Associations between perinatal risk and physical health in pre-adolescence in the Adolescent Brain Cognitive Development (ABCD) Study®: the unexpected relationship with sleep disruption.

BACKGROUND: To investigate relationships among different physical health problems in a large, sociodemographically diverse sample of 9-to-10-year-old children and determine the extent to which perinatal health factors are associated with childhood physical health problems. METHODS: A cross-sectional study was conducted utilizing the Adolescent Brain Cognitive Development℠ (ABCD) Study (n = 7613, ages 9-to-10-years-old) to determine the associations among multiple physical health factors (e.g., prenatal complications, current physical health problems). Logistic regression models controlling for age, sex, pubertal development, household income, caregiver education, race, and ethnicity evaluated relationships between perinatal factors and childhood physical health problems. RESULTS: There were significant associations between perinatal and current physical health measures. Specifically, those who had experienced perinatal complications were more likely to have medical problems by 9-to-10 years old. Importantly, sleep disturbance co-occurred with several physical health problems across domains and developmental periods. CONCLUSION: Several perinatal health factors were associated with childhood health outcomes, highlighting the importance of understanding and potentially improving physical health in youth. Understanding the clustering of physical health problems in youth is essential to better identify which physical health problems may share underlying mechanisms. IMPACT: Using a multivariable approach, we investigated the associations between various perinatal and current health problems amongst youth. Our study highlights current health problems, such as sleep problems at 9-to-10 years old, that are associated with a cluster of factors occurring across development (e.g., low birth weight, prenatal substance exposure, pregnancy complications, current weight status, lifetime head injury). Perinatal health problems are at large, non-modifiable (in this retrospective context), however, by identifying which are associated with current health problems, we can identify potential targets for intervention and prevention efforts.

Socioeconomic and racial/ethnic disparities in postpartum consultation for mental health concerns among US mothers.

Limited research has examined factors that impact access to postpartum mental healthcare. We investigated the predisposing, enabling, and need factors associated with postpartum consultation for mental health concerns in US mothers with or without depressive symptoms and examined potential disparities in access. We utilized cross-sectional data from the Listening to Mothers II Survey, the second national US survey of women's childbearing experiences. The survey recruited 1573 women, aged 18-45 years, who spoke English and had given birth. Depressive symptoms were measured with the Postpartum Depression Screening Scale (PDSS-SF). The dependent variable was postpartum consultation for mental health concerns. Logistic regression analyses showed that mothers with scores of 14-21 and 22-35 on the PDSS-SF had higher odds of consulting a provider for mental health concerns (OR 3.97; OR 12.91). Latinas had lower odds of seeking mental health consultations than Whites (OR 0.39). Mothers who were employed prenatally full-time or part-time had lower odds of seeking consultations than non-employed mothers (OR 0.62; OR 0.52). Mothers with household incomes of $50,000-$74,999 had higher odds of seeking consultations than those with incomes less than $25,000 (OR 2.20). When regression analyses were restricted to mothers with PDSS-SF scores ≥ 14, findings were similar by race/ethnicity and prenatal employment. Significant depressive symptoms are common in women after giving birth and few sought any form of mental health consultation. Latinas and low-income women are less likely to seek postpartum mental health consultations. Mental health care interventions could be geared towards targeting these at-risk groups.

Determinants of breastfeeding initiation and cessation among employed mothers: a prospective cohort study.

BACKGROUND: The U.S. continues to have one of the lowest breastfeeding rates in the industrialized world. Studies have shown that full-time employment and early return to work decreased breastfeeding duration, but little is known about the relationship between leave policies and breastfeeding initiation and cessation. This study aimed to identify workplace-related barriers and facilitators associated with breastfeeding initiation and cessation in the first 6 months postpartum. METHODS: A prospective cohort study design was utilized to recruit 817 Minnesota women aged 18 and older while hospitalized for childbirth. Selection criteria included English-speaking, employed mothers with a healthy, singleton birth. These women were followed up using telephone interviews at 6 weeks, 12 weeks, and 6 months after childbirth. The main study outcomes were breastfeeding initiation, measured during hospital enrollment, and breastfeeding cessation by 6 months postpartum. RESULTS: Women were 30 years old; 86 % were White, and 73 % were married. Breastfeeding rates were 81 % at childbirth, 67 % at 6 weeks, 49 % at 12 weeks, and 33 % at 6 months postpartum. Logistic regression revealed the odds of breastfeeding initiation were higher for women who: held professional jobs, were primiparae, had graduate degree, did not smoke prenatally, had no breastfeeding problems, and had family or friends who breastfeed. Survival analyses showed the hazard for breastfeeding cessation by 6 months was: higher for women who returned to work at any time during the 6 months postpartum versus those who did not return, lower for professional workers, higher among single than married women, higher for every educational category compared to graduate school, and higher for those with no family or friends who breastfeed. CONCLUSIONS: While employer paid leave policy did not affect breastfeeding initiation or cessation, women who took shorter leaves were more likely to stop breastfeeding in the first 6 months postpartum. Future research should examine women's awareness of employer policies regarding paid and unpaid leave.

