Mosquito control exposures and breast cancer risk: analysis of 1071 cases and 2096 controls from the Ghana Breast Health Study.

Epidemiologic data on insecticide exposures and breast cancer risk are inconclusive and mostly from high-income countries. Using data from 1071 invasive pathologically confirmed breast cancer cases and 2096 controls from the Ghana Breast Health Study conducted from 2013 to 2015, we investigated associations with mosquito control products to reduce the spread of mosquito-borne diseases, such as malaria. These mosquito control products were insecticide-treated nets, mosquito coils, repellent room sprays, and skin creams for personal protection against mosquitos. Multivariable and polytomous logistic regression models were used to estimate odds ratios (ORadj) and 95% confidence intervals (CI) with breast cancer risk-adjusted for potential confounders and known risk factors. Among controls, the reported use of mosquito control products were mosquito coils (65%), followed by insecticide-treated nets (56%), repellent room sprays (53%), and repellent skin creams (15%). Compared to a referent group of participants unexposed to mosquito control products, there was no significant association between breast cancer risk and mosquito coils. There was an association in breast cancer risk with reported use of insecticide-treated nets; however, that association was weak and not statistically significant. Participants who reported using repellent sprays were at elevated risks compared to women who did not use any mosquito control products, even after adjustment for all other mosquito control products (OR = 1.42, 95% CI=1.15-1.75). We had limited power to detect an association with repellent skin creams. Although only a few participants reported using repellent room sprays weekly/daily or < month-monthly, no trends were evident with increased frequency of use of repellent sprays, and there was no statistical evidence of heterogeneity by estrogen receptor (ER) status (p-het > 0.25). Our analysis was limited when determining if an association existed with repellent skin creams; therefore, we cannot conclude an association. We found limited evidence of risk associations with widely used mosquito coils and insecticide-treated nets, which are reassuring given their importance for malaria prevention. Our findings regarding specific breast cancer risk associations, specifically those observed between repellent sprays, require further study.

Mental health status and dietary intake among California adults: a population-based survey.

California Health Interview Survey (2005-2015) data were used to examine the association between dietary intake frequencies and mental health - Kessler-6 scores categorised as no/low (NLPD), moderate (MPD) or serious psychological distress (SPD). The 245,891 surveys represented 27.7 million adults annually, with 13.2% having MPD and 3.7% SPD. Survey-adjusted regression adjusting for gender, age, race, education, poverty, marital status, BMI, geography and year found MPD and SPD associated with lower consumption of fruits (adjusted odds ratio 0.79 and 0.65, respectively), vegetables (AOR 0.81 and 0.68), and increased consumption of French fries (AOR 1.24, 1.30), fast food (AOR 1.32, 1.27), soda (AOR 1.23, 1.26) and variance-adjusted daily teaspoons of sugar (coefficients 3.05, 4.21), all p-values less than 0.001. In this large population-based sample, moderate and SPD were independently associated with unhealthy diet. Targeted public health interventions could focus on young adults and those with less than 12 years of education.

Burden of mental illness on hospital and patient outcomes among asthma hospitalizations.

OBJECTIVE: Empirical evidence demonstrates the comorbidity of asthma and mental illness, though limited studies have evaluated the patient and hospital outcomes associated with such conditions. As such, this study evaluated the burden of this comorbidity on health resource utilization and patient disposition among asthma hospitalizations. METHODS: A secondary analysis of the Nationwide Inpatient Sample (2009-2011) was conducted, with study population of asthma hospitalizations limited to those 18 years of age and older. International Classification of Disease, 9th Revision, Clinical Modification codes were utilized to identify asthma and mental illness discharges. Length of stay was defined as number of days stayed in the hospital, total charges were inflation-adjusted, and patient disposition was defined as routine versus not routine. All analyses were survey-weighted and adjusted for patient and hospital characteristics. RESULTS: Approximately 29% of the asthma hospitalizations reported mental illness. Any mental illness was associated with increased length of stay in the hospital (10% increase), total costs (11% increase), and lower odds of routine disposition (21% decrease). Substance-related disorder also increased length of stay in the hospital (4% increase), costs (9% increase), and lower odds of routine disposition (29% decrease). Age-stratified analyses further demonstrated similar trends among most age groups. CONCLUSION: The results of this study complement the extant literature by demonstrating the burden of the asthma-mental health nexus on health resource utilization and patient outcomes. The increased length of stay, cost, and decreased likelihood of routine disposition associated with mental illness highlight the need for integrated care to address mental illness as part of routine care.

