Substance use, dependence, and service utilization among the US uninsured nonelderly population

OBJECTIVES: We examined the prevalence and correlates of substance use, dependence, and service utilization among uninsured persons aged 12 to 64 years. METHODS: We drew study data from the 1998 National Household Survey on Drug Abuse. RESULTS: An estimated 80% of uninsured nonelderly persons reported being uninsured for more than 6 months in the prior year. Only 9% of these uninsured persons who were dependent on alcohol or drugs had received any substance abuse service in the past year. Non-Hispanic Whites were an estimated 3 times more likely than Blacks to receive substance abuse services. CONCLUSIONS: Compared with the privately insured, uninsured persons had increased odds of having alcohol/drug dependence and appeared to face substantial barriers to health services for substance use problems.     

Mammography knowledge and intentions among insured women.

METHOD. A survey was conducted among 1,113 randomly selected insured state university employees to evaluate knowledge of the American Cancer Society mammography guidelines, awareness of insurance coverage for screening mammograms, previous guideline adherence, and future mammography intentions. RESULTS: The survey, which included two mailings with follow-up phone cells of nonresponders, had a refusal rate of 6%. Respondents were relatively more likely to know the guideline for older age groups; 77% knew the guidelines for women 50+. Over one-third of the responders were not aware that their insurance policy covered screening mammograms. For women who had never had a mammogram, insurance knowledge was significantly related to intentions to have a mammogram in the future. Previous screening adherence, as well as future intentions, was positively related to the age of the respondent. The results are contrasted with those of previous studies, and the implications for the content of future breast cancer screening campaigns are discussed.     

Rate of preventative vaccine use and vaccine beliefs among a commercially insured population

Immunization is an important component of preventive healthcare services. By recognizing and understanding factors associated with suboptimal vaccination compliance, healthcare providers can better approach at-risk populations and target efforts at reinforcing the vital importance of immunizations. The objective of this study was to understand the factors associated with adherence, beliefs and behaviors of influenza, pneumococcal, and herpes zoster vaccines receipt among commercially insured adults. A cross-sectional survey of patients with medical and pharmacy benefits for a 24-month period between August 1, 2014 and July 31, 2016 who were eligible to receive at least one of three adult vaccines (influenza, pneumococcal, and herpes zoster) was completed. Patients were identified as eligible to receive a vaccine based on current guidelines from the CDC ACIP. Health plan members were identified from administrative claims data in the HealthCore Integrated Research DatabaseSM (HIRD). Among the participants, 11% were eligible and up-to-date on all three vaccines; 52% on some and 37% were not up-to-date on any of the three vaccines. Participants with a healthcare provider were more likely to be up-to-date on eligible vaccines: 79.9% for none, 91.3% for some, and 97.8% for all eligible vaccines. The composite Vaccine Myth Belief score was significantly associated with being up to date on eligible vaccines: 45.0%/12.8% for none, 12/5%/30.8% for some, and 8.9%/33.3% for those up-to-date on all eligible vaccines. Despite numerous interventions designed to increase vaccination rates among adults, compliance remains suboptimal. It is evident that patient and provider education is necessary to fill knowledge gaps and misunderstandings; however knowledge by itself is not sufficient to improve immunization practices. Our results highlight a population that could benefit from a multidisciplinary approach, including interventions at the individual and health system levels.     

Eroding access among nonelderly U.S. adults with chronic conditions: ten years of change

Both the connection to health care and its affordability worsened for many nonelderly U.S. adults living with chronic conditions between 1997 and 2006. This erosion varied by health insurance coverage, fundamental as it is to securing health services. Access to care among uninsured adults with chronic conditions deteriorated on all of our basic measures between 1997 and 2006. In addition, more of both the privately and publicly insured with chronic conditions went without health care because of its cost over this ten-year span, even while they were just as likely as or more likely than others to have a usual source of care over time.     

Lactose intolerance among Mexican Americans.

Thirty-three Mexican Americans between the ages of 9 and 60 were interviewed and tested for lactose intolerance. The participants of the study included 16 children and 17 persons not related by birth, including the parents of the children. Determination of lactose intolerance was based on a rise of less than 25mg/100 ml of blood glucose as measured by an Ames Dextrostix/Reflectance Meter following consumption of a lactose load. Forty-seven percent of the 17 nonrelated Mexican Americans were lactose intolerant. There was a marked relationship between low rise in blood glucose and symptoms of diarrhea, flatulence, and distention. Sixteen children from four families had an incidence of 50 per cent intolerance. The findings of intolerance in two successive generations of three families and in both sexes of the families adds support to the contention that lactose intolerance has a genetic basis, without sex predilection.     

