Abstract Objectives Healthcare data can reveal actionable opportunities to prevent asthma hospitalizations. Limited national-level data exist regarding social determinants of health (SDOH) and asthma hospitalizations. We examined SDOH-related International Classification of Diseases, Tenth Revision (ICD-10) Z-codes in national administrative data on asthma hospitalizations and described patient- and hospital-level characteristics associated with documented SDOH Z-codes. Methods Pooled cross-sectional analysis of 2016–2022 Nationwide Inpatient Sample for 200,452 U.S. hospitalizations (all ages) with a primary diagnosis of asthma. Presence of SDOH Z-codes (codes Z55– Z65) assessed by descriptive statistics and multivariable logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) for associations between SDOH Z-codes and patient- and hospital-level characteristics. Results In unweighted analyses, 3,149 asthma hospitalizations had SDOH Z-codes (1.57%). The most common SDOH Z-codes were homelessness (Z59.0; n=942) and unemployment (Z56.0; n=349). Weighted chi-square analyses found all selected variables were associated with asthma hospitalization SDOH Z-code documentation. Logistic regression results varied; adjusted odds for SDOH Z-code documentation were higher for asthma hospitalizations involving male patients (aOR=1.51; 95% CI, 1.39–1.63; P < .001) compared to female patients. Asthma hospitalizations involving rural hospitals had lower odds of SDOH Z-codes documentation (aOR=0.57; 95% CI, 0.47–0.70; P < .001) compared to urban teaching hospitals. Conclusions National 2016–2022 data indicate housing- and employment-related Z-codes were the most commonly documented SDOH within asthma hospitalizations. Future analyses could consider establishing causality and exploring how relationships between these SDOH may be used by public health practitioners and others to improve program interventions.

Objectives Previous studies link hearing impairment to greater social isolation and show they both independently increase dementia risk among older adults. Yet, it remains unclear whether social isolation mediates the relationship between hearing impairment and dementia. This study examines the roles of social isolation as a confounder or a mediator on the longitudinal association between hearing impairment and dementia Measurement Using longitudinal data from 2011-2022 National Health and Aging Trends Study, we estimated risk of dementia associated with hearing impairment using Cox-proportional hazard models after separately adjusting for demographic, socioeconomic, health status characteristics and social isolation. In addition, we employed the four-way decomposition method with parametric regression models to estimate the mediation effects of social isolation on the association of hearing impairment and dementia. Result Hearing impairment was associated with a greater than 2-fold increased dementia risk after adjusting for social isolation and other factors. Approximately 5 percent of this risk was positively mediated by social isolation. Conclusion Our results suggest that social isolation acts as a limited mediator to the associations of hearing impairment and dementia risk. This suggests that reduced social engagement partially explains, but does not drive, the hearing–dementia link. Interventions addressing both hearing loss and social isolation may jointly help reduce dementia risk in older adults.

Hypertension affects half of the U.S. population and increases the risk of heart attacks, strokes, and kidney failure. Managing the progression of hypertension requires medication adherence and lifestyle changes, yet little is known about the prevalence of such changes after receiving medical advice from a physician. Additionally, variations in adherence across racial/ethnic groups remain unclear. Our objective was to measure the changes in medication intake and four other lifestyle measures (reducing alcohol consumption, reducing salt intake, eating healthier, and increasing exercise) among older hypertensive patients in the U.S. using the 2017 Behavioral Risk Factor Surveillance System’s Hypertension Awareness module. We estimated unadjusted and adjusted percentage point changes in groups with and without a physician’s advice using linear probability models, controlling for predisposing, enabling, and need factors. Our findings indicate that physician advice significantly increased rates of all five lifestyle changes across all tested racial/ethnic groups. Non-Latino Black patients exhibited the highest overall adherence, with or without advice. Among non-Latino White patients, the largest increases were in changing eating habits (27.02 percentage points), reducing salt intake (25.06 percentage points), reducing alcohol consumption (27.63 percentage points), and increasing exercise (22.21 percentage points). Non-Latino Black patients experienced notable increases in changing eating habits (20.58 percentage points) and increasing exercise (16.79 percentage points). This study demonstrates the importance of physician advice in managing hypertension changes among older adults, finding they are more likely to make lifestyle changes after receiving direct advice from medical providers.

