The Role of Minority Stress and Social Resources in the Healthcare Utilization of Aging LGBT Adults

Research suggests that minority stress can influence the healthcare utilization of aging LGBT adults, and that social resources can buffer the effect of stress on healthcare utilization. Using data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (N = 2,560), multiple logistic regression assessed the associations between minority stress (i.e., internalized stigma and LGBT identity disclosure) and healthcare utilization (i.e., health screenings, emergency room use, routine checkups, and regular provider). We also examined the moderating effect of social resources, including social network size, social support, and LGBT community belonging, in these associations. Internalized stigma was negatively associated with having a routine checkup in the previous year (OR = 0.82, p = .038). Disclosure was positively associated with having a health screening within the past 3 years (OR = 1.52, p = .000) and having a regular provider (OR = 1.33, p = .021). Further, we found that social support moderated the association between disclosure and health screenings (OR = 1.52, p < .001); thus, having higher levels of social support and disclosure in tandem increased the likelihood of getting a health screening in the last three years. Health and human service professionals should provide information about internalized stigma and LGBT identity disclosure to educate their clients about the ways in which these minority stressors can impact their healthcare experiences. Providers should assess the social support of their aging LGBT clients and inform them about the added benefit that social support can have in their healthcare experiences.

Mental Health Screenings: Practices and Patterns of These and Other Health Screenings in U.S. School Districts

Schools’ health screenings can identify students’ missed health concerns. Data from the 2016 School Health Policies and Practices Study were used to determine the proportion of U.S. school districts with physical and mental health screening policies and the proportion that arrange off-campus mental health services. We also examined differences between districts with and without mental health screening policies regarding having physical health screening policies, patterns of these policies, and off-campus mental health service arrangements. Eleven percent of districts had no policies on any of the four physical health screenings assessed, and 87% lacked policies on mental health screenings, the latter especially concerning considering the impact of COVID-19. Districts with policies on mental health screenings were significantly more likely to have body mass index ( p < .01) and oral health ( p < .001) screening policies, and to arrange for off-campus case management ( p < .001), family counseling ( p < .05), group counseling ( p < .01), self-help ( p < .05) and intake evaluation ( p < .05).

Lung function decline is associated with serum uric acid in Korean health screening individuals

We performed a retrospective cohort study of 19,237 individuals who underwent at least three health screenings with follow-up periods of over 5 years to find a routinely checked serum marker that predicts lung function decline. Using linear regression models to analyze associations between the rate of decline in the forced expiratory volume in 1 s (FEV1) and the level of 10 serum markers (calcium, phosphorus, uric acid, total cholesterol, total protein, total bilirubin, alkaline phosphatase, aspartate aminotransferase, creatinine, and C-reactive protein) measured at two different times (at the first and third health screenings), we found that an increased uric acid level was significantly associated with an accelerated FEV1 decline (P = 0.0014 and P = 0.037, respectively) and reduced FEV1 predicted % (P = 0.0074 and P = 8.64 × 10–7, respectively) at both visits only in non-smoking individuals. In addition, we confirmed that accelerated forced vital capacity (FVC) and FEV1/FVC ratio declines were observed in non-smoking individuals with increased serum uric acid levels using linear mixed models. The serum uric acid level thus potentially predicts an acceleration in lung function decline in a non-smoking general population.

Targeting Cerebrovascular Health Needs among Minority Populations at Risk of Urban Flooding: Prospective Observational Study (Preprint)

