Role of information sources in adherence to COVID-19-related safety measures among college students in the USA.

OBJECTIVE: During the COVID-19 pandemic, information sources such as public officials, national/international media, social media, public health agencies, college/university officials, etc., played a vital role in adherence to safety measures, including hygiene practices, social distancing, and mask-wearing. We analyze the role of trusted sources of information in adherence to safety measures and explore potential disparities among US college students during the pandemic. METHODS: We analyze Healthy Minds Study (HMS) 2020-2021 COVID Module data and utilize multivariable logistic regressions controlling for sociodemographic and COVID-19-related factors. Subgroup analyses were conducted by gender, citizenship status, race, and educational level. RESULTS: Significant differences were found in adherence to safety measures when information was received from different sources. Demographic subgroups within the college student population depended on different sources of COVID-19-related information. Adherence to COVID-19-related safety measures also differed by demographic characteristics. CONCLUSION: This analysis supports the necessity for targeted health-related messaging among US college students.

Nursing home closures and access to post-acute care and long-term care services in rural areas.

PURPOSE: Nursing home closures have raised concerns about access to post-acute care (PAC) and long-term care (LTC) services. We estimate the additional distance rural residents had to travel to access PAC and LTC services because of nursing home closures. METHODS: We identify nursing home closures and the availability of PAC and LTC services in nursing homes, home health agencies, and hospitals with swing beds using the Medicare Provider of Services file (2008-2018). Using distances between ZIP codes, we summarize distances to the closest provider of PAC and LTC services for rural and urban ZIP codes with nursing home closures from 2008 to 2018 and no nursing homes in 2018. FINDINGS: Compared to urban ZIP codes, rural ZIP codes experiencing nursing home closure had higher distances to the closest nursing home providing PAC (6.4 vs. 0.94 miles; p < 0.05) and LTC services (7.2 vs. 1.1 miles; p < 0.05), and these differences remain even after accounting for the availability of home health agencies and hospitals with swing beds. Distances to the closest providers with PAC and LTC services were even higher for rural ZIP codes with no nursing homes in 2018. About 6.1%-15.7% of rural ZIP codes with a nursing home closure or with no nursing homes had no PAC or LTC providers within 25 miles. CONCLUSIONS: Nursing home closures increased distances to nursing homes, home health agencies, and hospitals with swing beds for rural residents. Access to PAC and LTC services is a concern, especially for rural areas with no nursing homes.

Effects of the Affordable Care Act Insurance Expansions on Health Care Coverage, Access, and Health Status of 50-64-Year-Old Adults: Evidence From the First Six Years.

Individuals aged 50-64 face a higher burden of chronic conditions and an increased probability of insurance coverage loss, making them particularly vulnerable to limited access than younger adults. This study examines the effects of the Affordable Care Act (ACA) insurance expansions, including both Medicaid eligibility and other expansions, on health care coverage, access, and health status of adults aged 50-64 years over 6 years since the initial expansions in 2014. Using a triple difference-in-difference-in-differences model and nationally representative data, we find that the ACA increased private insurance and Medicaid coverage. There is evidence of improved access based on having a personal provider, completing a routine checkup, and reducing forgoing medical care due to cost. There is little evidence for the effects on self-reported health outcomes. Findings suggest that coverage expansions have improved access to care but have thus far not had discernible and consistent effects on self-reported health for 50-64-year-olds.

Effects of the ACA Medicaid expansions on access and health by nurse practitioner scope of practice laws.

BACKGROUND: The Affordable Care Act (ACA) Medicaid expansions increased demand for care whereas the Scope of Practice (SOP) laws for nurse procatitioners affect the supply of primary care providers. It is important to udnerstand the interaction of the demand and supply side policies on measures of access to care and health status. PURPOSE: To examine whether effects of the Affordable Care Act (ACA) Medicaid expansions on access to care and health status are moderated by state scope of practice (SOP) laws for nurse practitioners. METHODS: Using data from the 2011 to 2019 Behavioral Risk Factor Surveillance System, the study used a difference-in-differences design that compared outcome changes between expansion and non-expansion states and evaluated whether these changes differed by state SOP laws. DISCUSSION: Following Medicaid expansion, forgoing a needed doctor's visit due to cost declined more in expansion states with full SOP laws than states with reduced SOP laws by 3.0 percentage-points in years 1 to 3 after the expansion (p < .05). Furthermore, completing a routine checkup with a doctor increased more in expansion states with full SOP laws by 3.2 percentage-points in 4 to 6 years (p < .05). CONCLUSION: The ACA Medicaid expansions were associated with larger gains in certain access measures in states with full SOP laws.

