Using Individual Decision, Economic, and Health Status Data to Predict Health Checkup Behavior

Annually, the Behavioral Risk Factor Surveillance System (BRFSS) survey is administered by the Centers for Disease Control and Prevention (CDC). This article uses 2016 SMART BRFSS data to predict the likelihood a person will get a health checkup and it identifies which factor(s) influence the decision to obtain a checkup. Patterns of individual decision making were analyzed using various supervised data mining techniques. The best predictive model, with a predictive accuracy of 80%, can improve future BRFSS surveys by better understanding the responses and provide insight into the factors affecting decisions. The model was scored on new data to verify its accuracy. These findings supplement ongoing research to identify how behavior leads to better decision making related to medical checkups. The model can help identify poor decision-makers in high-risk groups. This research can also be used by healthcare professionals to improve clinical prevention services. Potentially, the research can be extended by combining the BRFSS data with ICD-10 and CPT codes. Better knowledge of diagnosis (ICD-10) and the cost associated with diagnosis (CPT) will help to understand a person’s health behavior. In the United States, expenditures on healthcare are rising significantly every year. Health decisions of individuals determine the overall health of a nation. Therefore, the U.S. Government should initiate health programs that encourage individuals to make better health decisions

Association between health literacy, health information access, and health care choices in China

Health literacy (HL) is influential in individual’s decision concerning health care choices through critically obtaining, understanding, and using health-related information. It is taken as an essential factor for health protection and promotion. This study intends to examine and understand the associations between HL, health information access, and health care choices when people feel ill, in order to guide individuals to safer decision making in using health services (regular checkup, use doctor service, change behavior) and avoiding unsafe choices (self-medication, ignoring symptoms). A questionnaire survey was conducted in Hefei city, China. The sample consisted of 279 participants aged 18-60 years old. Findings show that HL is associated with sociodemographic variables being higher in younger aged, more educated, and with a better economic status. Also, controlling for these variables, findings show that people with higher critical literacy tend to use health checkup and are more likely to prefer books/brochures as information source; people who seek health information from magazines, radio, and books/brochures tend to use doctor service. These findings suggest there is room for individuals, professionals, and Government to improve public HL levels and the quality of multiple health information in order to foster health prevention and correction.A literacia em saúde (LS) influencia a decisão individual respeitante às escolhas de saúde através da aquisição, compreensão e uso crítico de informação relacionada com a saúde. É considerada um fator essencial para a proteção e promoção da saúde. O presente estudo pretende examinar e compreender as associações entre a LS, o acesso a informação sobre saúde, e as escolhas de tratamento quando as pessoas se sentem doentes, para guiar os indivíduos na direção de melhores decisões na utilização de serviços de saúde (checkup regular, consulta médica, mudança comportamental) e evitar as escolhas inseguras (auto-medicação, ignorar os sintomas). Foi realizado um inquérito por questionário na cidade de Hefei na China. A amostra compreende 279 participantes com idades compreendidas entre os 18 e os 60 anos. Os resultados mostram que a LS está associada a variáveis sociodemográficas sendo maior nos mais jovens, mais escolarizados e com melhor situação económica. Adicionalmente, controlando estas variáveis, os resultados mostram que as pessoas com maior literacia crítica tendem a recorrer mais a checkup e têm maior probabilidade de escolher livros enquanto fonte de informação. As pessoas que procuram informação com base em revistas, rádio e livros tendem a usar mais a consulta médica. Estes resultados sugerem margem para melhoria para os indivíduos, profissionais de saúde e autoridades para melhorar os níveis públicos de LS e a qualidade de múltiplas informações sobre saúde para promover a prevenção e tratamento de problemas de saúde