BACKGROUND Social inequities affecting minority populations after Hurricane Katrina led to an expansion of environmental justice literature. In August 2017, Hurricane Harvey rainfall was estimated as a 3,000 to 20,000 year event. To address dual concerns of urban flooding and disproportionate stroke prevalence among minorities, Stomp out Stroke, a patient-centered community outreach intervention, focused on improving knowledge of race/ethnicity specific healthcare needs. OBJECTIVE Our study addressed social inequities in minority cerebrovascular health through (1) the identification of race/ethnicity specific healthcare needs and (2) the provision of structured stroke prevention screening during two annual community engagement events (May 2018 and May 2019). METHODS Stomp out Stroke registrant surveys (age>18 years) detailed sociodemographic characteristics, family history of stroke and stroke survivorship. Participant healthcare interests’ were assessed. Comparisons by race/ethnicity [Asian, African-American(AA), Hispanic or non-Hispanic White (NHW)] were conducted using Kruskal-Wallis or Chi-square test. P < 0.05 equaled a statistically significant difference between >2 groups. RESULTS A total of 1401 people registered for Stomp out Stroke. Registrants were 70% female, median age 45 years. Participants largely self-identified as members of minority groups - 32% Hispanic, 26% AA, 14% Asian compared to 24%NHW. Stroke survivors comprised 11% of our population (n=155), 124 stroke caregivers participated. Approximately 37% of participants had a family history of stroke (n=493). AAs were most likely to have Medicare/Medicaid insurance (24.6%); Hispanics were most likely to be uninsured (29.2%). Hispanics were more likely than NHW to obtain health screenings (62.8 vs 52.9%; P=0.03). Asian and AAs were more likely to request stroke education than NHWs or Hispanics (55 or 56% vs 41.7 or 43%). AAs were more likely to seek overall health education than NHWs (46.2 vs 32.65%; P<0.01). NHWs were less likely than AAs or Asians to speak to healthcare providers (14.5 vs 25.3 or 28.3%). During the 2018 and 2019 events, 2774 Health Screenings were completed. These screenings included Blood Pressure (n=1031, 37.2%), Stroke Risk Assessment (n=496, 17.9%), Bone Density (n=426, 15.4%), Carotid Ultrasound (n=380, 13.7%) , Body Mass Index (n=182, 6.5%), Serum Lipids (n=157, 5.6%) and Hemoglobin A1C (n=102, 3.7%). CONCLUSIONS Stomp out Stroke identified race/ethnicity specific healthcare needs and provided appropriate screenings to minority populations at increased risk of urban flooding and stroke. This community engagement protocol can be replicated in Southern US “Stroke Belt” cities (New Orleans LA, Charleston SC, Savannah GA) with similar flood risk.

Preparing Pharmacy Students for Practice to Support Underserved Older Persons

Interprofessional collaboration is needed to ensure high quality care. Effective programs teaching necessary team-based care skills are under investigation. This study evaluated the Aging in Place program, an interprofessional practice experience (IPE), in preparing pharmacy students for practice with underserved older persons. The Assessment of Interprofessional Team Collaboration Scale (AITCS) and Team Decision Making Questionnaire (TCMQ) were administered to students before and after their experience. The number of disciplines represented, campuses involved, resident sessions, resident interactions, and health screenings performed were documented. Overall, AITCS and TDMQ scores improved after participation in the program. Since the program’s inception, there have been 7 disciplines represented, 2 campuses involved, 125 student participants, 2 housing buildings, 90 resident sessions, and 370 health screenings performed. The Aging in Place program has grown and shown that an IPE program is feasible to better prepare pharmacy students for collaborative care with older residents of affordable housing buildings.

Abstract 15991: African American Women Attending a Community Blood Pressure Screening Program

Background: The socioeconomic determinants of health (SEDoH) are contributors to the widening health disparities between White and AA women. Low income is a key contributor to poor cardiovascular (CV) health. Limited data exists on socioeconomic characteristics of African American (AA) women attending community blood pressure (BP) screenings. Objective: To examine whether income is related to BP in AA women attending community health screenings. Methods: AA women (n=972) attending community health screenings in metro Atlanta were evaluated from 2015 to 2019. Sociodemographics, health histories, point of care lipids, and BP were collected. Hypertension (HTN) was defined as systolic BP (SBP) >130 or diastolic BP (DBP) > 80 mmHg. Descriptive statistics, chi-square, and OLS linear regression were used to examine SEDoH and BP after adjusting for age, body mass index (BMI), smoking, and lipids. Results: Mean age was 51±14.1 years, mean SBP 132±19.6 mmHg and DBP 82±12 mmHg. In the unadjusted regression model, income of $48K-$96K (ß=4.1, se=2.0, p=<.04) was associated with a higher SBP compared to those earning $96K and above. After adjusting for covariates, income groups <$24K (ß=7.0, se=2.7, p=.01), $24K-$48K (ß=4.6, se=2.3, p=.05), & $48K-$96K (ß=5.5, se=2.1, p=.01) were associated with a higher SBP. Age (ß=.52, se=.05, p=<.001), BMI (ß=.53, se=.10, p=<.001), current smoking (ß=7.7, se=3.5, p=.03) and total cholesterol (ß=1.0, se=.04, p=.02) were the only covariates significantly associated with increased SBP. Income of $48K-$96K (ß=2.7, se=1.4, p=.05) and current smoking (ß=5.1, se=2.3, p=.03) were associated with a higher DBP in the fully adjusted models. Conclusions: Middle-aged AA women have higher prevalence of HTN, even those with higher incomes. Understanding CV risks and SEDoH, between high and low levels of income, is essential to improving culturally appropriate care. Community based BP screenings targeting both low and middle income AA women are needed to identify AA women with HTN and reduce CV events.