Rates Of Health Service Utilization Research Articles

Direct Health Care Costs, Health Services Utilization, and Outcomes of Biliary Atresia: A Population-based Cohort Study.

Biliary atresia (BA) is the most common reason for liver transplant in childhood, and outcomes worsen with older age at hepatoportoenterostomy (HPE). We determined direct health care costs in children with BA, compared to controls in a population-based cohort of children in Ontario, Canada. We used health administrative data to identify all children diagnosed with BA between 2002 and 2016 (n = 121) and matched controls (n = 602). We determined annual direct healthcare costs, and rates of health services utilization, liver transplantation, death, portal hypertension, cirrhosis, esophageal varices, and major upper gastrointestinal bleeding requiring hospitalization. Multivariable regression models determined the association between age at HPE, risk of liver transplant, and direct costs. Incidence of BA was 6.07 (4.99-7.15) per 100,000 live births. The annual median (interquartile range) direct health care costs were higher in BA cases ($4210; interquartile range $1091-$16,765) compared to controls ($283; $112-$634). Compared to age at HPE <45 days, there was no significant association between direct costs and HPE ≥90 days (rate ratio 1.24, 95% confidence interval [CI] 0.78-1.97) or 45 to 90 days (rate ratio 1.05, 95% CI 0.73-1.50). Age at HPE ≥90 days was significantly associated with risk of undergoing liver transplant compared to age <45 days (hazard ratio 5.27, 95% CI 2.45-11.34). Direct costs were higher in patients with BA who underwent liver transplantation compared to those who did not ($39,476±$84,367 vs $22,579 ± $67,913). Direct ealth care costs were high in patients with BA, especially in those who underwent liver transplantation. Age at HPE was associated with risk of liver transplantation, but not direct health care costs, utilization, or other risk outcomes.

Determinants of Maternal Health Services Use among Vulnerable Women in a Rural Community in the Moroccan High Atlas.

Several factors affect the use of maternal health care services in developing countries. The aim was to describe the knowledge and attitudes of women in a rural area of the Moroccan High Atlas regarding aspects of maternal health, and to identify the determinants of use of maternal health care services. A cross-sectional study of 87 participants was conducted in a mountainous area near Marrakech utilizing two sampling methods (a door-to-door approach, and a mobile health caravan). Fisher test was used to compare two proportions, and the non-parametric Mann-Whitney test to compare two means (p value was 0.05). Median participants' age was 24 years old [15-60]. Findings indicated that husband's education (p=0.005), woman's age (p=0.011), awareness of warning signs during pregnancy (p=0.01) and use of health center for other purposes other than pregnancy (p=0.007) were important influencing factors for use of prenatal consultation services. Factors that influenced supervised birth outcomes were the age of the woman (p=0.013), her education (p=0.027) and a positive attitude towards monitoring her pregnancy by a health professional (p=0.006). To improve utilization rates for maternal health services, these factors must be considered when designing interventions that aim to improve the quality of these services in the community.