Posttraumatic Stress Disorder-Related Hospitalizations in the United States (2002-2011): Rates, Co-Occurring Illnesses, Suicidal Ideation/Self-Harm, and Hospital Charges.

The purpose of the present study was to evaluate posttraumatic stress disorder (PTSD)-related hospitalizations in the United States (2002-2011). Over this period, there were an estimated 1,477,944 hospitalizations (915,591 women) with either a primary (reason for hospitalization) or secondary PTSD diagnosis. Population-based hospitalization rates rose from 2002 to 2011; women in the age range of 20 to 44 years had the highest rates and the steepest rise. Most of the hospitalizations for men and women younger than 45 years had been assigned a primary diagnosis of mental illness (including PTSD). Mood and substance use disorders were among the most commonly co-occurring psychiatric diagnoses with PTSD. Suicidal ideation/suicide attempts declined with increasing age. The strongest predictor of this criterion was mood disorder, and its importance as a predictor increased as people aged. Total inflation-adjusted charges for all PTSD-related hospitalizations were $34.9 billion, with 36% being for hospitalizations where a mental illness (including PTSD) was the primary diagnosis.

Faith-Based Hospitals and Variation in Psychiatric Inpatient Length of Stay in California, 2002-2011.

We examined current treatment patterns at faith-based hospitals. Psychiatric discharges from all community-based hospitals in California were obtained for 2002-2011 and a Behavioral Model of Health Services Utilization approach used to study hospital religious affiliation and length of stay (LOS). During 10 years there were 1,976,893 psychiatric inpatient discharges, of which 14.3% were from faith-based nonprofit hospitals (eighteen Catholic, seven Seventh-day Adventist, and one Jewish hospital). Modest differences in patient characteristics and shorter LOS (7.5 vs. 8.3 days) were observed between faith-based and other hospitals. Multivariable negative binomial regression found shorter LOS at faith-based nonprofit hospitals (coefficient = -0.1169, p < 0.001, Wald χ (2) = 55) and greater LOS at all nonprofits (coefficient = 1.5909, p < 0.001, Wald χ (2) = 2755) as compared to local government-controlled hospitals. Faith-based hospitals provide a substantial and consistent amount of psychiatric care in California and may have slightly lower LOS after adjusting for patient and other hospital characteristics.

Impact of Clostridium difficile infection among pneumonia and urinary tract infection hospitalizations: an analysis of the Nationwide Inpatient Sample.

BACKGROUND: Clostridium difficile infection (CDI) remains one of the major hospital acquired infections in the nation, often attributable to increased antibiotic use. Little research, however, exists on the prevalence and impact of CDI on patient and hospital outcomes among populations requiring such treatment. As such, the goal of this study was to examine the prevalence, risk factors, and impact of CDI among pneumonia and urinary tract infection (UTI) hospitalizations. METHODS: The Nationwide Inpatient Sample (2009-2011), reflecting a 20% stratified sample of community hospitals in the United States, was used. A total of 593,038 pneumonia and 255,770 UTI discharges were included. Survey-weighted multivariable regression analyses were conducted to assess the predictors and impact of CDI among pneumonia and UTI discharges. RESULTS: A significantly higher prevalence of CDI was present among men with UTI (13.3 per 1,000) as compared to women (11.3 per 1,000). CDI was associated with higher in-hospital mortality among discharges for pneumonia (adjusted odds ratio [aOR] for men = 3.2, women aOR = 2.8) and UTI (aOR for men = 4.1, women aOR = 3.4). Length of stay among pneumonia and UTI discharges were also double upon presence of CDI. In addition, CDI increased the total charges by at least 75% and 55% among pneumonia and UTI discharges, respectively. Patient and hospital characteristics associated with CDI included being 65 years or older, Charlson Deyo index for comorbidity of 2 or more, Medicare as the primary payer, and discharge from urban hospitals, among both pneumonia and UTI discharges. CONCLUSION: CDI occurs frequently in hospitalizations among those discharged from hospital for pneumonia and UTI, and is associated with increased in-hospital mortality and health resource utilization. Interventions to mitigate the burden of CDI in these high-risk populations are urgently needed.

