Browsing by Subject "adults"
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Item A Multi-Level Analysis of Individual and Neighborhood Factors Associated with Patient Portal Use among Adult Emergency Department Patients with Multimorbidity(MDPI, 2023-01-22) Wang, Hao; Shen, Chan; Barbaro, Michael; Ho, Amy F.; Pathak, Mona; Dunn, Cita; Sambamoorthi, UshaBACKGROUND: Patient portals tethered to electronic health records (EHR) have become vital to patient engagement and better disease management, specifically among adults with multimorbidity. We determined individual and neighborhood factors associated with patient portal use (MyChart) among adult patients with multimorbidity seen in an Emergency Department (ED). METHODS: This study adopted a cross-sectional study design and used a linked database of EHR from a single ED site to patients' neighborhood characteristics (i.e., zip code level) from the American Community Survey. The study population included all adults (age > 18 years), with at least one visit to an ED and multimorbidity between 1 January 2019 to 31 December 2020 (N = 40,544). Patient and neighborhood characteristics were compared among patients with and without MyChart use. Random-intercept multi-level logistic regressions were used to analyze the associations of patient and neighborhood factors with MyChart use. RESULTS: Only 19% (N = 7757) of adults with multimorbidity used the patient portal. In the fully adjusted multi-level model, at the patient level, having a primary care physician (AOR = 5.55, 95% CI 5.07-6.07, p < 0.001) and health insurance coverage (AOR = 2.41, 95% CI 2.23-2.61, p < 0.001) were associated with MyChart use. At the neighborhood level, 4.73% of the variation in MyChart use was due to differences in neighborhood factors. However, significant heterogeneity existed in patient portal use when neighborhood characteristics were included in the model. CONCLUSIONS: Among ED patients with multimorbidity, one in five adults used patient portals. Patient-level factors, such as having primary care physicians and insurance, may promote patient portal use.Item Access to Health and Social Services for Poverty Level Adults with Chronic Disease or Disability(2006-12-01) Reese, Sharon E.; Kristine Lykens; Sue Lurie; Richard ScotchReese, Sharon E., Access to Health and Social Services for Poverty Level Adults with Chronic Disease or Disability. Doctor of Public Health (Health Management and Policy), December, 2006, 79 pp., 7 tables, 51 references. This dissertation reports the results of research into the difficulties poverty level adults with disabilities have in accessing vital health and social services. Chapter one gives a background of the problem, a purpose of the research, the research question, limitations and constraints, and the importance of the study. Chapter two is a review of the literature concerning this population and access. Chapter three reviews the methodology used in the study, with chapters four and five presenting results, conclusions and recommendations. Qualitative methods using a focus group and individual interviews five major themes emerged: health issues, access or obtaining care, interactions with providers, obtaining medication, and transportation (table 6). A review of these themes and the particular responses of participants in these areas highlighted the need for policy change in the area of access to services for this special group. This dissertation also makes recommendations for policy changes and potential barriers to those changes.Item Pre-diabetes Screening Tools for Adults Living in the United States(2014-05-01) Evans, Eva L.; Sterling, David; Fischbach, Lori; Felini, Martha J.Almost 37% of persons living in the US aged [greater than] 18 years have pre-diabetes, Persons with pre-diabetes are at high risk of developing type-2 diabetes (advanced hyperglycemia) and also have a higher risk of cardiovascular disease than those with normal blood glucose levels. Furthermore, results from cross-sectional studies indicate that microvascular complications arising from hyperglycemia may begin at the pre-diabetic stage. There is evidence that progression of pre-diabetes may be halted or even reversed with lifestyle and pharmaceutical interventions. However, less than 10% of US adults with pre-diabetes are aware of their condition, which indicates that current pre-diabetes screening methods are inadequate. US physicians need a comprehensive pre-diabetes screening tool. To this end, non-invasive screening score sets were created to screen for IFG, IGT and elevated HbA1c. Because preliminary analyses indicated that the screening accuracy of the pre-diabetes screening score sets would be enhanced by not restricting the score sets to only the pre-diabetic ranges of hyperglycemia, the pre-diabetes screening tool was designed to screen for hyperglycemia in the pre-diabetic and diabetic ranges. These hyperglycemia screening score sets have been based on a scoring system of non-invasive factors associated with hyperglycemia that are already routinely measured or assessed during a visit to the doctor. These factors were age, gender, smoking status, diabetes family history, history of cardiovascular disease, history of hypertension, height, body mass index, physical activity level (by surrogate measure of fasting heart rate), level of alcohol consumption, history of early menarche (women only), and history of gestational diabetes (parous women only). To boost performance for the non-invasive fasting hyperglycemia score set and the non-invasive elevated HbA1c screening score set, both for use in parous women, the fasting screening score set and the HbA1c screening score set included the factor, ethnicity. The pre-diabetes tools were externally and internally validated and were also compared to other non-invasive methods that might be used to screen for hyperglycemia.Item The influence of race/ethnicity and social determinants of health and HPV vaccination in vaccine-eligible adults in the U.S.