A longitudinal analysis of maternal depressive symptoms and children's food consumption and weight outcomes.

OBJECTIVE: Maternal depressive symptoms negatively impact mothers' parenting practices and children's development, but the evidence linking these symptoms to children's obesity is mixed. DESIGN: We use a large sample to examine contemporaneous and lagged associations between maternal depressive symptoms and children's BMI, obesity and food consumption, controlling for background characteristics. SETTING: Data from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), a longitudinal study of children from infancy through kindergarten in the USA, were collected at four waves from 2001 to 2007, when children were 9 months, 2 years, 4 years and 5½years of age, through surveys, child assessments and observations. SUBJECTS: A sub-sample of children from the ECLS-B is used (n 6500). RESULTS: Between 17 % and 19 % of mothers reported experiencing depressive symptoms; 17 % to 20 % of children were obese. Maternal depressive symptoms were associated with a small decrease in the likelihood her child was obese (0·8 percentage points) and with lower consumption of healthy foods. The duration of maternal depressive symptoms was associated with higher BMI (0·02 sd) among children whose parents lacked college degrees. CONCLUSIONS: Results indicate that mothers' depressive symptoms have small associations with children's food consumption and obesity. Among children whose parents lack college degrees, persistent maternal depressive symptoms are associated with slightly higher child BMI. Findings highlight the need to control for depression in analyses of children's weight. Interventions that consider maternal depression early may be useful in promoting healthy weight outcomes and eating habits among children.

Maternity leave duration and postpartum mental and physical health: implications for leave policies.

This study examines the association of leave duration with depressive symptoms, mental health, physical health, and maternal symptoms in the first postpartum year, using a prospective cohort design. Eligible employed women, eighteen years or older, were interviewed in person at three Minnesota hospitals while hospitalized for childbirth in 2001. Telephone interviews were conducted at six weeks (N = 716), twelve weeks (N = 661), six months (N = 625), and twelve months (N = 575) after delivery. Depressive symptoms (Edinburgh Postnatal Depression Scale), mental and physical health (SF-12 Health Survey), and maternal childbirth-related symptoms were measured at each time period. Two-stage least squares analysis showed that the relationship between leave duration and postpartum depressive symptoms is U-shaped, with a minimum at six months. In the first postpartum year, an increase in leave duration is associated with a decrease in depressive symptoms until six months postpartum. Moreover, ordinary least squares analysis showed a marginally significant linear positive association between leave duration and physical health. Taking leave from work provides time for mothers to rest and recover from pregnancy and childbirth. Findings indicate that the current leave duration provided by the Family and Medical Leave Act, twelve weeks, may not be sufficient for mothers at risk for or experiencing postpartum depression.

Are researchers in academic medicine flourishing? A survey of midcareer Ph.D. and physician investigators.

Introduction: Midcareer research faculty are a vital part of the advancement of science in U.S. medical schools, but there are troubling trends in recruitment, retention, and burnout rates. Methods: The primary sampling frame for this online survey was recipients of a single R01 or equivalent and/or K-award from 2013 to 2019. Inclusion criteria were 3-14 years at a U.S. medical school and rank of associate professor or two or more years as assistant professor. Forty physician investigators and Ph.D. scientists volunteered for a faculty development program, and 106 were propensity-matched controls. Survey items covered self-efficacy in career, research, work-life; vitality/burnout; relationships, inclusion, trust; diversity; and intention to leave academic medicine. Results: The majority (52%) reported receiving poor mentoring; 40% experienced high burnout and 41% low vitality, which, in turn, predicted leaving intention (P < 0.0005). Women were more likely to report high burnout (P = 0.01) and low self-efficacy managing work and personal life (P = 0.01) and to be seriously considering leaving academic medicine than men (P = 0.003). Mentoring quality (P < 0.0005) and poor relationships, inclusion, and trust (P < 0.0005) predicted leaving intention. Non-underrepresented men were very likely to report low identity self-awareness (65%) and valuing differences (24%) versus underrepresented men (25% and 0%; P < 0.0005). Ph.D.s had lower career advancement self-efficacy than M.D.s (P < .0005). Conclusions: Midcareer Ph.D. and physician investigators faced significant career challenges. Experiences diverged by underrepresentation, gender, and degree. Poor quality mentoring was an issue for most. Effective mentoring could address the concerns of this vital component of the biomedical workforce.