Smoking among Mexican Americans: a three-generation study.

Smoking behavior was investigated with data from a three-generation study of Mexican Americans in San Antonio, Texas. Rates of smoking among the men were found to be higher than rates for other White men obtained in previous studies, while rates for women were slightly lower than those reported for other White women. However, the percentage of light smokers was considerably higher among Mexican Americans than among other groups. There was no evidence that acculturation was a consistent predictor of greater likelihood of smoking. However, there was evidence that the smoking behavior of younger Mexican Americans, particularly the women, was associated with the smoking behavior of their parents.     

Birthweight differentials among Asian Americans.

OBJECTIVES. This study examines differentials in mean birthweight and the risk for low birthweight among various Asian-American groups in New York State (n = 499,377). METHODS. Using resident singleton live-birth records from New York State for 1985 and 1986, Asian-American births were compared with Black, American Indian, and White births. Multivariate ordinary least squares and logistic regression models were used to analyze ethnic differences. RESULTS. Compared with White births, the expected mean difference in birthweight was -115 g for Chinese, -235 g for Japanese, -164 g for Filipinos, -120 g for Blacks, and 74 g for American Indians. The risk for low birthweight was 45% higher for Filipinos and 49% higher for Blacks as compared with Whites. CONCLUSIONS. Results of this study suggest substantial heterogeneity in mean birthweight and risk for low birthweight among ethnic groups in general and the major Asian-American groups in particular. Interestingly, after controlling for ethnic differences in sociodemographic risk factors, Filipinos appear to resemble Blacks much more closely than they do their Japanese and Chinese counterparts with respect to risk for low birthweight.     

Health practices among Mexican Americans: Further evidence from the human population laboratory studies

Data are presented from sample surveys conducted in 1974 (N = 3,119) and 1975 (N = 657) in Alameda County, California, comparing discretionary health practices of Mexican Americans, Blacks, and Anglos. Practices include hours of sleep, regularity of meals, physical activity, obesity, smoking and drinking. Analyses reported focus on a summary measure of health practices and measures of smoking and exercise. Comparisons of crude percentages indicate that while there are differences among the groups, they are not dramatic. In general, Mexican Americans report fewer overall health practices, less exercise, and less smoking than Anglos. Controlling for the effects of age, sex, income, education, perceived health, health status, and use of health examinations reduces differences in overall health practices by decreasing Anglo rates and increasing rates for Chicanos and Blacks. However, even after adjustment for demographic and socioeconomic differences, rates remain lower for the two minority groups. Controlling for the effects of the eight covariates also reduces ethnic differences in exercise, but Chicanos still rank the lowest in terms of reported physical activity. By contrast, adjustment for demographic and socioeconomic differences does not reduce ethnic differentials in smoking behavior. Before and after adjustment Chicanos smoke least and Blacks smoke most. In general, controlling for socioeconomic status and health has the most effect, while some additional explanation is provided by age and sex. Overall, however, ethnicity and the covariates account for less than 10% of the variance in smoking and overall health practices, and less than 20% of the variance in exercise.     

Uninsured hospitalizations: rural and urban differences.

CONTEXT: Few studies have examined hospitalization patterns among the uninsured, especially from the perspective of rural and urban differences. PURPOSE: To examine whether the patterns of uninsured hospitalizations differ in rural and urban hospitals and to identify the most prevalent and costly diagnoses among uninsured hospitalizations. METHODS: We conducted a cross-sectional analysis of the Healthcare Cost and Utilization Project's National Inpatient Sample representing a total of 37,804,021 hospital discharges, with 4.9% of them generated by uninsured persons in 2002. We compared demographic and clinical characteristics and the proportion of frequent and costly diagnoses by rural and urban hospitals. We used multiple logistic regression models to examine the relationship between preventable conditions and rural and urban hospitals among uninsured hospitalizations. FINDINGS: Uninsured persons discharged from rural hospitals were more likely than their urban counterparts to be working-age adults (82% vs 79%) and to reside in a ZIP code area with a median household income of less than $35,000 per year (56% vs 26%). Rural uninsured hospitalizations were more likely to be for preventable conditions than were urban uninsured hospitalizations (P < .001). The proportion of total hospital charges related to preventable hospitalizations was 15.5% in rural hospitals versus 10.0% in urban hospitals. CONCLUSIONS: The patterns of uninsured hospitalizations in rural and urban hospitals were different in many ways. Providing adequate access to primary care could result in potential savings related to preventable hospitalizations for the uninsured, especially for rural hospitals.     

