis, compared to women who used infertility services, untreated women had lower average household incomes (295.3 vs. 229.8% of the federal poverty line respectively). Untreated women also had lower levels of education and were more likely to be divorced or never have married. In terms of health status, unevaluated women were less likely to have a usual place for healthcare (87.3%) as compared to women presenting for fertility care (91.9%) (p = 0.004). When examining insurance status, 23.3% of unevaluated women were uninsured as compared to 8.3% of evaluated women. On multivariate analysis, infertile women without insurance were at 0.37 odds of utilizing infertility care compared to women with insurance. Demographic factors are associated with the utilization of infertility care. Insurance status is a significant predictor of whether or not infertile women will access treatment. Data from the three most recent NSFG surveys along with prior analyses demonstrate the need for expanded insurance coverage in order to address the socioeconomic disparities between infertile women who are accessing services vs. those that are not.

Abstract PO-240: The effect of emotional disorders on adherence to mammography screening guidelines

Abstract INTRODUCTION: Approximately 18 million adults in the US experience a major depressive episode and 48 million report having some anxiety disorder each year. While some studies have found having an emotional disorder to be correlated with lower rates of screening mammography, this is not a consistent finding. We sought to determine whether women who felt limited by such disorders had lower mammography guideline compliance rates compared to women who did not, in a population-based study. METHODS: The National Health Interview Survey is a population-based survey administered annually by the Centers for Disease Control and is designed to be representative of the entire US civilian non-institutionalized population. We defined “emotional disorders” (EMD) as occurring in individuals who felt that they were limited in some way by depression, anxiety or another emotional problem. Women between the ages of 50 and 74, with and without EMD, were compared in terms of their adherence to screening guidelines, defined as having had a mammogram within the past two years, controlling for sociodemographic factors. RESULTS: In 2018, of the 5815 women surveyed who met our inclusion criteria (representing 48,522,391 women in the population), 3.25% stated that they were limited in some way by emotional issues. Of these, 68.28% stated they had a mammogram within the past two years; compared to 79.36% of women without EMD (p=0.002). Compared to those with no EMD, women with EMD tended to have lower education levels (less than grade 12: 19.51% vs 11.22%, p<0.001), lower family income (above four times the poverty threshold: 15.31% vs 44.74%, p<0.001) and less private insurance coverage (16.48% vs 55.93%, p<0.001). However, those with EMD were more likely to report having a usual place to go when sick than those without EMD (90.65% vs. 86.23%, p=0.003). Compliance with mammography screening was similarly influenced by these factors (p<0.001 for all). Controlling for these potential confounders, we found that EMD was no longer a significant predictor of mammography screening adherence (OR=0.77; 95% CI: 0.48-1.22, p=0.131). Rather, having a family income four times the poverty line or greater (OR=1.75; 95% CI: 1.29-2.37, p=0.001), having a usual place of healthcare (OR=2.67; 95% CI: 1.92-3.71, p<0.001), and insurance coverage (OR=1.65; 95% CI: 1.17-2.35, p=0.005 for governmental insurance, and OR=1.74; 95% CI: 1.21-2.51, p=0.003 for private insurance, vs. uninsured) were significant independent predictors of adherence to screening mammography guidelines. CONCLUSION: While EMD is correlated with lower mammography screening rates, adherence to screening mammography guidelines are driven primarily by socioeconomic factors such as income, insurance status, and access to healthcare. There is a need for policy level changes that target these modifiable issues for those who are medically underserved, including those with EMD who are more likely to have a family income that is below the poverty line. Citation Format: Idil Yazgan, Anees Chagpar. The effect of emotional disorders on adherence to mammography screening guidelines [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-240.

