{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T05:01:35Z","timestamp":1768885295243,"version":"3.49.0"},"posted":{"date-parts":[[2026,1,16]]},"group-title":"Public and Global Health","reference-count":19,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,1,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To examine how social determinants of health (SDOH) influence the utilization of preventive health services at a Federally Qualified Health Center (FQHC) in Erie, Pennsylvania, using the Andersen and Aday behavioral model (Andersen, 1995; Aday &amp; Andersen, 1974).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A cross-sectional, descriptive correlational study was conducted among adults (\u226518 years) receiving primary care at Community Health Net from March through October 2018. The data was collected via a self-administered questionnaire, classifying variables as predisposing, enabling, or need factors, per the Andersen and Aday model. The Protocol for Responding to &amp; Assessing Patients\u2019 Assets, Risks &amp; Experiences (PRAPARE) tool was used to assess SDOH. Mental health status was measured using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder 7-item scale. Logistic regression identified predictors of preventive service utilization.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 274 participants, 65.8% were over 50 years old, 50.2% had low annual incomes (\u2264$15,000), 71.0% had public insurance, 58.8% were unemployed, and 10.0% were homeless. A total of 78.8% of the participants reported experiencing emotional or physical problems that affected their social life; 16.1% reported having transportation barriers and 13.9% reported a lack of social support. Preventive service utilization was high (75.1%). Multivariable analysis showed that low incomes (\u2264$15,000) (odds ratio [OR] = 1.82, 95% CI [1.15, 2.89]), unemployment (OR = 2.10, 95% CI [1.30, 3.40]), and mental health conditions (OR = 3.05, 95% CI [1.80, 5.18]) were significant predictors of utilization. Homelessness showed a positive but not statistically significant association (OR = 1.68, 95% CI [0.92, 3.06). The most frequently reported unmet needs among participants were mental health care (24.8%), transportation (16.1%), and social support (13.9%).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Socioeconomic disadvantage and mental health needs are strongly associated with preventive service utilization in this FQHC population, consistent with the Andersen and Aday model and international evidence (Braveman &amp; Gottlieb, 2014; Marmot et al., 2008; Magnan, 2021). Addressing SDOH\u2014including poverty, unemployment, mental health, and access barriers\u2014 remains essential for advancing health equity in high-risk communities (World Health Organization, 2008; Artiga &amp; Hinton, 2022).<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.01.14.26344123","type":"posted-content","created":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T01:25:42Z","timestamp":1768613142000},"source":"Crossref","is-referenced-by-count":0,"title":["Social Determinants of Health and Preventive Service Utilization in a U.S. Community Health Center: An Application of the Andersen and Aday Model"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5635-3765","authenticated-orcid":false,"given":"Jennifer M. Torres","family":"Del Valle","sequence":"first","affiliation":[{"name":"School of Medicine, Complutense University of Madrid, Madrid, Spain"},{"name":"Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel \u00c1ngel","family":"S\u00e1nchez Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"School of Medicine, Complutense University of Madrid, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marisol Pe\u00f1a","family":"Orellana","sequence":"additional","affiliation":[{"name":"Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 Carri\u00f3n","family":"Baralt","sequence":"additional","affiliation":[{"name":"Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"issue":"3","key":"2026011908150829000_2026.01.14.26344123v1.1","first-page":"208","article-title":"A framework for the study of access to medical care","volume":"9","year":"1974","journal-title":"Health services research"},{"key":"2026011908150829000_2026.01.14.26344123v1.2","doi-asserted-by":"publisher","DOI":"10.2307\/2137284"},{"key":"2026011908150829000_2026.01.14.26344123v1.3","unstructured":"Artiga, S. , & Hinton, E. (2022). Beyond health care: The role of social determinants in promoting health and health equity. Kaiser Family Foundation. Published May 10, 2022. https:\/\/www.kff.org\/racial-equity-and-health-policy\/issue-brief\/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity\/"},{"key":"2026011908150829000_2026.01.14.26344123v1.4","doi-asserted-by":"publisher","DOI":"10.1177\/003335491412900105"},{"key":"2026011908150829000_2026.01.14.26344123v1.5","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2021.01394"},{"key":"2026011908150829000_2026.01.14.26344123v1.6","unstructured":"Centers for Disease Control and Prevention. (2023). Social determinants of health: Know what affects health. Published January 17, 2024. https:\/\/www.cdc.gov\/socialdeterminants\/index.htm"},{"key":"2026011908150829000_2026.01.14.26344123v1.7","doi-asserted-by":"publisher","DOI":"10.7326\/M17-2441"},{"key":"2026011908150829000_2026.01.14.26344123v1.8","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.21201"},{"key":"2026011908150829000_2026.01.14.26344123v1.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2017.05.011"},{"key":"2026011908150829000_2026.01.14.26344123v1.10","doi-asserted-by":"publisher","DOI":"10.31478\/202104c"},{"key":"2026011908150829000_2026.01.14.26344123v1.11","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)61690-6"},{"key":"2026011908150829000_2026.01.14.26344123v1.12","unstructured":"National Association of Community Health Centers. (2023). PRAPARE: Protocol for Responding to and Assessing Patients\u2019 Assets, Risks, and Experiences. https:\/\/prapare.org\/"},{"key":"2026011908150829000_2026.01.14.26344123v1.13","unstructured":"Office of Disease Prevention and Health Promotion. (2020). Healthy People 2030: Social determinants of health. https:\/\/health.gov\/healthypeople\/objectives-and-data\/social-determinants-health"},{"key":"2026011908150829000_2026.01.14.26344123v1.14","doi-asserted-by":"publisher","DOI":"10.1177\/003335491012500215"},{"key":"2026011908150829000_2026.01.14.26344123v1.15","unstructured":"Solar, O. , & Irwin, A. (2010). A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice).World Health Organization. https:\/\/www.who.int\/publications\/i\/item\/9789241500852"},{"key":"2026011908150829000_2026.01.14.26344123v1.16","unstructured":"Torres Del Valle, J. M. (2024). Determinantes sociales de salud, utilizaci\u00f3n de servicios preventivos y calidad de vida en un centro de salud comunitaria de los Estados Unidos [Doctoral dissertation, Universidad Complutense de Madrid]."},{"key":"2026011908150829000_2026.01.14.26344123v1.17","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-040218-043750"},{"key":"2026011908150829000_2026.01.14.26344123v1.18","unstructured":"Woolf, S. H. , Aron, L. Y. , Dubay, L. , Simon, S. M. , Zimmerman, E. , & Luk, K. X. (2015). How are income and wealth linked to health and longevity? Urban Institute and Center on Society and Health. https:\/\/www.urban.org\/research\/publication\/how-are-income-and-wealth-linked-health-and-longevity"},{"key":"2026011908150829000_2026.01.14.26344123v1.19","unstructured":"World Health Organization. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. https:\/\/www.who.int\/publications\/i\/item\/WHO-IER-CSDH-08.1"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.01.14.26344123","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T16:15:15Z","timestamp":1768839315000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.01.14.26344123"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,16]]},"references-count":19,"URL":"https:\/\/doi.org\/10.64898\/2026.01.14.26344123","relation":{},"subject":[],"published":{"date-parts":[[2026,1,16]]},"subtype":"preprint"}}