Publications

BACKGROUND: Limited English proficiency is associated with decreased access to ambulatory care, however, it is unclear if this disparity leads to increased use of emergency departments (EDs) for low severity ambulatory care sensitive conditions (ACSCs).

OBJECTIVE: We sought to determine the association between the patient's preferred language and hospital utilization for ACSCs.

RESEARCH DESIGN: We conducted a retrospective cohort study of all ED visits in New Jersey in 2013 and 2014. The primary outcome was hospital admission for acute ACSCs, chronic ACSCs, and fractures (a nonambulatory care sensitive control condition). Secondary outcomes included intensive care unit (ICU) utilization and length of stay. Mixed-effect regression models estimated the association between preferred language (English vs. non-English) and study outcomes, controlling for demographics, comorbidities, and hospital characteristics.

RESULTS: We examined 201,351 ED visits for acute ACSCs, 251,193 visits for chronic ACSCs, and 148,428 visits for fractures, of which 13.5%, 11.1%, and 9.9%, respectively, were by non-English speakers. In adjusted analyses, non-English speakers were less likely to be admitted for acute ACSCs [-3.1%; 95% confidence interval (CI), -3.6% to -2.5%] and chronic ACSCs (-2.3%; 95% CI, -2.8% to -1.7%) but not fractures (0.4%; 95% CI, -0.2% to 1.0%). Among hospitalized patients, non-English speakers were less likely to receive ICU services but had no difference in length of stay.

CONCLUSIONS: These findings suggest non-English-speaking patients may seek ED care for lower acuity ACSCs than English-speaking patients. Efforts to decrease preventable ED and increase access to ambulatory care use should consider the needs of non-English-speaking patients.

This study examines the number and dollar amount of payments to physicians from companies marketing prescription stimulant medications.

PURPOSE: Though researchers have documented that adolescents are vulnerable to coercion focused on reproductive and sexual autonomy, measures to assess this type of coercion for both adolescent females and males have not been validated in a population-based sample.

METHOD: The present study used secondary data collected from high school students across Kentucky (n=16,137 from two independent samples in 2010 and 2014) to 1) determine if five items measuring adolescent reproductive and sexual coercion (ARSC) are appropriate for use among both females and males; and 2) estimate prevalence of identified ARSC factors by sex.

RESULTS: For both male and females, given measurement items, the results supported a two-factor model of ARSC comprised of 1) verbal relationship manipulation and 2) contraceptive interference. Measurement invariance by sex was also supported. Additional findings indicated the high prevalence of ARSC and its associated subscales. Approximately 4 in 10 females and 3 in 10 males reported experiencing ARSC in the previous year, with almost all of those reporting contraceptive interference also reporting verbal relationship manipulation.

CONCLUSIONS: Findings suggest verbal relationship manipulation and contraceptive interference (together forming ARSC) may restrict the autonomous sexual and reproductive decision-making of both female and male adolescents.

This study uses National Health and Nutrition Examination Survey data to evaluate whether patients enrolled in the clinical trials that support the American College of Cardiology/American Heart Association (ACC/AHA) guideline are representative of the US adult population recommended additional pharmacotherapy by the ACC/AHA guideline.