Acculturation and Health Survey Question Comprehension Among Latino Respondents in the US

Although research has documented cultural variability in respondent comprehension and interpretation of survey questions, little information is currently available on the role that acculturation might play in minimizing cross-cultural differences in the comprehension or interpretation of survey questions. To investigate this problem, we examine the potential effects of acculturation to host culture on respondent comprehension of a set of health survey questions among two distinct Latino populations on the US mainland: Mexican–Americans and Puerto Ricans. Specifically, comprehension-related respondent behaviors coded from 345 face-to-face interviews conducted with Mexican–American, Puerto Rican, African American, and non-Latino White adults living in Chicago are examined. Findings indicate that Latino respondents who were born outside of the US and who have a preference for communicating in Spanish, relative to English, were more likely to express comprehension difficulties. These findings suggest that pretest survey instruments with immigrant populations may be a useful strategy for identifying problematic questions.     

Meeting the Need for State-Level Estimates of Health Insurance Coverage: Use of State and Federal Survey Data

Objective. Critically review estimates of health insurance coverage available from different sources, including the federal government, state survey initiatives, and foundation-sponsored surveys for use in state policy research.
Study Setting and Design. We review the surveys in an attempt to flesh out the current weaknesses of survey data for state policy uses. The main data sources assessed in this analysis are federal government surveys (such as the Current Population Survey's Annual Social and Economic Supplement, and the National Health Interview Survey), foundation-supported surveys (National Survey of America's Families, and the Community Tracking Survey), and state-sponsored surveys.
Principal Findings. Despite information on estimates of health insurance coverage from six federal surveys, states find the data lacking for state policy purposes. We document the need for state representative data on the uninsured and the recent history of state data collection efforts spurred in part by the Health Resources Services Administration State Planning Grant program. We assess the state estimates of uninsurance from the Current Population Survey and make recommendations for a new consolidated federal survey with better state representative data.
Conclusions. We think there are several options to consider for coordinating a federal and state data collection strategy to inform state and national policy on coverage and access.     

Chiropractic Use by Urban and Rural Residents With Insurance Coverage

ABSTRACT:  Purpose: To describe the use of chiropractic care by urban and rural residents in Washington state with musculoskeletal diagnoses, all of whom have insurance coverage for this care. The analyses investigate whether restricting the analyses to insured individuals attenuates previously reported differences in the prevalence of chiropractic use between urban and rural residents as well as whether differences in provider availability or patient cost-sharing explain the difference in utilization. Methods: Claims data from 237,500 claimants in 2 large insurance companies in Washington state for calendar year 2002 were analyzed, using adjusted clinical group risk adjustment for differences in disease burden and rural urban commuting area codes for rurality definition. Findings: The proportion of claimants using chiropractors was higher in rural than urban residents (44% vs 32%, P < .001). Lack of conventional providers in rural areas did not completely explain this difference, nor did differences in patient cost-sharing or demographics. Among those who used chiropractors, those in urban areas had more chiropractic visits than users of chiropractic in rural areas. Conclusions: Among insured adults, use of chiropractic care was higher in rural than in urban areas. Reasons suggested for this difference in previous reports were not borne out in this data set.     

A Descriptive Analysis of Health Insurance Coverage Among Farm Families in Minnesota

This paper reports the findings of a study of health insurance coverage and access to health services among farm families in Minnesota. The study included 1,482 families actively engaged in farming during 1989. While less than 10 percent of the population were uninsured during this period, the majority had limited coverage with high deductible and coinsurance provisions. Moreover, they were paying an estimated 15 to 20 percent more for their plans than a similar plan would have cost in the Minneapolis-St. Paul, MN, area. With the exception of cost, satisfaction with health services was found to be very high, and there were few indications of access problems.     

Rural-Urban Differences in Health Insurance Coverage and Patterns Among Working-Age Adults in Kentucky

Context: Past studies show that rural populations are less likely than urban populations to have health insurance coverage, which may severely limit their access to needed health services. Purpose: To examine rural-urban differences in various aspects of health insurance coverage among working-age adults in Kentucky. Methods: Data are from a household survey conducted in Kentucky in 2005. The respondents include 2,036 individuals ages 18-64. Bivariate analyses were used to compare the rural-urban differences in health insurance coverage by individual characteristics. Logistic regression analyses were used to examine the independent impact of rural-urban residence on the various aspects of health insurance coverage, while controlling for the individuals’ health status and sociodemographic characteristics. Findings: The overall rate of working-age adults with health insurance did not differ significantly between the rural and urban areas of Kentucky. However, there were significant rural-urban differences in insurance for specific types of health care and in patterns of insurance coverage. Rural adults were less likely than urban adults to have coverage for vision care, dental care, mental health care, and drug abuse treatment. Rural adults were also less likely to obtain insurance through employment, and their current insurance coverage was, on average, of shorter duration than that of urban adults. Conclusions: In Kentucky, the overall health insurance rate of working-age adults is influenced more by employment status and income than by whether these individuals reside in rural or urban areas. However, coverage for specific types of care, and coverage patterns, differ significantly by place of residence.     

