Despite the known benefits of preventive care in reducing morbidity and mortality, many Americans do not receive preventive services. Among the near elderly (50-64 years), the use of preventive services remains below recommended levels. Using the Health and Retirement Study, this dissertation examined the influence of individual characteristics and cohort membership on preventive service use in the near elderly through three separate analyses. The first examined differences in preventive service use between two near elderly birth cohorts. The second examined characteristics associated with different influenza vaccination patterns—no vaccination versus receiving at least one vaccination; and intermittent compared to regular vaccination. The third compared characteristics associated with receiving intermittent or regular mammograms in near elderly women.

Results show that improvements in education, income, and access to medical care in the later birth cohort led to increases in their use of preventive services. Other factors such as increases in obesity could adversely affect the preventive service use in future near elderly cohorts. In addition, the characteristics associated with the use of preventive care differ by type of service.

There were some differences in the factors associated with the two vaccination patterns. Predisposing characteristics—age, gender, race, marital status, and education were significant predictors of receiving at least one vaccination. However, only race and education were associated with regular vaccination. Insurance, chronic conditions, and physician visits were associated with both vaccination patterns. In comparison, enabling but not predisposing characteristics—insurance, income, and physician visits, were significant predictors of regular mammography. Obese women and those in poor health were also less likely to receive regular mammograms.

The health of the near elderly and their use of medical care are increasingly important to policymakers because of their impact on Medicare. Several proposals have been developed to allow the uninsured near elderly to buy-in to Medicare. However, this dissertation shows that in addition to health insurance, other characteristics such as cohort membership also influence preventive service use among near elderly individuals. It may also be useful for policymakers to consider that the characteristics associated with preventive service use differ by type of service.