Generational differences in fast food intake among South-Asian Americans: results from a population-based survey.

The goal of this study was to evaluate the association between generational status and fast food consumption among South-Asian Americans. We conducted a secondary analysis of data from the California Health Interview Survey for 2007, 2009, and 2011. After adjusting for control variables, South-Asian Americans of the third generation or more had a fast food intake rate per week 2.22 times greater than first generation South-Asian Americans. Public health practitioners must focus on ways to improve dietary outcomes among this fast-growing ethnic population in the United States.

Binge drinking by gender and race/ethnicity among California adults, 2007/2009.

BACKGROUND: This study provides binge drinking population estimates for California adults by gender and detailed race/ethnicity categories. This information may be helpful for planning targeted initiatives to decrease binge drinking. METHOD: Data were from the 2007 and 2009 California Health Interview Surveys. The 98 662 respondents represent an annual estimated population of 27.2 million adults. Survey adjusted binary logistic regression was used to calculate gender-specific binge drinking population rates and multinomial logit regression to estimate binge drinking frequency. RESULTS: Adjusting for socio-demographics, any binge drinking during the past year was reported by 31.0% (95% Confidence Interval = 30.5-31.4%) of men and 18.0% (17.7-18.3%) of women. Rates among White men and women were 30.5% and 19.6%, respectively. Binge drinking rates ranged from 11.9% among Chinese to 42.9% among Mexican men and from 4.8% among Vietnamese to 25.7% among "Other Latino" women. Five race/ethnicity categories of men and seven categories of women were significantly less likely to binge drink compared to Whites. Although Whites had the highest overall binge drinking rates, an estimated 12.5% of White men binge drank less than monthly, significantly exceeded by Mexican and Central American men, 19.9 and 19.6%, respectively. An estimated 9.6% of White women binge drank less than monthly, exceeded only by "Other Latino" women, 13.6%. CONCLUSION: These findings underscore the importance of detailed gender and race/ethnicity breakdowns when examining any binge drinking. Furthermore, there is variability across Asian and Latino subgroups in the frequency of binge drinking episodes, which is not evident in broad-group population studies.

Analysis of Participant Stigma and Associated Costs of a Peer-Led Social Media HIV Intervention.

HIV-related stigma is a primary barrier to seeking HIV care. Online social media interventions utilizing peer-led approaches provide an opportunity to revolutionize HIV health behavior change. Secondary analysis of the UCLA HOPE Study (6 waves) was done to examine the effectiveness of an online peer-led intervention in reducing HIV-related internalized stigma (IS), association between IS and sexual risk behaviors (SRB), and associated costs for changing the likelihood of HIV testing. Among 897 participants, an inverse relationship between IS (Discomfort with people with HIV, Stereotypes, Moral Judgment) and SRB (Number of Sexual Partners, Sexual Encounters) factors was identified over time (p < .05). Engagement in stigma conversations increased participant likelihood to request HIV tests (B = 0.02, Wald = 8.10, p = .004) when made in group versus one-on-one contact. Innovative technology has potential to improve HIV-care efforts through expanded reach to at-risk populations, improved communication maintenance, ease of accessibility, and user anonymity.