Respite care provides a relief to family caregivers by temporarily stepping in to provide care for older adults. Prior literature has shown that respite care services can improve both physical and mental health outcomes for caregivers and care recipients. Despite these benefits, respite utilization remains low, and little is known about the profiles of caregivers and care recipients who uses respite care. Using 2015, 2017 and 2021 National Health and Aging Trends Study (NHATS) and National Study of Caregiving (NSOC), we examined the prevalence and associates of respite usage among family caregivers of older adults. Our study sample represented weighted 15,329,939 caregivers, with average age around 59.14 years. 16.45% caregivers used respite care services. Findings revealed that caregivers with higher income and education levels were more likely to use respite. Those with higher emotional burdens, including feeling little joy in caregiving (6.0 percentage points more, p < 0.001), and struggling emotionally with caregiving responsibilities (5.62 percentage points more, p < 0.001), were more likely to use respite. Older care recipients with Medicaid coverage (5.8 percentage point more, p < 0.01), dementia diagnosis (9.76 percentage points more, p < 0.001) and more chronic conditions (5.23 percentage points more, p = 0.02) were positively associated with respite usage of caregivers. Our results suggests the current respite care demand is driven by caregivers’ desire to reduce caregiving burden, as well as the care recipient’s Medicaid status. The results underscore the need for expanded respite care funding and policies to improve access for low-income caregivers and those with emotionally and financially challenging circumstances.

Older adults suffering from serious psychological distress (SPD) have higher health care utilization and expenditures. However, it is unknown whether living alone might further amplify differences in health care usage and costs among older adults with SPD. Using pooled data from 2007-2019 Medical Expenditure Panel Survey, we estimated the incremental care expenditures and utilization associated with SPD among older adults living alone and living with others. The results show that in both living arrangements, having SPD is associated with increases in emergency department visits, hospital admissions, and prescription fill-ups, which leads to higher total prescription expenditures. However, the incremental differences of SPD-related incremental usage and expenditures between older adults living alone and living with others were similar. Our findings call for targeted community programs for older adults that go beyond eliminating physical loneliness, and innovative care coordination strategies that prioritize mental health and preventative care among older adults.

BACKGROUND:Adverse childhood experiences (ACEs) have been associated with poor health and underuse of preventive health services. However, less is known about how ACEs are associated with quality of care that children receive, like care that involves shared decision-making. METHODS:Using data from the 2021-2022 National Survey of Children's Health (n = 47 179) the association between ACEs, both individual and cumulative and (1) needing medical decisions made in the past 12 months and (2) three different measures of always receiving care that involved shared decision-making. Logistic regression models were used to calculate odds of each outcome. Each of the 11 ACEs and the cumulative number of ACEs served as independent variables each in separate models. RESULTS:After accounting for confounders, the number of ACEs experienced, and most individual ACE items were associated with higher odds of needing medical decisions made, and lower odds of receiving health care that involved providers always engaging in the three measures of shared decision-making. CONCLUSIONS:This study expands the research showing a deleterious impact of ACEs on utilization of health care by showing that ACEs are associated with lower quality health care. This can be particularly determinantal to children with a history of ACEs because they have a greater need for health care and are less likely to use many types of health care. Efforts to improve health care quality for all children will be of particular benefit to vulnerable groups, like those with a history of ACEs.

