Factors associated with use of preventive dental and health services among U.S. adolescents

Purpose: To examine adolescents’ use of preventive medical and dental services and its relationship to demographic characteristics and other variables reflecting access to and need for care.

Methods: Self- and parent-reported data from a sample of 5644 adolescents aged 11 to 21 years from the National Longitudinal Study of Adolescent Health (Add Health). Variables studied include the influence of both the adolescents’ demographic and socioeconomic characteristics (age, race/ethnicity, place of birth, acculturation, insurance status, and perception of health), as well as those of their parents (race/ethnicity, income, level of education, place of birth) on their lifetime use and use within the past year of medical and dental services. Bivariate and logistic regression analyses were conducted using SAS and SUDAAN.

Results: Approximately 32% of respondents had not had a physical examination in the year before the survey, and the same percentage had not had a dental examination. Approximately 2% reported never having had either a physical or a dental examination. Logistic regression reveals that lack of insurance, low family income, and low parental education level are significantly associated with the lack of preventive medical care. Lack of an annual dental visit was associated with male gender; black, Hispanic, or mixed race/ethnicity; and lack of insurance. Never having had a dental visit was the only dependent variable found to be associated with place of birth.

Conclusions: Health insurance and family income are most consistently related to adolescents’ use of preventive medical and dental care. However, the relationship between lack of dental care and place of birth emphasizes the need to improve access to dental services for immigrant teens. These findings are particularly relevant as states design systems of care for adolescents under the State Children’s Health Insurance Program.     

The Great Recession and Health Spending among Uninsured U.S. Immigrants: Implications for the Affordable Care Act Implementation

ObjectiveWe study the association between the timing of the Great Recession (GR) and health spending among uninsured adults distinguishing by citizenship/nativity status and time of U.S. residence.ConclusionsOur study findings suggest that recent immigrants could be forgoing essential care, which later translates into higher spending. It portrays the vulnerability of a population that would remain exposed to income shocks, even after the Affordable Care Act (ACA) implementation.     

Use of preventive services by men enrolled in Medicare+Choice plans

Objectives. We examined the effect of demographic and socioeconomic factors on use of preventive services (prostate-specific antigen testing, colorectal cancer screening, and influenza vaccination) among elderly men enrolled in 2 Medicare+Choice health plans.

Methods. Data were derived from administrative files and a survey of 1915 male enrollees. We used multivariate logistic regression to assess the effects of enrollee characteristics on preventive service use.

Results. Age, marital status, educational attainment, and household wealth were associated with receipt of one or more preventive services. However, the effects of these variables were substantially attenuated relative to earlier studies of Medicare.

Conclusions. Some Medicare HMOs have been successful in attenuating racial and socioeconomic disparities in the use of preventive services by older men.

     

上海市区1973至2005年癌症的发病趋势

目的了解企业职业人群的大肠癌筛查行为及相关因素,为提高职业人群大肠癌筛查参与率提出相应干预策略。方法于2016年采用自行设计的问卷,对上海市黄浦区某企业203名40~60岁职业人群的大肠癌筛查行为及其相关因素进行横断面调查。使用单因素和二元非条件logistic回归模型进行统计学分析。结果职业人群便隐血检测（FOBT）参与率为8.4%,直肠指检参与率为50.2%。多因素分析显示,文化程度较高（OR=4.27,95%CI为2.13~8.56）、正常体重及低体重（BMI < 24）（OR=1.93,95%CI为1.03~3.62）、大肠癌知识水平较高（OR=3.27,95%CI为1.76~6.09）是促使职业人群进行直肠指检的相关因素。结论职业人群FOBT、直肠指检参与率较低,企业应针对重点人群开展职工健康教育和促进活动,进一步提高大肠癌筛查的参与率。     

Fracture risk in the U.S. Medicare population

Using data from the 5% U.S. Medicare sample, we estimated the actuarial (life table) risk that a person aged 65 will fracture the upper or lower limbs or the pelvis, by age 75, 80, 85, and 90, taking into account the chance of dying in the interval. The actuarial risk of a 65-year old white woman sustaining a fracture by age 90 is 16% for the hip, 9% for distal forearm, 5% for proximal humerus, and 4% for ankle. Black women and white men have substantially lower risks, and the risks for black men are very low. Although hip fractures pose the single greatest risk, the risk of all other fractures combined is greater. White women have particularly high risks for all fractures, because of their longevity as well as their high fracture rates. It is important to adjust for the probability of dying when estimating risks in an elderly population.     