A65 VARIATION IN THE CARE OF CHILDREN WITH INFLAMMATORY BOWEL DISEASE: A CANGIEC POPULATION-BASED STUDY

Abstract Background Inflammatory bowel disease (IBD) is rising rapidly in Canadian children. These children require consistent high-quality specialized care to prevent long-term complications. Aims Evaluate variation in health services utilization and surgery rates across pediatric IBD centres in Ontario. Methods Incident cases of IBD &amp;lt;16y (1999–2010), identified from health administrative data using a validated algorithm, were assigned to pediatric IBD centres based on location of IBD hospitalization, endoscopy and outpatient care. Children receiving IBD-specific care outside pediatric centres were also grouped. Frailty models, median hazard ratios (MHR), and Kendall’s t described variation in IBD-related ED visits, hospitalizations, and surgery 6–60 months after diagnosis, adjusting for age, sex, rural/urban household, and income. Mean diagnostic lag (time from first health system contact for an IBD symptom to final IBD diagnosis) and proportion of children with IBD care by gastroenterologists (GIs) at each centre were evaluated as centre-level predictors of variation. Results Of 2584 IBD cases, 73.4% were treated in a pediatric IBD centre. Between-centre differences accounted for 0.18% (MHR 1.06) and 0.41% (MHR 1.09) of variation in hospitalizations and ED visits, respectively. Children treated at centres where a higher proportion of children were cared for by GIs were more likely to be hospitalized (HR 2.09, 95% CI 1.26–3.45). Children treated at centres with a longer mean diagnostic lag were also more likely to be hospitalized (HR 1.01, 95% CI 1.003–1.02). ED visits were not associated with the proportion of children cared for by gastroenterologists or diagnostic lag. Among 1529 CD cases, 14.1% required intestinal resection; 1.79% of variation in the risk of surgery resulted from between-centre differences (MHR 1.20). Surgery was less common among patients at centres where more children were cared for by GIs (HR 0.24, 95% CI 0.07–0.84) and with a longer mean diagnostic lag (HR 0.98, 95% CI 0.97–0.99). After adjusting for these, between-centre differences accounted for 0.005% (MHR 1.01) of variation in care. Minimal variation was observed among the 11.0% of 872 UC cases requiring colectomy, with 0.37% of variation due to between-centre differences (MOR 1.09). Colectomy risk was not associated with GI care or diagnostic lag. Conclusions Variation in ED visits, hospitalizations, and surgery among children with IBD is small; however, centre-level differences in GI specialist care use and time to diagnosis were associated with hospitalization and surgery. It is essential to understand between-centre differences to reduce variation and ensure high-quality care. Funding Agencies CCC

Suicidality, mental disorder and the utilization of mental health services among Australian adolescents

IntroductionSuicidality among adolescents continues to be a serious public health concern worldwide, and suicide is the leading cause of death for young Australians. However, to develop effective preventive interventions, it is essential to understand the types and rates of mental health service utilization among adolescents. This study investigated the association between suicidality and mental health service utilization among Australian adolescents, and to test whether service use is affected by the simultaneous presence of suicidality and mental disorders. MethodAdolescents aged 13–17 years (n = 2134) were used in this study from The Second Australian Child and Adolescent Mental Health and Wellbeing Survey – Young Minds Matter (YMM), which is a nationwide cross-sectional survey. Data were collected through face-to-face interviews with parents using a structured-questionnaire, while, adolescents completed a computer-based self-reported questionnaire privately. The YMM reported four types of mental health service: (1) health services – any services provided by a qualified health professional, regardless of where that service was provided; (2) school services – any services such as counseling or support programs provided by school or any educational institution; (3) telephone counseling services; and (4) online services. Both bivariate and multivariate analyses were used to assess the relationships between independent variables (suicidality, mental disorder) and their distributions over outcome variables (mental health services), adjusting for relevant sociodemographic and potential risk factors such as age, gender, remoteness, household income, family type, family functioning, parents' education, parents' employment, substance use by the child. An interaction between mental disorders and suicidality were included in the regression to examine whether and to what extent service use is affected if an adolescent has both suicidality and a mental disorder. ResultsOverall, 168 (8%) adolescents reported suicidality and prevalence of suicidality (ideation, plan and attempt) was higher in adolescents with mental disorders (P < 0.01 for all). Suicidality was high among girls irrespective of mental health condition. Both bivariate and multivariate analyses using child data and parent data showed a strong and significant association between suicidality and mental health service utilization among adolescents. Online service and health services were more likely to be accessed by adolescents with suicidality as reported in child data and parent data, respectively; while, school and telephone counselling service were less utilized within the same population. However, still, a large number of adolescents with suicidality did not access any services, even the incidence of seeking any mental health service was higher among adolescents with suicidality compared to those with a mental disorder. ConclusionThe limited number of suicidal adolescents is using mental health services, which is alarming for prevention of suicide. Further research is warranted to understand the quality of service received by adolescents and the factors influencing service utilization due to mental health-related problems. Also, interventions to improve care, prevention and monitoring are solely required for this group of people.

Health, wellness, and workplace experiences of lesbian, gay, and bisexual social workers

Using data from an online survey of 6,112 licensed social workers in 13 U.S. states, rates of reported behavioral health problems and service utilization, physical health problems, adverse childhood experiences, workplace stress, and compassion satisfaction were compared between heterosexual male, heterosexual female, gay/bisexual male, and lesbian/bisexual female respondents. Sexual minority workers reported far higher rates of mental health problems and service utilization, higher rates of physical problems, more frequent reporting of adverse childhood experiences, with no differences found between groups regarding workplace stress and compassion satisfaction. Minority stress theory and historical trauma are used as frameworks to conceptualize the findings.

