Association of Hospital Incentive Care Management Partnerships for Uninsured Patients With Emergency Department Utilization.

Importance: The South Carolina (SC) Healthy Outcomes Plan (HOP) program aimed to expand access to health care to individuals without insurance; it remains unknown whether there is an association between the SC HOP program and emergency department (ED) use among patients with high health care costs and needs. Objectives: To determine whether participation in the SC HOP was associated with reduced ED utilization among uninsured participants. Design, Setting, and Participants: This retrospective cohort study included 11 684 HOP participants (ages 18-64 years) with at least 18 months of continuous enrollment. Generalized estimating equations and segmented regression of interrupted time-series analyses of ED visits and charges were conducted from October 1, 2012, to March 31, 2020. Exposures: Time intervals related to the HOP were 1 year before and 3 years after participation. Main Outcomes and Measures: ED visits per 100 participants per month and ED charges per participant per month overall and by subcategory. Results: The mean (SD) age of the 11 684 participants in the study was 45.2 (10.9) years; 6293 (54.5%) were women; 5028 (48.4%) were Black participants and 5189 (50.0%) were White participants. Over the study period, the mean (SE) number of ED visits decreased by 44.1%, from 48.1 (5.2) to 26.9 (2.8) per 100 participants per month. The mean (SE) ED charges were reduced to $858 ($46) per participant per month, a decrease from a mean (SE) of $1583 ($88) per participant per month 1 year before HOP implementation. There was an immediate level decrease of 40% (relative risk [RR], 0.61; 99.5% CI, 0.48-0.76; P < .001) from the preenrollment period, with a sustained reduction trend of 8% (RR 0.92; 99.5% CI, 0.89-0.95; P < .001) during the postenrollment period. A level change for ED charges was detected, at a decrease of 40% (RR 0.60; 99.5% CI, 0.47-0.77; P < .001) directly after HOP enrollment with a subsequent downward trend of 10% (RR 0.90; 99.5% CI, 0.86-0.93; P < .001) for the postenrollment period. Conclusions and Relevance: In this retrospective cohort study, proportions and charges of ED visits by uninsured patients saw immediate and sustained decreases after HOP enrollment. Reducing ED charges may have been driven by decreasing the ED as the primary point of patient care, especially for high-frequency users. These findings have implications for other nonexpansion states seeking to maximize uninsured compensation for low-income populations through improved outcomes.

Prenatal syphilis screening among pregnant Medicaid enrollees by sexually transmitted infection history as well as race and ethnicity.

BACKGROUND: Congenital syphilis can cause severe morbidity, including miscarriage and stillbirth, and rates are increasing rapidly within the United States. However, congenital syphilis can be prevented with early detection and treatment of syphilis during pregnancy. Current screening recommendations propose that all women should be screened early in pregnancy, whereas women with elevated risks for congenital syphilis should be screened again later in pregnancy. The rapid increase in congenital syphilis rates suggests that there are still gaps in prenatal syphilis screening. OBJECTIVE: This study aimed to examine associations between the odds of prenatal syphilis screening and sexually transmitted infection history or other patient characteristics across 3 states with elevated rates of congenital syphilis. STUDY DESIGN: We used the Medicaid claims data from Kentucky, Louisiana, and South Carolina for women with deliveries between 2017 and 2021. Within each state, we examined the log-odds of prenatal syphilis screening as a function of the mother's health history, demographic factors, and Medicaid enrollment history. Patient history was established using a 4-year lookback period of the Medicaid claims data; in state A, sexually transmitted infection surveillance data were used to improve the sexually transmitted infection history. RESULTS: The prenatal syphilis screening rates varied by state, ranging from 62.8% to 85.1% of deliveries to women without a recent history of sexually transmitted infections and from 78.1% to 91.1% of deliveries to women with a previous sexually transmitted infection. For the main outcome of syphilis screening at any time during pregnancy, deliveries associated with previous sexually transmitted infections had 1.09 to 1.37 times higher adjusted odds ratios of undergoing screening. Deliveries to women with continuous Medicaid coverage throughout the first trimester also had higher odds of syphilis screening at any time (adjusted odds ratio, 2.45-3.15). Among deliveries to women with a previous sexually transmitted infection, only 53.6% to 63.6% underwent first-trimester screening and this rate was still just 55.0% to 69.5% when considering only deliveries to women with a previous sexually transmitted infection and full first-trimester Medicaid coverage. Fewer delivering women underwent third-trimester screening (20.3%-55.8% of women with previous sexually transmitted infection). Compared with deliveries to White women, deliveries to Black women had lower odds of first-trimester screening (adjusted odds ratio, 0.85 in all states) but higher odds of third-trimester screening (adjusted odds ratio, 1.23-2.03), potentially impacting maternal and birth outcomes. For state A, linkage to surveillance data doubled the rate of detection of a previous sexually transmitted infection because 53.0% of deliveries by women with a previous sexually transmitted infection would not have had sexually transmitted infection history detected using Medicaid claims alone. CONCLUSION: A previous sexually transmitted infection and continuous preconception Medicaid enrollment were associated with higher rates of syphilis screening, but Medicaid claims alone do not fully capture the sexually transmitted infection history of patients. The overall screening rates were lower than would be expected given that all women should undergo prenatal screening, but the rates in the third trimester were particularly low. Of note, there are gaps in early screening for non-Hispanic Black women who had lower odds of first-trimester screening when compared with non-Hispanic White women despite being at elevated risk for syphilis.