Prenatal health behaviors and postpartum depression: is there an association?

Postpartum depression is a prevalent mental disorder; however, scarce research has examined its association with prenatal health behaviors. This study investigated the associations of cigarette smoking, caffeine intake, and vitamin intake during pregnancy with postpartum depressive symptoms at 8 weeks after childbirth. Using a prospective cohort study design, participants were recruited from the postpartum floor at a hospital for women and newborns located in a northeastern city, from 2005 through 2008. Eligible women who were at least 18 years old and spoke English were interviewed in person while hospitalized for childbirth (N = 662). A follow-up home interview was conducted at 8 weeks postpartum with a 79% response rate (N = 526). Hierarchical regression analyses showed that smoking cigarettes anytime during pregnancy and not taking prenatal vitamins in the first trimester were significantly associated with worse depressive symptoms (Edinburgh Postnatal Depression Scale). Moreover, having a colicky infant, an infant that refuses feedings, being stressed out by parental responsibility, and having difficulty balancing responsibilities were stressors associated with worse depressive symptoms. Primary health care providers should consider evaluating women for risk of postpartum depression during their first prenatal visit, identifying prenatal health behaviors such as smoking and taking prenatal vitamins.

A Critical Review on the Complex Interplay between Social Determinants of Health and Maternal and Infant Mortality.

BACKGROUND: U.S. maternal and infant mortality rates constitute an important public health problem, because these rates surpass those in developed countries and are characterized by stark disparities for racial/ethnic minorities, rural residents, and individuals with less privileged socioeconomic status due to social determinants of health (SDoH). METHODS: A critical review of the maternal and infant mortality literature was performed to determine multilevel SDoH factors leading to mortality disparities with a life course lens. RESULTS: Black mothers and infants fared the worst in terms of mortality rates, likely due to the accumulation of SDoH experienced as a result of structural racism across the life course. Upstream SDoH are important contributors to disparities in maternal and infant mortality. More research is needed on the effectiveness of continuous quality improvement initiatives for the maternal-infant dyad, and expanding programs such as paid maternity leave, quality, stable and affordable housing, and social safety-nets (Medicaid, CHIP, WIC), in reducing maternal and infant mortality. Finally, it is important to address research gaps in individual, interpersonal, community, and societal factors, because they affect maternal and infant mortality and related disparities. CONCLUSION: Key SDoH at multiple levels affect maternal and infant health. These SDoH shape and perpetuate disparities across the lifespan and are implicated in maternal and infant mortality disparities.

Postpartum depressive symptoms and the combined load of paid and unpaid work: a longitudinal analysis.

PURPOSE: To investigate the effects of total workload and other work-related factors on postpartum depression in the first 6 months after childbirth, utilizing a hybrid model of health and workforce participation. METHODS: We utilized data from the Maternal Postpartum Health Study collected in 2001 from a prospective cohort of 817 employed women who delivered in three community hospitals in Minnesota. Interviewers collected data at enrollment and 5 weeks, 11 weeks, and 6 months after childbirth. The Edinburgh Postnatal Depression Scale measured postpartum depression. Independent variables included total workload (paid and unpaid work), job flexibility, supervisor and coworker support, available social support, job satisfaction, infant sleep problems, infant irritable temperament, and breastfeeding. RESULTS: Total average daily workload increased from 14.4 h (6.8 h of paid work; 7.1% working at 5 weeks postpartum) to 15.0 h (7.9 h of paid work; 87% working at 6 months postpartum) over the 6 months. Fixed effects regression analyses showed worse depression scores were associated with higher total workload, lower job flexibility, lower social support, an infant with sleep problems, and breastfeeding. CONCLUSIONS: Working mothers of reproductive years may find the study results valuable as they consider merging their work and parenting roles after childbirth. Future studies should examine the specific mechanisms through which total workload affects postpartum depressive symptoms.