No effects of pilot performance-based intervention implementation and withdrawal on the coverage of maternal and child health services in the Koulikoro region, Mali: an interrupted time series analysis.

Performance-based financing (PBF) has been promoted and increasingly implemented across low- and middle-income countries to increase the utilization and quality of primary health care. However, the evidence of the impact of PBF is mixed and varies substantially across settings. Thus, further rigorous investigation is needed to be able to draw broader conclusions about the effects of this health financing reform. We examined the effects of the implementation and subsequent withdrawal of the PBF pilot programme in the Koulikoro region of Mali on a range of relevant maternal and child health indicators targeted by the programme. We relied on a control interrupted time series design to examine the trend in maternal and child health service utilization rates prior to the PBF intervention, during its implementation and after its withdrawal in 26 intervention health centres. The results for these 26 intervention centres were compared with those for 95 control health centres, with an observation window that covered 27 quarters. Using a mixed-effects negative binomial model combined with a linear spline regression model and covariates adjustment, we found that neither the introduction nor the withdrawal of the pilot PBF programme bore a significant impact in the trend of maternal and child health service use indicators in the Koulikoro region of Mali. The absence of significant effects in the health facilities could be explained by the context, by the weaknesses in the intervention design and by the causal hypothesis and implementation. Further inquiry is required in order to provide policymakers and practitioners with vital information about the lack of effects detected by our quantitative analysis.

Mental and physical health in service member and veteran students who identify as American Indians and Alaskan natives

Objective The purpose of this study was to explore (a) current utilization rates of university mental health services among American Indian/Alaskan Native/Native Hawaiian (AI/AN/NH) student veterans and (b) predictors of mental health service utilization among AI/AN student veterans. Participants: Data for this cross-sectional study were obtained from the American College Health Association (ACHA)’s 2011–2014 National College Health Assessment II (n = 103). Methods: University mental health service utilization rates were calculated as a percentage for AI/AN/NH student veterans. Multivariable logistic regression was used to determine predictors of mental health service utilization. Results: Results showed that 14% of AI/AN/NH student veterans have used university mental health services. Predictors of mental health service utilization in this population included financial stress, lack of deployment during service, suicidal ideation, and a diagnosis of depression, model (13) = 162. 128, p < 0.001, Nagelkerke R 2 = 0.130. Conclusion: This research identified gaps in service provision for AI/AN service member and veteran students on college campuses and provided possible models for intervention development.

Youth Matters: Philly (YMP): Development, usability, usefulness, & accessibility of a mobile web-based app for homeless and unstably housed youth

BackgroundYoung people experiencing homelessness accounted for about 7% of the total homeless population in the United States in 2018. These young people are among the most marginalized youth populations and face numerous hardships. Accessing and connecting with provider organizations is challenging for these young people for myriad reasons related to their marginalization and vulnerability. As a result, homeless and unstably housed youth exhibit low rates of health and social service utilization, despite high rates of need. Objectives(1) To document the development of a mobile web-based app called Youth Matters: Philly (YMP) for young people experiencing homelessness or unstable housing that is designed to help them search, identify, locate, and utilize Philadelphia-based social and health services; and, (2) To explore youth’s perceptions of the usability, usefulness, and accessibility of YMP. MethodsWe used the Mobile App Rating Scale (MARS) to assess young people’s perceptions of YMP’s usability, usefulness, and accessibility. Ten young people who either were currently experiencing homelessness/unstable housing or recently had experienced such hardship participated in the study. During a two-week window, participants logged onto YMP at least three times and searched for resources. They then completed the MARS. Participants were between the ages of 18 and 25 years old (M = 21.5 years; SD = 2.3 years), mostly female (67%), and mostly black/African American (67%). Thirty percent identified as Hispanic/Latinx. All had spent time in foster care and aged out, with an average length of 8.1 years in care (SD = 4.0 years). We used Qualtrics to collect all data and descriptive statistics to analyze all data in SPSS. ResultsThe mean scores on the subscales of the MARS (Engagement, Functionality, Aesthetics, and Information) ranged from 3.60 (Aesthetics) to 3.98 (Functionality; Information) out of 5. The mean score for overall Quality was 3.47 (out of 5). We also asked a set of questions specific to YMP to assess perceived impact of the app on the respondents’ awareness, knowledge, attitudes, help seeking, and behavior change related to experiencing homelessness and unstable housing. For all questions, at minimum, all participants “somewhat agreed.” ConclusionsYMP is a promising way to increase engagement and overcome barriers to accessing services for youth experiencing homelessness or unstable housing. Findings offer insights into ways to improve future versions of YMP. YMP also offers a model for other localities committed to improving access to services for young people experiencing homelessness or unstable housing. Future research directions for YMP and similar technology are discussed.