Public Health Legal Services: A New Vision

In recent years, the medical profession has begun to collaborate more and more with lawyers in order to accomplish important health objectives for patients. That collaboration invites a revisioning of legal services delivery models and of public health constructs, leading to a concept we develop in this article, and call public health legal services. The phrase encompasses those legal services provided by non-government attorneys to low-income persons the outcomes of which when evaluated in the aggregate using traditional public health measures advance the public\u27s health. This conception of public health legal services has emerged most prominently from innovative developments in Los Angeles (the HIV Legal Checkup model), Boston (Medical-Legal Partnership for Children) and New York (LegalHealth). It departs from the commonplace understanding about public health law as concerned with the exercise of the state\u27s public health power. It extends that understanding to include the exercise of individual rights by private lawyers that also advances the public\u27s health. Just as it was once discovered that communities need access to health information, clean water, inoculation, and regulation of hazardous activities and products as part of a comprehensive scheme for promoting and achieving health, so too the emerging vision suggests that community health promotion also requires affordable access to effective legal information and assistance. The idea of public health legal services offers a rich and powerful incentive for public and private agencies to increase free and subsidized legal services. At the same time, the legal services necessary from a public health perspective may not be the ones currently emphasized by providers. The vision of public health legal services in many ways favors prevention over crisis management, and therefore calls upon traditional legal services providers to rethink their customary resource allocation models. The vision may call for painful short-term choices between the new model and the always urgent demand for litigation and crisis-driven work. This Article engages that tension in an effort to understand, if not resolve, its dimensions

J Community Health

Previous studies have shown an association between cervical cancer screening and racial/ethnic minority status, no usual source of care, and lower socioeconomic status. This study describes the demographics and health beliefs of women who report never being screened for cervical cancer by area of residence. Data from the 2010 Behavioral Risk Factor Surveillance System were used to study women aged 21-65 years who reported never being screened for cervical cancer. Multivariate logistic regression modeling was used to calculate predicted marginals to examine associations between never being screened and demographic characteristics and health belief model (HBM) constructs by metropolitan statistical area (MSA). After adjusting for all demographics and HBM constructs, prevalence of never being screened was higher for the following women: non-Hispanic Asians/Native Hawaiians/Pacific Islanders (16.5 %, 95 % CI = 13.7 %, 19.8 %) who live in MSAs; those with only a high school diploma who live in MSAs (5.5 %, 95 % CI = 4.7 %, 6.5 %); those living in non-MSAs who reported "fair or poor" general health (4.1 %, 95 % CI = 3.1 %, 5.4 %); and those living in either MSAs and non-MSAs unable to see a doctor within the past 12 months because of cost (MSA: 4.4 %, 95 % CI = 4.0 %, 4.8 %; non-MSA: 3.4 %, 95 % CI = 2.9 %, 3.9 %). The Affordable Care Act will expand access to insurance coverage for cervical cancer screening, without cost sharing for millions of women, essentially eliminating insurance costs as a barrier. Future interventions for women who have never been screened should focus on promoting the importance of screening and reaching non-Hispanic Asians/Native Hawaiians/Pacific Islanders who live in MSAs.ZZG3/Intramural CDC HHS/United States2015-06-02T00:00:00

Using Modeling and Simulation to Improve Oral Health Services Delivery in Hampton Roads, Virginia

The purpose of this study is to examine the system performance in delivering oral health services in a public health district based on the Conceptual Framework to Measure Performance of the Public Health System (PHS). Using modeling and simulation, a predictive model based on the conceptual framework dimensions: mission, structural capacity, processes, and outcomes was developed to predict the performance of public health district in delivering oral health services. This is a retrospective longitudinal study. The main objective of this study is to use a modeling and simulation approach to predict the performance of public health district dental clinic in delivering oral health services. Specifically, the following performance metrics were examined: average number of patients\u27 visits per day at a public health district dental clinic; average number of diagnostic and preventive dental services delivered by the dentist or the dental hygienist per day at a public health district dental clinic; average number of corrective services provided by the dentist per day at a public health district dental clinic; and average total dental services. The scenarios, based on the existing structural capacities and the number of personnel, were modeled and simulated using Rockwell Automation Software, Arena® version 13.5. Purposeful sampling consisted of five public health district dental clinics of Hampton Roads for the fiscal years, 2005–2010. For the purpose of this study the following five public health district dental clinics were chosen: Norfolk, Virginia Beach, Hampton, Peninsula, and Western Tidewater. Norfolk Health District operates two sites: Little Creek and Park Place. Virginia Beach District operates two sites: Birdneck and Pembroke. Western Tidewater Health District operates two sites: Isle of Wight and Southampton. Data analysis revealed that adding a new healthcare provider (a dental hygienist) to the system has a statistically significant influence in delivering oral health services at all public health districts\u27 dental clinics in the following performance metrics: number of patients\u27 visits per day, diagnosis and preventive services, corrective services, and total number of dental services (p \u3c 0.05)