The gap between the need for respite services and caregiver abilities to access them is well documented. (AARP, 2024). One reason for this gap is that many caregivers lack information regarding the cost and availability of respite services (Castro et al., 2023). Previous studies found that getting information on respite services can be cumbersome and the accessed information may be incomplete. (Leocadie et al., 2018). Drawing on institutional models of organizational behavior, we distinguish among three major types of information contexts: 1) Individualized, 2) Community-Level, and 3) Public-Level. The objective of our study is to examine the impact of information gathering on utilization of respite care among caregivers. Using data from the National Study of Caregivers (NSOC), we found that caregivers who seek information in the individual sphere have 16% higher odds (OR = 1.16) of using respite services whereas those who received information from community (OR = 0.82) or public (OR = 0.86) spheres have between 18% and 14% lower odds of using respite services. Rather, caregivers relying on community and public sphere for information had higher odds of receiving caregiving training and utilizing support group services. The results suggest that while individuals are more likely to seek functional, and costly, support via respite, public information sources are more likely to direct caregivers toward individualized self-help approaches via training to enhance caregiving activities or support group coping. These findings suggest that caregiver support policies should account for how informational disparities can create qualitative differences in formal support use.

IMPORTANCE School-based health centers (SBHCs) are primary care clinics colocated at schools. SBHCs have the potential to improve health care access and reduce disparities, but there is limited rigorous evidence on their effectiveness at the national level.OBJECTIVE To determine whether county-level adoption of SBHCs was associated with access, utilization, and health among children from low-income families and to measure reductions in income-based disparities.DESIGN, SETTING, AND PARTICIPANTS This survey study used a difference-in-differences design and data from a nationally representative sample of children in the US merged with SBHC indicators from the National Census of School-Based Health Centers. The main sample included children aged 5 to 17 years with family incomes that were less than 200% of the federal poverty level observed in the National Health Interview Survey, collected between 1997 to 2018. The sample was restricted to children living in a county that adopted a center between 2003 and 2013 or that did not have a center at any time during the study period. Analyses of income-based disparities included children from higher income families (ie, 200% or higher than the federal poverty level). Data were analyzed between January 2020 and July 2023.EXPOSURE County-by-year SBHC adoption.MAIN OUTCOMES AND MEASURES Outcomes included access (usual source of care, insurance status, barriers), ambulatory care use (general physician, eye doctor, dental, mental health visits), and health (general health status, missed school days due to illness). P values were adjusted for multiple comparisons using the sharpened q value method. RESULTS This study included 12 624 unweighted children from low-income families and 24631 unweighted children from higher income families. The weighted percentage of children in low-income families who resided in counties with SBHC adoption included 50.0% aged 5 to 10 years. The weighted percentages of the race and ethnicity of these children included 36.7% Hispanic children, 25.2% non-Hispanic Black children, and 30.6% non-Hispanic White children. The weighted percentages of children in the counties that never adopted SBHCs included 50.1% aged 5 to 10 years. The weighted percentages of the race and ethnicity of these children included 20.7% Hispanic children, 22.4% non-Hispanic Black children, and 52.9% non-Hispanic White children. SBHC adoption was associated with a 6.4 percentage point increase in dental visits (95% CI, 3.2-9.6 percentage points; P < .001), an 8.0 percentage point increase in having a usual source of care (95% CI, 4.5-11.5 percentage points; P < .001), and a 5.2 percentage point increase in insurance (95% CI, 1.2-9.2 percentage points; P = .03). No other statistically significant associations were found with other outcomes. SBHCs were associated with relative reductions in income-based disparities to dental visits by 76% (4.9 percentage points; 95% CI, 2.0-7.7 percentage points), to insured status by 63% (3.5 percentage points; 95% CI, 1.3-5.7 percentage points), and to having a usual source of care by 98% (7.2 percentage points; 95% CI, 5.4-9.1 percentage points).CONCLUSIONS AND RELEVANCE In this survey study with difference-in-differences analysis of SBHC adoption, SBHCs were associated with access to care and reduced income-based disparities. These findings support additional SBHC expansion.

