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Brennan MB, Tan TW, Schechter MC, Fayfman M. Using the National Institute on Minority Health and Health Disparities framework to better understand disparities in major amputations. Semin Vasc Surg 2023; 36:19-32. [PMID: 36958894 PMCID: PMC10039286 DOI: 10.1053/j.semvascsurg.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
Recently, the United States experienced its first resurgence of major amputations in more than 20 years. Compounding this rise is a longstanding history of disparities. Patients identifying as non-Hispanic Black are twice as likely to lose a limb as those identifying as non-Hispanic White. Those identifying as Latino face a 30% increase. Rural patients are also more likely to undergo major amputations, and the rural-urban disparity is widening. We used the National Institute on Minority Health and Health Disparities framework to better understand these disparities and identify common factors contributing to them. Common factors were abundant and included increased prevalence of diabetes, possible lower rates of foot self-care, transportation barriers to medical appointments, living in disadvantaged neighborhoods, and lack of insurance. Solutions within and outside the health care realm are needed. Health care-specific interventions that embed preventative and ambulatory care services within communities may be particularly high yield.
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Affiliation(s)
- Meghan B Brennan
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53583.
| | - Tze-Woei Tan
- Department of Surgery, Keck School of Medicine University of Southern California, Los Angeles, CA
| | - Marcos C Schechter
- Department of Medicine, Emory University School of Medicine, Atlanta, GA; Grady Health System, Atlanta, GA
| | - Maya Fayfman
- Department of Medicine, Emory University School of Medicine, Atlanta, GA; Grady Health System, Atlanta, GA
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A multimodal strategy to improve race/ethnic group equity in administration of neutralizing monoclonal antibody treatment for COVID-19 outpatients. J Clin Transl Sci 2023; 7:e37. [PMID: 36845303 PMCID: PMC9947608 DOI: 10.1017/cts.2022.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/17/2022] [Accepted: 12/13/2022] [Indexed: 02/12/2023] Open
Abstract
Introduction Racial and ethnic minority groups have higher rates of SARS-CoV-2 infection, severe illness, and death; however, they receive monoclonal antibody (mAb) treatment at lower rates than non-Hispanic White patients. We report data from a systematic approach to improve equitable provision of COVID-19 neutralizing monoclonal antibody treatment. Methods Treatment was administered at a community health urgent care clinic affiliated with a safety-net urban hospital. The approach included a stable treatment supply, a same-day test and treat model, a referral process, patient outreach, and financial support. We analyzed the race/ethnicity data descriptively and compared proportions using a chi-square test. Results Over 17 months, 2524 patients received treatment. Compared to the demographics of county COVID-19-positive cases, a greater proportion of patients who received mAb treatment were Hispanic (44.7% treatment vs. 36.5% positive cases, p < 0.001), a lower proportion were White Non-Hispanic (40.7% treatment vs. 46.3% positive cases, p < 0.001), equal proportion were Black (8.2% treatment vs. 7.4% positive cases, P = 0.13), and equal proportion occurred for other race patients. Discussion Implementation of multiple systematic strategies to administer COVID-19 monoclonal antibodies resulted in an equitable race/ethnic distribution of treatment.
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Zamor RL, Vaughn LM, McCann E, Sanchez L, Page EM, Mahabee-Gittens EM. Perceptions and experiences of Latinx parents with language barriers in a pediatric emergency department: a qualitative study. BMC Health Serv Res 2022; 22:1463. [PMID: 36457015 PMCID: PMC9717444 DOI: 10.1186/s12913-022-08839-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 10/17/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Prior research has shown disparities exist among Latinx children who require treatment for respiratory illnesses within the pediatric emergency department (PED). Limited data exist regarding Latinx families' experiences on the care they received at PEDs within non-traditional destination areas (NDA). Their experiences can identify areas of improvement to potentially reduce healthcare disparities among pediatric patients within this population. The purpose of this qualitative study was to explore the lived experiences of Latinx families with low English proficiency in the PED with a NDA. The broader purpose was to identify areas of improvement for reducing health care disparities among Latinx families. METHODS We used qualitative methods to analyze semi-structured interviews among Latinx families who presented to the PED with their 0-2 year-old child for a respiratory illness from May 2019 through January 2020. All participants had low English proficiency and requested a Spanish interpreter during registration. All interviews were transcribed and reviewed using thematic analysis based on a phenomenology framework. RESULTS Interviews were conducted with 16 Latinx parents. Thematic analysis revealed four major themes: (1) Uncertainty - Families expressed uncertainty regarding how to care for a child with distressing symptoms, (2) Communication - Families favored in-person interpreters which enhanced communication and allowed families to feel more informed, (3) System Burden - Families reported that the unfamiliarity with the US health system and lack of resources are additional burdens, and (4) Emotional Support - The emergency department visits garnered confidence and reassurance for families. CONCLUSIONS Our study identified four major themes among Latinx families within a PED of a NDA. Potential areas of interventions should focus on supporting access to an interpreter, improving information delivery, and enhancing education on community resources for families with low English proficiency.
