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Open Access Publications from the University of California

Scholarly Works (41 results)

  • Article
  • Peer Reviewed
UC Irvine Previously Published Works (2021)
Objectives: This study examined the association between food insecurity status and healthcare access, utilization, and quality among adults aged 55 years and older. Methods: Data collected between 2011 and 2016 for the California Health Interview Survey were used. The sample included 72,212 individuals who were divided into three groups: food secure (FS), low food security (L-FS), and very low food security (VL-FS). Results: Logistic regression analyses controlled for demographics. Food insecurity was associated with decreased access to and quality of care and increased utilization. Specifically, VL-FS was more likely to delay care than FS. Additionally, VL-FS and L-FS had greater odds of visiting an emergency room than FS. Furthermore, VL-FS and L-FS were more likely to have a doctor who did not always explain aspects of care carefully compared to FS. Discussion: These findings suggest a need for increased screening for food insecurity in healthcare settings.
    Cover page: Food insecurity and healthcare access, utilization, and quality among middle and later life adults in California
    • Thesis
    • Peer Reviewed
    UC Irvine Electronic Theses and Dissertations (2014)

    As California implements the Patient Protection and Affordable Care Act (ACA) of 2010, it is important to examine the various types of insurance coverage and their association with mental health need and service utilization. Using data from the California Health Interview Survey (CHIS) 2011-2012, this current study compared the mental health need and service use of California adults with various insurance types. The findings revealed that respondents' various insurance types were differentially associated with their mental health need and service use. In citing reasons for not seeking treatment, the uninsured were more likely to be concerned about cost, and the Medicare & Others group was less likely to be concerned about cost than those with Privately Purchased insurance. The Employment-Based insurance group was significantly more likely than the Privately Purchased group to be "concerned about what would happen if someone found out". Further, both the uninsured and the Medicare & Others group were more likely to discontinue treatment compared to their Privately Purchased counterparts. The reasons for discontinuing treatment varied among the different insurance groups. The results suggest that the ACA will improve mental health by reducing concerns about cost reported by the uninsured. However, there is still a need for programs to address other barriers to treatment.

      Cover page: Variations in Mental Health Need and Service Utilization by Insurance Type: Findings from a Population-Based Survey in California
      • Article
      • Peer Reviewed
      UC Irvine Previously Published Works (2011)

      Background

      Differences in health behaviors may be important contributors to racial/ethnic disparities in the health status of adults. Studies to date have not compared whether there are health behavior differences in exercise and dietary behaviors among middle-age and older adults in the four largest racial/ethnic categories.

      Objective

      To investigate racial/ethnic differences in exercise and dietary behaviors of middle-aged and older adults.

      Design

      We used data from the 2007 California Health Interview Survey. Multivariable logistic regression was used to examine interactions between age and race/ethnicity in predicting two categories of health behaviors. Analyses were conducted adjusting for sociodemographic characteristics, health insurance status, and healthcare utilization.

      Participants

      A population-based sample of 33,189 California adults 45 years old and older: 26,522 non-Hispanic whites, 1,686 African American/blacks, 2,565 Asian/Pacific Islanders (1,741 English-proficient; 824 limited English-proficient), and 2,416 Latinos (1,538 English-proficient; 878 limited English-proficient).

      Main measures

      Self-report leisure-time physical activity (moderate and vigorous) and daily consumption of fruits and vegetables.

      Key results

      Racial/ethnic minorities generally engaged in less healthy exercise and dietary behaviors than whites, with differences more pronounced in middle adulthood. The disparities were the greatest among English-proficient minorities. Specifically, among middle-aged respondents, all racial/ethnic minorities engaged in less vigorous physical activity than whites (ORs range = 0.28 to 0.73; 95% CI range = 0.16-1.00). Additionally, middle-aged, English-proficient minorities engaged in less moderate physical activity compared to whites (ORs range =0.57 to 0.67; 95% CI range = 0.45-0.79). Furthermore, middle-aged, English-proficient Latinos had a poorer diet than whites (OR = 0.54; 0.39-0.75). Few significant racial/ethnic differences emerged in the exercise and dietary behaviors of older adults.