Influenza vaccination coverage among adults with diabetes, United States, 2007–08 through 2017–18 seasons

BackgroundDiabetes is associated with higher risk of hospitalization, morbidity, and mortality from influenza. We assessed influenza vaccination coverage among adults aged ≥ 18 years with diabetes during the 2007–08 through 2017–18 influenza seasons and identified factors independently associated with vaccination during the 2017–18 season. MethodsWe analyzed data from the 2007–2018 National Health Interview Surveys, using Kaplan-Meier survival analysis to estimate season-specific influenza vaccination coverage. Multivariate logistic regression was conducted to examine whether diabetes was independently associated with self-reported influenza vaccination in the past 12 months and identify factors independently associated with vaccination among adults with diabetes using the 2017–18 data. ResultsDuring the 2007–08 through 2017–18 influenza seasons, influenza vaccination coverage among adults aged ≥ 18 years with diabetes ranged from 62.6% to 64.8%. In the 2017–18 influenza season, coverage was significantly higher among adults with diabetes (64.8%) compared with those without diabetes (43.9%). Having diabetes was independently associated with an increased prevalence of vaccination after controlling for other factors. Among adults with diabetes, living at or above poverty level, having more physician contacts, having usual place for health care, and being unemployed were independently associated with increased prevalence of vaccination; being 18–64 years and non-Hispanic black were independently associated with decreased prevalence of vaccination. ConclusionsDespite specific recommendations for influenza vaccination among people with diabetes, more than one-third of adults with diabetes are unvaccinated. Targeted efforts are needed to increase influenza vaccination coverage among adults with diabetes.

Shingles Vaccination of U.S. Adults Aged 50–59 Years and ≥60 Years Before Recommendations for Use of Recombinant Zoster Vaccine

In 2006, zoster vaccine live was recommended for adults aged ≥60 years. In 2011, zoster vaccine live was approved for use but not recommended for adults aged 50-59 years. This study assessed zoster vaccine live coverage among adults aged 50-59 years and ≥60 years. Data from the 2013-2017 National Health Interview Surveys were analyzed in 2019 to estimate national zoster vaccine live coverage among adults aged ≥50 years. State-specific zoster vaccine live coverage among adults aged ≥50 years was assessed using 2017 Behavioral Risk Factor Surveillance System data. Among adults aged 50-59 years, zoster vaccine live coverage was 5.7% in 2017, ranging from 4% to 6% during 2013-2017 (test for trend, p>0.05). Zoster vaccine live coverage among adults aged 50-59 years ranged from 5.8% in Pennsylvania to 14.7% in South Dakota. By 2017, zoster vaccine live was received by 34.9% of adults aged ≥60 years, a significant increase from 24.2% in 2013. Zoster vaccine live coverage among adults aged ≥60 years in 2017 ranged from 26.0% in Mississippi to 51.8% in Vermont. In 2017, major characteristics significantly associated with increased likelihood of zoster vaccine live vaccination among adults aged 50-59 years and ≥60 years were older age, having 4 to 9 physician contacts in the past 12 months, and having a usual place for health care. This study provides an assessment of zoster vaccine live coverage among adults aged ≥50 years before the newly recommended recombinant zoster vaccine came into widespread use. Providers should routinely assess adults' vaccination status and strongly recommend or offer needed vaccines to their patients.

QuickStats: Percentage* of Adults Aged 18-64 Years with a Usual Place for Health Care,† by Race/Ethnicity§ - National Health Interview Survey, United States, 2008 and 2018.

QuickStats: Percentage* of Adults Aged 18-64 Years with a Usual Place for Health Care,† by Race/Ethnicity§ - National Health Interview Survey, United States, 2008 and 2018.

Factors Associated with Buying Medications Abroad by Nativity and Race/Ethnicity in the US

Growing costs of prescription medication are leading to increased purchases of prescriptions abroad. Yet there is a research gap of factors associated with this practice by nativity and race/ethnicity. We analyzed the 2017 National Health Interview Survey (n = 26,488). The outcome was whether the respondent purchased prescription medications from another country to save money in the past 12 months. Predictors were drawn from Andersen's healthcare utilization model. We used logistic regression models to examine factors associated with purchases by nativity and race/ethnicity. Foreign-born and Hispanic respondents showed a higher rate of purchasing medications abroad compared to their US-born and non-Hispanic white counterparts. Foreign-born respondents who are uninsured, who have no usual place of healthcare, who have difficulty finding a doctor, and who have lived in the US for less than 10 years were more likely to buy medications abroad. Different racial/ethnic groups differed on associated enabling factors. Need factor was significantly associated only with Hispanics' purchase of medications abroad. Our research reveals the need for health education regarding the safety and the illegality of this behavior, especially among recent and Hispanic immigrants.