Broadband access within Medically Underserved Areas and its implication for telehealth utilization.

PURPOSE: There is little information as to how America's broadband infrastructure might impact recent efforts to expand access to virtual care for underserved communities. OBJECTIVE: To examine potential and realized access to broadband internet services within Medically Underserved Areas (MUAs) that rely on community health care service providers for primary care. METHODS: This cross-sectional study included 214,946 US Census Block Group estimates from the 2017 and 2019 American Community Survey and the corresponding Federal Communications Commission database. Changes in household broadband subscription rates and Healthy People 2020 access thresholds within MUAs were assessed. FINDINGS: In 2019, 24,304 MUA households (31.9%) met Healthy People 2020 targets for broadband subscription rates, compared to 64.4% of non-MUA households (n = 89,285). On average, 74.7% of MUA households had a broadband internet subscription compared to 85.2% of non-MUA households, whereas 61.1% (n = 46,635) of MUA households had access to broadband speeds of at least 25.0 Mbps, compared to 75.6% (n = 104,696) of non-MUA households. Within urban households, there was a 0.8 to 1.3 to 1.6 annual percentage point convergence in MUA versus non-MUA broadband disparities between across quintiles (P < .05). Rural MUA households showed little improvement in broadband access between 2017 and 2019. CONCLUSIONS: There has been an overall convergence of broadband access disparities between MUA and non-MUA households over time, but less improvements in access among the most rural households. Reimbursement for audio-only telehealth visits by state Medicaid agencies would help drive down barriers to virtual health care options for populations residing in MUAs.

Geographic proximity to primary care providers as a risk-assessment criterion for quality performance measures.

IMPORTANCE: Previous studies have found a mixed association between Patient-Centered Medical Home (PCMH) designation and improvements in primary care quality indicators, including avoidable pediatric emergency department (ED) encounters. Whether these associations persist after accounting for the geographic locations of providers relative to where patients reside is unknown. OBJECTIVE: To examine the association between geographic proximity to primary care providers versus hospitals and risk of avoidable and potentially avoidable ED visits among children with pre-existing diagnosis of attention-deficit/hyperactivity disorder or asthma. METHODS: Retrospective cohort study of a panel of pediatric Medicaid claims data from the South Carolina from 2016-2018 for 2,959 beneficiaries having a pre-existing diagnosis of attention-deficit/hyperactivity disorder (ADD, ages 6-12) and 6,390 beneficiaries with asthma (MMA, ages 5-18), as defined using Healthcare Effectiveness Data and Information Set (HEDIS) performance measures. We calculated differences in avoidable and potentially avoidable ED visits by the beneficiary's PCMH attribution type and in relation to differences in proximity to their primary care providers versus hospitals. Outcomes were defined using the New York University Emergency Department Algorithm (NYU-EDA). Differences in ED visit risk were assessed using generalized estimation equations and compared using marginal effects models. RESULTS: The 2.4 percentage point reduction in risk of avoidable ED visits among children in the ADD cohort who attended a PCMH versus those who did not increased to 3.9 to 7.2 percentage points as relative proximity to primary care providers versus hospitals improved (p < 0.01). Children in the ADD and MMA cohorts that were enrolled in a medical home, but did not attend one for primary care services exhibited a 5.4 and 3.0 percentage point increase in avoidable ED visit compared to children who were unenrolled and did not attend medical homes (p < 0.05), but these differences were only observed when geographic proximity to hospitals was more convenient than primary care providers. Mixed findings were observed for potentially avoidable visits. CONCLUSIONS: In several health care performance evaluations, patient-centered medical homes have not been found to reduce differences in hospital utilization for conditions that are treatable in primary care settings among children with chronic illnesses. Analytical approaches that also consider geographic proximity to health care services can identify performance benefits of medical homes. Expanding risk-adjustment models to also include geographic data would benefit ongoing quality improvement initiatives.

