Emergency department use among Asian adults living in the United States: Results from the National Health Interview Survey (2006 – 2013)

This paper presents secondary analyses of the National Health Interview Survey data focused on emergency department (ED) utilization among Asian adults residing in the United States. National Health Interview Survey data provided from survey years 2006-2013 was pooled and disaggregated by single-race Asian ethnic subgroups (Filipino, Chinese, Asian Indian, other Asian). We explored trends in reports of an ED visit over the survey years for the purpose of determining whether reports of an ED visit increased or decreased over survey years. We also explored background/biologic, environment, access to care, and behavior factors and their associations with having an ED visit. The majority of respondents were foreign-born (75.9%) and had lived in the United States for ten or more years (54.3%). Estimates for reports of any ED visits ranged from 8.3% for the Chinese to 15.3% for the Filipino subgroups. Filipinos were more likely to have an ED visit compared to the Chinese and other Asians (except Asian Indians). For the eight years of survey data, estimates indicate a trend of fewer reports of any ED visit among the Asian Indian and Filipino subgroups. Among Filipinos, having diabetes and a smoking history were associated with an ED visit. The odds of an ED visit were higher among Asians in the youngest age category, among other Asians born in the United States, and among those who saw/talked to a mental health professional within the previous year. As there is a paucity of information available about ED use among Asians or Asian subgroups, this report adds to the literature on patterns of health care utilization among Asian subgroups living in the United States with a specific focus on ED utilization

Exploring the Effectiveness of Transit Security Awareness Campaigns in the San Francisco Bay Area, Research Report 09-19

Public involvement in alerting officials of suspicious and potentially harmful activity is critical to the overall security of a transit system. As part of an effort to get passengers and the public involved, many transit agencies have security awareness campaigns. The objective of this research is to learn how transit agencies seek to make security awareness campaigns effective and explore how they measure the effectiveness of such campaigns, if at all. This research project includes data from case studies of five major agencies that provide transit service in the San Francisco Bay Area region. The case study data are comprised of descriptions of the types of security awareness campaigns the agencies have implemented, the goals of the campaigns, and how they seek to make their campaigns effective, as well as whether and how these agencies measure and determine the effectiveness of their campaigns. A positive finding of this research is the consistency with which Bay Area transit organizations address the need for passenger awareness as part of their overall security program. However, none of the five agencies analyzed for this study measures the effectiveness of their campaigns. Whereas they all have a similar goal—to increase passenger awareness about security issues—little evidence exists confirming to what extent they are achieving this goal. The paper concludes with suggestions for using outcome measurements to provide a reasonable indication of a campaign’s effectiveness by capturing the public’s response to a campaign

Illness identity as an important component of candidacy: Contrasting experiences of help-seeking and access to care in cancer and heart disease

How and when we use health services or healthcare provision has dominated exploration of and debates around healthcare access. Levels of utilisation are assumed as a proxy for access. Yet, focusing on utilisation conceals an important aspect of the access conundrum: the relationships that patients and potential patients have with the healthcare system and the professionals within those systems. Candidacy has been proposed as an antidote to traditional utilisation models. The Candidacy construct offers the ability to include patient-professional aspects alongside utilisation and thus promotes a deeper understanding of access. Originally applied to healthcare access for vulnerable populations, additional socio-demographic factors, including age and ethnicity, have also been shown to influence the Candidacy process. Here we propose a further extension of the Candidacy construct and illustrate the importance of illness identities when accessing healthcare. Drawing on a secondary data analysis of three data sets of qualitative interviews from colorectal cancer and heart failure patients we found that though similar access issues are apparent pre-diagnosis, diagnosis marks a critical juncture in the experience of access. Cancer patients describe a person-centred responsive healthcare system where their patienthood requires only modest assertion. Cancer speaks for itself. In marked contrast heart failure patients, describe struggling within a seemingly impermeable system to understand their illness, its implications and their own legitimacy as patients. Our work highlights the pressing need for healthcare professionals, systems and policies to promote a person centred approach, which is responsive and timely, regardless of illness category. To achieve this, attitudes regarding the importance or priority afforded to different categories of illness need to be tackled as they directly influence ideas of Candidacy and consequently access and experiences of care

Cell Phone Information Seeking Explains Blood Pressure in African American Women

Although cell phone use and Internet access via cell phone is not marked by racial disparities, little is known about how cell phone use relates to blood pressure and health information seeking behaviors. The purposes of this study were to (a) describe Internet activities, cell phone use, and information seeking; (b) determine differences in blood pressure and information seeking between cell phone information seekers and nonseekers; and (c) examine cell phone information seeking as a predictor of blood pressure in African American women. Participants ( N = 147) completed a survey and had their blood pressure measured. Independent-sample t tests showed a significant difference in systolic blood pressure in cell phone information seekers and nonseekers. Linear regression revealed cell phone information seeking as an independent predictor of systolic blood pressure, despite confounders. It is possible that cell phone information seekers were using health information to make decisions about self-management of blood pressure

Emerging needs in behavioral health and the integrated care model

Medically vulnerable populations are constantly at risk of having poor health related outcomes, low satisfaction in the healthcare system and increased mortality. Studies have shown the increased prevalence rates of various medical comorbidities in patients with severe mental illness. These patients are obviously vulnerable because of their mental illness but they are also more likely to have severe cases of medical conditions commonly seen in the general population. Expenditures and utilization of resources is often inappropriate due to frequent visits for acute needs and low rates of preventative care and primary care appointments. My proposed model focuses on the implementation of the integrated care model which encourages collaboration between mental health professionals and primary care physicians through referral programs or integrated clinic settings. This model is initiated with education to both current clinicians as well as future clinicians through medical schools and residency programs. Once the education component has begun, the next steps are formal exploration, preparation, implementation and evaluation of the model in clinics. The aim is to improve health outcomes by increasing preventative care and using behavioral techniques to assist with adherence, increase satisfaction in the healthcare system and contain expenditures by utilizing primary care services instead of emergency services when appropriate

Risk Management in the Arctic Offshore: Wicked Problems Require New Paradigms

Recent project-management literature and high-profile disasters—the financial crisis, the BP Deepwater Horizon oil spill, and the Fukushima nuclear accident—illustrate the flaws of traditional risk models for complex projects. This research examines how various groups with interests in the Arctic offshore define risks. The findings link the wicked problem framework and the emerging paradigm of Project Management of the Second Order (PM-2). Wicked problems are problems that are unstructured, complex, irregular, interactive, adaptive, and novel. The authors synthesize literature on the topic to offer strategies for navigating wicked problems, provide new variables to deconstruct traditional risk models, and integrate objective and subjective schools of risk analysis

The Role of Gender in Preparedness and Response Behaviors towards Flood Risk in Serbia

Adverse outcomes from 2014 flooding in Serbia indicated problematic response phase management accentuated by a gender imbalance. For this reason, we investigated the risk perceptions and preparedness of women and men regarding these types of events in Serbia. Face-to-face interviews, administered to 2500 participants, were conducted across 19 of 191 municipalities. In light of the current findings, men seemed to be more confident in their abilities to cope with flooding, perceiving greater individual and household preparedness. By contrast, women displayed a deeper understanding of these events. Perhaps owing to a deeper level of understanding, women demonstrated more household-caring attitudes and behaviors and were more prone to report a willingness to help flood victims at reception centers. Emergency management agencies and land planners should account for these differences in gender awareness and preparedness. Based on these findings, doing so may increase citizen participation and shared responsibility under flood hazard scenarios