Waste in the U.S. Health Care System: A Conceptual Framework

Context: Health care costs in the United States are much higher than those in industrial countries with similar or better health system performance. Wasteful spending has many undesirable consequences that could be alleviated through waste reduction. This article proposes a conceptual framework to guide researchers and policymakers in evaluating waste, implementing waste‐reduction strategies, and reducing the burden of unnecessary health care spending. Methods: This article divides health care waste into administrative, operational, and clinical waste and provides an overview of each. It explains how researchers have used both high‐level and sector‐ or procedure‐specific comparisons to quantify such waste, and it discusses examples and challenges in both waste measurement and waste reduction. Findings: Waste is caused by factors such as health insurance and medical uncertainties that encourage the production of inefficient and low‐value services. Various efforts to reduce such waste have encountered challenges, such as the high costs of initial investment, unintended administrative complexities, and trade‐offs among patients', payers', and providers' interests. While categorizing waste may help identify and measure general types and sources of waste, successful reduction strategies must integrate the administrative, operational, and clinical components of care, and proceed by identifying goals, changing systemic incentives, and making specific process improvements. Conclusions: Classifying, identifying, and measuring waste elucidate its causes, clarify systemic goals, and specify potential health care reforms that—by improving the market for health insurance and health care—will generate incentives for better efficiency and thus ultimately decrease waste in the U.S. health care system.     

Diet and physical activity of U.S. adults with heart disease following preventive advice

BACKGROUND: The extent to which persons with heart disease have been told to engage in and follow recommended preventive lifestyle actions is unknown. METHODS: Receipt of advice for and levels of reported fruit and vegetable intake and physical activity were analyzed among people with heart disease in 25 states/territories in the 2003 Behavioral Risk Factor Surveillance System, a telephone-based survey of US adults. RESULTS: Overall, 7392 of 113,795 people reported a heart attack or coronary heart disease. Among these, 54.4% of respondents with heart disease were told to eat more fruits and vegetables; 24.7% met recommended 5 servings per day. In multivariable analyses, those told to eat more fruits and vegetables were somewhat more likely than those not advised to meet recommended intake (Odds ratio [OR] 1.30, confidence interval [CI]: 1.10-1.55). Some 53.2% were told to be more physically active; 33.2% met recommended physical activity levels and 30.8% were sedentary. In multivariable analyses, having been told to engage in physical activity was not related to the likelihood of meeting recommended levels (OR: 1.09, 95%; CI: 0.93-1.27). In sub-analyses, receipt of cardiac rehabilitation after heart attack was associated with meeting both dietary (OR: 1.50, CI 1.18-1.92) and activity recommended levels (OR 1.47, CI 1.20-1.82). CONCLUSION: Dietary and physical activity advice and patient actions remain suboptimal. Further efforts to identify effective patient education techniques and barriers to behavior change are needed to improve secondary prevention of heart disease.     

Racial/Ethnic Disparities in Health and Health Care among U.S. Adolescents

Objective

To examine racial/ethnic disparities in medical and oral health status, access to care, and use of services in U.S. adolescents.

Data Source

Secondary data analysis of the 2003 National Survey of Children''s Health. The survey focus was children 0–17 years old.

Study Design

Bivariate and multivariable analyses were conducted for white, African American, Latino, Asian/Pacific Islander, American Indian/Alaskan Native, and multiracial adolescents 10–17 years old (n = 48,742) to identify disparities in 40 measures of health and health care.

Principal Findings

Certain disparities were especially marked for specific racial/ethnic groups and multiracial youth. These disparities included suboptimal health status and lack of a personal doctor or nurse for Latinos; suboptimal oral health and not receiving all needed medications in the past year for African Americans; no physician visit or mental health care in the past year for Asian/Pacific Islanders; overweight/obesity, uninsurance, problems getting specialty care, and no routine preventive visit in the past year for American Indian/Alaska Natives; and not receiving all needed dental care in multiracial youth.

Conclusions

U.S. adolescents experience many racial/ethnic disparities in health and health care. These findings indicate a need for ongoing identification and monitoring of and interventions for disparities for all five major racial/ethnic groups and multiracial adolescents.