The family crisis migration stress framework: A framework to understand the mental health effects of crisis migration on children and families caused by disasters.

Crisis migration refers to displacement of large numbers of individuals and families from their home countries due to wars, dictatorial governments, and other critical hazards (e.g., hurricanes). Although crisis migration can adversely influence direct and indirect effects on the mental health of adults and their children collectively as families, there is a deficiency in theory that addresses family level processes in this crisis migration context. We propose the Family Crisis Migration Stress Framework, which consolidates what is known about the multiple factors affecting mental health outcomes of crisis migrants into one cohesive model. In our article, we synthesize relevant theories and models of disaster, migration, and family resilience in order to create a framework in which to organize the complex processes that occur within families as a result of migration and that affect the mental health of children. We include examples from various national settings to illustrate the tenets of our framework. Future policy and intervention for crisis migrant should focus on the family as a unit, instead of parents and children as individual entities.

Assessing the relationship between psychosocial stressors and psychiatric resilience among Chilean disaster survivors.

BACKGROUND: According to the stress inoculation hypothesis, successfully navigating life stressors may improve one's ability to cope with subsequent stressors, thereby increasing psychiatric resilience. AIMS: Among individuals with no baseline history of post-traumatic stress disorder (PTSD) and/or major depressive disorder (MDD), to determine whether a history of a stressful life event protected participants against the development of PTSD and/or MDD after a natural disaster. METHOD: Analyses utilised data from a multiwave, prospective cohort study of adult Chilean primary care attendees (years 2003-2011; n = 1160). At baseline, participants completed the Composite International Diagnostic Interview (CIDI), a comprehensive psychiatric diagnostic instrument, and the List of Threatening Experiences, a 12-item questionnaire that measures major stressful life events. During the study (2010), the sixth most powerful earthquake on record struck Chile. One year later (2011), the CIDI was re-administered to assess post-disaster PTSD and/or MDD. RESULTS: Marginal structural logistic regressions indicated that for every one-unit increase in the number of pre-disaster stressors, the odds of developing post-disaster PTSD or MDD increased (OR = 1.21, 95% CI 1.08-1.37, and OR = 1.16, 95% CI 1.06-1.27 respectively). When categorising pre-disaster stressors, individuals with four or more stressors (compared with no stressors) had higher odds of developing post-disaster PTSD (OR = 2.77, 95% CI 1.52-5.04), and a dose-response relationship between pre-disaster stressors and post-disaster MDD was found. CONCLUSIONS: In contrast to the stress inoculation hypothesis, results indicated that experiencing multiple stressors increased the vulnerability to developing PTSD and/or MDD after a natural disaster. Increased knowledge regarding the individual variations of these disorders is essential to inform targeted mental health interventions after a natural disaster, especially in under-studied populations.

Perceived discrimination and well-being among unauthorized Hispanic immigrants: The moderating role of ethnic/racial group identity centrality.

OBJECTIVES: We investigated the association between perceived ethnic discrimination with psychological well-being and life satisfaction among a community sample of unauthorized Hispanic immigrants in the United States. We also assessed whether ethnic/racial group identity centrality moderated this relationship. METHOD: A community sample of self-reported unauthorized Hispanics (N = 140) completed questionnaires assessing perceived ethnic discrimination, ethnic/racial group identity centrality, psychological well-being, and life satisfaction. RESULTS: Discrimination negatively predicted psychological well-being and life satisfaction, and ethnic/racial group identity centrality moderated these relationships. High ethnic/racial group identity centrality reduced the association of discrimination with psychological well-being and life satisfaction. Ethnic/racial identity centrality lent psychological protection for those who reported higher levels of discrimination. CONCLUSION: Ethnic discrimination is a salient stressor for unauthorized Hispanic immigrants. Yet high ethnic/racial group identity centrality may protect these individuals from the negative effects of discrimination by providing a sense of belonging, acceptance, and social support in the face of rejection. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Evaluating the Effects of Coping Style on Allostatic Load, by Sex: The Jackson Heart Study, 2000-2004.

The objective of this study was to examine the cross-sectional association between coping styles and allostatic load among African American adults in the Jackson Heart Study (2000-2004). Coping styles were assessed using the Coping Strategies Inventory-Short Form; allostatic load was measured by using 9 biomarkers standardized into z-scores. Sex-stratified multivariable linear regressions indicated that females who used disengagement coping styles had significantly higher allostatic load scores (ß = 0.016; 95% CI, 0.001-0.032); no such associations were found in males. Future longitudinal investigations should examine why disengagement coping style is linked to increased allostatic load to better inform effective interventions and reduce health disparities among African American women.

