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BackgroundCommunity health centers (CHCs) provide comprehensive primary and preventive care to medically underserved, low-income, and racially/ethnically diverse populations. CHCs also offer enabling services, non-clinical assistance to reduce barriers to healthcare due to unmet social and material needs, to improve access to healthcare and reduce health disparities. For patients with modifiable cardiometabolic risk factors, including obesity, hypertension, and diabetes, enabling services may provide additional support to improve disease management. However, little is known about the relationship between enabling services and healthcare accessibility and utilization among patients with cardiometabolic risk factors.MethodsThis study uses data from the 2014 Health Center Patient Survey to examine the relationship between enabling services use and delayed/foregone care, routine check-ups, and emergency room visits, among adult community health center patients in the United States with cardiometabolic risk factors (N = 2358). Outcomes of enabling services users were compared to nonusers using doubly robust propensity score matching methods and generalized linear regression models.ResultsOverall, enabling service users were 15.4 percentage points less likely to report delayed/foregone care and 29.4 percentage points more likely to report routine check-ups than nonusers. Enabling service users who lived in urban areas, younger and middle-aged adults, and those with two cardiometabolic risk factors were also less likely to report delayed/foregone care and/or more likely to report routine check-ups in comparison with nonusers. However, among adults with three or more cardiometabolic risk factors, enabling services use was associated with a 41.3 percentage point increase in emergency room visits and a 7.6 percentage point decrease in routine check-ups.ConclusionsThe findings highlight the value in utilizing enabling services to improve timeliness and receipt of care among CHC patients with heightened cardiometabolic risk. There is a need for targeting high-risk populations with additional enabling services to support management of multiple chronic conditions.

Objective: Explore the ways in which a sample of college women interpret racially/ethnically coded vignettes to understand their perceptions of responsibility and trauma experienced by a hypothetical female sexual assault survivor and her need for social support. Participants: Convenience sample of college women (N = 51) attending a large, predominately white university in the Southeastern United States recruited between January and March 2013. Methods: Participants were randomly assigned one of three vignettes describing a hypothetical date rape scenario. Vignette scenarios were identical except for discrete statements coded to signify either an African American, Latina, or white female student. Participants responded to open-ended questions that gauged their interpretations of responsibility, trauma, and social support. Results: Qualitative analysis of open-ended responses revealed six overarching themes, including overt victim blaming/shaming, justification of the sexual assault, and perceived need for social support. Conclusions: Findings point to the significance of including race in discussions about and programs that address sexual assault on college campuses to ensure that all women who experience sexual violence receive the support that they need.

Objectives. We used data from the National Health Interview Survey (1997-2002) to examine the association between education and the prevalence of diabetes in US adults and whether this relation differs by race/ethnicity. Methods. The analyses were limited to non-Hispanic Blacks, non-Hispanic Whites, and Hispanics. SUDAAN was used to account for the complex sampling design. Results. Educational attainment was inversely associated with the prevalence of diabetes. Individuals with less than a high-school diploma were 1.6 (95% confidence interval [CI] = 1.4, 1.8) times more likely to have diabetes than those with at least a bachelor's degree. Whites and Hispanics exhibited a significant relation between diabetes and having less than a high-school education (odds ratio [OR] = 1.7; 95% CI = 1.5, 2.0; and OR= 1.6; 95% CI = 1.1, 2.3, respectively). In addition, the odds of having diabetes was stronger for women (OR = 1.9; 95% CI = 1.6, 2.4) than for men (OR= 1.4; 95% CI= 1.1, 1.6) Conclusions. Educational attainment was inversely associated with diabetes prevalence among Whites, Hispanics, and women but not among Blacks. Education may have a different effect on diabetes health among different racial/ethnic groups. doi:10.2105/AJPH.2005.072884

Objectives: We examine associations between social determinants and mental health and assess how the associations vary by race/ethnicity using a large, diverse sample of older adults. Method: A retrospective study of 444,057 older adults responding to the Medicare Health Outcomes Survey in 2015–2017 was conducted. Using a multilevel linear regression, we examined the associations between the self-reported number of unhealthy days due to mental health and social determinants, stratified by race/ethnicity. Results: Health factors were most strongly associated with unhealthy days across all racial/ethnic groups. Strength of other factors varied by race/ethnicity. Social/economic factors had stronger associations among Whites, Asians, and multiracial individuals, while such factors were not significant for American Indians/Alaska Natives and Native Hawaiians/Other Pacific Islanders. Discussion: We found varying degrees of associations between social determinants and poor mental health by racial/ethnic groups. These results suggest that homogeneous interventions may not meet the mental health needs of all. [ABSTRACT FROM AUTHOR]