Community social determinants and health outcomes drive availability of patient-centered medical homes.

The collaborative design of America's patient-centered medical homes places these practices at the forefront of emerging efforts to address longstanding inequities in the quality of primary care experienced among socially and economically marginalized populations. We assessed the geographic distribution of the country's medical homes and assessed whether they are appearing within communities that face greater burdens of disease and social vulnerability. We assessed overlapping spatial clusters of mental and physical health surveys; health behaviors, including alcohol-impaired driving deaths and drug overdose deaths; as well as premature mortality with clusters of medical home saturation and community socioeconomic characteristics. Overlapping spatial clusters were assessed using odds ratios and marginal effects models, producing four different scenarios of resource need and resource availability. All analyses were conducted using county-level data for the contiguous US states. Counties having lower uninsured rates and lower poverty rates were the most consistent indicators of medical home availability. Overall, the analyses indicated that medical homes are more likely to emerge within communities that have more favorable health and socioeconomic conditions to begin with. These findings suggest that intersecting the spatial footprints of medical homes in relation to health and socioeconomic data can provide crucial information for policy makers and payers invested in narrowing the gaps between clinic availability and the communities that experience the brunt of health and social inequalities.

Association of Patient-Centered Medical Home designation and quality indicators within HRSA-funded community health center delivery sites.

BACKGROUND: Patient-Centered Medical Home (PCMH) adoption is an important strategy to help improve primary care quality within Health Resources and Service Administration (HRSA) community health centers (CHC), but evidence of its effect thus far remains mixed. A limitation of previous evaluations has been the inability to account for the proportion of CHC delivery sites that are designated medical homes. METHODS: Retrospective cross-sectional study using HRSA Uniform Data System (UDS) and certification files from the National Committee for Quality Assurance (NCQA) and the Joint Commission (JC). Datasets were linked through geocoding and an approximate string-matching algorithm. Predicted probability scores were regressed onto 11 clinical performance measures using 10% increments in site-level designation using beta logistic regression. RESULTS: The geocoding and approximate string-matching algorithm identified 2615 of the 6851 (41.8%) delivery sites included in the analyses as having been designated through the NCQA and/or JC. In total, 74.7% (n = 777) of the 1039 CHCs that met the inclusion criteria for the analysis managed at least one NCQA- and/or JC-designated site. A proportional increase in site-level designation showed a positive association with adherence scores for the majority of all indicators, but primarily among CHCs that designated at least 50% of its delivery sites. Once this threshold was achieved, there was a stepwise percentage point increase in adherence scores, ranging from 1.9 to 11.8% improvement, depending on the measure. CONCLUSION: Geocoding and approximate string-matching techniques offer a more reliable and nuanced approach for monitoring the association between site-level PCMH designation and clinical performance within HRSA's CHC delivery sites. Our findings suggest that transformation does in fact matter, but that it may not appear until half of the delivery sites become designated. There also appears to be a continued stepwise increase in adherence scores once this threshold is achieved.

Reliability of the American Community Survey Estimates of Risk-Adjusted Readmission Rankings for Hospitals Before and After Peer Group Stratification.

