Variation in Trust in Cancer Information Sources by Perceptions of Social Media Health Mis- and Disinformation and by Race and Ethnicity Among Adults in the United States: Cross-Sectional Study.

BACKGROUND: Mis- and disinformation on social media have become widespread, which can lead to a lack of trust in health information sources and, in turn, lead to negative health outcomes. Moreover, the effect of mis- and disinformation on trust in information sources may vary by racial and ethnic minoritized populations. OBJECTIVE: We evaluated how trust in multiple sources of cancer information varied by perceptions of health mis- and disinformation on social media and by race and ethnicity. METHODS: Cross-sectional, nationally representative survey data from noninstitutionalized adults in the United States from the 2022 Health Information National Trends Survey 6 (HINTS 6) were analyzed (N=4137). The dependent variable measured the level of trust in cancer information sources. The independent variables were perceptions about health mis- and disinformation on social media and race and ethnicity. Multivariable logistic regression models were adjusted for survey weight and design, age, birth gender, race and ethnicity, marital status, urban/rural designation, education, employment status, feelings about household income, frequency of social media visits, and personal and family history of cancer. We also tested the interaction effect between perceptions of social media health mis- and disinformation and participants' self-reported race and ethnicity. RESULTS: Perception of "a lot of" health mis- and disinformation on social media, relative to perception of "less than a lot," was associated with a lower likelihood of high levels of trusting cancer information from government health agencies (odds ratio [OR] 0.60, 95% CI 0.47-0.77), family or friends (OR 0.56, 95% CI 0.44-0.71), charitable organizations (OR 0.78, 95% CI 0.63-0.96), and religious organizations and leaders (OR 0.64, 95% CI 0.52-0.79). Among White participants, those who perceived a lot of health mis- and disinformation on social media were less likely to have high trust in cancer information from government health agencies (margin=61%, 95% CI 57%-66%) and family or friends (margin=49%, 95% CI 43%-55%) compared to those who perceived less than a lot of health mis- and disinformation on social media. Among Black participants, those who perceived a lot of health mis- and disinformation on social media were less likely to have high trust in cancer information from religious organizations and leaders (margin=20%, 95% CI 10%-30%) compared to participants who perceived no or a little health mis- and disinformation on social media. CONCLUSIONS: Certain sources of cancer information may need enhanced support against the threat of mis- and disinformation, such as government health agencies, charitable organizations, religious organizations and leaders, and family or friends. Moreover, interventions should partner with racial and ethnically minoritized populations that are more likely to have low trust in certain cancer information sources associated with mis- and disinformation on social media.

Health Care Access and Utilization and the Latino Health Paradox.

BACKGROUND: The Latino health paradox is the phenomenon whereby recent Latino immigrants have, on average, better health outcomes on some indicators than Latino immigrants who have lived in the United States longer and US-born Latinos and non-Latino Whites. This study examined whether the paradox holds after accounting for health care access and utilization. METHODS: The 2019-2020 National Health Interview Survey data were used. The main predictors included population groups of foreign-born and US-born Latinos (Mexican or non-Mexican) versus US-born non-Latino Whites. Predicted probabilities of health outcomes (self-reported poor/fair health, overweight/obesity, hypertension, coronary heart disease, diabetes, cancer, and depression) were calculated and stratified by length of residence in the United States (<15 or ≥15 years) among foreign-born Latinos and sex (female or male). Multivariable analyses adjusted for having a usual source of care other than the emergency department, health insurance, a doctor visit in the past 12 months, predisposing and enabling factors, and survey year. RESULTS: After adjusting for health care access, utilization, and predisposing and enabling factors, foreign-born Latinos, including those living in the United States ≥15 years, had lower predicted probabilities for most health outcomes than US-born non-Latino Whites, except overweight/obesity and diabetes. US-born Latinos had higher predicted probabilities of overweight/obesity and diabetes and a lower predicted probability of depression than US-born non-Latino Whites. CONCLUSIONS: In this national survey, the Latino health paradox was observed after adjusting for health care access and utilization and predisposing and enabling factors, suggesting that, although these are important factors for good health, they do not necessarily explain the paradox.

A Price Too High: Injury and Assault among Delivery Gig Workers in New York City.

