School of Public Health
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The collections in this community comprise faculty research works, as well as graduate theses and dissertations.
Note: Prior to July 1, 2007, the School of Public Health was named the College of Health & Human Performance.
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Item Trends in Health Care Access/Experiences: Differential Gains across Sexuality and Sex Intersections before and after Marriage Equality(MDPI, 2022-04-21) Turpin, Rodman E.; Williams, Natasha D.; Akré, Ellesse-Roselee L.; Boekeloo, Bradley O.; Fish, Jessica N.Background: Sexual minority adults experience several health care access inequities compared to their heterosexual peers; such inequities may be affected by LGBTQ+ legislation, such as the 2015 national marriage equality ruling. Methods: Using population-based data (n = 28,463) from the Association of American Medical Colleges biannual Consumer Survey of Health Care Access, we calculated trend ratios (TR) for indicators of health care access (e.g., insurance coverage, delaying or forgoing care due to cost) and satisfaction (e.g., general satisfaction, being mistreated due to sexual orientation) from 2013 to 2018 across sexuality and sex. We also tested for changes in trends related to the 2015 marriage equality ruling using interrupted time series trend interactions (TRInt). Results: The largest increases in access were observed in gay men (TR = 2.42, 95% CI 1.28, 4.57). Bisexual men had decreases in access over this period (TR = 0.47, 95% CI 0.22, 0.99). Only gay men had a significant increase in the health care access trend after U.S. national marriage equality (TRInt = 5.59, 95% CI 2.00, 9.18), while other sexual minority groups did not. Conclusions: We found that trends in health care access and satisfaction varied significantly across sexualities and sex. Our findings highlight important disparities in how federal marriage equality has benefited sexual minority groups.Item RACIAL AND ETHNIC DIFFERENCES IN ACCESSING TIMELY CANCER SCREENING AND TREATMENT SERVICES: A QUANTITATIVE ANALYSIS(2013) King, Christopher Jerome; Thomas, Stephen B.; Chen, Jie; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This research is organized into three integrated studies that explored differences in screening and treatment services across the cancer care continuum by race and ethnicity. The Andersen Behavioral Model of Health Services Use and the Five Dimensions of Access were used as conceptual frameworks. In the first study (Chapter 2), data from the Medical Expenditure Panel Survey were used to examine breast and cervical cancer screening rates before and during the Great Recession (2007-2009). The interaction terms of recession and race and ethnicity were controlled to examine whether minorities exhibited different utilization patterns under economic shock compared to Whites. In Chapter 3, data from the National Health Interview Survey (NHIS) from 2006-2010 were used to identify adult cancer survivors and adults without a history of cancer. Multivariate logistic regressions were applied to examine the prevalence of cost, organizational and transportation barriers between survivors and the general population. The likelihood of experiencing barriers was explored by race and ethnicity. In Chapter 4, differences in the likelihood of experiencing access barriers among survivors by race and ethnicity was explored. Data were merged from the 2000-2011 (NHIS) to identify adult cancer survivors who reported cost, organizational and transportation barriers. Logistic regressions were applied to determine the likelihood of reporting each type of barrier, while controlling for demographic and socioeconomic variables. The Fairlie decomposition technique was applied to identify contributing factors that explained differences in accessing care based by race and ethnicity. Overall, results of the investigations demonstrate that: (1) breast and cervical screening rates declined most among White women during the recession period, while rates increased among Hispanic women during the same period; (2) minority cancer survivors were significantly more likely to experience access-to-care barriers than Whites; and (3) insurance, comorbidity, perceived health and nativity were leading factors that contributed to racial and ethnic differences in timely receipt of cancer screening and treatment services. As provisions of the Affordable Care Act take effect, findings provide insight into practices, policies, and future research that will help achieve Healthy People 2020 screening objectives and reduce racial and ethnic disparities in accessing timely cancer care.Item QUALITY OF PAST EXPERIENCES WITH HEALTHCARE PROVIDERS, LEVEL OF SELF-EFFICACY, AND DEGREE OF TRUST IN PROVIDERS AS DETERMINANTS OF PROVIDER AVOIDANCE: TESTING THE MODERATING EFFECTS OF RACE AND GENDER(2012) McDowell, April; Epstein, Norman B; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)A critical component in the prevention and treatment of illness and disease is individuals' timely and consistent consultation with healthcare providers. The purpose of the current study was to examine factors influencing individuals' avoidance of healthcare providers in a national sample of insured U.S. adults who potentially have access to healthcare but may not use it. Inadequate access to healthcare as a function of disparities (e.g., lack of health insurance) has increasingly received attention. However, there has been a lack of attention to factors that interfere with use of healthcare among individuals who potentially have access based on insurance coverage. Those individuals are at risk of negative health outcomes when they avoid medical consultation for serious health symptoms. Consequently, the present study examined factors influencing healthcare avoidance among individuals who have health insurance. A secondary analysis was conducted with a publically available data set, the 2007 Health Information National Trends Survey (NCI, 2009). The study examined the extent to which health self-efficacy, quality of past interactions that an individual has had with healthcare providers (HCPs), and trust in HCPs to take care of one's health needs predicted current avoidance of HCPs. The study also examined individuals' levels of trust in HCPs as a potential mediator of the relationship between the quality of interactions with HCPs and the degree to which individuals avoid HCPs, as well as patient race/ethnicity and gender as potential moderators of the relationship between quality of interactions with HCPs and trust in HCPs. Control variables included age, education, and income. Results provided support for the expected relationships between health self-efficacy, quality of interactions with HCPs, and trust in HCPs, and HCP avoidance. Furthermore, results revealed that trust in HCPs is a significant mediator between quality of interactions with HCPs and HCP avoidance. However, results did not provide support for race/ethnicity and gender as clinically significant moderators between quality of interactions with HCPs and trust in HCPs. Findings provide useful information about factors that influence individuals' avoidance of HCPs, thereby identifying targets for reducing this problematic public health phenomenon. Implications for theory, research, practice, and policy are presented.