Effects of the 2014 Affordable Care Act Medicaid Expansions on Health Care Access and Health Status of Poor Adults Aged 60-64 Years: Evidence From the First 6 Years.

BACKGROUND AND OBJECTIVES: Little is known on the effects of the Affordable Care Act (ACA) Medicaid expansions on health care access and health status of adults closest to 65. This study examines the effects of ACA Medicaid expansion on access and health status of poor adults aged 60-64 years. RESEARCH DESIGN AND METHODS: The study employs a difference-in-differences design comparing states that expanded Medicaid in 2014 under the ACA and nonexpansion states over 6 years postexpansion. The data are from the 2011-2019 Behavioral Risk Factor Surveillance System for individuals aged 60-64 years below the Federal Poverty Level. RESULTS: Having any health care coverage rate increased by 8.5 percentage points (p < .01), while the rate of forgoing a needed doctor's visit due to cost declined by 6.6 percentage points (p < .01). Similarly, rates of having a personal doctor/provider and completing a routine checkup increased by 9.1 (p < .01) and 4.8 (p < .1) percentage points, respectively. Moreover, days not in good physical health in the past 30 declined by 1.5 days (p < .05), with suggestive evidence for decline in days not in good mental health and improvement in self-rated health. DISCUSSION AND IMPLICATIONS: The ACA Medicaid expansions have improved health care access and health status of poor adults aged 60-64 years. Expanding Medicaid in the states that have not yet done so would reduce barriers to care and address unmet health needs for this population. Bridging coverage for individuals aged 60-64 years by lowering Medicare eligibility age could have long-term effects on well-being and health services utilization.

Cancer related knowledge, attitude, and practice among community health care providers and health assistants in rural Bangladesh.

BACKGROUND: Cancer remains one of the primary causes of death in Bangladesh. The success of cancer control in rural areas depends on the ability of the health care system and workforce to identify and manage cases properly at early stages. Community Health Workers (CHW) can play a vital role in this process. The present study aims to assess cancer related Knowledge, Attitude, and Practice (KAP) among 2 categories of CHWs - Community Health Care Providers (CHCP) and Health Assistants (HA) in rural Bangladesh. METHODS: A descriptive cross-sectional study was conducted using a self-administered questionnaire from July 2019 to June 2020. Multi-stage sampling technique was used to determine the sample. One Upazilla Health Complex (UHC) from each of the eight administrative divisions of Bangladesh were randomly chosen as study sites, from which 325 CHCPs and HAs were in the final sample. Multivariate logistic regression models were developed to determine the association between KAP scores and demographic variables. RESULTS: Our study shows that a modest number of respondents scored above average in the knowledge (54.15%), attitude (58.15%), and practice (65.54%) sections. Majority CHCPs (90.91%) and HAs (96.06%) did not receive govt. training on cancer. Only 20.71% HAs and 25.2% CHCPs knew about the availability of cancer treatment options in Bangladesh. Uncertainty about the availability of relevant treatments or vaccinations at public facilities was also high. Having cancer in the family, income, duration of employment and workplace locations were important predictors of cancer related KAP scores. CONCLUSION: Healthcare workforce's knowledge gap and unfavorable attitude towards cancer may result in poor delivery of care at the rural level. For many people in rural areas, CHCPs and HAs are the first point of contact with the healthcare system and thus effective cancer control strategies must consider them as key stakeholders. Targeted training programs must be adopted to address the cancer related KAP gaps among CHCPs and HAs.