Background: A majority of college students have health insurance, yet many report financial barriers to healthcare. Health insurance literacy is receiving attention across the field of health services research in trying to understand how to better inform patients about their coverage so they can make economical healthcare decisions. However, we lack psychometric studies on tools used to measure health insurance literacy. This study uses data from a health insurance needs assessment survey to assess evidence of validity based on internal structure of the Kaiser Family Foundation’s 10-item health insurance knowledge quiz. Methods: We administered the survey to 2,250 college students at a large university in the southeast U.S. We fit unidimensional binary item response theory (IRT) models to the data to evaluate the scale’s internal structure. Results: A two-parameter logistic (2PL) model fit the data sufficiently better than a 1PL or 3PL model. The 10 items cover a range of difficulty and discrimination (mean of -0.02 and 1.56, respectively; interpreted on a z-score scale), which allows precision in estimating health insurance knowledge scores of students over half a standard deviation below the sample mean (θ = -0.686). 2PL-IRT scores were strongly correlated (r = 0.99) with raw summated scores. Conclusion: This 10-item, publicly available, tool demonstrates sufficient internal structure validity to elicit scores that may be useful for patient education and health promotion practice. Results inform health education planning efforts to improve college student health insurance literacy by identifying areas of weaker knowledge and more precision in estimating ability.

Background: Despite declines in HIV incidences among U.S. women, Black women are faced with a heavier burden of HIV than other racial and ethnic groups. Conversely, Black women are tested for HIV at higher rates. Given this, few studies have examined preventive sexual health service (PSHS) utilization and HIV Pre-Exposure Prophylaxis (PrEP) acceptability. This study explores the association of PSHS, including HIV and STI testing and HIV PrEP acceptability among young Black women (YBW).

Method: A sample of YBW (N = 200) between the ages of 18-25 completed a self- administered questionnaire, assessing PSHS utilization, HIV-STI testing, and HIV PrEP acceptability. Descriptive analysis and logistic regression were conducted to assess the relationship between PSHS utilization and PrEP acceptability among YBW.

Results: Eighty-six percent of YBW reported being seen by a health provider within the past year. Of YBW who reported going to see a health provider during the last year, 49% reported being seen for preventive or routine care. Sixty-five percent of YBW reported ever being tested for a STI, 66% reported ever being tested for HIV, and 35% reported an interest in PrEP. Young Black women were 28 times more likely to be tested for HIV if they were tested for STIs, however, an association between STI testing and PrEP acceptability, and HIV testing and PrEP acceptability was not significant.

Conclusions: This study increases our understanding of the relationships between STI and HIV testing and PrEP acceptability among YBW. Further analysis is needed to better understand the associations of variability in PSHS utilization and PrEP acceptability.

Background: HIV prevention has expanded to include biomedical interventions to augment behaviorally-focused strategies. One such intervention is pre-exposure prophylaxis (PrEP), a once-daily medication used to reduce HIV-negative individuals’ risk of infection. Although clinical practice guidelines indicate its safety and efficacy, the prescription of PrEP has not met expectations. Previous literature has assessed facilitators and barriers to PrEP uptake among providers; however, there is a dearth of literature that aims to understand the training needs of providers who are not prescribing.

Methods: From September 2017—January 2018, qualitative interviews were conducted with healthcare providers who had not previously prescribed PrEP (n=20), and thematic content analysis was performed. The semi-structured interview guide aimed to understand participants’ attitudes toward the prescription of PrEP to assess training needs and preferences.

Results: Most participants were primary care providers (65%), female (85%) and aware of PrEP (85%). Four themes arose regarding future training needs for the provision of PrEP: 1.) Knowledge of PrEP: Providers needed training about dosing, side-effects, and contraindications; 2.) Identification of PrEP candidates: Providers sought training on eligibility requirements to determine who is best suited for PrEP; 3.) Management of PrEP patients: Providers desired skills regarding prescription guidelines and patient monitoring; 4.) Training modalities: Providers preferred in-person training opportunities over web-based modalities.