(2022-08) Garg, Ashvita; Thompson, Erika; Nguyen, Uyen-Sa D.T.; Luningham, Justin M.Background: Human Papillomavirus (HPV) vaccination is an essential primary prevention measure against HPV-related cancers, currently approved for catch-up for inadequately vaccinated adults by age 26 and for mid-adults aged 27-45 with shared clinical decision-making. Although HPV vaccination rates have been gradually increasing, racial/ethnic disparities and low catch-up among adults persist. Examining the Social Determinants of Health (SDOH) associated with HPV vaccination in different racial groups may help explain these disparities in lower vaccine uptake. Previous studies using national datasets have found differences in estimated prevalence of HPV vaccine uptake across datasets for racial/ethnic minorities, especially for Asian Americans, when compared to non-Hispanic White, with results varying from lower to higher uptakes. Despite Asian Americans being a very diverse racial group, most studies either combine them in one category or with other races, resulting in an incomplete picture of HPV vaccine uptake among different Asian American subgroups. Purpose: Using the SDOH framework, this study aimed to examine the racial/ethnic differences for HPV vaccination across three U.S. national databases among vaccine-eligible adults and examine the association between HPV vaccination and Asian racial subgroups. Methods: For the first aim, the study utilized 2017-2019 NHIS (n=30,788), 2017-2020 pre-pandemic NHANES (n=3,685), and 2017-2019 BRFSS (n=30,324) data, ages 18-45 years. Asian racial subgroup disparities for the second aim were assessed with 2014-2018 NHIS data (n=34,839, ages 18-38). Survey-weighted multivariable logistic regression models identified the association between HPV vaccination status (outcome) and explanatory variables: SDOH indicators, race/ethnicity, sex, nativity, and age. Results: The racial/ethnic differences in HPV vaccine uptake were not similar between the three datasets. In the NHIS dataset, compared to Non-Hispanic White, Non-Hispanic Asian and Non-Hispanic Asian males were more likely to be vaccinated. With NHANES data, Non-Hispanic Asian males were less likely to be vaccinated. While BRFSS data did not show statistically significant differences in HPV vaccination for difference races/ethnicity. However, inverse variance weighted averages indicated that compared to Non-Hispanic White, Non-Hispanic Asian individuals had higher odds of receiving HPV vaccination. Males compared to females and foreign-born compared to U.S.-born individuals were less likely to be vaccinated. Among SDOH factors, education level, time since last healthcare visit, health insurance status, and having a usual place of healthcare were significantly associated with HPV vaccination. Compared to White individuals, Asian Indian were less likely to be vaccinated while Filipino and individuals from other Asian subgroups were more likely to be vaccinated. Additionally, foreign-born Asian Indian compared to foreign-born White individuals and Asian Indian females compared to White females were less likely to be vaccinated. Regarding SDOH factors, education level, insurance status, and time since last healthcare were significantly associated with HPV vaccination. Conclusion: This study identified racial/ethnic differences in HPV vaccine uptake and SDOH indicators associated with HPV vaccination. Findings indicate that more studies are needed to assess the differences in these three surveillance systems that led to the conflicting findings and to explore the reasons for lower vaccination uptake among the Asian Indian population. Finally, tailoring HPV vaccine awareness campaigns and improving vaccination access for males, foreign-born, individuals lacking health insurance, or those failing to have regular healthcare visits could help promote HPV vaccination and reduce HPV-associated cancers.Item Trends in Diet Quality by Race/Ethnicity among Adults in the United States for 2011-2018(MDPI, 2022-10-15) Tao, Meng-Hua; Liu, Jialiang; Nguyen, Uyen-Sa D. T.This study aimed to investigate time trends in diet quality and the consumption of major food groups and nutrients by race/ethnicity among adults in the United States. Dietary data from 19,192 adults aged >/= 20 years from four National Health and Nutrition Survey (NHANES) cycles (2011-2018) were included. The Healthy Eating Index (HEI) 2015 scores (range: 0-100; higher scores indicate better diet quality) and dietary consumption of food groups and nutrients were estimated for each cycle. Linear regression was used to test trends. For the overall population, the estimated overall HEI-2015 scores significantly decreased (p for trend = 0.011). However, decreases were observed in the estimated consumption of added sugars and total carbohydrates, while the estimated consumption of soy products and polyunsaturated fatty acids was significantly increased. A significant decrease in overall HEI-2015 score was observed in the non-Hispanic white group, but not in other racial/ethnic groups. Decreases in added sugar intake were found in the non-Hispanic black and Hispanic groups; sodium intake significantly decreased in the non-Hispanic Asian group. From 2011 to 2018, there was a decrease in estimated overall diet quality in US adults; however, there were improvements in certain nutrients and dietary components. Nevertheless, disparities in diet quality exist among racial/ethnic groups.