The occupational health burden and mechanisms that link gig work to health are understudied. We described injury and assault prevalence among food delivery gig workers in New York City (NYC) and assessed the effect of job dependence on injury and assault through work-related mechanisms and across transportation modes (electric bike and moped versus car). Data were collected through a 2022 survey commissioned by the NYC Department of Consumer and Worker Protection among delivery gig workers between October and December 2021 in NYC. We used modified Poisson regression models to estimate the adjusted prevalence rate ratio associations between job dependence and injury and assault. Of 1650 respondents, 66.9% reported that food delivery gig work was their main or only job (i.e., fully dependent). About 21.9% and 20.8% of respondents reported being injured and assaulted, respectively. Injury and assault were more than twice as prevalent among two-wheeled drivers, in comparison to car users. Fully dependent respondents had a 1.61 (95% confidence interval (CI) 1.20, 2.16) and a 1.36 (95% CI 1.03, 1.80) times greater prevalence of injury and assault, respectively, than partially dependent respondents after adjusting for age, sex, race and ethnicity, language, employment length, transportation mode, and weekly work hours. These findings suggest that fully dependent food delivery gig workers, especially two-wheeled riders, are highly vulnerable to the negative consequences of working conditions under algorithmic management by the platforms. Improvements to food delivery gig worker health and safety are urgently needed, and company narratives surrounding worker autonomy and flexibility need to be revisited.

Trusting information on cancer varies by source of information and political viewpoint.

PURPOSE: This study investigated how trusting information on cancer varies by the source of information and political viewpoint. METHODS: This study used cross-sectional survey data from the 2020 Health Information National Trends Survey (HINTS). The study comprised a sample of 2949 adults 18 years and older. The outcome variable was measured by assessing respondents' trust in cancer-related information from various sources, including religious organizations and leaders, government health agencies, charitable organizations, family or friends, and doctors. Political viewpoint was measured as liberal, moderate, and conservative. Multivariate linear probability models were estimated and adjusted for individual-level characteristics. RESULTS: Multivariate analysis found that conservatives (73%, 95% CI = 68-78%) were significantly less likely to trust information on cancer from government health agencies compared to liberals (84%, 95% CI = 80-88%). There was no statistically significant difference in trusting government health agencies between liberals and moderates (80%, 95% CI = 76-84%). Both moderates (27%, 95% CI = 21-34%) and conservatives (34%, 95% CI = 29-39%) were more likely to trust information on cancer from religious organizations and leaders compared to liberals (19%, 95% CI = 13-24%). The relationship between political viewpoint and trust of doctors, family or friends, and charitable organizations were not statistically significant. CONCLUSION: Compared to liberals, conservatives are more likely to trust information on cancer from religious organizations and leaders and less likely to trust government health agencies when adjusting for other covariates. This finding emphasizes the role of political viewpoint in shaping individuals' perceptions of information sources and cancer-related information.

Unmet need for medical care among Medicare beneficiaries by health insurance literacy and disability.

BACKGROUND: Navigating the US healthcare system requires considerable health insurance literacy, especially for adults with disabilities. Limited health insurance literacy may lead to suboptimal treatment, leading to unmet need for medical care. OBJECTIVE: We examined whether unmet need for medical care among Medicare beneficiaries differs by health insurance literacy and disability status. METHODS: Using data from the 2010-2019 Medicare Current Beneficiary Survey, we identified 48,989 Medicare beneficiaries, including those in traditional Medicare and Medicare Advantage. Our outcomes were three measures of unmet need for medical care. Our key independent variables were health insurance literacy and disability status. For each outcome, we estimated the adjusted rates of reporting unmet need for medical care by health insurance literacy and disability while controlling for individual-level characteristics. RESULTS: Unmet need for medical care was higher among Medicare beneficiaries with disabilities across all outcomes, but the highest rates were among those with disabilities and limited health insurance literacy (27.4% [95% CI: 24.9-29.9] for experiencing delayed care, 17.7% [95% CI: 15.6-19.9] for experiencing trouble in getting needed care, and 20.8% [95% CI: 18.5-23.1] for not seeing a doctor despite medical need). Notably, there was an increasing trend in experiencing delayed care and trouble getting needed care among Medicare beneficiaries with disabilities over time, especially for those with limited health insurance literacy. CONCLUSIONS: Medicare beneficiaries with disabilities and limited health insurance literacy face disproportionate unmet need for medical care. Policies are needed to ensure that these beneficiaries have access to clear and accessible health insurance information.

Social media users' perceptions about health mis- and disinformation on social media.