Conclusion: Qualitative findings provide meaningful insight for the development of future training materials to inform healthcare providers about the adoption of PrEP within their practice as a primary prevention tool to combat HIV infection.

Background: Despite its proven effectiveness, the uptake of pre-exposure prophylaxis (PrEP) as a biomedical prevention strategy for HIV has been slow among at-risk populations. Prior studies indicate that uptake and adherence are influenced by individual, health system, and community level factors. Interventions at the patient level have achieved some successes, however, significant barriers to uptake remain at the community level. This study seeks to identify community-level factors that affect PrEP adoption by examining current PrEP users’ experiences. Methods: From February—May 2018, semi-structured interviews were conducted with current PrEP users (N=41). Interview questions aimed to explore participants’ knowledge, attitudes, and experiences with PrEP and to identify factors in the community that shape PrEP uptake. Interviews were audio-recorded, transcribed, coded using Atlas.ti, and thematically analyzed. Results: Participants were mostly men who have sex with men (75%), white (78%), had private health insurance (71%). Qualitative analysis revealed five community-level themes that influenced PrEP acceptability and initiation: 1.) Limited visibility and availability, 2.) Stigma, 3.) Limited PrEP awareness and knowledge, 4.) responsibility towards the community and 5.) Need to normalize PrEP. Conclusion: Findings underscore the need to address community-level challenges that impact PrEP uptake. In order to increase PrEP adoption, results point to community-level barriers that prevent individuals from obtaining a prescription. Improving access, addressing stigma and generalized marketing of PrEP are crucial to increasing PrEP uptake.

Background: Problem gambling has been shown to be associated with several mental health outcomes, including higher rates of depressive symptomatology, increased risk of alcohol and substance abuse disorders, higher anxiety, and poorer overall general health. However, much of the scientific literature is focused on adult populations and does not explore differences among different gambling behaviors. This research attempts to better understand the prevalence of problem gambling among college students, its correlates, and differences across socio-demographic groups and their sources of social support.

Methods: A sample of 6,013 students (ages 15-67) from a Midwestern public university participated in the study in February, 2014. Students were asked a range of questions about their socio-demographic characteristics, sources of money, sources of social support, motivation for gambling, and gambling behavior. We assessed differences stratified by gambling risk status using Chi-square tests and ANOVAs.

Results: About 4.2% of college students were at risk for developing problem gambling. Students at risk of developing gambling problems were more likely to be older, male, and have a lower grade point average. High risk college gamblers were more likely to seek help from parents, friends, and gamblers anonymous.

Conclusions: There is an identifiable population of college students at risk for problem gambling, with older male students being at higher risk. Health care professionals and college administrators should assess gambling activities on their campuses and develop tailored interventions designed to address risks.

Background: According to the Center for Disease Control, the prevalence of major depression with major depressive symptoms was 7.6%, where hypertension among U.S. adults is approximately 30.2%. Limited information is available for disparities of self-reported hypertension among the major depressed individuals in the U.S. general population.

Objective: This study aimed to examine (1)the prevalence of major depression and self-reported hypertension in the U.S. adult general population, (2) the prevalence of self-reported hypertension among major depressed individuals in the U.S. adult general population and (3) the prevalence of self-reported hypertension status by race/ethnicity among major depressed individuals. Methods: We analyzed data of 5,629 participants from the NHANES, 2009-2010. Depression was assessed using the Patient Health Questionnaire (PHQ-9), and PHQ-9≥10 was considered as having major depression. Self-reported hypertension was considered as hypertension told by a health professional. Data were analyzed using SAS 9.4 version. Proc survey procedure, the weighted sample, and the weighted percentage was reported.

Results: The prevalence of major depression was 7.8%, and hypertension was 32.0% among the study population. Self-reported hypertension (yes vs. no) among major depressed individual was significantly higher, 10.9% vs. 6.6% (p<0.0001).The prevalences of self-reported hypertension among Hispanic were 37.3% among depressed and 18.7% among non-depressed individuals (p<0.0001). In white, there were 37.9% among depressed and 27.9% among non-depressed (p<0.007). In African Americans, 52.8% among depressed and 34.8% among non-depressed (p<0.0003). In other races, they were 17.3% among depressed and 22.3% among non-depressed (p<0.5).

