Purpose Colleges and universities across the United States are developing and implementing data-driven prevention and containment measures against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Identifying risk factors for SARS-CoV-2 seropositivity could help to direct these efforts. This study aimed to estimate the associations between demographic factors and social behaviors and SARS-CoV-2 seropositivity and self-reported positive SARS-CoV-2 diagnostic test. Methods In September 2020, we randomly sampled Indiana University Bloomington undergraduate students. Participants completed a cross-sectional online survey about demographics, SARS-CoV-2 testing history, relationship status, and risk behaviors. Additionally, during a subsequent appointment, participants were tested for SARS-CoV-2 antibodies using a fingerstick procedure and SARS-CoV-2 IgM/IgG rapid assay kit. We used unadjusted modified Poisson regression models to evaluate the associations between predictors of both SARS-CoV-2 seropositivity and self-reported positive SARS-CoV-2 infection history. Results Overall, 1,076 students were included in the serological testing analysis, and 1,239 students were included in the SARS-CoV-2 infection history analysis. Current seroprevalence of SARS-CoV-2 was 4.6% (95% confidence interval: 3.3%, 5.8%). Prevalence of self-reported SARS-CoV-2 infection history was 10.3% (95% confidence interval: 8.6%, 12.0%). Greek membership, having multiple romantic partners, knowing someone in one's immediate environment with SARS-CoV-2 infection, drinking alcohol more than 1 day a week, and hanging out with more than five people when drinking alcohol increased both the likelihood of seropositivity and SARS-CoV-2 infection history. Conclusion Our findings have implications for American colleges and universities and could be used to inform SARS-CoV-2 prevention and control strategies on such campuses.
Background: Health insurance literacy (HIL) may influence medical financial burden among people who are sick and the most vulnerable. Objective: This study examined the relationships between HIL, health insurance factors, and medical debt among middle-age Americans, a population with an increasing prevalence of illnesses. Methods: Linear and generalized linear regression analyses were conducted on data drawn from the 2015–2016 waves of the Health Reform Monitoring Survey, a national, internet-based sample of Americans age 18 to 64 years. The analytical sample included 8,042 people age 50 to 64 years. Key Results: Adjusted mean HIL scores did not differ by private versus public insurance or by out-of-pocket costs. Mean HIL scores were lower with higher deductibles; however, differences in mean scores were small. Higher HIL was associated with lower medical debt (odds ratio = 0.97; 95% confidence interval [0.96, 0.98]), but at the highest HIL score, the risk of having medical debt was still 13.8%. Public coverage, higher annual deductibles, and out-of-pocket costs were associated with higher risks of having medical debt. Conclusions: The findings suggest that HIL plays an important role in medical debt burden. However, with the shift toward high cost-sharing insurance plans, addressing health care affordability issues along with HIL are critical to eliminate medical debt problems. [ HLRP: Health Literacy Research and Practice . 2021;5(4):e319–e332.] Plain Language Summary: Understanding and using health insurance (also defined as health insurance literacy) may influence the ability to pay medical bills among people who are sick and vulnerable. This study examined the relationships among health insurance literacy, health insurance factors, and difficulty paying medical bills (i.e., medical debt) in Americans age 50 to 64 years using data from the Health Reform Monitoring Survey. People with higher health insurance literacy reported lower medical debt. Type of insurance coverage did not influence medical debt. Those with annual deductibles and out-of-pocket health care costs were more likely to report having medical debt.
Although the number of men with health insurance has increased, men are less likely to utilize health services than females, and experience difficulty in paying medical bills. Understanding the details of health insurance can be challenging and the lack of understanding can have financial consequences. This study, guided by Andersen’s model of health-care utilization, assessed the relationship between confidence level in understanding health insurance terms and difficulty in paying medical bills among American men. Data were drawn from the Health Reform Monitoring Survey, 2015–2016. The study included 6,643 men aged between 18 and 64. Descriptive statistics examined participants’ difficulty in paying medical bills by predisposing, enabling, and need characteristics, and by confidence in understanding health insurance terms. A modified Poisson regression analysis examined the association between difficulty in paying medical bills, confidence in understanding health insurance terms score, and predisposing, enabling, and need characteristics. An increase in confidence in understanding health insurance terms score was associated with significantly lower reported difficulty in paying medical bills (PR = .98; 95% CI = [.97–.99]; p = .002). Participants with a college degree or higher were less likely to report difficulty in paying their medical bills compared to participants with less than a high school degree (PR = .72; 95% CI = [.56–.92]; p = .009). A better understanding of health insurance might prevent men from experiencing difficulties in paying medical bills. Additional research should be performed to understand the relationship between the level of confidence in understanding health insurance, knowledge level of health insurance terms, use of health insurance, and their impact on difficulty in paying medical bills.