      Conclusions

      Racial/ethnic disparities in exercise and dietary behaviors are most notable among middle-aged, acculturated minorities. Results highlight the need to promote positive exercise and dietary behaviors during critical preventive ages, when racial/ethnic disparities are large and the potential to prevent chronic disease is great.
        Cover page: Racial/Ethnic Disparities in Exercise and Dietary Behaviors of Middle-Aged and Older AdultsCreative Commons 'BY' version 4.0 license
        • Article
        • Peer Reviewed
        UC Irvine Previously Published Works (2019)

        Objectives

        To identify consumers' preferences over care settings, such as physicians' offices, emergency rooms (ERs), urgent care centers, retail clinics, and virtual physicians on smartphones, for minor illnesses.

        Data sources

        A survey conducted between 9/27/16 and 12/7/16 emailed to all University of California, Irvine employees.

        Study design

        Participants were presented with 10 clinical scenarios and asked to choose the setting in which they wanted to receive care. We estimated multinomial conditional logit regression models, conditioning the choice on out-of-pocket costs, wait time, travel time, and chooser characteristics.

        Data collection

        5451 out of 21 037 employees responded.

        Principal findings

        Out-of-pocket costs and wait time had minimal impact on patient's preference for site of care. Choices were driven primarily by the clinical scenario and patient characteristics. For chronic conditions and children's well-visits, the doctor's office was the preferred choice by a strong majority, but for most acute conditions, either the ER (for high severity) or urgent care clinics (for lower severity) were preferred to the office setting, particularly among younger patients and those with less education.

        Conclusions

        Patients have several alternatives to traditional physicians' offices and ERs. The low impact of out-of-pocket costs suggests that insurers interested in encouraging increased utilization of alternatives would need to consider substantial changes to benefit structure.
          Cover page: Patients' preferences over care settings for minor illnesses and injuries.
          • Article
          • Peer Reviewed
          UC Irvine Previously Published Works (2016)

          Objectives

          This study examined potential barriers to mental healthcare use of older adults from diverse ethnic and racial backgrounds.

          Design

          Data were obtained from the 2007, 2009, 2011-12, and 2013-14 California Health Interview Survey (CHIS), a population-based survey representative of California's noninstitutionalized population.

          Participants

          The total sample consisted of 75,324 non-Hispanic white (NHW), 6,600 black, 7,695 Asian and Pacific Islander (API), and 4,319 Hispanic adults aged 55 and older.

          Results

          Results from logistic regression analyses that controlled for multiple demographic and health status characteristics revealed ethnic and racial differences in reasons for not seeking treatment and for terminating treatment. Specifically, API and Hispanic adults had greater odds than NHWs of endorsing feeling uncomfortable talking to a professional as a reason for not seeking treatment. Hispanic respondents had lower odds of endorsing concerns about someone finding out than APIs, and APIs and blacks had significantly greater odds of endorsing this concern as a reason for not seeking treatment than NHWs. When asked about reasons for no longer receiving treatment, all respondents, irrespective of race or ethnicity, endorsed that they no longer needed treatment as the most frequent reason for terminating treatment, although specific ethnic and racial differences emerged with respect to perceptions of not getting better, lack of time or transportation, and lack of insurance coverage as reasons for no longer seeking treatment.