MENTAL HEALTH POLICY OUTCOMES: AN EXAMINATION OF OLDER ADULTS’ MENTAL HEALTH SERVICE USE, 2002-2012

Objectives: Though several national-level mental health policies have been enacted and implemented over the past decade, older adults’ rates of mental health service (MHS) utilization remain low. We aimed to examine individual- and community-level factors that have fostered the most successful implementations of national mental health policies in recent years. Methods: We conducted a multilevel growth curve analysis to examine older adults’ MHS use using the Medical Expenditure Panel Survey – Household Component, or MEPS-HC. We considered MHS use in the MEPS-HC for the period of 2002-2012, during which members of MEPS Panels 6-17 provided responses. We identified 8,416 respondents aged 65+ with mental health need, and examined the rates of actual MHS utilization among this sample as it varied by insurance status, rural/urban location, and race/ethnicity. Results: Analyses revealed that rates of older adults’ MHS use did not increase significantly over our examination period, regardless of race/ethnicity or rurality of location. Only insurance status was a significant predictor of change in MHS use rates over the years 2002-2012; t=3.93 (19), p<0.001. Conclusions: Findings suggest that rates of MHS use remained stagnant over the decade examined, revealing problems with implementation of relevant policies for older adults. Additionally, our analyses highlighted that although there were no disparities in rates of MHS use by geographic location or race/ethnicity, there may be significant disparities in identified need for services among older adults. We make suggestions for ensuring greater efficiency and efficacy of efforts to improve older adults’ MHS use in the coming decade.

The Effect of Health Insurance on the Utilization of Health Services: A Systematic Review and Meta-Analysis.

Insurance organizations are among the most influential organizations in the health system, which can lead to healthcare efficiency and patient satisfaction in case they are increasingly accessed. The main purpose of the present systematic review was to examine the effect of health insurance on the utilization of health services and also to examine the factors affecting it. The present study was a systematic review that aimed to examine the effect of health insurance on the utilization of health care services. The study was conducted in 2016 using Scopus, PubMed, Web of Science, Science Direct, and ProQuest databases. We examined the utilization rate of health insurance in insured people. The inclusion and exclusion criteria were included based on review and meta-analysis purposes. The utilization of health services increased for inpatient and outpatient services. The utilization rate of inpatient services increased by 0.51% whereas the utilization rate of outpatient services increased by 1.26%. We classified the variables affecting the utilization rate of insurance into three main categories and sub-categories: demographic variables of the household, socioeconomic status, and health status. Our study showed that insured people increased the utilization rate of health services, depending on the type of health services. Thus, health policymakers should consider the community’s health insurance as a priority for health programs. For now, implementing universal health insurance is a good solution.

The Effect of Health Insurance on the Utilization of Health Services: A Systematic Review and Meta-Analysis

Insurance organizations are among the most influential organizations in the health system, which can lead to healthcare efficiency and patient satisfaction in case they are increasingly accessed. The main purpose of the present systematic review was to examine the effect of health insurance on the utilization of health services and also to examine the factors affecting it. The present study was a systematic review that aimed to examine the effect of health insurance on the utilization of health care services. The study was conducted in 2016 using Scopus, PubMed, Web of Science, Science Direct, and ProQuest databases. We examined the utilization rate of health insurance in insured people. The inclusion and exclusion criteria were included based on review and meta-analysis purposes. The utilization of health services increased for inpatient and outpatient services. The utilization rate of inpatient services increased by 0.51% whereas the utilization rate of outpatient services increased by 1.26%. We classified the variables affecting the utilization rate of insurance into three main categories and sub-categories: demographic variables of the household, socioeconomic status, and health status. Our study showed that insured people increased the utilization rate of health services, depending on the type of health services. Thus, health policymakers should consider the community’s health insurance as a priority for health programs. For now, implementing universal health insurance is a good solution. [GMJ.2019;8:e1411]