This study used recently released nationally representative data with new measures on health information seeking to estimate the prevalence and predictors of adult social media users' perceptions of health mis- and disinformation on social media. Most adults who use social media perceive some (46%) or a lot (36%) of false or misleading health information on social media, but nearly one-fifth reported either none or a little (18%). More than two-thirds of participants reported that they were unable to assess social media information as true or false (67%). Our study identified certain population groups that might be a focus of future intervention work, such as participants who use social media to make decisions. The perception by social media users that false and misleading health information on social media is highly prevalent may lend greater urgency to mitigate the spread of false or misleading health information that harms public health.

Is use of a smuggler to cross the US-Mexico border associated with mental health problems among undocumented immigrants from Mexico?

Although numerous studies have found that Latine immigrants to the United States (US) have better health outcomes on average than persons born in the US, studies of persons living in Mexico have found that undocumented immigrants have worse health, especially those that were deported, compared to Mexican citizens that never migrated or migrated with authorization. However, the health outcomes of Mexican migrants using a smuggler to cross the US-Mexico border is a gap in the literature. We hypothesized that undocumented immigrant adults who used a smuggler to cross the US-Mexico border would be more likely to report mental health problems upon return to Mexico compared with undocumented immigrant adults that did not use a smuggler. We analyzed nationally representative, cross-sectional survey data of 1,563 undocumented immigrants currently living in Mexico. Most undocumented immigrants in the sample (87%) used a smuggler. Use of a smuggler by undocumented immigrant adults was associated with a 4.7% higher prevalence of emotional or psychiatric problems compared to undocumented immigrant adults that did not use a smuggler. We conclude that modality of ingress into the US is a risk factor for poorer mental health among undocumented immigrant adults.

Trends in Routine Checkup Within the Past Year Following a Hurricane.

The goal of this nationally representative, cross-sectional study is to evaluate the trends in routine checkup within the last year associated with exposure to a hurricane. We compared Puerto Rico (2017 Hurricane Irma, Hurricane Maria), Texas (2017 Hurricane Harvey), and Florida (2017 Hurricane Irma, Hurricane 2018 Michael) with states that had a category 1-2 hurricane make landfall from 2014 to 2019: Georgia, Louisiana, Mississippi, North Carolina, and South Carolina. We found that states impacted by a major hurricane in 2017 had a drop in routine checkup while the states that experienced a category 1-2 landfall did have a change in that year. By the following year, all states reported an increase in routine checkup suggesting that the disruption in routine care was temporary.

Unmet Need for Medical Care Among Fee-for-Service Medicare Beneficiaries with High and Low Need.

BACKGROUND: Unmet need for medical care is common among Medicare beneficiaries, but less is known whether unmet need differs between those with high and low levels of need. OBJECTIVE: To examine unmet need for medical care among fee-for-service (FFS) Medicare beneficiaries by level of care need. DESIGN, SETTING, AND PARTICIPANTS: We included 29,123 FFS Medicare beneficiaries from the 2010-2016 Medicare Current Beneficiary Survey. MAIN MEASURES: Our outcomes included three measures of unmet need for medical care. We also examined the reasons for not obtaining needed medical care. Our primary independent variable was a categorization of groups by levels of care need: those with low need (the relatively healthy and those with simple chronic conditions) and those with high need (those with minor complex chronic conditions, those with major complex chronic conditions, the frail, and the non-elderly disabled). RESULTS: The rates of reporting unmet need for medical care were highest among the non-elderly disabled (23.5% [95% CI: 19.8-27.3] for not seeing a doctor despite medical need, 23.8% [95% CI: 20.0-27.6] for experiencing delayed care, and 12.9% [95% CI: 10.2-15.6] for experiencing trouble in getting needed care). However, the rates of reporting unmet need were relatively low among the other groups (ranging from 3.1 to 9.9% for not seeing a doctor despite medical need, from 3.4 to 5.9% for experiencing delayed care, and from 1.9 to 2.9% for experiencing trouble in getting needed care). The most common reason for not seeing a doctor despite medical need was concerns about high costs for the non-elderly disabled (24%), but perception that the issue was not too serious was the most common reason for the other groups. CONCLUSIONS AND RELEVANCE: Our findings suggest the need for targeted policy interventions to address unmet need for non-elderly disabled FFS Medicare beneficiaries, especially for improving affordability of care.