Perinatal Depression: Challenges and Opportunities.

Perinatal depression (PND) is a major depressive episode during pregnancy or within 4 weeks after childbirth up to a year. Risk factors for PND include stressful life events, history of depression, poor social support, unplanned and unwanted pregnancies, poor relationship quality, current or previous abuse, and low socioeconomic status. This mental disorder has been shown to have negative effects on mothers' quality of life and their intimate relationships, birth outcomes, and breastfeeding likelihood, as well as long-term effects on children's cognitive and emotional development. To date, no nationally representative study has examined whether there are socioeconomic and/or racial/ethnic differences in PND. This study discusses the prevalence and risk factors for PND, as well as its health consequences for mothers and children, the reasons for its underreporting and undertreatment, the evidence for different screening instruments and different treatment options, and the existing supportive policies to address this disorder in the United States. We conclude with outlining next steps in addressing the gaps in the literature on PND.

The Potential for Health Information Technology Tools to Reduce Racial Disparities in Maternal Morbidity and Mortality.

Health information technology (health IT) potentially is a promising vital lever to address racial and ethnic, socioeconomic, and geographic disparities in maternal morbidity and mortality (MMM). This is especially relevant given that approximately 60% of maternal deaths are considered preventable.1-36 Interventions that leverage health IT tools to target the underlying drivers of disparities at the patient, clinician, and health care system levels potentially could reduce disparities in quality of care throughout the continuum (antepartum, intrapartum, and postpartum) of maternity care. This article presents an overview of the research (and gaps) on the potential of health IT tools to document SDoH and community-level geocoded data in EHR-based CDS systems, minimize implicit bias, and improve adherence to clinical guidelines and coordinated care to inform multilevel (patient, clinician, system) interventions throughout the continuum of maternity care for health disparity populations impacted by MMM. Telemedicine models for improving access in rural areas and new technologies for risk assessment and disease management (e.g., regarding preeclampsia) also are discussed.

A Comprehensive Overview of the Physical Health of the Adolescent Brain Cognitive Development Study Cohort at Baseline.

Physical health in childhood is crucial for neurobiological as well as overall development, and can shape long-term outcomes into adulthood. The landmark, longitudinal Adolescent Brain Cognitive Development StudySM (ABCD study®), was designed to investigate brain development and health in almost 12,000 youth who were recruited when they were 9-10 years old and will be followed through adolescence and early adulthood. The overall goal of this paper is to provide descriptive analyses of physical health measures in the ABCD study at baseline, including but not limited to sleep, physical activity and sports involvement, and body mass index. Further this summary will describe how physical health measures collected from the ABCD cohort compare with current normative data and clinical guidelines. We propose this data set has the potential to facilitate clinical recommendations and inform national standards of physical health in this age group. This manuscript will also provide important information for ABCD users and help guide analyses investigating physical health including new avenues for health disparity research as it pertains to adolescent and young adult development.

Individual factors associated with intentions to leave among directors of nursing in nursing homes.

BACKGROUND: Although the importance of nurse leadership stability and participation in decision making in nursing homes is well established, scarce literature exists on determinants of intent to leave among directors of nursing (DONs) in nursing homes. PURPOSE: : The purpose of this study was to examine factors associated with DON intent to leave in nursing homes. METHODOLOGY: We examined potential factors associated with DON intent to leave at three levels: individual DON characteristics, facility, and county-level market factors. A survey of nurse supervisors in Texas nursing homes, the 2003 Texas Nursing Facility Medicaid Cost Report, and the Area Resource File were merged. We only included respondents who identified themselves as DONs in this study (572 observations). We examined bivariate differences in individual DON characteristics on the basis of facility ownership (for-profit versus not-for-profit homes) and geographic location (urban versus rural location). We constructed three alternative logit models to explore the relationships between DON intent to leave and DON, facility, and market characteristics. FINDINGS: DONs working in for-profit homes were more inclined to leave, less satisfied with their job, and had lower levels of perceived empowerment in terms of autonomy. Educational level and intention to leave were significantly higher for DONs working in urban areas. Job satisfaction was significantly and inversely associated with intent to leave in all three models. Higher perceived salary competitiveness and level of empowerment were associated with reduced odds of intending to leave. Higher educational levels were associated with higher odds of intentions to leave. PRACTICE IMPLICATIONS: Nursing homes should focus on improving DON job satisfaction, empowerment in decision making, and salary competitiveness when designing retention strategies for DONs.