Combining Community-Based Participatory Research (CBPR) with a Random-Sample Survey to Assess Smoking Prevalence in an Under-Served Community.

ACKNOWLEDGMENTS: The authors would like to thank Laura McClure for her help with the manuscript submission, the Liberty City Community Health Advisory Board for its collaboration on this study, as well as the survey interviewers, and the survey participants. INTRODUCTION: Underserved communities might lag behind Healthy People 2010 objectives of smoking reduction because of smoking behavior disparities. This possibility was investigated through a random-sample survey conducted in a disenfranchised community in Miami-Dade County, Florida, using a Community-Based Participatory Research (CBPR) framework. The survey was triggered by our finding that this community had higher than expected incidence of tobacco-associated cancers. METHODS: Survey methods, resulting from a dialog between the Community Advisory Board and academic researchers, included: (a) surveying adult residents of a public housing complex located within the community; (b) probability sampling; (c) face-to-face interviews administered by trained community residents. 250 households were sampled from 750 addresses provided by the county Public Housing Agency. The completed surveys were reviewed by the academic team, yielding 204 questionnaires for the current analysis. RESULTS: Of the 204 respondents, 38% were current smokers. They estimated the percentages of smokers in their household and among their five best friends at 33% and 42%, respectively, and among adults and youth in the community at 72% and 53%, respectively. CONCLUSIONS: A mix of state-of-art methodology with CBPR principles is seldom encountered in the current literature. It allowed the research team to find a high smoking prevalence in an underserved community, twice the statewide and nationwide estimates. Similar or higher levels of smoking were perceived in respondent's entourage. Such disparity in smoking behavior, unlikely to result from self-selection bias because of our rigorous methodology, calls for community-specific tobacco control efforts commensurate to the magnitude of the problem.

Correlates of leisure time physical activity compliance in colorectal cancer survivors.

INTRODUCTION: Physical inactivity is a risk factor for cancer morbidity and mortality, but its influence in colorectal cancer (CRC) survivors is understudied. We investigated sociodemographic, physically limiting, and behavioral predictors influencing leisure time physical activity (LTPA) among CRC survivors. METHODS: Pooled 1997-2010 National Health Interview Survey data (N=2378) were used to evaluate LTPA compliance in CRC survivors according to Healthy People 2010 recommendations. Univariate and multivariable logistic regression analyses were performed to identify predictors of LTPA compliance among CRC survivors. Independent variables included: age, gender, race/ethnicity, education, health insurance, body mass index (BMI), ≥2 chronic conditions limiting physical activity, time since cancer diagnosis, and poverty, marital, smoking and alcohol status. RESULTS: Multivariable regression models reveal that Hispanics, non-Hispanic Blacks, those with ≥2 physically limiting chronic conditions, and current smokers were less likely to comply with LTPA recommendations. CRC survivors who were of "other" race, more than one race, those with some college degree or college degree, and current drinkers were more likely to comply. DISCUSSION: Hispanics, non-Hispanic Blacks, those with >2 physically limiting chronic conditions and current smokers warrant additional efforts to encourage physical activity and to determine the impact of regular physical activity on CRC survivorship.

State variations of chronic disease risk factors in older Americans.

The objective of this study was to examine and compare 3 key health behaviors associated with chronic disease (ie, risky drinking, smoking, and sedentary lifestyle). We used data from the National Health Interview Survey from 1997 through 2010 to calculate the prevalence of these behaviors among older Americans and rank each state, and we analyzed overall trends in prevalence for each behavior over the 14 years. Older adults residing in Arkansas and Montana had the worst chronic disease risk profile compared with other states. These findings indicate the need for improved or increased targeted interventions in these states.

Comparison of Florida skin cancer screening rates with those in different US regions.

OBJECTIVES: Florida has the second highest incidence of melanoma in the United States, and more than 600 Floridians die from melanoma annually. Given the lack of population-based data on skin cancer screening among the different US geographic regions, we compared skin cancer screening rates among Floridians to those in the rest of the South, the Northeast, the Midwest, and the West. METHODS: We used data from the 2000 and 2005 National Health Interview Survey. Data were grouped according to whether participants reported ever receiving a skin cancer examination in their lifetime. Data were pooled, and analyses accounted for sample weights and design effects. Multivariable logistic regression analyses were performed with self-reported skin screening as the outcome of interest. RESULTS: Results showed that compared to the rest of the US, Floridians who were women 70 years old and older, reported being of "other" race, of non-Hispanic ethnicity, having a high school education, having health insurance, and employed in the service industry or unemployed, had significantly higher lifetime skin cancer screening rates than their subgroup counterparts residing in the other regions. Multivariable logistic regression showed that Floridians remained significantly more likely to have ever been screened for skin cancer compared to the other US regions after controlling for a variety of sociodemographic variables. CONCLUSIONS: Increasing melanoma detection remains a national cancer goal for the US, and future identification of underlying causal factors for higher screening rates in Florida could inform intervention strategies in the other US regions.