Objective: This study assessed affordability of care in a diverse sample of Floridians aged ≥ 65 to ascertain concerns about health care costs. Methods: We surveyed 170 adults (40.6% white, 27.6% black, and 31.8% Hispanic) and conducted three race/ethnic-stratified focus groups ( n = 27). Results: Most participants had Medicare (97.1%). Among whites, 11.6% reported problems paying medical bills in the past 12 months versus 14.9% of blacks and 24.1% of Hispanics. In addition, 13% of whites, 19.2% of blacks, and 20.4% of Hispanics reported not getting needed prescription drugs because of costs. The most frequently identified concerns from the focus groups were the cost of prescription drugs, out-of-pocket expenses, and medical billing. Concerns about medical billing included understanding bills, transparency, timely postings, and uncertainty about who to contact about problems. Discussion: Our findings suggest that practices that help older adults effectively manage medical bills and costs may alleviate their concerns and guard against financial burdens.
Purpose The aim of this cross-sectional study was to examine the relationship between social factors and COVID-19 protective behaviors and two outcomes: depressive and perceived stress symptoms. Methods In September 2020, 1,064 randomly selected undergraduate students from a large midwestern university completed an online survey and provided information on demographics, social activities, COVID-19 protective behaviors (i.e., avoiding social events and staying home from work and school), and mental health symptoms. Mental health symptoms were measured using the Center for Epidemiological Studies Depression-10 questionnaire for depression and the Perceived Stress Scale-10 for stress symptoms. Results The results showed respondents who were males and also the respondents who were “hanging out” with more people while drinking alcohol reported significantly lower depressive symptoms and lower stress symptoms. On the contrary, staying home from work or school “very often” was associated with higher stress symptoms, compared with “never/rarely” staying home from work/school. Similarly, having a job with in-person interaction was also associated with increased stress. Conclusions These findings suggest that lack of social engagement was associated with depression and stress symptoms among college students during the COVID-19 pandemic. Planning social activities that align with recommended safety precautions, as well as meet students’ social needs, should be an important priority for higher education institutions.
Cost of care conversations (CoC) between patients and doctors have been shown to lower overall healthcare and patients’ costs. How, it is unclear why CoC are not occurring more frequently among high cost patients such as older adults. To address this important question, we conducted three race-stratified focus groups (n=10 Whites, n=9 African Americans, and n=8 Latino/Hispanics) to assess perceptions about, and barriers to, CoC in a convenient sample of adults ages ≥65 from Adult Centers in Tampa Bay, Florida. An inductive content analysis approach was utilized by research team members to analyze qualitative data. Findings indicated that CoC are not occurring. White participants perceived that CoC were not occurring because they did not have issues paying for care. African Americans perceived that CoC were not occurring because doctors are not trained to understand finances, insurance, and medical billing. Latinos/Hispanics perceived that doctors are meant to take care of patients, and receptionists, administrators and billing departments should handle CoC. Wait time and perceived stress/rush of doctors were identified as CoC barriers for whites, while doctors’ attitude was a barrier for Blacks/African Americans, and perceptions about CoC being “taboo” was a major barrier for Latinos/Hispanics. Overall, participants indicate that it is easier to have CoC if they had developed a good rapport with the doctor, had confidence in the doctor, and felt the doctor was interested in and cared about them. The findings suggest that promoting CoC among older adults will require addressing social and cultural concerns of racial/ethnic minority groups.
Rising healthcare costs create significant financial burden for Americans and is a threat to the well-being of our growing, racially/ethnically diverse, older population. In a mixed method study, we assessed ability to afford care and ascertain concerns about healthcare cost in a racially diverse sample of Floridians ages ≥ 65. We surveyed 170 adults (40.4% White, 27.6% African Americans/Black and 31.8% Latino/Hispanic) and conducted three race-stratified focus groups (n=27). Most participants had Medicare coverage (97.1%) and 27% also had Medicaid. Approximately 11.6% of Whites had problems paying medical bills in the past 12 months versus 14.9% of African Americans/Blacks and 24.1% of Latino/Hispanics. Additionally, 13% of Whites, 19.2% of African Americans/Blacks and 20.4% of Hispanics reported not getting needed prescription drugs because they could not afford them. Approximately 45.7% either perceived that their doctor “never” takes into account costs for treatment or did not know whether costs were considered. Multiple regression analyses showed no statistically significant racial/ethnic differences in affordability problems. From the focus groups, healthcare cost concerns most frequently identified by participants were the high cost of prescriptions drug, rising co-pays and out of pocket expenses, and medical billing. Participants’ concerns about medical billing included understanding their bills, transparency in billing, timely posting of charges, and uncertainty about who to talk to about billing problems. Our findings suggest that routine discussions about healthcare costs with doctors or designated healthcare personnel should help ease financial burden and healthcare costs concerns among older adults.
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