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Affiliation(s)
- Ronine L. Zamor
- grid.239573.90000 0000 9025 8099Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA ,grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267 USA ,grid.189967.80000 0001 0941 6502Present Address: Division of Emergency Medicine, Children’s Healthcare of Atlanta, Emory University, 1547 Clifton Road, NE 2nd Floor, Atlanta, GA 30322 USA
| | - Lisa M. Vaughn
- grid.239573.90000 0000 9025 8099Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA ,grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267 USA
| | - Erin McCann
- grid.239573.90000 0000 9025 8099Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA
| | - Luisanna Sanchez
- grid.239573.90000 0000 9025 8099Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA
| | - Erica M. Page
- grid.239573.90000 0000 9025 8099Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA
| | - E. Melinda Mahabee-Gittens
- grid.239573.90000 0000 9025 8099Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA ,grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267 USA
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Castillo AF, Davis AL, Krishnamurti T. Using implementation science frameworks to translate and adapt a pregnancy app for an emerging Latino community. BMC Womens Health 2022; 22:386. [PMID: 36131336 PMCID: PMC9490971 DOI: 10.1186/s12905-022-01975-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background Digital mobile health (mHealth) applications are a popular form of prenatal education and care delivery in the U.S.; yet there are few Spanish language options for native speakers. Furthermore, existing applications do not consider cultural differences and disparities in healthcare access, including those specific to emerging Latino communities. Objective To adapt and translate an English-language pregnancy mobile health app to meet the language and cultural needs of Spanish-speaking Latino immigrants living in the United States. Methods We use a multi-step process, grounded in implementation science frameworks, to adapt and translate the contents of an existing pregnancy app. Interviews with stakeholders (n = 12) who advocate for the needs of pregnant individuals in an emerging Latino community were used to identify domains of possible disparities in access to prenatal care. We then conducted semi-structured interviews with peripartum Spanish-speaking Latino users (n = 14) to understand their perspectives within those domains. We identified a list of topics to create educational material for the modified app and implemented a systematic translation approach to ensure that the new version was acceptable for immigrants from different countries in Latin America. Results The interviews with stakeholders revealed seven critical domains that need to be addressed in an adapted prenatal app: language and communication, financial concerns, social support, immigration status, cultural differences, healthcare navigation, and connection to population-specific community resources that offer Spanish language services. The interviews with peripartum Spanish-speaking Latino women informed how the existing content in the app could be adjusted or built upon to address these issues, including providing information on accessing care offered in their native language and community support. Finally, we used a systematic approach to translate the existing application and create new content. Conclusion This work illustrates a process to adapt an mHealth pregnancy app to the needs of an emerging Latino community, by incorporating culturally sensitive Spanish language content while focusing on addressing existing health disparities.
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Cordova-Marks FM, Valencia C, Badger TA, Segrin C, Sikorskii A. Depression among Underserved Rural and Urban Caregivers of Latinas with Breast Cancer. JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 2022; 33:450-464. [PMID: 37082709 PMCID: PMC10112537 DOI: 10.1080/10911359.2022.2062516] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Among Latino/as, informal caregiving duties are often deemed a family responsibility. Understanding psychological outcomes tied to caregivers of Latina breast cancer survivors is important to identify the impacts of cancer. Secondary analysis of baseline data collected in a randomized clinical trial (RCT) from 230 Latina breast cancer survivor-caregiver dyads. Characteristics of caregivers residing in rural/underserved and urban areas were compared using t- or chi-square tests. General linear models were used to analyze depressive symptoms in relation to residence, survivor-caregiver relationship, acculturation, obligation, reciprocity, and comorbidities. Urban residence was significantly associated with higher levels of depression controlling for survivor-caregiver relationship acculturation, obligation, reciprocity, and comorbidities. Mother caregivers had significantly higher levels of depression than other caregivers. Depression among Latino/a caregiver's providing care to an adult child is an important consideration as Latino/as are less likely to seek out/have access to mental health services than other groups.
