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Original article| Volume 24, ISSUE 3, e335-e343, May 2014

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Predicting Health Care Utilization in Marginalized Populations: Black, Female, Street-Based Sex Workers

Published:March 21, 2014DOI:https://doi.org/10.1016/j.whi.2014.02.001

      Abstract

      Background

      Patterns of social and structural factors experienced by vulnerable populations may negatively affect willingness and ability to seek out health care services, and ultimately, their health.

      Methods

      The outcome variable was utilization of health care services in the previous 12 months. Using Andersen's Behavioral Model for Vulnerable Populations, we examined self-reported data on utilization of health care services among a sample of 546 Black, street-based, female sex workers in Miami, Florida. To evaluate the impact of each domain of the model on predicting health care utilization, domains were included in the logistic regression analysis by blocks using the traditional variables first and then adding the vulnerable domain variables.

      Findings

      The most consistent variables predicting health care utilization were having a regular source of care and self-rated health. The model that included only enabling variables was the most efficient model in predicting health care utilization.

      Conclusions

      Any type of resource, link, or connection to or with an institution, or any consistent point of care, contributes significantly to health care utilization behaviors. A consistent and reliable source for health care may increase health care utilization and subsequently decrease health disparities among vulnerable and marginalized populations, as well as contribute to public health efforts that encourage preventive health.
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      References

        • Aday L.A.
        Health status of vulnerable populations.
        Annual Review of Public Health. 1994; 15: 487-509
      1. Agency for Healthcare Research and Quality. (2000). Addressing racial and ethnic disparities in health care fact sheet. AHRQ Publication No. 00–PO41. Available: http://www.ahrq.gov/research/disparit.htm.

        • Andersen R.M.
        Behavioral models of families' use of health services. Research series number 25.
        Center for Health Administration Studies, University of Chicago, Chicago, IL1968
        • Andersen R.M.
        Revisiting the behavioral model and access to care: Does it matter?.
        Journal of Health and Social Behavior. 1995; 36: 1-10
        • Butters J.
        • Erickson P.
        Meeting the health care needs of female crack users: A Canadian example.
        Women and Health. 2003; 37: 1-17
        • Cunningham C.O.
        • Sohler N.L.
        • Wong M.D.
        • Relf M.
        • Cunnigham W.E.
        • Drainoni M.-L.
        • et al.
        Utilization of health care services in hard-to-reach marginalized HIV-infected individuals.
        AIDS Patient Care. 2007; 21: 177-186
        • Dennis M.L.
        • Titus J.C.
        • White M.K.
        • Unsicker J.I.
        • Hodgkins D.
        Global Appraisal of Individual Needs - Initial (GAIN-I).
        Chestnut Health Systems, Bloomington, IL2002
        • Dennis M.L.
        • Chan Y.-F.
        • Funk R.
        Development and validation of the GAIN Short Screener (GSS) for internalizing, externalizing and substance use disorders and crime/violence problems among adolescents and adults.
        American Journal on Addictions. 2006; 15: 80-91
        • Gelberg L.
        • Andersen R.
        • Leake B.
        The Behavioral Model for vulnerable populations: Application to medical care use and outcomes for homeless people.
        Health Services Research. 2000; 34: 1273-1302
        • Hargraves J.L.
        • Hadley J.
        The contribution of insurance coverage and community resources to reducing racial/ethnic disparities in access to care.
        Health Services Research. 2003; 38: 809-830
        • Hatton D.C.
        Homeless women's access to health services: A study of social networks and managed care in the US.
        Women & Health. 2001; 33: 149-162
        • Institute of Medicine
        Unequal treatment: What healthcare providers need to know about racial and ethnic disparities in health-care.
        National Academies Press, Washington, DC2002
        • Kurtz S.P.
        • Surratt H.L.
        • Inciardi J.A.
        Sex Work and “Date” Violence.
        Violence Against Women. 2004; 10: 357-385
        • Lazarus L.
        • Chettiar J.
        • Deering K.
        • Nabess R.
        • Shannon K.
        Risky health environments: Women sex workers' struggles to find safe, secure and non-exploitative housing in Canada's poorest postal code.
        Social Science and Medicine. 2011; 73: 1600-1607
      2. Mead H., Cartwright-Smith L., Jones K., Ramos C., Woods K., & Siegel B. (2008). Racial and ethnic disparities in U.S. healthcare: A chartbook. The Commonwealth Fund 27. Available from www.commonwealthfund.org.

        • O'Daniel A.J.
        Access to medical care is not the problem: Low-income status and health care needs among HIV-positive African-American women in urban north Carolina.
        Human Organization. 2011; 70: 416-426
        • Sherbourne C.D.
        • Stewart A.L.
        The MOS Social Support Survey.
        Social Science and Medicine. 1991; 32: 705-714
        • Stein J.A.
        • Andersen R.
        • Gelberg L.
        Applying the Gelberg-Andersen behavioral model for vulnerable populations to health services utilization in homeless women.
        Journal of Health Psychology. 2007; 12: 791-804
        • Surratt H.L.
        • Inciardi J.A.
        HIV risk, seropositivity and predictors of infection among homeless and non-homeless women sex workers in Miami, Florida, USA.
        AIDS Care. 2004; 16: 594-604
        • Surratt H.L.
        • Kurtz S.P.
        • Weaver J.C.
        • Inciardi J.A.
        The connections of mental health problems, violent life experiences, and the social milieu of the ‘stroll’ with the HIV risk behaviors of female street sex workers.
        Journal of Psychology and Human Sexuality. 2005; 17: 23-44
        • Watters J.
        • Biernacki P.
        Targeted sampling: Options for the study of hidden populations.
        Social Problems. 1989; 36: 416-430

      Biography

      Leah M. Varga, PhD, is Associate Director of Clinical and Community Based Research at Florida International University. Her research interest focuses on social inequalities in health, particularly the social construction and experience of health by minority populations.

      Biography

      Hilary L. Surratt, PhD, is Professor and Co-Director of the Center for Applied Research on Substance Use and Health Disparities at Nova Southeastern University. She has expertise in prescription drug abuse and diversion, and development and evaluation of HIV interventions for vulnerable populations.