Awareness and Willingness to Use Biomedical Prevention Strategies for HIV Among Sexual and Gender Minority Youth: Results From a National Survey

PurposeSexual and gender minority youth (SGM), an umbrella term encompassing gay, bisexual, and transgender youth, experience disproportionately high rates of new HIV infections, and recent advances in biomedical HIV prevention modalities hold promise in reducing new infections. However, the extent to which SGM youth are aware of and willing to use these modalities is unknown.MethodsUsing data from the Survey of Today's Adolescents Relationships and Transitions, we analyze awareness of and willingness to take HIV pre-exposure prophylaxis (PrEP), nonoccupational HIV post-exposure prophylaxis, and rectal microbicides among adolescent sexual minority males aged 13–18 years and transgender youth aged 13–24 years.ResultsOverall, we found a majority of our respondents were not aware of any of these prevention modalities. Across both subsamples, age and outness to a health care provider were associated with increased PrEP awareness, and any anal sex was associated with PrEP willingness.ConclusionsThese findings highlight the importance of provider education on how to discuss SGM issues with patients and educate them about HIV prevention options.     

Food Allergy Among Low Birthweight Children in a National Survey

The aim of this paper was to investigate the association between birthweight and prevalence of food allergies using a national sample of US children. Adult report of birthweight and child food allergies were obtained for years 2005–2009 from the National Health Interview Survey (NHIS), a cross-sectional household survey of the US population. A total of 51,748 children aged 0–17 years were included in the analyses representing over 73 million children. Multivariable logistic regression analyses examined associations between birthweight categories and food allergies stratified by age and gender; accounting for the complex design of NHIS. Children aged 6–12 years who were born very low birthweight (500–1,499 g) were more likely to have reported food allergy compared to referent (3,000–3,499 g), OR = 1.72; 95% CI: 1.02–2.91. However, there was no clear trend of an association between birthweight and food allergy with increasing or decreasing birthweight across all ages. Estimates were generally stronger in younger male children as compared to estimates in females of the same age group. Marginal associations for respiratory allergy (OR = 1.52; 95% CI: 1.02–2.29) and hay fever (OR = 1.54; 95% CI: 0.93–2.54) were observed among very low birthweight children aged 0–5 years. There was limited evidence for a clear association between birthweight and food allergy. Marginal associations observed in children weighing 500–1,499 g at birth support efforts to minimize preterm births and very low birthweight given the increase in pediatric food allergies and the large number of children born low birthweight each year in the US.     

Attrition of Older Mexican American Survey Respondents

Objective The purpose of this study is to compare sample attrition between foreign born and US born older Mexican Americans. Methods Prospective cohort data over five waves (Hispanic established population for the epidemiological study of the elderly) of 3,050 older Mexican Americans were used to estimate the number and proportion of drop outs. Multivariate logistic regression of predictors of attrition included nativity, age, gender, race/ethnicity, marital status, financial strain, employment status, education, chronic conditions, cognitive function, disability, and depressive symptoms. Results Over 11 years of follow-up, 62% of the respondents dropped out of the study, but the difference between respondents born in the US and Mexico differed by only 2% points. Multivariate analyses of correlates for attrition related to death, refusal, and lost to follow-up revealed that older respondents in poor health were more likely to die and be lost to follow up. Conclusion Over 11 years of follow-up, immigrants were no more likely to drop out than US born respondents.     

Factors Associated with Ethnic Differences in Health Insurance Coverage and Type Among Asian Americans

This study examines the discrepancies in health insurance coverage and type across Asian American ethnic groups and the potential factors that may explain why these differences exist. Asian Americans are often considered as a homogeneous population and consequently, remain largely “invisible” in the current research literature. Recent data have highlighted discrepancies in the health insurance coverage between different Asian American ethnic groups—particularly the high uninsurance rates among Korean and Vietnamese Americans. For this study, the 2003 and 2005 California Health Interview Surveys were pooled to obtain a sample of 6,610 Asian American adults aged 18–64, including those of Chinese, Filipino, Japanese, South Asian, and Vietnamese ethnicity. Binomial and multinomial logistic regression models were used to examine the likelihood of current health coverage and insurance type (employer-based vs. private vs. public), respectively. The results showed that ethnic differences in uninsurance and insurance type were partially explained by socioeconomic and immigration-related characteristics—particularly for Vietnamese Americans and to a lesser extent, for Chinese and Korean Americans. There were also key differences in the extent to which specific ethnic groups purchased private insurance or relied on public programs (e.g., Medicaid) to offset the lack of employer-based coverage. This study reaffirms the tremendous heterogeneity in the Asian American population and the need for more targeted policy approaches. With the lack of adequate national data, more localized studies may help to improve our understanding of the health issues affecting specific Asian ethnic groups.     