Occupational vs. industry sector classification of the US workforce: which approach is more strongly associated with worker health outcomes?

OBJECTIVES: Through use of a nationally representative database, we examined the variability in both self-rated health and overall mortality risk within occupations across the National Occupational Research Agenda (NORA) Industry Sectors, as well as between the occupations within the NORA Industry sectors. METHODS: Using multiple waves of the National Health Interview Survey (NHIS) representing an estimated 119,343,749 US workers per year from 1986 to 2004, age-adjusted self-rated health and overall mortality rates were examined by occupation and by NORA Industry Sector. RESULTS: There was considerable variability in the prevalence rate of age-adjusted self-rated poor/fair health and overall mortality rates for all US workers. The variability was greatest when examining these data by the Industry Sectors. In addition, we identified an overall pattern of increased poor/fair self-reported health and increased mortality rates concentrated among particular occupations and particular Industry Sectors. CONCLUSIONS: This study suggests that using occupational categories within and across Industry Sectors would improve the characterization of the health status and health disparities of many subpopulations of workers within these Industry Sectors.

Posttraumatic stress disorder symptoms and television viewing patterns in the Nurses' Health Study II: A longitudinal analysis.

INTRODUCTION: The relation between TV viewing and posttraumatic stress disorder (PTSD) is controversial; prior work focused exclusively on whether TV viewing of disaster events constitutes a traumatic stressor that causes PTSD. This study evaluates a possible bidirectional relation between PTSD and TV viewing in community-dwelling women. METHODS: Data are from the PTSD subsample of the Nurses' Health II study, an ongoing prospective study of women aged 24-42 years at enrollment and who have been followed biennially (N = 50,020). Trauma exposure and PTSD symptoms (including date of onset) were assessed via the Brief Trauma Questionnaire and the Short Screening Scale for DSM-IV PTSD. Average TV viewing was reported at 5 times over 18 years of follow-up. Linear mixed models assessed differences in TV viewing patterns by trauma/PTSD status. Among women with trauma/PTSD onset during follow-up (N = 14,374), linear spline mixed models assessed differences in TV viewing patterns before and after PTSD onset. RESULTS: Women with high PTSD symptoms reported more TV viewing (hours/wk) compared to trauma-unexposed women at all follow-up assessments (ß = 0.14, SE = 0.01, p < .001). Among the women who experienced trauma during follow-up, significant increases in TV viewing (hours/day) prior to onset of high PTSD symptom levels were evident (ß = 0.15, SE = 0.02, p < .001). CONCLUSIONS: TV viewing following trauma exposure may be a marker of vulnerability for developing PTSD and also a consequence of having PTSD. High TV viewing levels may be linked with ineffective coping strategies or social isolation, which increase risk of developing PTSD.

Pre-disaster PTSD as a moderator of the relationship between natural disaster and suicidal ideation over time.

BACKGROUND: Natural disasters are associated with a variety of negative health consequences, including enhanced suicide risk. Factors that moderate the relationship between disaster exposure and enhanced suicide risk are unknown. The aim of the current study was to determine whether pre-disaster PTSD moderates the association between change over time in thoughts of death, suicidal ideation (SI), suicide plans, and suicide attempts (SA) from pre- to post-disaster. METHODS: Participants (n = 2832) were recruited from Chile as part of the larger PREDICT study and completed a measure of lifetime PTSD and panic disorder at baseline and a lifetime death/suicide measure at baseline in 2003 and again 6, 12, and 24 months later (i.e. "pre-disaster"). One year following a major earthquake and tsunami in 2010 (i.e., "post-disaster"), participants completed another death/suicide measure. RESULTS: Both those with and without pre-disaster PTSD experienced significant increases in SI from pre- to post-disaster. However, pre-disaster PTSD was associated with significantly accelerated increases in thoughts of death and SI from pre-to post-disaster. At nearly all time-points, pre-disaster PTSD was associated with higher thoughts of death and SI, suicide planning, and SA. In contrast, panic disorder did not moderate the association between time and changes in SI. LIMITATIONS: There was a long time-gap between pre-disaster and post-disaster, with limited data about what occurred during this time. CONCLUSION: Pre-disaster PTSD is an important predictor of increased SI following a natural disaster, and groups with pre-disaster PTSD should be prioritized for receipt of mental health resources following a natural disaster.