Undocumented Latino Immigrants and the Latino Health Paradox.

INTRODUCTION: Despite having worse healthcare access and other social disadvantages, immigrants have, on average, better health outcomes than U.S.-born individuals. For Latino immigrants, this is known as the Latino health paradox. It is unknown whether this phenomenon applies to undocumented immigrants. METHODS: This study used restricted California Health Interview Survey data from 2015 to 2020. Data were analyzed to test the relationships between citizenship/documentation status and physical and mental health among Latinos and U.S.-born Whites. Analyses were stratified by sex (male/female) and length of U.S. residence (<15 years/>= 15 years). RESULTS: Undocumented Latino immigrants had lower predicted probabilities of reporting any health condition, asthma, and serious psychological distress and had a higher probability of overweight/obesity than U.S.-born Whites. Despite having a higher probability of overweight/obesity, undocumented Latino immigrants did not have probabilities of reporting diabetes, high blood pressure, or heart disease different from those of U.S.-born Whites after adjusting for having a usual source of care. Undocumented Latina women had a lower predicted probability of reporting any health condition and a higher predicted probability of overweight/obesity than U.S.-born White women. Undocumented Latino men had a lower predicted probability of reporting serious psychological distress than U.S.-born White men. There were no differences in outcomes when comparing shorter- with longer-duration undocumented Latino immigrants. CONCLUSIONS: This study observed that the Latino health paradox may express patterns for undocumented Latino immigrants that are different from those for other Latino immigrant groups, emphasizing the importance of accounting for documentation status when conducting research on this population.

Access to care and satisfaction with care among fee-for-service Medicare beneficiaries by level of care need.

BACKGROUND: Variation among fee-for-service (FFS) Medicare beneficiaries by level of care need for access to care and satisfaction with care is unknown. OBJECTIVE: We examined access to care and satisfaction with care among FFS Medicare beneficiaries by level of care need. METHODS: We employed a cross-sectional study design. Using the Medicare Current Beneficiary Survey, we categorized 17,967 FFS Medicare beneficiaries into six groups based on level of care need: the relatively healthy (11.0%), those with simple chronic conditions (26.1%), those with minor complex chronic conditions (28.6%), those with major complex chronic conditions (14.2%), the frail (6.2%), and the non-elderly disabled or end-stage renal disease (ESRD) (13.9%). Outcome measures included multiple indicators for access to care and satisfaction with care. For each outcome, we conducted a linear probability model while adjusting for individual-level and county-level characteristics and estimated the adjusted value of the outcome by level of care need. RESULTS: The non-elderly disabled or ESRD were more likely to experience limited access to care and poor satisfaction with care than other five care need groups. Particularly, the rates of reporting trouble accessing needed medical care were the highest among the non-elderly disabled or ESRD (12.4% [95% CI: 9.6-15.3] vs. 2.1 [95% CI: 1.5-2.8] to 2.5 [95% CI: 1.6-3.5]). The leading reason for trouble accessing needed care among the non-elderly disabled or ESRD was attributable to affordability (59.6%). CONCLUSIONS: Policymakers need to develop targeted approaches to improve access to care and satisfaction with care for the non-elderly with a disability or ESRD.

Using machine learning to impute legal status of immigrants in the National Health Interview Survey.

We describe a novel machine learning method of imputing legal status for immigrants using nationally representative survey data from the Survey of Income and Program Participation (SIPP) and the National Health Interview Survey (NHIS). K-nearest Neighbor (KNN) classifier and Random Forest (RF) Algorithm machine learning were described as novel imputation methods compared to established regression-based imputation. After validating the imputation methods using sensitivity, specificity, positive predictive value (PPV) and accuracy statistics, the Random Forest Algorithm was more accurate in identifying undocumented immigrants and minimized bias in both socio-demographic variables included in the imputation, and unobserved health variables relative to regression-based imputation and KNN.•We developed a new machine learning method of imputing legal status for immigrants that can be used with nationally representative, publicly available data.•Our findings indicate that using machine learning to impute legal status of immigrants, specifically the Random Forest Algorithm, was more accurate in identifying undocumented immigrants and minimized bias relative to other imputation methods.

A healthy migrant effect? Estimating health outcomes of the undocumented immigrant population in the United States using machine learning.