The Impact of Private Insurance Coverage on Veterans' Use of VA Care: Insurance and Selection Effects

Objective. To examine private insurance coverage and its impact on use of Veterans Health Administration (VA) care among VA enrollees without Medicare coverage.
Data Sources. The 1999 National Health Survey of Veteran Enrollees merged with VA administrative data, with other information drawn from American Hospital Association data and the Area Resource File.
Study Design. We modeled VA enrollees' decision of having private insurance coverage and its impact on use of VA care controlling for sociodemographic information, patients' health status, VA priority status and access to VA and non-VA alternatives. We estimated the true impact of insurance on the use of VA care by teasing out potential selection bias. Bias came from two sources: a security selection effect (sicker enrollees purchase private insurance for extra security and use more VA and non-VA care) and a preference selection effect (VA enrollees who prefer non-VA care may purchase private insurance and use less VA care).
Principal Findings. VA enrollees with private insurance coverage were less likely to use VA care. Security selection dominated preference selection and naïve models that did not control for selection effects consistently underestimated the insurance effect.
Conclusions. Our results indicate that prior research, which has not controlled for insurance selection effects, may have underestimated the potential impact of any private insurance policy change, which may in turn affect VA enrollees' private insurance coverage and consequently their use of VA care. From the decline in private insurance coverage from 1999 to 2002, we projected an increase of 29,400 patients and 158 million dollars for VA health care services.     

Association of Race,Substance Abuse,and Health Insurance Coverage With Use of Highly Active Antiretroviral Therapy Among HIV-Infected Women, 2005

Objectives. We examined racial/ethnic disparities in highly active antiretroviral therapy (HAART) use and whether differences are moderated by substance use or insurance status, using data from the Women''s Interagency HIV Study (WIHS).Methods. Logistic regression examined HAART use in a longitudinal cohort of women for whom HAART was clinically indicated in 2005 (N = 1354).Results. Approximately 3 of every 10 eligible women reported not taking HAART. African American and Hispanic women were less likely than were White women to use HAART. After we adjusted for potential confounders, the higher likelihood of not using HAART persisted for African American but not for Hispanic women. Uninsured and privately insured women, regardless of race/ethnicity, were less likely than were Medicaid enrollees to use HAART. Although alcohol use was related to HAART nonuse, illicit drug use was not.Conclusions. These findings suggest that expanding and improving insurance coverage should increase access to antiretroviral therapy across racial/ethnic groups, but it is not likely to eliminate the disparity in use of HAART between African American and White women with HIV/AIDS.The epidemic of HIV/AIDS among women reflects a convergence of medical and social policy issues—including race, substance use, and sexual behavior—that are difficult to disentangle and address. Since the introduction of highly active antiretroviral therapy (HAART) as the standard of care in 1996, mortality rates from AIDS and its complications have declined dramatically.¹ However, the decline in AIDS deaths between 1993 and 2001 occurred at a much slower rate among African American men and women than among White men and women.² One possible explanation for the slower rate of decline is differences in access to quality medical care. In addition, there is growing evidence of lower use of HAART by women of color compared with other women.³Shapiro et al.⁴ analyzed data from the HIV Cost and Services Utilization Study, the only nationally representative study of US adults receiving care for HIV infection, and reported that African Americans were less likely than were Whites with similar CD4 counts to obtain combination drug therapy in 1998, 2 years after HAART became the standard of care for HIV infection. However, in a subsequent study that also analyzed HIV Cost and Services Utilization Study data, Cunningham et al.⁵ reported that racial/ethnic identity was not associated with receipt of HAART when they used a series of nested multivariate models that adjusted for factors that had been found to explain race-associated effects in earlier analyses. In their final analytic model, only insurance coverage and CD4 count were statistically significant predictors of HAART use.At least 2 studies^3,6 have provided evidence that HIV-infected African American women are less likely than HIV-infected White women to receive HAART, and several national studies have indicated that African Americans fare worse than Whites on a number of recognized standards of HIV care.^4,5,7 The same studies have also documented significant disparities in HAART use among illicit drug users. These studies assessed the independent effects of race, illicit substance abuse, and insurance coverage on use of medical care by people with HIV/AIDS.Studies of HIV-infected women have reported mixed findings regarding the roles of race/ethnicity and substance use in receipt of HAART when insurance status is taken into account. Analyzing data from the Women''s Interagency HIV Study (WIHS), Cohen et al.³ and Cook et al.⁶ reported that women who were either African American or illicit drug users were less likely to report using HAART than were their counterparts who were White or nondrug users, respectively. However, the studies'' findings differed on how Hispanic women fared relative to White women and on the effects of insurance coverage on receipt of HAART.Although these studies have substantially contributed to understanding factors associated with receipt of HAART, considerable gaps in knowledge still exist. We investigated the hypothesis that the combination of race/ethnicity and insurance status represents a greater risk than either factor alone for nonuse of HAART and that the association is more complex than the simple “main” effects used in previous research. We believe that continuing to track patterns of HIV care and clinically indicated HAART use, in particular, is important for gauging progress in reducing disparities in care and for informing HIV treatment policies and clinical practices.     

Sex Under the Influence of Drugs Among People Who Use Drugs in Cambodia: Findings From a National Survey

Archives of Sexual Behavior - Studies in drug use settings rarely use sex under the influence of drugs as an indicator of sexual risk behaviors. This study explored the prevalence of sex under the...