Longitudinal course of disaster-related PTSD among a prospective sample of adult Chilean natural disaster survivors.

Background: With an increasing number of individuals surviving natural disasters, it is crucial to understand who is most at risk for developing post-traumatic stress disorder (PTSD). The objective of this study was to prospectively examine the role that pre-existing psychopathology plays in developing PTSD after a disaster. Methods: This study uses data from a prospective 5-wave longitudinal cohort (years 2003-11) of Chilean adults from 10 health centres ( N = 1708). At baseline, participants completed the Composite International Diagnostic Interview (CIDI), a comprehensive psychiatric diagnostic instrument. In 2010, the sixth most powerful earthquake on record struck Chile. One year later, a modified version of the PTSD module of the CIDI was administered. Marginal structural logistic regressions with inverse probability censoring weights were constructed to identify pre-disaster psychiatric predictors of post-disaster PTSD. Results: The majority of participants were female (75.9%) and had a high-school/college education (66.9%). After controlling for pre-disaster PTSD, pre-existing dysthymia [odds ratio (OR) = 2.21; 95% confidence interval (CI) = 1.39-3.52], brief psychotic disorder (OR = 2.67; 95% CI = 1.21-5.90), anxiety disorders (not including PTSD; OR = 1.49; 95% CI = 1.27-1.76), panic disorder (OR = 2.46; 95% CI = 1.37-4.42), agoraphobia (OR = 2.23; 95% CI = 1.22-4.10), social phobia (OR = 1.86; 95% CI = 1.06-3.29), specific phobia (OR = 2.07; 95% CI = 1.50-2.86) and hypochondriasis (OR = 2.10; 95% CI = 1.05-4.18) were predictors of post-disaster PTSD. After controlling for pre-disaster anxiety disorders, dysthymia, and non-affective psychotic disorders, individuals with pre-disaster PTSD (vs those without pre-disaster PTSD) had higher odds of developing post-disaster PTSD (OR = 2.53; 95% CI = 1.37-4.65). Conclusions: This is the first Chilean study to demonstrate prospectively that pre-disaster psychiatric disorders, independent of a prior history of other psychiatric disorders, increase the vulnerability to develop PTSD following a major natural disaster.

Occupational Psychosocial Hazards Among the Emerging US Green Collar Workforce.

OBJECTIVE: To compare occupational psychosocial hazards in green collar versus non-green collar workers. METHODS: Standard Occupational Classification codes were used to link the 2010 National Health Interview Survey to the 2010 Occupational Information Network Database. Multivariable logistic regressions were used to predict job insecurity, work life imbalance, and workplace harassment in green versus non-green collar workers. RESULTS: Most participants were white, non-Hispanic, 25 to 64 years of age, and obtained greater than a high school education. The majority of workers reported no job insecurity, work life imbalance, or workplace harassment. Relative to non-green collar workers (n = 12,217), green collar workers (n = 2,588) were more likely to report job insecurity (Odds ratio [OR] = 1.13; 95% confidence interval [CI] = 1.02 to 1.26) and work life imbalance (1.19; 1.05 to 1.35), but less likely to experience workplace harassment (0.77; 0.62 to 0.95). CONCLUSIONS: Continuous surveillance of occupational psychosocial hazards is recommended in this rapidly emerging workforce.

Green Collar Workers: An Emerging Workforce in the Environmental Sector.

OBJECTIVE: We describe the socio-demographic, occupational, and health characteristics of "green collar" workers, a vital and emerging workforce in energy-efficiency and sustainability. METHODS: We linked data from the 2004 to 2012 National Health Interview Surveys (NHIS) and US Occupational Information Network (O*NET). Descriptive and logistic regression analyses were conducted using green collar worker status as the outcome (n = 143,346). RESULTS: Green collar workers are more likely than non-green workers to be men, age 25 to 64 years, obese, and with less than or equal to high school (HS) education. They are less likely to be racial/ethnic minorities and employed in small companies or government jobs. CONCLUSIONS: Green collar workers have a distinct socio-demographic and occupational profile, and this workforce deserves active surveillance to protect its workers' safety. The NHIS-O*NET linkage represents a valuable resource to further identify the unique exposures and characteristics of this occupational sector.

