Predictors of Past-Year Health Care Utilization Among Young Men Who Have Sex with Men Using Andersen&apos;s Behavioral Model of Health Service Use

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Abstract

Purpose: This study examined factors associated with past-year health care utilization among young gay, bisexual, and other men who have sex with men (YMSM) using Andersen's behavioral model of health service use. Methods: From 2018 to 2020, 751 YMSM (aged 13-18) recruited online and offline for the MyPEEPS mHealth HIV prevention study completed an online survey. Hierarchical logistic regression models assessed associations between past-year health care utilization (i.e., routine checkup) and predisposing (parental education, race/ethnicity, age, and internalized homonegativity), enabling (health literacy, health care facility type, U.S. Census Divisions), and need factors (ever testing for HIV). Results: The sample included 31.8% Hispanic, 23.9% White, and 14.6% Black YMSM; median age was 16. Most (75%) reported past-year health care utilization, often from private doctor's offices (29.1%); 6% reported no regular source of care. In the final regression model, higher odds of past-year health care utilization were found for younger participants (age 13-14, adjusted odds ratio [AOR] = 1.91; 95% confidence interval [CI]: 1.07-3.43; age 15-16 AOR = 1.55; 95% CI: 1.04-2.30; reference: 17-18) and those with increasing health literacy (AOR = 1.71; 95% CI: 1.36-2.16). YMSM with lower parental education had lower odds of past-year health care utilization (AOR = 0.56; 95% CI: 0.38-0.84), as did those relying on urgent care facilities (AOR = 0.60; 95% CI: 0.41-0.87; reference: routine care facilities) and those who identified as Mixed/Other race (AOR = 0.50; 95% CI: 0.28-0.91; reference: White). Conclusions: Findings highlight opportunities to intervene in YMSM's health risk trajectory before age 17 to reduce drop-off in routine health care utilization. Interventions to improve routine health care utilization among YMSM may be strengthened by building resilience (e.g., health literacy) while removing barriers maintained through structural disadvantage, including equity in education. Clinical Trial Registration Number: NCT03167606.

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Revisiting the Behavioral Model and Access to Medical Care: Does it Matter?

Ronald Andersen (1995)

The Behavioral Model of Health Services Use was initially developed over 25 years ago. In the interim it has been subject to considerable application, reprobation, and alteration. I review its development and assess its continued relevance.

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Education Improves Public Health and Promotes Health Equity.

Robert Hahn, Benedict Truman (2015)

This article describes a framework and empirical evidence to support the argument that educational programs and policies are crucial public health interventions. Concepts of education and health are developed and linked, and we review a wide range of empirical studies to clarify pathways of linkage and explore implications. Basic educational expertise and skills, including fundamental knowledge, reasoning ability, emotional self-regulation, and interactional abilities, are critical components of health. Moreover, education is a fundamental social determinant of health - an upstream cause of health. Programs that close gaps in educational outcomes between low-income or racial and ethnic minority populations and higher-income or majority populations are needed to promote health equity. Public health policy makers, health practitioners and educators, and departments of health and education can collaborate to implement educational programs and policies for which systematic evidence indicates clear public health benefits.

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Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations

J. Whitehead, John Shaver, Rob Stephenson (2016)

Background Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers. Methodology LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and “outness,” and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals’ demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas. Results Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men. Conclusions The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients’ disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas.

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Author and article information

Contributors

José E. Diaz: (View ORCID Profile)

Uri Belkind: (View ORCID Profile)

Journal

Title: LGBT Health

Abbreviated Title: LGBT Health

Publisher: Mary Ann Liebert Inc

ISSN (Print): 2325-8292

ISSN (Electronic): 2325-8306

Publication date Created: October 01 2022

Publication date (Print): October 01 2022

Volume: 9

Issue: 7

Pages: 471-478

Affiliations

[1 ]Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.

[2 ]Center for Research on AIDS, Yale School of Public Health, New Haven, Connecticut, USA.

[3 ]Department of Epidemiology, School of Global Public Health, New York University, New York, New York, USA.

[4 ]Columbia University School of Nursing, New York, New York, USA.

[5 ]Department of Population and Family Health, Mailman School of Public Health, New York, New York, USA.

[6 ]Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.

[7 ]Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

[8 ]Indigenous Wellness Research Institute, University of Washington School of Social Work, Seattle, Washington, USA.

[9 ]Birmingham AIDS Outreach, Birmingham, Alabama, USA.

[10 ]Department of Social Work, University of Alabama at Birmingham, Birmingham, Alabama, USA.

[11 ]Callen-Lorde Community Health Center, New York, New York, USA.

[12 ]Medicine-Pediatrics Division, General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.