Predictors of PrEP awareness, PrEP discussion and interest in long-acting injectable PrEP among Filipina transfeminine adults.

INTRODUCTION: Transfeminine adults are impacted by the HIV epidemic in the Philippines, and newly approved modalities of pre-exposure prophylaxis (PrEP), including long-acting injectable (LAI-PrEP), could be beneficial for this group. To inform implementation, we analysed PrEP awareness, discussion and interest in taking LAI-PrEP among Filipina transfeminine adults. METHODS: We utilized secondary data from the #ParaSaAtin survey that sampled Filipina transfeminine adults (n = 139) and conducted a series of multivariable logistic regressions with lasso selection to explore factors independently associated with PrEP outcomes, including awareness, discussion with trans friends and interest in LAI-PrEP. RESULTS: Overall, 53% of Filipina transfeminine respondents were aware of PrEP, 39% had discussed PrEP with their trans friends and 73% were interested in LAI-PrEP. PrEP awareness was associated with being non-Catholic (p = 0.017), having previously been HIV tested (p = 0.023), discussing HIV services with a provider (p<0.001) and having high HIV knowledge (p = 0.021). Discussing PrEP with friends was associated with older age (p = 0.040), having experienced healthcare discrimination due to transgender identity (p = 0.044), having HIV tested (p = 0.001) and having discussed HIV services with a provider (p < 0.001). Very interested in LAI-PrEP was associated with living in Central Visayas (p = 0.045), having discussed HIV services with a provider (p = 0.001) and having discussed HIV services with a sexual partner (p = 0.008). CONCLUSIONS: Implementing LAI-PrEP in the Philippines requires addressing systemic improvements across personal, interpersonal, social and structural levels in healthcare access, including efforts to create healthcare settings and environments with providers who are trained and competent in transgender health and can address the social and structural drivers of trans health inequities, including HIV and barriers to LAI-PrEP.

Asian, Latinx, or Multiracial? Assessing Filipinxs' Health Conditions and Outcomes by Aggregate Ethnic Category.

INTRODUCTION: Filipinxs are the second-largest Asian subgroup in the USA. While Filipinxs are most often considered Asian when constructing aggregate ethnic categories, recent research has identified a trend of a small portion of Filipinxs identifying as Latinx or multiracial. However, little research had addressed how identification with different aggregate ethnic categories may have implications for identifying health disparities among Filipinxs and how these compare to non-Hispanic whites. METHODS: Bivariate and multivariable regression analyses using 2011-2018 California Health Interview Survey data, comparing Asian Filipinxs, Latinx Filipinxs, and multiracial Filipinxs. RESULTS: In bivariate analyses, Asian Filipinxs had a higher prevalence of diabetes than Latinx or multiracial Filipinxs. After controlling for sociodemographics, Latinx Filipinxs had significantly lower odds of having diabetes or heart disease than Asian Filipinxs. Compared to non-Latinx Whites, Asian Filipinxs reported higher odds of being in fair/poor health, obese or overweight, high blood pressure, and diabetes, multiracial Filipinxs reported higher odds of being obese or overweight, and Latinx Filipinxs reported lower odds of heart disease. DISCUSSION: These findings suggest emerging differences in health linked to identification with different ethnic categories, underscoring the need to investigate nuances among Filipinxs in future research as well as highlighting the utility of emerging sociological insights in health research.

Intimate Partner Violence and Sexual Agency in a Nationally Representative Sample of Women and Girls in the Philippines.

This study examined the prevalence of intimate partner violence (Intimate Partner Violence) and its associations with sexual agency among women and adolescent girls in the Philippines. Data came from the 2017 Philippines National Demographic and Health Survey (DHS), a nationally representative, cross-sectional survey of women and girls ages 15-49. Participants included 11,727 women and girls who reported having a current male partner. Survey measures included three indicators of Intimate Partner Violence (physical, sexual, emotional), ability to refuse sex, ability to insist on condom use, perception that a husband/boyfriend can be justified in hitting or beating his wife/girlfriend, and sociodemographic characteristics. Descriptive and multivariable statistical analyses were conducted, with survey weightings used to account for the complex survey design. Overall, 23.9% reported Intimate Partner Violence in their current partnership (10.1% physical violence, 3.4% sexual violence, 19.0% emotional violence), 11.2% believed a husband or partner could be justified in hitting or beating their wife, 10.5% reported being unable to refuse sex with their partner, and 20.4% were unable to ask their partner to use a condom. In multivariable analyses, experiences of sexual (OR .68; 95% CI .50, .92), physical (OR .83; 95% CI .68, 1.02), and emotional violence (OR .69; 95% CI .58, .81) were associated with lower adjusted odds of being able to ask a partner to use a condom. When placed in the same model, emotional violence had the strongest association with lower odds of negotiating condom use with partner (OR .70; 95% CI .57, .85). Perception that a husband/boyfriend can be justified in hitting or beating his wife/girlfriend was associated with lower ability to refuse sex and ask a partner to use a condom. Findings indicate a need for further investment in interventions to prevent Intimate Partner Violence and support the sexual health and agency of women and girls who have experienced Intimate Partner Violence in the Philippines.

