American journal of preventive medicine
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Rates of non-access to needed medical services are elevated among uninsured and sociodemographic subpopulations. Clinical depression is associated with comorbid medical illness and reduced treatment adherence. The purpose of this study was to examine whether prior depression predicts missed needed medical care independent of health insurance status and socioeconomic and demographic characteristics. ⋯ Prior depression corresponded to greater probability of missed needed medical care report in the previous year, independent of health insurance status, employment, income, and demographics.
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Underinsurance is a barrier to vaccination among children. Information on vaccination among adults aged ≥18 years by insurance status is limited. This study assesses vaccination coverage among adults aged ≥18 years in the U.S. in 2012 by health insurance status and access to care characteristics. ⋯ Overall, vaccination coverage among adults aged ≥18 years is lower among uninsured populations. Implementation of effective strategies is needed to help improve vaccination coverage among adults aged ≥18 years, especially those without health insurance.
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Smoking cessation is the most effective therapeutic intervention for chronic obstructive pulmonary disease (COPD) patients. However, the proportion of smokers with COPD who have received physician advice to quit smoking is unknown. The purpose of this study is to assess the prevalence of receipt of smoking-cessation advice among adults with COPD and explore factors predicting advice receipt. ⋯ Having no usual source of care and no health insurance are major barriers to receiving smoking-cessation advice among patients with COPD. The Patient Protection and Affordable Care Act has the potential to increase advice receipt in this high-risk population by expanding health insurance coverage and increasing the number of people with a usual source of care.
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Randomized Controlled Trial
Making policy practice in afterschool programs: a randomized controlled trial on physical activity changes.
In the U.S., afterschool programs are asked to promote moderate to vigorous physical activity. One policy that has considerable public health importance is California's afterschool physical activity guidelines that indicate all children attending an afterschool program accumulate 30 minutes each day the program is operating. Few effective strategies exist for afterschool programs to meet this policy goal. The purpose of this study was to evaluate a multistep adaptive intervention designed to assist afterschool programs in meeting the 30-minute/day moderate to vigorous physical activity policy goal. ⋯ The Strategies To Enhance Practice intervention can make meaningful changes in the proportion of children meeting the moderate to vigorous physical activity policy within one school year. Additional efforts are required to enhance the impact of the intervention.
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Hookah, or waterpipe, tobacco smoking has increased among young adults (YAs) in the U.S., but few prospective studies have examined predictors of hookah use. The current study examined correlates of hookah use and predictors of hookah initiation at a 6-month follow-up in a nationally representative, prospective sample of U.S. YAs. ⋯ Results highlight rapid transitions in hookah use and several risk factors for initiation. Future studies should examine how these factors could be used as intervention targets to reduce tobacco use in this vulnerable age group.