Importance: Since the transition to the American Community Survey, data uncertainty has complicated its use for policy making and research, despite the ongoing need to identify disparities in health care outcomes. The US Centers for Medicare & Medicaid Services' new, stratified payment adjustment method for its Hospital Readmissions Reduction Program may be able to reduce the reliance on data linkages to socioeconomic survey estimates. Objective: To determine whether there are differences in the reliability of socioeconomically risk-adjusted hospital readmission rates among hospitals that serve a disproportionate share of low-income populations after stratifying hospitals into peer group-based classification groups. Design, Setting, and Participants: This cross-sectional study uses data from the 2014 New York State Health Cost and Utilization Project State Inpatient Database for 96 278 hospital admissions for acute myocardial infarction, pneumonia, and congestive heart failure. The analysis included patients aged 18 years and older who were not transferred to another hospital, who were discharged alive, who did not leave the hospital against medical advice, and who were discharged before December 2014. Main Outcomes and Measures: The main outcomes were 30-day hospital readmissions after acute myocardial infarction, pneumonia, and congestive heart failure assessed using hierarchical logistic regression. Results: The mean (SD) age of the patients was 69.6 (16.0) years for the safety-net hospitals and 74.9 (14.7) years for the non-safety-net hospitals; 9382 (48.8%) and 7003 (48.5%) patients, respectively, were female. For safety net designations, 20% (3 of 15) of all evaluations concealed and distorted differences in risk, with factors such as poverty failing to identify similar risk of acute myocardial infarction readmission until unreliable estimates were excluded from the analysis (OR, 1.23 [95% CI, 1.00-1.52], P = .02; vs OR, 1.17 [95% CI, 0.94-1.46], P = .15). By comparison, 2 of the 60 models (3%) for the peer group-based classification altered the association between socioeconomic status and readmission risk, concealing similarities in congestive heart failure readmission when adjusted using high school completion rates (OR, 1.27 [95% CI 1.02-1.58], P = .04; vs OR, 1.23 [95% CI, 0.98-1.53], P = .06) and distorting similarities in pneumonia readmissions when accounting for the proportion of lone-parent families (OR, 1.27 [95% CI, 0.98-1.66], P = .07; vs OR, 1.35 [95% CI, 1.02-1.80], P = .04) between the lowest and highest socioeconomic status hospitals in quartile 1. Conclusions and Relevance: There was greater precision in socioeconomic adjusted readmission estimates when hospitals were stratified into the new payment adjustment criteria compared with safety net designations. A contributing factor for improved reliability of American Community Survey estimates under the new payment criteria was the merging of patients from low-income neighborhoods with greater homogeneity in survey estimates into groupings similar to those for higher-income patients, whose neighborhoods often exhibit greater estimate variability. Additional efforts are needed to explore the effect of measurement error on American Community Survey-adjusted readmissions using the new peer group-based classification methods.

Comparison of small-area deprivation measures as predictors of chronic disease burden in a low-income population.

BACKGROUND: Measures of small-area deprivation may be valuable in geographically targeting limited resources to prevent, diagnose, and effectively manage chronic conditions in vulnerable populations. We developed a census-based small-area socioeconomic deprivation index specifically to predict chronic disease burden among publically insured Medicaid recipients in South Carolina, a relatively poor state in the southern United States. We compared the predictive ability of the new index with that of four other small-area deprivation indicators. METHODS: To derive the ZIP Code Tabulation Area-Level Palmetto Small-Area Deprivation Index (Palmetto SADI), we evaluated ten census variables across five socioeconomic deprivation domains, identifying the combination of census indicators most highly correlated with a set of five chronic disease conditions among South Carolina Medicaid enrollees. In separate validation studies, we used both logistic and spatial regression methods to assess the ability of Palmetto SADI to predict chronic disease burden among state Medicaid recipients relative to four alternative small-area socioeconomic deprivation measures: the Townsend index of material deprivation; a single-variable poverty indicator; and two small-area designations of health care resource deprivation, Primary Care Health Professional Shortage Area and Medically Underserved Area/Medically Underserved Population. RESULTS: Palmetto SADI was the best predictor of chronic disease burden (presence of at least one condition and presence of two or more conditions) among state Medicaid recipients compared to all alternative deprivation measures tested. CONCLUSIONS: A low-cost, regionally optimized socioeconomic deprivation index, Palmetto SADI can be used to identify areas in South Carolina at high risk for chronic disease burden among Medicaid recipients and other low-income Medicaid-eligible populations for targeted prevention, screening, diagnosis, disease self-management, and care coordination activities.

Group Prenatal Care Results in Medicaid Savings with Better Outcomes: A Propensity Score Analysis of CenteringPregnancy Participation in South Carolina.