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Affiliation(s)
- Felina M Cordova-Marks
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85719
| | - Celina Valencia
- Family and Community Medicine, University of Arizona, Tucson
| | - Terry A Badger
- Professor and Chair, Community and Systems Health Science Division, Professor, Department of Psychiatry, University of Arizona College of Nursing
| | - Chris Segrin
- Department Head Steve and Nancy Lynn Professor of Communication, Department of Communication, University of Arizona, Tucson, AZ
| | - Alla Sikorskii
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University
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Barriers and Facilitators to Prevention and Care of COVID-19 Infection in Cincinnati Latinx Families: a Community-Based Convergent Mixed Methods Study. J Racial Ethn Health Disparities 2022; 10:1067-1085. [PMID: 35411496 PMCID: PMC8999990 DOI: 10.1007/s40615-022-01294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/08/2022] [Accepted: 03/25/2022] [Indexed: 11/25/2022]
Abstract
Background Latinx populations have experienced disproportionately high case rates of COVID-19 across the USA. Latinx communities in non-traditional migration areas may experience greater baseline day-to-day challenges such as a lack of resources for immigrants and insufficient language services. These challenges may be exacerbated by the COVID-19 pandemic. Objective This article describes the results of an initial community health needs assessment to better understand the prevention and care of COVID-19 infection in the Cincinnati Latinx community. Methods We used convergent mixed methods to examine barriers and facilitators to COVID-19 prevention and care for those with infection. Results Latinx adults ≥ 18 years old completed 255 quantitative surveys and 17 qualitative interviews. Overarching mixed methods domains included knowledge, prevention, work, challenges, and treatment. Quantitative results largely reinforced qualitative results (confirmation). Certain quantitative and qualitative results, however, diverged and expanded insights related to caring for COVID-19 infection among Latinx adults (expansion). There were infrequent contradictions between quantitative and qualitative findings (discordance). Primary barriers for the Latinx community during the COVID-19 pandemic included insecurities in food, jobs, housing, and immigration. Key facilitators included having trusted messengers of health-related information. Conclusion Public health interventions should be centered on community partnerships and the use of trusted messengers. Wraparound services (including resources for immigrants) are essential public health services. Close partnership with employers is essential as lack of sick leave and mask supplies were more frequent barriers than knowledge. These findings emerged from experiences during the COVID-19 pandemic but likely generalize to future public health crises. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-022-01294-7.
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Plural Belongings: Mothering Co-resident Children Post-migration in the USA. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2020. [DOI: 10.1007/s12134-019-00702-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Alwan RM, Schumacher DJ, Cicek-Okay S, Jernigan S, Beydoun A, Salem T, Vaughn LM. Beliefs, perceptions, and behaviors impacting healthcare utilization of Syrian refugee children. PLoS One 2020; 15:e0237081. [PMID: 32764783 PMCID: PMC7413502 DOI: 10.1371/journal.pone.0237081] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 07/20/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Approximately 18,000 Syrian refugees have resettled to the United States. Half of these refugees are children, whose age and refugee status jeopardize their abilities to attain quality healthcare. Information on Syrian refugees' health in the U.S. is limited. This qualitative study sought to explore Syrian refugee parents' beliefs, perspectives, and practices regarding their children's health through in-depth interviews. METHODS Eighteen Syrian refugee parents residing in Cincinnati, Ohio were interviewed in Arabic by bilingual researchers using semi-structured in-depth interviews. The interviews were recorded, transcribed, and translated. Three members of the research team independently coded each interview using an inductive thematic analysis approach. RESULTS Analysis identified four salient themes: stressors preclude health seeking behaviors, parents perceive health barriers, parents are dissatisfied with the healthcare system, and parents use resilience behaviors to overcome barriers. Stressors included poor housing and neighborhoods, reliving traumatic experiences, depression and anxiety, and social isolation. Dissatisfaction included emergency room wait times, lack of testing and prescriptions. Health barriers included missed appointments and inadequate transportation, translation services, health literacy and care coordination. Parents reported resilience through faith, by seeking knowledge, use of natural remedies, and utilizing community resources. CONCLUSION This qualitative study provides information on the beliefs, practices, and behaviors of Syrian refugee parents related to health care utilization of pediatric refugees in the United States. Psychosocial and environmental stressors as well as perceived systemic health barriers, hinder health seeking behaviors in Syrian refugee parents. Culturally relevant care targeting perceived barriers and incorporating resilience behaviors may improve parental satisfaction and parental health seeking behaviors. Further study is needed to implement and evaluate interventions that target identified barriers.