The Association Between Moderate and Serious Mental Health Distress and General Health Services Utilization Among Chinese, Filipino, Japanese, Korean, and Vietnamese Adults in California.

INTRODUCTION: A growing body of literature has indicated that disaggregated analyses using distinct Asian subgroups allow for identification of varying mental health challenges and health services utilization. In this study, we examined the associations between distress and health services utilization among five Asian subgroups: Chinese, Korean, Japanese, Filipino, and Vietnamese adults in California. MATERIALS AND METHODS: Using a combined dataset using the 2011-2018 cross-sectional cycles of the California Health Interview survey, we assessed moderate and serious distress and four health services utilization indicators in a set of disaggregated analyses among adults 18 years of age and older in five Asian subgroups. We performed bivariate and multivariable analyses. RESULTS: The prevalence of and associations between moderate and serious distress and gaps in health services utilization varied among each Asian subgroup. Koreans had the highest prevalence of moderate and serious distress and the most gaps in health services utilization. Compared to those without moderate distress (p < .05), Japanese adults were more likely to delay care. Compared to those without serious distress (p < .05), Chinese adults who experienced serious distress were more likely to delay both medications and care, whereas Filipino and Vietnamese adults were more likely to delay medications. DISCUSSION: Disaggregating health data elucidates the impact of mental distress on healthcare-seeking behaviors among specific Asian subgroups. Identifying these influences can facilitate future tailored interventions, yet fully understanding the mechanism linking mental distress and healthcare usage will necessitate a comprehensive assessment of structural influences and Asian American experiences without otherization.

Responsive Medical Providers and Recent HIV Medical Services Engagement Among Transgender Women and Cisgender Men Who Have Sex With Men in the Philippines.

Transgender women and cisgender men who have sex with men (trans-WSM and cis-MSM) comprise the majority of new HIV infections in the Philippines. There is limited research in the Philippines on the relationship between having a provider responsive to the needs of these populations and recent engagement in HIV medical services such as HIV testing and treatment. We used multivariate logistic regression to examine the relationship between having a responsive medical provider and engagement in HIV medical services in the past 12 months among an online sample of 318 trans-WSM and cis-MSM in the Philippines. Participants without a responsive medical provider had lower adjusted odds of recent HIV medical service engagement than those who did (aOR = 0.32, 95% CI [0.16, 0.62], p = .00). In stratified analyses, this relationship was significant for trans-WSM but not cis-MSM. Increasing access to responsive providers in the Philippines could bolster recent engagement with HIV medical services.

From imperialism to inpatient care: Work differences of Filipino and White registered nurses in the United States and implications for COVID-19 through an intersectional lens.

In the United States, nursing is the largest healthcare profession, with over 3.2 million registered nurses (RNs) nationwide and comprised of mostly women. Foreign-trained RNs make up 15 percent of the RN workforce. For over half a century, the U.S. healthcare industry has recruited these RNs in response to nurse shortages in hospitals and nursing homes. Philippines-trained RNs make up 1 out of 20 RNs in this country and continue to be the largest group of foreign-trained nurses today. Recently, the news media has publicized the many deaths of Filipino RNs as a result of the COVID-19 pandemic in the United States. Given the imperial historical ties between these two countries in the context of the nursing profession and the enduring labor inequities that persist, this nationally representative study is one of the few to our knowledge to not only quantitatively examine the current work differences in characteristics and experiences of Philippines-trained RNs and U.S.-trained white RNs practicing in the United States today, but to also do so from an intersectionality lens. The overall aim of this paper is to illuminate how these differences may serve as potential factors contributing to the disproportionate number of Filipino nurses' COVID-19 related vulnerability and deaths in the workplace.

Transgender-specific developmental milestones and associated experiences of violence, discrimination, and stigma among Filipinx transgender women who are sexually active with men.