The Impact of Social Determinants of Maternal Mental Health in Marginalized Mothers.

Background: A deeper understanding of the key determinants of maternal mental health is important for improving care for women, especially women who are at an economic disadvantage. Objectives: To explore the associations of select social determinants: access, social support, and stress, with the onset of antepartum depression in low-income mothers. Participants: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, population-based surveillance system with selected data from 2016 to 2019, establishing a randomly selected sample of women with a recent live birth at most 4 months postdelivery, between 1,300 and 3,400 women per state (n ∼ 162,558). Methods: In this cross-sectional study, the phase 8 PRAMS was adapted to measure social support, access, stress, and their relationships with the onset of antepartum depression in low-income mothers. To assess low-income marginalization, a threshold was established based on income levels within 130% of the federal poverty level; antepartum (n ∼ 41,289). Results: The defined access, social support, and stress factors showed a statistically significant association with the onset of antepartum depression among low-income mothers. Of women in this sample, 22.6% indicated antepartum depression (p < 0.001; R2 = 0.066). Negative social support indicators were associated with an increased likelihood of antepartum depression; 3.71 increased odds of depression for abuse during pregnancy, and 0.79 decreased odds with positive acknowledgment of paternity. Access indicator terms showed an association with the decreased likelihood of antepartum depression through breastfeeding information support (Info from Baby Doc, odds ratio [OR] = 0.86), prenatal care utilization (12+ visits, OR = 0.82), and specific insurance type (insurance by job, OR = 0.82). All instances of stressful life events showed an increased likelihood of depression during pregnancy (for majority of stressful life events: OR >1.12). Conclusions: Economically marginalized mothers face unmet social and health care needs leading to poorer outcomes during pregnancy. These findings provide additional support for improved policy and public health efforts, such as assessment, education, and interventions, to decrease prevalence and improve treatment for antepartum depression among marginalized mothers.

Mental health and food consumption among California children 5-11 years of age.

OBJECTIVE: The purpose of this research was to determine if poor mental health is associated with the intake of specific foods among California children. DESIGN: Secondary data analysis of the 2007 and 2009 California Health Interview Survey (CHIS) was conducted. Mental health was measured using a shortened version of the Strengths and Difficulties Questionnaire (SDQ). Dietary measures were self-reported servings of fruit, vegetables, 100% fruit juice, high sugar foods, soda/sweetened drinks, and French fries/fried potatoes consumed the previous day, as well as frequency of fast food consumed during the past week. SETTING: Phone interviews were conducted via the CHIS on households in California. SUBJECTS: Data belonging to children (n = 11,190) ages 5-11 years whose parents completed the CHIS 2007 and 2009 random-dial telephone surveys was investigated. RESULTS: Of an estimated annual population of 3.7 million children, 180,000 (4.9%) had poor mental health. Children with poor mental health consumed more soda/sweetened drinks (0.60 vs 0.45 servings per day, p = 0.024), French fries/fried potatoes (0.27 vs 0.14 servings per day, p = 0.003), and fast food (2.02 vs 1.38 servings per week, p = 0.009) compared to children with good mental health. Mental health was not associated with other dietary measures. Adjusting for relevant socio-demographic characteristics, logistic regression found poor mental health to be significantly associated with any consumption of French fries/fried potatoes (odds ratio (OR) = 2.0, p = 0.001) or vegetables (OR 0.6, p = 0.005) on the previous day, and fast food two or more times in the past week (OR 1.7, p < 0.001). Interaction analysis revealed that an estimated 33% of girls with poor mental health consumed French fries, compared to 12% of girls with good mental health (OR 2.91, p = 0.006). CONCLUSIONS: Children with poor mental health are more likely to consume calorie-dense but nutrient-poor foods compared to their counterparts. Intake of such foods may contribute to worse physical health as these children mature.

Comfort in seeking support from sexual violence prevention education health services among college women.