This paper investigated whether the commonly observed immigrant health advantage persists among undocumented immigrants in the U.S. and provides nationally representative evidence on the health of this vulnerable population. Data were derived from pooled cross-sections of the National Health Interview Survey (NHIS, 2000-2018). The legal status of foreign-born NHIS respondents is imputed using a non-parametric machine learning model built based on information from the 2004, 2008 and 2014 cohorts of the Survey of Income and Program Participation (SIPP). Multivariate logistic regression analysis indicated that, despite exposure to numerous additional risk factors, the undocumented population experienced a more pronounced Healthy Migrant Effect, with lower odds of reporting fair or poor self-rated health, any physician-diagnosed chronic conditions or being obese. The observed patterns in undocumented health outcomes may be related to the additional challenges and exclusionary policies associated with undocumented migration that could in turn lead to a more pronounced selection of healthy and resilient individuals.

The impact of Medicaid funding structures on inequities in health care access for Latinos in New York, Florida, and Puerto Rico.

OBJECTIVE: To study the impact of Medicaid funding structures before and after the implementation of the Affordable Care Act (ACA) on health care access for Latinos in New York (Medicaid expansion), Florida (Medicaid non-expansion), and Puerto Rico (Medicaid block grant). DATA SOURCES: Pooled state-level data for New York, Florida, and Puerto Rico from the 2011-2019 Behavioral Risk Factor Surveillance System and data from the 2011-2019 American Community Survey and Puerto Rico Community Survey. STUDY DESIGN: Cross-sectional study using probit with predicted margins to separately compare four health care access measures among Latinos in New York, Florida, and Puerto Rico (having health insurance coverage, having a personal doctor, delayed care due to cost, and having a routine checkup). We also used difference-in-differences to measure the probability percent change of having any health insurance and any public health insurance before (2011-2013) and after (2014-2019) the ACA implementation among citizen Latinos in low-income households. DATA COLLECTION: The sample consisted of Latinos aged 18-64 residing in New York, Florida, and Puerto Rico from 2011 to 2019. PRINCIPAL FINDINGS: Latinos in Florida had the lowest probability of having health care access across all four measures and all time periods compared with those in New York and Puerto Rico. While Latinos in Puerto Rico had greater overall health care access compared with Latinos in both states, health care access in Puerto Rico did not change over time. Among citizen Latinos in low-income households, New York had the greatest post-ACA probability of having any health insurance and any public health insurance, with a growing disparity with Puerto Rico (9.7% any [1.6 SE], 5.2% public [1.8 SE]). CONCLUSIONS: Limited Medicaid eligibility (non-expansion of Florida's Medicaid program) and capped Medicaid funds (Puerto Rico's Medicaid block grant) contributed to reduced health care access over time, particularly for citizen Latinos in low-income households.

Association of health insurance coverage and probability of dying in an emergency department or hospital from a motor vehicle traffic injury.

OBJECTIVE: Describe the association of health insurance coverage with the odds of mortality in an emergency department (ED) or hospital for adult victims of a motor vehicle crash. METHODS: This cross-sectional study pooled and averaged 6 years of data, 2009-2014, from the Nationwide Emergency Department Sample (NEDS). Our analysis was restricted to patients 20-85 years old that were treated in an ED for an injury sustained from a motor vehicle traffic crash (N = 2,203,407 average annual hospital discharges). The outcome variables were whether the motor vehicle crash victim died in the ED or hospital. The predictor variable was health insurance status that was measured as uninsured, Medicare, Medicaid, private insurance, and other health insurance. RESULTS: Most patients that died had some form of health insurance with less than a quarter classified as uninsured (23%). Nearly half of the patients that died had private insurance (48%) followed by Medicare (13%), Medicaid (9%), and other insurance (8%). Compared to the uninsured, the multivariate adjusted odds ratios (ORs) for death were significantly (P < 0.001) lower for Medicare (OR = 0.83, 95% confidence interval [CI] = 0.76-0.92), Medicaid (OR = 0.76, 95% CI = 0.69-0.84), private insurance (OR = 0.63, 95% CI = 0.58-0.68), and other insurance (OR = O.61, 95% CI = 0.54-0.70). CONCLUSION: After accounting for hospital and patient characteristics, lack of health insurance was associated with a higher likelihood of death for patients admitted to an ED or hospital for injuries sustained from a motor vehicle crash.

Association of Maternal-Clinician Ethnic Concordance With Latinx Youth Receipt of Family-Centered Care.

