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How does where you live affect your primary care use?

Julia C Prentice, MSPH and Anne R Pebley, PhD. Dept. of Community Health Sciences, UCLA School of Public Health, University of California Los Angeles, Mail Box 951772, Los Angeles, CA 90095-1772, 310-825-1349, jprentic@ucla.edu

Individuals living in poorer neighborhoods have worse health outcomes. Decreased access to health care is one of several hypothesized mechanisms between neighborhood environment and poorer health outcomes. However, research has rarely studied how attributes of neighborhoods other than available health care resources might affect health care utilization. This paper investigates how neighborhood environment affects an individualís primary care use. Neighborhood characteristics hypothesized to affect primary care use include: 1) social support; 2) information networks; 3) health behavior norms and 4) health care resources. Data come from The Los Angeles Family and Neighborhood Survey (L.A.FANS), which interviewed 2,600 adults in 65 census tracts in Los Angeles, and the 2000 Census. L.A. FANS collected information on respondentsí primary care use, attitudes towards their neighborhood, such as how much they trust their neighbors, and health behavior norms. Individual responses were aggregated by neighborhood to get a measure of neighborhood social support, information networks and health behavior norms. Census tract socioeconomic measures of neighborhoods from the 2000 Census were included as proxies for health care resources. Two multi-level logistic regressions predict the probability of reporting a regular source of care (RSOC) and receiving a preventive check-up in the last two years based on these neighborhood level characteristics along with standard individual characteristics. Control variables included at the individual level follow the predisposing, enabling and need framework used in the Andersen Model of Health Services Use. There is wide variation between neighborhoods in primary care use. The percent of respondents having a RSOC varies from 48% to 100% between neighborhoods. Similarly, the percent of respondents receiving a check-up in the last two years varies from 31% to 97%. In multivariate models, neighborhood environment affects an individualís ability to access care, after controlling for individual characteristics through several mechanisms. Individuals living in extremely disadvantaged neighborhoods are less likely to use primary care, perhaps due to fewer health care resources. Individuals in neighborhoods with high levels of trust between neighbors and social norms against negative health behaviors are significantly more likely to use primary care. Thus, policies and programs that focus on community empowerment, such as increasing the trust between neighbors, and social marketing campaigns focusing on discouraging negative health behaviors may also indirectly encourage primary care use.

Learning Objectives: At the end of this session, the participant will be able to

Keywords: Primary Care, Community

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.

Psychosocial and Behavioral Factors in Health Care: Social Science Pespectives (Social Sciences in Health Contributed Papers)

The 132nd Annual Meeting (November 6-10, 2004) of APHA