Objective: Explores racial differences of sexual violence-(SV) health service-(HS) outcomes among college women: (1) seeking support from a confidential-resource-(CR) and (2) reporting SV to the Title IX office. Participants: Data was collected from all ages of women (N = 583) and grade levels from one-large university on the Pacific-coast. Methods: Logistic-regression of HS outcomes were performed using the Fall 2016 American College Health Association-NCHA-II-survey. Results: The following variables increased the likelihood of women seeking support from the two health-services: (#1CR) relationship-status, race, and experiencing sexual-violence. WOC were 7x more likely to seek support if physically-assaulted, and WW were 3.9x more likely to seek support if a graduate student. (#2Title IX) year in school, physical-assault, and receiving prevention-education after the first-year in college. Overall, there were significant differences by race in the variables that influenced WW and WOC's comfort or likelihood to seek support. Conclusion: Colleges need to consider the disproportionate impact of SV on WOC.

Effects of Mental Illness Amongst Adults in the United States Living With Diabetes Mellitus on Hospital Admissions.

OBJECTIVE: To examine the influence of comorbid mental illness on hospitalization among adults reporting diabetes mellitus. METHODS: This cross-sectional observational study used National Health Interview Survey (NHIS) data from 2000-2018 to examine hospitalization. Mental illness was defined as no to low psychological distress (NLPD), moderate psychological distress (MPD), and serious psychological distress (SPD) as per the Kessler-6 scale. Socio-demographic factors and health status were added as covariates in binary logistic regression. RESULTS: This study involved 48,807 survey participants and reflected an estimated population of 17,524,418 adults with diabetes in the United States, of whom 19.9% were hospitalized in the year prior to the survey. Among those who were hospitalized, 71.5% exhibited None to Low Psychological Distress (NLPD), 17.7% reported Moderate Psychological Distress (MPD), and 10.8% reported Serious Psychological Distress (SPD). Conversely, among non-hospitalized individuals, the percentages were as follows: 83.2% had NLPD, 11.4% had MPD, and 5.3% had SPD. The odds ratio (OR) for hospitalization was found to be OR=1.31 (95% CI: 1.20, 1.43, p<0.0001) for MPD and OR=1.42 (95% CI: 1.28, 1.58, p<0.0001) for SPD, in comparison to those with no or low psychological distress. CONCLUSION: Among adults with diabetes mellitus, those with mental illness were more likely to be hospitalized than those without mental illness. Programs and policies to improve care among adults with both mental illness and diabetes may help to reduce hospitalizations.

Understanding multi-level barriers to medication adherence among adults living with sickle cell disease.

There is limited research that identifies and examines multi-level barriers to medication adherence among adults with Sickle Cell Disease (SCD); Identify multi-level barriers to medication adherence among adults with SCD; and Examine the relationship between multi-level barriers and medication adherence levels. A cross-sectional study included 130 adults (ages ≥ 18 years old) living with SCD who receive treatment/care from one of the 10 adult SCD clinics within the Networking California for sickle cell care initiative. Study measures included the medication adherence report scale (Professor Rob Horne), Beliefs about Medicine Questionnaire (Professor Rob Horne), and patient reported outcomes measurement information system. Participants reported barriers to medication adherence across 3 levels: Community-level barriers (e.g., COVID-19 pandemic); Institutional-level barriers (e.g., bad experiences with the health care system); and Individual-level barriers (e.g., beliefs and depression severity). Depression severity and patient concerns about SCD medication were inversely correlated with medication adherence (rs = -0.302, P < .001; rs = -0.341, P < .001 respectively). Patient beliefs about the necessity of SCD medication were insignificantly correlated with medication adherence (rs = 0.065, P = .464). Medication adherence was higher among patients who had fewer adherence barriers than multiple adherence barriers (Median medication adherence: fewer barriers = 22 vs multiple barrier = 20.50, P = .085), suggesting clinical significance although statistically insignificant. Identifying multi-level adherence barriers and examining their relationship with medication adherence will help develop targeted public health strategies to promote improved medication adherence and wellness among adults with SCD.