Importance: Disparities in medical home provisions, including receipt of family-centered care (FCC), have persisted for Latinx youths in the US. Objective: To examine the association between maternal-clinician ethnic concordance and receipt of FCC among US-born Latinx youths. Design, Setting, and Participants: A cross-sectional secondary analysis of data from the Medical Expenditure Panel Survey from January 1, 2010, to December 31, 2017, was conducted. Data analysis was performed from January 6 to February 3, 2020. Latinx youths (age, ≤17 years) born in the US who had a usual source of care and used care in the past year, their Latina mothers (age, 18-64 years), and youths' health care clinician characteristics (eg, race, ethnicity, and sex) were evaluated using χ2 tests and propensity-score matching methods. Main Outcomes and Measures: Maternal reports on whether their youths' clinician listened carefully to the parent, explained things in a way the parent could understand, showed respect, and spent enough time with the patient. Results: There were 2515 US-born Latinx youths with linked maternal characteristics during the study period; 51.67% (95% CI, 48.87%-54.45%) of the youths were male, mean (SD) age was 8.48 (0.17) years (30.86% [95% CI, 28.39%-33.44%] were between ages 5 and 9 years), 61.53% (95% CI, 57.15%-65.74%) had public insurance coverage, and 39.89% (95% CI, 32.33%-47.89%) had mothers who were ethnically concordant with the youths' medical care clinician. We found that for youths with maternal-clinician ethnic concordance, the probabilities of reporting FCC were significantly higher than they would have been in the absence of concordance: that the medical care clinician listened carefully to the parent (average treatment effect on the treated [ATET], 5.44%; 95% CI, 2.14%-8.74%), explained things in a way the parent could understand (ATET, 4.82%; 95% CI, 1.60%-8.03%), showed respect for what the parent had to say (ATET, 5.51%; 95% CI, 2.58%-8.45%), and spent enough time with the patient (ATET, 5.28%; 95% CI, 1.68%-8.88%). Conclusions and Relevance: Given the increase of Latinx populations and the simultaneous shortage of underrepresented minority health care clinicians, the findings of this study suggest that increasing the number of clinicians from underrepresented minority backgrounds and ethnic-concordant parental-clinician relationships may help reduce disparities in receipt of medical home provision among US-born Latinx youths.

Primary Source of Information About COVID-19 as a Determinant of Perception of COVID-19 Severity and Vaccine Uptake : Source of Information and COVID-19.

BACKGROUND: Identifying the key determinants of vaccine uptake in the context of coronavirus disease 2019 (COVID-19) is critical to increasing vaccination rates, especially for Medicare beneficiaries. OBJECTIVE: We examined how the source of COVID-19 information shapes perceptions of COVID-19 severity and the likelihood of COVID-19 vaccine uptake among Medicare beneficiaries. DESIGN, SETTING, AND PARTICIPANTS: We included 6478 Medicare beneficiaries from the Fall 2020 Medicare Current Beneficiary Survey COVID-19 Supplement. MAIN MEASURES: Our dependent variables were perception of COVID-19 severity and the likelihood of getting a COVID-19 vaccine. Our key independent variable was the beneficiaries' primary source of information about COVID-19 and included six mutually exclusive categories: traditional news sources, guidance from government officials, social media, other webpages/Internet, friends or family members, or health care providers. KEY RESULTS: Compared to those relying on traditional news sources or guidance from governmental officials, those relying on other sources had lower perceptions of COVID-19 severity and lower likelihood of getting a COVID-19 vaccine. Those relying on social media had the lowest levels in all measures (65.5% for those who agreed that COVID-19 is more contagious than the flu, 62.1% for those who agreed that COVID-19 is more deadly than the flu, 87.8% for those who agreed that all should take COVID-19 precautions, and 43.3% for those who answered that they would get a COVID-19 vaccine). The likelihood of COVID-19 vaccine uptake was also low among those relying on health care providers (55.5%). These findings remained similar even after adjusting for perceptions of COVID-19 severity in the relationship between the source of COVID-19 information and the likelihood of COVID-19 vaccine uptake. CONCLUSIONS: The primary source of information that Medicare beneficiaries used to learn about COVID-19 may play a critical role in shaping perceptions of COVID-19 severity and attitudes toward getting a COVID-19 vaccine.

The Other US Border: Health Insurance Coverage Among Latino Immigrants In Puerto Rico.