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Affiliation(s)
- Riham M. Alwan
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States of America
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
- University of California San Francisco, San Francisco, CA, United States of America
- * E-mail:
| | - Daniel J. Schumacher
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States of America
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
| | - Sevsem Cicek-Okay
- College of Arts and Sciences, University of Cincinnati, Cincinnati, OH, United States of America
| | - Sarah Jernigan
- College of Education, Criminal Justice and Human Services, University of Cincinnati, Cincinnati, OH, United States of America
| | - Ahmed Beydoun
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States of America
| | - Tasnim Salem
- Independent Consultant, Dallas, TX, United States of America
| | - Lisa M. Vaughn
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States of America
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
- College of Education, Criminal Justice and Human Services, University of Cincinnati, Cincinnati, OH, United States of America
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Ruiz Y, Riciputi S, Alexander SC, DeMaria AL, Guilamo-Ramos V. Examining dual method contraceptive use among midwestern parenting Latinx teens: Perspectives from adolescent parents, caretakers, and nurses. Public Health Nurs 2020; 37:647-654. [PMID: 32656790 DOI: 10.1111/phn.12762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite dual method (DM) contraception being effective in reducing repeat-births and sexually transmitted infections (STIs), Latinx adolescent parents who live in non-traditional migration areas remain vulnerable for both outcomes. OBJECTIVE This study applied the Unified Theory of Behavior (UTB) and drew upon Bronfenbrenner's social ecological model to explore multiple stakeholders' (adolescent parents, caregivers, and nurses) perceptions of factors that influence DM intentions and use among Latinx adolescent parents. METHODS Semi-structured interviews with Latinx adolescent parent-caregiver dyads and nurses were analyzed using thematic analysis. RESULTS Study findings revealed that while all participant groups considered medical providers as DM influencers, contradicting views related to caregivers' as DM influencers emerged among adolescent parents and caregivers. Findings suggest that DM is deemed both acceptable and effective; and adolescent parents' reported DM self-efficacy. DM obstacles included negative emotions, environmental constraints, and poor knowledge and skills. CONCLUSIONS Study results suggest that constructs from the UTB framework are useful in identifying individual and social factors that can potentially influence DM intentions and use among Latinx adolescent parents. IMPLICATIONS FOR PUBLIC HEALTH NURSING This study's findings have potential implications for public health nurses interested in designing community-based interventions to reduce repeat-births and STIs among Latinx adolescent parents.
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Affiliation(s)
- Yumary Ruiz
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Shaina Riciputi
- Colorado Department of Human Services, Office of Behavioral Health, Denver, CO, USA
| | - Stewart C Alexander
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Andrea L DeMaria
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
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Canedo JR, Wilkins CH, Senft N, Romero A, Bonnet K, Schlundt D. Barriers and facilitators to dissemination and adoption of precision medicine among Hispanics/Latinos. BMC Public Health 2020; 20:603. [PMID: 32357943 PMCID: PMC7195743 DOI: 10.1186/s12889-020-08718-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/16/2020] [Indexed: 12/26/2022] Open
Abstract
Background With the rapid advances in gene technologies in recent years, the potential benefits of precision medicine (PM) may spread unevenly to disadvantaged populations, such as Hispanics/Latinos. The objective of this study was to explore patient-level barriers and facilitators to dissemination and adoption of PM among Hispanics/Latinos, including knowledge and awareness. Methods Self-identified Hispanics/Latinos from diverse countries in Latin America (N = 41) participated in the study. Using a cross-sectional observational qualitative research design, six focus groups and a demographic questionnaire were collected in English and Spanish. Qualitative content analysis was utilized to code the transcripts and identify emerging themes. Results Hispanics/Latinos never heard of and had no knowledge about PM. Barriers to dissemination and adoption of PM included lack of health insurance, financial burden, participants’ immigration status, distrust of government, limited English proficiency, low literacy levels, cultural norms, fear about genetic testing results, lack of transportation, newness of PM, and lack of information about PM. Facilitators included family support; information provided in Spanish; use of plain language and graphics; assistance programs for uninsured; trust in physicians, healthcare staff, well-known hospitals, academic institutions, and health care providers and community organization as sources of reliable information; personal motivation, and altruism or societal benefit. Conclusions Culturally-and linguistically-tailored, low-literacy educational material about PM should be created in English and Spanish. Future research should examine provider-level and system-level barriers and facilitators to implementation and adoption of PM among Hispanic/Latino patients.