BACKGROUND: For transgender people, reaching transgender (trans)-specific developmental milestones, including recognizing and expressing one's identity, plays an integral role in overall health, wellbeing, and the pursuit of gender affirmation. Yet trans people continue to face minority stressors, including structural violence (i.e., discrimination, violence, and stigma), which may interfere with the achievement of these milestones. Among trans women specifically, however, potential associations between gender developmental milestones and structural violence are not well characterized in the literature. In a sample of Filipinx (i.e., an inclusive term for describing non-binary genders in the Philippines) trans women who are sexually active with men (trans-WSM), we thus sought to: (a) describe the mean ages at which gender developmental milestones occur and (b) examine the associations between structural violence and mean ages at which at which Filipinx trans-WSM experience trans-specific developmental milestones. METHODS: Using data from Project #ParaSaAtin, an online survey of Filipinx trans-WSM (n = 139), we mapped age-estimates per trans-specific milestones and then tested whether structural violence is associated with the mean age at which trans women experience trans-specific developmental milestones. RESULTS: Overall, participants who reported higher levels of discrimination, stigma, and violence also experienced a later age for nearly each milestone (i.e., initial self-awareness of transfeminine identity, transfeminine expression in private, transfeminine expression in public, first consensual oral/vaginal/anal sex with a cisgender male partner, first consensual oral/vaginal/anal sex with a cisgender male partner as a trans women, and hormone integration) (all p-values <0.05). Of note, the single exception to this pattern was the non-significant association between stigma and initial disclosure of transfeminine identification to another person. CONCLUSION: Results are consistent with psychological literature outlining a temporal sequence of developmental milestones among young trans-WSM. For young trans-WSM in the Philippines, data from this study demonstrate significant associations between structural violence and the achievement of developmental milestones. These findings highlight the need for trauma-informed, strengths-based programming and institutional policies that measure and mitigate anti-trans violence.

Evaluating Translation of HIV-Related Legal Protections Into Practice: A Qualitative Assessment Among HIV-Positive Gay, Bisexual, and Other Men Who Have Sex With Men in Manila, Philippines.

Legal protections for people living with HIV (PLHIV) are important for protecting human rights, yet little research has examined how laws translate into awareness and understanding for key populations. The Philippines has recently revised their legal protections for PLHIV in response to its growing HIV epidemic, where HIV-positive gay, bisexual and other men who have sex with men bear the majority of cases. We present findings from interviews with 21 HIV-positive gay, bisexual and other men who have sex with men in Manila, Philippines regarding awareness, understanding, and needs regarding HIV-specific legal protections at the time just before new revisions to the omnibus HIV law were passed. Overall, there was no standardized way participants became aware of legal protections; few became aware through healthcare providers, while most learned through online resources, social media, and advocacy organizations. However, even after learning about HIV-specific legal protections, many found the law too complex to understand or did not understand how to use such protections. This led participants to preemptively take action to avoid HIV-related discrimination, even if they were protected by law. Participants demonstrated a strong desire for interventions and policies to improve legal awareness and understanding for PLHIV, government officials, and private businesses. This research demonstrates the value of increasing awareness and understanding in policy-specific interventions designed to improve quality of life for PLHIV. Interventions centered around legal protections are currently underdeveloped, providing a strong opportunity to integrate such interventions in existing practice or as stand-alone tools to decrease perceived stigmatization.

Using structural equation modelling to characterise multilevel socioecological predictors and mediators of condom use among transgender women and cisgender men who have sex with men in the Philippines.

BACKGROUND: Risks for condomless sex among transgender women and cisgender men who have sex with men (trans-WSM and cis-MSM, respectively) in the Philippines, where HIV recently became a national public health crisis, are shaped and exacerbated by various risk factors across multiple levels. METHODS: Between June 2018 and August 2019, we conducted a cross-sectional online study with 318 trans-WSM and cis-MSM respondents from Manila and Cebu cities. Structural equational modelling procedures were performed to determine direct, indirect and overall effects between condom use and latent variables across multiple socioecological levels: personal (ie, condom self-efficacy), social (ie, social capital), environmental (ie, barriers to condom and HIV services) and structural (ie, structural violence, antidiscrimination policies). RESULTS: Adjusted for gender, age, location and income, our model showed that: (1) all latent variables at the structural and environmental levels were significantly positively associated with each other (all ps<0.05); (2) barriers to condom and HIV services were significantly negatively associated with social capital (p<0.001) as well as condom self-efficacy (p<0.001); and (3) there were significantly positive associations between social capital and condom self-efficacy (p<0.001), and between condom self-efficacy and condom use (p<0.001). Moreover, social capital and condom self-efficacy fully mediated and buffered the negative effects between environmental and structural barriers and condom use. CONCLUSION: This is the first known study pointing to multiple relationships and pathways across multiple socioecological levels that can potentially be leveraged for future interventions aimed at improving condom use among Filipinx trans-WSM and cis-MSM. Such interventions should be multicomponent and build and/or strengthen social capital and condom self-efficacy, as well as intentionally target prominent structural and environmental barriers to condom use.