Correspondence Between Perceived Pubertal Development and Hormone Levels in 9-10 Year-Olds From the Adolescent Brain Cognitive Development Study.

Aim: To examine individual variability between perceived physical features and hormones of pubertal maturation in 9-10-year-old children as a function of sociodemographic characteristics. Methods: Cross-sectional metrics of puberty were utilized from the baseline assessment of the Adolescent Brain Cognitive Development (ABCD) Study-a multi-site sample of 9-10 year-olds (n = 11,875)-and included perceived physical features via the pubertal development scale (PDS) and child salivary hormone levels (dehydroepiandrosterone and testosterone in all, and estradiol in females). Multi-level models examined the relationships among sociodemographic measures, physical features, and hormone levels. A group factor analysis (GFA) was implemented to extract latent variables of pubertal maturation that integrated both measures of perceived physical features and hormone levels. Results: PDS summary scores indicated more males (70%) than females (31%) were prepubertal. Perceived physical features and hormone levels were significantly associated with child's weight status and income, such that more mature scores were observed among children that were overweight/obese or from households with low-income. Results from the GFA identified two latent factors that described individual differences in pubertal maturation among both females and males, with factor 1 driven by higher hormone levels, and factor 2 driven by perceived physical maturation. The correspondence between latent factor 1 scores (hormones) and latent factor 2 scores (perceived physical maturation) revealed synchronous and asynchronous relationships between hormones and concomitant physical features in this large young adolescent sample. Conclusions: Sociodemographic measures were associated with both objective hormone and self-report physical measures of pubertal maturation in a large, diverse sample of 9-10 year-olds. The latent variables of pubertal maturation described a complex interplay between perceived physical changes and hormone levels that hallmark sexual maturation, which future studies can examine in relation to trajectories of brain maturation, risk/resilience to substance use, and other mental health outcomes.

The psychosocial work environment and maternal postpartum depression.

BACKGROUND: Postpartum depression is a debilitating mental disorder affecting women after childbirth. This study examined the correlates of postpartum depression at 11 weeks after childbirth, focusing on work-related stressors and applying the job demand-control-support model. METHOD: Investigators recruited a prospective cohort of 817 employed Minnesota women when hospitalized for childbirth in 2001. Trained interviewers collected data in person and by telephone at enrollment and 5 and 11 weeks postpartum from three Minneapolis and St. Paul hospitals. RESULTS: Results of hierarchical regression analysis showed that worse depression scores (Edinburgh Postnatal Depression Scale) were associated with higher psychological demands, lower schedule autonomy, and lower perceived control over work and family. Perceptions of control mediated the relationships of coworker support and schedule autonomy with postpartum depression scores. Study findings showed no significant buffering effects for decision latitude; however, coworker support and decision latitude appear to act as functional substitutes in reducing postpartum depressive symptoms. CONCLUSION: These findings raise questions about the applicability of the job demand-control-support model to postpartum women or to postpartum depression. Future research could assess the impact of the interaction between the work and home environment on maternal postpartum depression.

The Association of Health Reform and Infant Health: Evidence from Massachusetts.

OBJECTIVE: To estimate whether the incidence of low birthweight and rates of infant mortality were associated with Massachusetts health reform in the overall population and for subgroups that are at higher risk for poor health outcomes. DATA SOURCES: Individual-level data on birthweight were obtained from the National Center for Health Statistics detailed natality files, and aggregated county-level mortality rates were generated from linked birth-death files. We used restricted versions of each file that had intact state and substate geographic identifiers. RESEARCH DESIGN: We employed a quasi-experimental difference-in-differences design. PRINCIPAL RESULTS: We found small and statistically nonsignificant associations between the reform and the incidence of low birthweight and infant mortality rates. Results were consistent across a number of subgroups and were robust to alternative comparison groups and alternative modeling assumptions. CONCLUSIONS: We found no evidence that the Massachusetts reform was associated with improvements in individual low birthweights or county-level infant mortality rates, despite increasing health insurance coverage rates for adult women of child-bearing age. Because our mortality analysis was ecological, we are not able to draw conclusions about how an individual-level health insurance intervention for uninsured pregnant women would affect the mortality outcomes of their infants.

Successful return to work for cancer survivors.