QuickStats: Age-Adjusted Percentages* of Adults Aged ≥18 Years Without a Usual Place of Health Care,† by Region§ - National Health Interview Survey, 2017¶.

QuickStats: Age-Adjusted Percentages* of Adults Aged ≥18 Years Without a Usual Place of Health Care,† by Region§ - National Health Interview Survey, 2017¶.

Assessment of Personal Health Care Management and Chronic Disease Prevalence: Comparative Analysis of Demographic, Socioeconomic, and Health-Related Variables.

BackgroundThe use of personal health care management (PHM) is increasing rapidly within the United States because of implementation of health technology across the health care continuum and increased regulatory requirements for health care providers and organizations promoting the use of PHM, particularly the use of text messaging (short message service), Web-based scheduling, and Web-based requests for prescription renewals. Limited research has been conducted comparing PHM use across groups based on chronic conditions.ObjectiveThis study aimed to describe the overall utilization of PHM and compare individual characteristics associated with PHM in groups with no reported chronic conditions, with 1 chronic condition, and with 2 or more such conditions.MethodsDatasets drawn from the National Health Interview Survey were analyzed using multiple logistic regression to determine the level of PHM use in relation to demographic, socioeconomic, or health-related factors. Data from 47,814 individuals were analyzed using logistic regression.ResultsApproximately 12.19% (5737/47,814) of respondents reported using PHM, but higher rates of use were reported by individuals with higher levels of education and income. The overall rate of PHM remained stable between 2009 and 2014, despite increased focus on the promotion of patient engagement initiatives. Demographic factors predictive of PHM use included people who were younger, non-Hispanic, and who lived in the western region of the United States. There were also differences in PHM use based on socioeconomic factors. Respondents with college-level education were over 2.5 times more likely to use PHM than respondents without college-level education. Health-related factors were also predictive of PHM use. Individuals with health insurance and a usual place for health care were more likely to use PHM than individuals with no health insurance and no usual place for health care. Individuals reporting a single chronic condition or multiple chronic conditions reported slightly higher levels of PHM use than individuals reporting no chronic conditions. Individuals with no chronic conditions who did not experience barriers to accessing health care were more likely to use PHM than individuals with 1 or more chronic conditions.ConclusionsThe findings of this study illustrated the disparities in PHM use based on the number of chronic conditions and that multiple factors influence the use of PHM, including economics and education. These findings provide evidence of the challenge associated with engaging patients using electronic health information as the health care industry continues to evolve.

Health and Healthcare Needs of Koreans in San Francisco Bay Area: The Korean Needs Assessment (KoNA) Project.

Korean Americans (KA) face a significant burden of health disparities. However, limited data are available on their health needs. This health needs assessment includes a community-based sample of 342 KA from the San Francisco Bay Area. The assessment investigated participants' sociodemographic characteristics, health status, and their healthcare needs. Nearly half of the survey participants rated their health as fair or poor, > 30% did not have a usual place for healthcare, and chronic conditions were prevalent. Limited English Proficiency (LEP) was significantly associated with low self-rated health and having no usual source of care, after adjusting for other sociodemographic factors. Older, LEP KA faced the highest health and health care burden. In addition, females were less likely to be physically active. Males were more likely to smoke. The findings provide guidance in identifying major KA health needs and supports local programming and policy development for KA.

252 - Identifying Strategies to Address Diabetes and Cardiovascular Disease Prevention in Hispanic Obese Young Adult Males in the Rio Grande Valley

Purpose: Hidalgo County, located on the Texas-Mexico border, has one of the highest rates of obesity and type 2 diabetes nationwide. A further breakdown yields 93,000 individuals comprising the 18–24 year old range (11% total population). Within this population, Hispanic young adult (18–26 years) males are medically high risk and are an underserved group. This population is less likely to have a usual place for healthcare, have a doctor's visit in the past year, have a well check-up, and have the highest delay in care. This lack of healthcare utilization makes it difficult to intervene in their health and offer solutions. Successfully identifying and engaging this high-risk group in an intervention that is socially and culturally adapted in preventive healthcare remains a problem.