Validation of the Malay Mental Help Seeking Attitude Scale

There is a rise in the incidence and prevalence of mental distress among Malaysians. However, the rate of mental health service utilization is low. As mental help-seeking attitude is a strong predictor for seeking mental health treatment, it is important to validate a feasible and psychometrically sound instrument in the Malaysian context. This study aimed to investigate the reliability and validity of a recently developed help-seeking attitude scale, the Mental Help Seeking Attitude Scale (MHSAS) among Malaysian youth. A total of 261 students from a secondary school (n=127) and a university (n=134) from the Klang Valley, Malaysia participated in this study. They were self-administered the 9-item Malay MHSAS along with the General Help-seeking Questionnaire (GHSQ) and Self-Stigma of Seeking Help Scale (SSOSH). Retest of the MHSAS was conducted with 47 students three months later. Factor analysis was employed to evaluate construct validity, while concurrent validity was determined through bivariate correlation with the SSOSH and GHSQ scales. Paired-samples t-test was conducted to evaluate test-retest reliability. The single dimensionality of the MHSAS’s original version was supported. Factor loadings ranged from .636 to .799, and inter-item correlation ranged from .547 to .726. Results revealed high internal consistency and test-retest reliability was confirmed. The scale also demonstrated acceptable concurrent validity when compared with the GHSQ and SSOSH. The Malay version of the MHSAS demonstrated good psychometric properties to measure help-seeking attitudes in the Malaysian youth population.

Mental Health Experiences and Service Use Among Veterinary Medical Students.

The mental health and wellness of veterinary students is an important contemporary focus of scholarship. Yet, to date, little empirical work has investigated mental health experiences and rates of mental health service use in large samples of veterinary students from multiple institutions. The purpose of this study is to explore the prevalence of mental health concerns among veterinary medical students, as well as rates of mental health service utilization, using validated measures and a large sample. Study participants were 573 veterinary medical students currently enrolled in accredited veterinary medical programs in the United States. Approximately one third of participants reported levels of depression or anxiety above the clinical cut-off, and a strong positive correlation was found between the two. Depression and anxiety were also associated with prior engagement in non-suicidal self-injury (NSSI), suicidal ideation, and prior suicide attempts. Nearly 80% of participants who scored above the clinical cut-off for depression or anxiety reported seeking some form of mental health services currently or in the past, and a majority reported having positive experiences with services. Results also indicated a higher than typical rate of NSSI among veterinary medical students. Implications for outreach, research, and education are discussed.

A stepped wedge cluster randomised trial of a cognitive remediation intervention in alcohol and other drug (AOD) residential treatment services

BackgroundExecutive functioning impairment is common in substance use disorder and is a major risk factor for poor treatment outcomes, including treatment drop-out and relapse. Cognitive remediation interventions seek to improve executive functioning and offer a promising approach to increase the efficacy of alcohol and other drug (AOD) treatments and improve long-term therapeutic outcomes. This protocol describes a study funded by the NSW Agency for Clinical Innovation that assesses the effectiveness of delivering a six-week group-based intervention of cognitive remediation in an ecologically valid sample of people attending residential AOD treatment services. We primarily aim to investigate whether cognitive remediation will be effective in improving executive functioning and treatment retention rates. We will also evaluate if cognitive remediation may reduce long-term AOD use and rates of health service utilisation, as well as improve personal goal attainment, quality of life, and client satisfaction with treatment. In addition, the study will involve an economic analysis of the cost of delivering cognitive remediation.Methods/designThe study uses a stepped wedge cluster randomised design, where randomisation will occur at the cluster level. Participants will be recruited from ten residential AOD treatment services provided by the non-government sector. The intervention will be delivered in 12 one-hour group-based sessions over a period of six weeks. All participants who are expected to receive treatment for the duration of the six-week intervention will be asked to participate in the study. The clusters of participants who are randomly assigned to the treatment condition will complete cognitive remediation in addition to treatment as usual (TAU). Primary and secondary outcome assessments will be conducted at pre-cognitive remediation/TAU phase, post-cognitive remediation/TAU phase, two-month follow-up, four-month follow-up, six-month follow-up, and eight-month follow-up intervals.DiscussionThis study will provide comprehensive data on the effect of delivering a cognitive remediation intervention within residential AOD treatment services. If shown to be effective, cognitive remediation may be incorporated as an adjunctive intervention in current treatment programs.Trial registrationAustralian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12618001190291. Prospectively registered 17th July 2018.