Trans-incarceration: Reimagining confinement and the criminality of aging.

As the U.S. population continues to age and will require increasing levels of care, scholars continue to question what conventional methods of "custodial care" and rehabilitation accomplish for the individuals receiving them, relative to those providing them. To this end, critical discourse surrounding the spatial institutionalization of older adults argues that formal institutions of care and rehabilitation are simply alternative and synonymous forms of incarceration and imprisonment. Using semi-structured interviews with ten male residents of a Rhode Island nursing home and ten incarcerated males at the Rhode Island state prison's medium security unit, this work explores the following questions within the existing scholarship of the medical sociology of confinement and incarceration: In what ways are experiences of confinement alike for older adults living in prisons and for those living in nursing homes, and what do these similarities/differences imply about aging, disabled, and economically unproductive bodies as "deviant" and subsequently "criminal" as the traditional definition of the carceral space expands? Participant responses across the nursing home and prison settings fit into three categories, including "home as historical/home as negation," "institution as escape," and "self as non-human/self as non-agent." As a result, there exist thematic consistencies amidst the subjective experiences of older adults across settings of confinement that argue for a shared "criminality" socially assigned to an aging body.

Health Conditions, Outcomes, and Service Access Among Filipino, Vietnamese, Chinese, Japanese, and Korean Adults in California, 2011-2017.

Objectives. To determine the impact of data disaggregation on the ability to identify health disparities and needs for future research for Filipino, Vietnamese, Chinese, Japanese, and Korean adults in California.Methods. Using available data from the 2011-2017 California Health Interview Survey, we conducted bivariate and multivariable analyses to assess disparities in health conditions, outcomes, and service access compared with non-Hispanic Whites for Asians as an overall group and for each individual subgroup.Results. As an aggregate category, Asians appeared healthier than did non-Hispanic Whites on most indicators. However, every Asian subgroup had at least 1 disparity disguised by aggregation. Filipinos had the most disparities, with higher prevalence of fair or poor health, being obese or overweight, and having high blood pressure, diabetes, or asthma compared with non-Hispanic Whites (P < .05) in multivariable analyses.Conclusions. Failure to disaggregate health data for individual Asian subgroups disguises disparities and leads to inaccurate conclusions about needs for interventions and research.

Home Health Utilization in Assisted Living Settings.

Home health agencies (HHAs) are one of the most commonly used third-party providers in the assisted living (AL) setting. One way ALs may be potentially able to meet the needs of their residents despite increased impairment is through supplementing the services offered with those delivered by HHAs. We explore the growth in the delivery of HHA services to Medicare beneficiaries in AL compared with other home settings between 2012 and 2014. We also examine demographic, cognitive, and functional characteristics of beneficiaries; HHA provider characteristics; and the variation in the percentage of home health use in ALs across the country. Our findings suggest that there was a slight growth in the share of HHA services being delivered in AL. HHA recipients in AL were more likely to have cognitive and activities of daily living impairments than those receiving HHA services in other settings. This is among the first studies to examine HHA utilization in AL.

Sword and Shield: Perceptions of law in empowering and protecting HIV-positive men who have sex with men in Manila, Philippines.

Legal protections for people living with HIV (PLHIV) are important for protecting human rights and combatting stigma. While much focus has been on the pernicious impacts of criminalisation of HIV transmission or nondisclosure, little research has accounted for the ways in which perception of protective laws may affect the everyday lives of PLHIV. The Philippines has the fastest growing HIV epidemic in the Asia & Pacific region, with HIV-positive men-who-have-sex-with-men (HIV+ MSM) bearing the majority of cases, and has recently revised their legal protections for PLHIV. We present findings from interviews with 21 HIV+ MSM in Manila, Philippines. Overall, participants viewed legal protections as both empowering and protective. Empowerment was achieved as protections helped participants manage internalised stigma, feel as if they had a weapon to fight discrimination, and perceive a more equitable climate around HIV within broader society. While participants felt as though the law sent positive signals that the government wanted to protect PLHIV, they doubted the actual legal process of bringing suits, leading to harms. Overall, this research presents ways in which legal protections can considered in interventions to empower PLHIV and also identifies opportunities to improve research and advocacy in settings with similarly protective laws.

