The differential rates in cost-related non-adherence to medical care by gender in the US adult population.

BACKGROUND: Cost-related non-adherence (CRN) to medical care is a persistent challenge in healthcare in the US. Gender is a key determinant of many healthcare behaviors and outcomes. Understanding variation in CRN by gender may provide opportunities to reduce disparities and improve outcomes. AIMS: This study aims to examine the differential rates in CRN by gender across a spectrum of socio-economic factors among the adult population in the US. METHOD: Data from the 2015 National Financial Capability Study (NFCS) were used for this study. CRN is identified if a respondent indicated not filling a prescription for medicine because of the cost and/or skipping a medical test, treatment, or follow-up recommended by a doctor because of the cost in the past 12 months. The differential rates in CRN by gender were assessed across socio-economic strata. A multivariable logistic regression analysis was performed to evaluate the difference in CRN rates by gender, controlling for potential confounders. RESULTS: A total of 26,287 adults were included in the analyses. Overall, the weighted CRN rate in the adult population is 19.8% for men and 26.2% for women. There was a clear pattern of differential rates in CRN across socio-economic strata by gender. Overall, men were less likely to report CRN (AOR = 0.74; 95% CI = 0.69-0.79), controlling for other risk factors. CONCLUSIONS: More research is needed to understand the behavioral aspects of gender difference in CRN. Patient-centered healthcare needs to take gender difference into account when addressing cost-related non-adherence behavior.

Understanding How Overweight and Obese Emerging Adults Make Lifestyle Choices.

To better understand health-related decision making among overweight and obese emerging adults. DESIGN AND METHODS: A cross-sectional design was used in the parent study involving overweight and obese emerging adults, ages 18-29 years. The goal of the parent study was to screen participants' diabetes risk and identify characteristics of emerging adults with prediabetes (N=107). A sub-sample of respondents (n=34) from the parent study were invited to participate in focus group interviews depending on whether they had prediabetes (three groups) or they did not have prediabetes (four groups). Each focus group interview lasted 90-120 minutes following a semi-structured interview guide. Conventional content analysis was used in the data analysis. Because of the similarities between participants with and without prediabetes, the findings were synthesized and reported in the aggregate. Moreover, during the analysis, the authors decided that rational choice theory provided a useful organizing structure for presenting the data. RESULTS: Emerging adults' behavioral decisions were rational reactions to their personal competence, perception of health, environment, and availability of resources to handle problems. Calculation of trade-offs and estimations of resource availability were often used when making decisions. CONCLUSIONS: Emerging adults choose unhealthy behaviors due to inaccurate information and insufficient competence to practice healthy lifestyles rather than because of laziness or being irrational. PRACTICE IMPLICATIONS: Behavioral interventions for emerging adults need to help them develop skills to enhance health literacy and problem solving, thereby enhancing their awareness of available resources and decreasing the perceived cost of making healthy choices.