The Use of Preventive Health Care Among Asian Americans: The Role of Individual and Contextual Factors

Background: Although preventive care is an essential component of comprehensive health care, a substantial proportion of the U.S. population lacks access to it. Disparities in preventive health care use are more pronounced in racial/ethnic minorities, including Asian Americans. Given a growing body of literature suggesting the characteristics of the neighborhood in which people live have an impact on health and health service use, the present study explored how individual- and neighborhood-level factors contribute to predicting the use of preventive health care in a sample of Asian Americans.The cross-level interaction between individual- and neighborhood-level factors was also included in order to investigate whether the relationship between individual factors and the use of preventive health care would depend on the factors of neighborhood where the survey participant lives.

Methods:Survey data were drawn from 2015 Asian American Quality of Life Study conducted with self-identified Asian Americans age 18 or above living in Central Texas. Given the nested nature of the data (e.g., 1,920 survey participants within 344 Census Tracts), multilevel logistic regression models of the use of preventive health care were tested. Individual-level variables included age, gender, marital status, education, health insurance, length of stay in the U.S., and self-rated health. To construct neighborhood-level variables, Geographic Information Systems (GIS) served as a methodological tool. First, survey participants’ reported residential addresses were geo-coded to determine their Census Tract and then linked with Census and related data. Three variables in neighborhood-level were derived from the 2016 American Community Survey (e.g., poverty level and density of Asian American population) and the Texas Medical Board (e.g., health care providers availability).

Results: At the individual-level, the odds of using preventive health care were higher among those who were younger adults, were male, were born in the U.S., and had health insurance. At the neighborhood-level, census-tract poverty level was positively associated with the use of preventive health care (OR=3.82, p<.01), indicating that those living in an impoverished neighborhood were more likely to use preventive health care. In addition, a cross-level interaction between health insurance and neighborhood health care provider availability (OR=2.83, p<.05) was found to be significant. Those who were uninsured and living in an area with limited health care provider availability (bottom 20%) were most disadvantaged. In an area with a higher proportion of health care providers, the difference between the insured and uninsured in the use of preventive health care was reduced.

Conclusions: Our findings confirm the critical role of health insurance as an enabler for preventive health care use and add to the growing literature on the effect of neighborhood-level factors. Furthermore, findings demonstrate an interactive role between individual and contextual factors. In a planning perspective for health care policy, identifying individuals without health insurance and the neighborhood with limited health care services could be a priority to diminish the disparity of the health care access.