Pamela Jo Johnson

Background: Reproductive-age women have a high rate of contact with the health care system for reproductive health care. Yet, beyond pregnancy, little is known about psychological distress and unmet health care needs among these women. We examined reasons for delayed medical care and types of foregone care by level of psychological distress. Materials and Methods: We used a nationally representative sample of U.S. women aged 18–49, from the 2015–2016 National Health Interview Survey. Using the K6 screening tool for nonspecific psychological distress, we examined differences in reasons for delayed care and types of care foregone due to cost by level of psychological distress (none, moderate psychological distress [MPD], and severe psychological distress [SPD]). Results: Overall, 20% of U.S. women aged 18–49 had MPD (16%) or SPD (4%), equating to nearly 13 million women of reproductive age living with psychological distress. Women with SPD or MPD are more likely to have delayed and foregone care. Notably, women with SPD have higher odds of needing but not receiving mental health care (adjusted odds ratios [AOR] = 12.4, 95% confidence interval [CI] 8.4–18.4), specialist care (AOR = 3.6, 95% CI 2.6–5.1), and follow-up care (AOR = 3.5, 95% CI 2.4–5.1) due to cost than women with no psychological distress. Cost is the greatest barrier to timely medical care for women with MPD and SPD. Conclusions: Women of reproductive age with psychological distress face considerable structural and cost-related barriers to accessing health care, which may be exacerbated by their psychological state. Despite recent policy advances such as the Affordable Care Act, additional efforts by policymakers and providers are crucial to address the needs of this population.

Introduction: Meditation is a common type of complementary and alternative medicine (CAM), and the evidence for its usefulness for health promotion is growing. Women have higher rates of overall CAM use than men do, but little is known about gender differences in meditation practices, reasons for use, or perceived benefits. Methods: Data from the 2012 National Health Interview Survey (NHIS) were used. The NHIS design is a multistage probability sample representative of US adults aged ≥18 ( n = 34,342). Design-based F-test and logistic regression were used; all analyses were weighted and were performed in 2017–2018. Results: Overall, 10.3% of women and 5.2% of men reported using some type of meditation in the past year ( p < 0.001). Among meditators, a higher percentage of women used meditation with yoga, tai chi, or qi gong, but men were more likely to use specific types of stand-alone practices ( e.g. , mindfulness) than women ( p < 0.001 for each type). The most common reason reported for using meditation was to reduce stress (35%). Although women and men reported similar reasons for meditating, there were gender differences in the prevalence of some reasons. Both men and women perceived meditation to be helpful (90% and 94%, respectively). Conclusions: There are gender differences in prevalence, purpose, and perceived benefits of using meditation. US adults aged ≥18 use meditation and find it helpful. Although currently less prevalent among men, providers can consider meditation as a tool for health promotion in both men and women.

Objective: The objective of this study is to examine unmet health care needs among midlife women (ages 50-64 years) in the United States by level of psychological distress. Method: Using data for a nationally representative sample of midlife women (N = 8,838) from the 2015-2016 National Health Interview Survey, we estimated odds ratios of reasons for delayed care and types of care foregone by level of psychological distress—none, moderate (moderate psychological distress [MPD], and severe (severe psychological distress [SPD]). Findings: More than one in five midlife women had MPD (15.3%) or SPD (5.2%). Women with MPD or SPD had 2 to 5 times higher odds of delayed and 2 to 20 times higher odds of foregone care. Conclusions: Midlife women with psychological distress have poorer health than those with no distress, yet they are less likely to get needed health care. There is a missed window of opportunity to address mental health needs and manage comorbid chronic conditions to facilitate healthy aging.

Objective: To describe, for a national sample of midlife and older adults, the types of complementary and alternative medicine (CAM) used for health and wellness and the perceived benefits of CAM use by race/ethnicity. Method: Using data from the 2012 National Health Interview Survey, we ran multiple logistic regression models to estimate the odds of each perceived benefit among adults ages 50 and older. Results: More than 38% of midlife and older adults used CAM in the past year. For six of seven perceived benefits examined, we found significant differences by race/ethnicity, with each group having higher odds of two or more perceived benefits compared with non-Hispanic Whites. Discussion: Although racial/ethnic minority groups are less likely to use CAM compared with non-Hispanic Whites, those who use CAM perceive great benefit. Future research should examine the potential contribution of evidence-based CAM to promoting health and well-being in a diverse aging population.