Uninsured working-age adults: characteristics and consequences.

While estimates of the country's uninsured vary, ranging from 10 to 18 percent of the general population, virtually every study on use of medical services reports that lack of health insurance represents a major barrier to medical care. Based on the 1986 national Robert Wood Johnson Access Survey of 10,130 noninstitutionalized persons, the characteristics of working-age adults without health insurance, and the consequences, are examined. Among working-age adults, the uninsured are most likely to be poor or near-poor, Hispanic, young, unmarried and unemployed. Compared with the insured, they have significantly fewer ambulatory visits during a year, are less likely to have contact with a medical provider during a 12-month period, and are more likely to receive their care in a hospital outpatient clinic or emergency room. Differences in health status do not account for these findings. Especially among persons with chronic and serious illnesses, the uninsured are less likely than the insured to receive medical care. Further, the uninsured are significantly more likely to report needing but not receiving medical care, primarily for economic reasons, and although poorer, they have higher out-of-pocket medical expenses than others in the population.     

Utilization of dental services in the United States and an insured population.

Dental service utilization rates among 1.2 million Pennsylvania Blue Shield dental insureds are compared to rates in the US population. Insurance appears to stimulate the utilization of dental services above national norms; children appear to be a major beneficiary of insurance's incentive effect on dental service use. The implications of these findings for health planners and dental insurance providers are discussed.     

Smoking during pregnancy among northwest Native Americans.

There is little available information on the smoking habits of Native Americans. The authors used data from the Washington State birth certificate to determine the prevalence of smoking during pregnancy among Native American mothers in Washington State. From 1984 through 1988, 39.8 percent of all Native Americans smoked during their pregnancy. Smoking patterns during pregnancy differed markedly between Native Americans and whites according to maternal age and marital status. The smoking prevalence in Native Americans, adjusted for maternal age and marital status, was 1.3 times higher than that found in Washington State white women. This is the first analysis of statewide smoking rates during pregnancy among Native Americans. The birth certificate can serve as a readily accessible and low cost surveillance system for populations such as Native Americans, who are otherwise difficult to study. Smoking intervention programs need to be targeted at Native Americans, and how their smoking patterns differ from those of the general population needs to be recognized.     

Regional variation in smoking among African Americans.

BACKGROUND: The impact of geographic region and metropolitan residence on smoking prevalence among African Americans has not been adequately examined. METHODS: This study analyzed 5 years of data from the National Health Interview Survey (1990-1994) on current smoking and regional variation among 16,738 African Americans. Results. Respondents in the West had the lowest unadjusted smoking prevalence rates and Midwest residents had the highest. Current smoking was lower among African Americans living in non-central cities than in central cities even after adjusting for several sociodemographic covariates. Multivariate logistic regression analysis revealed that black women in the South were significantly less likely to be smokers compared with any other gender/region group. CONCLUSIONS: These findings suggest the significance of gender and regional factors such as the social history of migration, social stress and racism, exposure to tobacco advertisement, variations in cultural influences, community structures, and coping strategies in under standing African American smoking behavior.     

Social heterogeneity in smoking among African Americans.

OBJECTIVES: This study assessed the effects of sociodemographic variables on the smoking behavior of African Americans. METHODS: Data for 14,397 African-American respondents (18-64 years old) to the National Health Interview Survey in the years 1990 through 1993 were examined in multivariate models. RESULTS: Age was the strongest predictor of smoking, and men were at least 1.75 times as likely as women to be smokers (P < .001). CONCLUSIONS: The Year 2000 goal of an 18% prevalence rate among African-American adults may not be attained without major community interventions focusing on male and middle-aged African Americans.     

Acculturation and alcohol consumption among Mexican Americans: a three-generation study.

Data from a three-generation study of Mexican Americans conducted in the San Antonio, Texas area are utilized to examine the influence of acculturation into the larger society on alcohol consumption. Acculturation was not related to alcohol consumption in the older generation. In the middle generation, it was related to lower alcohol consumption among men, as well as among women. In the younger generation, acculturation was related to more drinking among women, but not among men. Within-family analysis showed that the alcohol consumption of members of the younger generation was associated with the consumption of their parents, particularly in the case of younger women.