Suchergebnisse

Although homeless women appear to be at notable risk of unintended pregnancy, insufficient attention has been paid to understanding their access to birth control services and the characteristics of homeless women who want birth control services. To address these research gaps, the authors analyzed data from a probability sample of 974 homeless women who were interviewed in shelters and meal programs in Los Angeles County. Multivariate logistic regression analysis revealed that among those women who wanted birth control services during the past year, using these services was associated with fewer perceived barriers to health care, having a regular source of care, consistent use of contraception, and lower odds of alcohol dependence. Availability and cost barriers to birth control services must be reduced, and effective service linkages should be developed among providers of birth control services, substance abuse treatment, and primary care.

For some sample-based studies of the homeless, it may be relevant to adopt a period perspective, in which analyses focus on the mix of persons who experience homelessness at least once during some period of time, not just the mix of persons at a point in time. Period perspective presumably can be enhanced by weights that account for the intermittent nature of homelessness, but such weighting invites implementation problems related to calculation, specifying the weighting model, measurement, and especially weight disparity. Some of these problems can be mitigated by a sample design that assures independence between selection and individual respondent behavior, but remaining difficulties, particularly weight variability, raise questions about how weighting should be used in this context.

Data collected from the International Collaborative Study of Oral Health Outcomes USA (ICS-II) research locations were used to evaluate the relationship between having a usual source of dental care (USDC) and access to dental services. The robustness of the USDC effect after reducing simultaneity bias was tested in the population-based samples using sensitivity analysis. Logistic regression results provided evidence that USDC was the strongest and most consistent predictor of a dental visit in the past 12 months regardless of geographic location, dental care delivery system, or cultural diversity of the population. Even after removing cases that had a USDC for less than 1 or 2 years, the effect remained. From a policy perspective, USDC remains critical to understanding and explaining dental care utilization patterns. The findings suggest the need for designing interventions to increase the availability of a regular provider among vulnerable populations.

Where Californians live within the state plays an important role in determining their access to health care. This policy brief uses data from the 2001 California Health Interview Survey (CHIS 2001) to examine differences in four key measures of access to care related to the county in which a person with low- to moderate-household income resides. These measures are the percent of the county population who: 1) have a usual source of care, 2) use community or government clinics as their usual source of care, 3) are uninsured for all or part of a year, and 4) delayed any type of care because of cost or insurance issues. The study also found that health insurance played a major role in determining access to care. The study's findings have significant implications for the ongoing political debate over potential cutbacks in the Medi-Cal and Healthy Families programs. These findings demonstrate that, for moderate-to-low income children and adults, counties differ in the levels of access experienced by their low- and moderate-income populations. Additionally, both persistent uninsurance and intermittent coverage reduce access to care and place a larger burden on community, public, and hospital-based clinics. The demands on this already-stretched safety net will likely rise with any increase in the number of uninsured people, whether that lack of coverage is short-term or long-term.