Barriers and facilitators to uptake of condoms among Filipinx transgender women and cisgender men who have sex with men: A situated socio-ecological perspective.

Transgender women (TW) and cisgender men who have sex with men (cis-MSM) are disproportionately impacted by the national HIV crisis in the Philippines, where the HIV incidence has, in large part, been attributed to condomless sex. This study sought to qualitatively examine the socio-ecological factors that contribute to low condom uptake among Filipinx TW and cis-MSM communities in Manila. Between July and August 2017, we conducted semi-structured qualitative interviews with 30 TW and cis-MSM participants (n = 23 and 7, respectively). We identified structural factors described by TW and cis-MSM, and noted that they varied per situation and context of: (a) friends (e.g. as condom promoters and educators), (b) schools (e.g. lack of sex education and HIV curriculum), (c) health care facilities (e.g. availability, educational programmes, and HIV testing requirement), (d) stores (e.g. placement of condoms, distance to store, and cost), and (e) church (e.g. prohibition of condom distribution programmes, and unsupportiveness). Condom-related stigma as a social factor was pervasively present across all situation or context. Our findings support the need for multilevel condom promotion interventions that are tailored per situation or context. Future research is needed to identify factors that can be leveraged for condom promotion strategies within diverse situations.

Prioritizing HIV Services for Transgender Women and Men Who Have Sex With Men in Manila, Philippines: An Opportunity for HIV Provider Interventions.

Transgender women (TW) and men who have sex with men (MSM) are highly affected by the rising HIV epidemic in the Philippines. HIV providers are essential to curbing the epidemic. Between July and August 2017, we conducted one-on-one qualitative interviews with 15 HIV providers in Manila, Philippines. Overall, providers reported tension between willingness to provide care versus actual competencies. Most discussed treating every patient equally regardless of gender or sexual identities. However, many expressed hesitancies in providing HIV services due to (a) not knowing the health needs of TW and MSM, (b) having little to no training in HIV, and (c) difficulty being sensitive to patient gender and sexuality. Although providers were unsure about how to prioritize HIV services for TW and MSM, some expressed interest in learning and engaging these populations in their practices. Our findings suggest the importance of provider-focused interventions to prioritize TW and MSM health needs.

Gender affirmative HIV care framework: Decisions on feminizing hormone therapy (FHT) and antiretroviral therapy (ART) among transgender women.

BACKGROUND: Integration of feminizing hormone therapy (FHT) and antiretroviral therapy (ART) is critical in providing gender-affirming HIV care for transgender (trans) women living with HIV. However, interpersonal communications with HIV providers who are not competent with FHT may complicate this integration. METHODS: We conducted semi-structured interviews with trans women (n = 9) who self-reported as HIV-positive and their HIV providers (n = 15) from community-based venues (e.g., clinics) in Manila, Philippines. RESULTS: We identified five key themes from our qualitative data: (1) provider's concerns; (2) patient's goals; (3) affirmative vs. non-affirmative provider rhetoric; (4) alignment vs. misalignment of provider rhetoric to patient goals; and (5) FHT and ART-related decisions. Based on these themes, we describe a gender-affirmative HIV care framework to understand FHT-ART decisions among trans women living with HIV. Based on our data, this framework shows that provider-patient communications regarding ART and FHT consists primarily of provider concerns and patient goals regarding FHT. These communications can take on a gender-affirmative or non-affirmative style of rhetoric that either aligns or misaligns with patient goals and may lead to differences in FHT and ART-related decisions among trans women living with HIV. CONCLUSION: There exist mixed regimens and beliefs about taking FHT and ART among this sample of trans women. While trans participants' main source of health information is their HIV provider, providers are likely to communicate non-affirmative rhetoric that negatively impacts trans women's decision to take FHT and ART. Research is needed to elucidate co-prescriptions of gender-affirmative services with HIV care among this group in the Philippines.

Collective Coping Strategies for HIV-Related Challenges Among Men Who Have Sex With Men in Manila, Philippines.