          Conclusion

          Understanding how barriers to mental health treatment differ for older adults from diverse ethnic and racial backgrounds is an important step toward designing interventions to overcome these obstacles and improve mental health outcomes.
            Cover page: Barriers to Mental Health Care for an Ethnically and Racially Diverse Sample of Older Adults
            • Article
            • Peer Reviewed
            UC Irvine Previously Published Works (2017)
            This study examined whether disease-specific factors were important for how and how often White versus Vietnamese American spouses influenced their partners' diabetic diet. Results from a cross-sectional survey of 145 older adult spouses whose partners had type 2 diabetes revealed that Vietnamese American spouses used more frequent spousal influence (positive and negative) than White spouses. In addition, most of the factors associated with spousal influence differed for Vietnamese American and White spouses. Findings from this study highlight the importance of proximal and sociocultural factors in understanding older spouses' influence on their partners' diabetic diet.
              Cover page: Disease factors associated with spousal influence on diabetic diet: An exploratory comparison of Vietnamese American and White older adults
              • Thesis
              • Peer Reviewed
              UC Irvine Electronic Theses and Dissertations (2022)

              The constant influx of Latino immigrants throughout the decades has transformed the demographic composition of the United States, such that the Hispanic population has experienced a 592% growth since 1970. Given that chronic conditions affect minority groups earlier and at much higher rates than other populations, it is especially important to investigate health in the growing Latino community. Despite declining cancer incidence and mortality rates, Latina patients continue to have lower 5-year survival rates compared to their non-Hispanic white counterparts. Moreover, Hispanic adults are 1.7 times more likely to have been diagnosed with diabetes, 2.6 times more likely to be hospitalized for diabetes related end-stage renal disease, and 1.4 times more likely to die from diabetes compared to non-Hispanic white adults.

              Given the central role of family in the Latino culture, social relationships may help attenuate adverse health outcomes by promoting overall health and wellness for those involved. Dominant paradigms examining the impact of close relationships on focus on the individual, often a patient, or dyadic perspective, frequently spousal or parent-child relationships. However, these models fail to consider the unique cultural influences of other members that are present in Hispanic families. Given that familism, a cultural value that emphasizes family over self, is one of the most prominent values in the Hispanic community, it is especially important to consider the role that social network members play in disease management.

              To address these needs, a series of analyses examined the role of meaningful others, including medical providers and family members, on health behavior and health outcomes. Results from three separate datasets buttress the importance of such connections indicating that relationships matter for the overall health and wellness of Hispanic women. Research findings may have significant implications for the design of healthcare interventions that elicit change at the individual and social network levels with the goal of producing health equity for all.

                Cover page: Illness Burden in Hispanic Women: The Role of Social Networks
                • Article
                • Peer Reviewed
                UC Irvine Previously Published Works (2011)

                Background

                Asian Americans represent a mix of cultures and immigration experiences, which may put them differentially at risk for mental health problems. Yet, little is known about the mental health needs of older adults from various Asian subgroups compared to non-Hispanic whites.

                Objectives

                To compare the prevalence rates of mental distress of Chinese, Filipino, South Asian, Japanese, Korean, and Vietnamese older adults (aged 55 and older) to that of non-Hispanic whites; and to examine subgroup differences in utilization of mental health services.

                Methods

                A cross-sectional analysis of a population-based sample of California adults responding to the 2007 California Health Interview Survey. Multivariable logistic regression analysis was used to examine subgroup differences in mental health status and use of mental health services among the six different Asian subgroups and non-Hispanic whites, adjusting for respondents' demographic and health characteristics, socioeconomic status, and English-language proficiency.

                Results

                A total of 20,712 respondents were included. Filipino [aOR=2.25; 95% CI=1.14-4.47] and Korean Americans [aOR=2.10; 95% CI=1.06-4.17] were more likely to report symptoms indicative of mental distress compared to non-Hispanic whites, yet were less likely to have seen a primary care provider [Filipino: aOR=0.41; 95% CI=0.18-0.90; Korean: aOR=0.24; 95% CI = 0.08-0.69] or have taken a prescription medication [Filipino: aOR=0.20; 95% CI=0.10-0.40; Korean: aOR=0.15; 95% CI=0.05-0.40], even after adjusting for indicators of respondents' demographic and health characteristics, socioeconomic status, and English-language proficiency. In contrast, Japanese Americans were less likely to report symptoms indicative of mental distress [aOR=0.43; 95% CI=0.21-0.90], and were less likely to make use of mental health services compared to non-Hispanic whites.