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Affiliation(s)
- Juan R Canedo
- School of Graduate Studies and Research, Meharry Medical College, Nashville, TN, USA. .,Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Consuelo H Wilkins
- Vanderbilt University Medical Center, Nashville, TN, USA.,Meharry-Vanderbilt Alliance, Nashville, TN, USA
| | - Nicole Senft
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
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Hernandez SM, Sparks PJ. Barriers to Health Care Among Adults With Minoritized Identities in the United States, 2013-2017. Am J Public Health 2020; 110:857-862. [PMID: 32298177 DOI: 10.2105/ajph.2020.305598] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine the relationship between minoritized identity and barriers to health care in the United States.Methods. Nationally representative data collected from the 2013 to 2017 waves of the National Health Interview Survey were used to conduct descriptive and logistic regression analyses. Men and women were placed in 1 of 4 categories: no minoritized identities, minoritized identities of race/ethnicity (MIoRE), minoritized identities of sexuality (MIoS), or minoritized identities of both race/ethnicity and sexuality (MIoRES). Five barriers to health care were considered.Results. Relative to heterosexual White adults and after controlling for socioeconomic status, adults with MIoRE were less likely to report barriers, adults with MIoS were more likely to report barriers, and adults with MIoRES were more likely to report barriers across 2 of the study measures.Conclusions. Barriers to care varied according to gender, minoritized identity, and the measure of access to health care itself.Public Health Implications. Approaching health disparities research using an intersectional lens moves the discussion from examining individual differences to examining the role of social structures such as the health care system in maintaining and reproducing inequality.
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Affiliation(s)
- Stephanie M Hernandez
- The authors are with the Department of Demography, University of Texas at San Antonio
| | - P Johnelle Sparks
- The authors are with the Department of Demography, University of Texas at San Antonio
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Alvidrez J, Castille D, Laude-Sharp M, Rosario A, Tabor D. The National Institute on Minority Health and Health Disparities Research Framework. Am J Public Health 2020; 109:S16-S20. [PMID: 30699025 DOI: 10.2105/ajph.2018.304883] [Citation(s) in RCA: 346] [Impact Index Per Article: 86.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We introduce the National Institute on Minority Health and Health Disparities (NIMHD) research framework, a product that emerged from the NIMHD science visioning process. The NIMHD research framework is a multilevel, multidomain model that depicts a wide array of health determinants relevant to understanding and addressing minority health and health disparities and promoting health equity. We describe the conceptual underpinnings of the framework and define its components. We also describe how the framework can be used to assess minority health and health disparities research as well as priorities for the future. Finally, we describe how fiscal year 2015 research project grants funded by NIMHD map onto the framework, and we identify gaps and opportunities for future minority health and health disparities research.