Risk Factors for Serious Psychological Distress among Pregnant Women and Mothers with Children less than One Year of Age: An Evaluation of National Health Interview Survey Data (1997-2016).

OBJECTIVE: This study examined individual factors associated with serious psychological distress (SPD) in mothers. METHODS: The study used National Health Interview Survey data (1997-2016), with analysis being restricted to pregnant women and non-pregnant mothers whose youngest child was 12 months old or younger. The Andersen framework, a reliable tool to study health services, was used to examine the effect of individual predisposing, enabling, and need factors. RESULTS: Of 5,210 women, 13.3% had SPD, as determined by the Kessler-6 scale. Compared to those without SPD, those with SPD were more likely to be 18 to 24 years old (39.0% vs. 31.7%; all P values < .001), never have been married (45.5% vs. 33.3%), not have completed high school (34.4% vs. 21.1%), have a family income below 100% of the federal poverty level (52.5% vs. 32.0%), and have public insurance (51.9% vs. 36.3%). Furthermore, women with SPD had a lower proportion of "excellent" health status (17.5% vs. 32.7%). Multivariable regression found that having any formal education was associated with a lower likelihood of perinatal SPD than was not completing high school. For example, the bachelor's degree odds ratio was 0.48 (95% CI: 0.30, 0.76). A receiver operator curve analysis revealed that individual predisposing factors (e.g. age, marital status, and education), accounted for more explained variation than did enabling or need factors. CONCLUSION: There are high levels of poor maternal mental health. Prevention and clinical services should focus on mothers with less than a high school education and those reporting poor physical health.

Patient and hospital characteristics associated with inpatient severe sepsis mortality in California, 2005-2010.

OBJECTIVES: The primary objective of this study was to identify which patient demographic, patient health, and hospital characteristics were associated with in-hospital mortality. A secondary objective was to determine the relative influence of these characteristics on mortality. DESIGN AND SETTING: Public-use data for 2005-2010 were used in this retrospective, cross-sectional analysis of discharges from nonfederal, general acute hospitals in California. A staged logistic regression approach was used to examine the relative influence of variables associated with in-hospital mortality. PATIENTS: A total of 1,213,219 patient discharges for adults (aged ≥18 yrs) having International Classification of Diseases-9 diagnosis and procedure codes indicating severe sepsis. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Patient demographics (age, gender, race, ethnicity, and payer category), patient health status (acute transfer, Charlson-Deyo comorbidity index, and organ failures), and hospital characteristics (ownership type, teaching status, bed size, annual patient days, acute discharges, emergency department visits, inpatient surgeries, severe sepsis as a percentage of all discharges, and year) were obtained from the California Office of Statewide Health Planning and Development. Overall, in-hospital mortality was 17.8%. There was a steady annual increase in the number of sepsis discharges, but a decrease in mortality throughout the study period. Mortality increased with age and was associated with white race, and Medicaid (Medi-Cal) and private insurance. Patient health status additionally explained inpatient mortality. Hospital volume measures were statistically significant in regression analysis, whereas static structural measures were not. There were modest associations between measures of annual treatment volume and likelihood of inpatient mortality, notably decreasing likelihood with more acute discharges and with greater severe sepsis volume. CONCLUSIONS: Although patient demographics and health status are the most important predictors of in-hospital mortality of patients with severe sepsis, hospital characteristics do play a substantial role. Findings regarding hospital volume can be used to improve processes and improve patient outcomes.

Hospitalisation charges for fibromyalgia in the United States, 1999-2007.