Contextual factors, such as cultures of collectivism versus individualism, shape HIV coping strategies; despite this, little research regarding collective coping strategies applied to HIV exists. This may be important for the growing HIV epidemic in the Philippines, which has a collectivistic culture and where men who have sex with men (MSM) account for a majority of the cases. Fifteen semistructured, in-depth interviews with HIV-positive MSM and 6 interviews with community-based organization workers were conducted between June and August 2017. Data were analyzed using thematic framework analysis. Three strategies were identified: peer support, spirituality, and support from existing relationships. Each form of collective coping had unique mechanisms and benefits for dealing with HIV. Overall, helping MSM with HIV find a collective identity after an HIV diagnosis enables management of HIV-related challenges. Policies and research interventions that improve access to collective identities for MSM with HIV may improve management of HIV-related challenges.

Trends and emerging directions in HIV risk and prevention research in the Philippines: A systematic review of the literature.

BACKGROUND: The Philippines is experiencing one of the fastest growing epidemics globally. Evidence-based public health policies are needed. To describe the public health literature on HIV risk groups and prevention approaches in the Philippines, we reviewed published empirical studies with HIV-related outcomes. METHODS: Based on an a priori systematic review protocol, we searched PubMed, PsycINFO and CINAHL databases for quantitative studies conducted in the Philippines that reported on HIV risk groups factors and interventions to prevent HIV. The search included studies published as of April 2018. RESULTS: We identified 755 records, screened 699 unique titles and abstracts, and conducted full text review of 122 full reports of which 51 articles met inclusion criteria. The majority were cross-sectional studies describing HIV and STI prevalence and risk factors in samples recruited from the Philippines. Four HIV prevention programs conducted in the Philippines were identified, all of which reported improvements on HIV knowledge, attitudes, and behaviors. Overall, female sex workers (FSWs) constituted the primary study population, and few studies reported data from men who have sex with men (MSM), people who inject drugs (PWIDs), and youth. No studies reported on transgender populations. Most studies were focused on examining condom use-related outcomes and STI history, few had biomarkers for HIV, and none addressed biomedical HIV prevention strategies. CONCLUSION: This review identifies an agenda for future HIV research that is needed to address the growing and shifting nature of the HIV epidemic in the Philippines.

Welfare State Replacements: Deinstitutionalization, Privatization and the Outsourcing to Immigrant Women Enterprise.

The U.S. government has a long tradition of providing direct care services to many of its most vulnerable citizens through market-based solutions and subsidized private entities. The privatized welfare state has led to the continued displacement of some of our most disenfranchised groups in need of long-term care. Situated after the U.S. deinstitutionalization era, this is the first study to examine how immigrant Filipino women emerged as owners of de facto mental health care facilities that cater to the displaced, impoverished, severely mentally ill population. These immigrant women-owned businesses serve as welfare state replacements, overseeing the health and illness of these individuals by providing housing, custodial care, and medical services after the massive closure of state mental hospitals that occurred between 1955 and 1980. This study explains the onset of these businesses and the challenges that one immigrant group faces as owners, the meanings of care associated with their de facto mental health care enterprises, and the conditions under which they have operated for more than 40 years.

A Methodology to Identify a Cohort of Medicare Beneficiaries Residing in Large Assisted Living Facilities Using Administrative Data.

BACKGROUND: Assisted living is a popular option for housing and long-term care. OBJECTIVE: To develop and test a methodology to identify Medicare beneficiaries residing in assisted living facilities (ALFs). RESEARCH DESIGN: We compiled a finder file of 9-digit ZIP codes representing large ALFs (25+ beds) by matching Outcome and Assessment Information Set (OASIS) assessments and Medicare Part B Claims to the Medicare enrollment records and addresses of 11,751 ALFs. Using this finder file, we identified 738,567 beneficiaries residing in validated ALF ZIP codes in 2007-2009. We compared characteristics of this cohort to those of ALF residents in the National Survey of Residential Care Facilities (n=3009), a sample of community-dwelling Medicare beneficiaries (n=33,025,690), and long-stay nursing home residents (n=1,287,572). DATA SOURCES: A national list of licensed ALFs, Medicare enrollment records, and administrative health care databases. RESULTS: The ALF cohort we identified had good construct validity based on their demographic characteristics, health, and health care utilization when compared with ALF residents in the National Survey of Residential Care Facilities, community-dwelling Medicare beneficiaries, and long-stay nursing home residents. CONCLUSIONS: Our finder file of 9-digit ZIP codes enables identification of ALF residents using administrative data. This approach will allow researchers to examine questions related to the quality of care, health care utilization, and outcomes of residents in this growing sector of long-term care.