Conclusion: The national data revealed that disparities exist in self-reported hypertension status among depressed individuals by race/ethnicity.

issues: There were 467 gun-related homicides in Chicago during 2018, more than New York and Los Angeles combined, despite a 15% decrease in Chicago homicides from 2017. One factor contributing to the high gun violence is the recidivism of trauma victims themselves. This fact has prompted development of hospital-based initiatives to try to break the cycle of gun violence across the country. A critical need is to identify potential points for intervention during the process of care. Our project took place at a tertiary care and level I trauma center serving the west-side and western suburbs of Chicago; the institution treats 3 gun violence victims per week. The hospital’s pastoral care service is committed to disrupting the cycle of gun violence. description: In order to identify appropriate points of intervention, we developed a process map of the possible paths a trauma victim could take from the incident site through the emergency department to discharge or death. The pre-hospital path was ascertained from the institution’s Emergency Medical Services protocol, the hospital path through consultation with the medical director and trauma program manager, and possible paths to rehabilitation facilities through consultation with trauma social workers. lessons learned: The process map illustrates pathways taken by trauma victims and identifies intervention points at which it may be possible to break the cycle of gun violence in our community. recommendations: The next step for this project is to work with pastoral care and hospital personnel to implement violence reduction programs at identified intervention points.

issues:

Health professions students enter careers in which they must work with various providers including physicians, nurses, social workers, and dentists. However, the education of these disciplines is largely isolated from one another. At our academic institution, various health professions students work together to deliver care to high-cost high-needs patients in a program called interdisciplinary “hotspotting.” We believe this interprofessional experience helps prepare students for collaborative careers.

description:

26 medical, dental, nursing, public health, social work, and pharmacy school students formed 5 interdisciplinary teams, each supervised by a physician to care for one patient for 6 months. A survey was sent out to hotspotter students and the general medical student body at the start of the 6-month intervention. Students were asked to rate, from strongly disagree to strongly agree, their understanding of roles in interprofessional teams, confidence in working with other disciplines to provide care, and impact of social-environmental health determinants. Both groups will be surveyed again at the end of 6 months.

lessons learned:

Preliminary baseline results demonstrate that the majority of hotspotter students recognize the importance of interdisciplinary care but lack confidence in working in interdisciplinary teams. We anticipate that hotspotters will have a greater difference in scores after 6 months compared to the general student group. This will demonstrate that the hotspotter program improved understanding of roles within interprofessional teams and confidence in contextualizing care.

recommendations:

We recommend further evaluation of student perspectives and confidence in working in interdisciplinary teams with the consideration of incorporating them in the formal curriculum of health professional schools.

Issues

Although providers may understand the role of upstream factors impacting the health of patients, they often lack the practical knowledge and experience to connect patients to the appropriate community resources addressing social determinants of health. Oftentimes, providers must practice in a given community for years before becoming familiar with appropriate resources and how to facilitate their patients’ access to them. A need therefore exists to educate and empower future providers to connect patients with valuable community resources early in their clinical training, with a view to improving health outcomes.

Descriptions

We aim to create a community resource guide specific to Rhode Island that bridges theory and practice for Alpert Medical School (AMS) students beginning clinical training. Structured to mirror topics (healthcare, substance use, interpersonal violence, immigration, etc.) covered in AMS’s required clinical skills training course, the guide organizes relevant resources bycategory based on a comprehensive review of local community-based health-related and social service organizations. Designed as a flowchart, the guide allows students to find the most appropriate resource given the patient’s particular need(s).

Lessons Learned

We iteratively designed a guide by consulting community leaders and medical students. The primary challenge was balancing simplicity and having sufficient detail to render the guide useful for diverse patient encounters. We created a layered system, with the flowchart being the primary resource and uses QR codes to lead to additional information and forms.

Recommendations

To ensure sustainability and relevance, project leaders must continually update the guide. While the current guide is designed for print format, we aim to create a web-application.