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Affiliation(s)
- Jennifer Alvidrez
- All of the authors are with the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Dorothy Castille
- All of the authors are with the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Maryline Laude-Sharp
- All of the authors are with the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Adelaida Rosario
- All of the authors are with the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Derrick Tabor
- All of the authors are with the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
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Bertelsen C, Choi JS, Jackanich A, Ge M, Sun GH, Chambers T. Comparison of Referral Pathways in Otolaryngology at a Public Versus Private Academic Center. Ann Otol Rhinol Laryngol 2019; 129:369-375. [PMID: 31752501 DOI: 10.1177/0003489419887990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Delayed medical care may be costly and dangerous. Examining referral pathways may provide insight into ways to reduce delays in care. We sought to compare time between initial referral and first clinic visit and referral and surgical intervention for index otolaryngologic procedures between a public safety net hospital (PSNH) and tertiary-care academic center (TAC). METHODS Retrospective cohort study of eligible adult patients undergoing one of several general otolaryngologic procedures at a PSNH (n = 216) and a TAC (n = 161) over a 2-year time period. RESULTS PSNH patients were younger, less likely to have comorbidities and more likely to be female, Hispanic or Asian, and to lack insurance. Time between referral and first clinic visit was shorter at the PSNH than the TAC (Mean 35.8 ± 47.7 vs 48.3 ± 60.3 days; P = .03). Time between referral and surgical intervention did not differ between groups (129 ± 90 for PSNH vs 141 ± 130 days for TAC, P = .30). On multivariate analysis, the TAC had more patient-related delays in care than the PSNH (OR: 3.75, P < .001). Time from referral to surgery at a PSNH was associated with age, source of referral, type of surgery, diagnostic workup and comorbidities, and at a TAC was associated with gender and type of surgery and comorbidities. CONCLUSIONS Sociodemographic differences between PSNH and TAC patients, as well as differences in referral pathways between the types of institutions, influence progression of surgical care in otolaryngology. These differences may be targets for interventions to streamline care. LEVEL OF EVIDENCE 2c.
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Affiliation(s)
- Caitlin Bertelsen
- USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Janet S Choi
- USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Anna Jackanich
- USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Marshall Ge
- USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Gordon H Sun
- USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Tamara Chambers
- USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Arana-Chicas E, Ihde E, Cartujano-Barrera F, Suarez N, Tiznado D, Hurtado-de-Mendoza A, Ramírez-Mantilla M, Cox LS, Ellerbeck EF, Cupertino AP. Exploring Latinidad, Migration Processes, and Immigrant Experiences: Experiences Influencing Latino Health. Kans J Med 2019; 12:125-131. [PMID: 31803354 PMCID: PMC6884017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/13/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Over the last few decades, Latino migration to the U.S. has re-shaped the ethnic composition of the country, and influenced the meaning of "ethnic" and "racial" identity. The purpose of this qualitative study was to explore the definition and meaning of being Latino and how this may guide the development of interventions to promote their health. METHODS Twenty-six Latino immigrants living in Kansas completed a socio-demographic survey and semi-structured interviews to assess and explore personal immigration experiences and perspectives on the meaning of being Latino in the U.S. RESULTS Participant reports were grouped into eight themes on Latino identity that were organized by geographic origin, family roots/ties, and acculturation. Immigration experiences were described as both positive and negative with most participants experiencing discrimination and loneliness, but also reports of improved quality of life. Further, most participants reported a strong sense of Latinidad; that Latino immigrant communities in the U.S. are interdependent and supportive of each other. CONCLUSIONS The experience of being a member of a minority group might contribute to the development of a cohesive sense of Latino identity as participants acculturate to the U.S. while preserving a sense of attachment to their culture of origin. Future interventions should be sensitive to migration experiences as they might influence changes in health behaviors.
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Affiliation(s)
- Evelyn Arana-Chicas
- Hackensack University Medical Center, Department of Cancer Prevention and Control, Hackensack, NJ
| | - Erin Ihde
- Hackensack University Medical Center, The Deirdre Imus Environmental Health Center, Hackensack, NJ
| | | | - Natalia Suarez
- University of Illinois-Rockford, The National Center for Rural Health Professions, Rockford, IL
| | | | | | - Mariana Ramírez-Mantilla
- University of Kansas Medical Center, Department of Preventive Medicine and Public Health, Kansas City, KS
| | - Lisa Sanderson Cox
- University of Kansas Medical Center, Department of Preventive Medicine and Public Health, Kansas City, KS
| | - Edward F Ellerbeck
- University of Kansas Medical Center, Department of Preventive Medicine and Public Health, Kansas City, KS
| | - Ana Paula Cupertino
- Hackensack University Medical Center, Department of Cancer Prevention and Control, Hackensack, NJ
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Vaughn LM, Whetstone C, Boards A, Busch MD, Magnusson M, Määttä S. Partnering with insiders: A review of peer models across community-engaged research, education and social care. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:769-786. [PMID: 29512217 DOI: 10.1111/hsc.12562] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/31/2018] [Indexed: 06/08/2023]
