Purpose: Income inequality has been implicated as a potential risk to population health due to lower provision of healthcare services in deeply unequal countries or communities. We tested whether county economic inequality was associated with individual self-report of unmet healthcare needs using a state health survey data set.Methods: Adults residents of Ohio responding to the 2015 Ohio Medicaid Assessment Survey were included in the analysis. Ohio's 88 counties were classified into quartiles according to the Gini coefficient of income inequality. The primary outcome was a composite of self-reported unmet dental care, vision care, mental healthcare, prescription medication, or other healthcare needs within the past year. Unmet healthcare needs were compared according to county inequality quartile using weighted logistic regression.Results: The analytic sample included 37,140 adults. The weighted proportion of adults with unmet healthcare needs was 28%. In multivariable logistic regression, residents of counties in the highest (odds ratio [OR]=1.13, 95% confidence interval [CI]: 1.01–1.26; p=0.030) and second-highest (OR=1.16, 95% CI: 1.04–1.30; p=0.010) quartiles of income inequality experienced more unmet healthcare needs than residents of the most equal counties.Conclusion: Higher county-level income inequality was associated with individual unmet healthcare needs in a large state survey. This finding represents novel evidence for an individual-level association that may explain aggregate-level associations between community economic inequality and population health outcomes.

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Objective: The epidemiology of family meals among adults at a population level is poorly characterized and whether living with children impacts this health behaviour is uncertain. We determined the prevalence of family meals among US adults in a mid-western state whose families did and did not include minor children and described how it varied by sociodemographic characteristics. Design: The cross-sectional 2012 Ohio Medicaid Assessment Survey is representative of Ohio adults and included questions on their sociodemographic characteristics and the frequency with which they eat family meals at home. Setting: Trained interviewers administered landline and cell phone surveys to adults sampled from Ohio's non-institutionalized population. Subjects: We analysed data from 5766 adults living with minor children and 8291 adults not living alone or with children. Results: The prevalence of family meals was similar for adults who did and did not live with minor children: 47 % (95 % CI 46, 49 %) of adults living with and 51 % (95 % CI 50, 53 %) of adults living without children reported eating family meals on most (six or seven) days of the week. Family meal frequency varied by race/ ethnicity, marital and employment status in both groups. Non-Hispanic AfricanAmerican adults, those who were not married and those who were employed ate family meals less often. Conclusions: Adults in Ohio frequently shared meals with their family and family meal frequency was not strongly related to living with children. Broadening the scope of future studies to include adults who are not parents could enhance our understanding of the potential health benefits of sharing meals. Keywords Family meals Adults Family structure DisparitiesFamily meals are an important family practice associated with positive health outcomes among children and adolescents (1) , but few studies have examined the epidemiology of family meals among adults. For children and adolescents, a higher frequency of family meals is associated with healthier diets (2-4) and a lower likelihood of reporting disordered eating behaviours (5) , substance use (6) and depressive symptoms (7) . Family meals may help to prevent obesity in children and adolescents (8) and some researchers have found an inverse association between family meal frequency and BMI among parents (9)(10)(11) . Fruit and vegetable consumption may also be higher among parents who eat family meals more often (12) . Studies of family meals have predominantly relied on data collected from samples of children or adolescents and their parents. An exception is a study of commensal eating patterns that included adults living in one community and found that approximately two-thirds ate dinner with family members, but the authors did not examine if the presence of children affected this pattern (13) . Little is known about the epidemiology of family meals in families without minor children. Such families include married couples who do not have children and those couples whose children have grown and no longer live...

Objective To examine changes in the prevalence and odds of unmet healthcare needs and healthcare utilization among low-income women of reproductive age (WRA) after Ohio's 2014, ACA-associated Medicaid expansion, which extended coverage to non-senior adults with a family income ≤ 138% of the federal poverty level. Methods We analyzed publically available data from the 2012 and 2015 Ohio Medicaid Assessment Survey (OMAS), a cross-sectional telephone survey of Ohio's non-institutionalized adult population. The study included 489 low-income women in 2012 and 1273 in 2015 aged 19-44 years who were newly eligible for Medicaid after expansion in January 2014. Four unmet healthcare need and three healthcare utilization measures were examined. We fit survey-weighted logistic regression models adjusted for race/ethnicity, working status, and educational attainment to determine whether the odds of each measure differed between 2012 and 2015. Results In 2015, low-income WRA had a significantly lower odds of reporting an unmet dental care need (OR = 0.72, 95% CI 0.54, 0.95), unmet vision care need (OR = 0.68, 95% CI 0.50, 0.93), unmet mental health need (OR = 0.57, 95% CI 0.39, 0.83), and unmet prescription need (OR = 0.39, 95% CI 0.45, 0.80) compared to 2012. There were no significant differences in the odds of seeing a doctor or dentist in the past year or of having a usual source of care for low-income WRA in 2012 and 2015. Conclusions for Practice After Ohio's 2014 Medicaid expansion the odds of low-income WRA having unmet healthcare needs was reduced. Future research should examine outcomes after a longer period of follow-up and include additional measures, such as self-rated health status.

ObjectiveFamily meals are associated with a healthier diet among children and adolescents, but how family meal frequency varies in the U.S. population overall by household food availability and sociodemographic characteristics is not well characterized.DesignThe U.S. National Health and Nutrition Examination Survey 2007–2010 assessed the frequency of family meals eaten at home in the past week and the household availability of fruits, dark green vegetables, salty snacks, and sugar-sweetened beverages.SettingComputer-assisted face-to-face interviews with a selected adult (≥18 years) who owned or rented the home (i.e., the household reference person).SubjectsWe analyzed information on family meal frequency for 18,031 participants living in multi-person households in relation to sociodemographic characteristics and food availability.ResultsAmong the U.S. population living in households of two or more individuals, the prevalence (95% confidence interval) of having 0–2, 3–6 and ≥7 family meals/week was 18.0% (16.6–19.3), 32.4% (31.0–33.9), and 49.6% (47.8–51.4), respectively. Greater household availability of fruits and dark green vegetables and less availability of salty snacks and sugar-sweetened beverages was associated with more frequent family meals. Family meals were more prevalent in low-income households and those in which the reference person was ≥65 years, married, or had less than high school education.ConclusionsAbout half of the US population living in households of 2 or more people shares meals frequently with their family at home. Family meal frequency was positively associated with a healthier pattern of household food availability.