OBJECTIVE To estimate the effects of CHIPRA, a policy that provided states the option to extend Medicaid/CHIP eligibility to immigrant children who have not been legal residents for five years or more, on insurance coverage, access, utilization and health outcomes among immigrant children. DATA SOURCES Restricted use 2000-2016 National Health Interview Survey (NHIS). STUDY DESIGN We used a difference-in-differences design that compared changes in CHIPRA expansion states to changes in non-expansion states. DATA COLLECTION Our sample included immigrant children who were born outside the US, aged 0-18 with family income below 300% of the Federal Poverty Level (FPL). Subgroup analyses were conducted across states that did and did not have a similar state-funded option prior to CHIPRA (state-funded vs not state-funded), by length of time in the US (5 years vs 5-14 years), and global region of birth (Latin American vs. Asian countries). PRINCIPLE FINDINGS We found that CHIPRA was associated with a significant 6.35 percentage point decrease in uninsured rates (95% CI: -11.25, -1.45) and an 8.1 percentage point increase in public insurance enrollment for immigrant children (95% CI: 1.26, 14.98). However, the effects of CHIPRA became small and statistically not significant 3 years after adoption. Effects on public insurance coverage were significant in states without state-funded programs prior to CHIPRA (15.50 percentage points; 95% CI:8.05, 22.95) and for children born in Asian countries (12.80 percentage points; 95% CI: 1.04, 24.56). We found no significant changes in health care access and utilization, and health outcomes, overall and across subgroups due to CHIPRA. CONCLUSIONS CHIPRA's eligibility expansion was associated with increases in public insurance coverage for low-income children, especially in states where CHIPRA represented a new source of coverage versus a substitute for state-funded coverage. However, we found evidence of crowd-out in certain subgroups and no effect of CHIPRA on access to care and health. Our results suggest that public coverage may be an important tool for promoting the well-being of immigrant children but other investments are still needed.

BACKGROUND:Little is known about the associations of social experiences with mental health service use.AIM:This study aimed to classify social experiences variables in the past year and examine the associations of selected variables in social experiences with mental health service use among US adolescents.METHODS:A total of 13,038 adolescents (aged 12 to 17), of which 2208 received mental health services, were from the 2018 National Survey on Drug Use and Health. Multivariate logistic regression (MLR) analysis was conducted.RESULTS:The overall prevalence of mental health service use was 16.1%. 44 variables on social experiences were grouped into 10 disjoint clusters and one variable from each cluster was selected for MLR analysis. Being female, African American, Hispanics, insured and having depression in the past year were associated with increased odds of mental health service use. Negative feelings about going to school, having a serious fight at school/work, active involvement in substance use help programs, knowledge of drug prevention, negative perceptions about the role of religious beliefs on life decisions were positively associated with mental health service use.CONCLUSION:Mental health service use is associated with feelings about school and peers, perceptions about drug use, and involvement in activities.

For athletes of different sports, their muscle activities in different sports will show different special characteristics according to different sports. The purpose of this paper is to study the technology of multi-information fusion and to study the athletes of the long jump competition. The relevant research on the muscle specific ability test methods of the athletes in the long jump competition is of great significance to the study of the long jump. This paper proposes a long jumper's special muscle ability experiment, using the now very popular multi-information fusion technology, to conduct in-depth research on the biomechanics of the long jumper's special ability of the take-off muscle, which can provide an effective scientific basis for the special ability level and special strength of the long jumper's take-off sports. The results of the study show that the hip joint of the take-off leg produces greater hip extensor torque during the take-off action of long jump, and the active contraction ability of the knee flexor group is very important for taking off and avoiding damage to the posterior femoral muscle group. The change range of the pressure center is between 51.26% and 74.35%, which has great application value in actual training.

Immigrants living in the United States experience disparities in satisfaction with medical care. Practicing patient-centered communication and providing racially (or race-concordant) concordant care are suggested as effective approaches to improve care satisfaction. Using the Medical Expenditure Panel Survey, we found that immigrant patients with medical providers who practiced patient-centered communication were more likely to be satisfied with the care they received regardless of patient–provider racial concordance, and that simply having racially concordant medical providers did not significantly affect the satisfaction level for immigrant patients. The findings suggest that providing patient-centered communication may mitigate racial and cultural differences between providers and patients, and is key to reducing disparities and improving immigrant patients’ satisfaction level with medical care.