Chemical and Physical Exposures in the Emerging US Green-Collar Workforce.

OBJECTIVE: "Green collar" workers serve in occupations that directly improve environmental quality and sustainability. This study estimates and compares the prevalence of select physical and chemical exposures among green versus non-green U.S. workers. METHODS: Data from the U.S. 2010 National Health Interview Survey (NHIS) Occupational Health Supplement were linked to the Occupational Information Network (ONET) Database. We examined four main exposures: 1) vapors, gas, dust, fumes (VGDF); 2) secondhand tobacco smoke; 3) skin hazards; 4) outdoor work. RESULTS: Green-collar workers were significantly more likely to report exposure to VGDF and outdoor work than nongreen-collar workers [adjusted odds ratio (AOR) = 1.25; 95% CI = 1.11 to 1.40; AOR = 1.44 (1.26 to 1.63), respectively]. Green-collar workers were less likely to be exposed to chemicals (AOR = 0.80; 0.69 to 0.92). CONCLUSIONS: Green-collar workers appear to be at a greater risk for select workplace exposures. As the green industry continues to grow, it is important to identify these occupational hazards in order to maximize worker health.

Influence of socio-demographic characteristics on eye care expenditure: data from the Medical Expenditure Panel Survey 2007.

OBJECTIVE: To evaluate the association between sociodemographic factors and eye care expenditure and to assess the burden of ocular expenditure compared to total health care expenditure. METHODS: A retrospective analysis of ocular expenditure in participants of the 2007 Medical Expenditure Panel Survey. Data from 20,620 unique participants aged ≥18 years were evaluated for eye care expenditure by demographic characteristics. RESULTS: A total of 22% of the studied population had eye care expenditures in 2007. Demographic factors significantly associated with higher probability of having eye care expenditures included older age (65+ years 35%, 45-64 years 23%, <45 years 17%), female sex (female 26%, male 19%), higher educational attainment (greater than high school education 25%, less than high school education 17%), having insurance (private 24%, uninsured 13%), and visual impairment (mild 31%, none 22%). Older age, female sex, higher educational attainment, having insurance, and presence of visual impairment were also significantly associated with higher mean eye care expenditure. In those with eye care expenditure, the mean ratio between eye care and total medical expenditure was 24%, with uninsured patients spending 42% of their medical care expenditure on eye care. CONCLUSIONS: Demographic factors are associated with both the probability of having ocular expenditure and the amount of expenditure. Of all factors examined, insurance status has the most potential for modification. Policy makers should consider these numbers when devising the terms by which eye care coverage will be provided under the Patient Protection and Affordable Care Act.

Effect of childhood victimization on occupational prestige and income trajectories.

BACKGROUND: Violence toward children (childhood victimization) is a major public health problem, with long-term consequences on economic well-being. The purpose of this study was to determine whether childhood victimization affects occupational prestige and income in young adulthood. We hypothesized that young adults who experienced more childhood victimizations would have less prestigious jobs and lower incomes relative to those with no victimization history. We also explored the pathways in which childhood victimization mediates the relationships between background variables, such as parent's educational impact on the socioeconomic transition into adulthood. METHODS: A nationally representative sample of 8,901 young adults aged 18-28 surveyed between 1999-2009 from the National Longitudinal Survey of Youth 1997 (NLSY) were analyzed. Covariate-adjusted multivariate linear regression and path models were used to estimate the effects of victimization and covariates on income and prestige levels and on income and prestige trajectories. After each participant turned 18, their annual 2002 Census job code was assigned a yearly prestige score based on the 1989 General Social Survey, and their annual income was calculated via self-reports. Occupational prestige and annual income are time-varying variables measured from 1999-2009. Victimization effects were tested for moderation by sex, race, and ethnicity in the multivariate models. RESULTS: Approximately half of our sample reported at least one instance of childhood victimization before the age of 18. Major findings include 1) childhood victimization resulted in slower income and prestige growth over time, and 2) mediation analyses suggested that this slower prestige and earnings arose because victims did not get the same amount of education as non-victims. CONCLUSIONS: Results indicated that the consequences of victimization negatively affected economic success throughout young adulthood, primarily by slowing the growth in prosperity due to lower education levels.

Visual acuity and increased mortality: the role of allostatic load and functional status.

