Understanding health outcomes and patterns of health care utilization associated with patients' cumulative social determinant of health (SDOH) risk is essential to supporting better health care. This study compared mental and physical health outcomes and health care utilization by increasing number of social needs among a clinical adult population. Surveys were sent to 6000 patients with recent visits to 7 primary care clinics in Portland, Oregon in 2018. The final study sample included respondents who matched to medical claims data, N = 1748. The authors used a modified logistic regression model to estimate risk ratios for the relationship between cumulative SDOH factors and self-reported chronic conditions, and a 2-part model to estimate the effects of cumulative SDOH risk on health care utilization. Increased SDOH need was associated with increasing likelihood of worse self-reported health outcomes, especially mental health. Compared with those with no SDOH need, having 1–2 SDOH need(s) (adjusted risk ratio [aRR] 1.25; 95% confidence interval [CI]: 1.06–1.46) and 3 or more SDOH needs (aRR 1.45; 95% CI: 1.22–1.73) had a greater risk of reporting any behavioral health condition. However, the number of SDOH had a graded but inverse impact on use of mental health care services where fewer visits were observed among those using care. Having SDOH was associated with increased likelihood of having an emergency department visit and increased number of primary care visits. This study demonstrates the compounding impact of SDOH on health and health care use. This highlights the importance of collecting SDOH, including the total number of SDOH needs, when considering a patient's health and health care.

Annually, the University of California Los Angeles (UCLA) Public Health Scholars Training Program (Program) exposes and engages 35 to 40 undergraduate students, Public Health Scholars, through an 8-week intensive summer training program in public health. Experiential learning through internships is an integral part of the Program, allowing scholars to gain hands-on experience in the field of public health while providing pathways to enter the public health workforce and pursue graduate education. The Program leverages existing strong community partnerships developed through the school’s applied practice experiences as well as creates new partnerships. These relationships are mutually beneficial, improve community connections, expand relationships, and develop the school’s ability to work with undergraduate students. This article outlines an adapted, evidence-based experiential learning model and develops an evaluation framework to capture the program impact. In the program evaluation, scholars and professional mentors assess the impact of the Program on scholars’ intrapersonal, interpersonal, societal, strategic professional, and foundational public health skills. Mentor and peer relationships drive the experiential learning model, supporting the Program to train undergraduate scholars, prepare graduate students to be future mentors once established in the public health workforce, and build the capacity of partner organizations to train a diverse public health workforce. The Program provides a needed opportunity to scholars, most of whom are from underrepresented or underserved backgrounds, to receive in-depth exposure and engagement with public health.

Ensuring access to high-quality outpatient care is an important strategy to improve COVID-19 outcomes, reduce social inequities, and prevent potentially expensive complications of disease. This study assesses the equity of health care response to COVID-19 by examining outpatient care utilization by factors at the individual and community levels in the 12 months prior to and following COVID-19 diagnosis. Employing a retrospective, observational cohort design, we analyzed electronic health record data from a sample of 11,326 adults diagnosed with COVID-19 between March and July 2020. We used two-part models to estimate changes in use of primary and specialty care by race/ethnicity and community social vulnerability in the year before and after COVID-19 diagnosis. Our findings showed that while overall probability and counts of primary and specialty care visits increased following a positive COVID-19 diagnosis, disparities in care utilization by race/ethnicity and living in a socially vulnerable community persisted in the year that followed. These findings reiterate the need for strategic approaches to improve access to and utilization of care among those diagnosed with COVID-19, especially for individuals who are traditionally undeserved by the health system. Our findings also highlight the importance of systematic approaches for addressing social inequity in health care.