Puerto Rico is a US territory and a popular destination for Latino immigrants in the Caribbean. Even with few language and cultural barriers, however, many Latino immigrants in Puerto Rico are uninsured. Using data from the 2014-19 Puerto Rico Community Survey, we examined inequities in health insurance coverage for non-Puerto Rican Latinos ages 18-64 living in Puerto Rico according to citizenship status and Latino subgroup (Dominican, Cuban, Mexican, and other Latino). After controlling for potential confounders, we found that noncitizen Dominicans had a significantly lower probability of having any health insurance (57.2 percent) and having any private insurance (31.5 percent). Regardless of similarities in culture and language, Latino immigrants on the island, particularly Dominicans, experience major health insurance coverage inequities. Considering that Puerto Rico's immigration system is regulated by US federal statute, both federal and local policy makers should acknowledge and focus on reducing these immigrant disparities in health insurance coverage.

Trends in Self-reported Forgone Medical Care Among Medicare Beneficiaries During the COVID-19 Pandemic.

Importance: Evidence suggests that the COVID-19 pandemic has had a negative association with medical care access. As prior studies mainly focused on the initial stage of the COVID-19 pandemic, less is known about how trends in forgone medical care changed over time. Objective: To examine trends in and reasons for forgone medical care among Medicare beneficiaries during the COVID-19 pandemic. Design Setting and Participants: This cross-sectional study analyzed Medicare beneficiaries using data from 3 waves of survey data from the Medicare Current Beneficiary Survey COVID-19 Supplement (Summer 2020, Fall 2020, and Winter 2021). Data analyses were conducted between July and August 2021. Exposures: Date of interview. Main Outcomes and Measures: Self-reported forgone medical care because of COVID-19. Results: A total of 23 058 Medicare beneficiaries were included (13 005 women [56.4%]; 10 445 [45.3%] 75 years old and older). The survey response rates for each wave were 72.6%, 78.95, and 79.6%, respectively. The rates of reported forgone medical care because of COVID-19 decreased from the week of June 7, 2020, to the week of April 4 to 25, 2021, but the largest difference in the rates was found between June 7 and July 12, 2020 (22.4% to 15.9%). Physician-driven factors accounted for about 70% of the forgone medical care. The proportion of those who reported forgoing medical care because of physician-driven factors tended to decrease from 66.2% in the week of July 7, 2020, to 44.7% in the weeks of April 4 to 25, 2021. The likelihood of forgone medical care was 4 percentage points (95% CI, 0.03-0.05) higher among those who reported feeling more stressed or anxious than those who did not, 3 percentage points (95% CI, 0.01-0.04) higher among those who reported feeling more lonely or sad than those who did not, and 3 percentage points (95% CI, 0.01-0.04) higher among those who reported feeling less socially connected than those who did not. Conclusions and Relevance: The results of this cross-sectional survey study suggest that the COVID-19 pandemic may exacerbate existing barriers to care and lead Medicare beneficiaries to delay needed care. Policy makers must continue to identify effective means of meeting the forgone care backlog and maintaining continuity of care, especially for those with mental health problems.

Allostatic Load Among U.S.- and Foreign-Born Whites, Blacks, and Latinx.

INTRODUCTION: The objective of this study is to examine how allostatic load, a multidimensional measure of the body's cumulative response to stressors experienced throughout the life course, has changed over time and by age among U.S.- and foreign-born Whites, Blacks, and Latinx. METHODS: Data were from 26,818 adult participants in the 2005-2018 National Health and Nutrition Examination Survey, a national repeated cross-sectional study. Allostatic load was measured based on 10 indicators of cardiovascular, metabolic, and immunologic risk. The analyses were conducted in March 2020. RESULTS: Allostatic load increased over time across all groups. The difference between the first and last survey cycle was greatest among U.S.-born Black women (from 2.74 in 2005-2006 to 3.02 in 2017-2018), U.S.-born Latino men (from 2.69 to 3.09) and foreign-born Latino men (from 2.58 to 2.87). Aging gradients in allostatic load were steepest among foreign-born Blacks of both genders and foreign-born Latina women and flattest among U.S.-born and foreign-born Whites. CONCLUSIONS: Chronic exposure to stressors leads to an erosion of health that is particularly severe among foreign-born Blacks and Latinx. Policies should seek to reduce exposure to structural and environmental risks and to ensure equitable opportunities to achieve optimal health among racial/ethnic minorities and immigrants.