PURPOSE: Poor vision may detrimentally impact functional status and affect allostatic load (AL), a measure of cumulative physiological wear and tear on the body's regulatory systems. We examined the direct effects of visual acuity (VA) on mortality and its indirect effect on mortality through its impact on functional status and AL in older adults. METHODS: Data from 4981 participants (age ≥ 60 years) from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) with mortality linkage through 2006 were analyzed. Functional status was assessed by activities of daily living (ADL) and instrumental activities of daily living (IADL). The AL index was composed of 10 biomarkers: systolic and diastolic blood pressures, body mass index (BMI), glycosylated hemoglobin, total cholesterol, triglycerides, albumin, C-reactive protein, homocysteine, and creatinine clearance. Visual acuity was categorized as no (20/20-20/25), mild (20/30-20/40), moderate (20/50-20/80), or severe (≥20/200) visual impairment. Structural equation modeling using three mediating variables representing ADL, IADL, and AL examined the effects of VA on all-cause and cardiovascular disease (CVD)-related mortality. RESULTS: Adjusting for all covariates, a one-unit change in VA category increased mortality risk (hazard ratio [HR] = 1.17; 95% confidence interval [CI] 1.05, 1.32); IADL and AL predicted mortality (HR = 1.15; CI 1.10, 1.20 and HR = 1.13; CI 1.06, 1.20, respectively). Activities of daily living did not predict mortality (HR = 0.98; CI 0.91, 1.05). Worse VA was associated with increased AL (ß = 0.11; P = 0.013) and worse IADL (ß = 1.06; P < 0.001). Worse VA increased mortality risk indirectly through AL (HR = 1.01; CI 1.00, 1.03) and IADL (HR = 1.16; CI 1.09, 1.23). The total effect of VA on mortality including through IADL and AL was HR = 1.38 (CI 1.23, 1.54). Similar but slightly stronger patterns of association were found when examining CVD-related mortality, but not cancer-related mortality. CONCLUSIONS: Allostatic load and particularly IADL may function as mediators between VA impairment and mortality. Older adults with VA impairment could potentially benefit from interventions designed to prevent IADL functional status decline to reduce the risk of mortality.

The health of young US workers.

OBJECTIVES: To provide an overview of the health status of young US workers across four domains: functional health, physical and psychological health, health behavior, and health care utilization. METHODS: Pooled data from the 2004 to 2010 National Health Interview Survey were analyzed for 11,279 US workers aged 18 to 24 years, representing an estimated 16.9 million workers annually. Thirty-nine health indicators were examined and compared across nine occupational groups. RESULTS: Compared with other occupational groups, craft workers and laborers and helpers had the highest prevalence of risky health behaviors, including current smoking and risky drinking, as well as fewer reported visits to a primary care physician in the past year. CONCLUSIONS: Young workers engage in risky health behaviors, and may benefit from targeted workplace interventions to mitigate the potentially negative long-term effects on health and well-being.

Dilated eye examination screening guideline compliance among patients with diabetes without a diabetic retinopathy diagnosis: the role of geographic access.

OBJECTIVE: To estimate the prevalence of, and factors associated with, dilated eye examination guideline compliance among patients with diabetes mellitus (DM), but without diabetic retinopathy. RESEARCH DESIGN AND METHODS: Utilizing the computerized billing records database, we identified patients with International Classification of Diseases (ICD)-9 diagnoses of DM, but without any ocular diagnoses. The available medical records of patients in 2007-2008 were reviewed for demographic and ocular information, including visits through 2010 (n=200). Patients were considered guideline compliant if they returned at least every 15 months for screening. Participant street addresses were assigned latitude and longitude coordinates to assess their neighborhood socioeconomic status (using the 2000 US census data), distance to the screening facility, and public transportation access. Patients not compliant, based on the medical record review, were contacted by phone or mail and asked to complete a follow-up survey to determine if screening took place at other locations. RESULTS: The overall screening compliance rate was 31%. Patient sociodemographic characteristics, insurance status, and neighborhood socioeconomic measures were not significantly associated with compliance. However, in separate multivariable logistic regression models, those living eight or more miles from the screening facility were significantly less likely to be compliant relative to those living within eight miles (OR=0.36 (95% CI 0.14 to 0.86)), while public transit access quality was positively associated with screening compliance (1.34 (1.07 to 1.68)). CONCLUSIONS: Less than one-third of patients returned for diabetic retinopathy screening at least every 15 months, with transportation challenges associated with noncompliance. Our results suggest that reducing transportation barriers or utilizing community-based screening strategies may improve compliance.