 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Tess Fabrick Klaristenfeld, MPH1, Jennifer Clarke, MD2, Cynthia Rosengard, PhD3, Bradley, J. Anderson, PhD1, Megan R. Hebert, MA1, Kristen M. DaSilva1, and Michael D Stein, MD4. (1) Division of General Internal Medicine, Rhode Island Hospital, MPB-1, 539 Eddy Street, Providence, RI 02903, (401)444-3830, tessk@bu.edu, (2) Division of Internal Medicine, Rhode Island Hospital/Brown University, 593 Eddy St, MPB1, Providence, RI 02903, (3) Department of Medicine, Brown University School of Medicine, Rhode Island Hospital, DGIM, MPB-1, 593 Eddy St., Providence, RI 02903, (4) Division of General Internal Medicine, Rhode Island Hospital/Brown University, 593 Dudley Street, MPB-1, Providence, RI 02903
Background: Women who repeatedly enter and leave correctional systems comprise a population that faces numerous non-financial obstacles to healthcare utilization including substance abuse, violence, and homelessness. This population demonstrates high rates of morbidity and mortality and access to a usual source of healthcare is important to decreasing their health risks. Access may not be ensured by health insurance alone. Many women believe that their health is not under their own control (“chance-oriented health”) and may not seek care even if insured. In this study we aim to determine factors associated with having a usual source of healthcare (“USHC”). Research Objective: To determine factors beyond health insurance coverage associated with USHC utilization, we hypothesize predictors include chance-oriented health beliefs, lifestyle, and demographic factors. Study Design: Data were extracted from a longitudinal study of women leaving the correctional system. 150 women aged 18 to 40 completed the survey. USHC utilization was assessed by asking, “In the year before you came to [corrections], where did you usually go for health/medical care?” Responses were dichotomized to usual source of care (private doctor or community clinic) or other (ED, correctional healthcare, or none). Logistic regression was used to analyze the association between the USHC utilization outcome and independent variables. Potential predictors analyzed were demographic variables (age, race, homelessness), insurance coverage (private or Medicaid/Medicare versus none), and chance-oriented health (measured by the Chance Health Locus of Control [CHLC] of the Multidimensional Health Locus of Control Scale [MHLC], with higher scores indicating higher chance-oriented health beliefs). Principal Findings: 43% of respondents reported current health insurance coverage and 61% reported USHC utilization. Using logistic regression we found that those with insurance were estimated to be about 4.95 (p<. 001) times more likely to report UHCS utilization than those with no insurance. The homeless were about 0.33 times (p=. 025) as likely to report UHCS utilization as those with permanent residence. Increasing age and higher chance scores on the MHLC were associated with decreased odds of utilizing a USHC. Conclusions: Our findings confirm that having health insurance is a major predictor of USHC utilization in this population. Additionally, homelessness, older age, and chance-oriented health beliefs decrease the likelihood of utilizing a USHC. Therefore, we suggest that interventions addressing these factors may increase USHC utilization among women leaving correctional systems.
Learning Objectives:
Keywords: Access to Health Care, Correctional Health Care
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.