Study on the Status of Health Service Utilization among 3⁻5 Years Old Left-Behind Children in Poor Rural Areas of Hunan Province, China: A Cross-Sectional Survey.

The left-behind children (LBC) in China generally refer to children who remain in rural regions under the care of kin members while their parents migrate to urban areas. Due to some reasons, e.g., poverty, poor transportation conditions, lack of health resources, and preschool child care, it is hard for preschool-aged rural LBC to obtain essential health services. Random cluster sampling was used to recruit the caregivers and all the 3–5-year-old LBC in two rural counties in Hunan Province. A questionnaire was used to collect data on LBC demographics via face-to-face interviews with the caregivers. Health service needs were evaluated by the two-week prevalence rate, while health service utilization was measured by the two-week physician visit rate. Of the 559 respondents in the study, the two-week prevalence rate was 44.2% and the two-week physician visits rate was 48.6%. Nearly half of the sick children did not go to a hospital, 45.7% self-treated, and 5.3% did not take any treatment. The utilization rates of “health check,” “eye exam,” and “hearing screening for 3-year-olds” were extremely low (57.3%, 29.3%, 18.7%). The utilization rate of health services for preschool LBC in poor rural areas was extremely low, which can affect the normal growth and development of children.

\u201cI feel more comfortable speaking to a male\u201d: Aboriginal and Torres Strait Islander men\u2019s discourse on utilizing primary health care services

BackgroundAboriginal and Torres Strait Islander men have the highest morbidity and mortality rates, and lowest rates of health service utilization in Australia. There is a current perception that Aboriginal and Torres Strait Islander men are disinterested in their health. This study aimed to identify the perceived motivators, barriers and enablers of Aboriginal and Torres Strait Islander men’s utilization of primary health care services, explore their experiences and obtain suggestions from them as to how services could be modified to improve utilization.MethodsThis study utilized the principles of Indigenist Research Methods. Semi-structured interviews with Aboriginal and Torres Strait Islander men (N = 19) took place in South Australia and far north Queensland. Participants were asked about their experiences with primary health care services, including what they could remember as a child. A thematic analysis of the qualitative data was completed without the use of computer software.ResultsFeelings of invincibility, shame, being uncomfortable, fearful, along with long waiting times, having a lack of knowledge, and culturally inappropriate staff/services were all found to be barriers to service utilization. Enabling factors included convenience, the perceived quality of the service, feeling culturally safe and/or a sense of belonging, and having a rapport with staff. Motivation for attending primary health care services included going when feeling sick/unwell, attending a particular service (dental or sexual health), visiting for check-ups and preventative health and family encouragement.This study also highlights strategies surrounding logistical factors, promotion of services and improved communications, having culturally appropriate services and providing gender specific services all of which were suggested by the participants to improve service utilization.ConclusionContrary to common misperceptions, this study demonstrated that most of the Aboriginal and Torres Strait Islander men participants were motivated to engage with primary health care services for preventative health care. Even though there were men that fitted the stereo-type who avoid doctors, there were usually underlying reasons and barriers accounting for this reluctance. This study suggests that if primary health care services commit to better understanding the barriers, enablers and motivators their cohort of men face, then utilization could be greatly improved.