Effects of Perceived Discrimination and Trust on Breast Cancer Screening among Korean American Women

ObjectiveKorean American (KA) women continue to have lower breast cancer screening rates than other racial groups. Perceived discrimination and trust have been associated with breast cancer screening adherence, but little is known about the associations in KA women. MethodsSurveys were completed by 196 KA women in the Chicago metropolitan area. Multiple and Firth logistic regression analyses were performed to identify factors (perceived discrimination, trust, acculturation, cultural beliefs, health care access) influencing breast cancer screening adherence (mammogram). In addition, SPSS macro PROCESS was used to examine the mediating role of trust between perceived discrimination and breast cancer screening adherence. ResultsNinety-three percent of the women surveyed had health insurance and 54% reported having a mammogram in the past 2 years. Predictors of having a mammogram were knowing where to go for a mammogram, having a regular doctor or usual place for health care, greater trust in health care providers, and lower distrust in the health care system. Perceived discrimination had an indirect effect on breast cancer screening through trust. ConclusionsThe breast cancer screening rate among KA women is low. Perceived discrimination in health care, trust in health care providers, and distrust in the health care system directly or indirectly influenced breast cancer screening adherence in KA women. Trust is a factor that can be strengthened with educational interventions.

Surveillance of Vaccination Coverage among Adult Populations - United States, 2015.

Surveillance of Vaccination Coverage among Adult Populations - United States, 2015.

Self-reported Use of Eye Care Among Adult Chinese Americans: The Chinese American Eye Study

To identify the prevalence and determinants of self-reported eye care use among Chinese Americans. Population-based, cross-sectional study. A total of 4582 Chinese Americans 50 years and older residing in Monterey Park, California. Multivariable logistic regression analyses based on Andersen's Behavioral Model of Health Services Use were conducted to identify predisposing, enabling, and need variables associated with self-reported eye careuse. Prevalence of self-reported use assessed as eye care visit in the past 12 months, dilated eye examination in the past 12 months, and ever having had a dilated examination, and odds ratios for factors associated with these measures. Overall, 36% of participants reported an eye care visit and 21% reported a dilated examination in the past 12months. Forty-eight percent reported ever having had a dilated eye examination. Older age, female sex, preference for English, more education, health and vision insurance, a usual place for health care, currently driving, a greater number of comorbidities, and lower vision-specific quality-of-life (NEI VFQ-25) scores were associated with higher odds of reporting use of eye care. Use of eye care among Chinese Americans was found to be as low as what is reported for African Americans and Hispanics, and lower than what is reported for whites. Multiple modifiable factors are associated with use of eye care among the rapidly growing Chinese American population. Culturally sensitive interventions targeting these factors should be a priority. Further research is needed to investigate how findings from this group of Chinese Americans reflect other Asian Americans that are different in language and ethnicity.

Relationships between adult emotional states and indicators of health care utilization: Findings from the National Health Interview Survey 2006–2014

ObjectiveAdults with serious psychological distress have a high likelihood of mental health problems severe enough to cause serious impairment in social and occupational functioning requiring treatment. These adults visit doctors frequently yet have poor health compared to adults without serious psychological distress. This study examined associations between emotional states of serious psychological distress in relationship to healthcare utilization indicators. A guiding hypothesis was that somatization underlying emotional states contributes to excessive healthcare seeking among adults with serious psychological distress. MethodsUsing 2006–2014 National Health Interview Survey, in adults with serious psychological distress (n=9271), the six states: unable to make efforts, nervousness, hopelessness, sadness, worthlessness and restlessness were assessed in multivariate models in relation to four healthcare utilization indicators: change in the usual place of healthcare, change due to insurance, having seen a healthcare provider in the last 6months and having 10 or more doctor visits in the last 12months. Models were adjusted for sociodemographic variables, having seen a mental health provider, and health conditions. ResultsAdults feeling unable to make efforts were more likely to seek healthcare in the last 6months and at least ten times in the last twelve months. Adults feeling hopeless were less likely to be heavy healthcare utilizers. ConclusionsPredisposing medical conditions do not fully explain healthcare utilization in adults with serious psychological distress. Educating healthcare providers about the emotional states motivating healthcare seeking, and integrating mental healthcare into primary care, may improve the health of adults with serious psychological distress.