Abstract
Within community-engaged research, education and social care, peer models that partner with local "insiders" are increasingly common. Peer models are composed of insider "lay" community members who often share similarities or background with a project's target population. Peers are not academically trained, but work alongside researchers and professionals to carry out specific tasks within a project, or in the truest sense of partnership, peers collaborate throughout the project from start to finish as an equal member of the team. Although peer models are used widely, the literature lacks consistency and clarity. This systematic review of literature used a qualitative thematic synthesis to examine and report how, where and why peer models have been used in research, education and social care. We examined the language and titles used to describe the peers, details of their involvement in community-engaged projects, the setting, content/topic of study, level of engagement and related benefits/outcomes of such models. Focusing on the last 10 years, we conducted a comprehensive literature search twice between September 2016 and June 2017. The search resulted in 814 articles which were assessed for eligibility. Overall, 251 articles met our inclusion criteria and were categorised into three categories: empirical (n = 115); process/descriptive (n = 93); and "about" peers (n = 43). Findings suggest that there is a wide variety of peers, titles and terminology associated with peer models. There is inconsistency in how these models are used and implemented in research studies and projects. The majority of articles used an employment peer model, while only a handful involved peers in all phases of the project. The results of this literature review contribute to understanding the use, development and evolution of peer models. We highlight potential benefits of peer models for peers, their communities and community-engaged work, and we offer recommendations for future implementation of peer models.
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Affiliation(s)
- Lisa M Vaughn
- Pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Alicia Boards
- Educational and Community-Based Action Research, University of Cincinnati, Cincinnati, OH, USA
| | - Melida D Busch
- Edward L. Pratt Research Library, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Sylvia Määttä
- Department of Healthcare Improvement, Western Region, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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16
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Luque JS, Soulen G, Davila CB, Cartmell K. Access to health care for uninsured Latina immigrants in South Carolina. BMC Health Serv Res 2018; 18:310. [PMID: 29716586 PMCID: PMC5930513 DOI: 10.1186/s12913-018-3138-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 04/22/2018] [Indexed: 11/23/2022] Open
Abstract
Background South Carolina is considered a “new destination” state for Latino immigrants. Language barriers, transportation difficulties, low socioeconomic status, inflexible work schedules, different cultural norms, and anxiety and fear related to the current anti-immigrant political climate all negatively impact Latino immigrants’ frequency of contact with the health care system, and consequently they suffer poor health outcomes. The study objective was to explore uninsured Latina immigrant women’s access to health care and alternative treatment strategies in coastal South Carolina. Methods The study design was a qualitative interview design. Thirty women participated in semi-structured interviews in community sites. Thematic analysis identified salient categories of topics across interview participants. Results The themes were organized into four primary categories including: 1) Barriers and Facilitators to Healthcare, 2) Health Behaviors and Coping Mechanisms, 3) Disease Management Strategies, and 4) Cultural Factors. Participants demonstrated determination for accessing care but reported that their primary health care access barriers included the high cost of services, lack of health insurance, family and work responsibilities, and language barriers. Coping mechanisms included activating their social networks, visiting family and friends and assisting one another with navigating life challenges. Conclusion Participants overcame obstacles to obtain healthcare for themselves and their family members despite the multiple barriers presented. Social networks were leveraged to protect against some of the negative effects of financial barriers to health care access. Electronic supplementary material The online version of this article (10.1186/s12913-018-3138-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- John S Luque
- Institute of Public Health, Florida A&M University, Science Research Center, 1515 South MLK Blvd. Suite 207B, Tallahassee, FL, 32307, USA.
| | - Grace Soulen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Caroline B Davila
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kathleen Cartmell
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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Hur K, Zhou S, Bertelsen C, Johns MM. Health disparities among adults with voice problems in the United States. Laryngoscope 2017; 128:915-920. [DOI: 10.1002/lary.26947] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 08/23/2017] [Accepted: 09/05/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Kevin Hur
- USC Voice Center, Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine; University of Southern California; Los Angeles California U.S.A
| | - Sheng Zhou
- USC Voice Center, Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine; University of Southern California; Los Angeles California U.S.A
| | - Caitlin Bertelsen
- USC Voice Center, Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine; University of Southern California; Los Angeles California U.S.A
| | - Michael M. Johns
- USC Voice Center, Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine; University of Southern California; Los Angeles California U.S.A
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