This study investigated factors associated with successful return to work for cancer survivors in accordance with the Americans with Disabilities Act. A focus group was held with seven female cancer survivors. Participants discussed return-to-work issues following a cancer diagnosis. Factors such as coworker support and job flexibility improved their experiences, whereas coworker and supervisor ignorance about cancer and lack of support made returning to work more stressful. Participants discussed personal, environmental, and cancer-related factors that influenced their experiences with returning to work following a cancer diagnosis. Knowledge of factors that support employees helps occupational health nurses ease their transition, and may improve quality of life for employees. Physicians and health care provider teams may play a critical role in the employees' positive evaluation of their recovery process. This pilot study serves as a basis for a larger, population-based study.

Racial/Ethnic Differences in Unintended Pregnancy: Evidence From a National Sample of U.S. Women.

INTRODUCTION: Racial and ethnic minorities experience greater burden of unintended pregnancy in the U.S. This study examined the factors associated with racial and ethnic disparities in unintended pregnancy among women in the U.S. using the social ecological model. METHODS: This study utilized the National Survey of Family Growth data from 2006 to 2010. Data were analyzed in Autumn 2014 and Winter 2015. Decomposition analyses examined which intrapersonal, interpersonal, institutional, community, and public policy factors explained racial and ethnic disparities in unintended pregnancy. RESULTS: Unadjusted analyses found that black and Hispanic women had a greater likelihood of unintended pregnancy compared with white women. Decomposition models explained 51% of the disparity in unintended pregnancy between black and white women and 73% of that between Hispanic and white women. Factors contributing to the disparity between black and white women included age, relationship status, respondent's mother's age at first birth, Federal Poverty Level, and insurance status. Between Hispanic and white women, these factors included age, U.S.-born status, education, and relationship status. CONCLUSIONS: Given that the results showed factors at different levels of the social ecological model contribute to racial and ethnic disparities in unintended pregnancy, interventions that aim to reduce these disparities should target at-risk groups of women such as younger, unmarried, lower-income, less-educated, non-U.S. born women and uninsured or publicly insured women.

Does depression and substance abuse co-morbidity affect socioeconomic status? Evidence from a prospective study of urban African Americans.

Studies have established a graded association between mental health and socioeconomic status (SES). However, scarce research has examined the impact of substance use disorders (SUD) and depression comorbidity on SES. We use data from the Woodlawn Study, a longitudinal cohort study, which recruited a cohort of first graders from Chicago starting 1966-1967 (N=1242). Analyses focus on those interviewed in young adulthood and followed up through midlife. Regression analyses adjusting for childhood confounders showed that young adults with depression and SUD comorbidity had higher likelihood of having any periods of unemployment, higher likelihood of being unemployed for 3 or more months, and lower household income in midlife than those with neither disorder. Moreover, young adults with SUD without depression had higher odds of having any periods of unemployment and higher odds of being unemployed for 3 or more months than those with neither disorder. Findings point to the possibility of social selection where depression and SUD comorbidity contributes to a downward drift in SES. Clinical interventions that integrate the treatment of SUD and depression may be more effective at reducing socioeconomic disparities among minority populations.

Preventive care utilization among the uninsured by race/ethnicity and income.

BACKGROUND: Health insurance status affects access to preventive services. Effective use of preventive services is a key factor in the reduction of important health concerns and has the potential to enable adults to live longer, healthier lives. PURPOSE: To analyze the use of U.S. Preventive Services Task Force (USPSTF)-recommended preventive services among uninsured adults, with a focus on variation across race, ethnicity, and household income. METHODS: Using pooled 2004-2011 Medical Expenditure Panel Survey data, this study conducted multivariate logistic regressions to estimate variation in receipt of eight USPSTF-recommended preventive services by race/ethnicity among adults aged 18 years and older uninsured in the previous year. Stratified analyses by household income were applied. Data were analyzed in 2013. RESULTS: Uninsured adults received preventive services far below Healthy People 2020 targets. Among the uninsured, African Americans had higher odds of receiving Pap tests, mammograms, routine physical checkups, and blood pressure checks according to guidelines than whites. Moreover, compared to whites, Hispanics had higher odds of receiving Pap tests, mammograms, influenza vaccinations, and routine physical checkups and lower odds of receiving blood pressure screening and advice to quit smoking. When results were stratified by household income, racial/ethnic differences persisted except for the highest income levels (≥400% Federal Poverty Level), where they were largely non-significant. CONCLUSIONS: Generally, uninsured African American and Hispanic populations fare better than uninsured whites in preventive service utilization. Future research should examine reasons behind these racial/ethnic differences to inform policy interventions aiming to increase preventive service utilization among the uninsured.