title: The association between life chaos, health care use, and health status among HIV-infected persons.
abstract: BACKGROUND
  Whether having a stable and predictable lifestyle is associated with health care use and health status among HIV patients is unknown.
  
  
  OBJECTIVE
  To develop and test the reliability and validity of a measure of life chaos for adults with HIV and examine its association with health care use and health status.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Two hundred twenty HIV-infected persons recruited from those who tested positive in a mobile testing van and from HIV clinics serving low-income populations.
  
  
  METHODS
  Participants completed a survey every 6 months, assessing their health care use, SF-12 mental and physical health status and life chaos.
  
  
  RESULTS
  Cronbach's alpha for the six-item measure of chaos was .67. Those without a spouse or partner and those with one or more unmet social service needs, such as housing or transportation, had higher chaos scores. Compared to those with less chaos, those with more chaos were less likely to have two or more outpatient visits (adjusted odds ratio [OR] 0.48, 95% confidence interval [CI]: 0.24-0.98), more likely to have two or more missed visits (adjusted OR 2.30, 95%CI: 1.20-4.41) in the 6 months before study enrollment and had lower mental health status at enrollment and at follow-up. Life chaos was not associated with emergency department visits or physical health status.
  
  
  CONCLUSIONS
  We created a new measure of life chaos, which was associated with outpatient visits and mental health status. Chaos may be an important barrier to regular medical care. Future studies need to test this measure in more diverse populations and those with other diseases.
authors.affiliation: UCLA Division of General Internal Medicine and Health Services Research, University of California, 911 Broxton Avenue, Suite 101, Los Angeles, CA 90024, USA. mitchellwong@mednet.ucla.edu
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Wong
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Sarkisian
authors.forename: Cynthia
authors.initials: C
authors.lastname: Davis
authors.forename: Janni
authors.initials: J
authors.lastname: Kinsler
authors.forename: William E
authors.initials: WE
authors.lastname: Cunningham
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology* / Q000628:therapy; D006304:Health Status; D006801:Humans; D008016:Life Change Events; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D012959:Socioeconomic Factors