The Association of Spatial Accessibility to Health Care Services with Health Utilization and Health Status Among People with Disabilities

The purpose of this cross-sectional analysis was to determine the importance of spatial accessibility to health care services utilization and to the health status of persons with disabilities. This study utilizes two datasets (Survey of Access to Outpatient Medical Service in the Rural Southeast and Ohio Family Health Survey) to analyze. ArcGIS 9.2 was use to measure spatial accessibility to health care services. Bivariate analysis for health services utilization and health status included t-tests, and Chi-square, as appropriate for the level of measurement. Logistic regression models identified for the three outcomes (health care visit, regular check up visit, and perceived poor health status). The multivariate analyses of Survey of Access to Outpatient Medical Service in the Rural Southeast dataset revealed that those residing within an area that had a higher primary physician to population ratio were less likely to have made a health care services visit in the past year. Perceived travel time was significantly associated with poor health status adults who had to drive longer to access health care services were more likely to perceive themselves to be in poor health compared to adults who were faced with a shorter drive. The analyses of the Ohio Family Health Survey dataset indicate that participants of the survey who resided within areas that had a higher primary care physician to population ratio were less likely to perceive themselves to be in poor health. Likewise, those residing in areas that had a hospital located within a 30-minute commute were also less likely to report being in poor health. Further analyses of the Ohio Family Health Survey dataset, which is comprised of data collected from urban and rural areas, revealed that those driving longer to access health care services were more likely to perceive themselves to be in poor health compared to adults who were faced with a shorter drive in urban area. The model of rural areas revealed that those residing within an area that had a higher prim

The Association of Spatial Accessibility to Health Care Services with Health Utilization and Health Status Among People with Disabilities

The purpose of this cross-sectional analysis was to determine the importance of spatial accessibility to health care services utilization and to the health status of persons with disabilities. This study utilizes two datasets (Survey of Access to Outpatient Medical Service in the Rural Southeast and Ohio Family Health Survey) to analyze. ArcGIS 9.2 was use to measure spatial accessibility to health care services. Bivariate analysis for health services utilization and health status included t-tests, and Chi-square, as appropriate for the level of measurement. Logistic regression models identified for the three outcomes (health care visit, regular check up visit, and perceived poor health status). The multivariate analyses of Survey of Access to Outpatient Medical Service in the Rural Southeast dataset revealed that those residing within an area that had a higher primary physician to population ratio were less likely to have made a health care services visit in the past year. Perceived travel time was significantly associated with poor health status adults who had to drive longer to access health care services were more likely to perceive themselves to be in poor health compared to adults who were faced with a shorter drive. The analyses of the Ohio Family Health Survey dataset indicate that participants of the survey who resided within areas that had a higher primary care physician to population ratio were less likely to perceive themselves to be in poor health. Likewise, those residing in areas that had a hospital located within a 30-minute commute were also less likely to report being in poor health. Further analyses of the Ohio Family Health Survey dataset, which is comprised of data collected from urban and rural areas, revealed that those driving longer to access health care services were more likely to perceive themselves to be in poor health compared to adults who were faced with a shorter drive in urban area. The model of rural areas revealed that those residing within an area that had a higher prim

The Association of Spatial Accessibility to Health Care Services with Health Utilization and Health Status Among People with Disabilities

The purpose of this cross-sectional analysis was to determine the importance of spatial accessibility to health care services utilization and to the health status of persons with disabilities. This study utilizes two datasets (Survey of Access to Outpatient Medical Service in the Rural Southeast and Ohio Family Health Survey) to analyze. ArcGIS 9.2 was use to measure spatial accessibility to health care services. Bivariate analysis for health services utilization and health status included t-tests, and Chi-square, as appropriate for the level of measurement. Logistic regression models identified for the three outcomes (health care visit, regular check up visit, and perceived poor health status). The multivariate analyses of Survey of Access to Outpatient Medical Service in the Rural Southeast dataset revealed that those residing within an area that had a higher primary physician to population ratio were less likely to have made a health care services visit in the past year. Perceived travel time was significantly associated with poor health status adults who had to drive longer to access health care services were more likely to perceive themselves to be in poor health compared to adults who were faced with a shorter drive. The analyses of the Ohio Family Health Survey dataset indicate that participants of the survey who resided within areas that had a higher primary care physician to population ratio were less likely to perceive themselves to be in poor health. Likewise, those residing in areas that had a hospital located within a 30-minute commute were also less likely to report being in poor health. Further analyses of the Ohio Family Health Survey dataset, which is comprised of data collected from urban and rural areas, revealed that those driving longer to access health care services were more likely to perceive themselves to be in poor health compared to adults who were faced with a shorter drive in urban area. The model of rural areas revealed that those residing within an area that had a higher prim

