Adverse childhood experiences (ACEs) are linked to increased mental health problems in children, but their association with mental health services utilization is not well known. This secondary analysis used 2016 National Survey of Children’s Health data from two samples: children aged 6-17-years-old with a mental or behavioral condition in need of treatment or counseling (N = 5,723); and a subsample of children who experienced at least one ACE (n = 3,812). Multiple logistic regression and latent class analysis (LCA) were performed to examine the association between ACEs and mental health services utilization. Multiple logistic regressions also examined the associations of parent/caretaker vulnerability, school-system, and medical-system factors on mental health services utilization for children with ACEs using the Gelberg-Andersen Behavioral Model for Vulnerable Populations and a Systems of Care approach as the framework for model building. Children with increased ACE scores did not have higher odds of utilizing mental health services compared to children at lower levels of or no ACEs. For children who experienced adversity, increased parent/caretaker vulnerability was associated with lower odds and the current receipt of special education services with increased odds of mental health services utilization in adjusted models. Strengths of this study included the large dataset and generalizability to the U.S. population. There were limitations to the measurement of ACEs and other key variables. The current study identified children who experienced adversity as an underserviced population for mental health services.

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Low back and neck pain are frequent reasons for adults to seek healthcare. Three types of practitioners are commonly used in the United States: physicians, chiropractors and physical therapists. In this study, Andersen's "Behavioral Model of Health Services Utilization" is used to examine care seeking and provider selection. Estimates of back and neck pain prevalence in the United States are presented as well as care seeking rates and care consumption estimates for patients who used the three providers of interest. Multivariate regression analyses are presented that model the variables that most influence care seeking and provider selection.Cases with the conditions of low back pain and neck pain were drawn from the Medical Expenditure Panel Survey Panel 6 participants. Episodes of care and non-care were defined and the provider used during an episode was identified.Determinants of care seeking for low back pain included MSA status, insurance coverage, perceived health status, number of comorbidities and number of episodes. Determinants of care seeking for neck pain included insurance coverage and number of episodes. When condition was included in the analysis, it was a determinant of care seeking. All of these variables are enabling factors or need factors in Andersen's model.In the analysis of provider selection for low back pain, variables that determined the provider from whom care was sought included patient age, gender, race, ethnicity, marital status, MSA status, insurance coverage, perceived health status, if the condition was disabling and number of episodes. In the analysis of provider selection for neck pain, variables that determined the provider from whom care was sought included patient ethnicity, marital status, and if the condition was disabling.Andersen's Behavioral Model adequately predicts care seeking in LBP and NP with enabling and need factors playing a predominant role. In terms of equity of access this finding indicates a problem of access to care for persons who were uninsured. In the case of provider selection, all the constructs from the model were found to have a role in prediction indicating that access may be inequitable in the case of some providers.

Since the war on drugs in the 1980s, the United States has seen an exponential rise in the number of imprisoned individuals. This increase has been particularly dramatic for women. Nationwide, the population of women in prison has grown by 834% over the past 40 years, more than double the growth rate of men. Compared with incarcerated men, women in prison have higher rates of substance abuse, histories of physical and sexual abuse, mental illness, infectious disease and chronic illness. Most women in prison are defined by a challenging intersection of lower socioeconomic status and largely racial, ethnic, and minority gender status. This combination of identity factors both contributes to their health disparities and influences their experiences with health care. Given that the majority of women in prison are of reproductive age, gynecological care is a central aspect of women’s overall health care. However, women in prison are a small minority of the overall incarcerated population, and because of this, their gender-specific health needs are frequently unacknowledged. Using a feminist epistemology, this qualitative multiple case study provides an examination of the experiences of women before prison and in prison with gynecological care and prison staff’s experiences providing this care. The Gelberg Andersen Behavioral Model for Vulnerable Populations is adapted here for the study of women in prison. The model explains factors enabling and impeding women’s utilization of health care services, including previous health care experiences, prison infrastructure, and personal autonomy. Women in contact with the criminal justice system face difficulties accessing health care both outside and inside prison. Barriers on the outside included lack of health insurance, being addicted to drugs, and prioritizing children’s needs first. On the inside women cited a lack of confidentiality, the absence of trust in providers, and the inability to participate in treatment decision-making. In the case of women in prison, multiple external oppressions result in internalized negative beliefs. Such feelings of powerlessness, lack of control, curtailed agency, and threatened self-worth ultimately influence how women experience gynecological care in prison. Policy, practice and research implications are provided to meet the gender specific health needs of women in prison.