Background An adequate treatment dose, including a sufficient number of acupuncture treatments, is important for the clinical effectiveness of acupuncture treatment for common conditions. Objective To examine the characteristics of US adults who used a full course of acupuncture (≥6 treatments), a short course (1–5 treatments) or no acupuncture, including use of insurance benefits for acupuncture among users. Methods We used population-based survey data from the 2012 National Health Interview Survey (NHIS), the most current nationally representative data including use of acupuncture. We described subgroups of acupuncture users and used logistic regression to estimate the odds of past year acupuncture use versus non-use and completion of a full treatment course versus a short course. Covariates included demographic factors and health status. Analyses used strata, weights and clustering to account for the complex sample design. Results Among acupuncture users, 38% completed a full course. Acupuncture use was low (1.5%), but odds were higher among women and those with greater education and less poverty. Those who used acupuncture insurance benefits and who had greater education were more likely to receive a full treatment course. Insurance benefits attenuated disparities in use by sex and race/ethnicity. Conclusion Nationally, most people who use acupuncture do not receive a full treatment course. Considering evidence of effectiveness, low risk and relatively low cost of delivery, acupuncture could play a larger role in non-pharmaceutical treatment of common conditions such as pain. Policymakers should consider that, without insurance benefits for acupuncture, people are less likely to complete a full treatment course, which may contribute to disparities in use and health outcomes.

Background: Although the Affordable Care Act has been successful in expanding Medicaid to >17 million people, insurance alone may not translate into access to health care. Even among the insured, substantial barriers to accessing services inhibit health care utilization. Objectives: We examined the effect of selected barriers to health care access and the magnitude of those barriers on health care utilization. Research Design: Data come from a 2008 survey of adult enrollees in Minnesota’s public health care programs. We used multivariate logistic regression to estimate the effects of perceived patient, provider, and system-level barriers on past year delayed, foregone, and lack of preventive care. Subjects: A total of 2194 adults enrolled in Minnesota Health Care Programs who were mostly female (66%), high school graduates (76%), unemployed (62%), and living in metro areas (67%) were included in the analysis. Results: Reporting problems across all barriers increased the odds of delayed care from 2 times for provider-related barriers (OR=2.0; 95% CI, 1.2–3.3) to >6 times for access barriers (OR=6.2; 95% CI, 3.8–10.2) and foregone care from 2.6 times for family/work barriers (OR=2.6; 95% CI, 1.3–5.1) to >7 times for access barriers (OR=7.1; 95% CI, 3.9–13.1). Perceived discrimination was the only barrier consistently associated with all 3 utilization outcomes. Conclusions: Multiple types of barriers are associated with delayed and foregone care. System-level barriers and discrimination have the greatest effect on health care seeking behavior.

Objectives: To examine the prevalence of complementary and alternative medicine (CAM) use by race/ethnicity and to identify sociodemographic and health-related factors associated with CAM use among US adults with moderate mental distress (MMD). Methods: We analyzed data from the 2012 National Health Interview Survey (NHIS). We used data for 6016 noninstitutionalized US adults with MMD (3492 non-Hispanic whites, 953 non-Hispanic blacks, 1078 Hispanics, 268 Asians, and 225 others consisted of American Indian, Alaska Native, and those reporting multiple races). The 2012 NHIS asks about 36 types of CAM use in the past 12 months. We constructed (1) overall, any CAM use; (2) 5 major types of CAM use; and (3) individual types of CAM use indicators. Using a cross-sectional design with complex survey techniques, we estimated race/ethnicity-specific CAM prevalence, and odds of past year CAM use by race/ethnicity, sociodemographic, and health-related factors. Results: Nearly 40% of adults with MMD used CAM in the past year compared with 32% of those without MMD (P < .001). In adults with MMD, past year CAM use differed by race/ethnicity, ranging from 24.3% (blacks) to 44.7% (Asians) and 46.8% (others) (P < .001). Being younger, female, living in the west, higher education, being employed, more than 4 ambulatory care visits, and functional limitations were associated with higher odds of CAM use (P < .01). Conclusions: Adults with MMD use CAM more frequently than those without MMD. In addition, CAM use was significantly differed by race/ethnicity in adults with MMD. This underscores the need for good patient-provider communication and suggests opportunity for dialogue about integration between conventional providers and CAM practitioners to facilitate optimal mental health care.