Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
Geisler, William, Laura Chyu, Yasamin Kusunoki, Dawn Upchurch, and Edward Hook. 2006. "Influence of Health Insurance and Health Care Seeking Behaviors on the Prevalence of Genital Chlamydial Infection in Young Adults." Sexually Transmitted Diseases, 33(6): 389-396.
Background: Genital chlamydial infection remains prevalent in young adults. Differential access to health care and thus the opportunity for testing, treatment, sexual partner services, and risk reduction counseling may be among the factors contributing to variation in chlamydial prevalence.
Goal: We investigated associations of health insurance coverage and health care-seeking behaviors, both indicators of healthcare access, to chlamydial infection in a nationally representative sample of young adults.
Methods: Weighted logistic regression techniques were used to examine associations between indicators of healthcare access and chlamydial infection as determined using Chlamydia trachomatis ligase chain reaction among a subset of sexually active young adults ages 18 to 27 interviewed at wave III of the National Longitudinal Study of Adolescent Health (N = 9347). Analyses were stratified by gender and controlled for age and race/ethnicity.
Results: Having continuous health insurance coverage in the preceding 12 months was associated with a lower risk of chlamydial infection in both men and women. Usual site of health care was also associated with chlamydial infection. Men who reported emergency rooms as their usual site of care had a higher risk of infection, whereas women who used school clinics had a lower risk compared with those seen in primary care settings. Having seen a provider in the preceding 12 months was associated with a lower risk of chlamydial infection for men only. These associations remained even after adjusting for racial/ethnic differences in health insurance coverage and health care-seeking behaviors.
Conclusions: Independent of race/ethnicity, indicators of healthcare access are associated with chlamydial infection in young adults. Furthermore, our analyses reveal differences in these associations by gender. Improved healthcare access for young people could help reduce chlamydia-associated reproductive health morbidity potentially through access to chlamydial screening, treatment, sex partner services, and risk reduction counseling.