Objectives This study was undertaken to determine the cost savings of prevention of adverse birth outcomes for Medicaid women participating in the CenteringPregnancy group prenatal care program at a pilot program in South Carolina. Methods A retrospective five-year cohort study of Medicaid women was assessed for differences in birth outcomes among women involved in CenteringPregnancy group prenatal care (n = 1262) and those receiving individual prenatal care (n = 5066). The study outcomes examined were premature birth and the related outcomes of low birthweight (LBW) and neonatal intensive care unit (NICU) visits. Because women were not assigned to the CenteringPregnancy group, a propensity score analysis ensured that the inference of the estimated difference in birth outcomes between the treatment groups was adjusted for nonrandom assignment based on age, race, Clinical Risk Group, and plan type. A series of generalized linear models were run to estimate the difference between the proportions of individuals with adverse birth outcomes, or the risk differences, for CenteringPregnancy group prenatal care participation. Estimated risk differences, the coefficient on the CenteringPregnancy group indicator variable from identity-link binomial variance generalized linear models, were then used to calculate potential cost savings due to participation in the CenteringPregnancy group. Results This study estimated that CenteringPregnancy participation reduced the risk of premature birth (36 %, P < 0.05). For every premature birth prevented, there was an average savings of $22,667 in health expenditures. Participation in CenteringPregnancy reduced the incidence of delivering an infant that was LBW (44 %, P < 0.05, $29,627). Additionally, infants of CenteringPregnancy participants had a reduced risk of a NICU stay (28 %, P < 0.05, $27,249). After considering the state investment of $1.7 million, there was an estimated return on investment of nearly $2.3 million. Conclusions Cost savings were achieved with better outcomes due to the participation in CenteringPregnancy among low-risk Medicaid beneficiaries.

Health insurance coverage among diabetic adults from three major ethnic groups in the United States.

OBJECTIVE: The lack of adequate health insurance may result in a downward spiral of the diabetic condition, imposing an increased financial strain on family and the society as a whole. The objective of our study was to assess the insurance type and coverage among diabetic adults from three major ethnic groups. DESIGN AND SETTING: We used data of two cross-sectional national surveys to estimate insurance coverage among diabetic adults aged 20-64 years, 1988-1994 and 2003-2008. RESULTS: The prevalence of doctor-diagnosed diabetes has increased by 120%, 178% and 135% respectively among non-Hispanic Whites (NHWs), non-Hispanic Blacks (NHBs), and Mexicans & other Hispanics (M&OHs) from 1988-94 to 2003-08. However, during the same period, the percentages of diabetic adults covered by health insurance declined for all three groups. In the 2003-08 period, 15%, 19% and 40% of NHWs, NHBs and M&OHs, respectively, had no insurance. Diabetic NHBs and NHWs had an equal likelihood to be covered by government-sponsored programs. However, 70% of NHWs, in contrast to 37% of NHBs, were covered by private programs exclusively. Diabetic M&OHs remained at the lowest likelihood to be covered by government-sponsored programs. The diabetic citizen's probability of being insured was more than tripled compared with the non-citizens (OR=3.40, 95%=1.42-8.14). CONCLUSION: Increasing percentages of diabetics had no insurance. Diabetic Whites were more likely to be covered by private programs than diabetic Blacks. Hispanics were the group falling through the cracks between private programs due to low income and government programs because of immigration status.

Spatial visualization of multivariate datasets: an analysis of STD and HIV/AIDS diagnosis rates and socioeconomic context using ring maps.

OBJECTIVES: We used existing data systems to examine sexually transmitted disease (STD) and HIV/AIDS diagnosis rates and explore potential county-level associations between HIV/AIDS diagnosis rates and socioeconomic disadvantage. METHODS: Using South Carolina county data, we constructed multivariate ring maps to spatially visualize syphilis, gonorrhea, chlamydia, and HIV/AIDS diagnosis rates; gender- and race-specific HIV/AIDS diagnosis rates; and three measures of socioeconomic disadvantage-an unemployment index, a poverty index, and the Townsend index of social deprivation. Statistical analyses were performed to quantitatively assess potential county-level associations between HIV/AIDS diagnosis rates and each of the three indexes of socioeconomic disadvantage. RESULTS: Ring maps revealed substantial spatial association in STD and HIV/AIDS diagnosis rates and highlighted large gender and racial disparities in HIV/AIDS across the state. The mean county-level HIV/AIDS diagnosis rate (per 100,000 population) was 24.2 for males vs. 11.2 for females, and 34.8 for African Americans vs. 5.2 for white people. In addition, ring map visualization suggested a county-level association between HIV/AIDS diagnosis rates and socioeconomic disadvantage. Significant positive bivariate relationships were found between HIV/AIDS rate categories and each increase in poverty index category (odds ratio [OR] = 2.03; p=0.006), as well as each increase in Townsend index of social deprivation category (OR=4.98; p<0.001). A multivariate ordered logistic regression model in which all three socioeconomic disadvantage indexes were included showed a significant positive association between HIV/AIDS and Townsend index categories (adjusted OR=6.10; p<0.001). CONCLUSIONS: Ring maps graphically depicted the spatial coincidence of STD and HIV/AIDS and revealed large gender and racial disparities in HIV/AIDS across South Carolina counties. This spatial visualization method used existing data systems to highlight the importance of social determinants of health in program planning and decision-making processes.