Research on social determinants of health shows that factors outside of medical care including environment, education, and income also affect health. Some community health centers seek to address these by providing additional nonmedical services. Community health centers can find it difficult to justify these costs when the benefit is unclear. This review highlights studies on services like those the community health center Mary's Center provides through its Social Change Model, offering health, education, and social services in the Washington, District of Columbia metropolitan area. The review finds that most studies report positive results, though more research is needed, especially in the area of social services.

Objective: Previous research has found that having a spouse with Alzheimer's disease and related dementias (ADRD) is associated with higher health care expenditures, however it is unclear if this difference remains after accounting for the demographics and health status of the non-ADRD spouse. This paper aims to estimate the adjusted incremental health care expenditures of having a spouse with ADRD. Design: Cross-sectional study of publicly available survey data (2003-2017 Medical Expenditure Panel Survey). Setting: Representative sample of U.S. households. Participants: Community-dwelling and married older adults (n = 28,356). Measurement: Two-part models and recycled prediction techniques to estimate the incremental effects of having a spouse with ADRD on annual health care expenditures, while adjusting for demographics, socioeconomic characteristics, and health conditions. Results: Spouses of older adults with ADRD were older, had worse perceived mental health, and had greater difficulties with activities of daily living, compared to older adults with cognitively normal spouses. Spouses of ADRD patients had significantly higher unadjusted total health care expenditures, however their adjusted incremental expenditure was not significantly greater. After controlling for demographics and health status, ADRD spouses had significantly higher home health care expenditures, but significantly lower outpatient expenditures. Conclusion: Results suggested that the higher health care expenditures in older adults with ADRD spouses can be attributed to the higher rate of comorbidities, rate of functional limitations, and mean age in this group. The increased use of home health and decreased use of outpatient in this population suggests the importance of tailoring preventative health care and social services to meet the needs of this group.

Research on social determinants of health shows that factors outside of medical care including environment, education, and income also affect health. Some community health centers seek to address these by providing additional nonmedical services. Community health centers can find it difficult to justify these costs when the benefit is unclear. This review highlights studies on services like those the community health center Mary's Center provides through its Social Change Model, offering health, education, and social services in the Washington, District of Columbia metropolitan area. The review finds that most studies report positive results, though more research is needed, especially in the area of social services.

Background: No previous study has focused on the inter-relationship among alcohol and drug use variables in the past year. This study aimed to classify the past year alcohol and drug use variables and investigate the selected variables in past year alcohol and drug use with the unmet need for mental health services among US adults. Methods: Data came from the 2015 National Survey on Drug Use and Health (NSDUH). Oblique principal component cluster analysis (OPCCA) was used to classify 37 variables on alcohol and drug use in the past year into disjoint clusters. Weighted multiple logistic regression analysis was used to examine the associations of selected variables with the unmet need. Results: 37 alcohol and drug use variables were divided into 7 clusters. The variable with the lowest 1-R-2 ratio (R-2 is the squared correlation) from each cluster was selected as follows: tobacco use, pain reliever use, tranquilizer use, stimulant use, zolpidem products use, illicit drug and alcohol use, and benzodiazepine tranquilizers misuse. Multiple logistic regression analysis showed that pain reliever use (OR = 1.33, 95% CI = 1.17-1.50), tranquilizer use (OR = 2.49, 95% CI = 2.16-2.86), stimulant use (OR = 1.22, 95% CI = 1.01-1.47), and illicit drug and alcohol use (OR = 1.54, 95% CI = 1.34-1.77) revealed positive associations with the unmet need for mental health services. Conclusion: This is the first study using OPCCA to reduce the dominations of alcohol and drug use; several alcohol and drug use variables in the past year were associated with unmet need of mental health services.