Geospatial Determinants of Increased Screening Mammography in U.S. Black Women

Black women have the highest mortality rate due to breast cancer compared to any other racial/ethnic group in the U.S. and are more likely to be diagnosed with late-stage breast cancer compared to White women. Though the causes of these disparities are multifactorial, early detection by mammography, in combination with improved treatment, is related to improved breast cancer survival outcomes. Recently, the rate of Black women reporting having had a screening mammogram in the last two years has increased, and by some accounts surpassed, that of White women. This dissertation assesses this change in mammography among Black women in order to help inform future policies impacting preventive health care, which can lead to early diagnoses, and thus improvements in women’s health and reductions in the economic impact of treatment costs. The objective of the study was to identify factors, including geographic place and space, associated with the spatial variation of the increased screening mammography observed for Black women in the U.S. from 2008 to 2012. The central hypothesis was that the spatial distribution of the change in screening utilization is not random, and that the geospatial pattern of change is associated with changes in access to health care when controlling for education, income, demographic factors, and the larger ecological sociodemographic context. The central hypothesis was tested by pursuing the following aims: 1) Assess whether the geographic pattern of change from 2008-2012 of screening mammography among Black women in the U.S. is spatially clustered; and 2) Identify individual- and ecological-level factors associated with the geographic pattern of change from 2008-2012 of screening mammography among Black women in the U.S. Statistical software was used for assessing aspatial data, and Geographic Information Systems (GIS) was used for descriptive mapping and implementing spatial statistical analyses. Results indicate that changes in screening are not consistent across the U.S., Black and White women have increased and decreased screening in different regions, and the impact of variables associated with screening varies by location

Health, health insurance coverage, health care service utilization and family structure among children of immigrants

Family structure may alleviate or exacerbate barriers to better health and health care among children of immigrants, whose families tend to be highly interdependent and reliant on family cohesion as a survival strategy to manage challenges associated with immigrant status, such as policy restrictions, legal status issues, and linguistic barriers. Despite evidence has shown that children in single- and cohabiting-parent families have worse health and access to health care, very little is known about whether and how family structure plays a role in health and health care among children of immigrants. As a result, it is also unknown whether the relationship between family structure and these outcomes varies by immigrant generation, a significant indicator of health and access to health care. To this end, this three-paper dissertation examines the role of family structure on health, health insurance coverage, and health care service utilization among children of immigrants in different immigrant generations. This dissertation found that second- generation children of single parents are less likely to be in good health, and second-generation children of cohabiting parents have higher risk of being overweight or obese, compared to children of U.S.-born married parents. Another finding is that first- generation children of single and cohabiting parents residing in 33 Medicaid/CHIP eligibility expansion states had the greatest gains in overall and public health insurance coverage through Medicaid/CHIP expansion compared to their counterpart children in non-expansion states. Also, this policy change was associated with improved overall health insurance coverage among second-generation children in single-parent families. Lastly, a notable finding of this dissertation is that children of immigrants with married parents had most advantage in utilizing routine dental and medical care over time despite their lower initial rates of care use, compared to children of U.S.-born married parents. Although first-generation children with single parents had lower initial status of dental checkups as well, their rates of change in care use did not significantly increased unlike their counterpart children with married parents. Taken together, these three papers offer insights into the relationship between family structure and health and access to health care among children of immigrants during the post-ACA era. The findings of this dissertation have practical meaning under the current political environment in which formerly established policies and programs to address health care inequality between children of immigrants and non-immigrants are being challenged and restructured