Diabetes and the socioeconomic and built environment: geovisualization of disease prevalence and potential contextual associations using ring maps.

BACKGROUND: Efforts to stem the diabetes epidemic in the United States and other countries must take into account a complex array of individual, social, economic, and built environmental factors. Increasingly, scientists use information visualization tools to "make sense" of large multivariate data sets. Recently, ring map visualization has been explored as a means of depicting spatially referenced, multivariate data in a single information graphic. A ring map shows multiple attribute data sets as separate rings of information surrounding a base map of a particular geographic region of interest. In this study, ring maps were used to evaluate diabetes prevalence among adult South Carolina Medicaid recipients. In particular, county-level ring maps were used to evaluate disparities in diabetes prevalence among adult African Americans and Whites and to explore potential county-level associations between diabetes prevalence among adult African Americans and five measures of the socioeconomic and built environment--persistent poverty, unemployment, rurality, number of fast food restaurants per capita, and number of convenience stores per capita. Although Medicaid pays for the health care of approximately 15 percent of all diabetics, few studies have examined diabetes in adult Medicaid recipients at the county level. The present study thus addresses a critical information gap, while illustrating the utility of ring maps in multivariate investigations of population health and environmental context. RESULTS: Ring maps showed substantial racial disparity in diabetes prevalence among adult Medicaid recipients and suggested an association between adult African American diabetes prevalence and rurality. Rurality was significantly positively associated with diabetes prevalence among adult African American Medicaid recipients in a multivariate statistical model. CONCLUSIONS: Efforts to reduce diabetes among adult African American Medicaid recipients must extend to rural African Americans. Ring maps can be used to integrate diverse data sets, explore attribute associations, and achieve insights critical to the promotion of population health.

Associations between mental health and diabetes: findings from the South Carolina Medicaid managed care program in 2006-2008.

OBJECTIVES: To assess differences in services associated with mental health status and prescriptions among Medicaid patients diagnosed with diabetes mellitus. DESIGN: Secondary data analyses of South Carolina (SC) Medicaid enrollees. PARTICIPANTS: SC Medicaid enrollees with a diagnosis of diabetes mellitus (N = 555) continuously enrolled in either managed care (MC) or fee for service (FFS) programs between 2006 and 2008. MAIN OUTCOME MEASURES: Health Plan Employer Data and Information Set (HEDIS)-based diabetes management service outcomes including: 1) whether the recipient received a nephrology exam; 2) the number of eye exams received; 3) the number of low-density lipoprotein cholesterol services received; and 4) the number of Hemoglobin A1c blood tests conducted. Outcomes were fitted to regression models adjusting for sex, race, health program provider type (MC or FFS), rurality, poverty indexes, clinical risk group status, whether there was a female head of household, and indicators for classes of prescription pharmaceuticals (antipsychotics, antidepressants, and anticonvulsants). RESULTS: There are significant differences in the incidence of diabetes management service-use between enrollees in management plans and between recipients of classes of pharmaceuticals and mental health status. Enrollees in FFS have fewer claims associated with diabetes management services compared to counterparts in MC. CONCLUSIONS: Our early findings demonstrate the importance of efforts to collect HEDIS measures data and their potential as a resource for assessing quality of care. More importantly, this study illustrates the association between mental health status and associated pharmaceutical prescriptions.

Knowledge and perceived risk of tuberculosis: US racial and regional differences.

The purpose of this study is to report the findings of the 2004 National Health Interview Survey (NHIS) questions on tuberculosis (TB) knowledge and perceived risk of contracting TB. Tuberculosis (TB) continues to be a major health threat in the United States, but minimal effort is made on public education to increase knowledge about TB. Using data from the 2004 NHIS, this study examined knowledge and perceived risk of TB of 26,136 US respondents. Results showed that nationally, how much a respondent knew about tuberculosis, knowing someone with tuberculosis, being 18-34 years old, and being Black were most strongly associated with perceived high to medium risk of getting TB. Black respondents were nearly twice as likely to perceive a high to moderate risk compared to other races in the Northeast and South. Knowing someone with tuberculosis or having a lot or some knowledge of the disease was strongly associated with perceived risk in all regions of the nation. Conclusions were to increase efforts targeted toward broad health promotion education activities on TB risk.