Sexual health service use among university undergraduate students in Nova Scotia

University students are a high-risk population for acquiring sexually transmitted infections (STIs). However, the rates of sexual health service utilization among this population remain low. In this study, we sought to describe the rates and predictors of sexual health service use among undergraduate students at two Nova Scotia universities. An online survey of eight Canadian Maritime universities was conducted to collect information on undergraduate students’ sexual health behaviours ( n = 10,631). We conducted a secondary analysis on a subset of the data collected from sexually active undergraduate students at two Nova Scotia universities ( n = 3,709). The majority of sexually active female students (73%) and 20% of male students accessed sexual health services at least once in their lifetime. Fewer sexually active students (41% females; 25% males) have ever had an STI test. Twenty-two percent of female students and 8% of male students had ever accessed sexual health services at their university health centre. Non-heterosexual students were less likely to access sexual health services on campus than heterosexual students. Among female respondents, those who reported a greater sense of social support were more likely to access sexual health services on campus. Our results illustrate the characteristics of university undergraduate students who do and do not access sexual health services on campus. These findings will be used to inform the design of a qualitative study to further explore the perceived barriers and enablers to sexual health service use at university health centres.

Increased Rates of Mental Health Service Utilization by U.S. College Students: 10-Year Population-Level Trends (2007-2017).

This study aimed to document population-level trends in mental health service utilization by college students. The study drew on 10 years of data from the Healthy Minds Study, an annual Web-based survey, with a sample comprising 155,026 students from 196 campuses. Analyses focused on past-year mental health treatment and lifetime diagnoses of a mental health condition. Changes in symptoms of depression and suicidal ideation and levels of stigma were hypothesized as potential explanatory factors. Rates of treatment and diagnosis increased significantly. The rate of treatment increased from 19% in 2007 to 34% by 2017, while the percentage of students with lifetime diagnoses increased from 22% to 36%. The prevalence of depression and suicidality also increased, while stigma decreased. This study provides the most comprehensive evidence to date regarding upward trends in mental health service utilization on U.S. campuses over the past 10 years. Increasing prevalence of mental health problems and decreasing stigma help to explain this trend.

Identifying Barriers to Mental Health Service Utilization Among Heavy Drinking Community College Students

ABSTRACTThere are limited findings on mental health prevalence and service utilization rates among community college (CC) students. Utilizing a heavy drinking CC sample, the current study examined: 1) prevalence of mental health symptoms, 2) mental health service utilization and perceived unmet service need, and 3) barriers to service utilization. Participants were 142 CC students who were heavy alcohol users (70% female; 59% White) from three public CCs in the Pacific Northwest who were participating in a larger study designed to adapt a brief intervention for high-risk alcohol use. Findings of the current study revealed that 32% of CC students had a positive screen for depression; 25% had a positive screen for anxiety; a total of 28% received mental health services in the past 12 months; a total of 41% reported a perceived unmet need for mental health srvices at some point in the past 12 months (i.e., needing mental health services but not receiving it). Students with mental health symptoms reported more barriers to receiving services, and were more likely to not receive services due to cost, compared to students without mental health symptoms. There were differences in type of barrier as a function of alcohol use severity, although there was no difference in number of barriers. Campuses may benefit from understanding mental health service utilization barriers their students report and to effectively advertise the services offered. Training of student services personnel staff and faculty in screening for mental health or substance use may be a worthwhile and cost-effective endeavor.

Reducing bias in multivariate analyses due to the modifiable areal unit problem.

IntroductionThe Modifiable Areal Unit Problem (MAUP) arises from the aggregation of data organized by spatially defined boundaries. Aggregated values are influenced by the shape (zone effect) and scale of the aggregated units. Aggregations of the same data using different zones or scales can give different analytical results, none reliable.&#x0D; Objectives and ApproachUsing population-level administrative health data in Western Australia, the objectives were to: accurately measure the association between health service utilization and demographic, socio-economic, and service accessibility variables; and develop models to accurately forecast areas of high health service utilization into the future.&#x0D; Multiple zone designs and aggregation scales were used to examine the impact of MAUP in association studies. These zone designs and scales were then used in all-subset model selection processes, combined with repeated k-fold cross-validation, to generate forecast maps of areas having high future rates of health service utilization.&#x0D; ResultsThe impact of the MAUP and methods to reduce this bias in association studies will be presented, for both simple and complex model designs. Maps indicating gradients of predicted probabilities of high rate of health service demand in the future can be used to optimize the placement of services, through the use of catchment areas based on road-network travel distance and population distributions.&#x0D; Conclusion/ImplicationsThe impact of the MAUP on the analysis of spatially-aggregated data has been considered intractable. However, methods to reduce the impact of the MAUP can improve policy and planning decisions based on such studies.