                Discussion/conclusions

                The findings from this study not only highlight the unmet mental health needs among older Asian Americans, but also illustrate significant variations among the various Asian subgroups. Clinicians who work closely with these patients should regularly screen and assess older Asian adults for symptoms related to their mental health needs.
                  Cover page: Assessing the Mental Health Needs and Barriers to Care Among a Diverse Sample of Asian American Older AdultsCreative Commons 'BY' version 4.0 license
                  • Article
                  • Peer Reviewed
                  UC Irvine Previously Published Works (2010)
                  Racial/ethnic minorities are more likely to report receipt of lower quality of health care; however, the mediators of such patient reports are not known. To determine (1) whether racial disparities in perceptions of quality of health care are mediated by perceptions of being discriminated against while receiving medical care and (2) whether this association is further mediated by patient sociodemographic characteristics, access to care, and patient satisfaction across racial/ethnic groups. A cross-sectional analysis of a population-based sample of California adults responding to the 2003 California Health Interview Survey. Multivariable logistic regression was used to examine the relationship between perceived discrimination and perceived quality of health care after adjusting for patient characteristics and reports of access to care. A total of 36,831 respondents were included. African Americans (68.7%) and Asian/Pacific Islanders (64.5%) were less likely than non-Hispanic whites (72.8%) and Hispanics (74.9%) to rate their health care quality highly. African Americans (13.1%) and Hispanics (13.4%) were the most likely to report discrimination, followed by Asian/Pacific Islanders (7.3%) and non-Hispanic whites (2.6%). Racial/ethnic discrimination in health care was negatively associated with ratings of health care quality within each racial/ethnic group, even after adjusting for sociodemographic variables and other indicators of access and satisfaction. Feeling discriminated against fully accounted for the difference in low ratings of quality care between African Americans and whites, but not for other racial/ethnic minorities. Patient perceptions of discrimination may play an important, yet variable role in ratings of health care quality across racial/ethnic minority groups. Health care institutions should consider how to address this patient concern as a part of routine quality improvement.
                    Cover page: Racial/Ethnic Discrimination in Health Care: Impact on Perceived Quality of Care
                    • Article
                    • Peer Reviewed
                    UC Irvine Previously Published Works (2018)

                    Purpose of study

                    A currently proposed rule by the Centers for Medicare & Medicaid Services would require providers to devote more resources to discharge planning from hospitals to ensure the prioritization of patient preferences and goals in the discharge planning process. Annually, more than 3 million persons enter a nursing home in the United States, with the vast majority of patients coming directly from hospitals. Although early evidence suggests more family involvement than patient involvement in the discharge process, most of this work has relied on retrospective reports of the decision-making process postplacement. This article seeks to examine and compare the experiences and perspectives of patients and others involved in the selection of the nursing home (predominately adult children and spouses).

                    Primary practice setting

                    Large academic medical hospital with patients being discharged to a skilled nursing facility.

                    Methodology and sample

                    A total of 225 patients or their family members and involved others who completed an exit survey assessing their experiences and perspectives in selecting a skilled nursing home and in experiencing the discharge process more generally.

                    Results

                    Patients were the primary decision makers about 23% of the time but were often involved in the decision even when family members/involved others were primarily making decisions in the discharge process. Although patients were involved in the selection of the nursing home to a lesser degree than involved others, their level of satisfaction with the decision to be discharged to a skilled nursing home and their level of satisfaction with their personal level of involvement with the selection of the specific nursing home did not differ from the satisfaction ratings of the involved others. Furthermore, their confidence in the decision and their satisfaction with the decision did not differ from ratings provided by family members/involved others.

                    Implications for case management practice

                    Recommendations for case management practice include (1) encouraging patients and their families to take an active role in the discharge process; (2) incorporating technology into the discharge process that promotes this active level of engagement; and (3) facilitating access to data to promote discharge to the highest quality nursing homes available.
                      Cover page: Hospital Discharge and Selecting a Skilled Nursing Facility
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