Psychosocial Factors Related to Underuse of Medical Services

Chenshu Zhang, Judith S. Brook, Carl G. Leukefeld, David W. Brook

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


In this longitudinal study, we applied structural equation modeling (SEM) to examine the historical, predisposing, enabling/barrier, and need factors as related to the underuse of medical services during early midlife. We gathered longitudinal data on a prospective cohort of community-dwelling men and women (N = 548) followed from adolescence to early midlife. The findings supported a mediational model: A mutually affectionate parent–child relationship in early adolescence was inversely related to underuse of medical services in early midlife via the mediational roles played by later predisposing factors (i.e., depressive mood and cigarette smoking), need factor (i.e., physical health problems), barriers (i.e., financial difficulty), and enabling factors (i.e., social support for health services in early midlife). In addition, satisfaction with medical services in the neighborhood had an association with less underuse of medical services in early midlife. Family therapy focused on an increase in the affectionate relationship between the adolescents and his/her parents and cognitive-behavioral treatment of depressive mood may lead to a decrease in the underuse of medical services.

Original languageEnglish
Pages (from-to)652-665
Number of pages14
JournalJournal of Urban Health
Issue number4
StatePublished - Aug 1 2016

Bibliographical note

Publisher Copyright:
© 2016, The New York Academy of Medicine.


  • Cigarette smoking
  • Depressive mood
  • Financial difficulty
  • Longitudinal study
  • Neighborhood medical services
  • Parent–child relationship
  • Physical health problems
  • Social support
  • Underuse of medical services

ASJC Scopus subject areas

  • Health(social science)
  • Urban Studies
  • Public Health, Environmental and Occupational Health


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