OBJECTIVES: To estimate fibromyalgia (FM) hospitalisation costs (i.e. charges) for patients in the United States from 1999 to 2007; to determine factors associated with variation in costs of FM and non-FM hospitalisations; and to investigate hospital procedures associated with FM hospitalisations. METHODS: Data were from the Nationwide Inpatient Sample, a large database of hospitalisations in the U.S. Over the study period, an estimated 63,772 patients - two-thirds women, one-third men - had been hospitalised for FM (FM criterion was the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis code 729.1, Myositis and Myalgia, unspecified). Demographics and hospital characteristics were described with frequencies and mean inflation-adjusted charges. Two multivariable linear regressions (one for FM and a second for non-FM patients), with Consumer Price Index (CPI)-adjusted charges (hospital and related services category) in thousands of dollars as the dependent variable, were performed, excluding cases with masked or missing data. Procedures were categorised with a standard classification scheme. RESULTS: Survey-adjusted total CPI-adjusted charges over the study period were estimated to be approximately $1.0 billion. Hospital procedures and Charlson-Deyo Index (co-morbidity severity) scores were the strongest predictors of charges in bivariate and multivariate analyses (for both FM and non-FM patients). The majority of procedures for FM patients were related to musculoskeletal, gastrointestinal, or cardiovascular systems. Most FM patients, however, did not have any procedure or a life-threatening co-morbid illness. CONCLUSIONS: Over the nine-year period, hospital charges for FM were substantial. Studies of how to reduce or avoid these costs in the treatment of FM need to be undertaken.

Cost Barriers to Health Services in U.S. Adults Before and After the Implementation of the Affordable Care Act.

BACKGROUND: The Affordable Care Act (ACA) was passed in 2010 and implemented in 2014 in the United States (U.S.). It was partly intended to reduce the cost burden to health coverage and care. OBJECTIVE: To determine if ACA implementation reduced the odds of experiencing cost barriers to needed healthcare services for vulnerable groups. METHODOLOGY: National Health Interview Survey Data from the Integrated Public Use Microdata Set (2011-2013; 2015-2017) were used to examine cost barriers to primary health, mental health, dental services, and prescription medications particularly for adults living in poverty, those of color, and unmarried individuals before and after implementation of the ACA. The study sample included 112,245 individuals, representing an annual average of 138 million adults (aged 26 to 64 years of age), including 59,367 survey respondents from 2011 to 2013 and 52,878 from 2015 to 2017. RESULTS: Pre/post-ACA, cost barriers to medical care decreased from 9.6% to 7.0% of adults, mental care from 3.0% to 2.4%, dental care 15.0 to 11.7%, and prescriptions from 9.9% to 7.0% (all comparisons p<.001). Survey design-adjusted regression results indicated significant decreases in the odds of experiencing cost barriers to physical, mental, dental health services and prescription medications after the implementation of the ACA for people living under 200% poverty, unmarried adults, and people of color. While the race was not a substantial barrier post-ACA, living in poverty and being unmarried remained the biggest predictors of cost barriers to services. Cost barriers for all services increased post ACA for adults with private coverage, and among older adults for prescription and dental services. CONCLUSIONS: While the ACA was largely successful in reducing the number of uninsured adults in the U.S., remaining barriers suggest the need to strengthen the ACA and reduce cost barriers to healthcare services for everyone.

Examining the association of student mental health and food security with college GPA.

BACKGROUND: Low food security and poor mental health are a persistent concern for college students. OBJECTIVE: Examine how food security and mental health are associated with college student's grade point average (GPA). METHODS: American College Health Association (ACHA)-National College Health Assessment III survey data Spring 2020 of students from 75 US universities (n = 48,103) were utilized to examine relationships among mental health, food security and academic performance (GPA). RESULTS: The majority of the population self-reported high food security (58.3%) and moderate psychological distress (50.8%). Very low food security (B = -.523, OR = .59, p < .001) and moderate psychological distress (B = -0.19, OR = .83, p < .001) were inversely associated with high GPA. Reduced food security was associated with worse mental health measures. CONCLUSIONS: Food security and mental health are negatively associated with GPA. To improve student success, universities must enhance services that address food insecurity and mental health.