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Background: Violence against women, substance use and disorder, and HIV represent three significant threats to the health of women, yet little is known about the extent of these epidemics among indigent women. This study investigates and documents differences in the prevalence and co-occurrence of physical and sexual violence, substance use and disorder, and HIV risk behavior in sizable probability samples of sheltered homeless and low-income housed women., Methods: Retrospective self-reports were obtained through structured interviews with stratified random samples of women residing in shelters (N = 460) and low-income housing (N = 438) in Los Angeles County, California., Results: Sheltered women were more likely than housed women to report experiencing physical and sexual violence, substance use and disorder, HIV risk behavior, and co-occurrence of these problems in the past year. Differences remained when propensity weights were used to equate the groups on demographic and background characteristics., Conclusions: Findings suggest remarkable need for services among communities of indigent women. Higher rates of problems among women in shelters highlight the importance of differentiating among subgroups of indigent women in community-based prevention and intervention activities and tentatively suggest a protective influence of housing.

Summary: This study investigated the prevalence, location, and correlates of HIV testing in a random sample of women drawn from shelters (n = 460) and low-income housing units (n = 438) in Los Angeles County. Most women (83%) had been tested for HIV, with the most common location being a clinic or physician's office (82%). Sheltered women were more likely to have ever been tested and, among those tested, to have been tested in a treatment program, mobile van, hospital or emergency department, or jail. Multivariate analyses indicated that testing was more likely among women who were sampled from shelters, younger, living with a child, had a regular source of medical care, were drug or alcohol dependent in the past year, experienced sexual violence, and were at low risk for mental health problems. Few women reported lack of money, transportation, or access to testing facilities as primary barriers to being tested. Although our results suggest that most impoverished women in our study area did not experience significant impediments to HIV testing, programs to encourage testing among older women, stably housed women who lack a regular source of care, and women at high risk for mental health problems may be warranted.

Objective: To learn whether consumer reports of health plan quality can affect health plan selection., Data Sources: A sample of 311 privately insured adults from Los Angeles County., Study Design: The design was a fractional factorial experiment. Consumers reviewed materials on four hypothetical health plans and selected one. The health plans varied as to cost, coverage, type of plan, ability to keep one's doctor, and quality, as measured by the Consumer Assessment of Health Plans Study (CAHPS) survey., Data Analysis: We used multinomial logistic regression to model each consumer's choice among health plans., Principal Findings: In the absence of CAHPS information, 86 percent of consumers preferred plans that covered more services, even though they cost more. When CAHPS information was provided, consumers shifted to less expensive plans covering fewer services if CAHPS ratings identified those plans as higher quality (59 percent of consumers preferred plans covering more services). Consumer choices were unaffected when CAHPS ratings identified the more expensive plans covering more services as higher quality (89 percent of consumers preferred plans covering more services)., Conclusions: This study establishes that, under certain realistic conditions, CAHPS ratings could affect consumer selection of health plans and ultimately contain costs. Other studies are needed to learn how to enhance exposure and use of CAHPS information in the real world as well as to identify other conditions in which CAHPS ratings could make a difference.